bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do alternative weighting approaches for an Index of Multiple Deprivation change the association with mortality? A sensitivity analysis from Germany
Authors: Schederecker Florian , Kurz Christoph , Fairburn Jon , Maier Werner 
Published: August 2019

ObjectivesThis study aimed to assess the impact of using different weighting procedures for the German Index of Multiple Deprivation (GIMD) investigating their link to mortality rates.Design and settingIn addition to the original (normative) weighting of the GIMD domains, four alternative weighting approaches were applied: equal weighting, linear regression, maximization algorithm and factor analysis. Correlation analyses to quantify the association between the differently weighted GIMD versions and mortality based on district-level official data from Germany in 2010 were applied (n=412 districts).Outcome measuresTotal mortality (all age groups) and premature mortality (<65 years).ResultsAll correlations of the GIMD versions with both total and premature mortality were highly significant (p<0.001). The comparison of these associations using Williams’s t-test for paired correlations showed significant differences, which proved to be small in respect to absolute values of Spearman’s rho (total mortality: between 0.535 and 0.615; premature mortality: between 0.699 and 0.832).ConclusionsThe association between area deprivation and mortality proved to be stable, regardless of different weighting of the GIMD domains. The theory-based weighting of the GIMD should be maintained, due to the stability of the GIMD scores and the relationship to mortality.
Improving adherence to lung cancer guidelines: a quality improvement project that uses chart review, audit and feedback approach
Authors: Jazieh Abdulrahman , Alkaiyat Mohammad Omar , Ali Yosra , Hashim Mohamed Ahmed , Abdelhafiz Nafisa , Al Olayan Ashwaq 
Published: August 2019

IntroductionThe implementation of evidence-based clinical practice guidelines is one of the most effective interventions for improving quality of care. A gap between guidelines and clinical practice often exists, which may result in patients not receiving appropriate care. This project aimed at improving adherence to lung cancer guidelines at our institution.MethodThe records of patients with lung cancer were evaluated for adherence to guidelines by using an auditing tool that was developed to capture pertinent information. The study team collected data about the following variables: compliance with documentation of pathological diagnosis, documentation of disease stage prior to treatment initiation, presentation at thoracic tumour board within 30 days of diagnosis, management course, and management of end of life in terms of early ‘no code’ initiation, stopping chemotherapy and referral to palliative care prior to 2 weeks of death. Annual audits were performed from 2012 to 2015. Education and discussion with team members to address the deviations were the main interventions to improve adherence.ResultsThe baseline measurements were taken in 2012 (49 patients). Histological subtype identification improved from 94% to 100%. Presentation of new cases at the tumour board improved from 35% to 82%. Testing for epidermal growth factor receptor mutation for non-squamous cell lung cancer improved from 77% to 100%. The staging was documented in 100% of the cases.ConclusionRunning audits to monitor adherence to guidelines and discussions with the team have a positive effect on providing consistent evidence-based care for patients with lung cancer.
Douching, Talc Use, and Risk for Ovarian Cancer and Conditions Related to Genital Tract Inflammation
Authors: Gabriel Iwona M. , Vitonis Allison F. , Welch William R. , Titus Linda , Cramer Daniel W. 
Published: August 2019

Abstract

Background:
Douching is associated with disorders involving genital tract inflammation and genital talc use with epithelial ovarian cancer (EOC), but their joint effects are infrequently considered.

Methods:
From 2,040 cases of EOC and 2,100 controls enrolled in eastern Massachusetts and New Hampshire, we used unconditional logistic regression to estimate risk for EOC associated with douching and/or talc use. In subsets of cases and controls, we also collected information about pelvic inflammatory disease (PID), ectopic pregnancy, and cervical neoplasia to estimate risk for these events from douching and/or talc use.

Results:
The adjusted OR and 95% confidence interval (CI) for all EOC was 0.94 (0.76–1.16) in women who douched but never used talc and 1.28 (1.09–1.51) in women who used talc but never douched. Compared with women who never regularly douched or used talc, ORs (95% CIs) were 0.83 (0.52–1.33) for women who both used talc and homemade douches and 1.53 (1.11–2.10) for women who both used talc and store-bought douches. Cases who both douched and used talc were more likely to have had PID compared with cases who had used neither [OR = 5.03 (95% CI, 1.61–15.7)].

Conclusions:
Douching is not an independent risk factor for ovarian cancer, but the combination of talc use and store-bought douches may modestly increase the risk for EOC beyond that for talc use alone.

Impact:
The joint effect of talc use and douching, especially with commercial products, should be considered in evaluating risks associated with disorders involving genital tract inflammation or EOC.
Localized Treatment with Oncolytic Adenovirus Delta-24-RGDOX Induces Systemic Immunity against Disseminated Subcutaneous and Intracranial Melanomas
Authors: Jiang Hong , Shin Dong Ho , Nguyen Teresa T. , Fueyo Juan , Fan Xuejun , Henry Verlene , Carrillo Caroline C. , Yi Yanhua , Alonso Marta M. , Collier Tiara L. , Yuan Ying , Lang Frederick F. , Gomez-Manzano Candelaria 
Published: August 2019

Abstract

Purpose:
Intratumoral injection of oncolytic adenovirus Delta-24-RGDOX induces efficacious antiglioma immunity in syngeneic glioma mouse models. We hypothesized that localized treatment with the virus is effective against disseminated melanomas.

Experimental Design:
We tested the therapeutic effect of injecting Delta-24-RGDOX into primary subcutaneous (s.c.) B16-Red-FLuc tumors in s.c./s.c. and s.c./intracranial (i.c.) melanoma models in C57BL/6 mice. Tumor growth and in vivo luciferase-expressing ovalbumin-specific (OT-I/Luc) T cells were monitored with bioluminescence imaging. Cells were profiled for surface markers with flow cytometry.

Results:
In both s.c./s.c. and s.c./i.c. models, 3 injections of Delta-24-RGDOX significantly inhibited the growth of both the virus-injected s.c. tumor and untreated distant s.c. and i.c. tumors, thereby prolonging survival. The surviving mice were protected from rechallenging with the same tumor cells. The virus treatment increased the presence of T cells and the frequency of effector T cells in the virus-injected tumor and mediated the same changes in T cells from peripheral blood, spleen, and brain hemispheres with untreated tumor. Moreover, Delta-24-RGDOX decreased the numbers of exhausted T cells and regulatory T cells in the virus-injected and untreated tumors. Consequently, the virus promoted the in situ expansion of tumor-specific T cells and their migration to tumors expressing the target antigen.

Conclusions:
Localized intratumoral injection of Delta-24-RGDOX induces an in situ antovaccination of the treated melanoma, the effect of which changes the immune landscape of the treated mice, resulting in systemic immunity against disseminated s.c. and i.c. tumors.
Sorafenib Population Pharmacokinetics and Skin Toxicities in Children and Adolescents with Refractory/Relapsed Leukemia or Solid Tumor Malignancies
Authors: Inaba Hiroto , Panetta John C. , Pounds Stanley B. , Wang Lei , Li Lie , Navid Fariba , Federico Sara M. , Eisenmann Eric D. , Vasilyeva Aksana , Wang Yong-Dong , Shurtleff Sheila , Pui Ching-Hon , Gruber Tanja A. , Ribeiro Raul C. , Rubnitz Jeffrey E. , Baker Sharyn D. 
Published: August 2019

Abstract

Purpose:
To determine the pharmacokinetics and skin toxicity profile of sorafenib in children with refractory/relapsed malignancies.

Patients and Methods:
Sorafenib was administered concurrently or sequentially with clofarabine and cytarabine to patients with leukemia or with bevacizumab and cyclophosphamide to patients with solid tumor malignancies. The population pharmacokinetics (PPK) of sorafenib and its metabolites and skin toxicities were evaluated.

Results:
In PPK analysis, older age, bevacizumab and cyclophosphamide regimen, and higher creatinine were associated with decreased sorafenib apparent clearance (CL/f; P &lt; 0.0001 for all), and concurrent clofarabine and cytarabine administration was associated with decreased sorafenib N-oxide CL/f (P = 7e−4). Higher bilirubin was associated with decreased sorafenib N-oxide and glucuronide CL/f (P = 1e−4). Concurrent use of organic anion-transporting polypeptide 1B1 inhibitors was associated with increased sorafenib and decreased sorafenib glucuronide CL/f (P &lt; 0.003). In exposure–toxicity analysis, a shorter time to development of grade 2–3 hand–foot skin reaction (HFSR) was associated with concurrent (P = 0.0015) but not with sequential (P = 0.59) clofarabine and cytarabine administration, compared with bevacizumab and cyclophosphamide, and with higher steady-state concentrations of sorafenib (P = 0.0004) and sorafenib N-oxide (P = 0.0275). In the Bayes information criterion model selection, concurrent clofarabine and cytarabine administration, higher sorafenib steady-state concentrations, larger body surface area, and previous occurrence of rash appeared in the four best two-predictor models of HFSR. Pharmacokinetic simulations showed that once-daily and every-other-day sorafenib schedules would minimize exposure to sorafenib steady-state concentrations associated with HFSR.

Conclusions:
Sorafenib skin toxicities can be affected by concurrent medications and sorafenib steady-state concentrations. The described PPK model can be used to refine exposure–response relations for alternative dosing strategies to minimize skin toxicity.
Restoration of Height after 11 Years of Letrozole Treatment in 11β-Hydroxylase Deficiency
Authors: Atay Zeynep , Turan Serap , Buğdaycı Onur , Guran Tulay , Bereket Abdullah 
Published: August 2019

11β-hydroxylase deficiency (11β-OHD) is the second most common form of congenital adrenal hyperplasia (CAH). Males with 11β-OHD CAH are often diagnosed late with a significantly advanced bone age leading to a poor height prognosis due to early closure of epiphysis. Delaying epiphyseal fusion by treatment of aromatase inhibitors (AIs) might be a useful strategy in patients with very advanced bone ages. However, there are limited data regarding the effect on final height and long-term safety of this approach. We report our experience with 11 years of letrozole treatment and 17 years of follow-up in a boy with 11β-OHD. He presented at 2 years and 11 months of age with a bone age of 13 years (predicted adult height, PAH, 129.5 cm). Letrozole was added after 1 year of glucocorticoid treatment due to no improvement in height prognosis (130 cm), and continued until the age of 14 years and 11 months. He also received GnRH analog treatment at 10 years and 3 months of age for 2.5 years due to central activation of puberty. He reached a final height of 165.2 cm (35.2 cm above his PAH). This long-term treatment with letrozole was associated with changes in vertebral morphology such as vertebral body end-plate changes, Schmorl nodes, and mild protrusions in the intervertebral discs. Testicular volumes, gonadotropins, testosterone, and anti-Müllerian hormone were normal at age 20 years. A spermiogram showed a normal count but impaired sperm motility and morphology. This unique case represents the longest duration of AI treatment reported in CAH and the first case in which letrozole was started before puberty with the final height reported. We conclude that AIs may restore height in selected patients with CAH with very advanced bone age and severely compromised height prognosis.
The status of waterbird populations of Chhaya Rann Wetland Complex in Porbandar, Gujarat, India
Authors: Vargiya Dhavalkumar , Chakraborty Anita 
Published: August 2019

The present investigation was undertaken to study the diversity of wetland birds in Chhaya Rann (Gujarati: Deserted land) wetland complex, situated in the urban setting of Porbandar City, in the western state of Gujarat, India. Almost 70 species belonging to 21 families of wetland birds have been reported from here with an estimated count of 35,747 and 20,981 in the year 2016 and 2015 respectively. Anatidae and Scolopacidae represent the higher number of species (11 each) followed by Ardeidae (eight species) and Laridae (seven species). The wetland complex supports one IUCN Red Listed Vulnerable species (Common Pochard Aythya ferina), six Near Threatened species (Lesser Flamingo Phoeniconaias minor, Oriental Darter Anhinga melanogaster, Dalmatian Pelican Pelecanus crispus, Black-headed Ibis Threskiornis melanocephalus, Black-tailed Godwit Limosa limosa and River Tern Sterna aurantia), and 63 Least Concern species. The wetland meets the Criteria 5 and 6 for listing as a wetland of international importance under the Ramsar Convention.
Some recent evidence of the presence of the Critically Endangered Gyps vulture populations in northern Shan State, Myanmar
Authors: Oo Sai Sein Lin , Kham Nang Lao , Naing Kyaw Myo , Renner Swen C. 
Published: August 2019

Presence of the Critically Endangered Gyps vulture populations in northern Shan State, Myanmar. On 27 November 2018, we observed a flock of G. bengalensis, G. tenuirostris, and G. himalayanensis in Man Sant Village, Mong Yai Township, Northern Shan State, Myanmar. The most notable feature of our observation was the presence of G. bengalensis and G. tenuirostris: we could observe as many as 38 vultures of three species.
Records of the Marbled Cat Pardofelis marmorata and the Asiatic Golden Cat Catopuma temminckii (Mammalia: Carnivora: Felidae) from the community forests surrounding the Dzükou Valley in Nagaland, India
Authors: Joshi Bhavendu , Syiem Biang La Nam , Kuotsu Rokohebi , Menon Arjun , Gogoi Jayanta , Goswami Varun Rshav , Vasudev Divya 
Published: August 2019

Northeastern India, situated within the Indo-Burma and eastern Himalaya biodiversity hotspot complex, is known for its high diversity of wild felid species. For most of these species, however, data on distribution and population trends are limited. Here, we present photographic records of the Marbled Cat Pardofelis marmorata and Asiatic Golden Cat Catopuma temminckii from outside protected areas in the state of Nagaland. These records are from community forests around the Dzükou Valley in Nagaland and are some of the few records of the species from the state. The confirmed presence of the two species highlights the pivotal role of community-managed forests in the conservation of endangered species in the region.
Species diversity and spatial distribution of amphibian fauna along the altitudinal gradients in Jigme Dorji National Park, western Bhutan
Authors: Koirala Bal Krishna , Cheda Karma , Penjor Tshering 
Published: August 2019

This paper presents the results of a study conducted on the diversity and spatial distribution of amphibian fauna in two different habitat types along the elevation gradients of Mochu River valley in Jigme Dorji National Park, Bhutan. The survey was conducted from November 2017 to February 2019. The study aimed to assess the diversity and distribution of amphibians using an opportunistic visual encounter survey technique. A total of 16 species of amphibians belonging to nine genera distributed among seven families were documented during the study period. The Shannon diversity index was relatively higher in the primary forest habitat than in the agro-ecosystem, however, there was no statistically significant difference of species abundance. The decreasing trend of diversity and abundance of amphibian fauna was noticed towards higher altitudinal zones. About 56% of species were recorded in the lower sampling sites (1200–1600m) indicating more favourable climatic conditions and habitat types for amphibian assemblages at lower elevations.
The Rediscovery of Calanthe davidii (Orchidaceae) after 11 decades in the western Himalaya, India
Authors: Sharma Ashutosh , Singh Nidhan , Kumar Pankaj 
Published: August 2019

Calanthe davidii, a rare orchid species was rediscovered after a gap of 119 years in the western Himalaya and it is also a new distribution record for the flora of Himachal Pradesh State. Detailed morphological description, distribution, ecology and conservation status along with colour photographs of the species are provided.
Age and Sex Estimation Using Artificial Intelligence From Standard 12-Lead ECGs
Authors: Attia Zachi I. , Friedman Paul A. , Noseworthy Peter A. , Lopez-Jimenez Francisco , Ladewig Dorothy J. , Satam Gaurav , Pellikka Patricia A. , Munger Thomas M. , Asirvatham Samuel J. , Scott Christopher G. , Carter Rickey E. , Kapa Suraj 
Published: August 2019

Background:
Sex and age have long been known to affect the ECG. Several biologic variables and anatomic factors may contribute to sex and age-related differences on the ECG. We hypothesized that a convolutional neural network (CNN) could be trained through a process called deep learning to predict a person’s age and self-reported sex using only 12-lead ECG signals. We further hypothesized that discrepancies between CNN-predicted age and chronological age may serve as a physiological measure of health.

Methods:
We trained CNNs using 10-second samples of 12-lead ECG signals from 499 727 patients to predict sex and age. The networks were tested on a separate cohort of 275 056 patients. Subsequently, 100 randomly selected patients with multiple ECGs over the course of decades were identified to assess within-individual accuracy of CNN age estimation.

Results:

Of 275 056 patients tested, 52% were males and mean age was 58.6±16.2 years. For sex classification, the model obtained 90.4% classification accuracy with an area under the curve of 0.97 in the independent test data. Age was estimated as a continuous variable with an average error of 6.9±5.6 years (R-squared =0.7). Among 100 patients with multiple ECGs over the course of at least 2 decades of life, most patients (51%) had an average error between real age and CNN-predicted age of <7 years. Major factors seen among patients with a CNN-predicted age that exceeded chronologic age by >7 years included: low ejection fraction, hypertension, and coronary disease (
P
<0.01). In the 27% of patients where correlation was >0.8 between CNN-predicted and chronologic age, no incident events occurred over follow-up (33±12 years).

Conclusions:
Applying artificial intelligence to the ECG allows prediction of patient sex and estimation of age. The ability of an artificial intelligence algorithm to determine physiological age, with further validation, may serve as a measure of overall health.
Clinical Outcomes Following Implantation of Thin-Strut, Bioabsorbable Polymer-Coated, Everolimus-Eluting SYNERGY Stents
Authors: Kereiakes Dean J. , Windecker Stephan , Jobe R. Lee , Mehta Shamir R. , Sarembock Ian J. , Feldman Robert L. , Stein Bernardo , Dubois Christophe , Grady Timothy , Saito Shigeru , Kimura Takeshi , Underwood Paul , Allocco Dominic J. , Meredith Ian T. 
Published: August 2019

Background:
The thin-strut SYNERGY stent has an abluminal everolimus-eluting bioabsorbable polymer coating designed to facilitate vascular healing and reduce risk of stent thrombosis. In the multicenter, randomized EVOLVE II trial (The EVOLVE II Clinical Trial to Assess the SYNERGY Stent System for the Treatment of Atherosclerotic Lesion[s]), SYNERGY was noninferior to the durable polymer PROMUS Element Plus everolimus-eluting stent for the primary end point of 1-year target lesion failure. Longer-term clinical follow-up will support the relative efficacy and safety of SYNERGY.

Methods:
Patients with ≤3 native coronary lesions (reference vessel diameter ≥2.25–≤4.00 mm; length ≤34 mm) in ≤2 major epicardial vessels were randomized 1:1 to SYNERGY (N=838) or PROMUS Element Plus (N=846). EVOLVE II included a Diabetes substudy which pooled patients with diabetes mellitus from the randomized controlled trial (n=263) and from a sequential, single-arm substudy (N=203).

Results:

The 5-year target lesion failure rate was 14.3% for SYNERGY and 14.2% for PROMUS Element Plus (
P
=0.91). Landmark analysis demonstrated similar rates of target lesion failure from discharge to 1-year (
P
=0.90) and from 1 to 5 years (
P
=0.94). Definite/probable stent thrombosis was infrequent in both arms (SYNERGY 0.7% versus PROMUS Element Plus 0.9%;
P
=0.75). There were no significant differences in the rates of cardiac death, myocardial infarction, or revascularization. Among patients with diabetes mellitus, the target lesion failure rate to 1-year was noninferior to a prespecified performance goal and to 5 years was 17.0%.

Conclusions:
SYNERGY demonstrated comparable outcomes to PROMUS Element Plus, with low rates of stent thrombosis and adverse events through 5 years of follow-up. Five-year clinical outcomes were favorable in patients with diabetes mellitus. These data support the long-term safety and effectiveness of SYNERGY in a broad range of patients.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01665053.
Causes for the Century-Long Decline in Colorado River Flow
Authors: Hoerling M. , Barsugli J. , Livneh B. , Eischeid J. , Quan X. , Badger A. 
Published: August 2019

Abstract
Upper Colorado River basin streamflow has declined by roughly 20% over the last century of the instrumental period, based on estimates of naturalized flow above Lees Ferry. Here we assess factors causing the decline and evaluate the premise that rising surface temperatures have been mostly responsible. We use an event attribution framework involving parallel sets of global model experiments with and without climate change drivers. We demonstrate that climate change forcing has acted to reduce Upper Colorado River basin streamflow during this period by about 10% (with uncertainty range of 6%–14% reductions). The magnitude of the observed flow decline is found to be inconsistent with natural variability alone, and approximately one-half of the observed flow decline is judged to have resulted from long-term climate change. Each of three different global models used herein indicates that climate change forcing during the last century has acted to increase surface temperature (~+1.2°C) and decrease precipitation (~−3%). Using large ensemble methods, we diagnose the separate effects of temperature and precipitation changes on Upper Colorado River streamflow. Precipitation change is found to be the most consequential factor owing to its amplified impact on flow resulting from precipitation elasticity (percent change in streamflow per percent change in precipitation) of ~2. We confirm that warming has also driven streamflow declines, as inferred from empirical studies, although operating as a secondary factor. Our finding of a modest −2.5% °C−1 temperature sensitivity, on the basis of our best model-derived estimate, indicates that only about one-third of the attributable climate change signal in Colorado River decline resulted from warming, whereas about two-thirds resulted from precipitation decline.