bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ambulance-Attended Opioid Overdoses: An Examination into Overdose Locations and the Role of a Safe Injection Facility
Authors: Madah-Amiri Desiree , Skulberg Arne Kristian , Braarud Anne-Cathrine , Dale Ola , Heyerdahl Fridtjof , Lobmaier Philipp , Clausen Thomas 
Published: June 2018

Background Although the United States and numerous other countries are amidst an opioid overdose crisis, access to safe injection facilities remains limited. Methods We used prospective data from ambulance journals in Oslo, Norway, to describe the patterns, severity, and outcomes of opioid overdoses and compared these characteristics among various overdose locations. We also examined what role a safe injection facility may have had on these overdoses. Results Based on 48,825 ambulance calls, 1054 were for opioid overdoses from 465 individuals during 2014 and 2015. The rate of calls for overdoses was 1 out of 48 of the total ambulance calls. Males made up the majority of the sample ( n = 368, 79%), and the median age was 35 (range: 18–96). Overdoses occurred in public locations ( n = 530, 50.3%), the safe injection facility ( n = 353, 33.5%), in private homes ( n = 83, 7.9%), and other locations ( n = 88, 8.3%). Patients from the safe injection facility and private homes had similarly severe initial clinical symptoms (Glasgow Coma Scale median =3 and respiratory frequency median =4 breaths per minute) when compared with other locations, yet the majority from the safe injection facility did not require further ambulance transport to the hospital ( n = 302, 85.6%). Those overdosed in public locations (odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.17–2.35), and when the safe injection facility was closed (OR =1.4, 95% CI =1.04–1.89), were more likely to receive transport for further treatment. Conclusions Our findings suggest that the opening hours at the safe injection facility and the overdose location may impact the likelihood of ambulance transport for further treatment.
Barriers to Accessing Treatment for Pregnant Women with Opioid use Disorder in Appalachian States
Authors: Patrick Stephen W. , Buntin Melinda B. , Martin Peter R. , Scott Theresa A. , Dupont William , Richards Michael , Cooper William O. 
Published: June 2018

Background and aims Opioid agonist therapies (OATs) are highly effective treatments for opioid use disorders (OUDs), especially for pregnant women; thus, improving access to OAT is an urgent public policy goal. Our objective was to determine if insurance and pregnancy status were barriers to obtaining access to OAT in 4 Appalachian states disproportionately impacted by the opioid epidemic. Methods Between April and May 2017, we conducted phone surveys of OAT providers, opioid treatment programs (OTPs), and outpatient buprenorphine providers, in Kentucky, North Carolina, Tennessee, and West Virginia. Survey response rates were 59%. Logistic models for dichotomous outcomes (e.g., patient acceptance) and negative binomial models were created for count variables (e.g., wait time), overall and for pregnant women. Results The majority of OAT providers were accepting new patients; however, providers were less likely to treat pregnant women (91% vs. 75%; p < .01). OTPs were more likely to accept new patients than waivered buprenorphine providers (97% vs. 83%; p = .01); rates of accepting pregnant patients were lower in both (91% and 53%; p < .01). OTPs and buprenorphine providers accepted cash payments for services at high rates (OTP: 100%; buprenorphine: 89.4%; p < .01); Medicaid and private insurance were accepted at lower rates. In adjusted models, providers were less likely to accept pregnant women if they took any insurance (adjusted odds ratio [aOR] = 0.15, 95% confidence interval [CI]: 0.03–0.68) or were a buprenorphine provider (aOR = 0.09, 95% CI: 0.02–0.37). Conclusions We found that OAT providers frequently did not accept any insurance and frequently did not treat pregnant women in an area of the country disproportionately affected by the opioid epidemic. Policymakers could prioritize improvements in provider training (e.g., training of obstetricians to become buprenorphine prescribers) as a means to enhance access to pregnant women or enhancing reimbursement rates as a means of improving insurance acceptance for OAT.
On the power of epigenome-wide association studies using a disease-discordant twin design
Authors: Li Weilong , Christiansen Lene , Hjelmborg Jacob , Baumbach Jan , Tan Qihua 
Published: June 2018

Abstract

Motivation
Many studies have investigated the association between DNA methylation alterations and disease occurrences using two design paradigms, traditional case-control and disease-discordant twins. In the disease-discordant twin design, the affected twin serves as the case and the unaffected twin serves as the control. Theoretically the twin design takes advantage of controlling for the shared genetic make-up, but it is still highly debatable if and how much researchers may benefit from such a design over the traditional case-control design.

Results
In this study, we investigate and compare the power of both designs with simulations. A liability threshold model was used assuming that identical twins share the same genetic contribution with respect to the liability of complex human diseases. Varying ranges of parameters have been used to ensure that the simulation is close to real-world scenarios. Our results reveal that the disease-discordant twin design implies greater statistical power over the traditional case-control design. For diseases with moderate and high heritability (&gt;0.3), the disease-discordant twin design allows for large sample size reductions compared to the ordinary case-control design. Our simulation results indicate that the discordant twin design is indeed a powerful tool for epigenetic association studies.

Availability and implementation
Computer scripts are available at https://github.com/zickyls/EWAS-Twin-Simulation.

Supplementary information
Supplementary data are available at Bioinformatics online.
Quality of Life Impact of an Adjuvanted Recombinant Zoster Vaccine in Adults Aged 50 Years and Older
Authors: Curran Desmond , Oostvogels Lidia , Heineman Thomas , Matthews Sean , McElhaney Janet , McNeil Shelly , Diez-Domingo Javier , Lal Himal , Andrews Charles , Athan Eugene , Berglund Johan , Campora Laura , de Looze Ferdinandus , Korhonen Tiina , Leung Edward , Levin Myron , Volpi Antonio , Johnson Robert W ,   ZOE-50/70 Study Group
Published: June 2018

Abstract

Background
To determine the efficacy of an adjuvanted recombinant zoster vaccine in reducing the herpes zoster (HZ) burden of illness, HZ burden of interference with activities of daily living, and HZ impact on quality of life.

Methods
The assessments were integrated in two Phase III trials, ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229). HZ burden of illness and HZ burden of interference with activities of daily living were assessed by the Zoster Brief Pain Inventory (ZBPI) instrument and quality of life by the EuroQol-5 Dimension (EQ-5D) utility index and the SF-36 health survey. We report the ZOE-50 results and a pooled analysis of patients aged 70 years and older from the trials combined.

Results
The estimated vaccine efficacy in reducing HZ burden of illness and HZ burden of interference was greater than 90% in both the ZOE-50 and the pooled ZOE-70 analysis. In confirmed HZ cases, adjuvanted recombinant zoster vaccine reduced the maximal ZBPI worst-pain score in the pooled ZOE-70 analysis (p = .032) and the maximal ZBPI average-pain scores in both the ZOE-50 (p = .049) and the pooled ZOE-70 analysis (p = .043). In breakthrough HZ cases, trends for diminished loss of quality of life compared with placebo-recipient HZ cases were observed, with differences up to 0.14 on the EQ-5D index at time points during the 4 weeks following HZ onset.

Conclusions
Adjuvanted recombinant zoster vaccine reduced the HZ burden of illness significantly, particularly due to its very high vaccine efficacy in preventing HZ. For breakthrough HZ cases, the results suggest that the adjuvanted recombinant zoster vaccine mitigated severity of HZ-related pain, burden of interference with activities of daily living, and recipients’ utility loss.
Metabolic Positron Emission Tomography Response to Gamma Knife of the Ventral Intermediate Nucleus in Essential Tremor
Authors: Verger Antoine , Witjas Tatiana , Carron Romain , Eusebio Alexandre , Boutin Emmanuelle , Azulay Jean-Philippe , Regis Jean , Guedj Eric 
Published: June 2018

Abstract

BACKGROUND
To understand the substrates of response and nonresponse and to identify potential biomarkers for the selection and follow-up of patients with essential tremor (ET) treated with Gamma Knife (Elekta AB, Stockholm, Sweden) of the ventral intermediate nucleus (GKVIM).

OBJECTIVE
To characterize positron emission tomography (PET) changes in the metabolism of glucose and metabolic connectivity in patients with ET treated by GKVIM through observational study.

METHODS
Forty-two patients with right ET were referred to 18F-fluorodesoxyglucose positron emission tomography (18F-FDG PET) imaging before and after left GKVIM. Statistical Parametric Mapping T-score map comparisons were performed between pre- and post-GKVIM groups and between clinical responders and nonresponders. Metabolic connectivity was evaluated by the interregional correlation analysis method.

RESULTS
After GKVIM, patients with ET exhibited decreased left thalamic metabolism, which was associated with remote metabolic decreases in the right cerebellum, left temporal gyri, and bilateral frontal gyri (P < .05, family-wise error-corrected). Additionally, nonresponders (n = 7) showed metabolic decreases in the right temporo-occipital area (P < .005 corrected for cluster volume) after GKVIM. The metabolism in this area was already reduced in nonresponders before treatment in comparison to that in responders and was predictive of future response (sensitivity: 89%; specificity: 71%). In nonresponder patients, strong connectivity between the left thalamus and right temporo-occipital area was found before GKVIM and was lost after treatment, whereas this connectivity remained weak and stable in responders.

CONCLUSION
These findings could lead to better knowledge of the variability in the metabolic PET profiles among patients with ET, particularly the integration of 18F-FDG PET imaging in the pretherapeutic evaluation of patients with refractory ET candidates for GKVIM.
Anna Maria van Schurman
Authors: Larsen Anne , Lee Bo Karen 
Published: June 2018

Anna Maria van Schurman (b. 1607–d. 1678) was regarded throughout the seventeenth century as the most learned woman not only of the Netherlands but also of Europe. She was “the Star of Utrecht,” “the Tenth Muse,” “a miracle of her sex.” As the first woman to attend non-officially a university, she was also the first to advocate, boldly, that women should be admitted into universities. A brilliant linguist, she mastered at least fourteen languages and was the first Dutch woman to seek publication of her correspondence. Her letters in several languages to the intellectual men and women of her time reveal the breadth of her interests in theology, philosophy, medicine, education, literature, painting, sculpture, embroidery, and instrumental music. Van Schurman advocated higher studies for women in a Latin scholastic disputation and in two Latin letters to her mentor, the French Calvinist theologian André Rivet (b. 1572–d. 1651). Her letters, with Rivet’s reply, were first published in 1638 in Paris in an unauthorized version, and again, with her treatise and exchanges with other scholars, in Leiden in 1641. In 1646, the French literary historian and poet Guillaume Colletet (b. 1598–d. 1659) translated these letters into French, publishing them in Paris under the title Question célèbre: S’il est necessaire, ou non, que les Filles soient sçavantes (A famous question: Whether it is necessary or not for girls to be learned). Van Schurman’s treatise on women’s learning was translated into English in 1659 by the educator Clement Barksdale (b. 1609–d. 1687), as The Learned Maid or, Whether a Maid May Be a Scholar? In 1639 she also completed a treatise, De Vitae Termino (On the temporal limits of life), on the roles that God and physicians play at the end of human life. Her most famous work—Opuscula Hebræa, Græca, Latina, Gallica: Prosaica & Metrica (Minor works in Hebrew, Greek, Latin, and French: In prose and verse)—appeared in 1648 at the height of her fame. In 1666, van Schurman met Jean de Labadie (b. 1610–d. 1674), the founder of the Labadist community, and her life was radically reoriented. She devoted herself to a new form of piety, one shaped by Catholic mysticism in addition to her Calvinist background. She continued her writing, however, arguing in her mature treatise of 1673, Eukleria, seu Meliores Partis Electio (Eukleria, or choosing the better part, referring to Mary’s choice, Luke 10:41–42) that her former ways of knowing God had left her spiritually bankrupt. Her previous theological teachers disowned her for her choices, but she writes of “joy unspeakable” in her new community. The Eukleria is a fine display of her erudition, marshaled to demonstrate the very limitations of learnedness, in favor of a life more singularly dedicated to God. We thank Dr. Pieta van Beek for her help on an earlier version of the section on Editions and Translations.
Internal Medicine Residents’ Knowledge and Practice of Pulmonary Tuberculosis Diagnosis
Authors: Chida Natasha , Brown Christopher , Mathad Jyoti , Carpenter Kelly , Nelson George , Schechter Marcos C , Giles Natalie , Rebolledo Paulina A , Ray Susan , Fabre Valeria , Cantillo Diana Silva , Longworth Sarah , Amorosa Valerianna , Petrauskis Christian , Boulanger Catherine , Cain Natalie , Gupta Amita , McKenzie-White Jane , Bollinger Robert , Melia Michael T 
Published: June 2018

AbstractBackgroundInternal medicine physicians are often the first providers to encounter patients with a new diagnosis of tuberculosis. Given the public health risks of missed tuberculosis cases, assessing internal medicine residents’ ability to diagnose tuberculosis is important.MethodsInternal medicine resident knowledge and practice patterns in pulmonary tuberculosis diagnosis at 7 academic hospitals were assessed utilizing (a) a 10-item validated pulmonary tuberculosis diagnosis assessment tool and (b) a retrospective chart review of 343 patients who underwent a pulmonary tuberculosis evaluation while admitted to a resident-staffed internal medicine or infectious disease service. Our primary outcomes were the mean score and percentage of correct responses per assessment tool question, and the percentage of patients who had Centers for Disease Control and Prevention–recommended tuberculosis diagnostic tests obtained.ResultsOf the 886 residents who received the assessment, 541 responded, yielding a response rate of 61%. The mean score on the assessment tool (SD) was 4.4 (1.6), and the correct response rate was 57% (311/541) or less on 9 of 10 questions. On chart review, each recommended test was obtained for ≤43% (148/343) of patients, other than chest x-ray (328/343; 96%). A nucleic acid amplification test was obtained for 18% (62/343) of patients, whereas 24% (83/343) had only 1 respiratory sample obtained. Twenty patients were diagnosed with tuberculosis.ConclusionsSignificant knowledge and practice gaps exist in internal medicine residents’ abilities to diagnose tuberculosis. As residents represent the future providers who will be evaluating patients with possible tuberculosis, such deficiencies must be addressed.
Chronic heel pain: when is surgery indicated?
Authors: Abdel Salam Mohamed A. , Mansour Mohammed M. , El Naggar Ahmed 
Published: June 2018

Background:
Chronic recalcitrant heel pain is a commonly observed painful condition that often frustrates both the patient and the treating physician.

Methods:
Twenty-four patients (14 men and 10 women) with chronic resistant heel pain were included in this study. All patients were locally injected by platelet rich plasma (PRP), and according to the results of injection, patients were divided into two groups: group A patients had significant improvement and group B had no specific progress. Group B patients underwent surgical decompression of the first branch of lateral planter nerve “Baxter’s nerve” with release of medial planter fascia and calcaneal drilling.

Results:
PRP injection showed 58.3% satisfactory results with improvement of the Plantar Fasciitis Pain/Disability Scale (PFPS) from 79.15 (range, 71.8 to 83.8) to 22.3 (range, 15.4 to 25.5) and improvement of the Foot Function Index (FFI) from 160.42 (range, 155 to 166) to 30.4 (range, 23 to 38). PRP injection failed to provide satisfactory results in 10 patients (41.7%). This group of patients showed 90% satisfactory outcome after surgical interference with improvement of the PFPS from 60.8 (range, 55.4 to 63.8) to 21.8 (range, 16.4 to 25.6) and improvement of the FFI from 143.4 (range, 122 to 155) to 38 (range, 31 to 52).

Conclusions:
Conservative methods can provide satisfactory outcome in up to 90% in the treatment of chronic heel pain. Resistant cases can be managed by a local injection of PRP; surgical management should be reserved for patients who do not respond to PRP injection. Surgical management requires release of Baxter’s nerve and medial planter fascia, and calcaneal drilling.
Retrospective Evaluation of the Safety of Large Skin Flap, Large Skin Graft, and Interpolation Flap Surgery in the Outpatient Setting
Authors: Schmitt Adam , DePry Jennifer , Tsai Sheena , Bordeaux Jeremy 
Published: June 2018

BACKGROUND
As the number of cutaneous surgeries continues to increase, it is important to evaluate the safety of dermatologic surgery in the outpatient setting.

OBJECTIVE
The authors sought to determine postoperative bleeding, infection, dehiscence, and necrosis rates in office-based dermatologic surgery using large flap, large graft, and interpolation flap repairs. The authors evaluated the relationship between these complications and surgical site, closure type, repair size, antibiotic use, and antithrombotic use.

METHODS
Eligible patients were identified through searching the electronic medical records from one Mohs micrographic surgeon at University Hospitals Medical Center. Patient information, surgery characteristics, and complication information were collected. Univariate and multivariate analyses were conducted to reveal associations between each complication and closure type, repair size, repair site, antithrombotic use, and antibiotic use.

RESULTS
Three hundred and thirty-one reconstruction procedures after Mohs micrographic surgery and excision qualified for the study. The rates of postoperative infection, hemorrhage, hematoma, necrosis, and dehiscence were 5%, 0.3%, 2.4%, 3%, and 0.9%, respectively.

CONCLUSION
Complications were infrequent and non–life-threatening. The authors' results indicate that dermatologic surgery using large flaps, interpolation flaps, and large grafts is safe in the office setting.
Grading Severity and Activity in Thyroid Eye Disease
Authors: Dolman Peter J. 
Published: June 2018

Purpose:
Thyroid eye disease (TED) is an autoimmune disorder causing inflammation, expansion, and fibrosis of orbital fat, muscle, and lacrimal gland. This article reviews the different methods of grading severity and activity of TED and focuses on the VISA Classification for disease evaluation and planning management.

Methods:
Accurate evaluation of the clinical features of TED is essential for early diagnosis, identification of high-risk disease, planning medical and surgical intervention, and assessing response to therapy. Evaluation of the activity and severity of TED is based on a number of clinical features: appearance and exposure, periorbital tissue inflammation and congestion, restricted ocular motility and strabismus, and dysthyroid optic neuropathy. The authors review these clinical features in relation to disease activity and severity.

Results:
Several classification systems have been devised to grade severity of these clinical manifestations. These include the NO SPECS Classification, the European Group on Graves Orbitopathy severity scale, the Clinical Activity Score of Mourits, and the VISA Classification as outlined here. The authors compare and contrast these evaluation schemes.

Conclusions:
An accurate clinical assessment of TED, including grading of disease severity and activity, is necessary for early diagnosis, recognition of those cases likely to develop more serious complications, and appropriate management planning. The VISA Classification grades both disease severity and activity using subjective and objective inputs. It organizes the clinical features of TED into 4 discrete groupings: V (vision, dysthyroid optic neuropathy); I (inflammation, congestion); S (strabismus, motility restriction); A (appearance, exposure). The layout follows the usual sequence of the eye examination and facilitates comparison of measurements between visits and data collation for research.
Phi, Fat, and the Mathematics of a Beautiful Midface
Authors: Stein Ran , Holds John B. , Wulc Allan E. , Swift Arthur , Hartstein Morris E. 
Published: June 2018

Purpose:
The Golden ratio, or Phi, has been used to explain the substrates of two-dimensional beauty utilizing the faces of models. A “Phi point” has been identified at the apex of the cheek mound that can be targeted in filler injections. The authors report herein how they have applied this algorithm for surgical shaping of the “beautiful” cheek as a routine part of their lower blepharoplasty procedure. The authors present their technique and results with patients undergoing lower blepharoplasty along with the adjunct of liposculpture to areas of volume deficiency in the midface with a particular goal of enhancing the Phi point.

Methods:
This study was retrospective, consecutive, nonrandomized, interventional case series. The authors reviewed the medical records of 113 consecutive patients who underwent lower blepharoplasty with autologous fat transfer to the Phi point. The aesthetic outcome, patient satisfaction, and complication/revisions were evaluated.

Results:
One hundred two out of 113 patients achieved excellent lower lid position and cheek enhancement as assessed by both patient and surgeon. In these 102 patients, there was significant improvement in lower lid appearance, contour, transition to the cheek, and cheek projection as observed by the surgeon. Three patients required revision to achieve sufficient volume. Eight patients were satisfied with the outcome, nevertheless, requested additional filler injection to optimize.

Conclusions:
Lower blepharoplasty combined with autologous fat transfer to reshape the Phi point is a safe and reliable technique and another step further in our quest for recreating the beautiful face.