bluuebunny/crossref_metadata_2025_split huggingface dataset:
A decision tree to determine fitness to drive in epilepsy: Results of a pilot in two Australian states
Authors: Somerville Ernest R. ,   the Driving Committee of the Epilepsy Society of Australia
Published: May 2019

AbstractObjectiveCertification by treating physicians of fitness to drive in people with epilepsy creates a conflict of interest that may result in unsafe decisions, damage the doctor‐patient relationship, expose the physician to legal liability and prevent optimal treatment. Ideally, the treating physician should provide objective clinical information to the driver licensing authority (DLA), which then determines fitness or otherwise. However, DLAs in Australia do not employ medical staff and the national standards are complex. Fitness is determined by the treating physician, according to published national standards. The purpose of this study was to determine the feasibility of using a decision tree to determine fitness, according to the Australian standards.MethodsA decision tree was constructed to use clinical data to determine whether a patient met the national standard to drive a private motorcar, failed to meet it or required further assessment. A form was designed to collect the necessary clinical data from the treating physician. A computerized version of the decision tree was then used in a pilot in two Australian states in parallel with the existing certification system. Four hundred thirty‐nine drivers with declared epilepsy and their treating physicians were invited to participate when their annual driver licence review was due.ResultsTwo hundred fifty‐three (58%) forms were returned. All patients were considered fit to drive by their physician. Seventy‐six percent had not had a seizure for over two years. In 88.1%, there was agreement between the decision tree and treating physician, with 3.6% identified by the decision tree as requiring review. Although considered fit by their physician, 6.3% did not meet the national standard to drive.SignificanceThe decision tree model is a practical alternative to fitness certification by treating physicians. This Australian pilot can serve as a model for applying objective standards to driving assessments in other jurisdictions, using local driving standards. It has the potential to improve road safety by avoiding the negative effects of certification by treating physicians and can cope with complex standards. It is now in use in two states of Australia.
Climate change, biological invasions, and the shifting distribution of Mediterranean fishes: A large‐scale survey based on local ecological knowledge
Authors: Azzurro Ernesto , Sbragaglia Valerio , Cerri Jacopo , Bariche Michel , Bolognini Luca , Ben Souissi Jamila , Busoni Giulio , Coco Salvatore , Chryssanthi Antoniadou , Fanelli Emanuela , Ghanem Raouia , Garrabou Joaquim , Gianni Fabrizio , Grati Fabio , Kolitari Jerina , Letterio Guglielmo , Lipej Lovrenc , Mazzoldi Carlotta , Milone Nicoletta , Pannacciulli Federica , Pešić Ana , Samuel‐Rhoads Yanna , Saponari Luca , Tomanic Jovana , Eda Topçu Nur , Vargiu Giovanni , Moschella Paula 
Published: May 2019

AbstractClimate change and biological invasions are rapidly reshuffling species distribution, restructuring the biological communities of many ecosystems worldwide. Tracking these transformations in the marine environment is crucial, but our understanding of climate change effects and invasive species dynamics is often hampered by the practical challenge of surveying large geographical areas. Here, we focus on the Mediterranean Sea, a hot spot for climate change and biological invasions to investigate recent spatiotemporal changes in fish abundances and distribution. To this end, we accessed the local ecological knowledge (LEK) of small‐scale and recreational fishers, reconstructing the dynamics of fish perceived as “new” or increasing in different fishing areas. Over 500 fishers across 95 locations and nine different countries were interviewed, and semiquantitative information on yearly changes in species abundance was collected. Overall, 75 species were mentioned by the respondents, mostly warm‐adapted species of both native and exotic origin. Respondents belonging to the same biogeographic sectors described coherent spatial and temporal patterns, and gradients along latitudinal and longitudinal axes were revealed. This information provides a more complete understanding of the shifting distribution of Mediterranean fishes and it also demonstrates that adequately structured LEK methodology might be applied successfully beyond the local scale, across national borders and jurisdictions. Acknowledging this potential through macroregional coordination could pave the way for future large‐scale aggregations of individual observations, increasing our potential for integrated monitoring and conservation planning at the regional or even global level. This might help local communities to better understand, manage, and adapt to the ongoing biotic transformations driven by climate change and biological invaders.
Effectiveness and safety of furazolidone‐containing quadruple regimens in patients with Helicobacter pylori infection in real‐world practice
Authors: Song Conghua , Qian Xing , Zhu Yin , Shu Xu , Song Yanping , Xiong Zhijuan , Ye Jianfang , Yu Tao , Ding Ling , Wang Hui , Lu Nonghua , Xie Yong 
Published: May 2019

AbstractBackground & AimsThe eradication rate of Helicobacter pylori (H pylori) has decreased largely because of the antibiotic resistance. We aimed to evaluate the effectiveness and safety of furazolidone‐containing quadruple regimens for H pylori eradication.MethodsThis was an observational study of furazolidone‐containing quadruple regimens for H pylori infection in real‐world settings. Data sets were collected from the medical records and telephone interviews of patients referred to a specialist clinic for suspected H pylori reinfection from January 1, 2015, to January 1, 2018, at the First Affiliated Hospital of Nanchang University. Main outcome measures were the eradication rate and adverse reactions during medication.ResultsAmong 584 patients with H pylori infection that met the inclusion criteria, 561 (96.1%) were treated for the first time, 19 (3.3%) had one, and 4 (0.5%) had two or more prior to furazolidone‐containing quadruple regimens. The eradication rates for 10‐day and 14‐day regimens were 93.7% (95% CI: 91.5%‐95.9%) vs 98.2% (95% CI: 95.6%‐99.3%), respectively (P = 0.098). Adverse drug reactions occurred in 8.2% (48/584) with abdominal discomfort being the most common symptom. Overall adverse events with 10‐day regimens were lower than 14‐day regimens (6.1% vs 17.4%, P < 0.001). Logistic regression analysis indicated that poor adherence (adjusted odds ratio [AOR] = 46.5, 95% CI: 9.7‐222.4) was correlated with failed eradication. Adverse drug reactions during medication were related to smoking and tobacco status, alcohol intake history, regimens combined with tetracycline, and poor adherence (all P < 0.05).ConclusionsFurazolidone‐containing quadruple regimens proved both safe and highly effective in a real‐world setting.
DNA flow cytometric and interobserver study of crypt cell atypia in inflammatory bowel disease
Authors: Wen Kwun Wah , Umetsu Sarah E , Goldblum John R , Gill Ryan M , Kim Grace E , Joseph Nancy M , Rabinovitch Peter S , Kakar Sanjay , Lauwers Gregory Y , Choi Won‐Tak 
Published: May 2019

AimsThe pathological features and diagnostic reliability of crypt cell atypia (CCA) arising in inflammatory bowel disease (IBD) and its clinical significance are unknown.Methods and resultsDNA flow cytometry (FCM) was performed on 14 colon biopsies of CCA from seven IBD patients (male‐to‐female ratio, 5:2; mean age, 53 years; mean IBD duration, 15 years) using paraffin‐embedded tissue. Seven gastrointestinal pathologists were asked to diagnose each biopsy as negative for dysplasia (NEG), indefinite for dysplasia (IND), low‐grade dysplasia (LGD) or high‐grade dysplasia (HGD) by morphology alone, then again with knowledge of FCM results. Aneuploidy was detected in all 14 biopsies, and five of eight biopsies (63%) also showed strong and diffuse nuclear staining for p53 in the areas of CCA. Six (86%) patients developed HGD (n = 5) or adenocarcinoma (n = 1) in the same colonic segment where CCA had been diagnosed within a mean follow‐up time of 27 months. No follow‐up information was available in the remaining one patient. When diagnoses were grouped as NEG or ‘atypical’ (including IND, LGD or HGD), the overall agreement rate of 76% (kappa = 0.51) based on morphology alone improved to 90% (kappa = 0.81) with knowledge of FCM results. Even when categorised as NEG or dysplasia (LGD or HGD) with each of the IND diagnoses reclassified into three categories (NEG, LGD or HGD) based on the degree of suspicion for dysplasia, the overall agreement rate of 63% (kappa = 0.25) based on morphology alone improved to 73% (kappa = 0.46) with knowledge of FCM results. However, when grouped as NEG, LGD or HGD, the overall agreement rate was less than 40% (kappa < 0.09) regardless of knowledge of FCM results.ConclusionsThe presence of aneuploidy, p53 positivity and development of HGD or adenocarcinoma on follow‐up indicate that CCA likely represents a dysplastic lesion (at least LGD) and is a histological marker of neoplastic progression. Although the grading of CCA, largely based on cytological abnormalities, is subject to significant interobserver variability, CCA can be histologically identified and should lead to a recommendation of increased endoscopic surveillance, especially if aneuploidy is detected.
Bone marrow findings in metastatic melanoma, including role of BRAF immunohistochemistry
Authors: Corean Jessica L. E. , George Tracy I. , Patel Jay L. , Li K. David 
Published: May 2019

AbstractIntroductionWe describe peripheral blood smear, bone marrow morphology, histopathology, immunohistochemistry, including BRAF V600E, and molecular testing results of patients with metastatic melanoma to the bone marrow.MethodsWe performed a retrospective review for patients with metastatic melanoma to the bone marrow at our institution. Bone marrow morphology, histology, immunophenotyping, and cytogenetic/molecular genetic testing were reviewed, and BRAF V600E immunohistochemistry was performed. Results were compared to the literature.ResultsWe identified four patients with metastatic melanoma to the bone marrow presenting with at least one cytopenia. Two of the four patients had leukoerythroblastosis, with three patients having atypical cells on bone marrow aspirate/touch preparation, and all patients had aggregates of atypical cells on biopsy. Immunohistochemistry for S100, Melan A, and HMB45 confirmed the diagnosis in all patients, and BRAF V600E immunohistochemistry was detected in two of four patients, which correlated with molecular testing findings. Review of the literature found 27 total patients, with normocytic anemia and leukoerythroblastosis as common peripheral blood smear findings.ConclusionsFeatures including cytopenias (typically anemia), leukoerythroblastosis, and morphology of cohesive, large atypical cells in aspirate and biopsy, and immunohistochemical expression for S100, Melan A, and HMB45 were present in patients with metastatic melanoma. BRAF V600E immunohistochemistry is useful as a surrogate marker of molecular results. Regardless of clinical history, at the time of the bone marrow biopsies, hematologic malignancies are in the main differential diagnosis and very rarely included metastatic melanoma, likely due to the under‐recognized metastatic potential of melanoma to the bone marrow.
Post‐stroke sleep disturbances and rehabilitation outcomes: a prospective cohort study
Authors: Iddagoda Mayura T. , Inderjeeth Charles A. , Chan Kien , Raymond Warren D. 
Published: May 2019

AbstractBackgroundPoor sleep is common after stroke, and data regarding its effect on rehabilitation outcomes are limited. Controversial evidence was found concerning the effect of sedatives on improving sleep quality in poor sleepers after stroke.AimTo assess the prevalence of poor sleep in post‐stroke patients and its effect on rehabilitation outcomes.MethodA total of 104 stroke patients from two major stroke rehabilitation units in Western Australia was enrolled. Sleep quality was assessed using the Pittsburgh Sleep Quality Indexes at baseline and after stroke. The main outcome measures were Functional Independence Measure (FIM) change and length of stay (LOS). Sedative use during this period was also recorded.ResultsA total of 29.8% post‐stroke patients suffered from poor sleep. There was no relationship between poor sleep and the stroke characteristics, such as severity, side and type, or demographics, such as age and gender. Poor sleep quality was inversely associated with rehabilitation outcomes measured by FIM (Rs. −0.317, P = 0.005). However, there was no significant association between sleep quality and LOS (P = 0.763). Sedatives were used in 18.2% of patients but had no impact on sleep quality or rehabilitation outcomes.ConclusionThis research supported that poor sleep was frequent after stroke and had negative effects on rehabilitation outcomes. Use of sedatives was of limited benefit to improve sleep quality, and further studies are required to search for strategies to improve sleep problems after stroke.
Impact of supplemental private health insurance on dialysis and outcomes
Authors: Sriravindrarajah Arunan , Kotwal Sradha S. , Sen Shaundeep , McDonald Stephen , Jardine Meg , Cass Alan , Gallagher Martin 
Published: May 2019

AbstractBackgroundThe influence of health insurance systems on the treatment of end‐stage kidney disease (ESKD) patients ispoorly understood.AimWe investigated how supplemental private health insurance (PHI) coverage impacted ESKD treatment modalitiesand patient outcomes.The influence of health insurance systems on the treatment of end‐stage kidney disease (ESKD) patients is poorly understood. We investigated how supplemental private health insurance (PHI) coverage impacted ESKD treatment modalities and patient outcomes.MethodsAll adult patients commencing ESKD treatment in New South Wales, Australia from 2000 to 2010 were identified using the Australia and New Zealand Dialysis and Transplant Registry. Data were linked to the state hospitalisation dataset to obtain insurance status, allowing the comparisons of mortality, ESKD treatment modality and health service utilisation between privately insured and public patients.ResultsThe cohort of 5737 patients included 38% (n = 2152) with PHI. At 1 year after ESKD treatment initiation, PHI patients had lower mortality (hazard ratio 0.84, 95% confidence interval (CI) 0.74–0.95, P = 0.01), were more likely to be receiving home haemodialysis (HD) (odds ratio (OR) 1.38, 95% CI 1.01–1.89, P = 0.04), to have been transplanted (OR 1.75, 95% CI 1.25–2.46, P = 0.001) and used fewer hospital days (incidence rate ratio 0.85, 95% CI 0.74–0.96, P = 0.01). After adjustment, PHI patients were more likely to initiate ESKD treatment with facility‐based HD (OR 1.22, 95% CI 1.01–1.46, P = 0.03) but were less likely to be started on peritoneal dialysis (OR 0.81, 95% CI 0.67–0.98, P = 0.03).ConclusionOur findings suggest that supplemental PHI in Australia is associated with lower‐risk ESKD treatment attributes and improved health outcomes. A greater understanding of the treatment pathways that deliver these outcomes may inform treatment for the broader ESKD treatment population.
The Process, Challenges and Opportunities of Developing a Curriculum in a Creative and Therapeutic Arts Undergraduate Degree Programme
Authors: Pickard Beth 
Published: May 2019

AbstractThis article reflects upon the process, the challenges and the opportunities realised in the recent revalidation activity of an undergraduate degree programme in Creative and Therapeutic Arts (CTA) in the UK. The premise of the revalidation activity and the historical context of the course are briefly encapsulated, before engaging with theoretical frameworks at the forefront of contemporary Participatory Arts practice. This includes an initial focus on the relevance of Critical Disability Studies to Participatory Arts education, followed by exploration of the contrasting approaches of Socially Engaged Art practice, Inclusive Arts practice, Participatory Arts practice, Arts in Health and Arts Therapies. The challenge of defining a diverse practice which draws from such contrasting perspectives is further explored in relation to the challenge of working on the boundary between artistic and therapeutic practice. Geographical context is considered, drawing from the Welsh evidence base to inform culturally relevant provision. Curriculum design is reviewed in relation to experiential learning and inclusive practice literature, as well as relevant higher education policies. Upon briefly summarising the revalidated curriculum, a critical discussion around the future of the training and the discipline more broadly is developed, considering the contribution of the critical review and focus groups facilitated as part of this revalidation activity. It is hoped that this discussion will further nurture and challenge educators, students and practitioners in this exciting area of evolving, contemporary practice.
How parents describe the positive aspects of parenting their child who has intellectual disabilities: A systematic review and narrative synthesis
Authors: Beighton Carole , Wills Jane 
Published: May 2019

AbstractBackgroundIdentifying what parents describe to be positive about parenting their child who has intellectual disabilities is important for professional practice and how parents can be supported over a lifespan.MethodsStudies in which parents describe the positive aspects of parenting their child with intellectual disabilities were identified via electronic databases searches and analysed in a narrative synthesis.ResultsTwenty‐two studies were included. Consistent themes emerged relating to positive change, increased personal strength, growth and development largely related to parental intrapersonal orientation. Several studies emphasized that the presence of growth or positive change does not imply the absence of distress.ConclusionsPositive aspects are not consistently defined and measured differently across studies. Consistent themes are described variously attributed to theories relating to coping, adaptation or growth following adversity; however, no single theoretical framework emerged. Factors likely to predict a parent's ability to identify positive aspects are inconclusive.
Incidence of early pulmonary vein reconnections using different energy sources for pulmonary vein isolation: Multielectrode phased radiofrequency vs second‐generation cryoballoon
Authors: Wieczorek Marcus , Tajtaraghi Sharam , Sassani Kiarash , Hoeltgen Reinhard 
Published: May 2019

AbstractObjectiveTo determine and compare the incidence of early recurrence of conduction after pulmonary vein isolation (PVI) using two different ablation technologies: phased radiofrequency by a multipolar ablation catheter (PVAC) and cryo‐ablation by a second‐generation cryoballoon (CB).Methods and ResultsTwo hundred patients (pts) with atrial fibrillation underwent PVI with PVAC (Group 1) or CB (Group 2), with 100 pts in each group. The incidence of PV reconnection (PVR) for each vein was examined in both groups at least 30 minutes after successful PVI. There were no significant clinical differences between both groups. Total procedure‐, fluoroscopy‐, and left atrial (LA) dwell time were significantly shorter in Group 2 pts (P < .0001). Early PVR was recorded in 69/388 (18%) isolated PVs or left common trunks (CTs) in Group 1 compared with 25/386 (7%) in Group 2 (P < .0001). Forty‐three pts in Group1 were found to have PVR compared with 22 pts in Group 2 (P = .0015). Group 1 pts with CTs showed significantly more PVR than pts of Group 2 (P = .047). In both groups, CTs and CT branches were found to reconnect significantly more frequent compared with all other veins.ConclusionBoth PVAC and CB are effective to achieve PVI. Early PVR is observed with the significantly lower frequency with second‐generation CB compared with PVAC, contributing to shorter procedure‐, fluoroscopy, and LA dwell times. CTs and CT branches exhibit the highest incidence of PVR for both devices.
From persons to patients and back
Authors: Mitchell Derek 
Published: May 2019

AbstractIn this paper, I will show how philosophical theory can be applied in the most fundamental area of health care practice, the relationship between the provider and the receiver of care. I will look at the process of becoming a patient and remaining a person. This will begin with a discussion of Heidegger's notion of solicitude alongside the related notions of concern and care, leading to the affirmation of authentic solicitude as the most ontologically appropriate relationship between those who provide and those who receive care. I will then try to understand what happens to us when we become patients and to see what factors make it difficult for us to be persons as well as patients, within the health care environment. This will be followed by a brief discussion of the ancient idea ofphronesis(wisdom) in which I will attempt to elucidate, from the side of the health care professional, the way that their relationship with patients can work in a way that recognizes personhood in their patients. I will also consider the dialectical nature of the relationship between patients and doctors (and everyone else who treats us) and try to understand how this points towards the conclusion of a person‐centred approach to health care. Following this discussion, I will offer a couple of examples of what person‐centred health care might look like in practice, as a means of illustrating, in practical terms, the philosophical approach that I have used.
Fiscal Policy and Occupational Employment Dynamics
Authors: BREDEMEIER CHRISTIAN , JUESSEN FALKO , WINKLER ROLAND 
Published: May 2019

AbstractWe document substantial heterogeneity in occupational employment dynamics in response to government spending shocks in the United States. Employment rises most strongly in service, sales, and office (“pink‐collar”) occupations. By contrast, employment in blue‐collar occupations is hardly affected by fiscal policy. We provide evidence that occupation‐specific changes in labor demand are key for understanding these findings. We develop a business‐cycle model that explains the heterogeneous occupational employment dynamics as a consequence of composition effects due to heterogeneous employment changes across industries and occupation‐specific within‐industry employment shifts due to differences in the short‐run substitutability between labor and capital services across occupations.