bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Decision Aid to Promote Appropriate Colorectal Cancer Screening among Older Adults: A Randomized Controlled Trial
Authors: Lewis Carmen L. , Kistler Christine E. , Dalton Alexandra F. , Morris Carolyn , Ferrari Renée , Barclay Colleen , Brewer Noel T. , Dolor Rowena , Harris Russell , Vu Maihan , Golin Carol E. 
Published: May 2018

Background. Concerns have been raised about both over- and underutilization of colorectal cancer (CRC) screening in older patients and the need to align screening behavior with likelihood of net benefit. Objective. The purpose of this study was to test a novel use of a patient decision aid (PtDA) to promote appropriate CRC screening in older adults. Methods. A total of 424 patients ages 70 to 84 y who were not up to date with CRC screening participated in a double-blinded randomized controlled trial of a PtDA targeted to older adults making decisions about whether to undergo CRC screening from March 2012 to February 2015. Intervention. Patients were randomized to a targeted PtDA or an attention control. The PtDA was designed to facilitate individualized decision making—helping patients understand the potential risks, benefits, and uncertainties of CRC screening given advanced age, health state, preferences, and values. Outcomes. Two composite outcomes, appropriate CRC screening behavior 6 mo after the index visit and appropriate screening intent immediately after the visit, were defined as completed screening or intent for patients in good health, discussion about screening with their provider for patients in intermediate health, and no screening or intent for patients in poor health. Health state was determined by age and Charlson Comorbidity Index. Results. Four hundred twelve (97%) and 421 (99%) patients were analyzed for the primary and secondary outcomes, respectively. Appropriate screening behavior at 6 mo was higher in the intervention group (55% v. 45%, P = 0.023) as was appropriate screening intent following the provider visit (61% v. 47%, P = 0.003). Limitations. The study took place in a single geographic region. The appropriate CRC screening classification system used in this study has not been formally validated. Conclusions. A PtDA for older adults promoted appropriate CRC screening behavior and intent. Trial Registration: Clinicaltrials.gov, registration number NCT01575990. https://clinicaltrials.gov/ct2/show/NCT01575990?term=epic-d&rank=1
Back to the rough ground: From predictability to radical uncertainty
Authors: Dalal Farhad 
Published: May 2018

In this article I will begin by thinking about how schools of psychotherapy come to be created, and argue that this is a political process rather than a ‘scientific’, technical or rational one. I describe ways in which practice can at times be unhelpfully rigidified into techniques which are used to build borders between schools. I follow this by a description of how Eliasian gossip is used to reinforce methodological silos. Finally I consider group analysis’ relationship to psychoanalysis, science and the medical model in order to try to shed light on the question ‘one group analysis or many?’.
Risk factors for delayed‐onset rhabdomyolysis in doxylamine succinate intoxication patients
Authors: Lim Ji Yeon , Choi Yoon Hee , Lee Duk Hee , Lee Dong Hoon 
Published: May 2018

Background and Objectives:Patients who overdose on doxylamine, hypnotic agent, usually exhibit good outcomes, but some experience serious complications. Some patients who present with normal creatinine phosphokinase levels in the emergency department later develop rhabdomyolysis during observation. We investigated factors associated with delayed‐onset rhabdomyolysis in patients with doxylamine overdoses.Methods:Our investigation period was between 1 January 2011 and 29 February 2016. The initial blood samples were obtained for arterial blood gas analysis and measurements of the levels of electrolytes, creatinine phosphokinase, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase. Urine analyses including pH and occult blood analyses were performed. Follow‐up samples were obtained at 6 and 12 h after admission. Delayed‐onset rhabdomyolysis was defined by a follow‐up serum creatinine phosphokinase level greater than fivefold the upper limit of normal (>1000 IU/L). Comparisons of categorical variables between groups were performed using either the χ2 or Fisher exact tests. Continuous variables were compared between groups using the Mann–Whitney U test.Results:A total of 337 patients were enrolled. The large amount of ingested doxylamine (odds ratio = 7.002), tachycardia (odds ratio = 2.809), low arterial blood gas analysis pH (odds ratio = 2.267), and presence of occult blood in the urine (odds ratio = 2.048) were significant associated with delayed‐onset rhabdomyolysis.Conclusion:Laboratory follow‐up examinations were required for patients, ingested more than 18 mg/kg doxylamine poisoning, who had pulses exceeding 120 beats/min, had arterial blood gas analysis pH values below 7.3 on blood and urine testing, and/or exhibited the presence of occult blood in the urine, even if the initial creatinine phosphokinase level was normal.
The Role of Palliative Medicine in Assessing Hereditary Cancer Risk
Authors: Abusamaan Mohammed S. , Quillin John Martin , Owodunni Oluwafemi , Emidio Oluwabunmi , Kang In Guk , Yu Brandon , Ma Brittany , Bailey Lauryn , Razzak Rab , Smith Thomas J. , Bodurtha Joann N. 
Published: May 2018

Background: Hereditary cancer assessment and communication about family history risks can be critical for surviving relatives. Palliative care (PC) is often the last set of providers before death. Methods: We replicated a prior study of the prevalence of hereditary cancer risk among patients with cancer receiving PC consultations, assessed the history in the electronic medical record (EMR), and explored patients’ attitudes toward discussions about family history. This study was conducted at an academic urban hospital between June 2016 and March 2017. Results: The average age of the 75 adult patients with cancer was 60 years, 49 (55%) male and 49 (65%) white. A total of 19 (25%) patients had no clear documentation of family history in the EMR, sometimes because no family history was included in the admission template or an automatically imported template lacked content. In all, 24 (32%) patients had high-risk pedigrees that merited referral to genetic services. And, 48 (64%) patients thought that PC was an appropriate venue to discuss the implications of family history. The mean comfort level in addressing these questions was high. Conclusions: At an academic center, 25% of patients had no family history documented in the EMR. And, 32% of pedigrees warranted referral to genetic services, which was rarely documented. There is substantial room for quality improvement for oncologists and PC specialists—often the last set of providers—to address family cancer risk before death and to increase use and ease of documenting family history in the EMR. Addressing cancer family history could enhance prevention, especially among high-risk families.
Clean Colorectum at Diagnostic Colonoscopy: Subsequent Detection of Extracolonic Malignancies by Plasma Protein Biomarkers?
Authors: Wilhelmsen Michael , Christensen Ib J , Jørgensen Lars N , Madsen Mogens R , Vilandt Jesper , Hillig Thore , Klærke Michael , Nielsen Knud T , Laurberg Søren , Gawel Susan , Yang Xiaoping , Davis Gerard , Heijboer Anne Meike , Martens Frans , Nielsen Hans J 
Published: May 2018

Introduction: Most of the subjects undergoing diagnostic colonoscopy do not have neoplastic bowel lesions. Potentially, some of the symptoms may therefore be caused by extracolonic malignancy, and subjects with persisting symptoms may need subsequent examinations. Blood-based, cancer-associated biomarkers may aid in directing the examinations for other specific malignant diseases. Methods: EDTA plasma samples available from a previous prospective study of subjects undergoing diagnostic colonoscopy were used for analysis of 18 protein biomarkers. The study population of 3732 subjects included 400 patients with colorectal cancer (CRC) and 177 patients with extracolonic malignancies. Univariable analysis of the association of specific biomarkers and extracolonic cancers included those with 10 or more cases. Subsequently, reduced models of 4 or 6 biomarkers, respectively, were established by choosing those with the highest likelihood; age and sex were included as well. Results: Univariable analyses showed that CyFra21-1 had an area under curve (AUC) of 0.87 for lung cancers (n = 33), CA19-9 had an AUC of 0.85 for pancreatic cancer (n = 22), CA125 had an AUC of 0.95 for ovary cancer (n = 16), B2M had an AUC of 0.81 for non-Hodgkin lymphoma (n = 12), and total prostate-specific antigen had an AUC of 0.99 for prostate cancer (n = 10). The multivariable analysis of 4 or 6 biomarkers plus age and sex as explanatory variables showed AUCs of 0.82 to 0.85 both for extracolonic cancers and CRC. The 4 biomarkers included in the model for detection of extracolonic cancers were CA125, hsCRP, CA19-9, and CyFra21-1; the 2 additional for the 6 biomarkers model were CEA and Galectin-3. Similarly, the 4 biomarkers included in the model for detection of CRC were CEA, CyFra21-1, Ferritin, and HE4; the two additional for the 6 biomarkers model were hsCRP and Pepsinogen 2. Conclusions: Results of this study indicate that it may be possible to detect subjects that have an increased risk of extracolonic cancer following a colonoscopy without findings of neoplastic lesions. Combinations of various protein biomarkers may direct subsequent examination after colonoscopy with clean colorectum. The results, although preliminary, may form the basis for additional research directed both for primary examinations of subjects with symptoms of malignancy and subsequent examinations after colonoscopy.
Percutaneous Retrieval of IVC Filters With Struts Penetrating the Vertebral Body
Authors: Mohan Prasoon P. , Richardson Andrew J. , Salsamendi Jason T. 
Published: May 2018

Introduction: Inferior vena cava (IVC) filter penetration of the caval wall is a well-documented complication. Less frequently, the struts of an IVC filter can penetrate a vertebral body that can lead to symptoms of abdominal pain. Vertebral penetration poses a management challenge, and characteristics for successful endovascular retrieval of such filters has not been reported. Case Description: We present 2 cases of IVC filters with vertebral body penetration that were successfully retrieved through an endovascular approach. On preprocedure computed tomography, both patients had a small zone of osteolysis surrounding the penetrated struts into the vertebral body. The procedures were done via right internal jugular access using an Ensnare device. In one of the cases, the hangman technique was used to release the filter apex from the vessel wall. Both filters were able to be retrieved without using excessive force, follow-up venacavograms showed no sign of extravasation, and no postprocedure complications developed. Discussion: Preprocedure CT imaging is essential prior to IVC filter removal if vertebral penetration is suspected. The zone of osteolysis seen around the struts in both cases are likely the result of constant cardiorespiratory motion of the filter. Based on the fact that in both cases the filter legs were able to be disengaged from the vertebral body without the use of excessive force, we hypothesize that if a zone of osteolysis surrounding the struts can be confirmed on preprocedural CT, the filter removal can be safely attempted by the standard percutaneous endovascular approach.
Prevalence of frailty syndrome and its associated factors among community-dwelling elderly in East Coast of Peninsular Malaysia
Authors: Mohd Hamidin Fairus Asma , Adznam Siti Nur’Asyura , Ibrahim Zuriati , Chan Yoke Mun , Abdul Aziz Nur Hafizah 
Published: May 2018

Objective: Frailty is a clinical syndrome with increased risk of poor health outcomes and particularly prevalent in older adults and community population. The study’s aim was therefore to determine the prevalence of frailty and its association with sociodemographic and socioeconomic characteristics, health-related status, and anthropometric measurements among community-dwelling older adults. Methods: A total of 279 older adults aged 60 years and above were randomly selected. Respondents were classified as non-frail (<2 criteria) or frail (≥3 criteria) based on the ‘phenotype of frailty’. A binary logistic regression was used to determine predictors of frailty. Results: The prevalence of frailty was 18.3%. The frail older adults were positively associated with advanced age, being unmarried, hospitalisation in the previous year, poor self-rated health, and lower body mass index. Discussion: These results give an overview on underlying effects and guiding actions for prevention programmes functioning to reverse and minimise the adverse effects of frailty syndrome.
Prevalence and use of clinical pathways in 23 countries – an international survey by the European Pathway Association
Authors: Vanhaecht Kris , Bollmann Marcus , Bower Kathy , Gallagher Clare , Gardini Andrea , Guezo Jen , jansen Uwe , Massoud Rashad , Moody Karen , Sermeus Walter , Van Zelm Ruben , Whittle Claire , Yazbeck Anne-Marie , Zander Karen , Panella Massimiliano 
Published: May 2018

Objectives To give an overview on the use and prevalence of clinical pathways. Design Cross-sectional descriptive study. Study participants European Pathway Association (E-P-A) contact persons in 23 countries. Results Clinical pathways, also known as critical pathways or integrated care pathways, have been used in health care for 20 years. Although clinical pathways are well established, little information exists on their use and dissemination around the world. The E-P-A has performed their first international survey on the use and dissemination of clinical pathways in 23 countries. At present, pathways are used with a minority of patients, mainly in acute hospital trusts. Our survey showed that clinical pathways were predominantly viewed as a multidisciplinary tool to improve the quality and efficiency of evidence-based care. Pathways were also used as a communication tool between professionals to manage and standardize outcome-oriented care. Conclusions There is a future for the use of clinical pathways, but there is a need for international benchmarking and knowledge sharing with regard to their development, implementation and evaluation.
Incident Reporting: A Curate's Egg?
Authors: Armitage Gerry , Chapman E Jane 
Published: May 2018

Background Medical errors and adverse events are a source of concern to patients, practitioners and patient safety agencies across the world. The value of incident reporting as a means of improving patient safety has been questioned in the patient safety literature. Aim This paper provides a critical appraisal of incident reporting in the British National Health Service (NHS) as its prominence continues to grow at international, national and local levels. A number of implications are considered through reference to the available literature. Both national and local reporting systems will be discussed, before revisiting two key issues: the safety-information capacity of report data compared with medical record review, and the continued low reporting rate of medical staff. Conclusions While there are powerful drivers behind incident reporting, all of which have potentially beneficent rationales, a growing number of health-care professionals are beginning to question the usefulness of both reporting processes and outcomes. The authors suggest that an analysis of evidence of action taken to improve patient safety following the reporting of an incident would reveal low levels of activity and that, for many practitioners, the risk management activity is perceived as merely the act of reporting itself. Due to the continuing investment of organizational energy and finance into incident reporting, both at local and national level, it is prudent to reflect upon any uncertainties, so that further developments can be approached with confidence as part of the patient safety imperative.
Ketogenic Diet in Refractory Childhood Epilepsy
Authors: Weijenberg Amerins , van Rijn Margreet , Callenbach Petra M. C. , de Koning Tom J. , Brouwer Oebele F. 
Published: May 2018

Background: Ketogenic diet in children with epilepsy has a considerable impact on daily life and is usually adopted for at least 3 months. Our aim was to evaluate whether the introduction of an all-liquid ketogenic diet in an outpatient setting is feasible, and if an earlier assessment of its efficacy can be achieved. Methods: The authors conducted a prospective, observational study in a consecutive group of children with refractory epilepsy aged 2 to 14 years indicated for ketogenic diet. Ketogenic diet was started as an all-liquid formulation of the classical ketogenic diet, KetoCal 4:1 LQ, taken orally or by tube. After 6 weeks, the liquid diet was converted into solid meals. The primary outcome parameter was time-to-response (>50% seizure reduction). Secondary outcome parameters were time to achieve stable ketosis, the number of children showing a positive response, and the retention rate at 26 weeks. Results: Sixteen children were included. Four of them responded well with respect to seizure frequency, the median time-to-response was 14 days (range 7-28 days). The mean time to achieve stable ketosis was 7 days. The retention rate at 26 weeks was 50%. Of the 8 children who started this protocol orally fed, 6 completed it without requiring a nasogastric tube. Conclusions: Introduction of ketogenic diet with a liquid formulation can be accomplished in orally fed children without major complications. It allowed for fast and stable ketosis.
Structural and chemical study of weishanite, (Au,Ag,Hg), from the Keystone mine, Colorado, USA.
Authors: Bindi Luca , Keutsch Frank N. , Lepore Giovanni O. 
Published: May 2018

ABSTRACTStructural data for weishanite, an alloy of Au, Ag and Hg, were collected for the first time from a crystal from the Keystone Mine, Colorado, USA. The structure was solved in the space group P63/mmc with the unit cell a = 2.9348(8) and c = 4.8215(18) Å] and refined to R = 0.0299 for 40 observed reflections [4σ(F) level] and four parameters and to R = 0.0356 for all 47 independent reflections. The weishanite structure can be considered a derivative of the zinc structure, with Au, Ag and Hg disordered in the same structural position. On this basis, we suggest that the formula is normalized to 1 atom with Z = 2, leading, for the sample investigated, to Au0.41Ag0.31Hg0.28 (electron microprobe data). Accordingly, weishanite can be considered the Au-rich isotype of schachnerite. A comparison with other Au/Ag-Hg alloys is presented together with a critical discussion about the nomenclature rules to be applied to alloys and simple metals.
Exceptionally high whole-rock δ18O values in intra-caldera rhyolites from Northeast Iceland
Authors: Berg Sylvia E. , Troll Valentin R. , Harris Chris , Deegan Frances M. , Riishuus Morten S. , Burchardt Steffi , Krumbholz Michael 
Published: May 2018

ABSTRACTThe Icelandic crust is characterized by low δ18O values that originate from pervasive high-temperature hydrothermal alteration by18O-depleted meteoric waters. Igneous rocks in Iceland with δ18O values significantly higher than unaltered oceanic crust (~5.7‰) are therefore rare. Here we report on rhyolitic intra-caldera samples from a cluster of Neogene central volcanoes in Borgarfjörður Eystri, Northeast Iceland, that show whole-rock δ18O values between +2.9 and +17.6‰ (n= 6), placing them among the highest δ18O values thus far recorded for Iceland. Extra-caldera rhyolite samples from the region, in turn, show δ18O whole-rock values between +3.7 and +7.8‰ (n= 6), consistent with the range of previously reported Icelandic rhyolites. Feldspar in the intra-caldera samples (n= 4) show δ18O values between +4.9 and +18.7‰, whereas pyroxene (n= 4) shows overall low δ18O values of +4.0 to +4.2‰, consistent with regional rhyolite values. In combination with the evidence from mineralogy and rock H2O contents, the high whole-rock δ18O values of the intra-caldera rhyolites appear to be the result of pervasive isotopic exchange during subsolidus hydrothermal alteration with18O-enriched water. This alteration conceivably occurred in a near-surface hot spring environment at the distal end of an intra-caldera hydrothermal system, and was probably fed by waters that had already undergone significant isotope exchange with the country rock. Alternatively,18O-enriched alteration fluids may have been produced during evaporation and boiling of standing water in former caldera lakes, which then interacted with the intra-caldera rock suites. Irrespective of the exact exchange processes involved, a previously unrecognized and highly localized δ18O-enriched rock composition exists on Iceland and thus probably within the Icelandic crust too.
Acmonidesite, a new ammonium sulfate chloride from La Fossa crater, Vulcano, Aeolian Islands, Italy
Authors: Demartin Francesco , Castellano Carlo , Campostrini Italo 
Published: May 2018

AbstractThe new mineral acmonidesite, (NH4,K,Pb2+,Na)9Fe42+(SO4)5Cl8, was found in an active fumarole (fumarole FA, temperature ~250°C) at La Fossa crater, Vulcano, Aeolian Islands, Sicily, Italy. It occurs on a pyroclastic breccia as brown prismatic crystals up to 0.10 mm long, in association with salammoniac, alunite and adranosite. The mineral is orthorhombic, space group C2221 (no. 20) with a = 9.841(1), b = 19.448(3) c = 17.847(3) Å, V = 3415.7(9) Å3 and Z = 4. The six strongest reflections in the powder X-ray diffraction pattern are: [dobs in Å(I)(hkl)] 8.766(100)(110), 1.805(88)(390), 5.178(45)(131), 4.250(42)(221), 2.926(42)(330) and 2.684(32)(261). The empirical formula (based on 28 anions per formula unit [pfu]) is (NH4)5.77K1.42Pb0.62Na1.24Fe3.96Mn0.08S5.04O20.16Cl7.97Br0.08. The idealised formula is (NH4,K,Pb2+,Na)9Fe42+(SO4)5Cl8. The calculated density is 2.551 g cm–3. Using single-crystal diffraction data, the structure was refined to a final R(F) = 0.0363 for 4614 independent observed reflections [I > 2σ(I)]. The structure contains two independent, distorted octahedral iron sites, Fe1 and Fe2, with the iron atoms in the 2+ oxidation state, as confirmed by the interatomic distances and bond-valence calculations (2.06 and 1.94 vu, respectively). Fe1 is surrounded by two chlorine atoms and four oxygens of the sulfate ions, with the following average distances (Å): Fe1–O 2.125 and Fe1–Cl 2.472; and Fe2 is surrounded by three chlorine atoms and three oxygens of the sulfate ions, with the following average distances (Å): Fe2–O 2.110 and Fe2–Cl 2.531. Three independent sulfate anions are also present and are connected with the iron polyhedra to form a three-dimensional structure containing voids occupied by four independent ammonium ions (two of them partially replaced by K+), one Na+/Pb2+ site and one Cl– ion.
Lineage tracing of murine adult hematopoietic stem cells reveals active contribution to steady-state hematopoiesis
Authors: Chapple Richard H. , Tseng Yu-Jung , Hu Tianyuan , Kitano Ayumi , Takeichi Makiko , Hoegenauer Kevin A. , Nakada Daisuke 
Published: May 2018

Key Points
HSCs contribute robustly to steady-state hematopoiesis. Platelets receive extensive influx from HSCs compared with other myeloid or lymphoid cells.