bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘Place bonding’ in children’s hospice care: a qualitative study
Authors: Dunbar Helena , Carter Bernie , Brown Jayne 
Published: August 2018

BackgroundLimited knowledge exists of parents’ perceptions and experiences of children’s hospices and how these contribute to the varied access and uptake of services.AimThis study aimed to explore parents’ perspectives and experiences of a hospice, to understand the barriers and/or facilitators to accessing a hospice, and what characteristics parents wanted from hospice provision.MethodsA two-phase qualitative study underpinned by a constructivist grounded theory methodology was employed. Phase 1 used focus groups to collect data from parents of children already accessing the hospice (n=24). Phase 2 used in-depth semistructured interviews with parents of children who did not use the hospice (n=7) and with parents who had previous experience of using a hospice (n=7).ResultsA grounded theory of place bonding was developed which illustrates the cognitive journey taken by parents of children with life-limiting conditions considering/receiving hospice care for their child.ConclusionsFinding a place where they belonged and felt at ‘home’ made the decision to accept help in caring for their child with a life-limiting condition more acceptable. The theory of place bonding offers children’s hospices a new perspective from which to view how parents access, accept and build relationships at the hospice.
Molecular predictors of prevention of recurrence in HCC with sorafenib as adjuvant treatment and prognostic factors in the phase 3 STORM trial
Authors: Pinyol Roser , Montal Robert , Bassaganyas Laia , Sia Daniela , Takayama Tadatoshi , Chau Gar-Yang , Mazzaferro Vincenzo , Roayaie Sasan , Lee Han Chu , Kokudo Norihiro , Zhang Zhongyang , Torrecilla Sara , Moeini Agrin , Rodriguez-Carunchio Leonardo , Gane Edward , Verslype Chris , Croitoru Adina Emilia , Cillo Umberto , de la Mata Manuel , Lupo Luigi , Strasser Simone , Park Joong-Won , Camps Jordi , Solé Manel , Thung Swan N , Villanueva Augusto , Pena Carol , Meinhardt Gerold , Bruix Jordi , Llovet Josep M 
Published: August 2018

ObjectiveSorafenib is the standard systemic therapy for advanced hepatocellular carcinoma (HCC). Survival benefits of resection/local ablation for early HCC are compromised by 70% 5-year recurrence rates. The phase 3 STORM trial comparing sorafenib with placebo as adjuvant treatment did not achieve its primary endpoint of improving recurrence-free survival (RFS). The biomarker companion study BIOSTORM aims to define (A) predictors of recurrence prevention with sorafenib and (B) prognostic factors with B level of evidence.DesignTumour tissue from 188 patients randomised to receive sorafenib (83) or placebo (105) in the STORM trial was collected. Analyses included gene expression profiling, targeted exome sequencing (19 known oncodrivers), immunohistochemistry (pERK, pVEGFR2, Ki67), fluorescence in situ hybridisation (VEGFA) and immunome. A gene signature capturing improved RFS in sorafenib-treated patients was generated. All 70 RFS events were recurrences, thus time to recurrence equalled RFS. Predictive and prognostic value was assessed using Cox regression models and interaction test.ResultsBIOSTORM recapitulates clinicopathological characteristics of STORM. None of the biomarkers tested (related to angiogenesis and proliferation) or previously proposed gene signatures, or mutations predicted sorafenib benefit or recurrence. A newly generated 146-gene signature identifying 30% of patients captured benefit to sorafenib in terms of RFS (p of interaction=0.04). Thesesorafenib RFS responderswere significantly enriched in CD4+T, B and cytolytic natural killer cells, and lacked activated adaptive immune components. Hepatocytic pERK (HR=2.41; p=0.012) and microvascular invasion (HR=2.09; p=0.017) were independent prognostic factors.ConclusionIn BIOSTORM, only hepatocytic pERK and microvascular invasion predicted poor RFS. No mutation, gene amplification or previously proposed gene signatures predicted sorafenib benefit. A newly generated multigene signature associated with improved RFS on sorafenib warrants further validation.Trial registration numberNCT00692770.
Cardiopulmonary fitness in children with congenital heart diseases versus healthy children
Authors: Amedro Pascal , Gavotto Arthur , Guillaumont Sophie , Bertet Helena , Vincenti Marie , De La Villeon Gregoire , Bredy Charlène , Acar Philippe , Ovaert Caroline , Picot Marie-Christine , Matecki Stefan 
Published: August 2018

ObjectiveWe aimed to compare the cardiopulmonary fitness of children with congenital heart diseases (CHD) with that of age-adjusted and gender-adjusted controls. We also intended to identify clinical characteristics associated with maximum oxygen uptake (VO2max) in this population.Methods and resultsWe included in a cross-sectional multicentre study a total of 798 children (496 CHD and 302 controls) who underwent a complete cardiopulmonary exercise test (CPET). The association of clinical characteristics with VO2max was studied using a multivariate analysis. Mean VO2max in the CHD group and control represented 93%±20% and 107%±17% of predicted values, respectively. VO2max was significantly lower in the CHD group, overall (37.8±0.3vs 42.6±0.4 mL/kg/min, P<0.0001) and for each group (P<0.05). The mean VO2max decline per year was significantly higher in CHD than in the controls overall (−0.84±0.10 vs −0.19±0.14 mL/kg/min/year, P<0.01), for boys (−0.72±0.14vs 0.11±0.19 mL/kg/min/year, P<0.01) and for girls (−1.00±0.13 vs −0.55±0.21 mL/kg/min/year, P=0.05). VO2max was associated with body mass index, ventilatory anaerobic threshold, female gender, restrictive ventilatory disorder, right ventricle systolic hypertension, tricuspid regurgitation, the number of cardiac catheter or surgery procedures, and the presence of a genetic anomaly.ConclusionsAlthough the magnitude of the difference was not large, VO2max among children with CHD was significantly lower than in normal children. We suggest performing CPET in routine follow-up of these patients.Trial registration numberClinicalTrials.gov NCT01202916; Post-results.
Community-based stroke system of care improves patient outcomes in Chinese rural areas
Authors: He Mingli , Wang Jin’e , Dong Qing , Ji Niu , Meng Pin , Liu Na , Geng Shan , Qin Sizhou , Xu Wenyan , Zhang Chuantong , Li Dabo , Zhang Huamin , Zhu Jinping , Qin Hua , Hui Rutai , Wang Yibo 
Published: August 2018

BackgroundBuilding effective and efficient stroke care systems is a key step in improving prevention, treatment and rehabilitation of stroke. The aim of this study was to evaluate the effectiveness of this stroke system of care on stroke management during a 2-year follow-up.MethodsA stroke system of care was developed from November 2009 to November 2010 in three townships in Ganyu County. Additional three matched townships were invited as controls. We first investigated the stroke incidence of these populations. Subsequently, this stroke system of care and an educational campaign in the three intervention townships were implemented and the effectiveness of the system was evaluated in the next 2 years.ResultsAt postintervention, more patients in the intervention communities obtained stroke knowledge and then the proportion of patients with stroke who were admitted within 3 hours of onset markedly increased in 2012 (12.0% vs 8.1%, p=0.044) and in 2013 (15.2% vs 9.7%, p=0.008) compared with those in the control communities. In the intervention communities, this proportion of patients with acute ischaemic stroke who received thrombolytic treatment was markedly raised from 2.1% in 2012 to 3.0% in 2013. More importantly, the fatality rate substantially decreased in 2013 in the intervention communities compared with that in the control communities (6.1% vs 9.7%, p=0.032). Similarly, the disability rate significantly decreased in 2013 (45.3% vs 51.5%, p=0.045).ConclusionsThe community-based stroke system of care was effective and practical for optimising stroke treatments and improving patient outcomes.Trial registration numberChiCTR-RCH-13003408, Post-results.
Distinguishing rheumatoid arthritis from psoriatic arthritis
Authors: Merola Joseph F , Espinoza Luis R , Fleischmann Roy 
Published: August 2018

Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have key differences in clinical presentation, radiographic findings, comorbidities and pathogenesis to distinguish between these common forms of chronic inflammatory arthritis. Joint involvement is typically, but not always, asymmetric in PsA, while it is predominantly symmetric in RA. Bone erosions, without new bone growth, and cervical spine involvement are distinctive of RA, while axial spine involvement, psoriasis and nail dystrophy are distinctive of PsA. Patients with PsA typically have seronegative test findings for rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibodies, while approximately 80% of patients with RA have positive findings for RF and CCP antibodies. Although there is overlap in the pathogenesis of PsA and RA, differences are also present that affect the efficacy of treatment. In PsA, levels of interleukin (IL)-1β, IL-6, IL-17, IL-22, IL-23, interferon-γ and tumour necrosis factor-α (TNF-α) are elevated, and in RA, levels of IL-1, IL-6, IL-22, IL-33, TNF-α, chemokine ligand 11 and chemokine C-X-C motif ligand 13 are elevated. Differences in the pathogenesis of RA and PsA translate into some variances in the specificity and efficacy of therapies.
Cytokine Clearances in Critically Ill Patients on Continuous Renal Replacement Therapy
Authors: Chen Ling-Xin , Demirjian Sevag , Udani Suneel M. , Trevino Sharon A. , Murray Patrick T. , Koyner Jay L. 
Published: August 2018

<b><i>Background/Aims:</i></b> We sought to quantify any differences in cytokine clearance between continuous venovenous hemofiltration (CVVH-convective) compared to continuous venovenous hemodialysis (CVVHD-diffusive). <b><i>Methods:</i></b> We conducted a 20 patient, multicenter, prospective, open-label randomized trial (CVVH or CVVHD) at continuous renal ­replacement therapy (CRRT) initiation. Blood, urine, and effluent were collected at 0, 4, 24, and 48 h after initiation of CRRT. Serum electrolytes, cytokines levels, and clearances were measured. Cytokines studies included IL-1β, IL-1RA, IL-6, IL-10, and TNFα. <b><i>Results:</i></b> We randomized 20 patients to receive CRRT. After 4 h of CRRT there was no difference in total cytokine levels or change in cytokine concentrations across the 2 groups. With the exception of IL-1 RA, all cytokines levels decreased across patient groups regardless of modality. There was no significant difference in cytokine concentration across CRRT modality for any time point. <b><i>Conclusion:</i></b> Within the first 4 h of CRRT initiation, there is no significant difference between cytokine or solute clearance between CVVH and CVVHD.
Forgotten Industrial Heritage in Virtual Reality—Case Study: Old Power Plant in Piešt’any, Slovakia
Authors: Hain Vladimír , Ganobjak Michal 
Published: August 2018

Abstract
An industrial heritage provides one of the most important records of urban development and of the progress of human civilization in the last two centuries. Monumental industrial buildings reflect extraordinary technical and economic development and progress in science and technology. Even after the termination of their original function, industrial heritage buildings and equipment, along with their architecture, still participate in a significant way in the atmosphere of many cities. The research process in our study used the methods of industrial archaeology. In combination with the identified preserved and still valuable parts of the building and preserved original equipment and archival plans, it was possible to reconstruct the hypothetical virtual appearance of the historical monument. For this purpose, the article examines the case study: virtual reality reconstruction of the Old Power Plant in the city of Piešt’any. The contribution of a brief experience in the VR scene of Machinery Hall in the exhibition with its high immersion, located in the historical environment of the original Machinery Hall, had an educational effect (understanding by experience), bringing out the look and functionality of the lost industrial heritage. This effect appears to be an appropriate and meaningful use of VR in practice.
Description of two new species of Cnemaspis Strauch, 1887 (Squamata: Gekkonidae) from the Western Ghats of Kerala, India
Authors: CYRIAC VIVEK PHILIP , JOHNY ALEX , UMESH P. K. , PALOT MUHAMED JAFER 
Published: August 2018

Two new species of geckos of the genus Cnemaspis Strauch, 1887 are described from the southern Western Ghats of Kerala. Both species are medium to large sized Cnemaspis and can be differentiated from all other Indian congeners by a suite of distinct morphological characters. Both species are found in the high elevation forests of the two major massifs— Anaimalai Hills and Agasthyamalai Hills and are presently known to have very restricted distributional ranges. The discovery of these novel species highlights the understudied diversity of reptiles in the high mountain ranges of the Western Ghats.
Real-World Evidence in the Real World: Beyond the FDA
Authors: Krause Joan H. , Saver Richard S. 
Published: August 2018

The 21st Century Cures Act (“Cures Act”) relies on the concept of real-world evidence (“RWE”) to improve the Food and Drug Administration (“FDA”) approval process. This has amplified interest and furthered momentum in applying RWE more broadly, beyond FDA regulation. In this article, we discuss the understandable appeal of RWE's pragmatic application and its many potential benefits. But we also caution that claims about RWE's wide-ranging, ameliorative impact on the health care system are likely overstated.The real world of RWE is messy and uncertain. Successfully incorporating RWE into regular health care system decision-making, beyond the FDA, faces considerable obstacles and limitations. We review the reasons to be wary about RWE as a game-changer. These concerns including data reliability, insufficient incentives for stakeholders to generate and engage with high-quality RWE, and lack of comprehensive regulatory oversight. In addition, the push for RWE may impact the enforcement of the health care fraud and abuse laws, perhaps not in necessarily positive ways. Increased reliance on RWE may have significant implications for off-label fraud enforcement, further conflating the distinction between claims that are false for reimbursement rather than for scientific purposes.
An enhanced operation model for energy storage system of a typical combined cool, heat and power based on demand response program: The application of mixed integer linear programming
Authors: Eshraghi Amirhossein , Salehi Gholamreza , Heibati Seyedmohammadreza , Lari Kamran 
Published: August 2018

A model for operating an energy hub-based multiple energy generation micro-grid is optimized using the demand response program. The optimized objective model is validated against energy demand of a residential building in Tehran, Iran. The mathematical model and optimal analysis of the proposed tri-generation micro-grid are implemented by using a real-world modelling and considering the constraints of the storage system, demand response program and the performance of the devices and the power and gas grids. The dynamic optimal operation model is prepared on the basis of the mixed integer linear programming on the subsequent day and is solved to minimize the costs of energy supply. To demonstrate the improvements, different scenarios are developed so that the renewable energy resources and storages are fed into the combined cool, heat and power system gradually. The results reveal that the inclusion of each element results in a significant improvement in the operational parameters of the micro energy grid. Scenario 1 includes a combined cool, heat and power system alone, Scenario 2 is supplemented with renewable wind and solar energy resources in addition to combined cool, heat and power system and Scenario 3 includes electrical, heat and cold storages in addition to combined cool, heat and power system and renewable energy sources. Scenario 4 is similar to Scenario 3 in terms of equipment, but the only difference lies in the use of the demand response program in the former. Total operational cost is 12.7% lower in Scenario 2 than in Scenario 1, 9.2% lower in Scenario 3 than in Scenario 2 and 8.6% lower in Scenario 4 than in Scenario 3. Practical application: An optimized operation method is prepared for combined cool, heat and power systems running in different operation modes in which renewable energy sources and storages are added to the combined cool, heat and power and the demand response program is applied. The results reveal that the cost of energy supply, including the cost of electricity, gas and pollutant emissions, is reduced and the qualitative parameters of the operation, including efficiency and reliability of building micro-grid, are increased. The proposed algorithm and the evaluation method will enable building operators to plan demand response activity on the residential building in Tehran, while this can be extended to other buildings too.
Surgical Management of Normocalcemic Primary Hyperparathyroidism and the Impact of Intraoperative Parathyroid Hormone Testing on Outcome
Authors: Trinh Gina , Rettig Eleni , Noureldine Salem I. , Russell Jonathon O. , Agrawal Nishant , Mathur Aarti , Prescott Jason D. , Zeiger Martha A. , Tufano Ralph P. 
Published: August 2018

ObjectiveTo review our surgical experience and the impact of intraoperative parathyroid hormone (IOPTH) testing among patients with normocalcemic primary hyperparathyroidism.Study DesignCase series with chart review.SettingAcademic referral hospital.Subject and MethodsNormocalcemic hyperparathyroidism (NCHPT) patients were identified with normal‐range blood ionized calcium and serum elevated parathyroid hormone. Patient demographics, intraoperative findings, IOPTH dynamics, and biochemical outcomes were compared with those of classic primary hyperparathyroidism (PHPT) patients.ResultsOf the 2120 patients who underwent parathyroidectomy, 616 patients met the inclusion criteria: 119 (19.5%) patients had NCHPT, and 497 (80.5%) had classic PHPT. NCHPT patients had higher rates of multigland hyperplasia as compared with classic PHPT (12% vs 4%, P =. 002) and smaller gland size (P <. 001). Of 119 NCHPT patients, 114 (97%) achieved >50% drop in IOPTH intraoperatively, as opposed to 492 (99%) among 497 classic PHPT patients (P =. 014). IOPTH drop >50% had an equivalent positive predictive value for long‐term cure in both groups.ConclusionsSurgeons treating NCHPT patients should suspect the presence of multigland disease and have a low threshold for converting to bilateral exploration depending on IOPTH decay dynamics.
Discriminative ability and clinical utility of the Timed Up and Go (TUG) in identifying falls risk in people with multiple sclerosis: a prospective cohort study
Authors: Quinn Gillian , Comber Laura , McGuigan Chris , Galvin Rose , Coote Susan 
Published: August 2018

Objective: To investigate discriminative ability and clinical utility of the Timed Up and Go under single- and dual-task conditions between fallers and non-fallers in multiple sclerosis (MS). Design: Prospective cohort study. Setting: Neurology service in a tertiary hospital. Subjects: Participants were 101 people with MS and Expanded Disability Status Scale score of 3–6.5. One participant withdrew after the baseline assessment, and hence the data were analysed for 100 participants. Interventions: No specific intervention. Main Measures: Timed Up and Go and Timed Up and Go-Cognitive. Three-month prospective diaries recorded falls. Results: Mean age was 52.6 (SD 10.7) and 66 were female. Majority of the participants had progressive MS (72) and 73 used a walking aid; 56 participants recorded 791 falls. The area under the receiver operating characteristic curve values for Timed Up and Go and Timed Up and Go-Cognitive in distinguishing fallers (person with ⩾1 fall) from non-fallers are 0.60 and 0.57, respectively, and in distinguishing multiple fallers (⩾2 falls) the values are 0.46 and 0.43. A Timed Up and Go score of ⩾9 seconds has a sensitivity of 0.82 and a specificity of 0.34 to identify fallers and a sensitivity of 0.79 and a specificity of 0.27 to identify multiple fallers. A Timed Up and Go-Cognitive score of ⩾11 seconds has a sensitivity of 0.77 and a specificity of 0.30 to identify fallers and a sensitivity of 0.71 and a specificity of 0.26 to identify multiple fallers. Conclusion: The Timed Up and Go and Timed Up and Go-Cognitive do not demonstrate sufficient clinical utility or discriminative ability for assessing falls risk in MS.
Stabilization of Acute High-Grade Acromioclavicular Joint Separation: A Prospective Assessment of the Clavicular Hook Plate Versus the Double Double-Button Suture Procedure
Authors: Stein Thomas , Müller Daniel , Blank Marc , Reinig Yana , Saier Tim , Hoffmann Reinhard , Welsch Frederic , Schweigkofler Uwe 
Published: August 2018

Background:The stabilization strategy for acute high-grade acromioclavicular (AC) joint separations with AC-stabilizing clavicular hook plate (cHP) or coracoclavicular (CC)–stabilizing double double-button suture (dDBS) is still under consideration.Hypothesis:The CC-stabilizing dDBS is superior to the cHP according to an AC-specific radiologic assessment and score system.Study Design:Cohort study; Level of evidence, 2.Methods:Seventy-three consecutive patients with acute high-grade AC joint separation were prospectively followed in 2 treatment groups (64.4% randomized, 35.6% patient-selected treatment): open reduction and cHP (cHP group) or arthroscopically assisted dDBS (dDBS group) performed within 14 days of injury. Patients were prospectively analyzed by clinical scores (Taft, Constant score [CS], numeric analog scale for pain) and AC-specific radiographs (AC distance, CC distance [CCD], relative CCD [rCCD; 100 / AC distance × CCD]) at points of examination (preoperative and 6, 12, and 24 months). The minimal clinically important differences (MCIDs) were assessed by the anchor-based method.Results:Twenty-seven of 35 patients (mean age ± SD: 37.7 ± 9.7 years) after cHP implantation and 29 of 38 patients (34.2 ± 9.7 years) after dDBS implantation were continuously followed until the 24-month follow-up. All patients showed significantly increased scores after surgery as compared with preoperative status (all P < .05). As compared with GI, GII had significantly better outcomes at 24 months (Taft: cHP = 9.4 ± 1.7 vs dDBS = 10.9 ± 1.1, P < .05, MCID = 2.9; CS: cHP = 90.2 ± 7.8 vs dDBS = 95.3 ± 4.4, P < .02, MCID = 16.6) and at 24 months for Rockwood IV/V (Taft: cHP = 9.4 ± 1.7 vs dDBS = 11.1 ± 0.8, P < .0005; CS: cHP = 90.1 ± 7.7 vs dDBS = 95.5 ± 3.1, P < .04). Clinically assessed horizontal instability persisted in 18.52% (GI) and 6.89% (GII; P = .24). The rCCD showed equal loss of reduction at 24 months (GII = 130.7% [control = 111%] vs GI = 141.8% [control = 115%], MCID = 11.1%).Conclusion:This prospective study showed significantly superior outcomes in all clinical scores between GII and GI. The subanalysis of the high-grade injury type (Rockwood IV/V) revealed that these patients showed significant benefits from the dDBS procedure in the clinical assessments. The cHP procedure resulted in good to excellent clinical outcome data and displayed an alternative procedure for patients needing less restrictive rehabilitation protocols.