bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures
Authors: Coffman Joseph , Tran Thanh , Quast Troy , Berlowitz Michael S , Chae Sanders H 
Published: June 2019

BackgroundPreoperative testing before low-risk procedures remains overutilised. Few studies have looked at factors leading to increased testing. We hypothesised that consultation to a cardiologist prior to a low-risk procedure leads to increased cardiac testing.Methods and results907 consecutive patients who underwent inpatient endoscopy/colonoscopy at a single academic centre were identified. Of those patients, 79 patients (8.7%) received preoperative consultation from a board certified cardiologist. 158 control patients who did not receive consultation from a cardiologist were matched by age and gender. Clinical and financial data were obtained from chart review and hospital billing. Logistic and linear regression models were constructed to compare the groups. Patients evaluated by a cardiologist were more likely to receive preoperative testing than patients who did not undergo evaluation with a cardiologist (OR 47.5, (95% CI 6.49 to 347.65). Specifically, patients seen by a cardiologist received more echocardiograms (60.8% vs 22.2%, p<0.0001) and 12-lead electrocardiograms (98.7% vs 54.4%, p<0.0001). There was a higher rate of ischaemic evaluations in the group evaluated by a cardiologist, but those differences did not achieve statistical significance. Testing led to longer length of stay (4.35 vs 3.46 days, p=0.0032) in the cohort evaluated by a cardiologist driven primarily by delay to procedure of 0.76 days (3.14 vs 2.38 days, p=0.001). Estimated costs resulting from the longer length of stay and increased testing was $10 624 per patient. There were zero major adverse cardiac events in either group.ConclusionPreoperative consultation to a cardiologist before a low-risk procedure is associated with more preoperative testing. This preoperative testing increases length of stay and cost without affecting outcomes.
Cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI in Thailand: a randomised trial
Authors: Chotechuang Yotsawee , Phrommintikul Arintaya , Kuanprasert Srun , Muenpa Roungtiva , Patumanond Jayanton , Chaichuen Tuanchai , Sukonthasarn Apichard 
Published: June 2019

BackgroundThe benefit of an early coronary intervention after streptokinase (SK) therapy in low to intermediate-risk patients with ST-elevation myocardial infarction (STEMI) still remains uncertain. The current study aimed to evaluate the cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI after successful therapy with SK.MethodsWe randomly assigned low to intermediate Global Registry of Acute Coronary Events risk score to patients with STEMI who had successful treatment with full-dose SK at Lampang Hospital and Maharaj Nakorn Chiang Mai Hospital into early and delayed coronary intervention groups. The primary endpoints were 30-day and 6-month composite cardiovascular outcomes (death, rehospitalised with acute coronary syndrome, rehospitalised with heart failure and stroke).ResultsOne hundred and sixty-two patients were included in our study. At the 30 days, composite cardiovascular outcomes were 4.9% in the early coronary intervention group and 2.5% in the delayed group (p=0.682). At the 6 months, the composite cardiovascular outcomes were 16.1% in the early group and 6.2% in the delayed group (p=0.054).ConclusionsThe delayed coronary intervention (>24 hours) in low to intermediate STEMI after successful therapy with SK did not increase in short and long-term cardiovascular events compared with an early coronary intervention.Trial registration numberNCT02131103.
Redistributing medical resources for a bypass strategy for large vessel occlusion: a community-based study
Authors: Liu Ting-Yu , Wang Chun-Han , Chiang Wen-Chu , Tang Sung-Chun , Tsai Li-Kai , Lee Chung-Wei , Jeng Jiann-Shing , Ma Matthew Huei-Ming , Hsieh Ming-Ju , Lee Yu-Ching 
Published: June 2019

BackgroundA bypass strategy for large vessel occlusion (LVO) benefits patients receiving endovascular thrombectomy (EVT), but may delay some patients from receiving IV thrombolysis. However, patient centralization has been shown to improve outcomes.ObjectiveTo understand the current coverage of medical services for patients with stroke, and to identify the best coverage under different medical resource redistribution to help balance medical equality and patient centralization.MethodsThis 6-year geographic study of 7679 on-scene patients with suspected stroke with a positive Cincinnati Prehospital Stroke Scale (CPSS) score identified 4037 patients with all three CPSS items who were suspected as having an LVO. Geographic, population, and patient coverage rates for hospitals providing IV thrombolysis and those providing EVT were identified according to hospital service areas, defined as geographic districts with access to a hospital within a ≤15 min off-peak driving time estimated using Google Maps. Moreover, we estimated the effects on resource redistribution when implementing a bypass strategy.ResultsGeographic coverage rates for hospitals providing IV thrombolysis and those providing EVT were 64.75% and 56.62%, respectively, and population coverage rates were 97.30% and 92.72%, respectively. The service areas of hospitals providing IV thrombolysis covered 93.77% of patients with suspected stroke, and those of hospitals providing EVT covered 87.89% of patients with suspected LVO. The number of hospitals providing IV thrombolysis and those providing EVT could be reduced to six and two hospitals, respectively, without affecting hospital arrival time when implementing a bypass strategy.ConclusionHospitals providing IV thrombolysis and EVT could be reduced without reducing medical equality.
Associations between vaginal bacteria implicated in HIV acquisition risk and proinflammatory cytokines and chemokines
Authors: Sabo Michelle C , Lehman Dara A , Wang Bingjie , Richardson Barbra A , Srinivasan Sujatha , Osborn Lusi , Matemo Daniel , Kinuthia John , Fiedler Tina L , Munch Matthew M , Drake Alison L , Fredricks David N , Overbaugh Julie , John-Stewart Grace , McClelland R. Scott , Graham Susan M 
Published: June 2019

ObjectivesRecent studies have identified vaginal bacterial taxa associated with increased HIV risk. A possible mechanism to explain these results is that individual taxa differentially promote cervicovaginal inflammation. This study aimed to explore relationships between concentrations of bacteria previously linked to HIV acquisition and vaginal concentrations of proinflammatory cytokines and chemokines.MethodsIn this cross-sectional analysis, concentrations of 17 bacterial taxa and four proinflammatory cytokines (interleukin (IL)-1β, IL-6, IL-10 and tumour necrosis factor alpha (TNFα)) and two proinflammatory chemokines (IL-8 and interferon gamma-induced protein 10) were measured in vaginal swabs collected from 80 HIV-uninfected women. Cytokine and chemokine concentrations were compared between women with bacterial concentrations above or below the lower limit of detection as determined by quantitative PCR for each taxon. Principal component analysis was used to create a summary score for closely correlated bacteria, and linear regression analysis was used to evaluate associations between this score and increasing concentrations of TNFα and IL-1β.ResultsDetection ofDialister micraerophilus(p=0.01),Eggerthellasp type 1 (p=0.05) orMycoplasma hominis(p=0.03) was associated with higher TNFα concentrations, and detection ofD. micraerophilus(p<0.01), Eggerthellasp type 1 (p=0.04), M. hominis(p=0.02) orParvimonassp type 2 (p=0.05) was associated with significantly higher IL-1β concentrations. Seven bacterial taxa (D. micraerophilus,Eggerthellasp type 1,Gemella asaccharolytica, Sneathiasp,Megasphaerasp,M. hominisandParvimonassp type 2) were found to be highly correlated by principal component analysis (eigenvalue 5.24, explaining 74.92% of variability). Linear regression analysis demonstrated associations between this principal component and concentrations of TNFα (β=0.55, 95% CI 0.01 to 1.08; p=0.048) and IL-1β (β=0.96, 95% CI 0.19 to 1.74; p=0.016).ConclusionsThis study provides evidence that several highly correlated vaginal bacterial taxa may influence vaginal cytokine and chemokine concentrations. These results suggest a mechanism where the presence of specific bacterial taxa could influence HIV susceptibility by increasing vaginal inflammation.
Physical Activity, Sitting Time, and Risk of Myelodysplastic Syndromes, Acute Myeloid Leukemia, and Other Myeloid Malignancies
Authors: Rees-Punia Erika , Patel Alpa V. , Fallon Elizabeth A. , Gapstur Susan M. , Teras Lauren R. 
Published: June 2019

Abstract

Introduction:
There is limited research on associations of moderate-to-vigorous physical activity (MVPA) and sitting with risk of myeloid neoplasms (MN) or MN subtypes. We examined these associations in the Cancer Prevention Study-II Nutrition Cohort.

Methods:
Among 109,030 cancer-free participants (mean age 69.2, SD 6.1 years) in 1999, 409 were identified as having been diagnosed with a MN [n = 155 acute myeloid leukemia (AML), n = 154 myelodysplastic syndromes (MDS), n = 100 other ML] through June 2013. Cox proportional hazards regression was used to calculate multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations of MVPA (MET-h/wk) and sitting (h/d) with risk of all MN, myeloid leukemia only, MDS, and AML.

Results:
Compared with insufficient MVPA [&gt;0–&lt;7.5 metabolic equivalent hours/week (MET)-h/wk], the HR (95% CI) for meeting physical activity guidelines (7.5–&lt;15 MET-h/wk MVPA) and risk of MN was 0.74 (95% CI, 0.56–0.98) and for doubling guidelines (15–&lt;22.5 MET-h/wk) was 0.75 (0.53–1.07); however, there was no statistically significant association for higher MVPA (22.5+ MET-h/wk, HR, 0.93; 95% CI, 0.73–1.20). Similarly, meeting/doubling guidelines was associated with lower risk of MDS (HR, 0.57; 95% CI, 0.35–0.92/HR, 0.51; 95% CI, 0.27–0.98), but there was no association for 22.5+ MET-h/wk (HR, 0.93; 95% CI, 0.63–1.37). MVPA was not associated with risk of myeloid leukemia or AML. Sitting time was not associated with risk of any outcome.

Conclusions:
These results suggest that there may be a nonlinear association between MVPA and risk of MDS and possibly other MN.

Impact:
Further studies are needed to better understand the dose–response relationships between MVPA and risk of MDS, a highly fatal and understudied cancer.
High-Risk HPV Testing in Primary Screening for Cervical Cancer in the Public Health System, São Paulo, Brazil
Authors: Levi José Eduardo , Martins Toni Ricardo , Longatto-Filho Adhemar , Cohen Diane Dede , Cury Lise , Fuza Luiz Mario , Villa Luisa L. , Eluf-Neto José 
Published: June 2019

Abstract
Every year there are approximately 16,000 new cases of cervical cancer in Brazil. Novel screening technologies may reduce this number by expanding the population coverage but also by improving the detection rate of precursor lesions. We aimed to evaluate human papillomaviruses (HPV)-DNA testing in the context of routine cervical cancer screening in the public health system of the city of São Paulo, Brazil. Women participating in the primary screening program were invited to enroll. Liquid-based cytology samples were collected and cytology and Hr-HPV DNA testing were performed in parallel. Cytologists were blind to HPV results. Women older than 24 years with a positive high-risk HPV test and/or cytology class ≥ ASC-US were referred to colposcopy. From December 2014 to December 2016, 16,102 women joined the study. High-risk human papillomavirus (HR HPV) DNA prevalence was 14.9%, whereas cytologic abnormalities were found in 7.2% of the women. Per protocol, 1,592 Hr-HPV+ women, in addition to 72 patients with cytologic classification &gt; low-grade squamous intraepithelial lesion (LSIL) were referred. A total of 80 cervical intraepithelial neoplasia (CIN2+) cases were diagnosed, 79 were Hr-HPV DNA+ and 18 had normal cytology. Hr-HPV DNA detected a significant number of patients with premalignant lesions missed by cytology and all 16 CIN3+ cases were Hr-HPV DNA+. HPV genotyping may be useful in the management of Hr-HPV+ women, reducing the burden of colposcopic referral for those harboring genotypes with a weaker association to CIN3+. Use of HPV-DNA testing was shown to be feasible and advantageous over current cytologic screening in the public health system.
Cross-Species Single-Cell Analysis of Pancreatic Ductal Adenocarcinoma Reveals Antigen-Presenting Cancer-Associated Fibroblasts
Authors: Elyada Ela , Bolisetty Mohan , Laise Pasquale , Flynn William F. , Courtois Elise T. , Burkhart Richard A. , Teinor Jonathan A. , Belleau Pascal , Biffi Giulia , Lucito Matthew S. , Sivajothi Santhosh , Armstrong Todd D. , Engle Dannielle D. , Yu Kenneth H. , Hao Yuan , Wolfgang Christopher L. , Park Youngkyu , Preall Jonathan , Jaffee Elizabeth M. , Califano Andrea , Robson Paul , Tuveson David A. 
Published: June 2019

AbstractCancer-associated fibroblasts (CAF) are major players in the progression and drug resistance of pancreatic ductal adenocarcinoma (PDAC). CAFs constitute a diverse cell population consisting of several recently described subtypes, although the extent of CAF heterogeneity has remained undefined. Here we use single-cell RNA sequencing to thoroughly characterize the neoplastic and tumor microenvironment content of human and mouse PDAC tumors. We corroborate the presence of myofibroblastic CAFs and inflammatory CAFs and define their unique gene signatures in vivo. Moreover, we describe a new population of CAFs that express MHC class II and CD74, but do not express classic costimulatory molecules. We term this cell population “antigen-presenting CAFs” and find that they activate CD4+ T cells in an antigen-specific fashion in a model system, confirming their putative immune-modulatory capacity. Our cross-species analysis paves the way for investigating distinct functions of CAF subtypes in PDAC immunity and progression.Significance:Appreciating the full spectrum of fibroblast heterogeneity in pancreatic ductal adenocarcinoma is crucial to developing therapies that specifically target tumor-promoting CAFs. This work identifies MHC class II–expressing CAFs with a capacity to present antigens to CD4+ T cells, and potentially to modulate the immune response in pancreatic tumors.See related commentary by Belle and DeNardo, p. 1001.This article is highlighted in the In This Issue feature, p. 983
Comparative Evaluation of 10 Prehospital Triage Strategy Paradigms for Patients With Suspected Acute Ischemic Stroke
Authors: Schlemm Ludwig , Endres Matthias , Scheitz Jan F. , Ernst Marielle , Nolte Christian H. , Schlemm Eckhard 
Published: June 2019

Background
The best strategy to identify patients with suspected acute ischemic stroke and unknown vessel status (large vessel occlusion) for direct transport to a comprehensive stroke center instead of a nearer primary stroke center is unknown.

Methods and Results
We used mathematical modeling to estimate the impact of 10 increasingly complex prehospital triage strategy paradigms on the reduction of population‐wide stroke‐related disability. The model was applied to suspected acute ischemic stroke patients in (1) abstract geographies, and (2) 3 real‐world urban and rural geographies in Germany. Transport times were estimated based on stroke center location and road infrastructure; spatial distribution of emergency medical services calls was derived from census data with high spatial granularity. Parameter uncertainty was quantified in sensitivity analyses. The mothership strategy was associated with a statistically significant population‐wide gain of 8 to 18 disability‐adjusted life years in the 3 real‐world geographies and in most simulated abstract geographies (net gain −4 to 66 disability‐adjusted life years). Of the more complex paradigms, transportation of patients with clinically suspected large vessel occlusion based on a dichotomous large vessel occlusion detection scale to the nearest comprehensive stroke center yielded an additional clinical benefit of up to 12 disability‐adjusted life years in some rural but not in urban geographies. Triage strategy paradigms based on probabilistic conditional modeling added an additional benefit of 0 to 4 disability‐adjusted life years over less complex strategies if based on variable cutoff scores.

Conclusions
Variable stroke severity cutoff scores were associated with the highest reduction in stroke‐related disability. The mothership strategy yielded better clinical outcome than the drip‐‘n'‐ship strategy in most geographies.
Names as Rewards
Authors: Beretta Marco 
Published: June 2019

Abstract
Contemporary scientific terminology is populated by thousands of eponyms, technical terms derived from the names of discoverers and inventors. Since the ultimate goals of scientific language are precision and objectivity, the ever increasing use of eponyms is puzzling. Eponyms betray the inherent contradiction between the supposed neutrality and anonymity of scientific discourse and individual vindication. The systematic use of eponyms has resulted in one of the most effective reward systems in Western science. Moreover, it is interesting to note that eponyms do not represent a recent form of recognition; their genealogy can be traced back to classical antiquity, in particular to the Hellenistic era and as a feature of the scientific lexicon they have undergone surprisingly little change over more than two millennia. In my essay I explore the genealogy of scientific eponyms and their cultural background and I shall focus my attention on classical and early modern science. During classical antiquity the use of eponyms served an important dual purpose, on the one hand paying tribute to those individuals who, by dint of their discoveries and written works, gained eminence in a specific field of enquiry, and on the other hand helping to map the historical geography of a discipline and thus establish its boundaries as well as its future prospects. During the Renaissance, with the rediscovery of the classics and the reaffirmation of the cultural value of science and technology, the coining of eponyms gained unprecedented momentum and proliferated in most disciplines.
Rewarding Science in Ancient Greece and Rome
Authors: Cuomo Serafina 
Published: June 2019

Abstract
This paper surveys some of the ancient Greek and Roman evidence regarding rewards for science and scientists. It discusses Platonist views on whether science ought to be its own reward, and possible alternatives to such views. It concludes that a variety of attitudes existed on the issue in antiquity, and that they can be understood in terms of the social and economic status of ancient science practitioners.
Between Criminalization and Protection
Authors: Militello Vincenzo , Spena Alessandro 
Published: June 2019

AbstractThis double issue is focused on migrant smuggling and human trafficking. Both subjects are mainly treated from an Italian perspective; however, since these crimes have a generally transnational character, the analysis also takes international (UN) and supranational (EU) measures into account. Moreover, in both parts, the legal perspective is supplemented by the phenomenological/criminological one (based on both media reports and judicial case-studies), so as to grasp the practical aspects emerging from the different ways in which migrant smuggling and human trafficking are de facto committed: in particular, the links between these two and other crimes are underscored, as well as the involvement of criminal organizations in their perpetration. Finally, both parts are driven by a human rights-oriented approach, which gives relevance to dignity of persons as a fundamental meta-value of our legal systems.
The Onset of the Indonesian–Australian Summer Monsoon Triggered by the First-Branch Eastward-Propagating Madden–Julian Oscillation
Authors: Duan Yongliang , Liu Hongwei , Yu Weidong , Liu Lin , Yang Guang , Liu Baochao 
Published: June 2019

AbstractThe Madden–Julian oscillation (MJO) often causes the onset of the Indonesian–Australian summer monsoon (IASM) over Indonesia and northern Australia. In the present study, a composite analysis is conducted to reveal the detailed IASM onset process and its air–sea interactions associated with the first-branch eastward-propagating MJO (FEMJO) based on 30-yr ERA-Interim data, satellite-derived sea surface temperature (SST), outgoing longwave radiation (OLR), and SODA3 ocean reanalysis. The results distinctly illustrate the phase-locked relationships among the persistent sea surface warming north of Australia, the FEMJO, and the established westerlies. It is found that the SST to the north of Australia reaches its annual maximum just before the onset of the summer monsoon. The oceanic surface mixed layer heat budget discloses that this rapid warming is primarily produced by the enhanced surface heat flux. In addition, this premonsoon sea surface warming increases the air specific humidity in the low-level troposphere and then establishes zonal moisture asymmetry relative to the FEMJO convection. This creates a more unstable atmospheric stratification southeast of the FEMJO and favors convection throughout the vicinity of northern Australia, which ultimately triggers the onset of the IASM. The results in this study thus may potentially be applicable to seasonal monsoon climate monitoring and prediction.
Deep Learning for Spatially Explicit Prediction of Synoptic-Scale Fronts
Authors: Lagerquist Ryan , McGovern Amy , Gagne II David John 
Published: June 2019

AbstractThis paper describes the use of convolutional neural nets (CNN), a type of deep learning, to identify fronts in gridded data, followed by a novel postprocessing method that converts probability grids to objects. Synoptic-scale fronts are often associated with extreme weather in the midlatitudes. Predictors are 1000-mb (1 mb = 1 hPa) grids of wind velocity, temperature, specific humidity, wet-bulb potential temperature, and/or geopotential height from the North American Regional Reanalysis. Labels are human-drawn fronts from Weather Prediction Center bulletins. We present two experiments to optimize parameters of the CNN and object conversion. To evaluate our system, we compare the objects (predicted warm and cold fronts) with human-analyzed warm and cold fronts, matching fronts of the same type within a 100- or 250-km neighborhood distance. At 250 km our system obtains a probability of detection of 0.73, success ratio of 0.65 (or false-alarm rate of 0.35), and critical success index of 0.52. These values drastically outperform the baseline, which is a traditional method from numerical frontal analysis. Our system is not intended to replace human meteorologists, but to provide an objective method that can be applied consistently and easily to a large number of cases. Our system could be used, for example, to create climatologies and quantify the spread in forecast frontal properties across members of a numerical weather prediction ensemble.