bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary Middle Ear Mucosal Melanoma: Case Report and Comprehensive Literature Review of 21 Cases of Primary Middle Ear and Eustachian Tube Melanoma
Authors: Maxwell Anne K. , Takeda Hiroki , Gubbels Samuel P. 
Published: August 2018

Objective: To present a case of primary middle ear mucosal melanoma and perform a comprehensive literature review of middle ear and eustachian tube mucosal melanoma. Patient: A 61-year-old female presented with no prior history of melanoma and 3 months of aural fullness. A middle ear mass demonstrated primary mucosal melanoma. The mass extended from mesotympanum into hypotympanum, epitympanum, protympanum, eustachian tube, and mastoid antrum. Additionally, a nonenhancing expansile lesion of the petrous apex was noted on magnetic resonance imaging. Intervention: Subtotal temporal bone resection with transotic approach to the petrous abnormality was performed. Postoperative adjuvant radiation and immunotherapy were given. Results: Five months postoperatively, the patient developed an isolated cutaneous metastatic focus treated with wide local excision and has had no further evidence of recurrence to date. Upon comprehensive literature review, patients with primary middle ear melanomas (n = 10) present with otorrhea (50%), aural fullness (40%), and hearing loss (30%) most commonly, while hearing loss (81.8%) and aural fullness (54.5%) were the most common presenting symptoms for eustachian tube melanomas (n = 11). Patients were treated with combinations of surgery, radiation, and/or chemotherapy. Middle ear melanoma demonstrated particularly poor outcomes, with 70% mortality, 20% local recurrence, and 50% distant metastasis, whereas eustachian tube origin demonstrated 9.1%, 18.2%, and 36.4%, respectively. Conclusions: Middle ear and eustachian tube mucosal melanomas are exceedingly rare, with middle ear melanomas demonstrating a worse prognosis. Multimodality therapy is commonly used; however, outcomes are poor, with high mortality among affected patients.
Titles of Contention: Sociocultural Change and Conflict over Legalization of Indigenous Lands in Southeastern Ecuador
Authors: Márquez Porras Raúl , Eguiguren Riofrío María Beatriz , Vera Vera Ana 
Published: August 2018

Shuar communities in southeastern Ecuador are receiving collective property titles to their ancestral lands. This is being done as a way to guarantee their material and cultural survival, but the titling triggers sociocultural changes and conflict and its outcomes depend largely on the way it is implemented. The consequences of the titling process in communities in Nangaritza and El Pangui in which Shuar, Saraguro, and mestizos coexist include both tensions and informal arrangements to resolve the historically conflictive issue of access to the land. Las comunidades Shuar en el sureste de Ecuador están recibiendo títulos de propiedad colectiva de sus tierras ancestrales. Esto se está haciendo como una forma de garantizar su supervivencia material y cultural, pero la titulación desencadena cambios y conflictos socioculturales y sus resultados dependen en gran medida de la forma en que se implemente. Las consecuencias del proceso de titulación en comunidades de Nangaritza y El Pangui en las que cohabitan Shuar, Saraguro y mestizos incluyen tensiones y arreglos informales para resolver el problema histórico del acceso a la tierra.
New and Improved? 21st Century Cures Act Revisions to Certificates of Confidentiality
Authors: Wolf Leslie E. , Beskow Laura M. 
Published: August 2018

Certificates of Confidentiality (“Certificates”) are a federal legal tool designed to protect sensitive, identifiable research data from compelled disclosure. Congress first authorized their use in 1970 to facilitate research on illegal drug use. The scope of their use was later expanded to cover mental health research and then again to apply broadly to identifiable, sensitive research data, regardless of topic. Certificates can be critical to enabling conduct of essential research on sensitive topics, such as effective interventions to curb the opioid epidemic or reduce HIV transmission among minority youth. Nevertheless, there have been criticisms about Certificates and their use on several grounds. For example, researchers and institutional review boards (“IRBs”) may lack sufficient knowledge about them and, therefore, may not consider using them in studies for which they would be appropriate. In contrast to other protections, such as Department of Justice Privacy Certificates, Certificate protections were not automatically extended to these studies, but instead required an application. In addition, the concept of identifiable data had not kept up with technological changes that may allow for reidentification of data previously considered unidentifiable. Although a researcher who obtained a Certificate could use it to resist a legal demand for identifiable data, little was known about the actual effectiveness of the protection provided.The 21st Century Cures Act substantially revises the Certificates authorizing statute, and many of the changes are directly responsive to the criticisms that have been raised. Significantly, the Secretary of the Department of Health and Human Services (“HHS”) must issue Certificate protection to federally funded research involving identifiable, sensitive research data, and the National Institutes of Health (“NIH”) will automatically include such protections to research it funds. Non-federally funded researchers can continue to apply for Certificate protection. The definition of identifiable has been expanded to include data “for which there is at least a very small risk” of identification. Certificates will now not only protect against compelled disclosure, but also render protected data inadmissible in legal proceedings without participant consent. In addition, voluntary disclosure is no longer authorized, but there is now a broad exception for disclosure as required by federal, state, and local laws. In this paper, based on our previous research on Certificates, we critically evaluate the 21st Century Cures Act's Certificates revisions and their positive and negative impact on the dual goals of facilitating important, sensitive research while maximally protecting individual research participants.
Association of BMI Changes Between Adolescence and Young Adulthood With Smoking Cessation
Authors: Walker Jerome F. , Loprinzi Paul D. 
Published: August 2018

Purpose: Weight gain frequently accompanies smoking cessation. This study examined if increasing body mass index (BMI) during the early years of smoking influences quitting by young adulthood. Design: Longitudinal, observational study using in-home interview data. Setting: National Longitudinal Study of Adolescent and Adult Health (Add Health) 1994 to 2008. Subjects: Nine hundred forty-nine adolescent smokers (12-19 years) followed into young adulthood (20-32 years) through 4 waves of in-home interviews. Measures: Outcome variable: Young adult smoking status (yes or no) reported at in-home interviews. Factors: Gender and 4 longitudinal adolescent/young adult BMI trajectories—normal/normal, normal/overweight, normal/obese, and overweight/obese. Covariates: Race-ethnicity, education, household income, and recent quit attempt in adolescence. Analysis: Binary logistic regression analysis. Results: Overall, the rate at which young adults quit smoking was not significantly different based on gender. However, longitudinal changes in BMI trajectory and gender interact to influence young adult smoking status. Women having normal/overweight and normal/obese BMI trajectories were less likely to quit smoking than men. Odds that young adults having some college or post-high school education quit smoking were greater than those with high school education or less. Conclusion: At a minimum, providing direct information regarding anticipated weight changes after quitting is indicated in smoking cessation intervention, in addition to strategies to mitigate postcessation weight gain. Faced with weight gain, younger smokers, particularly women, may be more resistant to quitting smoking.
Effect of Patiromer in Hyperkalemic Patients Taking and Not Taking RAAS Inhibitors
Authors: Kloner Robert A. , Gross Coleman , Yuan Jinwei , Conrad Ansgar , Pergola Pablo E. 
Published: August 2018

Introduction: Hyperkalemia (potassium >5.0 mEq/L) affects heart failure patients with renal disease regardless of the use of renin–angiotensin–aldosterone system inhibitors (RAASi). The open-label TOURMALINE study showed that patiromer, a sodium-free, nonabsorbed potassium binder, lowers serum potassium of hyperkalemic patients similarly when given with or without food; unlike prior studies, patients were not required to be taking RAASi. We conducted post hoc analyses to provide the first report of patiromer in patients not taking RAASi. Methods: Hyperkalemic patients received patiromer, 8.4 g/d to start, adjusted to achieve and maintain serum potassium of 3.8 to 5.0 mEq/L. If taking RAASi, stable doses were required. The primary end point was the proportion of patients with serum potassium 3.8 to 5.0 mEq/L at week 3 or 4. This analysis presents data by patients taking or not taking RAASi. Results: Demographics and baseline characteristics were similar in patients taking (n = 67) and not taking RAASi (n = 45). Baseline mean (SD) serum potassium was 5.37 (0.37) mEq/L and 5.42 (0.43) mEq/L in patients taking and not taking RAASi, respectively. Mean (SD) daily patiromer doses were similar (10.7 [3.2] and 11.5 [4.0] g, respectively). The primary end point was achieved in 85% (95% confidence interval [CI]: 74-93) of patients taking RAASi and in 84% (95% CI: 71-94) of patients not taking RAASi. From baseline to week 4, the mean (SE) change in serum potassium was −0.67 (0.08) mEq/L in patients taking RAASi and −0.56 (0.10) mEq/L in patients not taking RAASi (both P < .0001 vs baseline, P = nonsignificant between groups). Adverse events were reported in 26 (39%) patients taking RAASi and 25 (54%) not taking RAASi; the most common adverse event was diarrhea (2% and 11%, respectively; no cases were severe). Five patients (2 taking RAASi) reported 6 serious adverse events; none considered related to patiromer. Conclusions: Patiromer was effective and generally well-tolerated for hyperkalemia treatment, whether or not patients were taking RAAS inhibitors.
Leading from the top: Evaluation and impact of an educational programme for Directors of Infection Prevention and Control (DIPC) within the Independent Healthcare Sector (IS)
Authors: Millward Sue 
Published: August 2018

Background: The Director of Infection Prevention and Control (DIPC) role was introduced into the UK in 2003 to address the need for effective leadership within Infection Prevention (IP). The role was embedded in English legislation in 2008. In one Independent healthcare organisation (with 31 acute hospitals spread geographically across the UK), the DIPC role is held by the hospital matron (known as Director of Nursing in the NHS), who influence resource allocation and ensure infection prevention is prioritised. A knowledge gap in microbiology, standard precautions and infection prevention regulatory requirements was identified and as there was no educational provision for this role, an accredited programme was developed. Twenty-five matrons completed the DIPC programme. Aims: Evaluate the impact of a DIPC educational programme on the delivery of IP services. Methodology: A post-course qualitative retrospective survey using open-ended questions was used to collect data from DIPCs who had completed the programme. Inductive thematic and content analysis methods were used to identify key themes from survey responses. Results: Out of 20 DIPCs, 16 completed the survey. Key findings included improvements in knowledge related to microbiology, IP and regulatory requirements of the DIPC role. DIPCs reported changes to service delivery including appointment of six IP nurses, improved surveillance processes, reduced infections and improved cleanliness standards. This small study demonstrates the impact of an educational programme for DIPCs who felt more empowered to manage the IP services effectively, resulting in improved patient safety through reduced infections.
Infectious Disease in Contact Sports
Authors: Peterson Andrew R. , Nash Emma , Anderson B.J. 
Published: August 2018

Context: Infections are common in contact sports. This review aims to describe the epidemiology, presenting signs and symptoms, treatment guidelines, and regulations for several common infections seen in contact sport athletes. The conditions discussed include bacterial skin infections, herpes simplex virus, molluscum contagiosum, common warts, tinea, scabies, head lice, conjunctivitis, human immunodeficiency virus, hepatitis C virus, and vaccine-preventable illnesses. Evidence Acquisition: Searches were performed across PubMed and MEDLINE research databases. In addition, general internet search engine results and reviews of reference lists of relevant papers were used to identify additional sources of evidence. Study Design: Clinical review. Level of Evidence: Level 4. Results: The most common infections seen in contact sport athletes include bacterial skin infections, herpes simplex virus, molluscum contagiosum, common warts, tinea, scabies, head lice, conjunctivitis, and vaccine-preventable illnesses. Other infections, including human immunodeficiency virus and hepatitis C, are uncommon but potentially life threatening. Conclusion: Infections are common in contact sport athletes. The provider who cares for these athletes should be aware of the most common infections and their appropriate management. Early diagnosis and appropriate clinical management are important for treating the infected athlete, minimizing risk of transmission, minimizing time lost from competition, and preventing large outbreaks.
Reducing delays in the diagnosis and treatment of muscle-invasive bladder cancer using simulation modelling
Authors: Chalk Daniel , Trent Neil , Vennam Sarath , McGrane John , Mantle Mark 
Published: August 2018

Objective: To develop a simulation model to identify key bottlenecks in the bladder cancer pathway at Royal Cornwall Hospital and predict the impact of potential changes to reduce these delays. Materials and methods: The diagnosis and treatment of muscle-invasive bladder cancer can suffer numerous delays, which can significantly affect patient outcomes. We developed a discrete event computer simulation model of the flow of patients through the bladder cancer pathway at the hospital, using anonymised patient records from 2014 and 2015. The changes tested in the model were for patients suspected to have muscle-invasive disease on flexible cystoscopy. Those patients were ‘fast-tracked’ to receive their transurethral resection of bladder tumour (TURBT) treatment using operating slots kept free for these patients. A staging computed tomography scan was booked in the haematuria clinic. Pathology requests were marked as 48 hour turnaround. The nurse specialist would then speak to the patient whilst they were on the ward following their TURBT to give information about their ongoing treatment and provide support. Results: The model predicted that if the changes were implemented, delays in the system could be reduced by around 5 weeks. The changes were implemented, and analysis of 3 months of the data post-implementation shows that the average time in the system was reduced by 5 weeks. The environment created by the changes in the pathway improved referral to treatment times in both muscle-invasive and non-muscle-invasive groups. Conclusion: The simulation model proved an invaluable tool for facilitating the implementation of changes. Simple changes to the pathway led to significant reductions in delays for bladder cancer patients at Royal Cornwall Hospital. Level of evidence: Not applicable for this cohort study.
How Long Does It Take for Patients to Complete PROMIS Scores? An Assessment of PROMIS CAT Questionnaires Administered at an Ambulatory Sports Medicine Clinic
Authors: Kadri Omar , Jildeh Toufic R. , Meldau Jason E. , Blanchett Jacob , Borowsky Peter , Muh Stephanie , Moutzouros Vasilios , Makhni Eric C. 
Published: August 2018

Background: Challenges exist in routinely collecting patient-reported outcomes (PROs) from patients at a busy ambulatory clinic. A number of validated Patient-Reported Outcomes Measurement Information System (PROMIS) subdomains allow for efficient PRO administration. Purpose: To determine the time to completion (TTC) of 3 PROMIS computer adaptive test (CAT) scores. CAT questionnaires were administered at the ambulatory clinic with the following PROMIS subdomains: Pain Interference (PI), Depression, and Physical Function for lower extremity (PF) or for upper extremity (UE). The secondary purpose was to determine the influence of patient demographic factors on TTC. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients were recruited from 3 fellowship-trained upper extremity and sports medicine orthopaedic surgery clinics. PROMIS CAT questionnaires were administered to consecutive patients during the study period (July 2017–September 2017). The start and completion times of each CAT were recorded. The primary outcome of interest was TTC of the questionnaires. Patients were stratified into age quartiles to determine the impact of age on TTC. Patient demographic information, such as sex, race, and ethnicity, was determined retroactively. Results: A total of 1178 questionnaire sets consisting of 3658 individual PROMIS forms were analyzed. The mean TTC was 3.29 minutes for all 4 forms in aggregate, with PROMIS PI, PF, UE, and Depression taking on average 1.05, 0.74, 0.96, and 0.57 minutes to complete, respectively. Patients from the oldest age quartile (mean ± SD, 70.3 ± 7.5 years) had a statistically significant longer TTC as compared with the second quartile (41.2 ± 4.7 years) (3.70 vs 2.87 minutes; P < .05). Asian patients had the longest PROMIS PF TTC, while white patients completed PF with the shortest TTC (1.28 vs 0.68 minutes; P < .05). Patients of unstated ethnicity had a longer TTC for PF as compared with their Hispanic/Latino and non-Hispanic/Latino counterparts (0.91 vs 0.30 and 0.70 minutes; P < .05). Conclusion: PROMIS CAT forms are efficient tools for collecting patient-reported outcomes in the ambulatory orthopaedic surgery clinic. Older patients, Asian patients, and patients of unstated ethnicity took longer to complete the forms.
Severity of diabetic retinopathy at the first ophthalmological examination in the Lebanese population
Authors: Harb Walid , Harb Georges , Chamoun Nabil , Kanbar Anthony , Harb Marc , Chanbour Wassef 
Published: August 2018

Aim: To determine the percentage and stage of diabetic retinopathy at the first ophthalmological examination after the patient’s diagnosis with type 2 diabetes mellitus. Methods: A retrospective descriptive study was conducted at ‘Clinique du Levant’ hospital between 2006 and 2016. A total of 484 randomly selected patients were included. Data were collected and analyzed for selected variables (sex, age, sources of referral, and duration of diabetes). Results: In total, 119 (24.6%) patients had diabetic retinopathy. Among them, 43 had proliferative diabetic retinopathy (8.9%). About 16.7% of the included patients had macular edema, which was severe in 6.2%. The average age of patients was 62.1 years with an average of 8.3 years of diabetes. About 55% were men, while 45% were women. The patients with no referral source presented 8.9 years after the onset of diabetes, whereas patients referred by general practitioners and secondary medical professionals presented after 5.8 and 5 years, respectively ( p < 0.05), but they represented only 23.2% of diabetics. Women presented earlier than men (7.3 versus 9.1 years; p = 0.012). About 82.6% were symptomatic, 44.1% had a visual impairment on Snellen charts that was severe in 11.2%. Also, 37.8% of the patients had a visually significant cataract. The duration of diabetes was the only dependent variable, p < 0.0001. The average age, sources of referral, and sex were not related to the severity of retinopathy. Conclusion: Diabetics with a more severe diabetic retinopathy are presenting late to the ophthalmology clinics. There is a need to promote outreach programs for people with diabetes for early detection of diabetic retinopathy in Lebanon.
Aloe barbadensis Miller leaf exudate is a potential treatment for bovine mastitis
Authors: Fiordalisi Samira de Aquino Leite , Honorato Luciana Aparecida , Kuhnen Shirley 
Published: August 2018

Background: Aloe barbadensis Miller is a well-known phytotherapeutic, and parts of its leaves are used for a wide range of medicinal purposes. This study seeks to assess the in vitro antimicrobial and cytotoxic effects of leaf exudate (LE) from A. barbadensis leaves against Staphylococcus aureus and MAC-T bovine mammary epithelial cells. Methods: Seasonal LE samples were collected, and the effect on total phenolic and aloin contents was determined. Antimicrobial activity of LE was evaluated using the broth microdilution method, and toxicity to MAC-T cells was determined by MTT assay. Results: Samples collected during different seasons of the year showed a seasonal effect on the chemical profile of LE (P<0.05). However, despite these chemical variations, we found no differences in antimicrobial activity against S. aureus. For all studied samples, the minimum inhibitory concentration (MIC) was 1,000 µg/ml. Furthermore, we found an elevated cytotoxic effect of LE on MAC-T cells with a significant reduction in cellular viability at 7.8 µg/ml (P<0.05) and an IC50 of 91.89 µg/ml. Conclusions: Despite the antimicrobial effects of LE, the high toxicity for MAC-T cells suggests that it is unsuitable for intramammary use, but does have potential as a topical antimicrobial.
Novel molecular and cell biological insights into function of rice α-amylase
Authors: Mitsui Toshiaki , Ochiai Akihito , Yamakawa Hiromoto , Kaneko Kentaro , Kitajima-Koga Aya , Baslam Marouane 
Published: August 2018

Abstract
α-Amylases have been of interest in diverse fields for many years because of their importance in basic biology, agriculture, and industry. Starch hydrolysis in plants has been studied extensively in germinating cereal seeds. It is generally accepted that α-amylases are secretory enzymes with a pivotal role in the breakdown of starch reserves in the endosperm. Intriguingly, however, recent investigations reveal that some α-amylases degrade starch in the plastids of living cells. The recent solving of the crystal structure of rice AmyI-1 isoform shows that the binding pocket of starch binding site 1 situated outside of the active site cleft interacts with the substances other than oligosaccharides. These findings provided novel insights into structural and cell biological aspects of α-amylase functions in intracellular transport, organelle targeting, and organ-specific actions. Under global warming, abnormal high temperatures during rice grain filling increase grain chalkiness, resulting in yield loss. Intensive “omics” analyses of developing caryopses and mature grains grown under heat stress showed the downregulation of starch synthesis enzymes and the upregulation of α-amylases. Transgenic studies using ectopic overexpression and suppression of α-amylase revealed that α-amylase is a key factor in grain chalkiness. Here we discuss unique new functions of α-amylase in rice cells.