bluuebunny/crossref_metadata_2025_split huggingface dataset:
Considerations on accuracy, pattern and possible underlying factors of brain microbleed progression in older adults with absence or mild presence of vascular pathology
Authors: Harper Alice M , Clayson Lauren , Wardlaw Joanna M , Valdés Hernández Maria del C ,   the Alzheimer’s Disease Neuroimaging Initiative
Published: March 2018

Objective To analyse brain microbleed (BMB) progression, its possible underlying factors, and the influence of inter-observer differences, in older individuals with none or mild vascular pathology. Methods This study analysed magnetic resonance images, cognitive, demographic and laboratory data from all individuals from the Alzheimer’s Disease (AD) Neuroimaging Initiative database who had the required sequences for identifying BMBs over three consecutive years at the time the database was accessed (January 2016). BMBs were assessed independently by two observers with similar levels of experience. Results A total of 291 patients were included in the study. The number of individuals with BMBs and the number of BMBs per individual slightly and nonsignificantly increased across three consecutive years (Y1: 55/291 [19%]; Y2: 61/291 [21%]; Y3: 66/291 [23%]) with 1–2 BMBs and (Y1: 11/291 [4%]; Y2: 12/291 [4%]; Y3: 14/291 [5%]) with ≥ 3 BMBs. Both observers identified a similar pattern of BMB prevalence and progression in each cognitive group (normal < early/late mild cognitive impairment (MCI) > AD patients) despite inter-observer differences (1.5 BMBs, 95% confidence interval –3.7, 6.2], κ=0.543), which were mainly in the cortex. Serum cholesterol was the main predictor of change in BMB count between time-points but did not predict overall progression. Conclusions Inter-observer differences are always present and it is difficult to ascertain their influence in the analysis of BMB progression, which was observed in cognitively normal and MCI individuals, but not in AD patients. This should be confirmed in further studies.
In Vitro and In Vivo Performance of Tissue-Engineered Tendons for Anterior Cruciate Ligament Reconstruction
Authors: Lee Kwang Il , Lee Jung Soo , Kang Kyoung Tak , Shim Young Bock , Kim Young Sik , Jang Ju Woong , Moon Seong Hwan , D’Lima Darryl D. 
Published: March 2018

Background: Anterior cruciate ligament (ACL) reconstruction is the current standard of care for ACL tears. However, the results are not consistently successful; autografts or allografts have certain disadvantages; and synthetic grafts have had poor clinical results. Purpose: To determine if recellularization of decellularized tendons combined with mechanical stimulation in a bioreactor could replicate the mechanical properties of the native ACL and be successfully used for ACL reconstruction in vivo. Study Design: Controlled laboratory study. Methods: Porcine tibialis tendons were decellularized and then recellularized with human adult bone marrow–derived stem cells. Tendons were cultured in a tissue bioreactor that provided biaxial cyclic loading for up to 7 days. To reproduce mechanical stresses similar to those experienced by the ACL within the knee joint, the tendons were subjected to simultaneous tension and torsion in the bioreactor. Expression of tendon-specific genes and newly synthesized collagen and glycosaminoglycan were used to quantify the efficacy of recellularization and dynamic bioreactor culture. The ultimate tensile load to failure and stiffness of recellularized constructs were measured after dynamic stimulation. Finally, the tissue-engineered tendons were used to reconstruct the ACL in 24 pigs, and ultimate tensile load to failure and stiffness were assessed after 3 months. Results: Dynamic bioreactor culture significantly increased the expression of tendon-specific genes, the quantity of newly synthesized collagen and glycosaminoglycan, and the ultimate tensile load and stiffness of recellularized tendons. After in vivo reconstruction, the ultimate tensile load and stiffness of the tissue-engineered tendons increased significantly up to 3 months after surgery and were within 80% of the ultimate tensile load of the natural ACL. Conclusion: This translational study indicates that recellularization and dynamic mechanical stimuli can significantly enhance matrix synthesis and ultimate tensile load of decellularized porcine tibialis tendons. This approach to tissue engineering can be very useful for ACL reconstruction and may overcome some of the disadvantages of autografts and allografts. Clinical Relevance: Dynamic bioreactor cultivation of tissue-engineered tendons may overcome the limitations of autografts and allografts.
The Impact of Public and Private Research on Premature Cancer Mortality and Hospitalization in the United States, 1999-2013
Authors: Lichtenberg Frank R. 
Published: March 2018

This article provides evidence about the impact that public and private research had on premature mortality and hospitalization due to cancer in the United States during the period 1999-2013. We estimate difference-in-differences models based on longitudinal, cancer-site-level data to determine whether the cancer sites about which more research-supported articles were published had larger subsequent reductions in premature mortality and hospitalization during the period 1999 to 2013, controlling for the change in the number of people diagnosed. Premature (before age 75 years) mortality is inversely related to the number of research-supported articles that had been published 9 to 15 years earlier, controlling for incidence and non-research publications. The number of hospital discharges attributed to cancer is also significantly inversely related to the number of research-supported articles previously published. Public and private research reduced the number of years of potential life lost before age 75 years due to cancer in 2013 by 566,000. JEL Classifications: I1, I18
Do clinicians assess patients’ religiousness? An audit of an aged psychiatry community team
Authors: Payman Vahid , Lim Zheng Jie 
Published: March 2018

Objectives: To determine the frequency and quality of religious history taking of patients by clinicians working in an old age psychiatry service. Methods: A retrospective audit of 80 randomised patient files from the Koropiko Mental Health Services for Older People (MHSOP) in Middlemore Hospital, Auckland, New Zealand. Results: A total of 66 clinical records were available for analysis. A religious history was taken in 33/66 (50%) patients. However, when such histories were evaluated using the FICA assessment tool, only 10/33 (30.3%) histories contained detailed information regarding the patient’s religiousness. Conclusions: The infrequency and low quality of religious histories discovered in this audit suggest that clinicians need more training in taking a religious history from patients.
Teaching History With Custom-Built Board Games
Authors: Hoy Benjamin 
Published: March 2018

Purpose. This article investigated the potential of a custom-built board game as a means to teach historical empathy, improve class participation, and to improve student understanding of the limitations of archival collections. Method. Participant behavior as well as verbal and written feedback were collected during a pilot study of POLICING THE SOUND. A total of 88 undergraduate and graduate participants from History and Indigenous Studies took part during the pilot study. Results. Student participation and understanding of historical context improved during the game. While graduate and undergraduate students showed similarity in their enjoyment of the game and their belief that it made historical arguments, the curricular differences in graduate and undergraduate programs influenced how each group approached the game. Conclusion. Participant feedback, facilitator observation, and external observation indicate that groups of players can resolve confusion more efficiently than individual players can, time constrained decision-making may help maintain student engagement, an inability to win does not necessarily cause disengagement in short educational games, and that a structured debrief is important in achieving educational goals even in custom-built games.
Improved Early Cleft Lip and Palate Complications at a Surgery Specialty Center in the Developing World
Authors: Park Eugene , Deshpande Gaurav , Schonmeyr Bjorn , Restrepo Carolina , Campbell Alex 
Published: March 2018

Objective: To evaluate complication rates following cleft lip and cleft palate repairs during the transition from mission-based care to center-based care in a developing region. Patients and Design: We performed a retrospective review of 3419 patients who underwent cleft lip repair and 1728 patients who underwent cleft palate repair in Guwahati, India between December 2010 and February 2014. Of those who underwent cleft lip repair, 654 were treated during a surgical mission and 2765 were treated at a permanent center. Of those who underwent cleft palate repair, 236 were treated during a surgical mission and 1491 were treated at a permanent center. Setting: Two large surgical missions to Guwahati, India, and the Guwahati Comprehensive Cleft Care Center (GCCCC) in Assam, India. Main Outcome Measure: Overall complication rates following cleft lip and cleft palate repair. Results: Overall complication rates following cleft lip repair were 13.2% for the first mission, 6.7% for the second mission, and 4.0% at GCCCC. Overall complication rates following cleft palate repair were 28.0% for the first mission, 30.0% for the second mission, and 15.8% at GCCCC. Complication rates following cleft palate repair by the subset of surgeons permanently based at GCCCC (7.2%) were lower than visiting surgeons ( P < .05). Conclusions: Our findings support the notion that transitioning from a mission-based model to a permanent facility-based model of cleft care delivery in the developing world can lead to decreased complication rates.
Opioid Sparing in Cleft Palate Surgery
Authors: Carr Logan , Gray Megan , Morrow Brad , Brgoch Morgan , Mackay Donald , Samson Thomas 
Published: March 2018

Objective:This study aimed to determine whether intraoperative acetaminophen was able to decrease opioid consumption, pain scores, and length of stay while increasing oral intake in cleft palate surgery.Design/Setting/Patients:One hundred consecutive patients with cleft palate who underwent a von Langenbeck or 2-flap palatoplasty and intravelar veloplasty at a tertiary medical center by the 2 senior authors from 2010 to 2015 were reviewed.Interventions:Three intraoperative treatment groups were analyzed: intravenous (IV) acetaminophen, per rectal (PR) acetaminophen, and no acetaminophen. All patients received long-acting local anesthesia infiltration before incision. Additionally, all patients were admitted overnight and given weight-based per oral (PO) acetaminophen and oxycodone and IV morphine as needed based on pain scores.Outcomes Measured:The study outcomes included pain scores, opioid requirement, length of stay, and oral intake.Results:The treatment groups were comprised of 40 patients who received IV acetaminophen, 22 PR acetaminophen, and 35 none. Concerning demographic data, there was no statistical difference between treatment groups. There was no statistically significant difference for opioid intake, although both IV and PR acetaminophen groups had decreased pain scores ( P = .029). There was no difference in oral intake ( P = .13) or length of stay ( P = .31) between treatment groups.Conclusion:In this study, intraoperative administration of acetaminophen was associated with decreased pain scores, but no opioid-sparing effect. As other studies have shown an opioid-sparing effect with postoperative acetaminophen, we recommend withholding the intraoperative dose and beginning therapy in the immediate postoperative period.
Financial impact of oral chemotherapy wastage on society and the patient
Authors: Monga Varun , Meyer Chenise , Vakiner Brandon , Clamon Gerald 
Published: March 2018

Background Targeted oral agents are now increasingly being utilized in cancer treatment, but are expensive. Changing the dose of these medications due to toxicity or discontinuation secondary to disease progression or death causes waste from unused medication. Limiting waste is an important goal, as waste has a substantial financial impact on patients and insurance companies. Methods Patients started on oral targeted agents' sunitinib, everolimus, axitinib, or vemurafenib between January 2012 and February 2015 who obtained their medications at Holden Comprehensive Cancer Center specialty pharmacy were included in the analysis. We acquired dispensing data retrospectively for each of the agents and reviewed patient charts. Wasted tablets/capsules were calculated from their last fill to the dates of stoppage or dose adjustment. The amount associated with the wastage was calculated using the average wholesale price. Repository drug usage data during the same time period was obtained. Results Eighty-eight patients had their prescriptions filled at Holden Comprehensive Cancer Center during the study time period. Waste occurred in 41% of all patients with primary reasons attributed to cancer progression in 25 patients, death in five patients, toxicity in five patients and increase in dosage of targeted therapy in two patients. A total of 1179 tablets or capsules were wasted from all causes, priced at a total of $248,595.69. Conclusion Oral chemotherapy medications are associated with wastage, which is a significant financial burden to society. Progression of disease emerged as the single most important factor accounting for wastage. Novel ideas are needed to prevent wastage, thereby reducing healthcare costs.
Treatment outcomes of conventional or high-dose ranibizumab for vascularized pigment epithelial detachment based on lesion subtypes
Authors: Chan Clement K , Sarraf David , Abraham Prema 
Published: March 2018

Introduction: A post hoc study was conducted to compare visual and anatomic outcomes of vascularized serous pigment epithelial detachment (Group 1) with fibrovascular pigment epithelial detachment (Group 2) due to age-related macular degeneration treated with either 0.5 or 2.0 mg ranibizumab injections. Methods: A prospective, randomized trial was performed with the following regimens for 12 months: (1) 0.5 mg monthly, (2) 0.5 mg monthly for 4 months followed by pro re nata injections, (3) 2.0 mg monthly, and (4) 2.0 mg monthly for 4 months followed by pro re nata injections. Primary measure was best-corrected standardized vision. Secondary measures included central subfield, thickness surface area A2, greatest linear diameter, heights of pigment epithelial detachment and choroidal neovascularization (CNV), subretinal fluid, cystoid macular edema, and adverse events. Results: For 36 eyes (8 in Group 1 and 28 in Group 2), follow-up time was 12 months. There were no differences in baseline features between groups except for pigment epithelial detachment A2 (Group 2 > Group 1). Two-way analysis of variance showed comparable improvements in anatomic and vision outcomes. Three-way analysis of variance also showed similar responses for both lesion subtypes with high-dose treatment. There was a trend toward greater pigment epithelial detachment resolution in Group 1 eyes. There were no differences in retinochoroidal angiomatous proliferation (Type-3 CNV) and cataracts between groups, although greater percentages of eyes in Group 1 developed retinal pigment epithelial tears (25% vs 10.7%). Conclusion: There were no differences in vision and anatomic outcomes between lesion subtypes, and similarly, more rapid responses to high-dose than conventional-dose ranibizumab occurred for eyes with both lesion subtypes. More retinal pigment epithelial tears may develop in eyes with vascularized serous pigment epithelial detachment.
Choosing wisely and the use of antibiotics in ophthalmic surgery: There is more than meets the eye
Authors: Grosso Andrea , Ceruti Piero , Scarpa Giuseppe , Giardini Franco , Marchini Giorgio , Aragona Emanuela , Bert Fabrizio , Bandello Francesco , Siliquini Roberta 
Published: March 2018

Background: One of the directions of modern ophthalmology is toward an odontoiatric model, and new settings of eye care are becoming the standard of care: one day surgery and also office-based therapies. Methods: Retrospective analysis of three tertiary-care centers in Italy and analysis of the literature. Results: We provide readers with state-of-the-art measures of prophylaxis in ophthalmic surgery. Discussion and conclusion: Role of antibiotics is criticized in the light of stewardship antimicrobial paradigm.
Volumetric Nephrogram Represents Renal Function and Complements Aortic Anatomic Severity Grade in Predicting EVAR Outcomes
Authors: Balceniuk Mark D. , Trakimas Lauren , Aghaie Claudia , Mix Doran , Rasheed Khurram , Seaman Matthew , Ellis Jennifer , Glocker Roan , Doyle Adam , Stoner Michael C. 
Published: March 2018

Introduction: Chronic kidney disease (CKD) is a predictor of poor outcomes for patients undergoing endovascular aortic aneurysm repair (EVAR). Anatomic severity grade (ASG) represents a quantitative mechanism for assessing anatomical suitability for endovascular aortic repair. Anatomic severity grade has been correlated with repair outcomes and resource utilization. The purpose of this study was to identify a novel renal perfusion metric as a way to assist ASG with predicting EVAR outcomes. Methods: Retrospective review of a prospectively maintained database identified elective infrarenal aortic aneurysm repair cases. Anatomic grading was undertaken by independent reviewers. Using volumetric software, kidney volume, and a novel measure of kidney functional volume, the volumetric nephrogram (VN) was recorded. Systematic evaluation of the relationship of kidney volume and VN to CKD and ASG was undertaken using linear regression and receiver–operator statistical tools. Results: A total of 386 cases with patient and anatomic data were identified and graded. Mean age was 72.9 ± 0.4 years. Renal volume <281 mL correlated with CKD (area under the curve [AUC] = .708; P ≤ .0001). Volumetric nephrogram <22.5 HU·L correlated with CKD (AUC = 0.764; P ≤ .0001). High (≥15) ASG scores correlated with both renal volume (AUC = .628; P ≤ .0001) and VN (AUC = .628; P ≤ .0001). Regression analysis demonstrated a strong, inverse relationship between ASG and VN ( R2 = .95). Conclusion: These data demonstrate that VN is a strong predictor of CKD in a large database of patients undergoing elective aneurysm repair. We demonstrate an inverse relationship between renal function and ASG that has not been previously described in the literature. Additionally, we have shown that VN complements ASG as a model of overall cardiovascular health and atherosclerotic burden. Outcomes in patients with poor renal function may be related to anatomical issues in addition to well-described systemic ramifications.
“Boy Crisis” or “Girl Risk”? The Gender Difference in Nonsuicidal Self-Injurious Behavior Among Middle-School Students in China and its Relationship to Gender Role Conflict and Violent Experiences
Authors: Yang Xueyan , Xin Moye 
Published: March 2018

Purpose: We attempted to test if there were gender differences in nonsuicidal self-injurious (NSSI) behaviors among Chinese middle-school students, and analyze the impact of gender role conflict and violent experiences on these behaviors among middle-school students of different genders. Method: Based on the survey data from seven middle schools in Xi’an region of China, the gender difference in NSSI behaviors and its associated factors were analyzed in this study. Results: There was no significant gender difference in NSSI behaviors among middle-school students; however, female middle-school students were more likely to experience gender role conflicts while male students were more likely to experience all kinds of violence earlier. Gender role conflicts and violent experiences can explain the prevalence of NSSI behaviors by gender, to some extent. Conclusions: The hypothesis on gender patterns of “boy crisis” or “girl risk” on NSSI prevalence was not verified; however, a “girl risk” for gender role conflicts and a “boy crisis” in violent experiences were found. The gender role conflicts were significantly associated with NSSI prevalence among middle-school students to some extent; however, this relationship was adjusted by variables of violent experiences. The different variables of violent experiences were the important predictors of NSSI prevalence among male and female middle-school students with specific contents varying across genders.
LIBERTI: A SMART study in plastic surgery
Authors: Hibbard Jonathan C , Friedstat Jonathan S , Thomas Sonia M , Edkins Renee E , Hultman C Scott , Kosorok Michael R 
Published: March 2018

Background/aims: Laser treatment of burns scars is considered by some providers to be standard of care. However, there is little evidence-based research as to the true benefit. A number of factors hinder evaluation of the benefit of laser treatment. These include significant heterogeneity in patient response and possible delayed effects from the laser treatment. Moreover, laser treatments are often provided sequentially using different types of equipment and settings, so there are effectively a large number of overall treatment options that need to be compared. We propose a trial capable of coping with these issues and that also attempts to take advantage of the heterogeneous response in order to estimate optimal treatment plans personalized to each individual patient. It will be the first large-scale randomized trial to compare the effectiveness of laser treatments for burns scars and, to our knowledge, the very first example of the utility of a Sequential Multiple Assignment Randomized Trial in plastic surgery. Methods: We propose using a Sequential Multiple Assignment Randomized Trial design to investigate the effect of various permutations of laser treatment on hypertrophic burn scars. We will compare and test hypotheses regarding laser treatment effects at a general population level. Simultaneously, we hope to use the data generated to discover possible beneficial personalized treatment plans, tailored to individual patient characteristics. Results: We show that the proposed trial has good power to detect laser treatment effect at the overall population level, despite comparing a large number of treatment combinations. The trial will simultaneously provide high-quality data appropriate for estimating precision-medicine treatment rules. We detail population-level comparisons of interest and corresponding sample size calculations. We provide simulations to suggest the power of the trial to detect laser effect and also the possible benefits of personalization of laser treatment to individual characteristics. Conclusion: We propose, to our knowledge, the first use of a Sequential Multiple Assignment Randomized Trial in surgery. The trial is rigorously designed so that it is reasonably straightforward to implement and powered to answer general overall questions of interest. The trial is also designed to provide data that are suitable for the estimation of beneficial precision-medicine treatment rules that depend both on individual patient characteristics and on-going real-time patient response to treatment.