bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single-arm prospective interventional study assessing feasibility of using gallium-68 ventilation and perfusion PET/CT to avoid functional lung in patients with stage III non-small cell lung cancer
Authors: Bucknell Nicholas , Hardcastle Nicholas , Jackson Price , Hofman Michael , Callahan Jason , Eu Peter , Iravani Amir , Lawrence Rhonda , Martin Olga , Bressel Mathias , Woon Beverley , Blyth Benjamin , MacManus Michael , Byrne Keelan , Steinfort Daniel , Kron Tomas , Hanna Gerard , Ball David , Siva Shankar 
Published: December 2020

BackgroundIn the curative-intent treatment of locally advanced lung cancer, significant morbidity and mortality can result from thoracic radiation therapy. Symptomatic radiation pneumonitis occurs in one in three patients and can lead to radiation-induced fibrosis. Local failure occurs in one in three patients due to the lungs being a dose-limiting organ, conventionally restricting tumour doses to around 60 Gy. Functional lung imaging using positron emission tomography (PET)/CT provides a geographic map of regional lung function and preclinical studies suggest this enables personalised lung radiotherapy. This map of lung function can be integrated into Volumetric Modulated Arc Therapy (VMAT) radiotherapy planning systems, enabling conformal avoidance of highly functioning regions of lung, thereby facilitating increased doses to tumour while reducing normal tissue doses.Methods and analysisThis prospective interventional study will investigate the use of ventilation and perfusion PET/CT to identify highly functioning lung volumes and avoidance of these using VMAT planning. This single-arm trial will be conducted across two large public teaching hospitals in Australia. Twenty patients with stage III non-small cell lung cancer will be recruited. All patients enrolled will receive dose-escalated (69 Gy) functional avoidance radiation therapy. The primary endpoint is feasibility with this achieved if ≥15 out of 20 patients meet pre-defined feasibility criteria. Patients will be followed for 12 months post-treatment with serial imaging, biomarkers, toxicity assessment and quality of life assessment.DiscussionUsing advanced techniques such as VMAT functionally adapted radiation therapy may enable safe moderate dose escalation with an aim of improving local control and concurrently decreasing treatment related toxicity. If this technique is proven feasible, it will inform the design of a prospective randomised trial to assess the clinical benefits of functional lung avoidance radiation therapy.Ethics and disseminationThis study was approved by the Peter MacCallum Human Research Ethics Committee. All participants will provide written informed consent. Results will be disseminated via publications.Trials registration numberNCT03569072; Pre-results
Development of a national neonatal intensive care unit-specific antimicrobial stewardship programme in Canada: protocol for a cohort study
Authors: Ting Joseph Y. , Roberts Ashley , Tilley Peter , Robinson Joan L , Dunn Michael S , Paquette Vanessa , Lee Kyong-Soon , Shah Vibhuti , Yoon Eugene , Richter Lindsay L , Lodha Abhay , Shivananda Sandesh , Thampi Nisha , Autmizguine Julie , Shah Prakesh S 
Published: December 2020

IntroductionEarly empiric treatment with broad-spectrum antimicrobials is common in neonatal intensive care units (NICU) due to the non-specific clinical presentation of infection. However, excessive and inappropriate antimicrobial use can lead to the emergence of drug-resistant organisms and adverse neonatal outcomes. This study aims to develop and implement a nationwide NICU-specific antimicrobial stewardship programme (ASP) to promote judicious antimicrobial use and control the emergence of multidrug-resistant organisms (MDROs) in Canada.Methods and analysisOur study population will include all very low-birth-weight neonates admitted to participating tertiary NICU in Canada. Based on the existing limited literature, we will develop consensus on NICU antimicrobial stewardship interventions to enhance best practices. Using an expanded Canadian Neonatal Network (CNN) platform, we will collect data on antimicrobial use and the susceptibility of organisms identified in clinical samples from blood and cerebrospinal fluid over a period of 2 years. These data will be used to provide all NICU stakeholders with benchmarked centre-adjusted antimicrobial use and MDRO prevalence reports. An ASP plan will be developed at both individual unit and national levels in the subsequent years. Knowledge translation strategies will be implemented through the well-established Evidence-based Practice for Improving Quality methodology.Ethics and disseminationEthics for the study has been granted by the University of British Columbia Children’s & Women’s Research Ethics Board (H19-02490) and supported by CNN Executive Committee. The study results will be disseminated through national organisations and open access peer-reviewed publications.Trial registration numberNCT04388293.
EPHA mutation as a predictor of immunotherapeutic efficacy in lung adenocarcinoma
Authors: Bai Hua , Duan Jianchun , Li Chengcheng , Xie Wenzhuan , Fang Wenfeng , Xu Yu , Wang Guoqiang , Wan Rui , Sun Jing , Xu Jiachen , Wang Xin , Fei Kailun , Zhao Zhengyi , Cai Shangli , Zhang Li , Wang Jie , Wang Zhijie 
Published: December 2020

BackgroundEphrin type-A receptors (EPHA) are members of family of receptor tyrosine kinases and are related to tumor immunogenicity and immune microenvironment, however, the association betweenEPHAmutation (EPHAmut) and efficacy of immune checkpoint inhibitors (ICIs) has not been investigated in non-small cell lung cancer (NSCLC).MethodsMultiple cohorts were used to assess the immunotherapeutic predictive performance ofEPHAmut, including one discovery cohort (n=79) and two public validation cohort (cohort 1: NSCLC, n=165; cohort 2: pan-cancer, n=1662). The Cancer Genome Atlas cohort was used for prognostic analysis and mechanism exploration.ResultsIn the discovery cohort, patients withEPHAmuthad superior disease control rate (72.2% vs 36.1%, p=0.01) and progression-free survival (PFS) (HR 0.38; 95% CI 0.21 to 0.68; p<0.001) compared with those with wide-typeEPHA(EPHAwt) in NSCLC. The association betweenEPHAmutand immunotherapy outcomes in NSCLC was consistently observed in the validation cohorts by multivariable models (cohort 1, PFS HR 0.59; 95% CI 0.37 to 0.96; p=0.03; cohort 2, overall survival (OS) HR 0.63; 95% CI 0.41 to 0.98; p=0.04). Further pooled estimates of the discovery and validation cohorts showed that patients withEPHAmutexhibited a significantly longer PFS and OS in lung adenocarcinoma (LUAD) while not squamous cell lung cancer (LUSC). Consistently, mechanism analysis revealed that patients withEPHAmutwas associated with increased T cell signatures and downregulatedtransforming growth factor-βsignaling compared with patients withEPHAwtin LUAD while not LUSC.ConclusionsOur results demonstrated thatEPHAmutis an independent classifier that could stratify patients with LUAD for ICIs therapy. Further prospective studies are warranted.Trial registration numberNCC2016JZ-03, NCC2018-092.
A Hakim’s Tale
Authors: Hamza Shireen 
Published: December 2020

Abstract
In the fourteenth century, the physician Shihāb al-Dīn Nāgaurī added an autobiographical chapter to the end of a medical text, describing his experiences learning and practicing medicine in India. Because this text is not easily accessible, especially when compared to autobiographies of physicians written in Arabic, I present the Persian text and translation of this chapter here. It is the final chapter of Cure of Illness (Shifāʾ al-maraẓ), composed in 1388 CE, and is one of the few texts of ṭibb (often known as Greco-Arabic medicine or Islamic medicine) from the early centuries of its spread in India. Nāgaurī reflects on the pluralism of his environment. He studied medicine with a ḥakīm (a practitioner of ṭibb) from Kabul as well as with local jogis (who taught him Ayurveda). He preferred his Hindu patients to his Muslim patients, finding the latter lacking in faith. The themes raised by Nāgaurī’s tale can help us study hybridity in Indian medicine before the European colonial encounter.
Beyond Respecting Mencius and Criticizing Xunzi: A Return to Equal Status for the Two Sages
Authors: Liang Tao 
Published: December 2020

Abstract
Mencius 孟子 took Confucius’ idea of benevolence and, based on it, developed his theory that human nature is good. Xunzi 荀子 emphasized Confucius’ idea of ritual propriety and developed his theory that human nature is bad. This juxtaposition largely came to define their philosophies and their place in the history of Confucianism. Reconciling the two has been a point of contention ever since the Han dynasty. By the end of the Han dynasty, the scales had tipped in favor of Mencius, and this favoritism continued through the Six Dynasties era, the Tang and Song dynasties and beyond. As the Mencius became canonized, the Xunzi fell further out of favor with academics. Through all this, there have still been attempts to directly reconcile and even combine the two branches of Confucianism. This is an important cultural enterprise, which has gained new force in recent years. This article threads out some of the more important arguments in this continuing discussion and advocates for viewing the two branches with equal import and authority in the Confucian tradition.
Dynamical Seasonal Predictions of Tropical Cyclone Activity: Roles of Sea Surface Temperature Errors and Atmosphere–Land Initialization
Authors: Zhang Gan , Murakami Hiroyuki , Yang Xiaosong , Findell Kirsten L. , Wittenberg Andrew T. , Jia Liwei 
Published: December 2020

AbstractClimate models often show errors in simulating and predicting tropical cyclone (TC) activity, but the sources of these errors are not well understood. This study proposes an evaluation framework and analyzes three sets of experiments conducted using a seasonal prediction model developed at the Geophysical Fluid Dynamics Laboratory (GFDL). These experiments apply the nudging technique to the model integration and/or initialization to estimate possible improvements from nearly perfect model conditions. The results suggest that reducing sea surface temperature (SST) errors remains important for better predicting TC activity at long forecast leads—even in a flux-adjusted model with reduced climatological biases. Other error sources also contribute to biases in simulated TC activity, with notable manifestations on regional scales. A novel finding is that the coupling and initialization of the land and atmosphere components can affect seasonal TC prediction skill. Simulated year-to-year variations in June land conditions over North America show a significant lead correlation with the North Atlantic large-scale environment and TC activity. Improved land–atmosphere initialization appears to improve the Atlantic TC predictions initialized in some summer months. For short-lead predictions initialized in June, the potential skill improvements attributable to land–atmosphere initialization might be comparable to those achievable with perfect SST predictions. Overall, this study delineates the SST and non-oceanic error sources in predicting TC activity and highlights avenues for improving predictions. The nudging-based evaluation framework can be applied to other models and help improve predictions of other weather extremes.
Improving Predictions of Surface Air Temperature Anomalies over Japan by the Selective Ensemble Mean Technique
Authors: Ratnam J. V. , Doi Takeshi , Morioka Yushi , Oettli Pascal , Nonaka Masami , Behera Swadhin K. 
Published: December 2020

AbstractThe selective ensemble mean (SEM) technique is applied to the late spring and summer months (May–August) surface air temperature anomaly predictions of the Scale Interaction Experiment–Frontier Research Center for Global Change, version 2 (SINTEX-F2), coupled general circulation model over Japan. Using the Köppen–Geiger climatic classification we chose four regions over Japan for applying the SEM technique. The SINTEX-F2 ensemble members for the SEM are chosen based on the anomaly correlation coefficients (ACC) of the SINTEX-F2 predicted and observed surface air temperature anomalies. The SEM technique is applied to generate the forecasts of the surface air temperature anomalies for the period 1983–2018 using the selected members. Analysis shows the ACC skill score of the SEM prediction to be higher compared to the ACC skill score of predictions obtained by averaging all the 24 members of the SINTEX-F2 (ENSMEAN). The SEM predicted surface air temperature anomalies also have higher hit rate and lower false alarm rate compared to the ENSMEAN predicted anomalies over a range of temperature anomalies. The results indicate the SEM technique to be a simple and easy to apply method to improve the SINTEX-F2 predictions of surface air temperature anomalies over Japan. The better performance of the SEM in generating the surface air temperature anomalies can be partly attributed to realistic prediction of 850-hPa geopotential height anomalies over Japan.
Longer Prehospital Time Decreases Reliability of Vital Signs in the Field: A Dual Center Study
Authors: Schellenberg Morgan , Biswas Subarna , Bardes James M. , Trust Marc D. , Grabo Daniel , Wilson Alison , Inaba Kenji 
Published: December 2020

Background Field vital signs are integral in the American College of Surgeons (ASA) Committee on Trauma (COT) triage criteria for trauma team activation (TTA). Reliability of field vital signs in predicting first emergency department (ED) vital signs, however, may depend upon prehospital time. The study objective was to define the effect of prehospital time on correlation between field and first ED vital signs. Methods All highest level TTAs at two Level I trauma centers (2008-2018) were screened. Exclusions were unrecorded prehospital vital signs and those dead on arrival. Demographics, prehospital time (scene time + transport time), injury data, and vital signs were collected. Differences between field and first ED vitals were determined using the paired Student’s t test. Propensity score analysis, adjusting for age, sex, injury severity score (ISS), and mechanism of injury compared outcomes among patients with ISS ≥16. Multivariate linear regression determined impact of prehospital time on vital sign differences between field and ED among propensity-matched patients. Results After exclusions, 21 499 patients remained. Mean prehospital time was 32 vs. 41 minutes ( P < .001). On propensity score analysis, longer prehospital time was associated with significantly greater differences in systolic blood pressure (SBP) ( P < .001), pulse pressure (PP) ( P = .003), and Glasgow Coma Scale (GCS) ( P < .001). On multivariate analysis, linear regression that demonstrated longer prehospital time was associated with greater differences in SBP, heart rate (HR), and PP ( P < .001). Conclusions Field vital signs are less likely to reflect initial ED vital signs when prehospital times are longer. Given the reliance of trauma triage criteria on prehospital vital signs, medical providers must be cognizant of this pitfall during the prehospital assessment of trauma patients.
The Need for Nutritional Education Reform in US Medical Education System
Authors: Sutherland Mason , McKenney Kelly , Shanahan Hunter , McKenney Mark , Elkbuli Adel 
Published: December 2020

Background To compare the setting, quality, and utility of nutritional education received by general surgery residents and faculty surgeons and their perceptions and challenges in managing patient nutritional needs. Methods Cross-sectional analysis utilizing anonymous survey data distributed by the Association of Program Directors in Surgery (APDS) to its affiliated general surgery residency programs. Results 90.2% (n = 65) of residents and 85.7% (n = 24) of faculty surgeons reported having received nutritional education. The majority (78%) of respondents utilize patient nutrition on a regular basis (monthly or more often), with 54% reporting utilization daily or weekly. Overall, 65% of respondents reported experiencing challenges in managing patient nutritional needs, and 86% agreed that additional nutritional education during training would assist with patient care. Residents and faculty surgeons both significantly reported challenges in determining which specific nutritional formula to use ( X2 = 22.414, P = .049). Residents were associated with reporting challenges in successfully managing oral, enteral, and parenteral routes of nutrition ( X2 = 16.241, P = .023). Conclusions Despite receiving nutritional education, the majority of surgery residents and faculty surgeons report difficulty in managing their patients nutritional needs. Surgery residents report difficulties with all delivery modes of nutrition, including oral, parenteral, and enteral. Revising medical school nutritional education competencies to focus on more practical aspects of nutrition, reform of formal course format, greater interprofessional collaboration with dieticians starting at the student level, and enforcement of nutritional education requirements by medical school and residency program accrediting bodies can serve to advance physicians’ nutritional knowledge and improve patient outcomes.
Assessment of Pediatric Middle Ear Effusions With Wideband Tympanometry
Authors: Callaham Sarah , Newby Maxwell , Saoji Aniket A. , Ramadan Jad , Carr Michele M. 
Published: December 2020

ObjectiveTo determine if wideband tympanometry (WBT) can differentiate types of middle ear effusion (MEE): serous, mucoid, and purulent.Study DesignProspective cohort study.SettingTertiary care children’s hospital.MethodsChildren who met American Academy of Otolaryngology–Head and Neck Surgery’s guidelines for ventilation tube insertion had WBT after anesthesia induction but before tympanotomy. MEE was categorized into 1 of 4 comparison groups: serous effusion, mucoid effusion, purulent effusion, or no effusion. WBT measurements were averaged to 16 one‐third octave frequency bands, and comparison of the absorbance patterns for each MEE type was performed through a linear mixed effects model.ResultsA total of 118 children (211 ears) were included: 47 females (39.8%) and 71 males (60.2%). The mean age was 2.73 years (95% CI, 2.25‐3.22); mean weight, 14.35 kg (95% CI, 12.85‐15.85); and mean Z score, 1.13 (95% CI, –0.64 to 2.33). Effusions included 61 mucoid (28.9%), 30 purulent (14.2%), and 14 serous (6.6%), with 106 (50.2%) having no effusion. No significant differences were found for sex, race, age, weight, or Z score among the 4 types of effusion (P <. 05). WBT showed a significant difference in median absorption among the effusion groups (P <. 001), with a medium effect size of 0.35.ConclusionsWBT has potential use to differentiate types of MEE and should be studied further as a tool for investigating how the natural history and management of serous and mucoid effusions may differ.
There is no I in Escape: Using an Escape Room Simulation to Enhance Teamwork and Medication Safety Behaviors in Nursing Students
Authors: Sarage Dawn , O’Neill Barbara J. , Eaton Carrie Morgan 
Published: December 2020

Background. Nurse educators are challenged to develop simulation activities that will engage interest and help baccalaureate nursing students administer medications safely. Students must be able to recognize and report medication errors and effectively collaborate with their patient care team to provide safe and competent care to patients across the healthcare spectrum. Escape rooms are an innovative learning platform where students can work as a team to build these skills. Aim. We report on the strategies and resources used to create and implement an escape room simulation for a problem-based learning activity to practice medication safety behaviors, using critical thinking, communication and team building skills. Methods. Using Kolb’s Learning Cycle and the International Association for Clinical Simulation in Learning (INACSL) Standards of Best PracticeSM, we developed a team-based, four-hour escape room simulation activity around detecting and reporting medication errors in the hospital setting. The escape room simulation included a high-fidelity patient manikin, two embedded participants in the roles of family member and health care provider (HCP), puzzles, riddles, clues and lifelines. The learning objectives were paired with essential Quality and Safety Education for Nurses (QSEN) competencies. Promoting Excellence and Reflective Learning in Simulation (PEARLS) was used for debriefing. Results. The result was a hybrid escape room simulation that mimics a situation nursing students might face in the hospital setting where they have to work as a team to assess a new patient, reconcile medications, perform medication calculations, problem solve intravenous infusion set ups, and communicate medication errors. Data collected for quality purposes indicated a positive student response. Discussion / Conclusion / Implication. The escape room platform served as a foundation for incorporating other simulation modalities and provided a stimulating learning activity. The next step is to conduct a multi-site study with pre-test and post-test data collected from students to gauge learning and behavior change.
How Can We Help Alleviate the Financial Concerns of Non-Directed (Altruistic) Living Kidney Donors?
Authors: Maghen Ariella , Mendoza Georgina , Vargas Grecia B. , Connor Sarah E. , Nassiri Sima , Kwan Lorna , Wood Erika L. , Lalezari Jonathan , Friedman Sarah , Waterman Amy D. , George Sheba , Maliski Sally L. , Veale Jeffrey L. 
Published: December 2020

Introduction: The recent increase in non-directed donors (NDDs) in the United States (U.S.) may help reduce the overwhelming number of patients on the waitlist. However, non-directed donation may be limiting its full potential. Out-of-pocket donation costs upward of $8,000 may be a barrier to potential donors with altruistic tendencies, but inadequate financial support. This study aimed to describe the financial concerns of 31 U.S. NDDs. Methods: We conducted qualitative interviews and administered quantitative demographic surveys between April 2013 and April 2015. Interview transcripts were analyzed using grounded theory techniques to describe and expand on themes relevant to the NDD experience. Findings: We identified 4 sub-themes related to the theme of financial concerns: (1) direct costs related to transportation, lodging, and parking, (2) indirect costs of lost wages encountered from taking time off work to recover from surgery, (3) sources of financial support, and (4) suggestions for alleviating donor financial burden. Two thirds of participants (20) expressed concerns about direct and indirect donation costs. 11 NDDs reported the negative impact of direct costs,15 NDDs had concerns about indirect costs; only 7 donors received supplemental financial support from state mandates and transplant programs. Discussion: Understanding the financial concerns of NDDs may guide improvements in the NDD donation experience that could support individuals who are interested in donating but lack the financial stability to donate. Removing financial disincentives may help increase nondirected donation rates, increase the living donor pool, and the number of kidneys available for transplantation.