bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of HRCT Imaging vs SPECT/CT Scans in the Staging of Malignant External Otitis
Authors: Balakrishnan Ramaswamy , Dalakoti Pooja , Nayak Dipak Ranjan , Pujary Kailesh , Singh Rohit , Kumar Rajesh 
Published: April 2019

ObjectiveThe prognosis of patients with malignant external otitis (MEO) depends on the extent of the inflammatory changes in the temporal bone and skull base. The efficacy of high‐resolution computed tomography (HRCT) imaging in accurately assessing the extent of disease is compared with that of single‐photon emission computed tomography/computed tomography (SPECT/CT) scan.Study DesignA clinical chart review was conducted with medical records and radiologic images.SettingTertiary care medical college hospital.Subjects and MethodsThis study involved patients with clinically diagnosed MEO who underwent both modalities of imaging of the skull base. Staging of the disease extent was compared between the imaging systems among patients. Symptom control and survival rates were analyzed with respect to the SPECT/CT staging of MEO.ResultsOut of 28 patients included in this study, 72% had SPECT/CT scans showing higher staging than the HRCT imaging. Four patients had mild uptake (stage 1), and 15 had disease confined to the mastoid/temporal bone, not reaching midline (stage 2). All patients in stages 1 and 2 were surviving with good symptom control. Five patients with petrous involvement reaching midline (stage 3) had persistent symptoms, and all 4 cases with SPECT/CT showing sphenoid involvement and crossing midline (stage 4) died within a year of diagnosis.ConclusionsSPECT/CT scan is more sensitive than HRCT imaging in detecting the extent of disease and is a better prognosticator for patients with MEO.
Estimation of overdiagnosis by detection to incidence ratio in cancer screening
Authors: Hakama Matti , Malila Nea 
Published: April 2019

Objective We aimed to introduce a concept of overdiagnosis with actual formulae. In screening for invasive cancer, the detection proportion to incidence rate (D/I) ratio is used as an intermediate indicator of effect. D is the detection rate (proportion) at screen and I is the background risk (i.e. the expected incidence rate if there were no screening). We sought to determine a proper use of the D/I ratio in the estimation of overdiagnosis in screening. Methods We propose the difference between the D/I ratio per year and incidence-based sensitivity as an estimate of overdiagnosis. As an example to evaluate this, we used screening for colorectal cancer, run as a randomized public health policy in Finland. Conclusion The use of the D/I ratio is inappropriate in predicting effect, and we recommend that the D/I ratio be used as a component in the estimation of overdiagnosis in screening for invasive cancer.
Dissociation of identity following left parietal haematoma – a single case report
Authors: Sreenivasa Vyjayanthi , Mayur Prashanth 
Published: April 2019

Objectives: Dissociative identity disorder in relation to brain injury has only rarely been reported in literature. This case report, which illustrates a de novo onset of dissociative identity for the first time in an elderly man who had a left parietal haematoma, adds to this scant literature base and supports an integrative view of bridging the dichotomy between organic and functional to explain complex psychiatric phenomena. Methods: It is a single case report collected through serial semi-structured interviews of the patient and his family over a 12-week period. Results: The patient was an elderly man transiently dissociated into various identities, some of whom seemed to be based upon individuals who had traumatized him in the past. This occurred three weeks after recovery from hemiparesis and delirium following a left parietal haematoma. The dissociations ended after six weeks, which coincided not only with the resolution of the haematoma but also with a faith-healing ritual. A speculative psychobiological formulation was drawn of possible brain origins of dissociation of identity. Conclusions: This report is a compelling account of temporal correlation between dissociation of identity and left parietal haematoma.
Changes in the stress markers cortisol and glucose before and during intradermal testing in cats after single administration of pre-appointment gabapentin
Authors: Hudec Christopher P , Griffin Craig E 
Published: April 2019

Objectives Intradermal allergy testing can be difficult to interpret in cats. Studies have shown that intradermal testing leads to elevations in blood cortisol, which may be an explanation for weak wheal reactions in cats. The primary objective of this study was to determine whether utilizing pre-appointment gabapentin will alter stress before and during intradermal testing, as determined by cortisol/glucose concentrations. Methods This was a randomized, single-blinded, crossover clinical trial of 16  privately owned healthy cats. Cats were scheduled two veterinary visits and randomly assigned to receive either gabapentin (25.0–30.5 mg/kg) or no treatment prior to the first visit and the opposite treatment prior to the second visit. Blood samples were obtained to measure cortisol/glucose concentrations at three time points: directly after physical examination; directly after sedation; and 10 mins after the second blood sample. A limited intradermal test was performed after the second blood sample. The primary author also recorded which visit they believed gabapentin was administered with low/high confidence. A non-blinded owner assessment survey documenting stress levels in their cats was also obtained. Results Mean cortisol concentrations were calculated to be 0.30 μg/dl lower in the gabapentin group but this reduction was not significant. Mean glucose concentrations were calculated to be 18 mg/dl higher in the gabapentin group. Gabapentin had no negative effect on intradermal histamine readings. The author was able to correctly identify when 14/16 cats received gabapentin. Non-blinded owners (n = 14/16) believed their cats were less stressed when gabapentin was administered. Conclusions and relevance Gabapentin did not significantly decrease cortisol/glucose concentrations. A sedative effect, rather than suppression of the pituitary–adrenocortical axis, may have led to the lower stress assessment. It is unlikely that pre-appointment gabapentin will alter intradermal testing in a majority of cats. This study supports recent clinical trials demonstrating that administration of gabapentin can lower veterinarian/owner assessment of stress in cats.
Children’s and parents’ views on hospital contact isolation: A qualitative study to highlight children’s perspectives
Authors: Alvarez Evelyn N , Pike Megan C , Godwin Hilary 
Published: April 2019

Background: To date, there has been a paucity of studies conducted on the experiences of children under hospital contact isolation precautions. Furthermore, the studies that have examined children’s experiences at the hospital typically reflect the perspectives of their parents, and few have directly involved interviews with children themselves, and even fewer with children in isolation. Methods: To address this gap, we conducted semi-structured, open-ended interviews with hospitalized children to assess their experiences of being placed in isolation. Where possible, the children’s parents also completed written surveys to assess parental perspectives on their child’s experiences. Results: Two important findings of the study were the children’s resilience during a difficult time and children’s varying awareness of the pathophysiology of infections as it relates to isolation precautions. Examination of the parent–child dyads elucidated some discordance between parents’ and children’s perspectives on how children experienced their isolation, on what the children’s preferred activities were while in isolation, and how much children understood about the reasons they were in isolation. Conclusion: This study supports earlier studies that suggest that the benefits of isolation procedures may be outweighed by how negatively isolation is experienced by patients, particularly when the patients are children. It also highlights the need for child-friendly isolation signs. Because parental and child perceptions differed in cases where data from both were available, this study suggests larger studies on children’s perspectives and/or on parent–child dyads are needed.
Development and validation of the Highly Effective Health Behavior Pattern Inventory – Short Form
Authors: Kang Eunkyo , Kim Soojeong , Rhee Ye E , Yun Young H 
Published: April 2019

Objectives The purpose of this study was to develop and validate a short form (SF) of the highly effective health behavior pattern inventory (HEBPI) for chronic disease patients for comfort to use. Methods HEBPI-SF is a self-reported questionnaire based on highly effective health behaviors associated with building healthy habits. HEBPI-SF was validated by calculating adjusted odds ratios (aOR) for the 12 HEBPI-SF health behavior subscales and the maintenance of the 12 corresponding health habits. Results HEBPI-SF developed in this study comprised 12 subscales and 53 items, utilizing patient data (N = 724) derived from the original HEBPI (12 subscales and 131items). HEBPI-SF demonstrated high reliability (Cronbach’s α of 0.703–0.859) and showed that the 12 health behaviors included in the HEBPI are associated with the maintenance of the corresponding health habits (aOR: 2.29–8.42). The scores of the HEBPI-SF showed a positive correlation with physical, mental, social, spiritual and general health status, quality of life, and self-management strategies. Discussion HEBPI-SF is a reliable tool for the assessment of health behaviors of chronically ill patients. Considering previous findings of simple health behaviors significantly affecting health status, this survey tool for the assessment of health behaviors is useful for promotion and maintenance of healthy habits.
Switching from infliximab to biosimilar in inflammatory bowel disease: overview of the literature and perspective
Authors: Milassin Ágnes , Fábián Anna , Molnár Tamás 
Published: April 2019

Background: Biological therapy has revolutionized the treatment of inflammatory bowel disease (IBD). After the expiration of patents for biological innovator products, development of biosimilars increased. CT-P13 was the first biosimilar approved for the same indications as the reference product; however, the approval was based on extrapolated data from rheumatoid arthritis and ankylosing spondylitis. Our aim was to review clinical studies about switching from originator infliximab (IFX-O) to biosimilar infliximab (IXF-B) in IBD, focusing on recently published data and the future of biosimilars. Methods: The PubMed database was searched for original articles published up to 1 December 2018 reporting data on IFX-B in IBD. Results: A total of 29 studies assessing switching from IFX-O to IFX-B, 14 assessing induction therapy with IFX-B were found. Efficacy, safety and immunogenicity were discussed. Studies confirm that CT-P13 is safe and equally efficient as the reference product for both induction and maintenance therapy; and that switching from the reference product to biosimilar is non-inferior to continuous biosimilar use. However, efficacy and safety data on Flixabi (SB2) in IBD patients is lacking. Conclusion: Switching from the originator to a biosimilar in patients with IBD is acceptable, although scientific and clinical evidence is lacking regarding reverse switching, multiple switching and cross-switching among biosimilars in IBD patients.
Endovascular treatment of acute ischaemic stroke in octogenarians and nonagenarians compared with younger patients
Authors: Kawabata Yasuhiro , Nakajima Norio , Miyake Hidenori , Fukuda Shunichi , Tsukahara Tetsuya 
Published: April 2019

Purpose: Endovascular therapy for emergent large vessel occlusion has been established as the standard approach for acute ischaemic stroke. However, the effectiveness and safety of endovascular therapy in the very elderly population has not been proved. Objective: To determine the safety and effectiveness of endovascular therapy in octogenarians and nonagenarians. Methods: We retrospectively reviewed all patients who underwent endovascular therapy at two stroke centres between April 2012 and July 2018. Functional outcome was assessed using the modified Rankin scale at 90 days after stroke or at discharge. A favourable outcome was defined as a modified Rankin scale score of 0–2 or not worsening of the modified Rankin scale score before stroke. Outcome was compared between younger patients (aged 46–79 years, n = 40) and octogenarians and nonagenarians (aged 80–97 years, n = 19). Results: Octogenarian and nonagenarian patients had pre-stroke functional deficit (modified Rankin scale score >1) more frequently than younger patients (57.9% vs. 20.0%, respectively, P = 0.0059). No difference was observed between very elderly and younger patients in the rate of successful reperfusion (89.5% vs. 67.5%, respectively, P = 0.11), favourable functional outcome (47.4% vs. 45.0%, respectively, P = 1.00) and mortality (21.1% vs. 27.5%, respectively, P = 1.00). On multiple regression analysis, successful reperfusion, concomitant use of intravenous thrombolysis, and out-of-hospital onset were independent predictors of favourable outcome ( P = 0.0003, 0.015 and 0.028, respectively). Conclusions: Successful reperfusion, concomitant use of intravenous thrombolysis, and out-of-hospital onset were clinical predictors of favourable outcome. However, we did not observe an age-dependent effect of clinical outcome after endovascular therapy.
Low Walking Impairment Questionnaire score after a recent myocardial infarction identifies patients with polyvascular disease
Authors: Jönelid Birgitta , Kragsterman Björn , Berglund Lars , Andrén Bertil , Johnston Nina , Lindahl Bertil , Oldgren Jonas , Christersson Christina 
Published: April 2019

Objectives To evaluate whether the Walking Impairment Questionnaire score could identify patients with polyvascular disease in a population with recent myocardial infarction and their association with cardiovascular events during two-year follow-up. Design A prospective observational study. Setting Patients admitted to the acute coronary care unit, the Department of Cardiology, Uppsala University Hospital. Participants Patients admitted with acute Non-STEMI- or STEMI-elevation myocardial infarction. Main outcome measures The Walking Impairment Questionnaire, developed as a self-administered instrument to assess walking distance, speed, and stair climbing in patients with peripheral artery disease, predicts future cardiovascular events and mortality. Two hundred and sixty-three patients with recent myocardial infarction answered Walking Impairment Questionnaire. Polyvascular disease was defined as abnormal findings in the coronary- and carotid arteries and an abnormal ankle–brachial index. The calculated score for each of all three categories were divided into quartiles with the lowest score in first quartile. Results The lowest (worst) quartile in all three Walking Impairment Questionnaire categories was associated with polyvascular disease, fully adjusted; distance, odds ratio (OR) 5.4 (95% confidence interval (CI) 1.8–16.1); speed, OR 7.4 (95% CI 1.5–36.5); stair climbing, OR 8.4 (95% CI 1.0–73.6). In stair climbing score, patients with the lowest (worst) score had a higher risk for the composite cardiovascular endpoint compared to the highest (best) score; hazard ratio 5.3 (95% CI 1.5–19.0). The adherence to medical treatment was high (between 81.7% and 99.2%). Conclusions The Walking Impairment Questionnaire is a simple tool to identify myocardial infarction patients with more widespread atherosclerotic disease and although well treated medically, stair climbing predicts cardiovascular events.
Risk factors attributed to failure of ultrasound-guided compression for post-cardiac catheterization femoral artery pseudoaneurysms
Authors: Shatnawi Nawaf J , Al-zoubi Nabil A , Jarrah Jadallah , Khader Yousef , Heis Mowafeq , Al-Omari Mamoon H 
Published: April 2019

Background: Femoral pseudoaneurysm is the most important access site complication following cardiac catheterization. Ultrasound-guided compression repair is a safe and effective therapeutic modality with variable failure rates and risk factors. The aim of this study was to investigate which factors were associated with a higher incidence of ultrasound-guided compression repair failure for post-cardiac catheterization femoral pseudoaneurysm. Methods: Data were retrospectively collected from medical records at King Abdullah University Hospital during the period from January 2011 to December 2016. A total of 42 patients with post-cardiac catheterization femoral pseudoaneurysm had attempted ultrasound-guided compression repair. Data regarding patients, procedure and aneurysm-related factors were evaluated by univariate analysis and multivariate logistic regression. Results: Ultrasound-guided compression repair failed in 31% of the patients. Patients with body mass index of ⩾28 kg/m2, platelet count of ⩽180,000/L, time lag (age of aneurysm) of >48 h following puncture time, aneurysmal neck diameter of ⩾4 mm and communicating tract length of <8 mm were associated with higher rate of ultrasound-guided compression repair failure in the univariate analysis. In the multivariate analysis, time lag (age of aneurysm) > 48 h (odds ratio = 5.7), body mass index ⩾ 28 kg/m2 (odds ratio = 7.8), neck diameter > 4 mm (odds ratio = 14.4) and tract length < 8 mm (odds ratio = 18.6) were significantly associated with ultrasound-guided compression repair failure. Conclusion: Ultrasound-guided compression repair for patients with post-cardiac catheterization femoral pseudoaneurysm was successful in 69% of the patients. Risk factors for failed ultrasound-guided compression repair were as follows: delayed ultrasound-guided compression repair of >48 h, body mass index ⩾ 28 kg/m2, wide neck diameter > 4 mm and short aneurysmal communication tract < 8 mm.
Understanding Cultural Heritage: Multiplicity and Contestations in Chamba Town in the Western Himalayas
Authors: Kaushal Chandan 
Published: April 2019

The idea of heritage is not new; originating in the West in the nineteenth century, it travelled in the world through colonial policy. However, heritage or world heritage, as it is known today, was conceived and propagated by global agencies like UNESCO in the second half of the twentieth century. The present article aims to explore the heritage status demand for Chamba town located in the Western Himalayas. Heritage is treated here not as a thing, but as a different kind of attitude towards past. Drawing form Ericksen’s idea heritage in this article is understood as different ‘historicity regimes’. Pursuance for heritage status for Chamba which was ruled by a single dynasty until Independence, having vibrant past, can be seen as part of globalization. Heritage here means for some a ‘brand’ for marketing a place for tourist attraction and for others preservation of antiquities or veneration of past which plays a decisive role in negotiating, maintaining and creating a group identity. Official and unofficial heritage practices coexist which sometimes lead to contestation over meaning and practice. Analysing categories that organize experiences of temporality in Chamba such as antiquity and heritage employed by scholars and practitioners are coexistent with folklore, memory and beliefs that are part of everydayness and differ from how practitioners make sense of past.
Spatial Mapping of ‘People–Place Ties’ as an Integral Part of Heritage Management Process
Authors: Nanda Gayatri , Khare Ajay 
Published: April 2019

Cultural manifestations of communities imbue deep-rooted meanings to places and establish intricate webs of relationships between people and places. These relationships cohesively add to the unique heritage of any place. In this era of urbanization, these webs are getting ruptured to make way for a globalized, homogenized and incoherent built environment leading to the loss of meanings, associations and identities. With the increasing recognition for the need of a holistic heritage management in both national and global platforms, a probe towards formulating a framework for such interventions becomes extremely essential today. This article signifies the role of spatial mapping of ‘people–place ties’ in the heritage management process. The methodology of documenting community–place relationships, mapping and interpreting maps to form a basis for interventions is demonstrated by taking the case of Puri, India. A number of research methods such as mental maps, essays and precoded questionnaire surveys have been used. To visualize this qualitative aspect, choropleth maps have been generated with the help of Geographic Information System (GIS) to be compared for residents of various age groups to interpret built environment qualities which need to be conserved/intervened. Thus, this process could be a part of a framework designed to sensitively intervene in rapidly transforming morphologies of heritage cities and help in sustaining and reinforcing their ‘place identity’.
Crisis management in the treatment of childhood acute lymphoblastic leukemia: putting right what can go wrong (emergency complications of disease and treatment)
Authors: Hough Rachael , Vora Ajay 
Published: April 2019

AbstractThe improvement in overall survival in children with acute lymphoblastic leukemia (ALL) over the last 5 decades has been considerable, with around 90% now surviving long term. The risk of relapse has been reduced to such an extent that the risk of treatment-related mortality is now approaching that of mortality caused by relapse. Toxicities may also lead to the suboptimal delivery of chemotherapy (treatment delays, dose reductions, dose omissions), potentially increasing relapse risk, and short- and long-term morbidity, adding to the “burden of therapy” in an increasing number of survivors. Thus, the need to reduce toxicity in pediatric ALL is becoming increasingly important. This work focuses on the risk factors, pathogenesis, clinical features, and emergency management of the life-threatening complications of ALL at presentation and during subsequent chemotherapy, including leucostasis, tumor lysis syndrome, infection, methotrexate encephalopathy, thrombosis, and pancreatitis. Potential strategies to abrogate these toxicities in the future are also discussed.
Progress in adult ALL: incorporation of new agents to frontline treatment
Authors: Leonard Jessica , Stock Wendy 
Published: April 2019

Abstract
Treatment of acute lymphoblastic leukemia (ALL) in adults remains a challenge, as the delivery of intensive chemotherapeutic regimens in this population is less feasible than it is in the pediatric population. This has led to higher rates of treatment-related toxicity as well as lower overall survival in the adult population. Over the past several years, a host of novel therapies (eg, immunotherapy and targeted therapies) with better tolerability than traditional chemotherapy are now being introduced into the relapsed/refractory population with very encouraging results. Additionally, insights into how to choose effective therapies for patients while minimizing drug toxicity through pharmacogenomics and the use of minimal residual disease (MRD) monitoring to escalate/de-escalate therapy have enhanced our ability to reduce treatment-related toxicity. This has led to the design of a number of clinical trials which incorporate both novel therapeutics as well as MRD-directed treatment pathways into the frontline setting. The use of increasingly personalized treatment strategies for specific disease subsets combined with standardized and rapid molecular diagnostic testing in the initial diagnosis and frontline treatment of ALL will hopefully lead to further improvements in survival for our adult patients.