bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Tuberculosis Treatment Response With Serial C-Reactive Protein Measurements
Authors: Wilson Douglas , Moosa Mahomed-Yunus S , Cohen Ted , Cudahy Patrick , Aldous Collen , Maartens Gary 
Published: October 2018

Abstract

Background
Novel biomarkers are needed to assess response to antituberculosis therapy in smear-negative patients.

Methods
To evaluate the utility of C-reactive protein (CRP) in monitoring response to antituberculosis therapy, we conducted a post hoc analysis on a cohort of adults with symptoms of tuberculosis and negative sputum smears in a high–tuberculosis and HIV prevalence setting in KwaZulu-Natal, South Africa. Serial changes in CRP, weight, and hemoglobin were evaluated over 8 weeks.

Results
Four hundred twenty-one participants being evaluated for smear-negative tuberculosis were enrolled, and 33 were excluded. Two hundred ninety-five were treated for tuberculosis (137 confirmed, 158 possible), and 93 did not have tuberculosis. One hundred and eighty-three of 213 (86%) participants who agreed to HIV testing were HIV positive. At week 8, the on-treatment median CRP reduction in the tuberculosis group (interquartile range [IQR]) was 79.5% (25.4% to 91.7%), the median weight gain was 2.3% (−1.0% to 5.6%), and the median hemoglobin increase was 7.0% (0.8% to 18.9%); P &lt; .0001 for baseline to week 8 comparison of absolute median values. Only CRP changed significantly at week 2 (median reduction [IQR], 75.1% [46.9% to 89.2%]) in the group with confirmed tuberculosis and in the possible tuberculosis group (median reduction [IQR], 49.0% [−0.4% to 80.9%]). Failure of CRP to reduce to ≤55% of the baseline value at week 2 predicted hospitalization or death in both tuberculosis groups, with 99% negative predictive value.

Conclusions
Change in CRP may have utility in early evaluation of response to antituberculosis treatment and to identify those at increased risk of adverse outcomes.
Impact of a Multiplex PCR Assay for Bloodstream Infections With and Without Antimicrobial Stewardship Intervention at a Cancer Hospital
Authors: Buss Brian A , Baures Timothy J , Yoo Minkyoung , Hanson Kimberly E , Alexander Donald P , Benefield Russell J , Spivak Emily S 
Published: October 2018

Abstract
Implementation of Biofire FilmArray Blood Culture Identification Multiplex PCR panel (BCID) at a cancer hospital was associated with reduced time to appropriate antimicrobial therapy. Additional reductions were not observed when BCID was coupled with antimicrobial stewardship intervention.
Hip Hop without a DJ
Authors: Peterson Sean 
Published: October 2018

Abstract
To make headway in a commercial landscape dominated by sample-based production, instrumental hip hop band The Roots employed strategies that made their first five albums (1993–1999) sound more and more like hip hop made with vinyl-based samples. Such strategies included repurposing musical material from breakbeats, EQing their recordings to sound vinyl-based, self-sampling, adding scratching sounds by a vocal percussionist or DJ, and judiciously using actual samples from preexisting recordings. Though the band was once adherent to an “organic” approach, which involved using only traditional instruments and recording without a click track, they eventually adopted these approaches to allow them to participate in an aesthetic that characterized hip hop of their day. By discovering ways to perform hip hop with instruments, they not only overcame the legacy of so-called disco rap but also signaled a new stage in hip hop’s musical dialogue between humanity and technology.
Rapid Neural Polyphenism in Cephalopods
Authors: Hanlon Roger T. , Chiao Chuan-Chin 
Published: October 2018

Abstract
Octopus, squid, and cuttlefish can change their appearance (phenotype) in 200–700 msec due to neural control of chromatophore organs, iridophore cells, and three-dimensional papillae in their elaborate skin. Great strides have been made in determining the primary visual background stimuli that guide camouflage skin patterning in cuttlefish, yet many key details remain unknown. The current behavioral/psychophysical experimental paradigm developed in cuttlefish needs to be expanded to octopus and squid, which will potentially elucidate general principles governing complex behaviors such as communication and camouflage. The neural underpinnings of this dynamic polyphenic system are poorly known. Peripheral control mechanisms of chromatophores and iridophores have been elucidated recently, but central nervous system experimentation has lagged far behind; both aspects require targeted neurobiological study, genomic approaches, and system modeling. The unusual neuroanatomy and complex behavior of these marine invertebrates provide an opportunity to discover novel mechanisms of visual perception, decision-making, and motor output.
Environmental Enrichment and Neuronal Plasticity
Authors: Clemenson Gregory D. , Gage Fred H. , Stark Craig E.L. 
Published: October 2018

Abstract
This chapter reviews the literature on environmental enrichment and specifically discusses its influence on the hippocampus of the brain. In animal models, the term “environmental enrichment” is used to describe a well-defined manipulation in which animals are exposed to a larger and more stimulating environment. This experience has been shown to have a powerful and positive impact on hippocampal cognition and neuroplasticity in animals. In humans, however, the translation of environmental enrichment is less clear. Despite the fact that humans live considerably more enriching lives compared to laboratory animals, studies have shown that training and expertise (such as exercise and spatial exploration) can lead to both functional and structural changes in the human brain. This chapter is a comprehensive review of environmental enrichment, drawing parallels between animal models and humans to present a more complete understanding of environmental enrichment.
The Naturalization of Timbre
Authors: Hui Alexandra 
Published: October 2018

Abstract
This chapter explores the use of timbre in scientific studies of animal vocalizations in the decades around the end of the twentieth century. In the first case, I examine the efforts of naturalists and ornithologists to represent timbre in their notation of bird song in the field. The second case study discusses current work in cognitive science to better understand the origins of human language and music through the study of songbirds. I argue that by assuming—implicitly, then explicitly—timbral perception in non-human species, the naturalists and scientists in both episodes are attempting to make timbre natural. These efforts to naturalize and universalize the perceptual importance of timbre as biologically meaningful says more about our ongoing inability to define timbre in some form other than by what it is not. Here too, timbre is not what birds hear, or at least not what they necessarily care about.
Post-traumatic stress disorder in veterans
Authors: Haveman-Gould Bradley , Newman Chelsea 
Published: October 2018

ABSTRACT
Post-traumatic stress disorder (PTSD) affects about 20% of US military veterans and is a major cause of mortality in these men and women. The incidence of PTSD has persisted over the last decade with the Iraq and Afghanistan wars, yet treatment and adherence remain inadequate in part due to clinician lack of knowledge about cognitive processing therapy and prolonged exposure, the proven gold standards in treatment. This article reviews the most current and successful PTSD treatment options and identifies risk factors for patient nonadherence in hopes of reducing the rate of veteran suicide related to PTSD.
Characteristics of Patients With Opioid Use Disorder Associated With Performing Overdose Reversals in the Community: An Opioid Treatment Program Analysis
Authors: Katzman Joanna G. , Greenberg Nina H. , Takeda Mikiko Y. , Moya Balasch Monica 
Published: October 2018

Objective:
The primary outcome of this study is to identify characteristics of study participants in a large opioid treatment program (OTP) for opioid use disorder (OUD) who used take-home naloxone to perform 1 or more opioid overdose (OD) reversal(s) in the community.

Methods:
This 6-month prospective cohort study provided take-home naloxone and opioid OD education for 287 study participants with OUD. Characteristics associated with use of the take-home naloxone were determined from among 16 variables using multivariable logistic regression.

Results:
The study participants who had greater odds of using the take-home naloxone to perform OD reversals, compared to those who did not use the take-home naloxone, (a) received emergency room care themselves for OD (OR = 4.89, 95% CI 1.54–15.52, P = 0.007), (b) previously witnessed someone else OD (OR = 5.67, 95% CI 1.24–25.87, P = 0.025), (c) tested positive for 2 or more illicit substances at their 6-month urine analysis (OR = 5.26, 95% CI 1.58–17.54, P = 0.007) or were missing their 6-month urine analysis (OR = 3.46, 95% CI 1.42–8.43, P = 0.006). In addition, they had greater odds of being (d) less than 30 years old (OR = 2.80, 95% CI 1.02–7.66, P = 0.045), and (e) Hispanic (OR = 3.98, 95% CI 1.41–11.21, P = 0.009).

Conclusions:
This study prospectively identified several characteristics of patients enrolled in an OTP with increased odds of using take-home naloxone in their social networks. Future harm reduction efforts may benefit by using targeted characteristics to identify those most likely to use naloxone in their communities.
Topical Estrogen Prescription Fill Rates for Women With a History of Breast Cancer Who Are Taking Hormone Therapy
Authors: Huntley Joseph H. , Richter Lee A. , Blackford Amanda L. , Aliu Oluseyi , Pollack Craig E. 
Published: October 2018

OBJECTIVE:
To evaluate how often women with a history of breast cancer who are taking hormone therapy (HT) filled prescriptions for topical estrogens and whether this frequency varied over time and by type of HT used.

METHODS:
We performed a retrospective cohort study using medical and outpatient drug claims from a large commercial claims database for the years 2010–2015. Women younger than age 65 years taking HT for breast cancer were classified as users of 1) tamoxifen only, 2) aromatase inhibitor(s) only, or 3) any other or multiple HTs. Our outcome variable was filling a prescription for topical estrogen in a given year. We used multivariable logistic regression models estimated with generalized estimating equations to determine whether the fill rate varied over time and by HT category adjusting for age, receipt of surgical or radiation treatment, types of outpatient health care provider visits, and comorbidities.

RESULTS:
We identified 352,118 records from 176,012 unique patients (mean age 54.3 years, range 18–64 years) who met eligibility criteria. Aromatase inhibitors were used more commonly (56.0% of patient-years) than tamoxifen (38.8%). Overall, 3.0% (range 2.9–3.1%) of women filled any topical estrogen prescription in a given calendar year. More than half of filled topical estrogen prescriptions were for tablets (57.0%) with the remainder for creams (25.8%) and rings (17.3%). In adjusted analyses, the fill rate for women taking tamoxifen was significantly less (2.4%; 95% CI 2.3–2.5%) than for women taking aromatase inhibitors (3.3%; 95% CI 3.2–3.4%). There was a small but statistically significant increase in fill rates across years (odds ratio 1.03, 95% CI 1.02–1.04).

CONCLUSION:
A small proportion of women with a history of breast cancer who were taking HT filled a topical estrogen prescription, with significant differences by type of HT. More evidence is needed to inform national guidelines regarding safety and appropriate use of topical estrogens in this patient population.
Hereditary Cancer Risk Assessment and Genetic Testing in the Community-Practice Setting
Authors: DeFrancesco Mark S. , Waldman Richard N. , Pearlstone Melissa M. , Karanik Dana , Bernhisel Ryan , Logan Jennifer , Alico Lindsey , Adkins Royce T. 
Published: October 2018

OBJECTIVE:
To evaluate the feasibility and results of incorporating routine hereditary cancer risk assessment, counseling, and follow-up genetic testing in the community obstetrics and gynecology practice setting without referral to a genetic counselor.

METHODS:
This prospective process intervention study was conducted with two obstetrics and gynecology practice groups (five sites). The intervention included baseline process assessment, refinement of clinic-specific patient screening workflows and tools, and training in hereditary cancer risk screening and follow-up. Outcomes related to hereditary cancer assessment and testing were measured during an 8-week postintervention period. Patients and health care providers were surveyed about satisfaction with the process. Data also were collected during the 8 weeks before the intervention to assess the effects of screening process improvements.

RESULTS:
A total of 4,107 patients were seen during the postintervention period, and 92.8% (3,811) were assessed for hereditary cancer risk. Among those assessed, 906 of 3,811 (23.8%) women met National Comprehensive Cancer Network guidelines for genetic testing, and 813 of 906 (89.7%) eligible patients were offered genetic testing. A total of 165 of 4,107 (4.0%) women completed genetic testing and received a final test result. This represents a fourfold increase over genetic testing immediately before the intervention (1.1%) and an eightfold increase over the previous year (0.5%). Testing identified pathogenic variants in 9 of 165 (5.5%) tested women. All health care providers (15/15) reported that they will continue to use the established hereditary cancer risk assessment process. In addition, 98.8% (167/169) of patients who submitted a sample for genetic testing and completed a patient satisfaction survey stated that they were able to understand the information provided, and 97.6% (165/169) expressed satisfaction with the overall process.

CONCLUSION:
It is feasible to incorporate hereditary cancer risk assessment, education, and testing into community obstetrics and gynecology practices. As a result, multigene panel testing identified significant cancer risks that otherwise would not have been recognized.
External Use of an Oxidized Regenerated Cellulose Agent in the Treatment of Labial Agglutination in Postmenopausal Women
Authors: Wyman Allison M. , Lafranchise Elizabeth , Lynch Catherine 
Published: October 2018

BACKGROUND:
Vulvovaginal diseases affect women of all ages. Vaginal atrophy and vulvar lichen sclerosus are common etiologies for chronic vulvovaginal pruritus and labial agglutination in both prepubertal and postmenopausal women.

CASES:
We present two cases of a novel approach in management of symptomatic labial agglutination in postmenopausal women. At the time of surgical intervention, an oxidized regenerated cellulose gauze was sutured in place within the operative field of separation of the labia minora and clitoral hood adhesions. At more than 18-months’ follow-up, no recurrence of agglutination has been noted.

CONCLUSION:
The use of an oxidized regenerated cellulose agent may create an effective barrier to recurrence of labial agglutination in postmenopausal women.
Characterization of Risk Factors and Timing of Venous Thromboembolism in Patients With Uterine Serous Carcinoma
Authors: Gressel Gregory M. , Turker Lauren , Dioun Shayan M. , McGinn Aileen P. , Nevadunsky Nicole S. 
Published: October 2018

OBJECTIVE:
To characterize risk factors and timing of venous thromboembolism in women with uterine serous carcinoma.

METHODS:
A retrospective cohort study was performed including all women diagnosed with uterine serous carcinoma from 1999 to 2016 at our institution. Clinicopathologic data and information regarding timing of venous thromboembolism were abstracted from the medical record. Logistic regression and Cox proportional hazards modeling were used to examine the association between covariates and risk and timing of venous thromboembolism.

RESULTS:
Seventy of the 413 included patients (17%) developed venous thromboembolism, with a median time from presentation to venous thromboembolism of 7.2 months (interquartile range 1.0–24.8) and from surgery to venous thromboembolism of 13.2 months (interquartile range 3.5–33.6). Fifty-nine of the 70 patients (84%) who developed venous thromboembolism were diagnosed either before surgery or greater than 6 weeks postoperatively. Twenty-two of the 70 patients (31%) who developed clots were on chemotherapy at the time of diagnosis. Venous thromboembolism was highly associated with cancer stage and presence of hypertension (P<.01). Cox proportional hazards modeling revealed that only cancer stages III and IV (hazard ratio [HR] 3.20, 95% CI 1.54–6.64 and HR 8.68, 95% CI 4.50–16.73, respectively) and hypertensive or cardiovascular diseases (HR 2.29, 95% CI 1.08–4.85 and HR 1.82, 95% CI 1.05–3.13) were associated with time to venous thromboembolism.

CONCLUSION:
Patients with uterine serous carcinoma are at high risk of developing venous thromboembolism even many months after their cancer diagnosis. This study generates the hypothesis that venous thromboembolism prophylaxis may be beneficial in patients with uterine serous carcinoma during other time points along the continuum of disease rather than only in the postoperative period, especially for those with advanced cancer.
Novel Approach to Reduction of an Incarcerated Uterus
Authors: Gardner Bennett , Kozakiewicz Melissa L. , Whitecar Paul W. , Nitsche Joshua F. , Brost Brian C. 
Published: October 2018

BACKGROUND:
Incarceration of the pregnant uterus is a rare condition and can lead to bladder obstruction, renal failure, or uterine rupture. We present a novel, noninvasive technique to reduce an incarcerated uterus.

METHOD:
With conscious sedation, the patient was placed in all-fours position. The physician's hands were placed on the patient's abdomen and pressure applied until the uterine fundus was palpated. Gentle, steady fundal pressure on both sides was directed toward the maternal chest (bilateral mediocephalad pressure) elevating the uterus out of the pelvis. This approach successfully reduced the gravid incarcerated uterus and was well tolerated by the patient and fetus.

EXPERIENCE:
The author's experience with this method is limited to this case. Prior experience with reduction of the incarcerated uterus has been with methods previously described in the literature.

CONCLUSION:
In conjunction with conscious sedation and all-fours positioning, transabdominal manipulation of the uterine fundus with bilateral mediocephalad pressure may facilitate reduction of an incarcerated uterus. This method may obviate the need for more invasive procedures.
Cesarean Scar Pregnancy, Incidence, and Recurrence
Authors: Grechukhina Olga , Deshmukh Uma , Fan Linda , Kohari Katherine , Abdel-Razeq Sonya , Bahtiyar Mert Ozan , Sfakianaki Anna K. 
Published: October 2018

OBJECTIVE:
To describe the treatment and subsequent pregnancy outcomes in patients with cesarean scar pregnancies at a single institution over 5 years.

METHODS:
This is a case series of all cesarean scar pregnancies diagnosed from May 2013 to March 2018 at Yale-New Haven Hospital. Data were collected on each patient using electronic medical record review and included patient demographics; medical, surgical, and obstetric history; pregnancy characteristics; treatment modalities used; response to therapy; complications; and subsequent pregnancy outcomes.

RESULTS:
Thirty cases of cesarean scar pregnancies were diagnosed in 26 patients, including one recurrence in one patient and three recurrences in another. Forty-six percent of cesarean scar pregnancies were in Hispanic women. The median number of prior cesarean deliveries was two. Mean gestational age at the time of diagnosis was 46 days (SD±10). Fetal cardiac activity was detected in 18 cases. Three patients initially were erroneously diagnosed with a viable intrauterine pregnancy and failed medical termination. Others opted for termination through systemic methotrexate alone (n=4), systemic and local methotrexate (n=12), systemic and local methotrexate with potassium chloride injected into the gestational sac (n=3), potassium chloride injection with laparotomy and wedge resection (n=1), methotrexate with bilateral uterine artery embolization (n=2), or intrauterine balloon (n=4). Five patients who underwent expectant management or methotrexate therapy had retained products of conception and required hysteroscopy and curettage. One patient opted for hysterectomy after failed curettage. After complete resolution of cesarean scar pregnancies, there were 10 subsequent spontaneous conceptions in eight patients, including four recurrent cesarean scar pregnancies, four term pregnancies, and one spontaneous abortion. One viable normally located pregnancy is ongoing.

CONCLUSION:
There is a wide array of treatment modalities available for cesarean scar pregnancies. Women with a cesarean scar pregnancy are at risk for its recurrence in the future, although normal pregnancy after a cesarean scar pregnancy is also possible. Safe outcomes depend on timely diagnosis and multidisciplinary care by skilled clinicians.
Utilization of Time-driven Activity-based Costing to Determine the True Cost of a Single or 2-level Anterior Cervical Discectomy and Fusion
Authors: Schroeder Gregory D. , Hilibrand Alan S. , Kepler Christopher K. , McKenzie James C. , Nicholson Kristen J. , Stawicki Christie , Paul Jonathan , Kumar Priyanka , Hollern Douglas A. , Murphy Hamadi , Milhouse Paul W. , Kurd Mark F. , Woods Barret I. , Radcliff Kris E. , Anderson David G. , Vaccaro Alexander R. , Rihn Jeffery A. 
Published: October 2018

Study Design:
This is a prospective case series.

Objective:
To determine the actual cost of performing 1- or 2-level anterior cervical discectomy and fusion (ACDF) using actual patient data and the time-driven activity-based cost methodology.

Summary of Background Data:
As health care shifts to use value-based reimbursement, it is imperative to determine the true cost of surgical procedures. Time-driven activity-based costing determines the cost of care by determining the actual resources used in each step of the care cycle.

Materials and Methods:
In total, 30 patients who underwent a 1- or 2-level ACDF by 3 surgeons at a specialty hospital were prospectively enrolled. To build an accurate process map, a research assistant accompanied the patient to every step in the care cycle including the preoperative visit, the preadmission testing, the surgery, and the postoperative visits for the first 90 days. All resources utilized and the time spent with every member of the care team was recorded.

Results:
In total, 27 patients were analyzed. Eleven patients underwent a single-level ACDF and 16 underwent a 2-level fusion. The total cost for the episode of care was $29,299±$5048. The overwhelming cost driver was the hospital disposable costs ($13,920±$6325) which includes every item used during the hospital stay. Intraoperative personnel costs including fees for the surgeon, resident/fellow, anesthesia, nursing, surgical technician, neuromonitoring, radiology technician and orderlies, accounted for the second largest cost at $6066±$1540. The total cost excluding hospital overhead and disposables was $9071±$1939.

Conclusions:
Reimbursement for a bundle of care surrounding a 1- or 2-level ACDF should be no less than $29,299 to cover the true costs of the care for the entire care cycle. However, this cost may not include the true cost of all capital expenditures, and therefore may underestimate the cost.