bluuebunny/crossref_metadata_2025_split huggingface dataset:
Presidents without Roots: Understanding the Peruvian Paradox
Authors: Vergara Alberto , Watanabe Aaron 
Published: May 2019

Peru’s posttransition democracy presents a paradox: presidents have remained unpopular despite presiding over a period in which democratic institutions strengthened and the economy grew rapidly. O’Donnell’s work on delegative democracy suggests that the Peruvian paradox results from weak vertical accountability. Since Peru’s return to democracy, parties and civil society have been too weak to hold elected leaders accountable. Furthermore, presidents have faced opposition to reform from entrenched neoliberal technocrats. With no one holding them accountable and little capacity to govern, presidents have chosen to delegate decision-making authority to technocrats. Even when leaders have won office on reformist platforms, continuity has prevailed, and citizens have lost trust in their elected leaders. The origins of the Peruvian paradox and weak vertical accountability can be traced to the destruction of the institutional and organizational foundations of democracy in the 1990s under Alberto Fujimori’s authoritarian regime. La democracia pos-transición en Perú presenta una paradoja: los presidentes siguen siendo impopulares a pesar de presidir un período en el que las instituciones democráticas se fortalecieron y la economía creció rápidamente. El trabajo de O’Donnell sobre la demo-cracia delegativa sugiere que la paradoja peruana resulta de una débil rendición de cuentas vertical. Desde el retorno de Perú a la democracia, los partidos y la sociedad civil han sido demasiado débiles para responsabilizar a los líderes electos. Además, los presidentes han enfrentado la oposición a la reforma de tecnócratas neoliberales atrincherados. Sin que nadie los responsabilice y con poca capacidad para gobernar, los presidentes han optado por delegar la autoridad en la toma de decisiones a los tecnócratas. Incluso cuando los líderes han sido eligidos en plataformas reformistas, la continuidad ha prevalecido y los ciudadanos han perdido la confianza en sus líderes electos. Los orígenes de la paradoja peruana y la débil rendición de cuentas vertical se remonta a la destrucción de los cimientos institucionales y organizativos de la democracia en la década de 1990 bajo el régimen autoritario de Alberto Fujimori.
Reduction of exposure to plasticizers in stored red blood cell units
Authors: Münch Frank , Göen Thomas , Zimmermann Robert , Adler Werner , Purbojo Ariawan , Höllerer Christine , Cesnjevar Robert Anton , Rüffer André 
Published: May 2019

Introduction: Plastic can be toxic and hazardous to an organism’s health, but it is being widely used in our daily lives. Di-2-ethylhexyl-phthalate is the most common plasticizer in medical devices made of polyvinylchloride and is commonly found in soft bags storing red blood cell units. Di-2-ethylhexyl-phthalate and its degradation product mono-2-ethylhexyl-phthalate can migrate into human body fluids, for example, blood and tissues. The aim of the study was to assess the concentration of plasticizers in red blood cell units according to storage time and after mechanical rinsing using a cell salvage device. Methods: Levels of di-2-ethylhexyl-phthalate and mono-2-ethylhexyl-phthalate were analysed in 50 unwashed red blood cell units using liquid chromatography coupled with tandem mass spectrometry. In addition, phthalate concentrations were measured before and after mechanical rinsing in six more washed red blood cell units with storage times ranging between 36 and 56 days. A linear regression model was determined by the daily increase of di-2-ethylhexyl-phthalate and mono-2-ethylhexyl-phthalate in the stored red blood cell units subject to their storage time (range = 4-38 days), and the effect of mechanical rinsing on their phthalate concentration was calculated. Results: A linear correlation was found between storage time of unwashed red blood cell units and the concentration of di-2-ethylhexyl-phthalate (p < 0.001) or mono-2-ethylhexyl-phthalate (p < 0.001). Stored red blood cell units older than 14 days had significantly higher concentrations of both contaminants than red blood cell units of shorter storage time (p < 0.001). Mechanical rinsing in washed red blood cell units attained a reduction in the di-2-ethylhexyl-phthalate and mono-2-ethylhexyl-phthalate concentration by a median of 53% (range = 18-68%; p = 0.031) and 87% (range = 68-96%; p = 0.031), respectively. Conclusion: Leaching of di-2-ethylhexyl-phthalate and mono-2-ethylhexyl-phthalate into red blood cell units depends on the duration of storage time. Plasticizers can be significantly reduced by mechanical rinsing using cell salvage devices, and thus, red blood cell units can be regenerated with respect to chemical contamination.
Baseball Pitchers’ Perceived Effort Does Not Match Actual Measured Effort During a Structured Long-Toss Throwing Program
Authors: Melugin Heath P. , Larson Dirk R. , Fleisig Glenn S. , Conte Stan , Fealy Stephen A. , Dines Joshua S. , D’Angelo John , Camp Christopher L. 
Published: May 2019

Background: During rehabilitation throwing programs, baseball players are commonly asked to throw at reduced levels of effort (ie, 50% effort, 75% effort, etc) to moderate stress to healing tissues. It is currently unknown how changes in players’ perceived exertion compares with changes in actual exertion during structured long-toss programs. Purpose: To determine whether decreased effort correlates with decreased throwing metrics, whether metrics decrease proportionally with reductions in perceived effort, and to quantify intrathrower variability. Study Design: Descriptive laboratory study. Methods: Sixty male high school and collegiate baseball pitchers participated in a structured throwing program. A motusBASEBALL sleeve was worn by all players, which measured elbow varus torque, arm velocity, arm slot, and shoulder rotation. Ball velocity was measured with a radar gun. Each pitcher threw 5 throws a distance of 120 ft with 3 efforts: maximum effort, 75% effort, and 50% effort. Throwing metrics were compared among the 3 levels of effort to see if each 25% decrease resulted in proportional decreases in elbow varus torque and ball velocity. Intrathrower variability was determined for each throwing metric at each degree of effort. Results: All throwing metrics decreased as players decreased their perceived effort ( P < .001). However, these observed decreases were much smaller in magnitude than the decreases in perceived effort. During the 75% effort throws, elbow varus torque was only reduced to 93% of maximum and velocity dropped to 86% of maximum. Similarly, for the 50% effort throws, elbow varus torque remained 87% of max effort torque, while velocity remained 78% of max. Intrathrower reliability was considered excellent for most metrics (intraclass correlation coefficient, >0.75). Conclusion: For every 25% decrease in perceived effort, elbow varus torque only decreased 7% and velocity only decreased 11%. Thus, when players throw at what they perceive to be reduced effort, their actual throwing metrics do not decrease at the same rate as their perceived exertion. Clinical Relevance: Measured effort decreased with decreasing perceived effort, but these were not proportional. This has significant implications for physical therapists, physicians, trainers, coaches, and athletes to understand and monitor elbow stress during the rehabilitation process.
Care Burden and Mental Ill Health in Spouses of People With Parkinson Disease Dementia and Lewy Body Dementia
Authors: Vatter Sabina , Stanmore Emma , Clare Linda , McDonald Kathryn R. , McCormick Sheree A. , Leroi Iracema 
Published: May 2019

Objectives: To explore and compare levels of mental health, care burden, and relationship satisfaction among caregiving spouses of people with mild cognitive impairment or dementia in Parkinson disease (PD-MCI or PDD) or dementia with Lewy bodies (DLB). Methods: Spouses (n = 136) completed measures of mood, stress, resilience, general health, quality of life, care burden, and relationship satisfaction, as well as sociodemographic factors. Additionally, data on motor and neuropsychiatric symptom severity of people with PD-MCI, PDD, or DLB were obtained in a subsample. Results: Most spouses were married women (>85%) who provided a median of 4 years of care and 84 hours of weekly care. Among these, relationship dissatisfaction, stress, anxiety, care burden, and feelings of resentment were common. Spouses of people with PDD and DLB had significantly higher rates of burden, resentment, and depression compared to spouses of people with PD-MCI. Furthermore, unique group differences emerged whereby spouses of people with PDD had significantly longer duration of care provision, higher stress, more relationship dissatisfaction, and fewer positive interactions, compared to PD-MCI group, whereas anxiety and lower levels of mental health were prominent in spouses of people with DLB, compared to PD-MCI group. Despite this, the majority of spouses reported good quality of life, resilience, and satisfaction with the caring role. Conclusion: Both PDD and DLB significantly contribute to poorer mental health and higher levels of care burden in spouses. Clinicians should actively screen the risk of burden, stress, depression, and anxiety among caregiving spouses of people with these conditions.
Serum ammonia as an early predictor of in-hospital mortality in patients with glufosinate poisoning
Authors: Lee J , Lee Y , Kim YS , Choi JG , Go TH , Kim H , Cha YS 
Published: May 2019

Background: The mortality rate associated with human glufosinate poisoning is high. We evaluated the usefulness of serum ammonia and sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) scores for early prediction of in-hospital mortality in glufosinate ammonium poisoning. Methods: A prospectively collected pesticide poisoning registry at a single academic medical center was retrospectively analyzed. Data were collected from consecutive patients diagnosed with glufosinate ammonium poisoning between May 2007 and February 2018. The initial serum ammonia level was defined as the highest serum ammonia level measured within 12 h after emergency department (ED) arrival. The SOFA and APACHE II scores were calculated using data obtained within the first 12 h after ED arrival. The patients were divided into survivor and nonsurvivor groups by in-hospital death status. Results: In total, 110 patients were included. Ten patients (9.1%) died in the hospital despite treatment. Median initial serum ammonia level was significantly higher in the nonsurvivor group than in the survivor group (219 (range: 158–792) versus 100.5 (range: 25–317) µg/dL, p < 0.001). Median SOFA and APACHE II scores in the survivor and nonsurvivor groups were 2 (range: 0–10) versus 5 (range: 1–8) ( p = 0.044) and 7 (range: 0–28) versus 16 (range: 8–22) ( p = 0.001), respectively. In the multiple logistic regression analysis, the initial serum ammonia level was the only independent predictor (cutoff value: 151 µg/dL). Conclusion: An initial serum ammonia level >151 µg/dL was an independent early predictor of in-hospital mortality in glufosinate ammonium poisoning.
The effect of vascular access type on intra-access flow volume during hemodialysis
Authors: Park Hoon Suk , Kim Woo Jeong , Choi Joonsung , Kim Hyung Wook , Baik Jun Hyun , Kim Young Ok , Park Cheol Whee , Yang Chul Woo , Jin Dong Chan 
Published: May 2019

Introduction: Previous studies have revealed that vascular access resistance is constant during hemodialysis, but differs according to vascular access type. It is possible that intra-access flow volume (Qac) variation during hemodialysis may also differ according to vascular access type. We conducted this study to investigate whether there are differences in Qac according to vascular access type during hemodialysis. Methods: A total of 58 lower-arm arteriovenous fistula, 14 lower-arm arteriovenous graft, 27 upper-arm arteriovenous fistula, and 45 upper-arm arteriovenous graft cases were studied. Three consecutive Qac values (at 30, 120, and 240 min after the start of hemodialysis) were measured in each patient by the ultrasound dilution technique. Variations in Qac over time were analyzed using repeated measures analysis of variance and multivariate regression analyses, to assess the impact of different factors on Qac variation. Results: The repeated measures analysis of variance revealed that a significant interaction exists between time and vascular access type (p < 0.001). This suggests that vascular access type affects Qac change (%) variation over time during hemodialysis. In a multivariate analysis, mean arterial pressure change during hemodialysis (p = 0.009), access type (p < 0.001), and access location (p < 0.001) were independent variables causing Qac change variation. Conclusion: This study showed that there is a significant difference in Qac variation according to vascular access type during hemodialysis and that arteriovenous graft (vs arteriovenous fistula) and the lower-arm location (vs upper arm) were associated with a decrease in Qac during hemodialysis. This suggests that consideration of vascular access type is required to minimize Qac variation during hemodialysis.
Exploration of the Stanford Integrated Psychosocial Assessment for Transplantation With Psychosocial and Medical Outcomes in Kidney and Kidney–Pancreas Transplant Recipients
Authors: Chen Gloria , Bell Cynthia S. , Loughhead Penelope , Ibeche Bashar , Bynon John S. , Hall David R. , De Golovine Aleksandra , Edwards Angelina , Dar Wasim A. 
Published: May 2019

Introduction: The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a psychometric instrument designed to assess patient risk for transplant. We investigated the association between SIPAT scores and demographic data with psychosocial and medical outcomes within a diverse kidney/kidney–pancreas transplant population. Design: The SIPAT was administered to all pretransplant candidates. A retrospective review of transplanted patients who had at least 6 months of follow-up was completed. Results: The sample included 136 patients: male (n = 77 [57%]) with a mean age of 47 years old. Thirty-eight percent were black (n = 51), 55% had less than a high school education (n = 74), and 65% had low socioeconomic status (n = 89). Statistical difference was found among SIPAT scores and substance use and support system instability ( P = .035, P = .012). Females ( P = .012) and patients with a history of psychopathology ( P = .002) developed or had a relapse of psychopathology following transplant. Patients with more than a high school education ( P = .025) and who were less than 30 years ( P = .026) had higher rejection incidence rates. Risk factors for rehospitalizations included Hispanic race, diabetes, and low socioeconomic status ( P = .036, P = .038, P = .014). African American/Black and male patients had higher incidence of infection events ( P = .032, P = .049). Mortality and treatment nonadherence were not significantly associated with SIPAT scores or demographic variables. Conclusion: The SIPAT was associated with posttransplant substance use and support system instability, while demographic variables were associated with the development and/or relapse of psychopathology, graft loss, rejection, infection events, and medical rehospitalizations. Revision of the SIPAT to include additional demographic components may lend to improved prediction of transplant outcomes.
Correlates of Moderate-to-Vigorous Physical Activity and Exercise Motivation in Underserved African American Men
Authors: Abshire Demetrius A. , Wilson Dawn K. , Sweeney Allison M. , Pinto Bernardine M. 
Published: May 2019

Effective interventions are needed to increase physical activity (PA) in African American men, but little is known about correlates of PA and exercise motivation in this population. Using an ecological approach that considers cognitive, social, and environmental factors, correlates of moderate-to-vigorous physical activity (MVPA) and exercise motivation in underserved African American men were examined. Greater exercise motivation, greater social support for exercise, and more favorable environmental perceptions were hypothesized to be associated with higher MVPA, and greater social support and environmental perceptions were hypothesized to be associated with higher exercise motivation. This secondary analysis used baseline data from the Positive Action for Today’s Health (PATH) trial. African American men ( n = 166, aged 48 ± 15 years) completed surveys that assessed cognitive, social, and environmental factors theoretically relevant to MVPA. Accelerometers were used to obtain a 7-day estimate of MVPA. Hierarchical linear regression analyses showed that exercise motivation was positively associated with MVPA ( B = 1.15, SE = .41, p = .006). Exercise attitudes ( B = .16, SE = .07, p = .037), exercise self-concept ( B = .28, SE = .06, p < .001), exercise support from friends ( B = .12, SE = .06, p = .048), and places for walking and cycling ( B = .13, SE = .06, p = .032) were positively associated with exercise motivation. Interventions that improve exercise motivation and associated variables may be warranted to increase MVPA in underserved African American men. ClinicalTrials.gov # NCT01025726
Penehyclidine hydrochloride suppressed peripheral nerve injury-induced neuropathic pain by inhibiting microglial MAPK/p-p38/IL-1β pathway activation
Authors: Zheng Shao-Hua , Yan Chao-Ying , Duan Na , Wang Wei , Mei Xiao-Peng 
Published: May 2019

Background Millions of people suffered from neuropathic pain, which is related to neuroinflammation in the central nervous system. Penehyclidine hydrochloride is a premedication of general anesthesia, which has been confirmed possessing neuroprotective effects against various neurodegenerative or neuroinflammatory diseases. However, it is not clear that whether penehyclidine hydrochloride could suppress neuropathic pain through its anti-neuroinflammatory effects. Methods This study investigated the effects of penehyclidine hydrochloride on rat spinal nerve ligation injury-induced neuropathic pain with behavioral, morphological, and molecular biological methods in animals. Results The results indicated that penehyclidine hydrochloride could attenuate spinal nerve ligation-induced neuropathic pain without any motor impairment and had no effect on sham-operated animals after repeated intraperitoneal administration. Intraperitoneal penehyclidine hydrochloride could suppress spinal nerve ligation-induced ipsilateral spinal dorsal horn microglial activation with downregulation of OX42 expression. Moreover, intraperitoneal penehyclidine hydrochloride inhibited spinal nerve ligation-induced spinal p-p38 mitogen-activated protein kinase expression, which was specially colocalized with the spinal dorsal horn microglia. Furthermore, intraperitoneal penehyclidine hydrochloride could depress spinal neuroinflammation by suppressing spinal nerve ligation-induced interleukin (IL)-1β over-expression. Conclusion These results indicated that the anti-allodynic effects of penehyclidine hydrochloride on spinal nerve ligation-induced neuropathic pain did not rely on motor impairment. Inhibiting spinal microglial p-p38/IL-1β pathway activation might contribute to the anti-allodynic effect of penehyclidine hydrochloride on nerve injury-induced neuropathic pain.
Neoadjuvant zoledronic acid for HER2-positive breast cancer: the Zo-NAnTax trial
Authors: Crocamo Susanne , Binato Renata , de Paula Bruno , Vignal Giselle , Magalhães Lídia , Sarmento Roberta , Accioly Maria Theresa , Small Isabele , Gioia Sandra , Maroun Pedro , Moutinho Pamela , Freitas Vivianne , Catein Karuline , Abdelhay Eliana 
Published: May 2019

Background: Preclinical evidence suggests that zoledronic acid (ZOL) works synergistically with chemotherapy by enhancing anti-tumor activity. ZOL blocks the mevalonate pathway and may indirectly interact with human epidermal growth factor receptor 2 (HER2) pathway activation. The clinical efficacy and biological rationale of chemotherapy plus anti-HER2 therapy and ZOL as a part of neoadjuvant therapy has not been previously tested. Patients and methods: We conducted a phase II clinical trial to evaluate the efficacy and safety of ZOL as part of a neoadjuvant treatment in patients with HER2-positive breast cancer (BC). The protocol consisted of four cycles of doxorubicin/cyclophosphamide with ZOL, followed by four cycles of docetaxel with trastuzumab and ZOL prior to surgery. The primary endpoint was the pathologic complete response (pCR) rate. Secondary endpoints were safety and the identification of clinicopathological characteristics associated with pCR. Results: A total of 71 patients with stage IIA to IIIB BC were included, with 60 eligible for the safety assessment and 58 for the efficacy analysis. Overall, the pCR rate was 42%, with higher rates in hormone receptor (HR)-positive tumors (40%), which contrasts with the results of pivotal trials. The most commonly observed grade 3 and 4 events were febrile neutropenia (grade 3, 20%; grade 4, 3%) and diarrhea (grade 3, 12%). Conclusions: The addition of ZOL as a repositioning drug in neoadjuvant treatment was an effective and well-tolerated therapy. This drug combination might overcome endocrine and anti-HER2 resistance. The higher pCR rates in the HR-positive subgroup deserve further translational investigation.
The Conceptualization of the Natural Environment in Healthcare Facilities: A Scoping Review
Authors: Chi Peggy , Gutberg Jennifer , Berta Whitney 
Published: May 2019

Objectives: To identify how the natural environment (NE) in healthcare has been conceptualized. Background: The NE appears to afford significant therapeutic benefits. A clear concept of the NE in healthcare affords a shared understanding from which to advance science to facilitate comparisons across contexts. In this article, the various meanings of the NE were brought together into one framework by which to map its themes and their relationships. Method: A scoping review was conducted using database searches in MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane for articles published up to July 2018. The bibliography of the included articles were manually searched for published books. Results: This review includes 137 peer-reviewed articles and research-based books from 27 countries. A conceptual framework was developed to identify five themes that conceptualize the NE in healthcare: (1) definitions of the NE in healthcare, (2) processes of the NE in healthcare, (3) usages of the NE in healthcare, (4) opinions about the NE in healthcare, and (5) NE’s impacts on health and work outcomes in healthcare. These themes are filtered by the NE’s physical and programmatic designs; changes in one affect the others. Definitions of the NE are described as human-made space, located in the indoors and outdoors, containing elements of nature and designed with the purpose to positively influence humans. Processes are described as the participatory approach in NE's development and its therapeutic goals. Usages are categorized into nature contact, frequency of usage, and accessibility. Opinions are accounted for by perceptions, preference, and satisfaction. Outcomes are related to physical health, mental health and well-being and work. Conclusions: This framework contributes to the conceptual discussion and emphasizes NE’s complementarity to the biomedical healthcare system.