bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital to home transport at end of life: Survey of clinician experience
Authors: Raed Mona , Grossoehme Daniel H , Brown Miraides , Friebert Sarah 
Published: August 2019

Background: Palliative transport is transport home of patients requiring critical care transport support with expectation of imminent death. Many parents prefer their child’s death at home; evidence suggests death in the preferred location improves bereavement outcomes. Little is known about the clinical and demographic diversity of patients receiving palliative transport or the perspectives of participating staff. Aim: The objectives of the present study were to (1) characterize demographic and clinical factors involved in palliative transport, (2) identify challenges encountered, and and (3) ascertain staff perspectives. Design: Ten-year retrospective chart review and cross-sectional staff survey using study-specific questionnaire. Setting/participants: Twenty-three patients had palliative transport from a tertiary pediatric hospital from 2004 to 2013, of which 12 met inclusion criteria. Survey responses from 22 participating staff were received. Results: The cohort of 12 patients was 58% female, with a mean (range) age of 5.5 (0.01–22) years; racial composition was not significantly different than the palliative care clinical census over the same time period. Distances under 30 miles accounted for 50% of palliative transports. The majority of patients (75%) died within 2 days of palliative transport. Six unanticipated events are described. Staff reported palliative transport as a positive experience, regarding it as an important job component. However, 63% were dissatisfied or undecided about the plan should the patient die enroute, and 48% experienced some level of dissatisfaction with communication. Conclusion: Palliative transport is a feasible option for some patients. Staff experienced palliative transport as valuable, although process concerns were noted. This study underscores the importance of preparedness, training, and education for palliative transports.
Interim results of a prospective, randomized, open-label, Phase 3 study of the long-term safety and efficacy of lasmiditan for acute treatment of migraine (the GLADIATOR study)
Authors: Brandes Jan Lewis , Klise Suzanne , Krege John H , Case Michael , Khanna Rashna , Vasudeva Raghavendra , Raskin Joel , Pearlman Eric M , Kudrow David 
Published: August 2019

Objectives To address the need for long-term lasmiditan data, the GLADIATOR study evaluated the safety (primary) and efficacy (secondary) of lasmiditan for the intermittent, acute treatment of migraine attacks for up to 1 year. Methods In this prospective, randomized, open-label, Phase 3 study, patients who had completed either of two single-attack studies were offered the opportunity to be randomized 1:1 to lasmiditan 100 mg or 200 mg. Patients were asked to use lasmiditan as the first treatment for each new migraine attack of at least moderate severity. Assessments occurred at baseline and at prespecified time increments up to 48 hours after each dose of study drug using an electronic diary, and safety was assessed throughout the study. Migraine Disability Assessment (MIDAS) was assessed at each visit. Results As of the cut-off date for this interim analysis (6 March 2018), 1978 patients had received ≥ 1 lasmiditan dose and treated 19,058 migraine attacks. Overall, treatment-emergent adverse events (TEAEs) were similar to those in the single-attack studies and included dizziness (18.6%), somnolence (8.5%), and paresthesia (6.8%). The frequency of TEAEs generally decreased with subsequent attacks. No treatment-related serious adverse events and no cardiovascular TEAEs potentially due to vasoconstriction were observed. For both lasmiditan doses, efficacy measures were generally consistent over study quarters and treated attacks. Overall, across all treated attacks at 2 hours post-dose, pain freedom was observed in 26.9% of the attacks treated with lasmiditan 100 mg and 32.4% of the attacks treated with lasmiditan 200 mg. MIDAS total scores decreased over time. Conclusions The interim results of this long-term study showed intermittent lasmiditan (100 mg and 200 mg) to be generally well tolerated and efficacious for the acute treatment of migraine over a 1-year period. Trial registration number: NCT02565186; https://clinicaltrials.gov/ct2/show/NCT02565186
Cyclophosphamide desensitization in patients with severe hypersensitivity reactions to bendamustine
Authors: Figgins Bradley , Primeaux Brian , Shank Brandon R , Chen Sheree E , Weber Donna M , Lu Huifang 
Published: August 2019

Introduction Cyclophosphamide is a nitrogen mustard alkylator employed in the treatment of many malignancies and autoimmune disorders. Despite reports of cyclophosphamide hypersensitivity ranging from rash to anaphylaxis, no cases of desensitization have been reported in the oncologic setting. Case report We report a cyclophosphamide desensitization protocol used for two patients who experienced severe hypersensitivity to bendamustine, a structurally related drug with potential cross immunogenicity. Management and outcome An interdisciplinary approach including immunologist, oncologist, and clinical pharmacists resulted in the development of a multi-step desensitization protocol for cyclophosphamide. The desensitization protocol described enabled the safe administration of cyclophosphamide for the two patients with limited treatment alternatives. Discussion To the authors' knowledge, this is the first report of cyclophosphamide desensitization in the oncologic setting. Two patients with advanced hematologic malignancies were able to receive cyclophosphamide with minimal adverse effects, despite experiencing previous severe hypersensitivity to another nitrogen mustard analogue.
Clinical and radiological results with a 36-mm cobalt-chrome prosthetic head, cross-linked Durasul liners associated with Allofit cups: a more than 10-year follow-up period
Authors: Georis Pierre , Thirion Thierry , Gillet Philippe 
Published: August 2019

Background: Highly cross-linked polyethylene is currently a common articulation surface used for total hip arthroplasty (THA). Aim: The aim of the present study is in vivo assessment of highly cross-linked Durasul polyethylene linear and volumetric wear when associated with a 36-mm prosthetic femoral head. Methods: We retrospectively reviewed clinical and radiographic data of 78 patients (81 hips) having primary THAs using Durasul liner combined with a 36-mm CoCr prosthetic head. All of them were followed for more than 10 years. Patient outcome was assessed with the Harris Hip Score (HHS) preoperatively and at last follow-up. 2-D prosthetic head penetration into polyethylene, 3D wear rates and cup migration were evaluated. Results: The preoperative and last follow-up HHS were 50.43 +/− 10.42 and 97.44 +/− 5.51 respectively. The annual penetration of the prosthetic head into Durasul® liner was 0.029 +/− 0.003 mm. The annual linear penetration and volumetric wear extrapolation rates using Charnley and Ilchmann formulas were 37.84% and 57.76% respectively of that seen with conventional polyethylene liner. At last follow-up, the total loss of material in Durasul represents only 0.15% of the initial polyethylene mass. We did not observe any significant cup migration in the study group. Conclusions: Results are promising, and we believe that these data authorise the continued use of highly cross-linked polyethylene liner associated with a 36-mm prosthetic head for total hip arthroplasties in older patients. More long-term follow-up studies are mandatory before we feel comfortable with the project of using cross-linked polyethylene in young and active patients instead of ceramic-on-ceramic bearings.
“Getting to Zero New HIV Infections in the Caribbean”: Knowledge and Attitudes Toward Male Circumcision Among Adolescent Males in The Bahamas
Authors: George Clemon , Roberts Robin , Deveaux Lynette , Brennen Delon F.P. , Read Stanley E. 
Published: August 2019

Male circumcision (MC) plays a significant role in reducing new HIV infections, particularly in high prevalence countries. This cross-sectional study assesses the prevalence of MC and attitudes toward MC among youth aged 15–18 years in The Bahamas, a medium HIV prevalence country. The survey included 797 young men who completed a questionnaire on MC. Data analyses included chi-squared tests. The self-reported prevalence of MC among youth was 16.7% (121/759). Most of the circumcised youth were circumcised as infants, 84% (107/121) were pleased with their circumcision, and 71% would recommend it to others. For uncircumcised youth, 35% (189/533) would consider voluntary male circumcision (VMC) and 26% would recommend MC to others. In all scenarios, circumcised youth were more likely to be positive about MC. Among uncircumcised young men, being older (17–18 years compared to 15–16 years) was the only variable statistically associated with considering MC or recommending MC. After being presented with information on the benefits of MC for HIV prevention, the number of men who were positive about MC increased. Most of the young men in this cohort would consider VMC for reducing HIV incidence. Also, many stated that, if they had a male child, they would have him circumcised. The attitudes of these youth emphasize the need to provide information on HIV in addition to general health benefits of MC if there were to be a sustainable MC program within this population.
High blood sugar levels but not diabetes mellitus significantly enhance oxaliplatin chemoresistance in patients with stage III colorectal cancer receiving adjuvant FOLFOX6 chemotherapy
Authors: Yang I-Ping , Miao Zhi-Feng , Huang Ching-Wen , Tsai Hsiang-Lin , Yeh Yung-Sung , Su Wei-Chih , Chang Tsung-Kun , Chang Se-fen , Wang Jaw-Yuan 
Published: August 2019

Background: The high prevalence of type 2 diabetes mellitus (DM) among patients with colorectal cancer (CRC) is becoming a serious public health concern worldwide. FOLFOX4 chemotherapy is one of the most widely used adjuvant therapies in patients with stage III colon cancer after surgical resection. However, chemotherapy resistance is associated with a poor prognosis. The prognostic impact of high blood sugar levels on oxaliplatin resistance in CRC patients is an unexplored topic. Methods: In total, 157 patients with stage III CRC were classified according to their fasting blood sugar level (⩾126 or <126 mg/dl). Clinicopathological features and oxaliplatin chemoresistance/survival outcome of the two groups were compared. In vitro cell proliferation assay was performed through d-(+)-glucose administration. Results: Multivariate analysis results revealed that high blood sugar level was a significantly independent prognostic factor of disease-free survival and overall survival (both p < 0.05), but not DM history. After metformin administration, enhanced proliferation of CRC cells (HT-29, HCT-116, SW480, and SW620) with d-(+)-glucose administration could be reversed and oxaliplatin chemosensitivity considerably increased ( p < 0.05). Furthermore, phosphorylation of two glycolysis-related target proteins, SMAD3 and MYC, notably increased under high glucose concentration. Conclusions: Hyperglycemia can affect clinical outcomes in stage III CRC patients receiving adjuvant chemotherapy, and the mechanism underlying oxaliplatin resistance is possibly associated with increased phosphorylation of SMAD3 and MYC and upregulation of EHMT2 expression.
Predictors of left ventricle ejection fraction and early in-hospital mortality in patients with ST-segment elevation myocardial infarction: Single-center data from a tertiary referral university hospital in Istanbul
Authors: Emet Samim , Elitok Ali , Karaayvaz Ekrem Bilal , Engin Berat , Cevik Erdem , Tuncozgur Asli , Aydogan Mehmet , Mercanoglu Fehmi , Ozcan Mustafa , Oncul Aytac 
Published: August 2019

Background: Little is known about the management and mortality rates of ST-segment elevation myocardial infarction patients in developing countries. In this study, to expose independent predictors of early (24 h) in-hospital mortality and ejection fraction, we report our experience with 362 ST-segment elevation myocardial infarction patients admitted to the Istanbul Medical Faculty, Istanbul University, a tertiary referral university hospital, and treated with primary percutaneous intervention. Methods: This is a retrospective study that enrolled all patients (362) admitted with ST-segment elevation myocardial infarction to Department of Cardiology, Istanbul Medical Faculty, Istanbul University, between January 2015 and December 2016. The clinical characteristics of patients were collected retrospectively from medical chart review. Collected data were analyzed using IBM SPSS Statistics (version 21). Results: In the forward stepwise logistic regression analysis, target vessel diameter ( p = 0.001), systolic blood pressure ( p < 0.001), and troponin T levels ( p = 0.007) were independent predictors for early in-hospital mortality, while target vessel diameter ( p = 0.03), troponin T level ( p < 0.001), heart rate ( p = 0.001), and chest pain ( p = 0.001) duration were the independent predictors for ejection fraction of 50% and above. Conclusion: Our study is one of the few studies to investigate the predictors of early in-hospital mortality among patients hospitalized with ST-segment elevation myocardial infarction in a tertiary referral university hospital in a developing country. The identified predictors for mortality (including left ventricle ejection fraction and troponin T levels), left ventricle ejection fraction (including troponin T level, chest pain duration), and heart rate are consistent with what has been described in large registries in the United States and Europe.
Acceptability of artificial intelligence (AI)-led chatbot services in healthcare: A mixed-methods study
Authors: Nadarzynski Tom , Miles Oliver , Cowie Aimee , Ridge Damien 
Published: August 2019

Background Artificial intelligence (AI) is increasingly being used in healthcare. Here, AI-based chatbot systems can act as automated conversational agents, capable of promoting health, providing education, and potentially prompting behaviour change. Exploring the motivation to use health chatbots is required to predict uptake; however, few studies to date have explored their acceptability. This research aimed to explore participants’ willingness to engage with AI-led health chatbots. Methods The study incorporated semi-structured interviews (N-29) which informed the development of an online survey (N-216) advertised via social media. Interviews were recorded, transcribed verbatim and analysed thematically. A survey of 24 items explored demographic and attitudinal variables, including acceptability and perceived utility. The quantitative data were analysed using binary regressions with a single categorical predictor. Results Three broad themes: ‘Understanding of chatbots’, ‘AI hesitancy’ and ‘Motivations for health chatbots’ were identified, outlining concerns about accuracy, cyber-security, and the inability of AI-led services to empathise. The survey showed moderate acceptability (67%), correlated negatively with perceived poorer IT skills OR = 0.32 [CI95%:0.13–0.78] and dislike for talking to computers OR = 0.77 [CI95%:0.60–0.99] as well as positively correlated with perceived utility OR = 5.10 [CI95%:3.08–8.43], positive attitude OR = 2.71 [CI95%:1.77–4.16] and perceived trustworthiness OR = 1.92 [CI95%:1.13–3.25]. Conclusion Most internet users would be receptive to using health chatbots, although hesitancy regarding this technology is likely to compromise engagement. Intervention designers focusing on AI-led health chatbots need to employ user-centred and theory-based approaches addressing patients’ concerns and optimising user experience in order to achieve the best uptake and utilisation. Patients’ perspectives, motivation and capabilities need to be taken into account when developing and assessing the effectiveness of health chatbots.
Quantum Decision Theory, Bounded Rationality and the Ellsberg Paradox
Authors: Wei Mengxing , al-Nowaihi Ali , Dhami Sanjit 
Published: August 2019

We test a simple quantum decision model of the Ellsberg paradox. We find that the theoretical predictions of the model are in conformity with our experimental results. The predictions of our quantum model are not statistically significantly different from those of the source dependent model. The source dependent model requires the specification of probability weighting functions in order to fit the evidence. On the other hand, our quantum model makes no recourse to probability weighting functions. This suggests that much of what is normally attributed to probability weighting may actually be due to quantum probability. When we replace quantum probability by Kolmogorov probability in our model, then the Ellsberg paradox reemerges. Hence, we make essential use of quantum probability theory. All our development uses no more than standard linear algebra and real numbers, which are very familiar to economists. This makes our paper accessible to a wider audience than the quantum community. JEL Classification: D01, D81, D91
Diagnosis and Management of Deltoid Ligament Insufficiency
Authors: Sridharan Sarup S. , Dodd Andrew 
Published: August 2019

Background: Surgical management of patients with acute and chronic ankle instability (CAI) has historically focused on the lateral ligament complex. Recent studies in CAI patients have shown that magnetic resonance imaging (MRI) and arthroscopy demonstrate concomitant injury to the deltoid ligament complex We performed a systematic review to determine if consistent clinical, diagnostic imaging, or arthroscopic findings of deltoid ligament injury in the setting of CAI have been described. In addition, we sought to determine if treatment options and/or clinical outcomes have been described. Methods: A systematic review was conducted using the PubMed, MEDLINE, and Embase databases. Articles were included if they had a majority of patients 18 years of age or older, focused on deltoid ligament injury in ankle instability, and reported diagnostic and/or treatment methods. Articles were excluded if the study focused on the deltoid ligament in the acute fracture setting. All included articles were assessed for diagnostic criteria, treatments, and patient outcomes. Results: Our search yielded 157 articles, of which a total of 13 were included in our study. Arthroscopy was described as the gold standard to diagnose and evaluate the severity of deltoid ligament injury, however, little objective data on the arthroscopic diagnosis of deltoid ligament insufficiency was reported. MRI was the imaging modality of choice to evaluate deltoid ligament injury and had a high sensitivity and specificity when compared with arthroscopy. No standard MRI diagnostic criteria for deltoid ligament injury were identified in the literature. Specific treatment techniques and long-term outcomes were not well described in the manuscripts included in this review. Conclusion: There is limited knowledge on deltoid ligament insufficiency in the setting of chronic ankle instability. Criteria for characterizing deltoid ligament damage with diagnostic imaging appear to be evolving, but there is no standard classification. Only 1 author has described a method to evaluate deltoid ligament competency on arthroscopic examination. There are currently no objective data to guide treatment decisions. Level of Evidence: Level III.
Clinical significance of DNA methylation in chronic lymphocytic leukemia patients: results from 3 UK clinical trials
Authors: Wojdacz Tomasz K. , Amarasinghe Harindra E. , Kadalayil Latha , Beattie Alice , Forster Jade , Blakemore Stuart J. , Parker Helen , Bryant Dean , Larrayoz Marta , Clifford Ruth , Robbe Pauline , Davis Zadie A. , Else Monica , Howard Dena R. , Stamatopoulos Basile , Steele Andrew J. , Rosenquist Richard , Collins Andrew , Pettitt Andrew R. , Hillmen Peter , Plass Christoph , Schuh Anna , Catovsky Daniel , Oscier David G. , Rose-Zerilli Matthew J. J. , Oakes Christopher C. , Strefford Jonathan C. 
Published: August 2019

AbstractChronic lymphocytic leukemia patients with mutated immunoglobulin heavy-chain genes (IGHV-M), particularly those lacking poor-risk genomic lesions, often respond well to chemoimmunotherapy (CIT). DNA methylation profiling can subdivide early-stage patients into naive B-cell–like CLL (n-CLL), memory B-cell–like CLL (m-CLL), and intermediate CLL (i-CLL), with differing times to first treatment and overall survival. However, whether DNA methylation can identify patients destined to respond favorably to CIT has not been ascertained. We classified treatment-naive patients (n = 605) from 3 UK chemo and CIT clinical trials into the 3 epigenetic subgroups, using pyrosequencing and microarray analysis, and performed expansive survival analysis. The n-CLL, i-CLL, and m-CLL signatures were found in 80% (n = 245/305), 17% (53/305), and 2% (7/305) of IGHV-unmutated (IGHV-U) cases, respectively, and in 9%, (19/216), 50% (108/216), and 41% (89/216) of IGHV-M cases, respectively. Multivariate Cox proportional analysis identified m-CLL as an independent prognostic factor for overall survival (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.24-0.87; P = .018) in CLL4, and for progression-free survival (HR, 0.25; 95% CI, 0.10-0.57; P = .002) in ARCTIC and ADMIRE patients. The analysis of epigenetic subgroups in patients entered into 3 first-line UK CLL trials identifies m-CLL as an independent marker of prolonged survival and may aid in the identification of patients destined to demonstrate prolonged survival after CIT.
Nonalcoholic Fatty Liver Disease in Nonobese Subjects of African Origin Has Atypical Metabolic Characteristics
Authors: Thompson Debbie S , Tennant Ingrid A , Soares Deanne P , Osmond Clive , Byrne Chris D , Forrester Terrence E , Boyne Michael S 
Published: August 2019

AbstractBackgroundNonobese nonalcoholic fatty liver disease is reported in several populations. However, because persons of African origin display unique fat accumulation, insulin resistance, and lipid profiles, we investigated fatty liver in nonobese persons of African origin.MethodWe recruited 78 urban Jamaican volunteers. CT was used to estimate liver and abdominal fat and dual-energy X-ray absorptiometry to measure body composition. Fasting blood was collected for lipids, alanine aminotransferase (ALT), adiponectin, and fetuin-A. Homeostatic model assessment of insulin resistance (HOMA-IR), whole-body insulin sensitivity index (WBISI), insulinogenic index (IGI), and oral disposition index (oDI) were calculated after a 75-g oral glucose tolerance test.ResultsFifty-two percent of participants were male; mean (±SD) age was 28.5 ± 7.8 years, and body mass index was 22.4 ± 3.0 kg/m2. Mean liver attenuation (MLA) and liver/spleen (LS) ratio, both inversely correlated to liver fat, were 62.8 ± 4.3 HU and 1.2 ± 0.1, respectively; 3.8% of participants had liver fat >30% (LS ratio < 1). In age, sex, and BMI-adjusted correlations, MLA was negatively associated with weight (r = −0.30; P = 0.009) and height (r = −0.28; P = 0.017) and was associated with fasting glucose (r = 0.23; P = 0.05), fasting insulin (r = 0.42; P ≤ 0.001) and HOMA-IR (r = 0.35; P = 0.004). Serum lipids, ALT, adiponectin, fetuin-A, WBISI, IGI, and oDI were not associated with liver fat.ConclusionsIn nonobese Afro-Caribbean participants, greater liver fat was associated with weight and height and lower fasting insulin and hyperinsulinemia appears to be influential in the reduction of NAFLD. These findings may be influenced by ethnicity, body size, and method of estimating liver fat.