bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Immunonutrition in Advanced Human Immunodeficiency Virus Disease: A Randomized Placebo-controlled Clinical Trial (Promaltia Study)
Authors: Serrano-Villar Sergio , de Lagarde María , Vázquez-Castellanos Jorge , Vallejo Alejandro , Bernadino José I , Madrid Nadia , Matarranz Mariano , Díaz-Santiago Alberto , Gutiérrez Carolina , Cabello Alfonso , Villar-García Judit , Blanco José Ramón , Bisbal Otilia , Sainz Talía , Moya Andrés , Moreno Santiago , Gosalbes María José , Estrada Vicente 
Published: May 2018

Abstract

Background
While nutritional interventions with prebiotics and probiotics seem to exert immunological effects, their clinical implications in human immunodeficiency virus (HIV)–infected subjects initiating antiretroviral therapy (ART) at advanced HIV disease remain unclear.

Methods
This was a pilot multicenter randomized, placebo-controlled, double-blind study in which 78 HIV-infected, ART-naive subjects with &lt;350 CD4 T cells/μL or AIDS were randomized to either daily PMT25341 (a mixture of synbiotics, omega-3/6 fatty acids and amino acids) or placebo for 48 weeks, each in combination with first-line ART. Primary endpoints were changes in CD4 T-cell counts and CD4/CD8 ratio from baseline to week 48 and safety. Secondary endpoints were changes in markers of T-cell activation, bacterial translocation, inflammation, and α and β microbiota diversity.

Results
Fifty-nine participants completed the follow-up with a mean CD4+ T-cell count of 221 ± 108 cells/μL and mean CD4/CD8 ratio of 0.26 ± 0.19. PMT25341 was well tolerated, without grade 3–4 adverse effects attributable to the intervention. While most of the assessed biomarkers improved during the follow-up in both arms, PMT25341-treated subjects did not experience any significant change, compared to placebo-treated subjects, in mean CD4+ T-cell count change (278 vs 250 cells/μL, P = .474) or CD4/CD8 ratio change (0.30 vs 0.32, P = .854). Similarly, we did not detect differences between treatment arms in secondary endpoints.

Conclusions
In HIV-infected patients initiating ART at advanced disease, the clear immunological benefits of ART were not enhanced by this nutritional intervention targeting the gut-associated lymphoid tissue and microbiota.

Clinical Trials Registration
NCT00870363.
Opportunities and challenges in developing deep learning models using electronic health records data: a systematic review
Authors: Xiao Cao , Choi Edward , Sun Jimeng 
Published: May 2018

AbstractObjectiveTo conduct a systematic review of deep learning models for electronic health record (EHR) data, and illustrate various deep learning architectures for analyzing different data sources and their target applications. We also highlight ongoing research and identify open challenges in building deep learning models of EHRs.Design/methodWe searched PubMed and Google Scholar for papers on deep learning studies using EHR data published between January 1, 2010, and January 31, 2018. We summarize them according to these axes: types of analytics tasks, types of deep learning model architectures, special challenges arising from health data and tasks and their potential solutions, as well as evaluation strategies.ResultsWe surveyed and analyzed multiple aspects of the 98 articles we found and identified the following analytics tasks: disease detection/classification, sequential prediction of clinical events, concept embedding, data augmentation, and EHR data privacy. We then studied how deep architectures were applied to these tasks. We also discussed some special challenges arising from modeling EHR data and reviewed a few popular approaches. Finally, we summarized how performance evaluations were conducted for each task.DiscussionDespite the early success in using deep learning for health analytics applications, there still exist a number of issues to be addressed. We discuss them in detail including data and label availability, the interpretability and transparency of the model, and ease of deployment.
Impact of Interethnic Difference of Collateral Angioarchitectures on Prevalence of Hemorrhagic Stroke in Moyamoya Disease
Authors: Hori Satoshi , Kashiwazaki Daina , Yamamoto Shusuke , Acker Güliz , Czabanka Marcus , Akioka Naoki , Kuwayama Naoya , Vajkoczy Peter , Kuroda Satoshi 
Published: May 2018

AbstractBACKGROUNDFragile, dilated moyamoya vessels are the main source of hemorrhagic stroke in moyamoya disease (MMD). However, the prevalence of hemorrhagic stroke largely differs between Asian and western countries, although the underlying pathophysiology has not been clarified.OBJECTIVETo systematically analyze the difference of collateral angioarchitectures between Japanese and European Caucasians with MMD.METHODSThis study included 71 patients with MMD, including Japanese (n = 41) and European Caucasians (n = 30). Using preoperative cerebral angiography, the developments of lenticulostriate artery (LSA), anterior choroidal artery (AChoA), posterior communicating artery (PcomA), and posterior choroidal artery (PChoA) were precisely evaluated, and ethic difference was analyzed in terms of patients’ age and the onset type.RESULTSCerebral angiography demonstrated that the marked dilatation of AChoA and PChoA were significantly more remarkable in Japanese than in European Caucasians (P = .004 andP = .002, respectively). Ageing advanced the dilatation and extension of PChoA and PcomA, and diminished the development of LSA in Japanese patients (P < .001,P = .03, andP = .03, respectively). European Caucasian patients did not have the specific dilated pattern like Japanese patients.CONCLUSIONThe marked dilatation of PChoA and PcomA is considered a powerful predictive marker of hemorrhage in MMD. Collateral channels spontaneously shift from the anterior to posterior circulation in Japanese patients during ageing but not in European Caucasian patients. These different dilation patterns of the collateral pathway may be associated with an ethnic difference of the clinical onset type in MMD.
Advice Across Disciplines and Contexts
Authors: MacGeorge Erina L. , Van Swol Lyn M. 
Published: May 2018

AbstractAdvice has been studied in many different academic disciplines, such as communication, psychology, business, sociology, education, and public health. These disciplines examine advice across diverse personal and professional relationships, in a broad range of contexts, and as exchanged across the multiple media we use to communicate. However, scholars from diverse fields are often unaware of research on advice outside their home domains. This introductory chapter examines ways advice has been conceptualized and operationalized across disciplines. It also offers analyses of prototypical advice and its principal functions. Finally, it provides overviews of the other chapters in the Handbook, highlighting key intellectual contributions made by the authors.
Advice in the Lawyer-Client Relationship
Authors: McGinniss Michael 
Published: May 2018

Abstract
The lawyer-client relationship is constituted through communication, and the lawyer’s advising role is a foundational element. This chapter begins by reviewing the most significant professional requirements impacting lawyers when advising clients. It then reviews the major models for advising in lawyer-client relationships. Attention is given to the methods employed in research on lawyer-client advising and some key findings of that research. Finally, it discusses best practices for lawyers in giving advice and for clients in receiving advice.
Advice Communication in Cyberspace
Authors: Feng Bo , Zhu Xun , Malloch Yining Zhou 
Published: May 2018

AbstractThis chapter focuses on advice communication in cyberspace. It discusses the relatively unique characteristics of advice seeking, provision, and reception via the Internet, using advice communication in traditional one-on-one, face-to-face, and personal relationship settings as a reference. Major theoretical frameworks that have informed the existing research on online advice, key research questions, and findings are reviewed. This chapter offers practical suggestions on effective advice communication online. It also discusses opportunities for future research in this area.
Reflections on Advice and the Ethics of Communication
Authors: Browne Stephen Howard 
Published: May 2018

Abstract
Advice is an inherently communicative act. Because it deals with human well-being, it is also, unavoidably, of ethical concern. The essays in this volume provide a wide and rich ground for speculating about the interplay of advice, communication, and ethics. This brief set of reflections discusses some of the features of advice that render it amenable to ethical analysis, and then considers the ethics of advising as understood from four ethical perspectives—deontology, consequentialism, virtue, and care. Throughout, the chapter highlights content from the chapters, ethical considerations for the practice of advising, and possible directions for further study.
Cinematic Depictions of Music Creative Processes in Classical and Popular Music
Authors: Cormac Joanne 
Published: May 2018

Abstract
This chapter focuses on depictions of the creative process in a particular type of biographical source: biopics of classical and popular composers. Biopics reach broader audiences than traditional musicological texts and provide a window into how the creative process is understood in the popular imagination. This chapter outlines the main motifs that are usually associated with music creative processes in film. It compares depictions of classical composers with popular musicians, arguing that over time the two have converged as popular musicians have begun to be treated as artists rather than professional entertainers. Simultaneously, the chapter analyzes some of the cinematic conventions that are commonly used in the depiction of the creative act, particularly visual techniques such as flashbacks and overlays, and the manipulation of the soundtrack. These techniques idealize the creative act as a product of the mind, emphasizing its subconscious aspects rather than the practical techniques of composition.
Music for Cochlear Implants
Authors: Helmreich Stefan 
Published: May 2018

Abstract
This paper examines compositions and performances created by scientists and musicians who seek to make music for cochlear implants, surgically implanted assistive medical technologies used by many hard-of-hearing and deaf people. The implant employs a microphone to capture an audio signal, which is then divided into frequency bands and transmitted to a receiver emplaced in a recipient’s skull, behind the ear. The implant provides poor reproduction of those timbral features of sound central to many normative experiences and expectations of music. Compositions and performances for implant users seek either (1) to improve the way the implant processes frequency, (2) to create music that works well with an implant’s available frequency profile, or (3) to access the implant directly, crafting music specially tailored for the implant through the device’s signal relays. Critically assaying such projects, this paper reevaluates and recontextualizes what can count as timbre in diverse deaf and hearing worlds.
What Is the Influence of a Delay to Surgery >24 Hours on the Rate of Red Blood Cell Transfusion in Elderly Patients With Intertrochanteric or Subtrochanteric Hip Fractures Treated With Cephalomedullary Nails?
Authors: Mattisson Leif , Lapidus Lasse J. , Enocson Anders 
Published: May 2018

Objectives:
To evaluate the influence of delay to surgery >24 hours on the rate of red blood cell transfusion in a selected population of hip fracture patients.

Design:
Cohort study.

Setting:
Tertiary care university hospital.

Patients:
A consecutive series of 987 patients (714 females) with a mean age of 86.3 (range 50–106) years operated with an intramedullary nail due to an unstable intertrochanteric or subtrochanteric hip fracture.

Intervention:
Patients operated with an intramedullary nail due to an unstable intertrochanteric or subtrochanteric hip fracture.

Main Outcome Measures:
Red blood cell transfusion rate, mortality, and postoperative length of stay were analyzed. Logistic regression analysis was used to adjust for anticoagulants, acetylsalicylic acid class, fracture type, preoperative hemoglobin (Hb) value, and time to surgery. Follow-up time was 1 year.

Results:
There was an increased preoperative transfusion rate among patients delayed for more than 24 hours to surgery (22%), compared with those operated within 24 hours (6.1%) (P < 0.001). After adjusting for anticoagulants, acetylsalicylic acid class, fracture type, preoperative Hb value, and time to surgery, it was found that anticoagulants [relative risk (RR), 2.0; confidence interval (CI), 1.1–3.5] and surgery delayed for more than 24 hours (RR, 3.9; CI, 2.3–6.1) were significantly associated with an increased rate of preoperative transfusions, although an increasing preoperative Hb value was associated with a lower rate of transfusions (RR, 0.3; CI, 0.2–0.4).

Conclusion:
We found an increased rate of preoperative transfusions among patients with unstable intertrochanteric or subtrochanteric hip fractures operated with an intramedullary nail that were delayed for surgery more than 24 hours.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Is First Rib Fracture a Culprit or a Sign of Injury Severity? It Is Both
Authors: Fokin Alexander , Wycech Joanna , Picard Eric , Weisz Russell , Puente Ivan 
Published: May 2018

Objectives:
First rib fractures (first RFX) have been correlated with increased morbidity and mortality. Whether this is due to the fracture of the rib itself or due to an increased number of associated injuries remains debatable.

Design:
Retrospective cohort study.

Setting:
Level 1 trauma center.

Patients:
One thousand eighty-nine patients with rib fractures divided into 3 groups: group A (n = 44) with isolated first RFX, group B (n = 116) with first RFX combined with other rib fractures, and group C (n = 929) with rib fractures without first RFX.

Intervention:
None.

Outcome measurements:
Age, sex, Injury Severity Score, mortality, number of ribs fractured (RFX), incidences of flail chest, multiple coinjuries, hospital and intensive care unit lengths of stay, and duration of mechanical ventilation.

Results:
Group A, when compared with group B, had significantly lower Injury Severity Score, RFX, rates of flail chest, pulmonary coinjuries, and shorter hospital length of stay and intensive care unit length of stay. Group A compared with group C had significantly lower age, RFX, rates of flail chest, and hemopneumothorax. In group B, all outcome measurements were significantly higher than those in group C. Incidence of subclavian artery, brachial plexus, and first thoracic vertebra injuries was significantly higher in group A. Frequency of traumatic brain and orthopaedic coinjuries was comparable in both groups with first RFX.

Conclusions:
Isolated first RFX alone are associated with higher incidence of injuries to subclavian structures and the first thoracic vertebrae. When they are combined with fractures of other ribs, the overall severity of trauma expands significantly.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Comparing Radiographic Progression of Bone Healing in Gustilo IIIB Open Tibia Fractures Treated With Muscle Versus Fasciocutaneous Flaps
Authors: Mehta Devan , Abdou Salma , Stranix John T. , Levine Jamie P. , McLaurin Toni , Tejwani Nirmal , Thanik Vishal , Leucht Philipp 
Published: May 2018

Objectives:
To investigate how muscle and fasciocutaneous flaps influence the progression of bone healing in acute Gustilo IIIB tibia fractures.

Design:
Retrospective Chart Review.

Setting:
Urban Academic Level I Trauma Center.

Patients/Participants:
Between 2006 and 2016, 39 patients from a database of operatively treated long bone fractures met the inclusion criteria, which consisted of adults with acute Gustilo IIIB tibia shaft fracture requiring flap coverage and having at least 6 months of radiographic follow-up.

Intervention:
Soft tissue coverage for patients with Gustilo IIIB open tibia fractures was performed with either a muscle flap or fasciocutaneous flap.

Main Outcome Measurements:
A radiographic union score for tibia (RUST) fractures, used to evaluate fracture healing, was assigned to patients' radiographs postoperatively, at 3, 6, and 12 months from the initial fracture date. Mean RUST scores at these time points were compared between those of patients with muscle flaps and fasciocutaneous flaps. Union was defined as a RUST score of 10 or higher.

Results:
There was a significant difference (P = 0.026) in the mean RUST score at 6 months between the muscle group (8.54 ± 1.81) and the fasciocutaneous group (6.92 ± 2.46). There was no significant difference in the mean RUST score at 3 months (P = 0.056) and at 12 months (P = 0.947) between the 2 groups. There was also significance in the number of fractures reaching union, favoring muscle flaps, at 6 months (P = 0.020).

Conclusions:
Patients with acute Gustilo IIIB tibia fractures who received muscle flaps have significantly faster radiographic progression of bone healing in the first 6 months than do patients who received fasciocutaneous flaps. Furthermore, according to radiographic evaluation, more Gustilo IIIB tibia fractures receiving muscle flaps reach union by 6 months than those flapped with fasciocutaneous tissue.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Helical Blade Versus Screw Fixation in the Treatment of Hip Fractures With Cephalomedullary Devices: Incidence of Failure and Atypical “Medial Cutout”
Authors: Chapman Talia , Zmistowski Benjamin , Krieg James , Stake Seth , Jones Christopher M. , Levicoff Eric 
Published: May 2018

Objective:To evaluate the rates and mechanisms of failure for cephalomedullary nail fixation using helical blade versus screw fixation and to identify the predictors of failure.Design:Retrospective study.Setting:Community teaching hospital.Patients/Participants:A total of 126 patients were treated with cephalomedullary fixation for low-energy hip fractures.Intervention:All procedures used the Trochanteric Fixation Nail (Synthes) with either a helical blade [71 (56.3%)] or screw [55 (43.7%)].Main Outcome Measurements:Failures, defined by nonunion, hardware cutout, and need for revision surgery were independently reviewed by a fellowship-trained orthopaedic trauma surgeon for an assessment of reduction quality and hardware placement.Results:Seven failures of fixation (5.6%) occurred, all of which used a helical blade. Five failures resulted from medial migration of the helical blade through the femoral head, whereas 2 resulted from typical superolateral cutout and varus collapse. There was no difference in the average tip apex distance between the cases using blade versus screw fixation or between failures and the remainder of the cohort. Basicervical fractures had a significantly higher rate of failure than other fracture patterns.Conclusions:This study showed a higher failure rate with use of the blade and supports the use of screw fixation in these fractures. In addition, we confirm an atypical mode of failure, lateral migration of the femoral head with protrusion of the helical blade, which contributes significantly to the overall failure rate of this implant and occurs despite appropriate fracture reduction and hardware placement.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Multicenter Observational Study of Family Participation in ICU Rounds
Authors: Au Selena S. , Roze des Ordons Amanda L. , Parsons Leigh Jeanna , Soo Andrea , Guienguere Simon , Bagshaw Sean M. , Stelfox Henry T. 
Published: May 2018

Objectives:
Guidelines recommend offering family members of critically ill patients the option to attend interdisciplinary team rounds as a way to improve communication and satisfaction. Uncertainty remains around the benefits and risks.

Design:
We conducted an observational study to describe family participation in ICU rounds and its association with rounding processes.

Setting:
Rounds conducted under the leadership of 33 attending physicians in seven hospitals across three Canadian cities.

Patients:
Three hundred two individual rounds on 210 unique patients were observed.

Interventions:
Quantitative and qualitative data were collected using standardized observational tools.

Measurements and Main Results:
Among the 302 rounds observed, family attended in 68 rounds (23%), were present in ICU but did not attend in 59 rounds (20%), and were absent from the ICU in 175 rounds (58%). The median duration of rounds respectively for these three groups of patients was 20 minutes (interquartile range, 14–26 min), 16 minutes (interquartile range, 13–22 min), and 16 minutes (interquartile range, 10–23 min) (p = 0.01). There were no significant differences in prognostic discussions (35% vs 36% vs 36%; p = 0.99) or bedside teaching (35% vs 37% vs 34%; p = 0.88). The quality of rounds was not significantly associated with family attendance in rounds or presence in the ICU (quality score [1 (low) to 10 (high)] median 8 [interquartile range, 7–8] vs 7 [interquartile range, 6–9] vs 7 [interquartile range, 6–9]; p = 0.11). Qualitative analyses suggested that family attendance may influence relationship building, information gathering, patient and family education, team dynamics, future family meetings, workflow, and shared clinical decision-making.

Conclusions:
Our results suggest family attendance in ICU rounds is associated with longer duration of rounds, but not the frequency of trainee teaching, discussions of prognosis, or quality of rounds. Family attendance in rounds may enhance communication and complement family conferences.
Effect of Interleukin-1 Blockade on Left Ventricular Systolic Performance and Work: A Post Hoc Pooled Analysis of 2 Clinical Trials
Authors: Buckley Leo F. , Carbone Salvatore , Trankle Cory R. , Canada Justin M. , Erdle Claudia Oddi , Regan Jessica A. , Viscusi Michele M. , Kadariya Dinesh , Billingsley Hayley , Arena Ross , Abbate Antonio , Van Tassell Benjamin W. 
Published: May 2018

Background:
Interleukin-1 (IL-1) blockade seems to improve anaerobic exercise in patients with systolic heart failure through improved left ventricular (LV) systolic performance. However, it is unclear whether IL-1 blockade affects LV systolic performance.

Methods:
We pooled data from 2 clinical trials of patients with systolic heart failure who were randomized to IL-1 blockade or placebo. We estimated changes in LV systolic performance (LV ejection fraction [LVEF] and end-systolic elastance [LVEes]) and pressure–volume area (PVA), a surrogate of oxygen consumption, after 14 days of treatment.

Results:
LVEF increased from 30% (24%–38%) to 36% (29%–43%) between baseline and day 14 only in anakinra-treated patients (P = 0.03 for within-group change and P = 0.02 for between-group change compared with placebo). LVEes increased from 1.0 mm Hg/mL (0.7–1.5) to 1.3 mm Hg/mL (0.8–1.6) in anakinra-treated patients between baseline and day 14 but not in placebo-treated patients (P = 0.03 for within-group change and P = 0.08 for between-group change). A change in PVA between baseline and 14 days was not detected in either anakinra or placebo patients.

Conclusions:
In this post hoc analysis, LVEes and LVEF increased significantly in patients treated with an IL-1 blocker but not in placebo-treated patients. An effect of IL-1 blockade on calculated PVA was not detected.