bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meridional Atmospheric Heat Transport Constrained by Energetics and Mediated by Large-Scale Diffusion
Authors: Armour Kyle C. , Siler Nicholas , Donohoe Aaron , Roe Gerard H. 
Published: April 2019

Abstract
Meridional atmospheric heat transport (AHT) has been investigated through three broad perspectives: a dynamic perspective, linking AHT to the poleward flux of moist static energy (MSE) by atmospheric motions; an energetic perspective, linking AHT to energy input to the atmosphere by top-of-atmosphere radiation and surface heat fluxes; and a diffusive perspective, representing AHT in terms downgradient energy transport. It is shown here that the three perspectives provide complementary diagnostics of meridional AHT and its changes under greenhouse gas forcing. When combined, the energetic and diffusive perspectives offer prognostic insights: anomalous AHT is constrained to satisfy the net energetic demands of radiative forcing, radiative feedbacks, and ocean heat uptake; in turn, the meridional pattern of warming must adjust to produce those AHT changes, and does so approximately according to diffusion of anomalous MSE. The relationship between temperature and MSE exerts strong constraints on the warming pattern, favoring polar amplification. These conclusions are supported by use of a diffusive moist energy balance model (EBM) that accurately predicts zonal-mean warming and AHT changes within comprehensive general circulation models (GCMs). A dry diffusive EBM predicts similar AHT changes in order to satisfy the same energetic constraints, but does so through tropically amplified warming—at odds with the GCMs’ polar-amplified warming pattern. The results suggest that polar-amplified warming is a near-inevitable consequence of a moist, diffusive atmosphere’s response to greenhouse gas forcing. In this view, atmospheric circulations must act to satisfy net AHT as constrained by energetics.
Health-related life events in patients with somatic symptom disorders: A case control study
Authors: Reddy Balaswamy , Chaturvedi Santosh Kumar , Desai Geetha , Manjunatha Narayana , Guruprasad Srinivas 
Published: April 2019

Background: The positive association between adverse life events and somatoform disorders is a consistent observation. But no systematic studies have evaluated the relationship between health-related life events (HLEs) in patients with somatic symptom disorder (SSD)/somatoform disorders. Aim: To examine the nature and relationship of HLE in patients with SSD and to assess the correlates of HLE. Methods: A total of 50 adult patients with SSD and 50 matched healthy controls from a Neuropsychiatric hospital were recruited. Sociodemographic interview, scale for assessment of somatic symptoms (SASS), Patient Health Questionnaire-15 (PHQ-15) and a semi-structured interview schedule to gather information on HLE were used. Results: Patients in the SSD group had a significantly higher number of total HLE in general (4.72 ± 2.63, 3.36 ± 1.92; p = .004), major HLE (1.48 ± 1.45, 0.68 ± 0.94; p = .006), during their lifetime in comparison to controls. Infections, trauma, non-communicable diseases and reproductive system–related diseases were the more common types of HLE in SSD group. Conclusion: Our findings may implicate a role of major HLE of patients and HLE of their family members in the pathophysiology of SSD.
Evaluation of pioneering introduction of integrative and prophetic medicine education in an Arabic medical school (Taibah University, Saudi Arabia): 10 years' experience
Authors: Hamouda Osama , Sweilam Mohammad , Abdellah Antar , El Sayed Salah Mohamed 
Published: April 2019

Objective To assess physicians' attitudes toward integrative medicine (IM), including prophetic medicine (PM), combining the best of modern medicine with the best of alternative and complementary medicine. Most physicians are unfamiliar with IM and PM and may thus be against them and it may communicate that to the public. Methods Taibah University (Saudi Arabia) is the sole university in the Arab world with an educational medical course in IM and PM. We assessed IM scientific knowledge and students’ feedback regarding course contents, course design, and teaching methods. A questionnaire was administered to medical students who attended the course. Results A total 650 students (264 men, 386 women) participated in the study; 83% considered the IM (including PM) education beneficial. Among them, 49.6% (range, 60% to 100%) reported that they gained medical benefit from studying IM, and 74% expressed strong positive attitudes toward studying IM. Among participants, 65.8% agreed with the current course topics, without the need to add or delete any topics; 95% of students were satisfied with IM and PM education. Students' interest in the branches of IM included all IM subspecialties. Conclusion IM and PM education should be globally generalized to all medical students, physicians, and health practitioners, particularly in Arabic universities.
The Italian Rare Pancreatic Exocrine Cancer Initiative
Authors: Brunetti Oronzo , Luchini Claudio , Argentiero Antonella , Tommasi Stefania , Mangia Anita , Aprile Giuseppe , Marchetti Paolo , Vasile Enrico , Casadei Gardini Andrea , Scartozzi Mario , Barni Sandro , Delfanti Sara , De Vita Fernando , Di Costanzo Francesco , Milella Michele , Cella Chiara Alessandra , Berardi Rossana , Cataldo Ivana , Santini Daniele , Doglioni Claudio , Maiello Evaristo , Lawlor Rita T , Mazzaferro Vincenzo , Lonardi Sara , Giuliante Felice , Brandi Giovanni , Scarpa Aldo , Cascinu Stefano , Silvestris Nicola 
Published: April 2019

Introduction: Exocrine pancreatic cancers include common type pancreatic ductal adenocarcinoma and cystic neoplasms, which account for 85% and 10% of cases, respectively. The remaining 5% are rare histotypes, comprising adenosquamous carcinoma, acinar cell carcinoma, signet ring cell carcinoma, medullary carcinoma, pancreatoblastoma, hepatoid carcinoma, undifferentiated carcinoma and its variant with osteoclast-like giant cells, solid pseudopapillary carcinoma, and carcinosarcoma. Due to their low incidence, little knowledge is available on their clinical and molecular features as well as on treatment choices. The national initiative presented here aims at the molecular characterization of series of rare histotypes for which therapeutic and follow-up data are available. Methods: A nationwide Italian Rare Pancreatic Cancer (IRaPaCa) task force whose first initiative is a multicentric retrospective study involving 21 Italian cancer centers to retrieve histologic material and clinical and treatment data of at least 100 patients with rare exocrine pancreatic cancers has been created. After histologic revision by a panel of expert pathologists, DNA and RNA from paraffin tissues will be investigated by next-generation sequencing using molecular pathway–oriented and immune-oriented mutational and expression profiling panels constructed availing of the information from the International Cancer Genome Consortium. Bioinformatic analysis of data will drive validation studies by immunohistochemistry and in situ hybridization, as well as nanostring assays. Conclusions: We expect to gather novel data on rare pancreatic cancer types that will be useful to inform the design of therapeutic choices.
Global Health Education in Child Neurology and Neurodevelopmental Disabilities Training Programs in the United States: A National Survey
Authors: Jimenez-Gomez Andres , Stowe Robert C. , Balasa Alfred , Castillo Jonathan , Lotze Timothy E. 
Published: April 2019

Objectives: To describe the current landscape of opportunities and education in global health among child neurology and neurodevelopmental disabilities training programs and provide a framework for future development of global health education. Methods: Authors surveyed Trainee and Program Director groups, obtaining information regarding global health interest, participation and obstacles (trainees); and collaborations in global health, academic yield and obstacles, and global health educational development within the training program (program directors). Results: Of identified trainees and program directors, 35% and 48% responded, respectively. Among trainees, 82% reported interest in global health, with 25% reporting influence in program selection. Among program directors, 34% reported global health collaborations, most frequently clinical. Academic yield (conference participation or publications) was described by 46% of programs. Major obstacles described by both groups included administrative issues and funding; however, the latter was most important for program directors but not for trainees. Among program directors, 16% reported global health curricula, with lectures (100%), orientation courses (50%), and pre/post-travel sessions (50%) being commonest elements. The main content included education in public health, resourcefulness, and epidemiology. Half of responding programs offered a formal global health training track, including opportunities in language education (67%) and advanced degrees (33%). Conclusions: Similar to other specialties, growing interest in global health among trainees corresponds to growing availability of said opportunities; however, most display significant logistic obstacles and lack curricular development. Potential areas for intervention, including an interdisciplinary approach, and potential benefits to stakeholders are identified for programs wishing to expand in global health education.
Clinical, Neuroimaging, and Electrographic Predictors of Phenobarbital Failure in Newborns With Hypoxic Ischemic Encephalopathy and Seizures
Authors: Dwivedi Deepak , Lin Nan , Venkatesan Charu , Kline-Fath B. , Holland Katherine , Schapiro Mark 
Published: April 2019

Background: Many neonates with hypoxic ischemic encephalopathy and seizures do not respond to the first line antiepileptic drug, phenobarbital. Little is known about what factors are associated with its failure. Objective: To examine factors associated with failure of phenobarbital therapy in neonates with hypoxic ischemic encephalopathy and seizures. Design/Methods: A single-center retrospective review of 50 term (>35 weeks) neonates with hypoxic ischemic encephalopathy and seizures treated with phenobarbital as the first-line antiepileptic. Neonates were classified into either responders (n = 30) or nonresponders (n = 20). Nonresponse was defined as continued seizures after maximum dosing of phenobarbital or an additional antiepileptic. Subjects with acceptable magnetic resonance imaging (MRI) scans obtained within 2 weeks of birth were included in the study and rated using an MRI injury scoring system. Charts were reviewed for demographic, clinical, and laboratory variables. Resuscitation and seizure scores were also calculated. Electroencephalographic (EEG) background activity was reviewed in 2 different time epochs (12-24 hours and 24-36 hours of life) and graded as per ACNS guidelines. Results: There were no significant group differences in demographic, clinical, and laboratory variables except nonresponders, who had higher mean seizure score ( P = .01) and significantly more injury on MRI scan for white matter ( P = .004), parenchymal cortex ( P = .027), and watershed ( P = .009) regions. Neonates with moderately abnormal or severely abnormal background EEG responded poorly to phenobarbital. Conclusion: In the presence of above factors, one can anticipate that additional antiepileptic medication may be needed. These data also support that larger studies should be done to look prospectively at using alternative agents first line in patients with severe injury.
Comparing significant prostate cancer detection rates after the introduction of pre-biopsy MRI: turning PROMIS into action
Authors: Johnston Maximilian J , Thorman Hannah , Shah Aarti , Peppercorn Delia , Emara Amr , Scott Karen , Nedas Timothy G , Hindley Richard G 
Published: April 2019

Introduction: Basingstoke was a participating centre in the MRC funded PROMIS trial between 2013 and 2015 recruiting 130 patients. In response to a perceived change in prostate biopsy histological grading following the introduction of pre-biopsy magnetic resonance imaging at our centre, we decided to undertake a retrospective analysis of prostate histology before and after participation in the study. Methods: We identified 206 patients in both 2012 and 2016 who had undergone prostate biopsy. We reviewed the type of biopsy performed (transrectal or transperineal), the number of cores sampled, the number of positive cores and the cancer grade. The proportion of men who had pre-biopsy multiparametric magnetic resonance imaging was also recorded. Results: Although the total numbers undergoing biopsy were equivalent in 2012 and 2016, 37% of all patients undergoing biopsy underwent a transperineal template biopsy in 2012, increasing to 54% in 2016. The overall percentage of positive biopsy results (Gleason score ⩾3+3) increased from 70% to 83.0% (χ2=9.83, P=0.002). While the number of grade group 1 cancers significantly decreased from 63.9% (2012) to 22% (2016), there was a corresponding increase in the number of grade group 3 or higher cancers detected from 11% to 51%. In 2012, 33% of patients had multiparametric magnetic resonance imaging prior to biopsy compared with 90% in 2016. The pre-biopsy magnetic resonance imaging improved the cancer detection rates for both methods of biopsy sampling. Conclusion: Our study has confirmed that the introduction of pre-biopsy multiparametric magnetic resonance imaging can improve diagnostic accuracy and reduce the number of insignificant cancers detected. This overall upgrading of the biopsied population, and the resulting shift towards detecting an increased number of significant cancers, is likely to have a positive impact on treatment allocation and longer-term outcomes for our patients. This effect should be reproducible in other centres. Level of evidence: Not applicable for this multicentre audit.
A radiographic analysis of the abnormal hallux interphalangeus angle range: Considerations for surgeons performing Akin osteotomies
Authors: Nguyen Jacqueline K , Sullivan Martin , Alpuerto Bernardino B , Mueller Samuel , Sly Nicole 
Published: April 2019

Purpose: This study is aimed to determine the abnormal radiological hallux interphalangeus angle (HIA) range, which can assist surgeons in determining the required bone resection in an Akin osteotomy of the proximal phalanx of the great toe. Methods: Radiographs of 141 feet were analyzed. The mean HIA and range were calculated. Results: The prevalence of hallux valgus interphalangeus (HVI) deformity was 78% (110/141). The mean HIA was 13.5° ± 4.5° (1.4–24.4). Fifty percent had abnormal HIA values of 10–15°, 40% had values of 15–20°, and 10% had greater than 20°. A large proportion of patients with HVI deformities may need greater than the standard 2–3-mm bone wedge removal during Akin osteotomy. Conclusion: The high prevalence and wide range of HVI deformities should alert surgeons to the possibility that greater than 3-mm bone wedge resections may be required. Level of Evidence: Level IV.
Adult Learning Theories in Context: A Quick Guide for Healthcare Professional Educators
Authors: Mukhalalati Banan Abdulrzaq , Taylor Andrea 
Published: April 2019

Background: Adult learning theories play a pivotal role in the design and implementation of education programs, including healthcare professional programs. There is a variation in the use of theories in healthcare professional education programs and this is may be in part due to a lack of understanding of the range of learning theories available and paucity of specific, in-context examples, to help educators in considering alternative theories relevant to their teaching setting. This article seeks to synthesize key learning theories applicable in the learning and teaching of healthcare professionals and to provide examples of their use in context. Method and results: A literature review was conducted in 2015 and 2016 using PubMed, Scopus, Web of Science, and ERIC academic databases. Search terms used identified a range of relevant literature about learning theories, and their utilization in different healthcare professional education programs. The findings were synthesized and presented in a table format, illustrating the learning theory, specific examples from health and medical education, and a very brief critique of the theory. Outcome: The literature synthesis provides a quick and easy-to-use summary of key theories and examples of their use to help healthcare professional educators access a wider range of learning theories to inform their instructional strategies, learning objectives, and evaluation approaches. This will ultimately result in educational program enhancement and improvement in student learning experiences.
Acalabrutinib for mantle cell lymphoma
Authors: Witzig Thomas E. , Inwards David 
Published: April 2019

AbstractMantle cell lymphoma (MCL) is a unique type of non-Hodgkin lymphoma characterized by the overexpression of cyclin D1. MCL patients typically live for years but experience multiple relapses. Acalabrutinib is a novel second-generation oral Bruton tyrosine kinase inhibitor approved by the US Food and Drug Administration for relapsed MCL based on a clinical trial demonstrating an overall response rate of 81%. It provides a valuable new treatment option for MCL patients and is now being tested upfront.
Towards an assessment instrument for suffering in patients with psychiatric conditions: assessing cognitive validity
Authors: Verhofstadt Monica , Chambaere Kenneth , Leontjevas Roeslan , Peters Gjalt-Jorn Ygram 
Published: April 2019

BackgroundUnbearable suffering is a key criterion in legally granting patients' euthanasia requests in Belgium yet a generally accepted definition of unbearable suffering remains elusive. The ability to understand and assess unbearable suffering is essential, particularly in patients with psychiatric conditions, as the underlying causes of these conditions are not always apparent. To enable research into when and why suffering experiences incite patients with psychiatric conditions to request euthanasia, and to help explore preventive and curative perspectives, the development of an assessment instrument is needed.AimsTo improve the cognitive validity of a large initial item pool used to assess the nature and extent of suffering in patients with psychiatric conditions.MethodCognitive validity was established via two rounds of cognitive interviews with patients with psychiatric conditions with (n= 9) and without (n= 5) euthanasia requests.ResultsDuring the first round of cognitive interviews, a variety of issues relating to content, form and language were reported and aspects that were missing were identified. During the second round, the items that had been amended were perceived as sufficiently easily to understand, sensitive to delicate nuances, comprehensive and easy to answer accurately. Neither research topic nor method were perceived as emotionally strenuous, but instead as positive, relevant, comforting and valuable.ConclusionsThis research resulted in an item pool that covers the concept of suffering more adequately and comprehensively. Further research endeavours should examine potential differences in suffering experiences over time and in patients with psychiatric conditions with and without euthanasia requests. The appreciation patients demonstrated regarding their ability to speak extensively and openly about their suffering and wish to die further supports the need to allow patients to speak freely and honestly during consultations.Declaration of interestsNone.
Impact of Essential Medicine Stock Outs on Cancer Therapy Delivery in a Resource-Limited Setting
Authors: Martei Yehoda M. , Grover Surbhi , Bilker Warren B. , Monare Barati , Setlhako Dipho I. , Ralefala Tlotlo B. , Manshimba Patrick , Gross Robert , Shulman Lawrence N. , DeMichele Angela 
Published: April 2019

PURPOSE Essential cancer medicine stock outs are occurring at an increasing frequency worldwide and represent a potential barrier to delivery of standard therapy in patients with cancer in low- and middle-income countries. The objective of this study was to measure the impact of cancer medicine stock outs on delivery of optimal therapy in Botswana. METHODS We conducted a retrospective analysis of patients with common solid tumor malignancies who received systemic cancer therapy in 2016 at Princess Marina Hospital, Gaborone, Botswana. Primary exposure was the duration of cancer medicine stock out during a treatment cycle interval, when the cancer therapy was intended to be administered. Mixed-effects univariable and multivariable logistic regression analyses were used to calculate the association of the primary exposure, with the primary outcome, suboptimal therapy delivery, defined as any dose reduction, dose delay, missed cycle, or switch in intended therapy. RESULTS A total of 378 patients met diagnostic criteria and received systemic chemotherapy in 2016. Of these, 76% received standard regimens consisting of 1,452 cycle intervals and were included in this analysis. Paclitaxel stock out affected the highest proportion of patients. In multivariable mixed-effects logistic regression, each week of any medicine stock out (odds ratio, 1.9; 95% CI, 1.7 to 2.13; P < .001) was independently associated with an increased risk of a suboptimal therapy delivery event. CONCLUSION Each week of cancer therapy stock out poses a substantial barrier to receipt of high-quality cancer therapy in low- and middle-income countries. A concerted effort between policymakers and cancer specialists is needed to design implementation strategies to build sustainable systems promoting a reliable supply of cancer medicines.
Association of Glucose Concentrations at Hospital Discharge With Readmissions and Mortality: A Nationwide Cohort Study
Authors: Spanakis Elias K , Umpierrez Guillermo E , Siddiqui Tariq , Zhan Min , Snitker Soren , Fink Jeffrey C , Sorkin John D 
Published: April 2019

Abstract

Context
Low blood glucose concentrations during the discharge day may affect 30-day readmission and posthospital discharge mortality rates.

Objective
To investigate whether patients with diabetes and low glucose values during the last day of hospitalization are at increased risk of readmission or mortality.

Design and Outcomes
Minimum point of care glucose values were collected during the last 24 hours of hospitalization. We used adjusted rates of 30-day readmission rate, 30-, 90-, and 180-day mortality rates, and combined 30-day readmission/mortality rate to identify minimum glucose thresholds above which patients can be safely discharged.

Patients and Setting
Nationwide cohort study including 843,978 admissions of patients with diabetes at the Veteran Affairs hospitals 14 years.

Results
The rate ratios (RRs) increased progressively for all five outcomes as the minimum glucose concentrations progressively decreased below the 90 to 99 mg/dL category, compared with the 100 to 109 mg/dL category: 30-day readmission RR, 1.01 to 1.45; 30-day readmission/mortality RR, 1.01 to 1.71; 30-day mortality RR, 0.99 to 5.82; 90-day mortality RR, 1.01 to 2.40; 180-day mortality RR, 1.03 to 1.91. Patients with diabetes experienced greater 30-day readmission rates, 30-, 90- and 180-day postdischarge mortality rates, and higher combined 30-day readmission/mortality rates, with glucose levels <92.9 mg/dL, <45.2 mg/dL, 65.8 mg/dL, 67.3 mg/dL, and <87.2 mg/dL, respectively.

Conclusion
Patients with diabetes who had hypoglycemia or near-normal glucose values during the last day of hospitalization had higher rates of 30-day readmission and postdischarge mortality.