bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multicenter Prospective Cohort Study of the Diagnostic Yield and Patient Experience of Multiplex Gene Panel Testing For Hereditary Cancer Risk
Authors: Idos Gregory E. , Kurian Allison W. , Ricker Charité , Sturgeon Duveen , Culver Julie O. , Kingham Kerry E. , Koff Rachel , Chun Nicolette M. , Rowe-Teeter Courtney , Lebensohn Alexandra P. , Levonian Peter , Lowstuter Katrina , Partynski Katlyn , Hong Christine , Mills Meredith A. , Petrovchich Iva , Ma Cindy S. , Hartman Anne-Renee , Allen Brian , Wenstrup Richard J. , Lancaster Johnathan M. , Brown Krystal , Kidd John , Evans Brent , Mukherjee Bhramar , McDonnell Kevin J. , Ladabaum Uri , Ford James M. , Gruber Stephen B. 
Published: March 2019

Purpose Multiplex gene panel testing (MGPT) allows for the simultaneous analysis of germline cancer susceptibility genes. This study describes the diagnostic yield and patient experiences of MGPT in diverse populations. Patients and Methods This multicenter, prospective cohort study enrolled participants from three cancer genetics clinics—University of Southern California Norris Comprehensive Cancer Center, Los Angeles County and University of Southern California Medical Center, and Stanford Cancer Institute—who met testing guidelines or had a 2.5% or greater probability of a pathogenic variant (N = 2,000). All patients underwent 25- or 28-gene MGPT and results were compared with differential genetic diagnoses generated by pretest expert clinical assessment. Post-test surveys on distress, uncertainty, and positive experiences were administered at 3 months (69% response rate) and 1 year (57% response rate). Results Of 2,000 participants, 81% were female, 41% were Hispanic, 26% were Spanish speaking only, and 30% completed high school or less education. A total of 242 participants (12%) carried one or more pathogenic variant (positive), 689 (34%) carried one or more variant of uncertain significance (VUS), and 1,069 (53%) carried no pathogenic variants or VUS (negative). More than one third of pathogenic variants (34%) were not included in the differential diagnosis. After testing, few patients (4%) had prophylactic surgery, most (92%) never regretted testing, and most (80%) wanted to know all results, even those of uncertain significance. Positive patients were twice as likely as negative/VUS patients (83% v 41%; P < .001) to encourage their relatives to be tested. Conclusion In a racially/ethnically and socioeconomically diverse cohort, MGPT increased diagnostic yield. More than one third of identified pathogenic variants were not clinically anticipated. Patient regret and prophylactic surgery use were low, and patients appropriately encouraged relatives to be tested for clinically relevant results.
Predictive Biomarkers in Metastatic Colorectal Cancer: A Systematic Review
Authors: Ruiz-Bañobre Juan , Kandimalla Raju , Goel Ajay 
Published: March 2019

PURPOSE The development and use of predictive biomarkers to guide treatment decisions are paramount not only for improving survival in patients with metastatic colorectal cancer (mCRC), but also for sparing them from unnecessary toxicity and reducing the economic burden of expensive treatments. We conducted a systematic review of published studies and evaluated the predictive biomarker landscape in the mCRC setting from a molecular and clinical viewpoint. METHODS Studies analyzing predictive biomarkers for approved therapies in patients with mCRC were identified systematically using electronic databases. Preclinical studies and those providing no relevant information were excluded. RESULTS A total of 173 studies comprising 148 biomarkers were selected for final analysis. Of all the biomarkers analyzed, 1.4% (two of 148) were explored in a prospective manner, whereas 98.6% (146 of 148) were evaluated in retrospective studies. Of the latter group, 78.8% (115 of 146) were not tested in subsequent phases, 9.6% (14 of 146) were tested in other retrospective cohorts, 8.9% (13 of 146) were retrospectively tested in at least one or more randomized cohorts, and only 2.7% (four of 146) were prospectively tested in a clinical trial. Finally, only 1.4% (two of 148) were validated sufficiently and are recognized as biomarkers for guiding treatment decision making in patients with mCRC. These markers were RAS mutational status for anti-EGFR antibodies and microsatellite instability status for anti–programmed cell death-1 drugs. CONCLUSION Despite notable efforts to identify predictive biomarkers for various therapies used in the mCRC setting, because of a lack of data beyond retrospective studies and successful biomarker-driven approaches, only two molecular biomarkers have thus far found their translation into the clinic, highlighting the imperative need for implementing novel strategies and additional research in this clinically important field.
Hyperglycemia and Metformin Use Are Associated With B Vitamin Deficiency and Cognitive Dysfunction in Older Adults
Authors: Porter Kirsty M , Ward Mary , Hughes Catherine F , O’Kane Maurice , Hoey Leane , McCann Adrian , Molloy Anne M , Cunningham Conal , Casey Miriam C , Tracey Fergal , Strain Sean , McCarroll Kevin , Laird Eamon , Gallagher Alison M , McNulty Helene 
Published: March 2019

AbstractContextEmerging evidence suggests that deficiencies of folate-related B vitamins can arise with metformin treatment and are independently linked with cognitive dysfunction, a comorbidity of diabetes.ObjectiveTo determine the impact of hyperglycemia and metformin use on relevant B vitamin biomarkers and cognitive outcomes in older adults.Setting and ParticipantsCommunity-dwelling older adults (74.1 ± 8.3 years, n = 4160) without dementia, recruited to the Trinity, Ulster and Department of Agriculture cohort study in 2008 to 2012, were classified as normoglycemic (n = 1856) or hyperglycemic, based on HbA1c ≥5.7% (39 mmol/mol), either with (n = 318) or without (n = 1986) metformin treatment.Main Outcome MeasuresBiomarkers of folate, vitamin B12, vitamin B6, and riboflavin were measured. Cognitive assessments included the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and the Frontal Assessment Battery (FAB).ResultsMetformin use was associated with higher risk of deficiency of vitamin B12 (combined B12 index ≤−1; OR 1.45; 95% CI, 1.03 to 2.02) and vitamin B6 (plasma pyridoxal 5-phosphate <30.0 nmol/L; OR 1.48; 95% CI, 1.02 to 2.15). Fortified foods when eaten regularly had a positive impact on all relevant B vitamin biomarkers, even with hyperglycemia. After adjustment for relevant covariates, metformin use was associated with an increased risk of cognitive dysfunction as assessed with the RBANS (OR 1.36; 95% CI, 1.03 to 1.80) and FAB (OR 1.34; 95% CI, 1.03 to 1.74).ConclusionsUse of metformin by older adults is associated with poorer cognitive performance; B vitamin deficiency may be implicated. Fortified foods can optimize B vitamin status and may be beneficial for maintaining better cognitive health in older people with or at risk for diabetes.
Tips and Resources for Medication Reconciliation
Authors: Shenoy Anant M. , Bennett Amy , Segal Alan Z. 
Published: March 2019

ABSTRACT
Medication errors occur despite best intentions and are often the result of medication discrepancies. Medication reconciliation reduces the likelihood of errors by addressing medication discrepancies that result from multiple points of care, transitions in care, or patient report. Providers and practices may feel overwhelmed by new record systems and regulatory requirements, but multiple resources are available to assist providers to perform medication reconciliation with their patients. Providers and practices should implement medication reconciliation strategies, such as adoption of a multidisciplinary approach, engagement of patients to track medications, and identification of patients who are at high risk for medication list discrepancies and errors. Medication reconciliation will ultimately improve quality of care.
Antiepileptic Drug Treatment of Epilepsy in Children
Authors: Moosa Ahsan N. V. 
Published: March 2019

ABSTRACT

PURPOSE OF REVIEW
The treatment of epilepsy in children is highly individualized at each and every major step in the management. This review examines various factors that modify the treatment from the point of initiation of therapy to the decision to stop an antiepileptic drug (AED).

RECENT FINDINGS
AED therapy leads to seizure freedom in about 70% of all children with epilepsy. AED initiation could be delayed until a second seizure in most children and may be avoided altogether in many children with self-limited childhood focal epilepsies. Three key factors influence the choice of AED: seizure type(s), efficacy of the drug for the seizure type, and the side effect profile of the drug(s). For epileptic spasms, steroids and vigabatrin are the most effective treatment options. For absence seizures, ethosuximide and valproic acid are superior to lamotrigine. For focal seizures, many newer AEDs have favorable side effect profiles with efficacy comparable to older-generation drugs. For generalized epilepsies, valproic acid remains the most effective drug for a broad range of seizure types. Genetic and metabolic etiologies may guide unique treatment choices in some children. After 2 years or more of seizure freedom, if the recurrence risk after AED withdrawal is acceptable, slow weaning of AEDs should be done over the span of 6 weeks or longer. After discontinuation, about 70% of patients remain seizure free, and of those with recurrence, the majority achieve seizure control with restarting an AED. When treatment with two or more AEDs fails, other treatment opportunities for drug-resistant epilepsy, including epilepsy surgery, vagal nerve stimulation, and dietary therapies should be considered.

SUMMARY
Carefully selected medical therapy guided by seizure type and AED characteristics is effective in more than two-thirds of children with epilepsy.
NOVIDADES
Authors: Koury Josely Correa , Castro Luciana Maria Cerqueira 
Published: March 2019

Chegamos a 2019 e, conforme anunciado, apresentamos DEMETRA: Alimentação, Nutrição & Saúde com algumas novidades. Contamos agora com um conselho editorial deliberativo composto por um docente de cada departamento do Instituto de Nutrição da UERJ, o qual auxiliará na condução dos rumos da revista. Na tentativa de atender aos critérios de exogenia, faz parte de nossas novidades a presença de editores associados por área de atuação, cuidadosamente escolhidos considerando a produção científica e a expertise nas diferentes áreas da Alimentação, Nutrição e Saúde, de diferentes regiões do país. Ainda estamos em processo de envio de convites para pesquisadores estrangeiros e acreditamos que, em breve, teremos um maior número deles na Revista. Os editores associados colaborarão na gestão do fluxo dos manuscritos, iniciando pela indicação de pareceristas e acompanhando todo o processo de avaliação e aprovação.Além das novidades administrativas, temos novo layout e novas regras para submissão. Incluímos uma nova categoria de artigos, denominada “Outras linguagens”, que receberá textos de reflexão sobre temas de interesse para os leitores da revista, com relação aos campos da Alimentação, Nutrição, Saúde, Comensalidade, Artes e Cultura, utilizando recursos iconográficos, poéticos, literários, musicais e audiovisuais. Gostaríamos que esta categoria de artigo estimulasse os autores a ousar, enveredando pelos caminhos da poesia, fotografia, vídeos, entre outras formas de arte, sempre contextualizando com o escopo da revista.A partir de abril 2019, DEMETRA passa a ser publicada em fluxo contínuo, ou seja, todas as edições permanecerão abertas e após a diagramação dos artigos aceitos, estes serão disponibilizados online. Com isso, o fluxo de artigos será acelerado, aumentando o tempo de exposição do material e reduzindo o tempo de espera dos autores, o que dará maior visibilidade à Revista e aos trabalhos publicados por meio de citações. Ainda como forma de aumentar a visibilidade, criamos uma página no Facebook e no Twitter.Todo o esforço para a atualização e melhora da qualidade da Revista é muito recente; desde novembro do ano passado, estamos trabalhando para que tudo funcione da melhor forma possível. Esperamos poder contar com a colaboração de todos.Aproveitamos para agradecer aos parceiros e parceiras que concordaram em participar de mais este desafio: a manutenção e o crescimento de um veículo de divulgação científica sem custo para o leitor e de qualidade acadêmica. DOI: 10.12957/demetra.2019.40758
Inferior dental blocks versus infiltration dentistry: is it time for change?
Authors: Renton Tara 
Published: March 2019

Dentistry is unique in that high volume surgery is undertaken efficiently on conscious patients, an anathema to most other surgical specialties who predominantly operate on unconscious patients. Local anaesthesia provides an efficient block to nociceptive pain (the first stage of the pain pathway) but only addresses one small part of the pain experience. Currently the inferior dental block (IDB) is the ‘go to’ standard for dental LA for mandibular dentistry despite its significant shortcomings. Unfortunately, as creatures of habit clinicians continue to practise what is taught at dental school, namely IDBs, when evolving more patient-safe practice takes time to be taken up by the workforce.Local anaesthesia blocks are inefficient in providing swift pulpal anaesthesia. Malamed stated that the rate of inadequate anaesthesia ranged from 31% to 81%. When expressed as success rates, this indicates a range of 19% to 69%. These numbers are so wide ranging as to make selection of a standard for rate of success for IDB seemingly impossible. LA blocks also increase the risk of systemic complications and they may be associated with nerve injury. Though LA-related permanent nerve injury is rare (approximately 1in 52–57K IDBs), once the injury occurs approximately 75% may resolve but the remaining 25% are untreatable. Most patients with trigeminal nerve injuries experience chronic pain in their lip, teeth and gums or tongue and gums, depending on which nerve is damaged. This is a lifelong burden that these patients find difficult to accommodate, especially when they were never warned about the possible risk.The risk of nerve injury can be mitigated by altering the block technique or by avoiding block anaesthesia altogether. With novel development in pharmacology of LA and equipment, block anaesthesia is likely to become rarely needed in dentistry.CPD/Clinical Relevance: Dentistry is a profession predicated upon causing and/or managing pain in patients. Providing effective pain control during surgery is essential but using techniques with the minimum risks is imperative.
Pediatric Inflammatory Myofibroblastic Tumor of the Liver: A Rare Cause of Portal Hypertension
Authors: Thavamani Aravind , Mandelia Chetan , Anderson Peter M. , Radhakrishnan Kadakkal 
Published: March 2019

ABSTRACT
Hepatic inflammatory pseudotumors or myofibroblastic tumors are benign neoplasms rarely seen in children. We report a case of a previously healthy 10-year-old girl with prolonged fever and abdominal pain who was found to have hepatosplenomegaly and pancytopenia. Imaging revealed a periportal mass along with thrombosis of portal vein and splenomegaly. Liver biopsy showed normal hepatic architecture with no evidence of cirrhosis. She underwent endoscopic banding of esophageal varices. Biopsy of the mass was suggestive of inflammatory myofibroblastic tumor without malignant changes. She has been successfully managed with nonsteroidal anti-inflammatory drug and pulse steroids with resolution of symptoms and decrease in size of the tumor with more than 2 years of follow-up.
Vergleich Impedanzregelung (IC) – Parallele Impedanzregelung (PIC) zur Kraft-/Impedanzregelung dynamischer Systeme
Authors: Mack Michael 
Published: March 2019

Zusammenfassung
Bei der gleichzeitigen Regelung von Kräften und Nachgiebigkeiten besteht für die serielle Anordnung von Kraft- und Nachgiebigkeitsregler der Impedanzregelung (IC) das Problem der gegenseitigen Beeinflussung der Regelkreise. Mit der im Folgenden im Vergleich gegenüber der IC präsentierten neuen parallelen Impedanzregelung (PIC) wird durch eine parallele Regleranordnung die gegenseitige Beeinflussung der Regler vermieden. Übersteigen die einwirkenden Störkräfte die auszuübenden Sollkräfte, kann durch die PIC ein nachgiebiges Verhalten bei wesentlich verringerter Antriebsleistung erreicht werden.
Implementation of a clinical reasoning curriculum for clerkship-level medical students: a pseudo-randomized and controlled study
Authors: Bonifacino Eliana , Follansbee William P. , Farkas Amy H. , Jeong Kwonho , McNeil Melissa A. , DiNardo Deborah J. 
Published: March 2019

AbstractBackgroundThe National Academies of Sciences reportImproving Diagnosis in Healthcarehighlighted the need for better training in medical decision-making, but most medical schools lack formal education in clinical reasoning.MethodsWe conducted a pseudo-randomized and controlled study to evaluate the impact of a clinical reasoning curriculum in an internal medicine clerkship. Students in the intervention group completed six interactive online modules focused on reasoning concepts and a skills-based workshop. We assessed the impact of the curriculum on clinical reasoning knowledge and skills and perception of education by evaluating: (1) performance on a clinical reasoning concept quiz, (2) demonstration of reasoning in hospital admission notes, and (3) awareness of attending physician utilization of clinical reasoning concepts.ResultsStudents in the intervention group demonstrated superior performance on the clinical reasoning knowledge quiz (67% vs. 54%, p < 0.001). Students in the intervention group demonstrated superior written reasoning skills in the data synthesis (2.3 vs. 2.0, p = 0.02) and diagnostic reasoning (2.2 vs. 1.9, p = 0.02) portions of their admission notes, and reported more discussion of clinical reasoning by their attending physicians.ConclusionsExposure to a clinical reasoning curriculum was associated with superior reasoning knowledge and superior written demonstration of clinical reasoning skills by third-year medical students on an internal medicine clerkship.
From groups to actions and back in online-offline sociolinguistics
Authors: Blommaert Jan 
Published: March 2019

AbstractThe papers in this volume all articulate a keen awareness of the shift in sociolinguistic economies caused by online technologies. We now live in an online-offline nexus of communication, and realizing this invites changes in the ways in which we traditionally view and imagine the foundations of our disciplinary approaches. In reviewing the papers, I focus on two important aspects of such revisionist enterprises. One is the emergence of an analytical triad of infrastructures, actions and moralizations, evidence of which is offered in the different papers. The second aspect is of a more general nature: we can suggest, on the basis of the evidence presented in this volume, to reverse the general heuristic of research from groups-individuals-language towards interaction-individuals-groups. This reversal of direction would equip our disciplines with an extraordinarily powerful theory of social action.
Te veniente die, te decedente canebat: il τόπος del mattino e della sera tra neoterismo e poesia augustea
Authors: Gagliardi Paola 
Published: March 2019

AbstractThe reference to the rising and setting of the sun to indicate the unceasing duration of an action becomes a τόπος in Latin poetry from an influential distich of Cinna onwards, which was reworked a number of times in Augustan poetry. As well as Vergil and Horace, who adapt the model to different genres and occasions, the treatment of it by the elegists is interesting, in whom the two terms that define East and West are set in relation to the eternity of poetic renown. This transformation may go back to Gallus, to whom Ovid, above all, makes significant references. The numerous occurrences of the τόπος in different authors and genres make possible interesting comparisons.
A PRODUÇÃO DE UVA ORGÂNICA NA SERRA GAÚCHA: O CASO DOS AGRICULTORES ORGÂNICOS DE COTIPORÃ/RS / THE PRODUCTION OF ORGANIC GRAPE IN THE SERRA GAUCHA: THE CASE OF THE ORGANIC AGRICULTURISTS OF COTIPORÃ/RS
Authors: Pierozan Vinício Luís 
Published: March 2019

A viticultura é um cultivo perene bastante presente no estado do Rio Grande do Sul e tem a Serra Gaúcha como o principal polo vitícola do país, tendo sua produção atrelada a colonização italiana, que deu início ao povoamento do território. A maior parte da produção é realizada no sistema convencional, todavia a região serrana também vem se destacando atualmente pela viticultura orgânica. A uva já é a fruta mais cultivada no sistema orgânico no estado do Rio Grande do Sul e tem a sua base centrada na agricultura familiar e na pequena propriedade rural. Neste artigo é discutido a formação do território da viticultura orgânica no município de Cotiporã pertencente a Serra Gaúcha, um dos municípios de maior produção de uva no estado e que tem na viticultura a principal atividade agrícola. Para cumprir com os objetivos propostos a pesquisa foi embasada em diferentes etapas: coleta de dados e informações em fontes primárias e secundárias, revisão de referencial teórico sobre o tema, trabalho de campo, aplicação de entrevistas semiestruturadas e análise dos dados coletados. Concluiu-se que a viticultura orgânica está em expansão no município, os viticultores buscam no sistema orgânico melhor qualidade de vida, preservação ambiental e rentabilidade financeira.Palavras-chave: Viticultura Orgânica; Preservação Ambiental; Cotiporã. ABSTRACTThe viticulture is a quite present everlasting cultivation in the state of Rio Grande do Sul and it takes the Serra Gaúcha as the main viticultural pole of the country, having his production harnessed the Italian colonization, which gave beginning to the settlement of the territory. Most of the production are carried out in the conventional system, however the mountain region also comes standing out at present for the organic viticulture. The grape is already the fruit most cultivated in the organic system in the state of Rio Grande do Sul and it has his base centered in the familiar agriculture and in the small rural property. In this article it is discussed the formation of the territory of the organic viticulture the local authority of Cotiporã pertaining to Serra Gaúcha, one of the local authorities of bigger production of grape in the state and what has in the viticulture the main agricultural activity. To be necessary with the objectives proposed the inquiry it was supported in different stages: collection of data and informations in primary and secondary fountains, revision of theoretical referential system on the subject, work of field, application of semistructured interviews and analysis of the collected data. It was ended that the organic viticulture is in expansion in the local authority, the vinedressers look in the best organic system for quality of life, environmental preservation and financial profitability.Keywords: Organic Viticulture; Environmental Preservation; Cotiporã.