bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing the Volume of Low-Value Outpatient MRI Joint Examinations in Patients ≥55 Years of Age
Authors: Kandiah Joshua W. , Chan Vivian W. Y. , Luo Jing , Dong Flora , Nugent James P. , Forster Bruce B. 
Published: January 2020

Purpose: Magnetic resonance imaging (MRI) is not beneficial in patients with joint pain and concomitant osteoarthritis (OA). We attempt to determine whether evaluation of OA via X-rays can reduce inappropriate MRI and computed tomography (CT) arthrogram use. In our jurisdiction, CT arthrograms are used as surrogate tests because of MRI wait times. Materials and Methods: Our intervention required patients ≥55 years of age scheduled for outpatient MRI of the knee/hip/shoulder at an urban hospital to have X-rays (weight bearing when appropriate) from within 1 year. Red flags (ie, neoplasm, infection) were identified for which MRI would be indicated regardless. Through review of radiographs on picture archiving and communication system/digital media and use of the validated Kellgren-Lawrence (KL) OA scale, radiologists assessed the presence and degree of OA. A finding of significant OA (KL > 2) without red flags would preclude MRI. Monthly averages of MRI and CT arthrogram examinations were measured 33 months before and 23 months following introduction of the intervention. Results: The proportion of protocoled MRI requisitions that were avoided was 21%. If extrapolated to the province of British Columbia, 2419 of 11 700 examinations could have been prevented in the past year. The average monthly number of knee/hip/shoulder MRI examinations as a percentage of total MRI examinations decreased from 4.9% to 4.3% ( P < .02) following the intervention. The average monthly number of knee/hip/shoulder CT arthrogram examinations decreased from 20.6 to 12.1 ( P < .0001). Conclusion: We were able to decrease the number of MRI and CT arthrogram examinations in patients ≥55 years of age with joint pain by implementing an evaluation for OA via recent X-ray imaging.
A community-based model of HIV care for men who have sex with men and transgender women in Chicago
Authors: Brito Maximo O , Khosla Shaveta , Santana Lyanne , Lubrano Antonio , Martinez Tamara , Eugeni Alissa , Mehta Supriya D , Novak Richard M 
Published: January 2020

Socioeconomically disadvantaged men who have sex with men (MSM) and transgender women (TGW) share a disproportionate burden of the HIV epidemic. Providing care in the community may help improve retention and treatment outcomes of these clients. Our objective was to compare HIV outcomes between a community-based model (CBM) and a hospital-based model (HBM) of HIV care. This was a retrospective cohort study of MSM and TGW with HIV treated at community clinics or at a hospital-based clinic. The primary outcome was the cumulative probability of virologic failure (HIV viral load ≥200 copies/ml). We conducted multivariable Cox proportional hazard regression to identify differences in outcome by care setting. Of 258 MSM and TGW, approximately half received care in the CBM. They were more likely to be African American (71% versus 59%), uninsured (48% versus 39%), and used illicit drugs (40% versus 25%). There was no difference in virologic failure by setting (58% CBM, 53% HBM; cumulative incidence of virologic failure: 35% CBM, 25% HBM; adjusted HR = 1.11; 95% CI: 0.88–1.39). Despite serving clients at greater risk for failure, virologic failure in our CBM was similar to a traditional HBM for MSM and TGW living with HIV.
Factors Affecting Decisions Regarding Terminal Care Locations of Patients With Metastatic Breast Cancer
Authors: Nogami Noriko , Nakai Katsuya , Horimoto Yoshiya , Mizushima Akio , Saito Mitsue 
Published: January 2020

Background: Metastatic breast cancer (MBC) is generally incurable, but patients can survive longer than those with other cancer types. Treatment strategies for MBC are complex, and it is difficult to establish evidence of efficacy since symptoms and patient backgrounds vary markedly. Some patients struggle to decide where to receive end-of-life care, despite palliative care intervention, and some die in unexpected places. With the aim of ascertaining the best way to intervene on behalf of patients with end-stage breast cancer, we retrospectively examined interventions provided by our palliative care team. We investigated factors influencing the decision-making processes of patients with MBC regarding end-of-life care locations and where patients actually died. Methods: Clinical records of 44 patients with MBC, all Japanese women, who received palliative care interventions at our hospital, were retrospectively investigated. We examined factors, such as age, possibly impacting decision-making processes regarding the final location and actual place of death. Results: Thirty-five (80%) patients were able to decide where to receive end-of-life care, while the others were not. For these 35 patients, desired locations were the palliative care unit (77%), home palliative care (14%), and the hospital (9%). Age and recurrence-free survival (RFS) were factors influencing patients’ decision-making processes ( P = .030 and .044, respectively). Of the 35 patients, 25 (71%) were able to receive end-of-life care at their desired locations. Conclusions: Young patients and those with short RFS struggled with making decisions regarding where to receive end-of-life care. Such patients might benefit from prompt introduction of advanced care planning.
A systematic review of upper extremity neuropathy following total hip arthroplasty
Authors: Schwarzman Garrett R , Schwarzman Logan S , Macgillis Kyle J , Gonzalez Mark H 
Published: January 2020

Background: There is a paucity of literature describing upper extremity neuropathy following the procedure. We performed a systematic review of upper extremity neuropathy following total hip arthroplasty (THA) to provide characteristics regarding the incidence, suspected aetiology, and outcomes of such complications. Methods: A systematic review of the literature was performed which investigated the COCHRANE and Medline databases regarding “peripheral neuropathy total hip arthroplasty” and “nerve palsy associated total hip arthroplasty.” Studies were excluded if they were not Level I, II, or III of evidence or had incomplete reported data. Studies were evaluated and data was extracted for the analysis if they met all inclusion criteria. Data extracted was compiled to assess nerve injury, aetiology, and resolution of symptoms. Results: The search included 77 articles and 4 were selected for inclusion. A total of 21,346 patients underwent a THA with 40 of those cases resulting in an upper extremity nerve injury yielding a complication rate of 0.20%. The most likely aetiology of the upper extremity neuropathy was a compression neuropathy related to improper patient positioning of the contralateral/ipsilateral arm. Full resolution was reported in 74.42% of these cases (32 of 43 cases). Conclusions: Upper extremity neuropathy following THA is a rare complication that presents with variations of sensory and motor deficits. A thorough attention to proper positioning of the upper extremity is necessary to mitigate this risk.
Ableist contours of Down syndrome in Australia: Facebook attitudes towards existence and parenting of people with Down syndrome
Authors: Johnson Belinda , West Raelene 
Published: January 2020

The emergence of online disability hate speech on social media platforms is the latest form of ableist expression. This was highlighted when an alarming amount of negative attitudinal responses emerged towards people with Down syndrome and their parents on the 60 Minutes Facebook platform to their segment ‘Does Australia really want to see the end of Down syndrome?’ This article analyses the varying contours of ableism within these responses. The responses could be categorised into three broad themes: the construction of Down syndrome as an economic burden on society and a drain on public resources; social attitudes to Down syndrome; and bias related to information provided by the medical profession to pregnant women with a high probability of a Down syndrome birth. These findings allowed us to interrogate what this means in terms of how Australians view difference associated with Down syndrome, and to consider the operationalisation of ableism within the Australian social landscape.
Centralization of Pancreatic Surgery Improves Results: Review
Authors: Ahola R. , Sand J. , Laukkarinen J. 
Published: January 2020

Background and Aims: The effect of operation volume on the outcomes of pancreatic surgery has been a subject of research since the 1990s. In several countries around the world, this has led to the centralization of pancreatic surgery. However, controversy persists as to the benefits of centralization and what the optimal operation volume for pancreatic surgery actually is. This review summarizes the data on the effect of centralization on mortality, complications, hospital facilities used, and costs regarding pancreatic surgery. Materials and Methods: A systematic librarian-assisted search was performed in PubMed covering the years from August 1999 to August 2019. All studies comparing results of open pancreatic resections from high- and low-volume centers were included. In total 44, published articles were analyzed. Results: Studies used a variety of different criteria for high-volume and low-volume centers, which hampers the evaluating of the effect of operation volume. However, mortality in high-volume centers is consistently reported to be lower than in low-volume centers. In addition, failure to rescue critically ill patients is more common in low-volume centers. Cost-effectiveness has also been evaluated in the literature. Length of hospital stay in particular has been reported to be shorter in high-volume centers than in low-volume centers. Conclusion: The effect of centralization on the outcomes of pancreatic surgery has been under active research and the beneficial effect of it is associated especially with better short-term prognosis after surgery.
Isolated superior striate vein thrombosis in adults
Authors: Mazini Bianca , Bonvin Christophe , Gailloud Philippe , San Millán Diego 
Published: January 2020

Background Isolated cerebral deep medullary vein thrombosis has been described in the setting of hemorrhagic periventricular white matter lesions in preterm and full-term neonates, but to the best of our knowledge, has never been reported in adults. We present two cases of isolated thrombosis of the superior striate vein occurring in adults that could be analogous to deep medullary vein thrombosis in that they involve deep cerebral veins only without thrombosis of the subependymal or internal cerebral veins. Case description Two women aged 20 and 39, presented with transient neurological deficits and headache. Diagnosis of isolated superior striate vein thrombosis was based on CT and MRI findings with long term imaging follow-up. Both patients evolved favorably under conservative treatment without anticoagulation. Thrombophilia workup was negative and both patients were active smokers under oral contraception. Conclusion Isolated superior striate vein thrombosis is a rare form of intracranial venous thrombosis and should be considered in the differential diagnosis of stroke-like episodes with headache in adults. Isolated superior striate vein thrombosis presents with characteristic imaging features on CT and MRI.
Safety of carotid artery stenting for elderly patients with cervical carotid artery stenosis
Authors: Taguchi Akira , Sakamoto Shigeyuki , Okazaki Takahito , Oshita Jumpei , Kuwabara Masashi , Kurisu Kaoru 
Published: January 2020

Background Several recent randomized controlled trials have reported that perioperative complications of carotid artery stenting increase with age, and Japan has the highest proportion of elderly in the world. We retrospectively compared clinical factors, treatment outcomes, and adverse events between younger and elderly carotid artery stenting patients at a single institution in Japan to assess carotid artery stenting safety for the aged population. Methods A total of 150 consecutive patients treated with carotid artery stenting using the dual protection (simultaneous flow reversal and distal filter) and blood aspiration method were enrolled. Patients were classified into an elderly (O) group ≥75 years (54/150, 36.0%) and a younger (Y) group <75 years (96/150, 64%) for comparison of demographics, clinical background, incidence of captured debris during the procedure, outcome, minor stroke, major adverse events (major stroke, myocardial infarction, or death) within 30 days, hyperintense spots on diffusion-weighted images after carotid artery stenting, and postoperative hospitalization days. Results The carotid artery stenting procedure was successful in all cases. No major adverse events occurred within 30 days in the Y group, and only one occurred in the O group ( P = 0.348). Visible debris was captured in a significantly greater proportion of O group patients than in Y group patients (33/54 (63.5%) vs. 40/96 (42.1%), P = 0.016), but there was no significant difference in the frequency of hyperintense spots on diffusion-weighted images between Y and O groups (23/96 (24.0%) vs. 16/52 (30.8%), P = 0.435). Conclusions Carotid artery stenting using dual protection and blood aspiration is equally safe for younger and elderly patients.
The impact of body mass index and sociodemographic factors on moderate-to-vigorous physical activity and sedentary behaviors of women with young children: A cross-sectional examination
Authors: Dinkel Danae M , Hein Nicholas , Snyder Kailey , Siahpush Mohammad , Maloney Shannon , Smith Lynette , Farazi Paraskevi A , Hanson Corrine 
Published: January 2020

Objectives: Moderate-to-vigorous physical activity provides multiple benefits to women after childbirth. To achieve these benefits, the recommendation that adults obtain, 150 min of moderate-to-vigorous physical activity per week and reduce sedentary behaviors, also applies to women in the post-partum phase of the life span. However, research examining the moderate-to-vigorous physical activity and sedentary behaviors of women with young children (0–2 years) is limited. A greater understanding of these behaviors from a nationally representative sample is needed. Therefore, the primary objective of this study was to determine the levels of moderate-to-vigorous physical activity and sedentary behaviors of a nationally representative sample of women with young children within the United States. A secondary objective was to examine the influence of body mass index and sociodemographic factors on these behaviors. Methods: Cross-sectional data from four cycles of the National Health and Nutrition Examination Survey (2007–2008, 2009–2010, 2011–2012, and 2013–2014) were used for analysis. Descriptive statistics were calculated and a generalized linear model was used to investigate associations between mean minutes of moderate-to-vigorous physical activity, sedentary activity, body mass index, and sociodemographic variables. Discussion: Women with young children (n = 477) obtained 634 min in moderate-to-vigorous physical activity per week and this was positively associated with having a higher income (p < 0.001) and the number of children in the home (p < 0.001). In total, 62% of women were meeting the World Health Organization guidelines for aerobic activity. Lower odds of achieving guidelines was associated with being Black (p = 0.004), Mexican American (p = 0.009), or married (p = 0.042) compared with being White or not married. Finally, women accumulated ~5 h of sedentary activity per day, with higher levels associated with race (p = 0.005), education (p = 0.022), and number of children within the home (p < 0.001). Research efforts should continue to focus on strategies to help non-adhering women with young children achieve the physical activity recommendations and reduce time spent in sedentary behaviors.
Accuracy of aortic dissection detection risk score alone or with D-dimer: A systematic review and meta-analysis
Authors: Tsutsumi Yusuke , Tsujimoto Yasushi , Takahashi Sei , Tsuchiya Asuka , Fukuma Shingo , Yamamoto Yosuke , Fukuhara Shunichi 
Published: January 2020

Background:To evaluate the diagnostic accuracy and clinical utility of the acute aortic dissection detection risk score (ADD-RS) alone or with D-dimer as a screening test to exclude acute aortic syndrome.Methods:We conducted a systematic review and meta-analysis of studies examining the diagnostic accuracy of ADD-RS. We searched MEDLINE, Embase and Cochrane Controlled Register of Trials up to 12 December 2018.Results:We identified nine studies involving 26,598 patients for ADD-RS alone and 3421 patients with D-dimer. Overall, the methodological quality based on the Quality Assessment of Diagnostic Accuracy Studies 2 was moderate to high. Bivariate meta-analyses showed that the pooled sensitivities were 0.94 (95% confidence interval (CI) 0.90, 0.96) at the threshold of ADD-RS ≥1, 0.46 (95% CI, 0.34, 0.59) at ADD-RS ≥2, 1.00 (95% CI 0.99, 1.00) at ADD-RS ≥1 with D-dimer and 0.99 (95% CI 0.97, 1.00) at ADD-RS ≥2 with D-dimer. For the low prevalence population, failure rate and efficiency were 0.8% and 38.3% at ADD-RS ≥1, 0.03% and 14.5% at ADD-RS ≥1 with D-dimer, and 0.1% and 33.6% at ADD-RS ≥2 with D-dimer, respectively. For the high prevalence population, failure rate and efficiency were 3.8% and 33.3% at ADD-RS ≥1, 0.2% and 12.3% at ADD-RS ≥1 with D-dimer and 0.6% and 28.4% at ADD-RS ≥2 with D-dimer, respectively.Conclusions:ADD-RS alone or with D-dimer was a useful screening test with high sensitivity to exclude acute aortic syndrome. However, the optimal threshold of ADD-RS alone or with D-dimer may depend on the clinical setting.
Subclonal NT5C2 mutations are associated with poor outcomes after relapse of pediatric acute lymphoblastic leukemia
Authors: Barz Malwine J. , Hof Jana , Groeneveld-Krentz Stefanie , Loh Jui Wan , Szymansky Annabell , Astrahantseff Kathy , von Stackelberg Arend , Khiabanian Hossein , Ferrando Adolfo A. , Eckert Cornelia , Kirschner-Schwabe Renate 
Published: January 2020

AbstractActivating mutations in cytosolic 5′-nucleotidase II (NT5C2) are considered to drive relapse formation in acute lymphoblastic leukemia (ALL) by conferring purine analog resistance. To examine the clinical effects of NT5C2 mutations in relapsed ALL, we analyzed NT5C2 in 455 relapsed B-cell precursor ALL patients treated within the ALL-REZ BFM 2002 relapse trial using sequencing and sensitive allele-specific real-time polymerase chain reaction. We detected 110 NT5C2 mutations in 75 (16.5%) of 455 B-cell precursor ALL relapses. Two-thirds of relapses harbored subclonal mutations and only one-third harbored clonal mutations. Event-free survival after relapse was inferior in patients with relapses with clonal and subclonal NT5C2 mutations compared with those without (19% and 25% vs 53%, P &lt; .001). However, subclonal, but not clonal, NT5C2 mutations were associated with reduced event-free survival in multivariable analysis (hazard ratio, 1.89; 95% confidence interval, 1.28-2.69; P = .001) and with an increased rate of nonresponse to relapse treatment (subclonal 32%, clonal 12%, wild type 9%, P &lt; .001). Nevertheless, 27 (82%) of 33 subclonal NT5C2 mutations became undetectable at the time of nonresponse or second relapse, and in 10 (71%) of 14 patients subclonal NT5C2 mutations were undetectable already after relapse induction treatment. These results show that subclonal NT5C2 mutations define relapses associated with high risk of treatment failure in patients and at the same time emphasize that their role in outcome is complex and goes beyond mutant NT5C2 acting as a targetable driver during relapse progression. Sensitive, prospective identification of NT5C2 mutations is warranted to improve the understanding and treatment of this aggressive ALL relapse subtype.
Feed-forward regulatory loop driven by IRF4 and NF-κB in adult T-cell leukemia/lymphoma
Authors: Wong Regina Wan Ju , Tan Tze King , Amanda Stella , Ngoc Phuong Cao Thi , Leong Wei Zhong , Tan Shi Hao , Asamitsu Kaori , Hibi Yurina , Ueda Ryuzo , Okamoto Takashi , Ishida Takashi , Iida Shinsuke , Sanda Takaomi 
Published: January 2020

Abstract
Adult T-cell leukemia/lymphoma (ATL) is a highly aggressive hematological malignancy derived from mature CD4+ T-lymphocytes. Here, we demonstrate the transcriptional regulatory network driven by 2 oncogenic transcription factors, IRF4 and NF-κB, in ATL cells. Gene expression profiling of primary ATL samples demonstrated that the IRF4 gene was more highly expressed in ATL cells than in normal T cells. Chromatin immunoprecipitation sequencing analysis revealed that IRF4-bound regions were more frequently found in super-enhancers than in typical enhancers. NF-κB was found to co-occupy IRF4-bound regulatory elements and formed a coherent feed-forward loop to coordinately regulate genes involved in T-cell functions and development. Importantly, IRF4 and NF-κB regulated several cancer genes associated with super-enhancers in ATL cells, including MYC, CCR4, and BIRC3. Genetic inhibition of BIRC3 induced growth inhibition in ATL cells, implicating its role as a critical effector molecule downstream of the IRF4-NF-κB transcriptional network.
The value of monitoring data in a process evaluation of hygiene behaviour change in Community Health Clubs to explain findings from a cluster-randomised controlled trial in Rwanda
Authors: Waterkeyn Juliet , Waterkeyn Anthony , Uwingabire Fausca , Pantoglou Julia , Ntakarutimana Amans , Mbirira Marcie , Katabarwa Joseph , Bigirimana Zachary , Cairncross Sandy , Carter Richard 
Published: January 2020

Abstract
Background
A cluster-Randomised Controlled Trial evaluation of the impact of the Community Health Clubs (CHCs) in the Community Based Environmental Health Promotion Programme in Rwanda in 2015 appeared to find little uptake of 7 hygiene indicators 1 year after the end of the intervention, and low impact on prevention of diarrhoea and stunting.

Methods
Monitoring data was revisited through detailed community records with all the expected inputs, outputs and external determinants analysed for fidelity to the research protocol. Five household inventory observations were taken over a 40-month period including 2 years after the end of the cRCT in a random selection of the 50 intervention CHCs and data compared to that of the trial. Focus Group Discussion with all Environmental Health Officers of the Ministry of Health provided context to understand the long-term community dynamics of hygiene behaviour change.

Results
It was found that the intervention had been jeopardised by external determinants with only 54% fidelity to protocol. By the end of the designated intervention period in June 2014, the treatment had reached only 58% of households with 41% average attendance at training sessions by the 4056 registered members and 51% mean completion rate of 20+ sessions. Therefore only 10% of 50 CHCs provided the full so-called ‘Classic’ training as per-protocol. However, sustainability of the CHCs was high, with all 50 being active 2 years after the end of the cRCT and over 80% uptake of recommended practices of the same 7 key indicators as the trial was achieved by 2017.

Conclusions
The cRCT conclusion that the case study of Rusizi District does not encourage the use of the CHC model for scaling up, raises concerns over the possible misrepresentation of the potential of the holistic CHC model to achieve health impact in a more realistic time frame. It also questions the appropriateness of apparently rigorous quantitative research, such as the cluster-Randomised Controlled Trial as conducted in Rusizi District, to adequately assess community dynamics in complex interventions.