bluuebunny/crossref_metadata_2025_split huggingface dataset:
Yield of Emergent CT in Patients With Epilepsy Presenting With a Seizure
Authors: Kvam Kathryn A. , Douglas Vanja C. , Whetstone William D. , Josephson S. Andrew , Betjemann John P. 
Published: November 2018

Background: Studies of emergent neuroimaging in the management of patients presenting with a breakthrough seizure are lacking. We sought to determine how often emergent computed tomography (CT) scans are obtained in patients with known epilepsy presenting with a seizure and how often acute abnormalities are found. Methods: This multicenter retrospective cohort study was performed in the emergency department at 2 academic medical centers. The primary outcomes were percentage of visits where a CT scan was obtained, whether CT findings represented acute abnormalities, and whether these findings changed acute management. Results: Of the 396 visits included, CT scans were obtained in 39%, and 8% of these scans demonstrated acute abnormalities. Patients who were older, had status epilepticus, a brain tumor, head trauma, or an abnormal examination were all significantly more likely to undergo acute neuroimaging ( P < .05). In the multivariable model, only history of brain tumor (odds ratio [OR] 5.88, 95% confidence interval [CI], 1.33-26.1) and head trauma as a result of seizure (OR 3.92, 95% CI, 1.01-15.2) reached statistical significance in predicting an acutely abnormal scan. The likelihood of an acute imaging abnormality in visits for patients without a history of brain tumor or head trauma as a result of the seizure was 2.7% (2 visits). Both of these patients had abnormal neurological examinations. Conclusion: Obtaining an emergent CT scan for patients with epilepsy presenting with a seizure may be avoidable in most cases, but might be indicated for patients with a history of brain tumor or head trauma as a result of seizure.
Assessment and patient selection process for a pain management programme: a case study in specialty care
Authors: Knight Lucie D , Guildford Beth J , Daly-Eichenhardt Aisling , McCracken Lance M 
Published: November 2018

Introduction: The present study audited the process of assessing and selecting patients for a pain management programme with the aim of reviewing best practice in the light of the latest British Pain Society guidelines for pain management programmes for adults. The guidelines include defined inclusion/exclusion criteria and it was explored how they are used by clinicians providing a pain management service. Method: The records of 200 consecutive patients who attended a multidisciplinary assessment for a central London specialist Pain Management Service from September 2014 to December 2014 were audited. The proportions of patients who were offered a programme, were discharged or referred for a different service were calculated. Clinic letters were reviewed to collect information on assessment outcomes, recommendations and inclusion/exclusion criteria used. Results: About half the patients (53%) seen for assessment were offered treatment within the service, most frequently the intensive residential programme (30.5%, with an additional 11.6% offered case management first), followed by the five session outpatient programme (8.1%) and a minority was offered individual treatment (2.5%); 44.7% of the patients were discharged following the assessment. The three most frequently used reasons for exclusion were: not ready to engage with the pain management approach (35%), complex psychological or other needs needing to be prioritised (29.5%) and the patient declining a programme (19.3%). Conclusion: Reviewing the use of inclusion/exclusion criteria revealed some challenges regarding patient selection. For example, a sizable proportion of patients were still seeking pain reduction and were not open to a self-management approach when this was the recommended treatment for them. Complex patients might need other treatment approaches before they can be considered for a programme. Having a range of pain management options of varying intensities available seems helpful in meeting individual patient need.
Radiofrequency ablation for patients with refractory symptomatic anaemia secondary to gastric antral vascular ectasia
Authors: Magee Cormac , Lipman Gideon , Alzoubaidi Durayd , Everson Martin , Sweis Rami , Banks Matthew , Graham David , Gordon Charles , Lovat Laurence , Murray Charles , Haidry Rehan 
Published: November 2018

BackgroundGastric antral vascular ectasia (GAVE) is a rare cause of gastrointestinal bleeding, often causing iron deficiency anaemia. Previous studies have looked at the management of this with argon plasma coagulation, laser therapy and endoscopic band ligation.MethodsThis was a single‐centre prospective study to evaluate the efficacy and safety of radiofrequency ablation (RFA) in patients with GAVE with persistent anaemia refractory to at least one session of first‐line endoscopic therapy. Patients were treated with a through‐the‐scope (TTS) radiofrequency catheter at two endoscopic sessions six weeks apart. The primary outcome was change in haemoglobin at six months posttreatment. The secondary outcomes were reduction in blood or iron requirements, endoscopic surface area regression and complications.ResultsTwenty patients were treated. The mean change in haemoglobin at six months was +12.6 g/l (95% confidence interval 11.7–24.3 g/l), paired t test p < 0.001. At six months, three of 14 individuals who had required blood transfusions had ongoing blood transfusions and five of 17 who had required iron had ongoing iron needs. Surface area regression was scored as 74% ± 25% but no correlation was seen between this and other outcomes. Three of 20 patients experienced pain which was managed with oral analgesia. Of the 14 patients who had reached 12‐month follow‐up, three required retreatment (21%).DiscussionThis small study suggests that RFA is a safe and effective treatment for GAVE. Our study uses the TTS catheter compared to other studies, and demonstrates prolonged improvement in haemoglobin and reduction in blood and iron requirements with a novel assessment of surface area regression.
Development and reliability of a hand-held dynamometer device to measure the ankle dorsiflexor muscle strength
Authors: Kimura Masanobu , Ogata Yuto , Akebi Toru , Ochi Mitsuhiro , Hachisuka Kenji , Saeki Satoru 
Published: November 2018

Background Ankle dorsiflexor muscle strength is a crucial component of gait. Objective We describe the development of a simple, hand-held dynamometer to measure the ankle dorsiflexor muscle strength in the sitting position. In addition, we examine its intra- and inter-rater reliability. Methods Measurements of the peak ankle dorsiflexor muscle strength were obtained by two examiners for 30 ankles of 15 healthy adults at two time points, with a one-day interval between measurements, to determine the inter- and intra-rater reliability. The intraclass correlation coefficients were calculated, and an intraclass correlation coefficient > 0.90 was considered as excellent reliability. A Bland–Altman analysis was used to assess systemic bias. The minimal detectable change in muscle strength was calculated with a confidence level of 95% (MDC95). Results The reliability of the device was excellent for both intra- (intraclass correlation coefficients [1,3] = 0.94) and inter-rater (intraclass correlation coefficients [2,3] = 0.96) comparisons. No fixed or proportional bias was observed between the two examiners. The MDC95 was 0.77 N/kg. Conclusions Our results indicate the excellent reliability and responsiveness of our device. By obtaining the measurements of dorsiflexor strength while sitting, compensatory motions are suppressed, yielding a more consistent measurement that can be reliably used to detect subtle changes in the ankle dorsiflexor muscle strength.
BMP-7/Smad expression in dedifferentiated Schwann cells during axonal regeneration and upregulation of endogenous BMP-7 following administration of PTH (1-34)
Authors: Kokubu Naoki , Tsujii Masaya , Akeda Koji , Iino Takahiro , Sudo Akihiro 
Published: November 2018

Purpose: To determine the expression and distribution of bone morphogenetic protein (BMP)-7 and related molecules during peripheral nerve regeneration and to assess whether administration of parathyroid hormone (PTH) drug (1-34) potentiates the intrinsic upregulation of BMP-7/Smad signaling. Methods: The rat sciatic nerves were crushed with an aneurysm clip resulting in axonal degeneration. In the normal nerve, and at 1, 2, 4, and 8 weeks after injury, BMP-7, BMP receptors, p-Smad 1/5/8, and Noggin, the endogenous BMP antagonist, were evaluated. Additionally, the distribution of BMP-7 was assessed by fluorescent double immunostaining. In vitro studies were also performed to examine the effect of BMP-7 and PTH (1-34) administration on rat Schwann cells (SCs). Results: Aneurysm clip made reliable animal model of the nerve injury with recovery at 8 weeks after the injury. BMP-7/Smad protein and mRNA were significantly upregulated on axon-SCs units at 1 week after injury, and this upregulated expression was maintained for 4 weeks. Besides, significant upregulation of Noggin’s expression was observed on axon-SCs units at 2 weeks after injury. Moreover, fluorescent double immunostaining showed co-localization between expression of BMP-7 and p75NTR during axonal regeneration. In the in vitro study, administration of BMP-7 induced significant proliferation of SCs. Application of PTH (1-34) upregulated BMP-7 on SCs. Discussion/conclusion: BMPs were reported to be involved in protection and recovery after injury as well as in neurogenesis. Our current study showed that BMP/Smad signaling molecules were upregulated on dedifferentiated SCs after peripheral nerve injury and that administration of BMP-7 increased SC viability in vitro. These results suggested that axonal regeneration could be induced via upregulation of endogenous BMP-7 on SCs by PTH (1-34) administration.
Association between antibiotic consumption and the rate of carbapenem-resistant Gram-negative bacteria from China based on 153 tertiary hospitals data in 2014
Authors: Yang Ping , Chen Yunbo , Jiang Saiping , Shen Ping , Lu Xiaoyang , Xiao Yonghong 
Published: November 2018

Abstract
Background
This study aimed to investigate the relationship between the rate of carbapenem-resistant Gram-negative bacteria and antibiotic consumption intensity in 153 tertiary hospitals from China in 2014.

Methods
A retrospective study using national surveillance data from 2014 was conducted. Data on the annual consumption of each antibiotic, as well as the rate of carbapenem-resistant Gram-negative bacteria, were collected from each participating hospital, and the correlation between antibiotic consumption and carbapenem- resistant rate was analyzed.

Results
The overall antibiotic consumption intensity among the hospitals varied between 23.93 and 86.80 defined daily dosages (DDDs) per 100 patient-days (median, 46.30 DDDs per 100 patient-days). Cephalosporins were the most commonly used antibiotic, followed by quinolones, penicillins, and carbapenems, and the rate of carbapenem-resistant Gram-negative bacteria from each hospital varied. The correlations between carbapenem consumption intensity and rate of carbapenem resistance revealed correlation factors of 0.271 for Escherichia coli (p < 0.01), 0.427 for Klebsiella pneumoniae (p < 0.01), 0.463 for Pseudomonas aeruginosa (p < 0.01), and 0.331 for Acinetobacter baumannii (p < 0.01).

Conclusions
A significant relationship existed between the carbapenem consumption and the rates of carbapenem-resistant gram negative bacilli. Rational use of carbapenems should be implemented to address the issue of carbapenem resistance in hospitals.
Low Concordance of Patient-Reported Outcomes With Clinical and Clinical Trial Documentation
Authors: Fares Charlene M. , Williamson Timothy J. , Theisen Matthew K. , Cummings Amy , Bornazyan Krikor , Carroll James , Spiegel Marshall L. , Stanton Annette L. , Garon Edward B. 
Published: November 2018

Purpose Health care research increasingly relies on assessment of data extracted from electronic medical records (EMRs). Clinical trial adverse event (AE) logs and patient-reported outcomes (PROs) are sources of data often available in the context of specific research projects. The aim of this study was to evaluate the extent of data concordance from these sources. Patients and Methods Patients enrolled in clinical trials or receiving standard treatment for lung cancer (n = 62) completed validated questionnaires on physical and psychological symptoms at up to three assessment points. Temporally matched documentation was extracted from EMR notes and, for clinical trial participants (n = 41), AE logs. Evaluated data included symptom assessment, vital signs, medication logs, and laboratory values. Agreement (positive, negative) and Cohen’s κ coefficients were calculated to assess concordance of symptoms among sources, with PROs considered the gold standard. Results Patient-reported weight loss correlated significantly with clinical measurements ( t = 2.90; P = .02), and average number of PROs correlated negatively with albumin concentration, supporting PROs as the gold standard. Comparisons of PROs versus EMR yielded poor concordance across 11 physical symptoms, anxiety, and depressive symptoms (all κ < 0.40). Providers under-reported the presence of each symptom in the EMR compared with PROs. AE logs showed similarly poor concordance with PROs (all κ < 0.40, except shortness of breath). Negative agreement among sources was higher than positive agreement for all symptoms except pain. Conclusion There was poor concordance between EMR notes and AE logs with PROs. Findings suggest that EMR notes and AE logs may not be reliable sources for capturing physical and psychological symptoms experienced by patients with lung cancer, supporting use of PRO assessments in oncology practices.
Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: ASCO Clinical Practice Guideline Focused Update
Authors: Burstein Harold J. , Lacchetti Christina , Anderson Holly , Buchholz Thomas A. , Davidson Nancy E. , Gelmon Karen A. , Giordano Sharon H. , Hudis Clifford A. , Solky Alexander J. , Stearns Vered , Winer Eric P. , Griggs Jennifer J. 
Published: November 2018

Purpose To update the ASCO clinical practice guideline on adjuvant endocrine therapy based on emerging data about the optimal duration of aromatase inhibitor (AI) treatment. Methods ASCO conducted a systematic review of randomized clinical trials from 2012 to 2018. Guideline recommendations were based on the Panel’s review of the evidence from six trials. Results The six included studies of AI treatment beyond 5 years of therapy demonstrated that extension of AI treatment was not associated with an overall survival advantage but was significantly associated with lower risks of breast cancer recurrence and contralateral breast cancer compared with placebo. Bone-related toxic effects were more common with extended AI treatment. Recommendations The Panel recommends that women with node-positive breast cancer receive extended therapy, including an AI, for up to a total of 10 years of adjuvant endocrine treatment. Many women with node-negative breast cancer should consider extended therapy for up to a total of 10 years of adjuvant endocrine treatment based on considerations of recurrence risk using established prognostic factors. The Panel noted that the benefits in absolute risk of reduction were modest and that, for lower-risk node-negative or limited node-positive cancers, an individualized approach to treatment duration that is based on considerations of risk reduction and tolerability was appropriate. A substantial portion of the benefit for extended adjuvant AI therapy was derived from prevention of second breast cancers. Shared decision making between clinicians and patients is appropriate for decisions about extended adjuvant endocrine treatment, including discussions about the absolute benefits in the reduction of breast cancer recurrence, the prevention of second breast cancers, and the impact of adverse effects of treatment. Additional information can be found at www.asco.org/breast-cancer-guidelines .
Processing parameters for electrospinning poly(methyl methacrylate) (PMMA)/titanium isopropoxide composite in a pump-free setup
Authors: Nyangasi Leah , Andala Dickson , Onindo Charles , Wanyonyi Alphonse , Chepngetich Josphine 
Published: November 2018

Background: Electrospinning is a technique for producing nanofibers, useful in many fields of nanotechnology. The size and morphology of the nanofibers obtained depends on the polymer solution properties, the parameters of the equipment and the conditions of the surrounding. In almost all reported electrospinning set ups, a pump ,which regulates the flow of the polymer solution, has been included as one of the requirements. In this study, the effects of solution concentration, viscosity, voltage and the distance from the tip of the syringe to the aluminum collector on the morphology and diameters of poly(methyl methacrylate)(PMMA) fibers were investigated, using a pump-free electrospinning set up. Methods: Varied PMMA concentration (50 -120 mg/mL), voltage (10-18 kV) and distance (5 – 18 cm) of electrospinning were studied and the optimum electrospinning conditions identified. PMMA/ titanium isopropoxide solution of ratio 1:2 was prepared, electrospun at optimized conditions (15 kV, 18 cm, Dichloromethane/Dimethylformamide 60:40) and the fibers obtained analyzed using a scanning electron microscope. Results: Solutions of PMMA whose concentrations were less than 50 mg/mL, produced beads on fibers, whereas those at ~ 100 mg/mL formed the best bead-free fibers of diameter 350±50 nm. The results showed a direct dependence of fiber diameter on the solution viscosity. Fibers of larger diameters were obtained when the distance from the tip of the syringe to the aluminum collector and voltage were increased but at higher distances (>18 kV) fewer fibers were collected. When the voltage was steadily increased, the fibers broadened and the diameters were non-uniform due to splaying and splitting. Increasing the distance between the pipette-tip and the collector from 10 to 18 cm resulted in reduced electric field which in turn yielded fewer fibers. Conclusions: The results obtained in a pump free set-up were comparable to those eletrospun in the presence of a pump.
Burden of cancer in Kenya: types, infection-attributable and trends. A national referral hospital retrospective survey
Authors: Macharia Lucy Wanjiku , Mureithi Marianne Wanjiru , Anzala Omu 
Published: November 2018

Background:Cancer in Africa is an emerging health problem. In Kenya it ranks third as a cause of death after infectious and cardiovascular diseases. Nearly 31% of the total cancer burden in sub-Saharan Africa is attributable to infectious agents. Information on cancer burden is scanty in Kenya and this study aimed to provide comprehensive hospital based data to inform policies.Method:A cross-sectional retrospective survey was conducted at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH) from 2008 to 2012. Data was obtained from the patients files and the study was approved by the KNH/University of Nairobi and MTRH Ethics and Research Committees. Results: In KNH, the top five cancers were: cervical (62, 12.4%), breast (59, 11.8%), colorectal (31, 6.2%), chronic leukemia (27, 5.4%) and stomach cancer 26 (5.2%). Some 154 (30.8%) of these cancers were associated with infectious agents, while an estimated 138 (27.6%) were attributable to infections. Cancers of the cervix (62, 12.4%), stomach (26, 5.2%) and nasopharynx (17, 3.4%) were the commonest infection-associated cancers. In MTRH, the five common types of cancers were Kaposi’s sarcoma (93, 18.6%), breast (77, 15.4%), cervical (41, 8.2%), non-Hodgkin’s lymphoma (37, 7.4%) and colorectal, chronic leukemia and esophageal cancer all with 27 (5.4%). Some 241 (48.2%) of these cancers were associated with infectious agents, while an estimated 222 (44.4%) were attributable to infections. Kaposi’s sarcoma (93, 18.6%), cancer of the cervix (41, 8.2%) and non-Hodgkin’s lymphoma (37, 7.4%) were the commonest infection-associated cancers.Conclusion:Our results suggest that30.8% and 48.2% of the total cancer cases sampled in KNH and MTRH respectively were associated with infectious agents, while 27.6% and 44.4% were attributable to infections in the two hospitals respectively. Reducing the burden of infection-attributable cancers can translate to a reduction of the overall cancer burden.
Optimization of nutrient media for sweetpotato (Ipomoea batatas L.) vine multiplication in sandponics: Unlocking the adoption and utilization of improved varieties
Authors: Makokha Phabian , Matasyoh Lexa G. , Ssali Reuben T. , Kiplagat Oliver K. , Wanjala Bramwel W. , Low Jan 
Published: November 2018

Background: Sweetpotato, being a vegetatively propagated crop is prone to seed degeneration, and a continuous source for high quality sweetpotato seed is critical for an efficient seed system. In most Sub-Saharan African countries, the National Agricultural Research Systems use tissue culture to produce limited quantity of pre-basic sweetpotato seed which is then used as starting material to maintain and produce basic seed in mini-screen houses, net tunnels or open field multiplication in low-virus pressure areas by either the private seed companies or vine multipliers. Soil is the predominant media for pre-basic seed multiplication. Multiplying pre-basic sweetpotato seed in sand with fertigation, also known as ‘sandponics’ is a possible opportunity towards sustainable production of pre-basic sweetpotato seed. It would be beneficial to examine the feasibility and the potential to replace soil system with ‘sandponics’ for growing pre-basic sweetpotato seed. Methods: Pot experiments were conducted to study how sweetpotato vine propagation is affected by sequentially omitting nitrogen, phosphorus, calcium, sulfur and boron from fertilizer applications on cv. Kabode. The experiment was laid in a randomized complete block design with five levels of the factor fertilizer, replicated four times with two blocks. The effect of fertilization of nitrogen at (0, 100, 150, 200 & 250), phosphorus at (0, 30, 60, 90 & 120), calcium at (0, 100, 200, 300 & 400), sulfur at (0, 30, 60, 90 & 120) and boron at (0, 0.1, 0.2, 0.3 & 0.4) ppm on sweetpotato vegetative growth parameters was measured 45 days after planting. Results: The obtained results showed that application of 200, 60, 200, 120 and 0.3 ppm of N, P, Ca, S and B respectively recorded the highest values in sweetpotato vegetative growth parameters. Conclusions: These results imply that pre-basic sweetpotato vine yields in sandponics could be increased by using this optimized media.