bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fibular Plate Fixation and Correlated Short-term Complications
Authors: Bäcker Henrik Constantin , Greisberg Justin K. , Vosseller J. Turner 
Published: September 2019

Background. The most common method of surgical stabilization of fibular fractures is plate osteosynthesis. Despite its ubiquity, there is a dearth of large series reporting implant-related outcomes and complications. The purpose of this study was to report on short-term complications and hardware removal after plate fixation of distal fibula fractures. Methods. A retrospective chart analysis and review of radiographic images was performed of 461 ankle fractures between 2011 and 2017. In 404 cases, a fibular fracture was treated surgically; 94.1% underwent tubular and 5.9% locking plate fixation. The primary outcome was radiographic union, with a mean follow-up of 11.6 months. Minor, intermediate, and major complications were recorded as well as the rate of hardware removal. Results. The union-rate with plate fixation was 99.5% (402/404). The overall complication rate was 19.3% (n = 78/404). Of these complications, 79.5% (62/78) were considered minor. These complications included erythema, heterotopic ossification, neurapraxia, delayed union, and deep-vein thrombosis; 20.5% (16/78) of the complications were considered intermediate (9/78, 11.5%) or major (7/78, 9.0%). Intermediate and major complications included deep infection, nonunion/malunion, and osteomyelitis. Subsequent surgery was needed in 7 cases (1.7%, 7/404). In another 93 patients, hardware-related symptoms were identified: 23 (5.7%) underwent syndesmosis screw removal and 54 (13.4%) hardware removal. No correlation to the fixation technique was identified. Conclusion. This study shows a relatively low rate of major complications and a high union rate of 99.5% for fibular plate osteosynthesis in a large cohort. Any other treatment, including other fixation techniques, will need to show an equivalent or better complication and reoperation profile. Level of Evidence: Level III: Retrospective, comparative study
Treatment of Recalcitrant Maxillary Sinusitis With Endoscopic Modified Medial Maxillectomy: A Systematic Review of Safety and Efficacy
Authors: Loftus Catherine A. , Yoo Frederick , Desiato Vincent M. , Schlosser Rodney J. , Soler Zachary M. 
Published: September 2019

Background Endoscopic sinus surgery is an effective treatment option for patients with chronic rhinosinusitis (CRS), although approximately 20% of patients fail to improve with standard surgical procedures. Expanded procedures such as the endoscopic modified medial maxillectomy (EMMM) have been described in management of refractory maxillary sinusitis. Objective This study aims to review the current literature on the safety and efficacy of the EMMM for treatment of refractory maxillary sinusitis. Methods A literature search was performed of PubMed, Ovid, and Cochrane databases according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. English-language articles evaluating the EMMM procedure on patients with recalcitrant maxillary sinusitis were included. Full-text articles were obtained and evaluated by 2 reviewers independently, with a third reviewer for mediation of disagreements. Results Six studies met eligibility criteria and were included into the study, with follow-up ranging from 12 to 82.8 months. Two studies contained Level 2 evidence and 4 studies contained Level 4 evidence. EMMM was found to be effective in CRS and cystic fibrosis-related CRS (0% and 9.1% revision rate, respectively). Symptom resolution was noted 60% to 80% of patients. Four studies reported complications, with a total of 4 complications out of 211 patients. Conclusions There are no high-quality Level 1 studies evaluating the efficacy and safety of the EMMM procedure. Level 2 to Level 4 studies indicate that this procedure is relatively safe with a low complication rate and symptom resolution in up to 80% of patients with recalcitrant maxillary sinusitis.
Provincial Needs Assessment to Determine the Current State of Glomerulonephritis Care in Ontario
Authors: Pang Jocelyn , D’Antonio Christina , Heale Esti , Boll Philip , Blake Peter , Evans Jenna M. , Hladunewich Michelle 
Published: September 2019

Background: Despite its relative rarity, glomerulonephritis (GN) accounts for 20% of prevalent end-stage renal disease patients in Ontario. Early identification and appropriate management of GN to delay progression of disease can reduce patient morbidity and health system costs. As such, a provincial GN needs assessment was conducted to inform on the development of the provincial GN strategic framework in Ontario. Objective: To understand the current state of GN care in Ontario from nephrologist, hospital administrator, and patient and family perspectives. Design: Cross-sectional. Settings: 26 regional renal programs in Ontario. Patients: 23 patients and family members living with GN who do not require renal replacement therapy. Measurements: Patient and family member interviews as well as a survey of nephrologists. Methods: The study included 3 components: (1) interviews with patients and family members, (2) a survey of nephrologists, and (3) interviews with regional renal programs. The Ontario Renal Network provincial office developed the needs assessment questions and the physician survey questions after consultation with practicing nephrologists and hospital administrators. Thematic analysis was used to assess interview data and descriptive statistics to assess survey data. Results: Interviews with patients and family members (n = 23) identified gaps in care related to diagnosis and referral to nephrology care, education and decision-making, and psychosocial supports. The survey of nephrologists (n = 74) identified various issues that contribute to unstandardized GN care across Ontario, including a lack of provincial expertise in providing complex GN care, access to medication, multidisciplinary team support as well as patient education, and psychosocial supports. Interviews with regional renal programs aligned with interview and survey findings (n = 11). Limitations: Interviews with patients and family members were facilitated by 1 interviewer and limited to 20 interviews due to resource limitations. All nephrologists, patients, and family members who participated in the survey and interviews were volunteers and English-speaking, which may have resulted in self-selection bias. Conclusions: The provincial GN needs assessment emphasized the necessity to develop and implement a provincial GN strategy. The strategic framework includes 4 objectives: (1) ensure patients are supported to make informed decisions, (2) establish a provincial model of care, (3) leverage data to enable planning, decision-making, and monitoring of outcomes, and (4) ensure appropriate access to medication. This is the first Ontario strategy to address provincial gaps in GN care.
Microbial biosynthesis of lactate esters
Authors: Lee Jong-Won , Trinh Cong T. 
Published: September 2019

AbstractBackgroundGreen organic solvents such as lactate esters have broad industrial applications and favorable environmental profiles. Thus, manufacturing and use of these biodegradable solvents from renewable feedstocks help benefit the environment. However, to date, the direct microbial biosynthesis of lactate esters from fermentable sugars has not yet been demonstrated.ResultsIn this study, we present a microbial conversion platform for direct biosynthesis of lactate esters from fermentable sugars. First, we designed a pyruvate-to-lactate ester module, consisting of a lactate dehydrogenase (ldhA) to convert pyruvate to lactate, a propionate CoA-transferase (pct) to convert lactate to lactyl-CoA, and an alcohol acyltransferase (AAT) to condense lactyl-CoA and alcohol(s) to make lactate ester(s). By generating a library of five pyruvate-to-lactate ester modules with divergent AATs, we screened for the best module(s) capable of producing a wide range of linear, branched, and aromatic lactate esters with an external alcohol supply. By co-introducing a pyruvate-to-lactate ester module and an alcohol (i.e., ethanol, isobutanol) module into a modularEscherichia coli(chassis) cell, we demonstrated for the first time the microbial biosynthesis of ethyl and isobutyl lactate esters directly from glucose. In an attempt to enhance ethyl lactate production as a proof-of-study, we re-modularized the pathway into (1) the upstream module to generate the ethanol and lactate precursors and (2) the downstream module to generate lactyl-CoA and condense it with ethanol to produce the target ethyl lactate. By manipulating the metabolic fluxes of the upstream and downstream modules through plasmid copy numbers, promoters, ribosome binding sites, and environmental perturbation, we were able to probe and alleviate the metabolic bottlenecks by improving ethyl lactate production by 4.96-fold. We found that AAT is the most rate-limiting step in biosynthesis of lactate esters likely due to its low activity and specificity toward the non-natural substrate lactyl-CoA and alcohols.ConclusionsWe have successfully established the biosynthesis pathway of lactate esters from fermentable sugars and demonstrated for the first time the direct fermentative production of lactate esters from glucose using anE. colimodular cell. This study defines a cornerstone for the microbial production of lactate esters as green solvents from renewable resources with novel industrial applications.
Study of Unilateral Retinoblastoma With and Without Histopathologic High-Risk Features and the Role of Adjuvant Chemotherapy: A Children’s Oncology Group Study
Authors: Chévez-Barrios Patricia , Eagle Ralph C. , Krailo Mark , Piao Jin , Albert Daniel M. , Gao Yun , Vemuganti Geeta , Ali Mohammad Javed , Khetan Vikas , Honavar Santosh G. , O’Brien Joan , Leahey Ann-Marie , Matthay Katherine , Meadows Anna , Chintagumpala Murali 
Published: September 2019

PURPOSE To prospectively determine the prevalence of high-risk histopathologic features (HRFs) in patients with unilateral retinoblastoma who undergo enucleation and to evaluate the role of chemotherapy in preventing recurrences. PATIENTS AND METHODS Children newly diagnosed with enucleated unilateral retinoblastoma were enrolled prospectively. After central histopathology review, patients with specific HRFs received chemotherapy; others were observed. Primary end points were event-free survivals (EFS). RESULTS Of the 331 patients enrolled during 2005 to 2010, 321 eligible patients had central histopathologic review. Discordance between central review and contributing institutions occurred in 23% of patients with HRFs and in 17% of patients without HRFs. Postlaminar optic nerve involvement was present in 53 patients; 42 had massive posterior uveal invasion (≥ 3 mm); 15 had concomitant peripapillary 3 mm or greater choroid and postlaminar optic nerve involvement; and 15 had focal (< 3 mm) choroidal concomitant with lamina or prelamina optic nerve involvement. Two-year EFS for patients with HRFs requiring adjuvant chemotherapy was 0.96 (95% CI, 0.89 to 0.98), and 2-year EFS for patients without HRFs for which observation was indicated was 0.99 (95% CI, 0.96 to 1.0). The 2-year EFS for all patients was 0.98 (95% CI, 0.96 to 0.99). CONCLUSION Adequate handling and interpretation of histopathology of eyes with retinoblastoma is necessary to assign metastatic risk. Concomitant less than 3 mm choroidal and any prelaminar/laminar optic nerve invasion show no recurrence and may warrant no adjuvant chemotherapy. In contrast, concomitant greater than 3 mm peripapillary choroidal invasion and 1.5 mm or greater of postlaminar optic nerve invasion have the poorest outcomes, supporting the need for a more intensive adjuvant chemotherapy regimen for this subgroup. Strict criteria for adjuvant therapy may improve outcomes of children who undergo enucleation at diagnosis and may avoid unnecessary adjuvant chemotherapy for those who are not at risk for recurrence.
Genomic Biomarkers to Predict Resistance to Hypomethylating Agents in Patients With Myelodysplastic Syndromes Using Artificial Intelligence
Authors: Nazha Aziz , Sekeres Mikkael A. , Bejar Rafael , Rauh Michael J. , Othus Megan , Komrokji Rami S. , Barnard John , Hilton Cameron B. , Kerr Cassandra M. , Steensma David P. , DeZern Amy , Roboz Gail , Garcia-Manero Guillermo , Erba Harry , Ebert Benjamin L. , Maciejewski Jaroslaw P. 
Published: September 2019

PURPOSE We developed an unbiased framework to study the association of several mutations in predicting resistance to hypomethylating agents (HMAs) in patients with myelodysplastic syndromes (MDS), analogous to consumer and commercial recommender systems in which customers who bought products A and B are likely to buy C: patients who have a mutation in gene A and gene B are likely to respond or not respond to HMAs. METHODS We screened a cohort of 433 patients with MDS who received HMAs for the presence of common myeloid mutations in 29 genes that were obtained before the patients started therapy. The association between mutations and response was evaluated by the Apriori market basket analysis algorithm. Rules with the highest confidence (confidence that the association exists) and the highest lift (strength of the association) were chosen. We validated our biomarkers in samples from patients enrolled in the S1117 trial. RESULTS Among 433 patients, 193 (45%) received azacitidine, 176 (40%) received decitabine, and 64 (15%) received HMA alone or in combination. The median age was 70 years (range, 31 to 100 years), and 28% were female. The median number of mutations per sample was three (range, zero to nine), and 176 patients (41%) had three or more mutations per sample. Association rules identified several genomic combinations as being highly associated with no response. These molecular signatures were present in 30% of patients with three or more mutations/sample with an accuracy rate of 87% in the training cohort and 93% in the validation cohort. CONCLUSION Genomic biomarkers can identify, with high accuracy, approximately one third of patients with MDS who will not respond to HMAs. This study highlights the importance of machine learning technologies such as the recommender system algorithm in translating genomic data into useful clinical tools.
Intrathecal Drug Delivery Systems for Cancer Pain: An Analysis of a Prospective, Multicenter Product Surveillance Registry
Authors: Stearns Lisa M. , Abd-Elsayed Alaa , Perruchoud Christophe , Spencer Robert , Hammond Krisstin , Stromberg Katherine , Weaver Todd 
Published: September 2019

BACKGROUND:
The safety and efficacy of intrathecal drug delivery systems (IDDSs) for the treatment of cancer-related pain have been demonstrated in randomized controlled clinical trials (RCTs). Despite positive evidence for this therapy, IDDS remains underutilized to treat cancer pain. Real-world registry data augment existing safety and effectiveness data and are presented here to broaden awareness of this therapeutic option, needed for adequate cancer-related pain treatment, and as a viable tool addressing concerns with systemic opioid use.

METHODS:
This prospective, long-term, multicenter (United States, Western Europe, and Latin America) registry started in 2003 to monitor the performance of SynchroMed Infusion Systems. Patient-reported outcomes were added in 2013. Before data acquisition, all sites obtained Ethics Committee/Institutional Review Board approval and written patient consent. The study was registered (NCT01524276 at clinicaltrials.gov) before patients were enrolled. Patients who provided informed consent were enrolled in the registry at initial IDDS implant or replacement.

RESULTS:
Through July 2017, 1403 patients with cancer pain were enrolled and implanted. The average (minimum/maximum) age of patients was 59 years (13/93 years), with 56.6% female. The most frequent cancer types were lung, breast, colon/rectal, pancreatic, and prostate. The majority of patients whose registry follow-up ended (87%; 1141/1311) were followed through death, with 4.3% (n = 57) exiting due to device explant or therapy discontinuation; the remaining 113 (8.6%) discontinued for reasons such as transfer of care, lost to follow-up, and site closure. Pain scores within the cohort of patients providing baseline and follow-up data improved significantly at 6 (P = .0007; n = 103) and 12 (P = .0026; n = 55) months compared to baseline, with EuroQol with 5 dimensions (EuroQol-5D) scores showing significant improvement at 6 months (P = .0016; n = 41). Infection requiring surgical intervention (IDDS explant, replacement, pocket revision, irrigation and debridement, etc) was reported in 3.2% of patients.

CONCLUSIONS:
Adequate and improved pain control in patients with cancer, even in advanced stages, with concurrent quality of life maintenance is attainable. Results from this large-scale, multicenter, single-group cohort supplement existing RCT data that support IDDS as a safe and effective therapeutic option with a positive benefit–risk ratio in the treatment of cancer pain.
Revisiting Approximate Linear Programming: Constraint-Violation Learning with Applications to Inventory Control and Energy Storage
Authors: Lin Qihang , Nadarajah Selvaprabu , Soheili Negar 
Published: September 2019

Approximate linear programs (ALPs) are well-known models for computing value function approximations (VFAs) of intractable Markov decision processes (MDPs). VFAs from ALPs have desirable theoretical properties, define an operating policy, and provide a lower bound on the optimal policy cost. However, solving ALPs near-optimally remains challenging, for example, when approximating MDPs with nonlinear cost functions and transition dynamics or when rich basis functions are required to obtain a good VFA. We address this tension between theory and solvability by proposing a convex saddle-point reformulation of an ALP that includes as primal and dual variables, respectively, a vector of basis function weights and a constraint violation density function over the state-action space. To solve this reformulation, we develop a proximal stochastic mirror descent (PSMD) method that learns regions of high ALP constraint violation via its dual update. We establish that PSMD returns a near-optimal ALP solution and a lower bound on the optimal policy cost in a finite number of iterations with high probability. We numerically compare PSMD with several benchmarks on inventory control and energy storage applications. We find that the PSMD lower bound is tighter than a perfect information bound. In contrast, the constraint-sampling approach to solve ALPs may not provide a lower bound, and applying row generation to tackle ALPs is not computationally viable. PSMD policies outperform problem-specific heuristics and are comparable or better than the policies obtained using constraint sampling. Overall, our ALP reformulation and solution approach broadens the applicability of approximate linear programming.This paper was accepted by Yinyu Ye, optimization.
Caring for HIV-positive children: healthcare providers' pre-and post-disclosure experiences in Nairobi, Kenya
Authors: Makworo Drusilla , Odero Theresa 
Published: September 2019

Background The number of children living with HIV has increased worldwide, largely due to improvements in antiretroviral therapy. Most of these children are living in sub-Saharan Africa. The rate of disclosure to children of their HIV-positive status is low in low-resource countries compared to high-resource countries. Aim To explore health professionals' experiences of caring for HIV-positive children before and after their HIV-positive status was disclosed to them. The health professionals included nurses, counsellors, nutritionists, social workers, pharmacists and clinicians with at least 1 year of experience at the paediatric section of the comprehensive care centre. Methods Nine health professionals were interviewed. Findings Results revealed that there were more challenges before disclosure than after. The main challenge was communicating with the children. The children's main concerns before disclosures included the reason for treatment and its duration, and clinic follow-up. Conclusions Health professionals should be trained on the benefits of HIV disclosure to children, in order to allow for open and direct communication between healthcare providers, parents/carers and children.
Reviews
Authors: Inchley Maggie , Bartley Sarah , Massey-Chase Kate 
Published: September 2019

Applied Theatre with Looked-After Children: Dramatising Social Care, Claire MacNeill (2018) Oxford: Peter Lang, ISBN: 9 7817 8707 0714, 287 pp., £40.00
Applied Theatre: Economies, Molly Mullen (ed.) (2018) London: Bloomsbury, ISBN: 9 7813 5000 1725, 280pp., US$76.99
Web of Performance: An Ensemble Workbook, Monica Prendergast and Will Weigler (eds) (2018) Victoria, BC: University of Victoria Press, ISBN: 9 7815 5058 6220, free e-book, https://dspace.library.uvic.ca//handle/1828/9426
In simply connected cotangent bundles, exact Lagrangian cobordisms are h-cobordisms
Authors: Tanaka Hiro Lee 
Published: September 2019

Abstract
Let Q be a simply connected manifold. We show that every exact Lagrangian cobordism between compact, exact Lagrangians in T
*
Q is an h-cobordism. This is a corollary of the Abouzaid–Kragh Theorem.
Strategic Activism in an Uncertain World
Authors: van der Made Allard 
Published: September 2019

Abstract
We model private politics in the presence of two-sided incomplete information. An interest group (IG) threatens to inform consumers about a firm’s damaging technology should the firm not adopt a clean technology. The IG does not know how costly adopting the clean technology is and the firm does not know how much the IG cares about the damages. In equilibrium an IG who cares a lot signals its type to the firm and the firm is more inclined to adopt the clean technology if it receives such a signal. However, impasses can occur: the firm does not adopt the clean technology despite the fact that the IG has signaled that it cares a lot and threatens to inform a large fraction of the consumer population. The IG never informs all consumers: as soon as a certain fraction of the consumers is informed by the IG the firm reduces its price and thereby reveals to the remaining consumers that it is employing a damaging technology. The IG’s actions increase consumer well-being, but decrease total welfare unless the cost of adopting the clean technology is likely to be low. Yet, since the IG is inclined to target firms with this property, a regulator might want to delegate information provision to the IG.