bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single postoperative infusion of zoledronic acid to improve patient-reported outcome after hip or knee replacement: study protocol for a randomised, controlled, double-blinded clinical trial
Authors: Brandt Jonathan , Ledin Håkan , Ranstam Jonas , Roos Ewa , Aspenberg Per , Schilcher Jörg 
Published: September 2020

IntroductionIn Sweden, roughly 3000 patients are reoperated each year due to pain and loss of function related to a loosened hip or knee prosthesis. These reoperations are strenuous for the patient, technically demanding and costly for the healthcare system. Any such reoperation that can be prevented would be of great benefit. Bisphosphonates are drugs that inhibit osteoclast function. Several clinical trials suggest that bisphosphonates lead to improved implant fixation and one small study even indicates better functional outcome. Furthermore, in epidemiological studies, bisphosphonates have been shown to decrease the rate of revision for aseptic loosening by half. Thus, there are several indirect indications that bisphosphonates could improve patient-reported outcome, but no firm evidence.Methods and analysisThis is a pragmatic randomised, placebo-controlled, double-blinded, academic clinical trial of a single postoperative dose of zoledronic acid, in patients younger than 80 years undergoing primary total hip or knee replacement for osteoarthritis. Participants will be recruited from two orthopaedic departments. All surgeries will be performed, and study drugs given at Motala Hospital, Sweden. The primary endpoint is to investigate between-group differences in the Hip dysfunction and Osteoarthritis Outcome Score and the Knee injury and Osteoarthritis Outcome Score at 3-year follow-up. Secondary outcomes will be investigated at 1 year, 3 years and 6 years, and stratified for hip and knee implants. These secondary endpoints are supportive, exploratory or explanatory. A total of 1000 patients will be included in the study.Ethics and disseminationThe study has been approved by the Regional Ethical Review Board in Linköping (DNR 2015/286-31). The study will be reported in accordance with the Consolidated Standards of Reporting Trials statement for pharmacological trials. The results will be submitted for publication in peer-reviewed academic journals and disseminated to patient organisations and the media.Trial registration numberEudraCT: No 2015-001200-55; Pre-results.
Morbidity and mortality associated with prescription cannabinoid drug use in COPD
Authors: Vozoris Nicholas T , Pequeno Priscila , Li Ping , Austin Peter C , Stephenson Anne L , O'Donnell Denis E , Gill Sudeep S , Gershon Andrea S , Rochon Paula A 
Published: September 2020

IntroductionRespiratory-related morbidity and mortality were evaluated in relation to incident prescription oral synthetic cannabinoid (nabilone, dronabinol) use among older adults with chronic obstructive pulmonary disease (COPD).MethodsThis was a retrospective, population-based, data-linkage cohort study, analysing health administrative data from Ontario, Canada, from 2006 to 2016. We identified individuals aged 66 years and older with COPD, using a highly specific, validated algorithm, excluding individuals with malignancy and those receiving palliative care (n=185 876 after exclusions). An equivalent number (2106 in each group) of new cannabinoid users (defined as individuals dispensed either nabilone or dronabinol, with no dispensing for either drug in the year previous) and controls (defined as new users of a non-cannabinoid drug) were matched on 36 relevant covariates, using propensity scoring methods. Cox proportional hazard regression was used.ResultsRate of hospitalisation for COPD or pneumonia was not significantly different between new cannabinoid users and controls (HR 0.87; 95% CI 0.61–1.24). However, significantly higher rates of all-cause mortality occurred among new cannabinoid users compared with controls (HR 1.64; 95% CI 1.14–2.39). Individuals receiving higher-dose cannabinoids relative to controls were observed to experience both increased rates of hospitalisation for COPD and pneumonia (HR 2.78; 95% CI 1.17–7.09) and all-cause mortality (HR 3.31; 95% CI 1.30–9.51).ConclusionsNew cannabinoid use was associated with elevated rates of adverse outcomes among older adults with COPD. Although further research is needed to confirm these observations, our findings should be considered in decisions to use cannabinoids among older adults with COPD.
Mass splitting in an 331-TC coupled scenario
Authors: Doff A. 
Published: September 2020

The root of most of the technicolor (TC) problems lies in the way the ordinary fermions acquire their masses, where an ordinary fermion [Formula: see text] couples to a technifermion [Formula: see text] mediated by an extended technicolor (ETC) boson leading to fermion masses that vary with the ETC mass scale [Formula: see text] as [Formula: see text]. Recently, we discussed a new approach consisting of models where TC and QCD are coupled through a larger theory, in this case the solutions of these equations are modified compared to those of the isolated equations, and TC and QCD self-energies are of the irregular form, which allows us to build models where ETC boson masses can be pushed to very high energies. In this work we extend these results for 331-TC models, in particular considering a coupled system of Schwinger–Dyson equations, we show that all technifermions of the model exhibit the same asymptotic behavior for TC self-energies. As an application we discuss how the mass splitting of the order [Formula: see text](100) GeV could be generated between the second and third generation of fermions.
When to Stop Reviewing in Technology-Assisted Reviews
Authors: Li Dan , Kanoulas Evangelos 
Published: September 2020

Technology-Assisted Reviews (TAR) aim to expedite document reviewing (e.g., medical articles or legal documents) by iteratively incorporating machine learning algorithms and human feedback on document relevance. Continuous Active Learning (CAL) algorithms have demonstrated superior performance compared to other methods in efficiently identifying relevant documents. One of the key challenges for CAL algorithms is deciding when to stop displaying documents to reviewers. Existing work either lacks transparency—it provides an ad-hoc stopping point, without indicating how many relevant documents are still not found, or lacks efficiency by paying an extra cost to estimate the total number of relevant documents in the collection prior to the actual review.
In this article, we handle the problem of deciding the stopping point of TAR under the continuous active learning framework by jointly training a ranking model to rank documents, and by conducting a “greedy” sampling to estimate the total number of relevant documents in the collection. We prove the unbiasedness of the proposed estimators under a with-replacement sampling design, while experimental results demonstrate that the proposed approach, similar to CAL, effectively retrieves relevant documents; but it also provides a transparent, accurate, and effective stopping point.
Persistent Poverty and Cancer Mortality Rates: An Analysis of County-Level Poverty Designations
Authors: Moss Jennifer L. , Pinto Casey N. , Srinivasan Shobha , Cronin Kathleen A. , Croyle Robert T. 
Published: September 2020

Abstract

Background:
Cancer mortality is higher in counties with high levels of (current) poverty, but less is known about associations with persistent poverty. Persistent poverty counties (with ≥20% of residents in poverty since 1980) face social, structural, and behavioral challenges that may make their residents more vulnerable to cancer.

Methods:
We calculated 2007 to 2011 county-level, age-adjusted, and overall and type-specific cancer mortality rates (deaths/100,000 people/year) by persistent poverty classifications, which we contrasted with mortality in counties experiencing current poverty (≥20% of residents in poverty according to 2007–2011 American Community Survey). We used two-sample t tests and multivariate linear regression to assess mortality by persistent poverty, and compared mortality rates across current and persistent poverty levels.

Results:
Overall cancer mortality was 179.3 [standard error (SE) = 0.55] deaths/100,000 people/year in nonpersistent poverty counties and 201.3 (SE = 1.80) in persistent poverty counties (12.3% higher, P &lt; 0.0001). In multivariate analysis, cancer mortality was higher in persistent poverty versus nonpersistent poverty counties for overall cancer mortality as well as for several type-specific mortality rates: lung and bronchus, colorectal, stomach, and liver and intrahepatic bile duct (all P &lt; 0.05). Among counties experiencing current poverty, those counties that were also experiencing persistent poverty had elevated mortality rates for all cancer types as well as lung and bronchus, colorectal, breast, stomach, and liver and intrahepatic bile duct (all P &lt; 0.05).

Conclusions:
Cancer mortality was higher in persistent poverty counties than other counties, including those experiencing current poverty.

Impact:
Etiologic research and interventions, including policies, are needed to address multilevel determinants of cancer disparities in persistent poverty counties.
Tumor Cell–Derived TGFβ1 Attenuates Antitumor Immune Activity of T Cells via Regulation of PD-1 mRNA
Authors: Wu Pengfei , Geng Bo , Chen Qun , Zhao Enyang , Liu Jiang , Sun Chen , Zha Caijun , Shao Yong , You Bosen , Zhang Wenfu , Li Lulu , Meng Xiangqi , Cai Jinquan , Li Xuedong 
Published: September 2020

Abstract
Dysfunction in T-cell antitumor activity contributes to the tumorigenesis, progression, and poor outcome of clear cell renal cell carcinoma (ccRCC), with this dysfunction resulting from high expression of programmed cell death-1 (PD-1) in T cells. However, the molecular mechanisms maintaining high PD-1 expression in T cells have not been fully investigated in ccRCC. Here, we describe a mechanism underlying the regulation of PD-1 at the mRNA level and demonstrated its impact on T-cell dysfunction. Transcriptomic analysis identified a correlation between TGFβ1 and PD-1 mRNA levels in ccRCC samples. The mechanism underlying the regulation of PD-1 mRNA was then investigated in vitro and in vivo using syngeneic tumor models. We also observed that TGFβ1 had prognostic significance in patients with ccRCC, and its expression was associated with PD-1 mRNA expression. CcRCC-derived TGFβ1 activated P38 and induced the phosphorylation of Ser10 on H3, which recruited p65 to increase SRSF3 and SRSF5 expression in T cells. As a result, the half-life of PD-1 mRNA in T cells was prolonged. SRSF3 coordinated with NXF1 to induce PD-1 mRNA extranuclear transport in T cells. We then demonstrated that TGFβ1 could induce SRSF3 expression to restrict the antitumor activity of T cells, which influenced immunotherapy outcomes in ccRCC mouse models. Our findings highlight that tumor-derived TGFβ1 mediates immune evasion and has potential as a prognostic biomarker and therapeutic target in ccRCC.
See related Spotlight on p. 1464
Outcomes in Renal Cell Carcinoma With IVC Thrombectomy: A Multiteam Analysis Between an NCI-Designated Cancer Center and a Quaternary Care Teaching Hospital
Authors: Alsina Angel E. , Wind Daniel , Kumar Ambuj , Rogers Ebonie , Buggs Jacentha , Bukkapatnam Raviender , Sexton Wade J. 
Published: September 2020

Introduction Interteam performance and Clavien-Dindo (C-D) complications in renal cell carcinoma with inferior vena cava thrombectomy (RCC-IVCT) have not been reported. We aimed to describe complications by the degree of complexity and surgical teams in a collaborative effort between a National Cancer Institute-designated Comprehensive Cancer Center and a Quaternary Care Teaching Hospital. Methods Between January 2011 and May 2019, 73 consecutive RCC-IVCT were included. C-D grades III or higher were captured. Teams involved were urologic-oncology, vascular, hepatobiliary/transplant, and cardiothoracic. The Mayo Clinic tumor thrombus classification was used. Results Overall complication rate was 42% (n = 31). Nineteen percent had grade III, 18% had grade IV, and 6% had grade V complications. Patients with level IV thrombus had the highest in-hospital mortality rate (75%). Thrombus level did not show a correlation to complication rates (14% level I, 45% level II, 32% level III, 42% level IV). A positive correlation found between the number of teams involved and complication rates (35% with 2-team, 59% with 3-team, P = .059). Thromboembolic events (6% vs 24%, P = .02) and disposition other than home (22% vs 48%, P = .01) were statistically lower for the 2-team groups. Two-team in-hospital mortality was 1/51 (2%) versus 3-team (3/22,14%, ( P = .07). No statistical differences were found in infections, thromboembolic events, and grades of complications between surgical teams. Conclusions Despite similar interteam performance, the consistency of surgeons in high complexity cases could improve outcomes further. Complexity was higher for hepatobiliary/transplant and cardiothoracic teams. A combination of intraoperative events and patient selection (comorbidities and age) contributed to death. Overall, in-hospital mortality was lower than in most reported series.
Surgical repair for post-tuberculosis tracheobronchial stenosis
Authors: Vinh Vu Huu , Khoi Nguyen Van , Quang Nguyen Viet Dang , Khanh Huynh Quang 
Published: September 2020

Aim Post-tuberculosis tracheobronchial stenosis is rare but one of the most dangerous complications of tracheobronchial tuberculosis. Balloon dilatation, stent insertion, laser photoresection, argon plasma coagulation, and cryotherapy are some of the initial treatments recommended for mild to moderate cases. Here, we report a case series of patients who underwent segmental resection and end-to-end anastomosis for bronchial stenosis and a sliding technique for severe and long-segment tracheal stenosis. Methods We retrospectively reviewed the medical records of patients with post-tuberculosis tracheobronchial stenosis operated on in our thoracic surgery department. Of the 7 cases that were treated, two had severe tracheal stenosis stretching over 50% of the tracheal length, one was operated on using resection and end-to-end anastomosis, and the other had sliding tracheoplasty. The other 5 cases of bronchial stem stenosis were treated with segmental resection and end-to-end anastomosis. Results All five patients with bronchial stenosis had a good outcome; the ipsilateral lung was well ventilated and respiratory function was good. One patient with tracheal stenosis, treated with segmental resection and end-to-end anastomosis, died after the surgery, and the other patient, treated with slide tracheoplasty, had a good recovery. Conclusion The treatment plan for patients with post-tuberculosis tracheobronchial stenosis should be on a patient-by-patient basis. Sliding tracheoplasty can be a treatment option in patients with long-segment tracheal stenosis.
Influence of physicians’ seniority on head computed tomography use for patients with isolated vertigo/dizziness
Authors: Tsai Ming-Ta , Chang Kung-Pin , Huang Jyun-Bin , Cheng Shih-Yu , Chiang Charng-Yen , Cheng Fu-Jen 
Published: September 2020

Objective Vertigo/dizziness is a common reason for emergency department (ED) visits. Emergency physicians (EPs) must distinguish patients with dizziness/vertigo owing to serious central nervous system (CNS) disorders. We aimed to evaluate the association between physician seniority and use of head computed tomography (CT) and ED length of stay (LOS) in patients presenting to the ED with isolated dizziness/vertigo. Methods This retrospective cohort study included adult patients with non-traumatic dizziness/vertigo in the ED. EPs were categorized according to seniority: junior (less than 6 years’ clinical experience), intermediate (7–12 years), and senior (≥12 years). Results Among 2589 patients with isolated dizziness/vertigo, 460 (17.8%) received brain CT; 46 (1.78%) had CNS disorder as a final diagnosis. Junior and intermediate EPs ordered more CT examinations than senior EPs: (odds ratio [OR] = 1.329, 95% confidence interval [CI]: 1.002–1.769 and OR = 1.531, 95% CI: 1.178–2.001, respectively). Patients treated by junior and intermediate EPs had lower patient ED LOS (OR = −0.432, 95% CI: −0.887 to 0.024 and OR = −0.436, 95% CI: −0.862 to −0.011). Conclusions We revealed different judgment strategies among senior, intermediate, and junior EPs. Senior EPs ordered fewer CT examinations for patients with isolated vertigo/dizziness but had longer patient LOS.
CEACAM5 stimulates the progression of non-small-cell lung cancer by promoting cell proliferation and migration
Authors: Zhang Xinwen , Han Xingbao , Zuo Pengli , Zhang Xiuying , Xu Hongbang 
Published: September 2020

Objective To detect the expression of CEA-related cell adhesion molecule 5 (CEACAM5) in non-small-cell lung cancer (NSCLC) and explore its function in the progression and development of NSCLC. Methods qRT-PCR and immunohistochemistry were performed to detect CEACAM5 expression in human NSCLC tissues and cell lines. The correlation between CEACAM5 expression and the clinicopathological features of patients with NSCLC was also investigated. MTT, colony formation, wound healing, and immunoblot assays were performed to detect the functions of CEACAM5 in NSCLC cells in vitro, and immunoblotting was used to detect the effects of CEACAM5 on p38–Smad2/3 signaling. Results CEACAM5 expression was elevated in human NSCLC tissues and cells. We further found that CEACAM expression was correlated with clinicopathological features including T division, lymph invasion, and histological grade in patients with NSCLC. The in vitro assays confirmed that CEACAM5 depletion inhibited the proliferation and migration of NSCLC cells by activating p38–Smad2/3 signaling. We verified the involvement of CEACAM5 in the suppression of NSCLC tumor growth in mice. Conclusion CEACAM5 stimulated the progression of NSCLC by promoting cell proliferation and migration in vitro and in vivo. CEACAM5 may serve as a potential therapeutic target for the treatment of NSCLC.
New Registered Nurse Transition to the Workforce and Intention to Leave: Testing a Theoretical Model
Authors: Hallaran Amy J. , Edge Dana S. , Almost Joan , Tregunno Deborah 
Published: September 2020

Background The transition of new nurses into practice has been identified as challenging, and new nurses report having intentions to leave (ITL) jobs. Concerns of ITL are worrisome for the nursing profession, especially when faced with the need to replace an aging nursing workforce and to maintain quality patient care. Purpose Guided by components of Meleis et al.’s mid-range transition theory, the purpose of this study was to test a theoretical model linking transition and ITL, as well as the personal, community and societal conditions of transition. Methods A predictive, non-experimental design using cross-sectional data was employed. Ontario registered nurses, who had graduated within two years, were randomly selected to complete a mailed questionnaire in 2015 ( N = 217). Structural equation modeling was undertaken to test the model. Results The new nurses reported a relatively positive transition; yet, 44% of the respondents indicated leaving their first job, and 1% departed the nursing profession. A revised model of the constructs showed a more adequate fit with the data, but overall, the hypothesized model was not supported and methodological validity of tools questioned. From the modeling, lower role stress led to a positive transition. Conclusions Given organizational and governmental investments in orientation and transition programs, challenges in measuring transition and ITL requires additional research. Our findings highlight the value of organizations supporting new nurses by reducing role stress through reasonable workloads and expectations, which in turn contributes to a positive transition.
Managing ethical aspects of advance directives in emergency care services
Authors: Poveda-Moral Silvia , Rodríguez-Martín Dolors , Codern-Bové Núria , José-María Pilar , Sánchez-Valero Pere , Pomares-Quintana Núria , Vicente-García Mireia , Falcó-Pegueroles Anna 
Published: September 2020

Background: In Hospital Emergency Department and Emergency Medical Services professionals experience situations in which they face difficulties or barriers to know patient’s advance directives and implement them. Objectives: To analyse the barriers, facilitators, and ethical conflicts perceived by health professionals derived from the management of advance directives in emergency services. Research design, participants, and context: This is a qualitative phenomenological study conducted with purposive sampling including a population of nursing and medical professionals linked to Hospital Emergency Department and Emergency Medical Services. Three focus groups were formed, totalling 24 participants. We performed an inductive-type thematic discourse analysis. Ethical considerations: This study was approved by ethical committees of Ethical Commitee of Clínic Hospital (Barcelona) and Comittee of Emergency Medical Services (Barcelona). The participants received information about the purpose of the study. Patients’ anonymity and willingness to participate in the study were guaranteed. Findings: There were four types of barriers that hindered the proper management of patients’ advance directives in Hospital Emergency Department and Emergency Medical Services: personal and professional, family members, organisational and structural, and those derived from the health system. These barriers caused ethical conflicts and hindered professionals’ decision-making. Discussion: These results are in line with those of previous studies and indicate that factors such as gender, professional category, and years of experience, in addition to professionals’ beliefs and the opinions of colleagues and family members, can also influence the professionals’ final decisions. Conclusion: The different strategies described in this study can contribute to the development of health policies and action protocols to help reduce both the barriers that hinder the correct management and implementation of advance directives and the ethical conflicts generated.
Situated Cognition: Implications for Visitor Studies
Authors: Koran Mary Lou , Willems Patricia Pulido , Camp Betty Dunckel 
Published: September 2020

The development of visitor studies can benefit from the growing bodies of research in cognitive and social science. Recent perspectives in learning assume that thinking and learning occur as individuals interact in specific contexts. This emphasis contrasts with traditional information-processing models that highlight the processing and movement of information through mental structures, deemphasizing the importance of context. The situated perspective can inform us about the ways in which the organization of classrooms as well as informal learning environments—such as museums, zoos, parks, and nature centers—may affect opportunities for productive learning. This offers new opportunities for exploring situational effects in informal learning settings and incorporating them within a larger psychological context. This article discusses illustrative ongoing research and its implications for visitor studies in general.