bluuebunny/crossref_metadata_2025_split huggingface dataset:
Building resilience to adverse childhood experiences: An assessment of the effects of the Stepping Stones with Children training programme on Tanzanian children affected by HIV and their caregivers
Authors: Holden Sue , Gordon-Dseagu Vanessa LZ , Gordon Gill , Chiziza Nelson , Kiwia Pfiriaeli , Magesa Daniel , Manyama Willbrord , Welbourn Alice 
Published: July 2018

Objective: To evaluate the effects of a transformative training programme on children aged 5–14  years affected by HIV and their caregivers. Method: A formative process was used to draft, pilot and finalise training materials in Tanzania. We ran workshops with children living with HIV, their caregivers and some siblings in four communities. We assessed changes in knowledge, attitudes and well-being, and compared the health of child participants living with HIV with that of a control group of children living with HIV. Results: Although we intentionally excluded ‘disclosure’ of HIV sero-status to children as an indicator, the proportion who knew their sero-status increased from 27% to 93%. Assessment of clinical data before and after the workshops showed a statistically significant increase ( p-value of <.01) in the CD4 count among the child participants living with HIV ( n = 85, mean CD4 change + 317; from 530 to 847) compared with the control group ( n = 91, mean CD4 change + 133; from 557 to 690). The mean weight gain was 3.51 kg for child participants and 1.33 kg for controls. Other benefits included improved relationships and reduced violence against the children, greater confidence, more willingness to use HIV services and better networks of support. Conclusion: The Stepping Stones with Children programme can achieve multiple outcomes, including disclosure and better adherence to treatment, to reduce the impact of the adverse childhood experience of being affected by HIV. It is possible and acceptable to include children aged five and over in learning about HIV, sexual health and skills to improve their resilience.
Who drives an officer’s career, the individual or his institution? The case of French officers
Authors: Morin Gabriel , Chanut Véronique 
Published: July 2018

The phenomenon of managerialisation, whose impact is being felt by the state, as well as its elites, helps bring about the emergence of the individual. The military is not immune to the organisational transformations that follow in its wake. By analysing the career path of French officers, this study explores the effects of this managerialisation. The research question as formulated sets out to determine whether it is the individual or his institution that drives the career of the French officer. The empirical study is based on very dense primary data collected from actors who play a key role in forming the French military elites: general officers, in some cases, directors of military schools, who have, in turn, been students, instructors and designers of this career path of the military leader. The results reveal that despite an unprecedented process of civilianisation within the military institution, the career of military leader is proving to be more immutable. The career path of the French officer can thus be read as a marker of military institutional identity. Points for practitioners As an institution, the military may seem to mirror the major evolutions of society, in particular, the phenomenon of managerialisation, which is making its impact felt on the state, along with its corollary, individualism. Analysing the career of French officers makes it possible to explore the effects of this managerialisation. The study results reveal a mitigation of the effects of this phenomenon, also called civilianisation in the case of the armed forces, and, on the contrary, reveal the invariant character of the career of military leader, pillar of the military institutional identity.
Chinese herbal medicine for functional dyspepsia: systematic review of systematic reviews
Authors: Chu Michael H. K. , Wu Irene X. Y. , Ho Robin S. T. , Wong Charlene H. L. , Zhang Anthony L. , Zhang Yan , Wu Justin C. Y. , Chung Vincent C. H. 
Published: July 2018

Background: Pharmacotherapy, including prokinetics and proton pump inhibitors for functional dyspepsia (FD) have limited effectiveness, and their safety has been recently questioned. Chinese herbal medicine (CHM) could be considered as an alternative. A systematic review (SR) of SRs was performed to evaluate the potential effectiveness and safety of CHM. Method: We conducted a comprehensive literature search for SRs with meta-analyses in eight international and Chinese databases. Pooled effect estimation from each meta-analysis was extracted. The AMSTAR instrument was used to assess the methodological quality of the included SRs. Results: A total of 14 SRs of mediocre quality assessing various CHMs, alone or in combination with conventional pharmacotherapy, were included. Meta-analyses showed that CHM was more effective than prokinetic agents for the alleviation of global dyspeptic symptoms. Three specific CHM formulae appeared to show superior results in the alleviation of global dyspeptic symptoms, including Si Ni San, modified Xiao Yao San and Xiang Sha Liu Jun Zi decoction. No significant difference in the occurrence of adverse events in using CHM or pharmacotherapy was reported. Conclusion: CHM can be considered as an alternative for the treatment of FD symptoms when prokinetic agents and proton pump inhibitors are contraindicated. Future trial design should focus on measuring changes in individual dyspeptic symptoms and differentiate the effectiveness of different CHM for postprandial distress syndrome and epigastric pain syndrome. A network meta-analysis approach should be used to explore the most promising CHM formula for FD treatment in the future.
Clinico-epidemiology, malacology and community awareness of Schistosoma mansoni in Haradenaba and Dertoramis kebeles in Bedeno district, eastern Ethiopia
Authors: Mohammed Jemal , Weldegebreal Fitsum , Teklemariam Zelalem , Mitiku Habtamu 
Published: July 2018

Background: Schistosoma mansoni is a major public health problem. Different studies reported unidentified sites in Ethiopia with variable prevalence and intensity, but there is no report from this study area. Objective: To assess the clinico-epidemiology, malacology, risk factors, and community awareness of S. mansoni in Haradenaba and Dertoramis kebeles in the Bedeno district, eastern Ethiopia. Methods: A cross-sectional study was conducted among 1011 study participants in 413 systematically selected households from Haradenaba and Dertoramis kebeles from 30 June 2016 to 30 July 2017. Data were collected by using pretested, structured questionnaires, clinical examinations, and stool examinations. Stool samples were processed by the Kato-Katz method and examined microscopically. Snails were collected by scooping from water contact points. Data were analyzed using SPSS, version 16 statistical software. Result: The overall prevalence of S. mansoni was 35.7%. Heavy-intensity infection was detected in 8.9% of the study participants. Results included: participants who were unaware about the possible source of infection (adjusted odds ratio: 2.95; 95% confidence interval: 1.25, 7.95), modes of transmission (adjusted odds ratio: 5.51; 95% confidence interval: 3.52, 12.51), prevention (adjusted odds ratio: 4.01; 95% confidence interval: 2.00, 8.75) about schistosomiasis/bilharziasis were more likely infected with S. mansoni than those who were aware. Participants who swim or bathe in the river were more likely infected with S. mansoni than those who do not (adjusted odds ratio: 6.41; 95% confidence interval: 3.15, 11.25). Biomphalaria pfeifferi snails were collected from all water bodies in Haradenaba and Dertoramis, but they did not shed schistosome cercaria in the laboratory. Conclusion: S. mansoni infection is found in high magnitude in these study areas, despite not being previously reported. A majority of the study participants had low awareness about the source of infection, mode of transmission, and prevention methods of schistosomiasis. Efforts should be made to improve community awareness about transmission and prevention of schistosomiasis.
Surgical site infection after primary total knee arthroplasty is associated with a longer duration of surgery
Authors: Teo Bryon Jun Xiong , Yeo William , Chong Hwei-Chi , Tan Andrew Hwee Chye 
Published: July 2018

Purpose: Surgical site infection (SSI) is a serious complication following total knee arthroplasty (TKA) leading to considerable morbidity. The incidence is reported to be up to 2%. Risk factors continue to be an area of intense debate. Our study aims to report the incidence of SSI and identify possible risk factors in our patients undergoing TKA. Methods: Prospectively collected data for 905 patients who underwent elective unilateral TKA by a single surgeon from February 2004 to July 2014 were reviewed. Patient demographics and relevant co-morbidities such as diabetes and heart disease were analysed. The presence of superficial wound infections and/or prosthetic joint infections was included. Results: The overall infection rate was 1.10% (10 of 905 patients). Six patients (0.66%) were diagnosed with superficial infections and four with PJI (0.44%). The mean operative duration for TKA with SSI was significantly longer at 90.5 ± 28.2 min, compared to 72.2 ± 20.3 min in TKA without SSI ( p = 0.03). All superficial infections occurred within the first month post-surgery and were self-limiting with oral antibiotics. The four patients with PJI required repeated procedures following TKA, including debridement, implant removal and/or revision arthroplasty. None of the 10 patients had a history of diabetes. There were no significant differences in demographics and co-morbidities between those who developed infection after TKA and those who did not. Conclusion: An overwhelming majority had good outcomes with only four deep infections resulting in revision surgery. We report that the risk of infection in TKA was significantly associated with a longer operative duration.
Does My Patient With Shoulder Pain Have a Rotator Cuff Tear? A Predictive Model From the ROW Cohort
Authors: Jain Nitin B. , Fan Run , Higgins Laurence D. , Kuhn John E. , Ayers Gregory D. 
Published: July 2018

Background: Rotator cuff tears are the leading cause of shoulder pain and disability. However, the diagnosis of a rotator cuff tear based on patient characteristics, symptoms, and physical examination findings remains a challenge because of a lack of data. Moreover, data on the predictive ability of a combination of these characteristics and tests are not available from a large cohort of patients. Consequently, clinicians rely on expensive imaging, such as magnetic resonance imaging (MRI), to make a diagnosis. Purpose: To model patient characteristics, symptoms, and physical examination findings that predict a rotator cuff tear. We present a nomogram based on our predictive model that can be used in patients with shoulder pain to determine the probability of the diagnosis of a rotator cuff tear without the need for imaging. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We recruited patients from outpatient clinics who were ≥45 years of age and who had shoulder pain of at least 4 weeks’ duration. A rotator cuff tear was diagnosed based on expert clinical impression and the presence/absence of a tear on a blinded review of MRI. Ultimately, 301 patients were included in the analysis. Results: A total of 123 patients (41%) had rotator cuff tears, and 178 patients (59%) did not. The predictors of the diagnosis of a rotator cuff tear included external rotation strength ratio of the affected versus unaffected shoulder (odds ratio [OR], 1.20 [95% CI, 1.08-1.34]), male sex (OR, 1.98 [95% CI, 1.10-3.56]), positive lift-off test result (OR, 4.33 [95% CI, 1.46-12.86]), and positive Jobe test result (OR, 9.19 [95% CI, 4.69-17.99]). A nomogram based on these predictor variables was plotted. Conclusion: Presented is a model that can accurately predict the diagnosis of a rotator cuff tear with satisfactory discrimination and calibration based on 4 variables: sex, lift-off test, Jobe test, and external rotation strength ratio. Data from this study can be used to aid in the diagnosis of a rotator cuff tear in day-to-day clinical practice in outpatient settings without the need for expensive imaging such as MRI.
Creating a comprehensive, unit-based approach to detecting and preventing harm in the neonatal intensive care unit
Authors: Sedlock Emily W , Ottosen Madelene , Nether Klaus , Sittig Dean F. , Etchegaray Jason M , Tomoaia-Cotisel Andrada , Francis Nicole , Yager Lauren , Schafer Leslie , Wilkinson Rebekah , Khan Amir , Arnold Cody , Davidson Allison , Thomas Eric J 
Published: July 2018

Background Error detection and analysis alone cannot create or sustain a culture of safe, high-quality, compassionate care for patients. Some experts have endorsed a unit-based approach to improving quality, but there are few examples and those rarely focus on reducing all preventable harms and engaging frontline clinicians, patients, and families. Approach: We implemented a unit-based approach comprising seven building blocks for creating a comprehensive approach to detect and prevent harm at the unit level within a hospital: (1) unit quality council and stakeholder buy-in, (2) parent engagement and advisory council, (3) frontline clinician and parent quality improvement training, (4) measurement of organizational contextual factors, (5) electronic health record trigger development and synthesis of harm measures, (6) subcommittees to review harm, and (7) quality improvement teams. Challenges and Lessons Learned: Challenges include conceptualizing triggers for a unit unfamiliar with this methodology, establishing unit resources for collecting and analyzing data, and creating processes to integrate parents in unit quality efforts. The seven essential building blocks helped overcome these challenges and could be adopted by other healthcare organizations. Conclusion These building blocks create a generalizable foundation for establishing a unit-based approach to detecting and preventing harm.
The rise of apoptosis: targeting apoptosis in hematologic malignancies
Authors: Valentin Rebecca , Grabow Stephanie , Davids Matthew S. 
Published: July 2018

AbstractDysregulation of the B-cell leukemia/lymphoma-2 (BCL-2) family of proteins of the intrinsic apoptotic pathway is fundamental to the pathophysiology of many hematologic malignancies. The BCL-2 family consists of regulatory proteins that either induce apoptosis (proapoptotic) or inhibit it (prosurvival). BCL-2, myeloid cell leukemia-1, and B-cell lymphoma–extra large are prosurvival proteins that are prime targets for anticancer therapy, and molecules targeting each are in various stages of preclinical and clinical development. The US Food and Drug Administration (FDA)-approved BCL-2 inhibitor venetoclax was first proven to be highly effective in chronic lymphocytic leukemia and some B-cell non-Hodgkin lymphoma subtypes. Subsequently, venetoclax was found to be active clinically against a diverse array of hematologic malignancies including multiple myeloma, acute myeloid leukemia, myelodysplastic syndrome, acute lymphoblastic leukemia, and others. Here, we give a brief introduction to BCL-2 family biology and the mechanism of action of BCL-2 Homology 3 (BH3) mimetics, and provide an overview of the clinical data for therapeutically targeting prosurvival proteins in hematologic malignancies, with a focus on BCL-2 inhibition. To prioritize novel agent combinations and predict responders, we discuss the utility of functional assays such as BH3 profiling. Finally, we provide a perspective on how therapies targeting BCL-2 family proteins may be optimally implemented into future therapeutic regimens for hematologic malignancies.
Monoclonal gammopathy of clinical significance: a novel concept with therapeutic implications
Authors: Fermand Jean-Paul , Bridoux Frank , Dispenzieri Angela , Jaccard Arnaud , Kyle Robert A. , Leung Nelson , Merlini Giampaolo 
Published: July 2018

Abstract
Monoclonal gammopathy is a common condition, particularly in the elderly. It can indicate symptomatic multiple myeloma or another overt malignant lymphoid disorder requiring immediate chemotherapy. More frequently, it results from a small and/or quiescent secreting B-cell clone, is completely asymptomatic, and requires regular monitoring only, defining a monoclonal gammopathy of unknown significance (MGUS). Sometimes, although quiescent and not requiring any treatment per se, the clone is associated with potentially severe organ damage due to the toxicity of the monoclonal immunoglobulin or to other mechanisms. The latter situation is increasingly observed but still poorly recognized and frequently undertreated, although it often requires rapid specific intervention to preserve involved organ function. To improve early recognition and management of these small B-cell clone–related disorders, we propose to introduce the concept of monoclonal gammopathy of clinical significance (MGCS). This report identifies the spectrum of MGCSs that are classified according to mechanisms of tissue injury. It highlights the diversity of these disorders for which diagnosis and treatment are often challenging in clinical practice and require a multidisciplinary approach. Principles of management, including main diagnostic and therapeutic procedures, are also described. Importantly, efficient control of the underlying B-cell clone usually results in organ improvement. Currently, it relies mainly on chemotherapy and other anti–B-cell/plasma cell agents, which should aim at rapidly producing the best hematological response.
Outcomes of Chemotherapy for Microsatellite Instable–High Metastatic Colorectal Cancers
Authors: Shulman Katerina , Barnett-Griness Ofra , Friedman Vered , Greenson Joel K. , Gruber Stephen B. , Lejbkowicz Flavio , Rennert Gad 
Published: July 2018

PurposeMicrosatellite instable-high (MSI-H) colorectal cancers (CRCs) are known to carry better survival in the local disease stage even without treatment. The influence of types of treatment on survival of MSI-H metastatic CRCs (mCRCs) is still unclear and is evaluated in this study.Materials and MethodsPatients with MSI-H mCRC treated with first-line chemotherapy, with or without bevacizumab, identified in the Israeli population-based Molecular Epidemiology of Colorectal Cancer (MECC) study, were diagnosed between 1998 and 2013 and followed up until May 2017; MSI status was determined by comparing 10 markers in tumor and normal tissue. Dates of metastases and death and treatment details were extracted from oncology records.ResultsAmong 590 patients treated for mCRC, 106 (18%) had MSI-H tumors. Patients with MSI-H had a median overall survival (OS, from start of first-line treatment) of 1.6 years. The presence of a somatic B-Raf proto-oncogene ( BRAF) mutation was a significant adverse prognostic factor in the MSI-H group (hazard ratio [HR], 1.8; 95% CI, 1.1 to 3.0; P = .026). MSI-H tumors without BRAF mutation (n = 87) had similar OS benefit from fluorouracil (FU) only as from any combination protocols (HR, 0.93; P = .78), whereas microsatellite-stable (MSS) tumors without BRAF mutation (n = 456) showed improved OS over FU-only regimens when combination chemotherapy with or without bevacizumab was used (HR, 0.58; P < .01; P value for interaction = .07). Patients with MSI-H/BRAF wild type (WT) had survival advantage over patients with MSS disease (adjusted HR, 0.58; 95% CI, 0.35 to 0.98) when treated with FU-only protocols.ConclusionClinical outcomes differ substantially between patients with MSS/BRAF-WT mCRC and MSI-H/BRAF-WT mCRC, with measurable differences between chemotherapy regimens. MSI-H mCRCs are a clinically distinct subset of colorectal cancers. Their current poor outcome suggests that new clinical trials are needed to identify therapeutic options, potentially taking advantage of the new developments in the field of immunotherapy.
Evidence That Dynorphin Acts Upon KNDy and GnRH Neurons During GnRH Pulse Termination in the Ewe
Authors: Weems Peyton W , Coolen Lique M , Hileman Stanley M , Hardy Steven , McCosh Rick B , Goodman Robert L , Lehman Michael N 
Published: July 2018

AbstractA subpopulation of neurons located within the arcuate nucleus, colocalizing kisspeptin, neurokinin B, and dynorphin (Dyn; termed KNDy neurons), represents key mediators of pulsatile GnRH secretion. The KNDy model of GnRH pulse generation proposes that Dyn terminates each pulse. However, it is unknown where and when during a pulse that Dyn is released to inhibit GnRH secretion. Dyn acts via the κ opioid receptor (KOR), and KOR is present in KNDy and GnRH neurons in sheep. KOR, similar to other G protein–coupled receptors, are internalized after exposure to ligand, and thus internalization can be used as a marker of endogenous Dyn release. Thus, we hypothesized that KOR will be internalized at pulse termination in both KNDy and GnRH neurons. To test this hypothesis, GnRH pulses were induced in gonad-intact anestrous ewes by injection of neurokinin B (NKB) into the third ventricle and animals were euthanized at times of either pulse onset or termination. NKB injections produced increased internalization of KOR within KNDy neurons during both pulse onset and termination. In contrast, KOR internalization into GnRH neurons was seen only during pulse termination, and only in GnRH neurons within the mediobasal hypothalamus (MBH). Overall, our results indicate that Dyn is released onto KNDy cells at the time of pulse onset, and continues to be released during the duration of the pulse. In contrast, Dyn is released onto MBH GnRH neurons only at pulse termination and thus actions of Dyn upon KNDy and GnRH cell bodies may be critical for pulse termination.
First Trimester Urinary Bisphenol and Phthalate Concentrations and Time to Pregnancy: A Population-Based Cohort Analysis
Authors: Philips Elise M , Kahn Linda G , Jaddoe Vincent W V , Shao Yongzhao , Asimakopoulos Alexandros G , Kannan Kurunthachalam , Steegers Eric A P , Trasande Leonardo 
Published: July 2018

Abstract

Background
Increasing evidence suggests that exposure to synthetic chemicals such as bisphenols and phthalates can influence fecundability. The current study describes associations of first trimester urinary concentrations of bisphenol A (BPA), BPA analogs, and phthalate metabolites with time to pregnancy (TTP).

Methods
Among 877 participants in the population-based Generation R pregnancy cohort, we measured first trimester urinary concentrations of bisphenols and phthalates [median gestational age, 12.9 weeks (interquartile range, 12.1, 14.4)]. We used fitted covariate-adjusted Cox proportional hazard models to examine associations of bisphenol and phthalate concentrations with TTP. Participants who conceived using infertility treatment were censored at 12 months. Biologically plausible effect measure modification by folic acid supplement use was tested.

Results
In the main models, bisphenol and phthalate compounds were not associated with fecundability. In stratified models, total bisphenols and phthalic acid were associated with longer TTP among women who did not use folic acid supplements preconceptionally [respective fecundability ratios per each natural log increase were 0.90 (95% CI, 0.81 to 1.00) and 0.88 (95% CI, 0.79 to 0.99)]. Using an interaction term for the exposure and folic acid supplement use showed additional effect measure modification by folic acid supplement use for high-molecular-weight phthalate metabolites.

Conclusions
We found no associations of bisphenols and phthalates with fecundability. Preconception folic acid supplementation seems to modify effects of bisphenols and phthalates on fecundability. Folic acid supplements may protect against reduced fecundability among women exposed to these chemicals. Further studies are needed to replicate these findings and investigate potential mechanisms.