bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contributions of Stereopsis and Aviation Experience to Simulated Rotary Wing Altitude Estimation
Authors: Hartle Brittney , Sudhama Aishwarya , Deas Lesley M. , Allison Robert S. , Irving Elizabeth L. , Glaholt Mackenzie G. , Wilcox Laurie M. 
Published: June 2019

Objective We examined the contribution of binocular vision and experience to performance on a simulated helicopter flight task. Background Although there is a long history of research on the role of binocular vision and stereopsis in aviation, there is no consensus on its operational relevance. This work addresses this using a naturalistic task in a virtual environment. Method Four high-resolution stereoscopic terrain types were viewed monocularly and binocularly. In separate experiments, we evaluated performance of undergraduate students and military aircrew on a simulated low hover altitude judgment task. Observers were asked to judge the distance between a virtual helicopter skid and the ground plane. Results Our results show that for both groups, altitude judgments are more accurate in the binocular viewing condition than in the monocular condition. However, in the monocular condition, aircrew were more accurate than undergraduate observers in estimating height of the skid above the ground. Conclusion At simulated altitudes of 5 ft (1.5 m) or less, binocular vision provides a significant advantage for estimation of the depth separation between the landing skid and the ground, regardless of relevant operational experience. However, when binocular cues are unavailable aircrew outperform undergraduate observers, a result that likely reflects the impact of training on the ability to interpret monocular depth cues.
Expanding Access: Cost‐effectiveness of Cochlear Implantation and Deaf Education in Asia
Authors: Emmett Susan D. , Sudoko Chad K. , Tucci Debara L. , Gong Wenfeng , Saunders James E. ,   Global HEAR (Hearing Loss Evaluation, Advocacy, and Research) Collaborative:, Akhtar Nasima , Bhutta Mahmood F. , Touch Sokdavy , Pradhananga Rabindra Bhakta , Mukhtar Nadeem , Martinez Norberto , Martinez Frances Dianne , Ramos Hubert , Kameswaran Mohan , Kumar Raghu Nandhan Sampath , Soekin Soekirman , Prepageran Narayanan 
Published: June 2019

ObjectiveTo determine the cost‐effectiveness of cochlear implantation (CI) with mainstream education and deaf education with sign language for treatment of children with profound sensorineural hearing loss in low‐ and lower‐middle income countries in Asia.Study DesignCost‐effectiveness analysis.SettingBangladesh, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, and Sri Lanka participated in the study.Subjects and MethodsCosts were obtained from experts in each country with known costs and published data, with estimation when necessary. A disability‐adjusted life‐years model was applied with 3% discounting and 10‐year length of analysis. A sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost‐effectiveness was determined with the World Health Organization standard of cost‐effectiveness ratio per gross domestic product (CER/GDP) per capita <3.ResultsDeaf education was cost‐effective in all countries except Nepal (CER/GDP, 3.59). CI was cost‐effective in all countries except Nepal (CER/GDP, 6.38) and Pakistan (CER/GDP, 3.14)—the latter of which reached borderline cost‐effectiveness in the sensitivity analysis (minimum, maximum: 2.94, 3.39).ConclusionDeaf education and CI are largely cost‐effective in participating Asian countries. Variation in CI maintenance and education‐related costs may contribute to the range of cost‐effectiveness ratios observed in this study.
Evaluation of qSOFA as a Predictor of Mortality Among ICU Patients With Positive Clinical Cultures—A Retrospective Cohort Study
Authors: Kelly Barry , Patlak Johann , Shaefi Shahzad , Boone Dustin , Mueller Ariel , Talmor Daniel 
Published: June 2019

Objective: To compare the discriminative value of the quick-sequential organ failure assessment score (qSOFA) to SOFA in a critically ill population, in which a microbial pathogen was isolated within 48 hours of admission to intensive care. Design: Retrospective cohort study. Setting: Academic tertiary referral center from July 2008 to June 2017. Patients: Hospitalized patients admitted to intensive care unit. Interventions: None. Measurements and Main Results: The primary outcome was in-hospital mortality for all patients with confirmed positive microbiological cultures within 48 hours of admission to intensive care unit (ICU). Subgroup analysis was performed on patients with pathogenic bacteremia or positive cultures in cerebrospinal fluid. Of the 11 415 patients analyzed with positive microbiology specimens within 48 hours of admission, 2933 (25.7%) had a qSOFA ≥2. Of these, 16.6% reached the primary outcome of in-hospital mortality. Unsurprisingly, the discriminative value of qSOFA on admission was significantly worse than that of SOFA (0.73 vs 0.76; P = .0004), despite observing a significant association between qSOFA category and in-hospital mortality ( P < .0001). In secondary analyses, similar observations were found using qSOFA within 6 and 24 hours of ICU admission. When analysis was focused on patients with pathogenic bacteremia or positive cerebrospinal fluid (CSF) cultures (n = 1646), there was no significant difference between the discriminative value of qSOFA and SOFA (0.75 vs 0.78; P = .17). Conclusions: Quick-sequential organ failure assessment score at admission was not superior to SOFA in predicting in-hospital mortality in patients with positive clinical cultures within 48 hours of admission to ICU. Quick-sequential organ failure assessment score at admission to the ICU was associated with mortality and showed reasonable calibration and discrimination. When the analysis was focused on patients with pathogenic bacteremia or positive CSF cultures, qSOFA performed similarly to SOFA in discriminatory those who will die from sepsis.
Reliability, feasibility and satisfaction of telemedicine evaluations for cervical dystonia
Authors: Fraint Avram , Stebbins Glenn T. , Pal Gian , Comella Cynthia L. 
Published: June 2019

Introduction Telemedicine is used successfully for evaluating patients with neurologic diseases, but has not been tested in cervical dystonia (CD). CD is uniquely suited for telemedicine as the scales validated to assess its severity rely only on visual inspection. The study sought to determine reliability, feasibility and satisfaction of telemedicine visits for evaluating CD. Methods Patients 18 years and older with a diagnosis of CD and scheduled for botulinum toxin (BoNT) injections were recruited, with a total of 46 enrolled. Dystonia severity was evaluated using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) motor severity subscale. Three total evaluations took place: an initial telemedicine evaluation on the day prior to a scheduled BoNT injection; an in-person evaluation in clinic immediately before injections; and a follow-up telemedicine visit 4–6 weeks after injection with subsequent completion, by both participants and the clinician, of satisfaction questionnaires. Agreement between telemedicine and in-person TWSTRS data was calculated using intra-class correlation coefficients (ICC) and kappa statistics where appropriate. Feasibility was determined by the percent of patients completing all three visits, and satisfaction with telemedicine visits was determined based on answers to satisfaction questionnaires. Results There was excellent agreement between visit types for the TWSTRS motor severity summary score (κ = 0.890; 95th CI 0.713; 0.949). Only two individual TWSTRS items failed to meet the threshold for moderate agreement. Feasibility and satisfaction were high. Discussion Telemedicine is reliable and feasible in the evaluation of CD. Some CD patients would prefer telemedicine visits. Participants and the clinician were satisfied with telemedicine visits.
The irreversible HCV-associated risk of gastric cancer following interferon-based therapy: a joint study of hospital-based cases and nationwide population-based cohorts
Authors: Chen Chun-Wei , Cheng Jur-Shan , Chen Tai-Di , Le Puo-Hsien , Ku Hsin-Ping , Chang Ming-Ling 
Published: June 2019

Background: Hepatitis C virus (HCV) infection causes many extrahepatic malignancies; whether it increases gastric cancer risk and the risk reverses after anti-HCV therapy remain elusive. Method: A nationwide population-based cohort study of Taiwan National Health Insurance Research Database (TNHIRD) was conducted. In parallel, the risk factors and HCV-core-protein expressions were surveyed in gastric cancer patients from a tertiary care center. Results: From 2003 to 2012, of 11,712,928 patients, three 1:4:4, propensity-score-matched TNHIRD cohorts including HCV-treated (7545 patients with interferon-based therapy ⩾ 6 months), HCV-untreated ( n = 30,180), and HCV-uninfected cohorts ( n = 30,180) were enrolled. The cumulative incidences of gastric cancer [HCV-treated: 0.452%; 95% confidence interval (CI): 0.149–1.136%; HCV-untreated: 0.472%; 95% CI: 0.274–0.776%; HCV-uninfected: 0.146%; 95% CI 0.071–0.280%] were lowest in HCV-uninfected cohort ( p = 0.0028), but indifferent between treated and untreated cohorts. HCV infection [hazards ratio (HR): 2.364; 95% CI: 1.337–4.181], male sex (HR: 1.823; 95% CI: 1.09–3.05) and age ⩾ 49 years (HR: 3.066; 95% CI: 1.56–6.026) were associated with incident gastric cancers. Among 887 (males: 68.4%; mean age: 66.5 ± 12.9 years, 2008–2018) hospitalized gastric cancer patients, HCV Ab-positive rate was 7.8%. None of the investigated factors exhibited different rates between HCV Ab-positive and Ab-negative patients. No HCV-core-positive cells were demonstrated in gastric cancer tissues. Conclusions: HCV infection, male sex and old age were risk factors for gastric cancer development. HCV-associated gastric cancer risk might be neither reversed by interferon-based therapy, nor associated with in situ HCV-core-related carcinogenesis.
Neuroimaging markers of clinical progression in chronic inflammatory demyelinating polyradiculoneuropathy
Authors: Pitarokoili Kalliopi , Sturm Dietrich , Labedi Adnan , Greiner Tineke , Eitner Lynn , Kumowski Nina , Enax-Krumova Elena K. , Fisse Anna Lena , Maier Christoph , Gold Ralf , Tegenthoff Martin , Schmidt-Wilcke Tobias , Yoon Min-Suk 
Published: June 2019

Background: One of the main goals of novel, noninvasive imaging techniques like high-resolution nerve ultrasound (HRUS) and corneal confocal microscopy (CCM) is the prediction of treatment response for patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Methods: A total of 17 patients with CIDP were examined prospectively at baseline and every 9 months over a period of 18 months using CCM to quantify corneal nerve degeneration markers and immune cell infiltration as well as HRUS to detect changes of the cross-sectional area (CSA) of the peripheral nerves. Additionally, skin biopsy of the distal and proximal leg as well as quantitative sensory testing were performed at the first follow-up visit. Results: A value of more than 30 total corneal cells/mm2 in CCM at baseline identified patients with clinical progression with a sensitivity/specificity of 100% in our cohort. Corneal nerve fiber density and length remained low and stable over the study period and intra-epidermal fiber density was markedly reduced in the majority of the patients. Furthermore, an increase in Bochum ultrasound score (BUS), which summarizes the CSA of the ulnar nerve in Guyons’ canal, the ulnar nerve in the upper arm, the radial nerve in the spiral groove and the sural nerve between the gastrocnemius muscle, and a maximum BUS of 4 at study initiation identified patients with disease progression (sensitivity 80%, specificity 88%). Conclusions: BUS and corneal total cell infiltration seem to represent early markers for clinical progression in CIDP, thus having the potential to identify at-risk patients and impact treatment decisions.
Optimizing Ambulance Transport of Hemodialysis Patients to the Emergency Department: A Cohort Study
Authors: Vinson Amanda J. , Bartolacci John , Goldstein Judah , Swain Janel , Clark David , Kiberd Bryce , Tennankore Karthik K. 
Published: June 2019

Background: Dialysis patients who require ambulance transport to the emergency department (“ambulance-ED”) may subsequently require timely dialysis in a monitored setting (“urgent dialysis”). Objective: The purpose of this study was to develop and internally validate a risk prediction model for urgent dialysis based on patient characteristics at the time of paramedic assessment before ambulance-ED. Design: Cohort Study Setting: Region of Nova Scotia, Canada, covered by a single emergency medical services provider Patients: Thrice-weekly hemodialysis patients who initiated dialysis between 2009 and 2013 (follow-up to 2015) and experienced one or more ambulance-ED events. Measurements: The primary outcome (“urgent dialysis”) was defined as dialysis within 24 hours of an ambulance-ED in a monitored setting or dialysis within 24 hours of an ambulance-ED with an initial ED potassium of >6.5 mmol/L. Predictors of urgent dialysis based on paramedic assessment before ambulance-ED included presenting complaint, vital signs and time from last dialysis to ambulance dispatch. Methods: Associations with urgent dialysis were analyzed using logistic regression from which a risk prediction model was created. The model was internally validated using bootstrapping and model performance was assessed by discrimination and calibration. Results: Among 197 patients, there were 624 ambulance-ED events and 87 episodes of urgent dialysis. Weakness as a presenting complaint (odds ratio [OR]: 4.62, 95% confidence interval [CI]: 1.23-17.29), >24 hours since last dialysis (OR: 2.09, 95% CI: 1.15-3.81), and vital signs, including heart rate <60 beats/minute (OR: 3.06, 95% CI: 1.09-8.61), oxygen saturation <90% (OR: 3.04, 95% CI: 1.55-5.94), elevated respiratory rate (≥20 breaths/min), and systolic blood pressure>160 mmHg, were associated with urgent dialysis after ambulance-ED. A risk prediction model incorporating these variables had very good discrimination (C-statistic: 0.81, 95% CI: 0.76-0.86). The negative predictive value was 93.6% using the optimal cut point. Of patients who were predicted to need urgent dialysis but were transported to a facility incapable of providing it, 31% were re-transported for urgent dialysis. Limitations: Findings of our study may not be generalizable to other centers where the practice of ambulance transfer and availability of monitored dialysis may differ, and data were lacking for potential missed dialysis sessions or changes in routine dialysis scheduling. Conclusions: Patient characteristics at the time of paramedic assessment are associated with urgent dialysis after ambulance-ED. This risk prediction model has the potential to guide dialysis patient transport to dialysis-capable facilities when needed.
The Relationship Between BMI and Stability of Intertrochanteric Fracture Following Low-Energy Falls. A Retrospective Cohort Study
Authors: Irving Devan , Hinkley Jacob , Marquart Matthew 
Published: June 2019

Introduction: Intertrochanteric proximal femur fractures are common injuries in the elderly. Certain patterns are considered unstable and confer increased risks. Risk factors for these patterns are not well defined. We sought to determine whether increased body mass index (BMI) was associated with increased risk of sustaining an unstable pattern intertrochanteric (IT) fracture following low-energy trauma. Materials and methods: Retrospective case review of all patients presenting to a level-2 trauma center between October 2010 and August 2014 with Intertrochanteric fracture. Fracture pattern (stable or unstable) and BMI were analyzed using odds ratios and age was controlled for. Results: Four hundred fifty-two patients were identified. No difference was found between fracture stability when BMI of 25 was used as a cutoff. However, when a BMI of 30 was used as a cutoff, there was a trend of difference (relative difference 30%) in rates of fracture type favoring unstable patterns in the obese group. This difference approached but did not reach statistical significance ( P = .08). When adjusted for age, the difference remained but still did not reach statistical significance ( P = .11). Discussion: Unstable type IT fractures were found more frequently in the obese cohort (BMI >30) than those who were not obese.
Evaluation of orthotic insoles for people with diabetes who are at‐risk of first ulceration
Authors: Martinez‐Santos Ana , Preece Stephen , Nester Christopher J. 
Published: June 2019

AbstractObjectiveThis study focussed on pressure relieving orthotic insoles designed for retail footwear and people with diabetes and at risk of first forefoot ulceration. The aim was to investigate whether the pressure relieving effects of a customised metatarsal bar and forefoot cushioning are sensitive to bar location and shape, and material choice.Research design and methodsPatient‐specific foot shape was used to design an orthotic insole, with metatarsal bar location and shape customised according to plantar pressure data. Changes in forefoot plantar pressure were investigated when 60 people with diabetes and neuropathy walked in nine variants of the orthotic insole. These comprised three variations in proximal/distal location of the customised metatarsal bar and three different metatarsal head offloading materials.Results & conclusionsThe most frequent reductions in pressure occurred when the anterior edge of the metatarsal bar was placed at 77% of the peak pressure values, and its effects were independent of the choice of EVA or Poron offloading material. In the flat insole, 61% of participants had one or more metatarsal head areas with pressure above the 200 KPa, reducing to 58% when adopting generic orthotic design rules and 51% when using the best orthotic insole of the nine tested. Our results confirm that plantar pressure relief is sensitive to orthotic insole design decisions and individual patient feet.
Combination chemotherapy of valproic acid (VPA) and gemcitabine regulates STAT3/Bmi1 pathway to differentially potentiate the motility of pancreatic cancer cells
Authors: Li Hehe , Zhang Zhengle , Gao Chenggang , Wu Shihong , Duan Qingke , Wu Heshui , Wang Chunyou , Shen Qiang , Yin Tao 
Published: June 2019

Abstract
Background
Gemcitabine is the standard first-line chemotherapy regimen for pancreatic cancer. However, its therapeutic value is substantially limited in pancreatic cancer patients due to occurrence of resistance towards gemcitabine. A strategy of combined chemo-regimens is widely employed in clinical settings in attempt to reduce the chance of developing therapeutic resistance. Valproic acid (VPA) has been reported as a promising anticancer drug in various clinical trials and studies. However, the clinical value and potential dose–effect of VPA in combination with gemcitabine for pancreatic cancer treatment are under investigated.

Results
In this study, we determined the synergistic effect of VPA and gemcitabine and found that high-dose VPA significantly and dose-dependently enhanced the sensitivity of pancreatic cancer cells to gemcitabine. Intriguingly, low-dose VPA potentiated the migration and invasion of pancreatic cancer cells that already showed gemcitabine-induced motility. Moreover, low-dose VPA increased the reactive oxygen species (ROS) production, which activated AKT to further stimulate the activation of STAT3, Bmi1 expression and eventually promoted the migration and invasion of pancreatic cancer cells induced by gemcitabine. Whereas high-dose VPA stimulated excessive ROS accumulation that promoted p38 activation, which suppressed the activation of STAT3 and Bmi1.

Conclusion
Pancreatic cancer cells respond differentially towards low- or high-dose of VPA in combination with gemcitabine, and a low VPA further potentiate pancreatic cancer cell to migrate and invade. Our results suggest that STAT3/Bmi1 signaling cascade, which is regulated by ROS-dependent, AKT- or p38-modulated pathways, primarily mediated the sensitivity and motility of pancreatic cancer cells towards combined gemcitabine and VPA regimen. These findings suggest a highly clinically relevant new mechanism of developing resistance against combined chemo-regimens, warranting further mechanistic and translational exploration for VPA in combination with gemcitabine and other chemotherapies.
Deletion of the Homeodomain Protein Six6 From GnRH Neurons Decreases GnRH Gene Expression, Resulting in Infertility
Authors: Pandolfi Erica C , Tonsfeldt Karen J , Hoffmann Hanne M , Mellon Pamela L 
Published: June 2019

AbstractHypothalamic GnRH (luteinizing hormone–releasing hormone) neurons are crucial for the hypothalamic-pituitary-gonadal (HPG) axis, which regulates mammalian fertility. Insufficient GnRH disrupts the HPG axis and is often associated with the genetic condition idiopathic hypogonadotropic hypogonadism (IHH). The homeodomain protein sine oculis–related homeobox 6 (Six6) is required for the development of GnRH neurons. Although it is known that Six6 is specifically expressed within a more mature GnRH neuronal cell line and that overexpression of Six6 induces GnRH transcription in these cells, the direct role of Six6 within the GnRH neuron in vivo is unknown. Here we find that global Six6 knockout (KO) embryos show apoptosis of GnRH neurons beginning at embryonic day 14.5 with 90% loss of GnRH neurons by postnatal day 1. We sought to determine whether the hypogonadism and infertility reported in the Six6KO mice are generated via actions within the GnRH neuron in vivo by creating a Six6-flox mouse and crossing it with the LHRHcre mouse. Loss of Six6 specifically within the GnRH neuron abolished GnRH expression in ∼0% of GnRH neurons. We further demonstrated that deletion of Six6 only within the GnRH neuron leads to infertility, hypogonadism, hypogonadotropism, and delayed puberty. We conclude that Six6 plays distinct roles in maintaining fertility in the GnRH neuron vs in the migratory environment of the GnRH neuron by maintaining expression of GnRH and survival of GnRH neurons, respectively. These results increase knowledge of the role of Six6 in the brain and may offer insight into the mechanism of IHH.
Photochromic Performance of 5-Heteroaryl-4-vinyl-2-phenylthiazole Derivatives
Authors: Takami Shizuka , Nishiyama Minori , Mizuno Masaki , Yamaguchi Tadatsugu , Hashimoto Yuichiro , Kawai Tsuyoshi 
Published: June 2019

Abstract
Compounds 5-(5-methyl-2-phenyl-4-thiazolyl)-4-(5-methyl-1-phenyl-1-propenyl)-2-phenylthiazole 1a and 5-(2-methyl-5-phenyl-3-thienyl)-4-(2-methyl-1-phenyl-1-propenyl)-2-phenylthiazole 2a having an S-N heteroatom-contact interaction and a CH-N hydrogen bonding were synthesized in an attempt to obtain new photochromic compounds having terarylene and 1-aryl-2-vinylcyclopentene backbones. The S-N interaction and CH-N hydrogen bonding of 1a and 2a can be explained by DFT calculation and temperature dependent 1H NMR spectra. The tethering interactions are expected to stabilize the reactive conformation of 1a and 2a, and to increase the photocyclization quantum yield. Two 5-heteroaryl-4-vinyl-2-phenylthiazoles 1 and 2 underwent reversible photocyclization reactions from the open-ring isomers 1a and 2a to the closed-ring isomers 1b and 2b, respectively. The photocyclization quantum yields of 1a and 2a are 0.57 and 0.63, which are 3 times larger than that of 1-thiazolyl-2-vinylcyclopentene derivatives (0.20). The number of photochromic cycles exhibited by 1b was 50 in the presence of air, which is higher than that of 2b.