bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Starr County Border Health Initiative: Focus Groups on Diabetes Prevention in Mexican Americans
Authors: Brown Sharon A. , Perkison William B. , García Alexandra A. , Cuevas Heather E. , Velasquez Mary M. , Winter Mary A. , Hanis Craig L. 
Published: April 2018

Purpose The purpose of the study was to conduct focus groups with Mexican Americans in an impoverished rural community on the Texas-Mexico border to identify current barriers to adopting healthier lifestyles and to obtain recommendations for diabetes prevention. Methods Three separate 2-hour focus groups were led by an experienced bilingual Mexican American moderator. Interviews included questions about cultural factors and barriers that influence lifestyle behaviors, aspects of previous diabetes self-management interventions that were helpful for motivating behavioral change, and recommendations for diabetes prevention. Results Twenty-seven participants attended a focus group session; each session involved 7 to 12 informants. Individuals were diagnosed with prediabetes or type 2 diabetes mellitus; most were female, foreign born, and Spanish speaking. Interviews documented the cultural importance of food. Informants raised priority issues for diabetes prevention, including the need to learn how to prepare healthier foods and track caloric intake. Major barriers to healthier lifestyles included high costs of healthy foods, fatigue from busy schedules and working multiple jobs, a cultural view that exercise is a waste of valuable time, and fear of deportation. Conclusions Cultural influences and barriers to implementing healthy lifestyles should be assessed regularly and strategies implemented to overcome them. Such factors may change as environmental, sociocultural, and political environments change.
Evaluation of Appropriate Sodium Polystyrene Sulfonate Use With a Hyperkalemia Order Set: A Pilot Study
Authors: Mueller Zachary T. , Crannage Andrew J. 
Published: April 2018

Background: No consensus guidelines exist to assist practitioners in the management of hyperkalemia. Sodium polystyrene sulfonate (SPS) is a common treatment option for hyperkalemia. To aid health-care professionals, a hyperkalemia order set was created at a 979-bed community teaching hospital. Objective: The objective of this study was to determine whether use of a hyperkalemia order set is associated with appropriate use of SPS. Methods: Orders for SPS were evaluated for appropriateness in this retrospective cohort of adult patients. Data were collected from December 1, 2015, to December 31, 2016. All orders for SPS not from an order set were randomly matched to those from the order set in a 2:1 fashion. Appropriate use was defined as potassium level >5.5 mEq/L and no contraindications to use. The primary outcome was the absolute difference in the proportion of patients with appropriate SPS use in the order set group compared to the nonorder set group. Results: A total of 120 patients were analyzed, 40 in the order set group and 80 in the nonorder set group. Baseline characteristics were similar between the groups. Appropriate use occurred in 97.5% of order set patients compared to 60% in the nonorder set group ( P < .001). Use of the order set was associated with a greater reduction in serum potassium, quicker follow-up potassium level, and lower incidence of gastrointestinal adverse effects. Conclusions: The use of a hyperkalemia order set is associated with appropriate use of SPS. Requiring the use of the hyperkalemia order set for administration of SPS may enhance patient care and safety.
Lupus myocarditis: a single center experience and a comparative analysis of observational cohort studies
Authors: Tanwani J , Tselios K , Gladman D D , Su J , Urowitz M B 
Published: April 2018

Background Lupus myocarditis (LM) is reported in 3–9% of patients with systemic lupus erythematosus (SLE) but limited evidence exists regarding optimal treatment and prognosis. This study aims to describe LM in a defined lupus cohort as compared with the existing literature. Patients and methods Patients with LM were identified from the University of Toronto Lupus Clinic database. Diagnosis was based on clinical manifestations and electrocardiographic, imaging, and biochemical criteria. Demographic, clinical, diagnostic and therapeutic variables and outcomes were collected in a standardized data retrieval form. A literature review was performed to identify cohort studies reporting on LM treatment and outcome. A comparative analysis was conducted between our patients and the combined cohort of the existing studies. Results Thirty patients were diagnosed with LM (prevalence 1.6%) and compared with a cumulative cohort of 117 patients from five distinct studies. No significant differences were found regarding the age at diagnosis (32.6 ± 13.4 years) and SLE duration (2.5 years median). Concomitant lupus activity from other organ systems was observed in 97% of the patients. Chest pain was more frequently reported in our cohort whereas dyspnea was more prominent in the other studies. Diagnostic criteria were similar across studies. Therapeutic approach was comparable and consisted of glucocorticosteroids (96.6%) and immunosuppressives (70%). Mortality was approximately 20% whereas another 20% of the patients achieved partial and 60% complete recovery. Conclusions LM usually occurs early in the disease course and in the context of generalized lupus activity. Despite aggressive therapy, approximately 40% of the patients died or had residual heart damage.
Teaching Residents How to Talk About Death and Dying: A Mixed-Methods Analysis of Barriers and Randomized Educational Intervention
Authors: Miller David C. , Sullivan Amy M. , Soffler Morgan , Armstrong Brett , Anandaiah Asha , Rock Laura , McSparron Jakob I. , Schwartzstein Richard M. , Hayes Margaret M. 
Published: April 2018

Objectives: We present a pilot study exploring the effects of a brief, 30-minute educational intervention targeting resident communication surrounding dying in the intensive care unit (ICU). We sought to determine whether simulation or didactic educational interventions improved resident-reported comfort, preparation, and skill acquisition. We also sought to identify resident barriers to using the word “dying.” Methods: In this mixed-methods prospective study, second- and third-year medical residents were randomized to participate in a simulation-based communication training or a didactic session. Residents completed a pre–post survey after the sessions evaluating the sessions and reflecting on their use of the word “dying” in family meetings. Results: Forty-five residents participated in the study. Residents reported increases in comfort (Mean [M]-pre = 3.3 [standard deviation: 0.6], M-post = 3.7 [0.7]; P < .01, Cohen d = 0.75) and preparation (M-pre = 3.4 [0.7], M-post = 3.9 [0.6]; P < .01, d = 1.07) using the word “dying” after both the simulation and didactic versions. Residents randomized to the simulation reported they were more likely to have learned new skills as compared to residents in the didactic (M-simulation = 2.2 [0.4], M-didactic = 1.9 [0.3]; P = .015, d = 0.80). They estimated that they used the word “dying” in 50% of their end-of-life (EOL) conversations and identified uncertain prognosis as the main barrier to explicitly stating the word “dying.” Conclusion: A 30-minute educational intervention improves internal medicine residents’ self-reported comfort and preparation in talking about death and dying in the ICU. Residents in simulation-based training were more likely to report they learned new skills as compared to the didactic session. Residents report multiple barriers to using the word “dying” EOL conversations.
Use of Patient-Specific 3D-Printed Titanium Implants for Complex Foot and Ankle Limb Salvage, Deformity Correction, and Arthrodesis Procedures
Authors: Dekker Travis J. , Steele John R. , Federer Andrew E. , Hamid Kamran S. , Adams Samuel B. 
Published: April 2018

Background: The advancement of 3D printing technology has allowed for the use of custom-designed implants for difficult-to-treat foot and ankle pathologies. This study reports on the radiographic and functional outcomes of a case series of patients treated with patient-specific 3D-printed titanium implants. Methods: Fifteen consecutive patients treated with custom-designed 3D-printed implant cages for severe bone loss, deformity correction, and/or arthrodesis procedures were included in this study. A minimum of 1 year of clinical and radiographic follow-up was required. No patients were lost to follow-up. Patients completed a visual analog scale for pain, the Foot and Ankle Ability Measure Activities of Daily Living score, and the American Orthopaedic Foot & Ankle Society Score outcomes questionnaires preoperatively and at most recent follow-up. All patients had postoperative radiographs and computed tomography (CT) scans to assess bony incorporation. The mean age was 53.3 years (range, 22-74 years) with a mean follow-up of 22 months (range, 12-48 months) for these 15 patients. Results: Radiographic fusion verified by CT scan occurred in 13 of 15 patients. There was significant improvement in pain and all functional outcome score measures. All patients who went on to fusion were satisfied with their surgery. There were 2 failures, consisting of 1 infection and 1 nonunion, with an overall clinical success rate of 87%. Conclusion: These patients demonstrated the successful use of patient-specific 3D-printed titanium implants to treat complex large bony defects, deformities, and arthrodesis procedures. These implants offer surgeons a novel and promising approach to treat both lower extremity pain and deformity that is not always available with current techniques. Level of Evidence: Level IV, retrospective case series.
Thromboembolism and Mortality in the Tasmanian Atrial Fibrillation Study
Authors: Admassie Endalkachew , Chalmers Leanne , Bereznicki Luke R. 
Published: April 2018

Background: Although utilization of anticoagulation in patients with atrial fibrillation (AF) has increased in recent years, contemporary data regarding thromboembolism and mortality incidence rates are limited outside of clinical trials. This study aimed to investigate the impact of the direct oral anticoagulants (DOACs) on the clinical outcomes of patients with AF included in the Tasmanian Atrial Fibrillation Study. Methods: The medical records of all patients with a primary or secondary diagnosis of AF who presented to public hospitals in Tasmania, Australia, between 2011 and 2015, were retrospectively reviewed. We investigated overall thromboembolic events (TEs), ischemic stroke/transient ischemic attack (IS/TIA), and mortality incidence rates in patients admitted to the Royal Hobart Hospital, the main teaching hospital in the state. We compared outcomes in 2 time periods: prior to the availability of DOACs (pre-DOAC; 2011 to mid-2013) and following their general availability after government subsidization (post-DOAC; mid-2013 to 2015). Results: Of the 2390 patients with AF admitted during the overall study period, 942 patients newly prescribed an antithrombotic medication (465 and 477 from the pre-DOAC and post-DOAC time periods, respectively) were followed. We observed a significant decrease in the incidence rates of overall TE (3.2 vs 1.7 per 100 patient-years [PY]; P < .001) and IS/TIA (2.1 vs 1.3 per 100 PY; P = .022) in the post-DOAC compared to the pre-DOAC period. All-cause mortality was significantly lower in the post-DOAC period (2.9 vs 2.2 per 100 PY, P = .028). Increasing age, prior stroke, and admission in the pre-DOAC era were all risk factors for TE, IS/TIA, and mortality in this study population. The risk of IS/TIA was more than doubled (hazard ratio: 2.54; 95% confidence interval: 1.17-5.52) in current smokers compared to ex- and nonsmokers. Conclusion: Thromboembolic event and all-cause mortality rates were lower following the widespread availability of DOACs in this population.
The link between depression and performance on the Symbol Digit Modalities Test: Mechanisms and clinical significance
Authors: Patel Viral P , Feinstein Anthony 
Published: April 2018

Objective: To determine the mechanism and clinical significance of depression-related differences in performance on the Symbol Digit Modalities Test (SDMT). Methods: The influence of depression on two versions of a computerized SDMT (i.e. fixed versus variable code) was assessed. Both versions involve processing speed, but the fixed c-SDMT also encompasses incidental visual memory. Results: Depression was associated with a 19.06% slowing on the variable ( p = 0.002) and an 8.10% slowing on the fixed ( p = 0.219) c-SDMT. Conclusion: Depression-associated differences in performance on the SDMT appear linked more to a reduction in processing speed than a decline in incidental visual memory and exceed the 10% threshold considered clinically significant.
Influence of Body Position on Shoulder and Trunk Muscle Activation During Resisted Isometric Shoulder External Rotation
Authors: Krause David A. , Dueffert Lucas G. , Postma Jaclyn L. , Vogler Eric T. , Walsh Amy J. , Hollman John H. 
Published: April 2018

Background: External rotation (ER) strengthening of the shoulder is an integral component of rehabilitative and preventative programs for overhead athletes. A variety of shoulder ER strengthening exercises are reported, including those intended to integrate the core musculature. The purpose of this study was to examine ER torque and electromyographic (EMG) activation of shoulder and trunk muscles while performing resisted isometric shoulder ER in 3 positions (standing, side lying, and side plank). Hypothesis: Significantly greater force and shoulder muscle activation would be generated while side lying given the inherent stability of the position, and greater trunk muscle activation would be generated in the less stable plank position. Study Design: Quasi-experimental repeated-measures study. Level of Evidence: Level 5. Methods: A convenience sample of 25 healthy overhead recreational athletes (9 men, 16 women) participated in this study. EMG electrodes were placed on the infraspinatus, posterior deltoid, middle trapezius, multifidi, internal obliques, and external obliques. EMG signals were normalized to a maximal isometric contraction. Participants performed resisted isometric ER in standing, side-lying, and side plank positions. Results were analyzed using a repeated-measures analysis of variance with post hoc Bonferroni corrections (α = 0.05). Results: There was no significant difference in ER torque between positions (α = 0.05). A significant difference in EMG activity of shoulder and trunk musculature between positions was found in 7 of the 8 muscles monitored. Significantly greater EMG activity in the infraspinatus, middle trapezius, and the nondominant external and internal obliques was found in the side plank position as compared with standing and side lying. Conclusion: While there was no difference in ER torque between the 3 exercise positions, EMG activity of the shoulder and trunk muscles was dependent on body position. Clinical Relevance: If a clinician is seeking to integrate trunk muscle activation while performing shoulder ER strengthening, the side plank position is preferred as compared with standing or side lying.
Bilateral Central Retinal Vein Occlusion in Idiopathic Pulmonary Arterial Hypertension
Authors: Pham Hang , Akduman Levent , Kavali Sweta 
Published: April 2018

Purpose: To report a case of bilateral central retinal vein occlusion in a young female patient with idiopathic pulmonary arterial hypertension. Methods: Case report and literature review. Patient: A 33-year-old female with a history of idiopathic pulmonary hypertension initially presented with progressive vision loss in the right eye and subsequently presented with vision loss in the left eye 2 weeks later. Results: Clinical examination revealed central retinal vein occlusion (CRVO) in the right eye followed by CRVO in the left eye within 2 weeks as confirmed by clinical examination, fundus photography, spectral domain optical coherence tomography, and fundus fluorescein angiography. Conclusion: Central retinal vein occlusion is an ocular finding associated with pulmonary arterial hypertension and can be bilateral.
The hydrothermal Waterberg platinum deposit, Mookgophong (Naboomspruit), South Africa. Part II: Quartz chemistry, fluid inclusions and geochronology
Authors: van den Kerkhof Alfons M. , Sosa Graciela M. , Oberthür Thomas , Melcher Frank , Fusswinkel Tobias , Kronz Andreas , Simon Klaus , Dunkl István 
Published: April 2018

AbstractThe historic Waterberg platinum deposit, ~15 km WNW of Mookgophong (formerly Naboomspruit), Limpopo Province, South Africa, is a rare fault-bound hydrothermal vein-type quartz-hematite-platinum-group mineralization. As a continuation of the geochemistry and ore mineralogy studies (Part I, Oberthür et al., 2018), this paper concentrates on the ore-bearing quartz and on the age constraints of ore formation. The state-of-the-art methods used include cathodoluminescence microscopy, electron probe microanalysis (EPMA) and laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) of trace elements, stable isotope (δ18O) analysis and fluid-inclusion studies. U-Pb and (U-Th)/He radiometric age determination gave ages of 900–1075 Ma suggesting platinum-group element (PGE) mineralization as a result of upwelling fluids with connection to the Bushveld complex during Kibaran tectonic movements along the Thabazimbi–Murchison Lineament. Felsic fragments containing Qtz-1 were cemented by different quartz generations (Qtz-2 to Qtz-4) and enable the characterization of the changing physicochemical parameters during multistage mineralization and cooling. The PGE minerals are associated with the earliest hydrothermal stage represented by botryoidal radial-fibrous quartz aggregates (Qtz-2a) which formed on brecciated felsite. The other quartz types are essentially barren. Cathodoluminescence studies of quartz indicate very high Al, Fe and K concentrations as confirmed by EPMA and LA-ICP-MS, whereas Ti is always very low. The varying Al concentrations in the quartz mainly indicate pH fluctuations, the high Fe3+ points at high oxygen fugacity. Micro-inclusions of iron oxide are associated with Pt ore (Fe, Pt, Pd, Au, W, Sb, As), rutile, kaolinite and muscovite. The hydrothermal activity must have been characterized by low saline (<10 wt%) H2O–NaCl solutions. These fluids mixed with original high-saline NaCl ± CaCl2 ± CO2 brines in the brecciated felsite (Qtz-1). According to the quartz-hematite geothermometer the ore depositional temperatures were ~370–330°C (Qtz-2a), whereas the successive quartz veins formed during cooling towards ~295°C. The transport of PGE must have been facilitated by strongly oxidizing chloride complexes of relatively low salinity and moderate acidity.
Platinum-group element remobilization and concentration in the Cliff chromitites of the Shetland Ophiolite Complex, Scotland
Authors: O'Driscoll Brian , Garwood Russell , Day James M. D. , Wogelius Roy 
Published: April 2018

ABSTRACTThe ~492 Ma Shetland Ophiolite Complex contains an extensive mantle section, within which numerous podiform chromitite bodies formed during melt percolation in a supra-subduction zone setting. One of the Shetland ophiolite chromitite localities has an unusual style of platinum-group element (PGE) mineralization. Specifically, the Cliff chromitite suite has relatively high (>250 ppm) Pt plus Pd, compared to other chromitites in the Shetland Ophiolite Complex. In this study, we apply petrographic observation, mineral chemistry and novel X-ray microtomography data to elucidate the petrogenesis of PGE-bearing phases at Cliff. The combined datasets reveal that the PGE at Cliff have probably been fractionated by an As-rich fluid, concentrating Pt and Ir into visible (0.1–1 µm) platinum-group minerals (PGM) such as sperrylite and irarsite, respectively. The high (>1 ppm) bulk-rock concentrations of the other PGE (e.g. Os) in the Cliff chromitites suggests the presence of abundant fine-grained unidentified PGM in the serpentinized groundmass. The spatial association of arsenide phases and PGM with alteration rims on Cr-spinel grains suggests that the high Pt and Pd abundances at Cliff result from a late-stage low-temperature (e.g. 200–300°C) hydrothermal event. This conclusion highlights the potential effects that secondary alteration processes can have on modifying and upgrading the tenor of PGE deposits.
The role of JAK2 inhibitors in MPNs 7 years after approval
Authors: Passamonti Francesco , Maffioli Margherita 
Published: April 2018

Abstract
Myeloproliferative neoplasms (MPNs) include essential thrombocythemia, polycythemia vera (PV), and primary myelofibrosis (MF). Phenotype-driver mutations of JAK2, CALR, and MPL genes are present in MPNs and can be variably combined with additional mutations. Driver mutations entail a constitutive activation of the JAK2/STAT pathway, the key signaling cascade in MPNs. Among JAK2 inhibitors (JAKis), ruxolitinib (RUX) has been approved for the treatment of intermediate and high-risk MF and for PV inadequately controlled by or intolerant of hydroxyurea. Other JAKis, such as fedratinib and pacritinib, proved to be useful in MF. The primary end points in MF trials were spleen volume response (SVR) and symptom response, whereas in PV trials they were hematocrit control with or without spleen response. In advanced MF, RUX achieved a long lasting SVR of >35% in ∼60% of patients, establishing a new benchmark for MF treatment. RUX efficacy in early MF is also remarkable and toxicity is mild. In PV, RUX achieved hematocrit control in ∼60% of cases and SVR in 40%. Symptom relief was evident in both conditions. In the long-term, however, many MF patients lose their SVR. Indeed, the definition of RUX failure and the design of new trials in this setting are unmet needs. Decrease of hemoglobin/platelet levels and increased infection rates are the most common side effects of RUX, and nonmelanoma skin tumors need to be monitored while on treatment. In conclusion, the introduction of JAKis raises the bar of treatment goals in MF and PV.
Care in Chronic Obstructive Lung Disease (CAROL): a randomised trial in general practice
Authors: Markun Stefan , Rosemann Thomas , Dalla-Lana Kaba , Steurer-Stey Claudia 
Published: April 2018

Disease management of chronic obstructive pulmonary disease (COPD) is complex and shortcomings in general practice care for COPD are common. A care bundle is a disease management aid used as a reminder and for steering specific elements of care. Our objectives were to test whether a COPD care bundle delivered to general practitioners (GPs) and practice assistants increases the implementation of key elements of COPD care.The study was a cluster-randomised clinical trial, with 1:1 randomisation of GPs and a 1-year follow-up. The intervention introduced a COPD care bundle and aimed at enhancing collaboration between GPs and practice assistants. The control group continued usual care. The primary outcome measure was the composite score from nine key elements of COPD care measured at the patient level.We enrolled 35 GPs and 216 patients with a median age of 69 years, 59% female, 69% Global Initiative for Chronic Obstructive Lung Disease group A or B. After 1 year, the between-group difference in change of the primary outcome measure was +2.2 (95% CI +1.5– +2.9) in favour of the intervention group. The intervention was associated with significantly higher implementation rates in seven out of nine key elements of care.Disease management using a COPD care bundle increased the implementation of key elements of COPD care in general practice.