bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Presentation and Stroke Incidence Differ by Moyamoya Etiology
Authors: Gatti John R. , Torriente Adriana Gonzalez , Sun Lisa R. 
Published: November 2020

Introduction: Moyamoya arteriopathy, which can be idiopathic or associated with sickle cell disease, neurofibromatosis, Down syndrome, or cranial radiation therapy, is a progressive cerebral arteriopathy associated with high rates of incident and recurrent stroke. Little is known about how these subgroups differ with respect to clinical presentation, radiographic findings, stroke risk, and functional outcomes. Methods: Using ICD codes, we identified children ages 28 days to 18 years treated for moyamoya arteriopathy at our tertiary care center between 2003 and 2019. Demographic, clinical, and radiographic data were extracted from the medical record. The Pediatric Stroke Recurrence and Recovery Questionnaire was administered to consenting participants. Results: Sixty-nine patients met inclusion criteria (33 idiopathic, 18 sickle cell disease, 11 neurofibromatosis, 6 Down syndrome, 1 cranial radiation therapy). Median follow-up time was 7.7 years; 24 patients had at least 5 years of follow-up data. Frequency of stroke at presentation differed by subgroup ( P < .001). Of patients with at least 2 years of follow-up, 33 (55%) experienced stroke. The proportion of patients experiencing stroke differed by subgroup (50% of idiopathic cases, 72% of sickle cell disease, 11% of neurofibromatosis, and 100% of Down syndrome, P = .003). The frequency of bilateral versus unilateral disease ( P = .001) and stroke-free survival following presentation ( P = .01) also differed by subgroup. Conclusions: In this single-center cohort, moyamoya subgroups differed with respect to clinical and radiographic characteristics, with neurofibromatosis-associated moyamoya syndrome having a milder phenotype and Down syndrome–associated moyamoya portending a more aggressive course. These findings need confirmation in a larger, multi-center cohort with longer duration of follow-up.
Evaluation of Erythropoietin Stimulating Agents (ESA) and Their Effect on Blood Optimization for Cardiac Surgery
Authors: Gill Kristina S. , Antigua Abigail D. , Barnett A. Kacee , Hall Aubrey J. , Klodell Charles T. 
Published: November 2020

Background: Cardiovascular surgeries increase the risk of receiving blood transfusions. Erythropoietin stimulating agents (ESAs) have been used to decrease the transfusion rate. The objective of this study was to evaluate the administration of blood products post-cardiothoracic surgery after receiving ESAs. Methods: This is a single-center, retrospective cohort study. Results: Between May 2017 to May 2018, 52 adult patients underwent cardiac surgery and received ESAs pre-operatively and/or post-operatively. A total of 35 patients were included in the study and 21 (60%) patients did not require a blood transfusion while 14 (40%) patients required a blood transfusion ( p = 0.597). The change in hemoglobin (Hgb = 0.773 g/dL, 1.7 g/dL; p = 0.002) and hematocrit (Hct = 2.31%, 4.3%; p = 0.04) was significantly different in patients who received ESAs alone versus ESAs with blood transfusion. Adverse drug reactions showed no significant difference between groups. Conclusions: In patients undergoing cardiac surgery, ESAs did not significantly reduce the need for blood transfusion. Future and larger studies are necessary to evaluate the effect of ESAs on blood transfusion.
Impact of Pharmacist-Led Patient Education in an Ambulatory Cancer Center: A Pilot Quality Improvement Project
Authors: Park Daniel , Patel Sweta , Yum Kendra , Smith Cardinale B. , Tsao Che-Kai , Kim Sara 
Published: November 2020

Introduction: Although pharmacist-driven patient education has been shown to increase adherence, reduce medication errors, and lower 30-day readmission rates, the data in the ambulatory oncology setting is limited. This pilot quality initiative study was conducted from June 1, 2018, to November 15, 2018, in the ambulatory cancer center affiliated with The Mount Sinai Hospital in New York, NY, to determine the impact of pharmacist counseling on chemotherapy regimens. Methods and Materials: English-speaking patients with gastrointestinal malignancies who were newly started on chemotherapy were selected for this study. They received a pharmacist-led education session regarding their medications, potential side effects, and how to manage them at home. After each session, they completed a 5-question survey on a 5-point Likert-scale about how they felt before and after speaking with a pharmacist. Survey results were analyzed by median scores and Wilcoxon signed-rank test. Results: Of the 96 patients who were counseled, 71 patients were included in this analysis. The median score increased from 3 to 5 for the understanding of their chemotherapy regimen and side effects (questions 1 and 2), 3 to 4.5 for knowledge about interactions with their oral chemotherapy (question 3), 4 to 5 for overall experience in the cancer center (question 5). The median score for anxiety level was unchanged at 3 (question 4). Conclusion: This survey-based study demonstrated the benefit of a pharmacist-led counseling session. An interdisciplinary approach involving the integration of oncology pharmacists in patient education can greatly impact the quality of care for oncology patients.
Morbidity and mortality after major large bowel resection of non-malignant polyp among participants in a population-based screening program
Authors: Paszat Lawrence F , Sutradhar Rinku , Luo Jin , Baxter Nancy N , Tinmouth Jill , Rabeneck Linda 
Published: November 2020

Background and aims Colonoscopy following positive fecal occult blood screening may detect non-malignant polyps deemed to require major large bowel resection. We aimed to estimate the major inpatient morbidity and mortality associated with major resection of non-malignant polyps detected at colonoscopy following positive guaiac fecal occult blood screening in Ontario's population-based colorectal screening program. Methods We identified those without a diagnosis of colorectal cancer in the Ontario Cancer Registry ≤24 months following the date of colonoscopy prompted by positive fecal occult blood screening between 2008 and 2017, who underwent a major large bowel resection ≤24 months after the colonoscopy, with a diagnosis code for non-malignant polyp, in the absence of a code for any other large bowel diagnosis. We extracted records of major inpatient complications and readmissions ≤30 days following resection. We computed mortality within 90 days following resection. Results For those undergoing colonoscopy ≤6 months following positive guaiac fecal occult blood screening, 420/127,872 (0.03%) underwent major large bowel resection for a non-malignant polyp. In 50/420 (11.9%), the resection included one or more rectosigmoid or rectal polyps, with or without a colonic polyp. There were one or more major inpatient complications or readmissions within 30 days in 117/420 (27.9%). Death occurred within 90 days in 6/420 (1.4%). Conclusions Serious inpatient complications and readmissions following major large bowel resection for non-malignant colorectal polyps are common, but mortality ≤90 days following resection is low. These outcomes should be considered as unintended adverse consequences of population-based colorectal screening programs.
Modeling costs and benefits of the organized colorectal cancer screening programme and its potential future improvements in Hungary
Authors: Csanádi Marcell , Gini Andrea , Koning Harry de , Széles György , Pitter János G , Oroszi Beatrix , Pataki Piroska , Fadgyas-Freyler Petra , Korponai Gyula , Vokó Zoltán , Lansdorp-Vogelaar Iris 
Published: November 2020

Objective The national population-based colorectal cancer screening programme in Hungary was initiated in December 2018. We aimed to evaluate the current programme and investigate the costs and benefits of potential future changes to overcome the low coverage of the target population. Methods We performed an economic evaluation from a healthcare payer perspective using an established micro-simulation model (Microsimulation Screening Analysis-Colon). We simulated costs and benefits of screening with fecal immunochemical test in the Hungarian population aged 50–100, investigating also the impact of potential future scenarios which were assumed to increase invitation coverage: improvement of the IT platform currently used by GPs or distributing the tests through pharmacies instead of GPs. Results The model predicted that the current screening programme could lead to 6.2% colorectal cancer mortality reduction between 2018 and 2050 compared to no screening. Even higher reductions, up to 16.6%, were estimated when tests were distributed through pharmacies and higher coverage was assumed. This change in the programme was estimated to require up to 26 million performed fecal immunochemical tests and 1 million colonoscopies for the simulated period. These future scenarios have acceptable cost-benefit ratios of €8000–€8700 per life-years gained depending on the assumed adherence of invited individuals. Conclusions With its limitations, the current colorectal cancer screening programme in Hungary will have a modest impact on colorectal cancer mortality. Significant improvements in mortality reduction could be made at acceptable costs, if the tests were to be distributed by pharmacies allowing the entire target population to be invited.
Study of Neurocognitive Function in Type 2 Diabetes Mellitus Patients Using P300 Event-Related Potential
Authors: Anandhalakshmi Swaminathan , Rajkumar Ramanathan , Arulmurugan Karuppannan , Kumar Janardanan , Thirunavukarasu Manickam 
Published: November 2020

Background: Diabetes mellitus is the most prevailing metabolic disease. It causes structural and functional alterations in several organs, including the central nervous system. Altered glucose metabolism, atherosclerosis, and inflammation of blood vessels are seen in diabetes. This may lead to neuronal degeneration and decline in cognition. Event-related potential P300 can detect cognitive decline before the emergence of obvious neurological manifestations. Objective: The aim of this study is to assess and compare the P300 latencies in subjects with type 2 diabetes mellitus and in nondiabetic subjects and to determine the influence of type 2 diabetes mellitus on cognitive functions. Materials and Methods: In this study our sample size was 248 subjects, with type 2 diabetes mellitus patients ( n = 124) and healthy controls ( n = 124) between the age group of 31 and 60 years. This cross-sectional comparative study was conducted at SRM Medical College Hospital and Research Centre. The subjects were evaluated by a structured interview and they were assessed with a general health questionnaire to rule out any subpsychiatric illness. Fasting and postprandial blood glucose, HbA1c level, lipid profile, and creatinine were estimated. P300 amplitude and peak latencies were recorded using the standard auditory oddball paradigm. Results: The latencies of P300 were significantly increased and the amplitude of P300 was significantly reduced in the diabetic group when compared to the control group ( P < .001). P300 latency has a positive correlation with the HbA1c levels ( r = 0.136) and the duration of diabetes ( r = 0.231). Conclusion: Prolongation of P300 latencies and the decreased amplitude in diabetic subjects may suggest the existence of a cognitive decline in individuals with type 2 diabetes compared to healthy individuals.
Effect of the Migration Option on Rural Microenterprise Establishment Decisions in the Mfantsiman Municipality of Ghana
Authors: Kodwiw William Yaw Amuesi , Mensah John Victor 
Published: November 2020

The role of microenterprise in providing economic opportunities and employment options to the poor due to their ease of entry is recognised across the world. To enhance rural job creation through microenterprise development interventions, it is essential to understand how microenterprise establishment decisions are made among rural dwellers. The study examined how the option to migrate to other localities affects microenterprise establishment decisions among rural dwellers in the Mfantsiman Municipality of Ghana. A mixed method design was used in the study. This involved a cross-sectional survey of 20 rural communities, during which data was collected from 800 respondents. Data were also collected from one focus group in each of the 20 communities. A conjoint decision analysis was carried out from interactions of the attributes of each respondent with the migration factor and other socio-economic factors. The migration option reduced the probability of local microenterprise establishment, with the most significant effect among people aged between 15 and 30 years. Furthermore, rural microenterprise establishment decisions are least influenced by the interactive effect of personal attributes and the migration factor as compared to interaction with other factors including access to electricity, institutional support services, market for outputs and returns on investment.
Simulating Peace Operations: New Digital Possibilities for Training and Public Education
Authors: Dorn A. Walter , Dawson Peter F. 
Published: November 2020

Background and Motivation. A plethora of warfighting games exist commercially, but there is a lack of digital games that deal with peace processes. Furthermore, none simulate actual peacekeeping. The United Nations currently deploys about 100,000 peacekeepers to some of the world’s most dangerous zones, where peacekeepers save lives, alleviate suffering, and help create conditions for peace. The United Nations and national militaries lack peacekeeping simulations to help train their soldiers. Additionally, the public needs to learn more about the way peacekeeping works. Thus, peacekeeping simulation and gaming are worth exploring, especially in the rapidly evolving digital space, which offers new avenues and benefits. Methods. We review the meager literature on the subject and observe that there are few digital games to directly draw from. We build on previous work that argued the need for such development, but we now assess important design principles and parameters. We draw upon peacekeeping tabletop exercises that are already well developed. Results. We conclude that excellent scenarios and simulation technologies exist that could be combined quite easily for effective peacekeeping training and public education. We find key materials and scenarios in exercises of the United Nations and of the Pearson Peacekeeping Centre. Highlighted areas for future digital design are the inclusion of non-military avatars, emphasis on soft skills development (especially empathy), and realistically complex links between actions and consequences. Conclusion. While describing some UN exploration at a proof-of-concept stage, we suggest that both the United Nations and the gaming industry should explore the idea further to achieve synergies between institutional and entertainment applications. The growing capacity of digital technology allows significant innovation, yielding results that could be useful, ethical, enjoyable, and potentially profitable.
Preventing Maltreatment at Home: A Meta-Analysis Examining Outcomes From Online Programs
Authors: Spencer Chelsea M. , Stith Sandra M. , King Erika L. 
Published: November 2020

Purpose: During the COVID-19 pandemic, there has been an increase in cases of intimate partner violence (IPV) related to stay-at-home orders, as well as the financial and emotional stress many individuals are experiencing. With limitations on group gatherings, typical in-person prevention and intervention resources, such as anger management groups or batterer intervention programs, may be inaccessible to people in need of resources. Method: In order to understand effective options for reducing risk when face-to-face interventions are not feasible, we conducted a meta-analysis to examine the effects of online programs aimed at improving participants’ well-being and reducing IPV risk. Six studies were identified in databases using key search terms. Results: Change score comparisons revealed that online programs reduced participants’ anger, depression, emotional IPV perpetration, and physical IPV perpetration significantly more than control groups. Discussion: Findings suggest that online resources can help motivated individuals struggling with anger and/or at risk for IPV perpetration.
Financial Hardship and Health Related Quality of Life Among Older Latinos With Chronic Diseases
Authors: Nedjat-Haiem Frances R. , Cadet Tamara , Parada Humberto , Jones Tessa , Jimenez Elvira E. , Thompson Beti , Wells Kristen J. , Mishra Shiraz I. 
Published: November 2020

Background: Financial hardship influences health-related quality of life (HRQoL) of older adults. However, little is known about the relationship between financial hardship and HRQoL among vulnerable populations. Objective: We examined the associations between financial hardship and HRQoL among older Latinos living with chronic disease, including cancer. Methods: This cross-sectional study included 68 Latinos (age range 50-87) with one or more chronic health conditions who participated in a pilot randomized clinical trial. Participants responded to 11 financial hardship questions. We used factor analysis to explore constructs of financial hardship. HRQoL was assessed using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G). Multiple linear regression examined the associations between financial hardship and HRQoL subscales (physical, social/family, emotional, functional well-being). Results: The factor analysis revealed 3 constructs of financial hardship: medical cost concerns, financial hardship treatment adherence, and financial worry. A 1-point increase in the factor score for financial hardship treatment adherence was associated with a 2.1-point (SE = 0.771) decrease in physical well-being and with a 1.71-point (SE = 0.761) decrease in functional well-being. A 1-point increase in the financial stress factor score was associated with a 2.0-point (SE = 0.833) decrease in social/family well-being, and with a 2.1-point (SE = 0.822) decrease in functional well-being. Conclusion: In this study of older Latinos with chronic diseases, financial hardship was associated with worse HRQoL across several domains. Healthcare providers should refer older Latinos living with chronic disease to appropriate support providers, such as care coordinators, social workers, or patient navigators, who can assist them with obtaining financial assistance and other resources.
Lateral and Frontal Cephalometric Measurements in a Cohort With Saethre-Chotzen Syndrome
Authors: Rizell Sara , Karlsson Peter , Ransjö Maria , Westerlund Anna , Yehia Zakaria , Kölby Lars 
Published: November 2020

Objective: Descriptions of the craniofacial morphology in Saethre-Chotzen syndrome (SCS) are primarily based on case reports or visual assessments of affected families. The aim of this study was to compare cephalometric measurements of the craniofacial skeleton in a cohort of individuals with SCS and age- and sex-matched individuals without craniofacial anomalies. Design: Retrospective case series. Patients: Eight girls and 4 boys with SCS (age range, 7.0-19.2 years). Methods: Cephalometric measurements were performed using lateral and frontal cephalograms. Results: Most of the individuals with Saethre-Chotzen syndrome exhibited lower values for SNA, SNB, s-n and s-ar, while their NSL/NL, NSL/ML, NL/ML, and n-s-ba values were higher than the respective mean reference values for healthy individuals. In comparison with age- and sex-matched individuals without craniofacial anomalies, the individuals with SCS showed higher values for the maxillary and mandibular angular measurements, as well as for the menton midline angle. Conclusions: This sample of 12 unrelated individuals with SCS is the largest collected to date for cephalometric measurements. We found that the syndrome is associated with bimaxillary retrognathism, posterior maxillary and mandibular inclination, neutral sagittal relation as well as a tendency toward an open vertical skeletal relation, a short and flattened skull base, and facial asymmetry, as compared to individuals without the syndrome.
Comparison of Head Shape Outcomes in Metopic Synostosis Using Limited Strip Craniectomy and Open Vault Reconstruction Techniques
Authors: Pressler Mark Philip , Hallac Rami R. , Geisler Emily L. , Seaward James R. , Kane Alex A. 
Published: November 2020

Aim: Metopic craniosynostosis (MCS), with its trigonocephalic head shape, is often treated with either limited incision strip craniectomy (LISC) followed by helmet orthotic treatment, or open cranial vault reconstruction techniques (OCVR). There is controversy regarding resultant shape outcomes among craniofacial surgeons. Those adverse to LISC claim normal head shape is never attained, while proponents believe there is gradual correction to an equivalent outcome. This study aims to quantitate, over time, the three-dimensional (3D) head shapes in patients who have undergone LISC or OCVR intervention for MCS. Methods: Sixty-three 3D images of 26 patients with MCS were analyzed retrospectively. Head shape analyses were performed at: (1) preoperative, (2) 1-month postoperative, (3) 10 to 14 months postoperative (1 year), and (4) 2 years postoperative. Composite 3D head shapes of patients were compared at each time point. Two-dimensional (2D) standardized cross sections of the forehead were also compared. Results: Composite head shapes for both groups were nested, to allow visual comparison as the child’s forehead grows and expands. The difference between LISC and OCVR 2D cross sections was calculated; 108.26 mm preoperatively, 127.18 mm after 1-month postoperative, 51.05 mm after 10 to 14 months postoperative, and 27.03 mm after 2 years postoperative. Conclusions: This study found excellent head shape outcomes for both the LISC and OCVR techniques at 2 years of age. It also corroborates the slow and progressive improvement in head shape with the LISC technique. This study highlights the advantages of 3D photography for measurement of contour outcomes, utilizing both 2D vector and 3D whole head analytical techniques.