bluuebunny/crossref_metadata_2025_split huggingface dataset:
How do neurologists diagnose transient ischemic attack: A systematic review
Authors: Fitzpatrick Tess , Gocan Sophia , Wang Chu Q , Hamel Candyce , Bourgoin Aline , Dowlatshahi Dar , Stotts Grant , Shamy Michel 
Published: December 2018

Background Identifying and treating patients with transient ischemic attack is an effective means of preventing stroke. However, making this diagnosis can be challenging, and over a third of patients referred to stroke prevention clinic are ultimately found to have alternate diagnoses. Aims We performed a systematic review to determine how neurologists diagnose transient ischemic attack. Summary of review A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using MEDLINE, Embase, and the Cochrane Library databases. Publications eligible for inclusion were those that included information on the demographic or clinical features neurologists use to diagnose transient ischemic attacks or transient ischemic attack–mimics. Of 1666 citations, 210 abstracts were selected for full-text screening and 80 publications were ultimately deemed eligible for inclusion. Neurologists were more likely to diagnose transient ischemic attack based on clinical features including negative symptoms or speech deficits. Patients with positive symptoms, altered level of consciousness, or the presence of nonfocal symptoms such as confusion or amnesia were more likely to be diagnosed with transient ischemic attack–mimic. Neurologists commonly include mode of onset (i.e. sudden versus gradual), recurrence of attacks, and localizability of symptoms to a distinct vascular territory in the diagnostic decision-making process. Transient ischemic attack diagnosis was more commonly associated with advanced age, preexisting hypertension, atrial fibrillation, and other vascular risk factors. Conclusions Neurologists rely on certain clinical and demographic features to distinguish transient ischemic attacks from mimics, which are not currently reflected in widely used risk scores. Clarifying how neurologists diagnose transient ischemic attack may help frontline clinicians to better select patients for referral to stroke prevention clinics.
Clinical and hemodynamic factors in predicting response to fluid challenge during right heart catheterization
Authors: Moghaddam Nima , Swiston John R. , Levy Robert D. , Lee Lisa , Huckell Victor F. , Brunner Nathan W. 
Published: December 2018

Fluid challenge during right heart catheterization has been used for unmasking pulmonary hypertension (PH) related to left‐sided heart disease. We evaluated the clinical and hemodynamic factors affecting the response to fluid challenge and investigated the role of fluid challenge in the classification and management of PH patients. We reviewed the charts of 67 patients who underwent fluid challenge with a baseline pulmonary arterial wedge pressure (PAWP) of≤ 18 mmHg. A positive fluid challenge (PFC) was defined as an increase in PAWP to > 18 mmHg after 500 mL saline infusion. Clinical characteristics and echocardiographic and hemodynamic parameters were compared between PFC and negative fluid challenge (NFC). PFC was associated with female sex, increased BMI, and hypertension. A greater rise in PAWP was observed in PFC (6.8 ± 2.3 vs. 3.8 ± 2.7 mmHg, P = 0.001). A larger increase in PAWP correlated with a lower transpulmonary gradient (r = –0.42, P < 0.001), diastolic pulmonary gradient (r = –0.42, P < 0.001), and pulmonary vascular resistance (r = –0.38, P < 0.001). We found 100% of the patients with PFC were classified as WHO group 2 PH compared to 49% of the NFC patients (P < 0.001). Fewer patients with PFC were started on advanced PH therapies and more were discharged from PH clinic. A PFC and the magnitude of PAWP increase after saline loading are associated with parameters related to left heart disease. In our population, fluid challenge appeared to influence the classification of PH and whether patients are started on therapy or discharged from clinic.
Better lung function with increased handgrip strength, as well as maximum oxygen uptake, in congenital heart disease across the lifespan
Authors: Smith Maia P , Müller Jan , Neidenbach Rhoia , Ewert Peter , Hager Alfred 
Published: December 2018

Background The respiratory benefits of muscle strength are well-known in heart-healthy populations, but recommendations and research often focus instead on aerobic fitness (peak oxygen uptake) or total activity. Independent benefits of strength thus may be underestimated, especially in congenital heart disease where perceived dangers of certain types of exercise may outweigh perceived benefits. To assess whether it is plausible that pulmonary benefits of strength in heart-healthy populations also apply in congenital heart disease, we simultaneously correlated these patients’ lung function with fitness, strength, and cardiac diagnosis. Methods Lung function (forced expiratory volume in one second percentage predicted (FEV1%pred)) was modeled as function of handgrip strength, congenital heart disease diagnosis, peak oxygen uptake and the interactions of handgrip with sex and diagnosis in 538 Germans (58% male, ages 6–82 years) in linear models corrected for age, sex, height and weight. Congenital heart disease diagnoses were: complex cyanotic; Fallot/Truncus arteriosus communis (common arterial trunk) (TAC); shunts; transposition of the great arteries (TGA); left heart; and other/none. Results Each kg of handgrip was associated with 0.74% higher FEV1%pred ( p < 0.001) and handgrip explained almost 10% of variance in FEV1%pred. While some groups had higher FEV1%pred than others ( p for global null <0.0001), all experienced similar associations with strength ( p for interaction with handgrip >0.10 for both sex and diagnosis.) Correction for peak oxygen uptake eliminated the association with congenital heart disease, but not handgrip. Conclusion Strength was associated with better lung function in all ages even after correction for peak oxygen uptake, regardless of sex and congenital heart disease. This suggests that strength may be at least as important for lung function as aerobic fitness. Heart-safe strength training may improve pulmonary function in congenital heart disease.
Apocrine gland anal sac adenocarcinoma with perineural metastasis in a cat
Authors: Raleigh Joseph S , Lanza Matthew R , Perry James A 
Published: December 2018

Case summary A 15-year-old female spayed domestic shorthair cat was presented for hyporexia and acute development of L4–Cd myelopathy (urinary incontinence, pelvic limb paresis with hyporeflexia and absent tail tone). Humane euthanasia was elected owing to the rapid neurological deterioration and necropsy was performed. Post-mortem examination identified a right-sided anal sac mass and medial iliac lymphadenopathy. No gross lesions were evident in the cauda equina or peripheral nerves. Histopathology and immunohistochemistry utilizing wide-spectrum cytokeratin confirmed apocrine gland carcinoma of the anal sac with lymph node, peripheral nerve and cauda equina metastasis. Relevance and novel information This is the first report of feline anal sac adenocarcinoma metastasizing to perineural tissue. In addition, it provides a novel differential diagnosis for L4–Cd myelopathy and urinary incontinence in a cat.
Successful utilization of the EMR in a multiple sclerosis clinic to support quality improvement and research initiatives at the point of care
Authors: Claire Simon Kelly , Hentati Afif , Rubin Susan , Franada Tiffani , Maurer Darryck , Hillman Laura , Tideman Samuel , Szela Monika , Meyers Steven , Frigerio Roberta , Maraganore Demetrius M 
Published: December 2018

Background Many physicians enter data into the electronic medical record (EMR) as unstructured free text and not as discrete data, making it challenging to use for quality improvement or research initiatives. Objectives The objective of this research paper was to develop and implement a structured clinical documentation support (SCDS) toolkit within the EMR to facilitate quality initiatives and practice-based research in a multiple sclerosis (MS) practice. Methods We built customized EMR toolkits to capture standardized data at office visits. Content was determined through physician consensus on necessary elements to support best practices in treating patients with demyelinating disorders. We also developed CDS tools and best practice advisories within the toolkits to alert physicians when a quality improvement opportunity exists, including enrollment into our DNA biobanking study at the point of care. Results We have used the toolkit to evaluate 541 MS patients in our clinic and begun collecting longitudinal data on patients who return for annual visits. We provide a description and example screenshots of our toolkits, and a brief description of our cohort to date. Conclusions The EMR can be effectively structured to standardize MS clinic office visits, capture data, and support quality improvement and practice-based research initiatives at the point of care.
Subscapularis-On Approach in Reverse Shoulder Arthroplasty
Authors: Lädermann Alexandre , Tay Eileen , Scheibel Markus 
Published: December 2018

Using a subscapularis- and deltoid-preserving anterior approach is an option for patients undergoing reverse shoulder arthroplasty. Outcomes are better at short term than compared with the standard deltopectoral approach. Maintaining the integrity of the subscapularis tendon and preserving the deltoid muscle minimizes the need for postoperative immobilization and rehabilitation, allowing the patient to achieve active shoulder range of motion more rapidly, without increasing the incidence of shoulder dislocation. Overall length of hospital stay and duration of postoperative physical therapy are minimized, leading to significant economic gain. Future studies with longer follow-up are required to document the potential long-term benefits of this surgical technique. Level of Evidence of the study: Review, Level IV
Surgery in nontuberculous mycobacteria pulmonary disease
Authors: Lu Mimi , Fitzgerald Dominic , Karpelowsky Jonathan , Selvadurai Hiran , Pandit Chetan , Robinson Paul , Marais Ben J. 
Published: December 2018

Medical treatment of pulmonary nontuberculous mycobacteria (NTM) disease has highly variable outcomes. Despite the use of multiple antibiotics, sputum clearance is often difficult to achieve, especially in cases with macrolide resistant NTM infection. Immunocompromised patients and those with structural lung disease are at increased risk, although occurrence in immunocompetent patients without structural lung disease is well recognised. Most pulmonary NTM disease involvesMycobacterium aviumcomplex (MAC), but with enhanced identification multiple species have now been recognised as opportunistic pathogens. The observed increase in NTM disease, especially infection with multidrug-resistantMycobacterium abscessuscomplex, is probably multifactorial. Surgery has been used as adjuvant treatment in patients with 1) focal disease that can be removed or 2) bothersome symptoms despite medical treatment that can be ameliorated. Early post-surgical mortality is low, but long-term morbidity and mortality are highly dependent on the degree of lung involvement and the residual lung function, the potency of medical treatment and the type of surgical intervention. In conjunction with antibiotic therapy, reported post-surgical sputum clearance was excellent, although publication bias should be considered. Bronchopleural fistulae were problematic, especially in pneumonectomy cases. Study results support the use of minimal resection surgery, in a carefully selected subgroup of patients with focal disease or persistent symptoms.Educational aimsTo critically review the literature describing the use of surgery in the treatment of pulmonary disease caused by nontuberculous mycobacteria (NTM).To assess the outcomes and complications observed with different surgical approaches used in the treatment of pulmonary NTM disease.
Nasal microbiota and symptom persistence in acute respiratory tract infections in infants
Authors: Neumann Roland P. , Hilty Markus , Xu Binbin , Usemann Jakob , Korten Insa , Mika Moana , Müller Loretta , Latzin Philipp , Frey Urs 
Published: December 2018

Acute respiratory tract infections (ARI) in infancy have been implicated in the development of chronic respiratory disease, but the complex interplay between viruses, bacteria and host is not completely understood. We aimed to prospectively determine whether nasal microbiota changes occur between the onset of the first symptomatic ARI in the first year of life and 3 weeks later, and to explore possible associations with the duration of respiratory symptoms, as well as with host, environmental and viral factors.Nasal microbiota of 167 infants were determined at both time-points by 16S ribosomal RNA-encoding gene PCR amplification and subsequent pyrosequencing. Infants were clustered based on their nasal microbiota using hierarchical clustering methods at both time-points.We identified five dominant infant clusters with distinct microbiota at the onset of ARI but only three clusters after 3 weeks. In these three clusters, symptom persistence was overrepresented in the Streptococcaceae-dominated cluster and underrepresented in the cluster dominated by “Others” (p<0.001). Duration of symptoms was not associated with the type of respiratory virus.Infants with prolonged respiratory symptoms after their first ARI tend to exhibit distinct microbial compositions, indicating close microbiota–host interactions that seem to be of importance for symptom persistence and recovery.
In the Shadow of Litigation: Arbitration and Medical Malpractice Reform
Authors: Staszak Sarah 
Published: December 2018

Abstract
Alongside the dramatic growth in the use of mandatory, binding arbitration in the United States, proposals to use arbitration in lieu of medical malpractice litigation have proliferated as a mechanism for providing a more efficient and less costly way to resolve disputes. However, these proposals have largely been divorced from an understanding of the history, politics, and law of arbitration, which comes with a significant cost. Although liberals developed arbitration with the goal of ensuring access to justice for those who struggled to find it in traditional courts, conservatives (both in Congress and in the private sector) began to promote it in the latter part of the 20th century as a way to keep what they considered “lesser” cases out of court and to better protect corporate and other powerful institutional defendants from litigation. This article examines this transition toward the use of private, mandatory, and binding arbitration through three periods of institutional change: partisan conversion, judicialization, and privatization. It argues that it is essential to situate malpractice reform proposals in the history, politics, and law of arbitration in practice, where partisan efforts have privatized arbitration with significant effects for equality under the law.
Beneath the Surface of Unnecessary Surgery: A Case Study on the Limits of Existing Protections
Authors: Smith David Barton 
Published: December 2018

Abstract
Unnecessary surgery has been a focus of health policy concern for decades. Such events are supposed to be prevented by the (a) self-policing of hospital medical staffs, (b) oversight of state medical boards, (c) third-party restrictions on payment, and (d) threat of malpractice lawsuits. While critics may point to failures of will on the part of those responsible for such policing, this case study points to more fundamental problems. The case involved an extension of the diagnosis of Chiari malformation to justify surgery to help relieve symptoms of individuals previously identified as suffering from chronic pain or fatigue syndrome. It illustrates how strenuous efforts to reduce what other members of the medical profession perceived as unnecessary surgery were overcome by (a) uncertainty concerning appropriate diagnosis and treatment, (b) patient desperation-driven self-referrals unrestricted by professional oversight or geographic boundaries, (c) the ambition of a surgeon determined to practice as he or she desired, (d) a business-focused national hospital chain insulated from direct clinical accountability, and (e) the highly profitable nature of the surgery itself.
The Devolution of Health Reform? A Comparative Analysis of State Innovation Waiver Activity
Authors: Wright Brad , Porter Anna , Singer Phillip M. , Jones David K. 
Published: December 2018

Abstract
Section 1332 of the Affordable Care Act (ACA) establishes state innovation waivers, which if approved allow states to waive certain ACA requirements, provided that insurance coverage remains comparable to the ACA with respect to affordability, benefit design, and enrollment, without increasing the federal deficit. The Trump administration has encouraged states to pursue these waivers, but the administration's haphazard approval process raises numerous questions about the malevolence and/or incompetence behind the administration's inconsistent behavior. The authors analyzed the thirteen 1332 waiver applications that states have submitted since January 2017, and they discuss the progress of states that are pursuing but have not submitted a 1332 waiver application and report on conversations with four states in the early stages of considering a 1332 waiver application. They found that most states are using or considering 1332 waivers to implement reinsurance programs rather than pursuing more sweeping reforms. Given evidence that such reinsurance programs both are more likely to gain federal approval and appear effective at stabilizing Health Insurance Marketplace premiums, they expect this trend to continue.
Prevalence of chloroquine and antifolate drug resistance alleles in Plasmodium falciparum clinical isolates from three areas in Ghana
Authors: Abugri James , Ansah Felix , Asante Kwaku P. , Opoku Comfort N. , Amenga-Etego Lucas A. , Awandare Gordon A. 
Published: December 2018

Background: The emergence and spread of resistance in Plasmodium falciparum to chloroquine (CQ) necessitated the change from CQ to artemisinin-based combination therapies (ACTs) as first-line drug for the management of uncomplicated malaria in Ghana in 2005. Sulphadoxine-pyrimethamine (SP) which was the second line antimalarial drug in Ghana, was now adopted for intermittent preventive treatment of malaria in pregnancy (IPTp). Methods: To examine the prevalence of molecular markers associated with CQ and antifolate drug resistance in Ghana, we employed restriction fragment length polymorphism polymerase chain reaction to genotype and compare single nucleotide polymorphisms (SNPs) in the P. falciparum chloroquine resistance transporter ( pfcrt, PF3D7_0709000), multidrug resistance ( pfmdr1, PF3D7_0523000), bifunctional dihydrofolate reductase-thymidylate synthase ( pfdhfr, PF3D7_0417200) and dihydropteroate synthase ( pfdhps, PF3D7_0810800) genes. Parasites were collected from children with malaria reporting to hospitals in three different epidemiological areas of Ghana (Accra, Kintampo and Navrongo) in 2012-2013 and 2016-2017. Results: The overall prevalence of the CQ resistance-associated pfcrt 76T allele was 8%, whereas pfmdr1 86Y and 184F alleles were present in 10.2% and 65.1% of infections, respectively. The majority of the isolates harboured the antifolate resistance-associated pfdhfr alleles 51I (83.4%), 59R (85.9 %) and 108N (90.5%). Pfdhps 437G and 540E were detected in 90.6% and 0.7% of infections, respectively. We observed no significant difference across the three study sites for all the polymorphisms except for pfdhps 437G, which was more common in Accra compared to Kintampo for the 2016-2017 isolates. Across both pfdhfr and pfdhps genes, a large proportion (61%) of the isolates harboured the quadruple mutant combination (I 51 R 59 N 108/ G 437). CQ resistance alleles decreased during the 12 years after CQ withdrawal, but an mediate SP resistance alleles increased. Conclusion: Surveillance of the prevalence of resistance alleles is necessary in monitoring the efficacy of antimalarial drugs.
Mothers explanatory models of infant stress & adversity in rural Haryana, India: qualitative findings from the Early Life Stress sub-study of the SPRING cluster-randomised controlled trial (SPRING-ELS)
Authors: Bhopal Sunil , Verma Deepali , Roy Reetabrata , Divan Gauri , Hill Zelee , Kirkwood Betty R. 
Published: December 2018

Background Exposure to a range of biological and psychosocial adversities in early childhood is of negative consequence through the lifecourse. This is particularly important for children in low- and middle-income countries where at least 250 million children are at high-risk of not meeting their developmental potential. Minimal evidence describes mothers’ views of this. We therefore elicited an explanatory model exploring mothers’ perceptions of infant stress and adversity in rural Haryana, India. Methods We did eight focus-group discussions to explore the perspectives of mothers in the general population of this rural area of India using a discussion guide based on Kleinman’s explanatory model. Data were coded by two analysts and arranged in themes for presentation. Illustrative quotations were used for presentation of findings. Results All mothers identified several causes of adversity and stress for children, including poverty, neglect and violence. They described the consequences of this for emotions, behaviour and school readiness of children, and that some of the consequences were reversible with appropriate management. Mothers described younger children as being unable to be affected by adversity, because they were “too young to understand”. Conclusions Mothers agreed with much of the current biomedical model for early childhood development, however the predominant view was that young infants were “too young to understand” is an important deviation. These findings are of importance in designing behaviour change strategies for this crucial period of early childhood which is rising up the global policy agenda with the aim of giving every child the opportunity to thrive.