bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neutropenia During Tocilizumab Treatment Is Not Associated with Infection Risk in Systemic or Polyarticular-course Juvenile Idiopathic Arthritis
Authors: Pardeo Manuela , Wang Jianmei , Ruperto Nicolino , Alexeeva Ekaterina , Chasnyk Vyacheslav , Schneider Rayfel , Horneff Gerd , Huppertz Hans-Iko , Minden Kirsten , Onel Karen , Zemel Lawrence , Martin Alan , Koné-Paut Isabelle , Siamopoulou-Mavridou Antigoni , Silva Clovis A. , Porter-Brown Benjamin , Bharucha Kamal N. , Brunner Hermine I. , De Benedetti Fabrizio 
Published: March 2019

Objective.To determine whether neutropenia is associated with increased risk for infection in patients with systemic juvenile idiopathic arthritis (sJIA) and polyarticular-course juvenile idiopathic arthritis (pcJIA) treated with tocilizumab (TCZ).Methods.Data up to Week 104 from 2 phase III trials of intravenous TCZ in sJIA (n = 112;ClinicalTrials.gov,NCT00642460) and pcJIA (n = 188;ClinicalTrials.gov,NCT00988221) were pooled. Worst common toxicity criteria grade and lowest observed absolute neutrophil count (ANC) were identified for each patient. Associations between patient characteristics and lowest observed ANC were tested using univariate regression analysis. Infection and serious infection rates per 100 patient-years (PY) in periods associated with grades 1/2 and 3/4 neutrophil counts were compared with rates associated with normal neutrophil counts.Results.ANC decreased to grade ≥ 3 in 25.0% and 5.9% of sJIA and pcJIA patients, respectively, and decreases were transient. Young age (p = 0.047) and methotrexate use (p = 0.012) were positively associated with neutropenia in patients with sJIA but not in patients with pcJIA. The rate of serious infections in patients with sJIA (10.9/100 PY; 95% CI 6.8–16.5) tended to be higher than in patients with pcJIA (5.2/100 PY; 95% CI 3–8.5). No increase in rates of serious or nonserious infections was observed during periods of neutropenia in either trial.Conclusion.Patients with JIA treated with TCZ experienced transient neutropenia that was not associated with an increased number of infections.
Treatment of Dactylitis and Enthesitis in Psoriatic Arthritis with Biologic Agents: A Systematic Review and Metaanalysis
Authors: Mourad Ahmed , Gniadecki Robert 
Published: March 2019

Objective.Biologic agents with different mechanisms of action [inhibitors of tumor necrosis factor-α (TNF-α), interleukin (IL)-12/23, and IL-17] showed efficacy in randomized controlled trials (RCT) in the treatment of psoriatic arthritis. We conducted a pooled metaanalysis of these agents for treatment of dactylitis and enthesitis and compared results with the American College of Rheumatology 20 (ACR20) response and Health Assessment Questionnaire–Disability Index (HAQ-DI) scores.Methods.A systematic literature search was performed and a pooled metaanalysis of RCT with anti-TNF-α (infliximab, golimumab, adalimumab), anti–IL-12/23 (ustekinumab), and anti–IL-17 (secu kinumab, ixekizumab) was conducted using the random-effects model. Bias was assessed using the Cochrane risk-of-bias tool.Results.Eighteen RCT were included in the pooled analysis (n = 6981). Both TNF-α inhibitors and novel biologics (ustekinumab, secukinumab, ixekizumab) demonstrated significant resolution of dactylitis at Week 24 with pooled risk ratios (RR) versus placebo of 2.57 (95% CI 1.36–4.84) and 1.88 (95% CI 1.33–2.65), respectively. For resolution of enthesitis at Week 24, RR for TNF-α inhibitors was 1.93 (95% CI 1.33–2.79) versus 1.95 (95% CI 1.60–2.38) for novel biologics. Both biologic categories showed overlapping ranges of ACR20 responses (TNF-α inhibitors: RR = 2.23, 95% CI 1.60–3.11; pooled IL-12/23 and −17: RR = 2.30, 95% CI 1.94–2.72) and similar quality of life improvement scores with mean HAQ-DI score changes of −0.29 (95% CI −0.39 to −0.19) and −0.26 (95% CI −0.31 to −0.22), respectively.Conclusion.The pooled analysis demonstrated that anti–TNF-α agents have the same efficacy as novel agents (ustekinumab, secukinumab, and ixekizumab) in dactylitis and enthesitis.
Appropriateness and Total Hip Arthroplasty: Determining the Structure of the American Academy of Orthopaedic Surgeons System of Classification
Authors: Riddle Daniel L. , Perera Robert A. 
Published: March 2019

Objective.In late 2017, the American Academy of Orthopaedic Surgeons (AAOS) published an appropriateness classification system using the RAND/University of California, Los Angeles (UCLA) approach for patients with hip osteoarthritis (OA). We determined the contribution of predictor variables in the system to final classification, rated as “appropriate,” “may be appropriate,” or “rarely appropriate” for hip arthroplasty.Methods.An AAOS-appointed expert panel developed 270 clinical vignettes incorporating all permutations of 5 evidence-driven indication variables associated with hip arthroplasty outcome or need. Indication variables were age, function-limiting pain severity, radiographic hip OA severity, hip motion, and presence of modifiable prognostic risk factors. Multinomial regression determined the relative contribution of each variable and a classification tree method determined variable combinations contributing to final classification.Results.Patient age and hip OA severity were the dominant predictors of appropriateness classification in both statistical models. Function-limiting pain made a slight contribution relative to age and hip OA severity while hip motion and the presence of modifiable prognostic factors did not meaningfully contribute to final classification. The regression model explained about 99% of the variance and the classification tree had an accuracy of 87.8%.Conclusion.Classification for hip arthroplasty appropriateness in the AAOS system is driven almost exclusively by age and OA severity. Function-limiting pain, a major reason patients seek surgery, contributes only slightly to the AAOS appropriateness criteria. The system relies heavily on traditional variables of patient age and radiographic hip OA severity. Future study of actual patient outcomes is needed to further test the validity of the AAOS system.
Uptake of the OMERACT-OARSI Hip and Knee Osteoarthritis Core Outcome Set: Review of Randomized Controlled Trials from 1997 to 2017
Authors: Smith Toby O. , Mansfield Michael , Hawker Gillian A. , Hunter David J. , March Lyn M. , Boers Maarten , Shea Beverley J. , Christensen Robin , Guillemin Francis , Terwee Caroline B. , Williamson Paula R. , Roos Ewa M. , Loeser Richard F. , Schnitzer Thomas J. , Kloppenburg Margreet , Neogi Tuhina , Ladel Christoph H. , Kalsi Gurdyal , Kaiser Ulrike , Buttel Thomas W. , Ashford Anne E. , Mobasheri Ali , Arden Nigel K. , Tennant Alan , Hochberg Marc C. , de Wit Maarten , Tugwell Peter , Conaghan Philip G. 
Published: March 2019

Objective.To assess the uptake of the OMERACT-OARSI (Outcome Measures in Rheumatology- Osteoarthritis Research Society International) core outcome set (COS) domains in hip and/or knee osteoarthritis (OA) trials.Methods.There were 382 trials of hip and/or knee OA identified from the ClinicalTrial.gov registry from 1997 to 2017. Frequency of COS adoption was assessed by year and per 5-yearly phases.Results.COS adoption decreased from 61% between 1997 and 2001 to 38% between 2012 and 2016. Pain (95%) and physical function (86%) were most consistently adopted. Patient’s global assessment (48%) was the principal missing domain.Conclusion.Limited adoption of the COS domains indicates that further consideration to improve uptake is required.
The flipped learning model in online based education for secondary teachers
Authors: Romero María del Carmen , Buzón-García Olga , Touron Javier 
Published: March 2019

The online-based model known as “flipped learning” raises new challenges that are different from those of face-to-face teaching. The flipped learning model enhances the active and autonomous learning of students, changes the relationships between them and with the teacher, and encourages innovation within the learning process. The following paper presents a descriptive, poll-based study after having implemented the model in the Curricular design course offered in two different departments, Mathematics and Technology and Computer Science, as part of the Master's Degree program in Secondary Education Teacher Training, taught online by the International University of La Rioja (UNIR). For this purpose, we have designed a learning model with a series of stages based on the events proposed by Gagné for the design of a teaching unit. In order to analyze the impact that the model has on student performance, the final grades obtained by the students are collected after individually designing a didactic unit, as required to demonstrate their learning, analyzing the difference between the control group and those participating in the designing experience. The results revolve around several axes, such as student satisfaction, the training they received, the perceived usefulness of the training received, the evaluation of the entire training process as it was carried out, and the performance achieved. This model ensures that the student is satisfied with and finds the usefulness of the training received, attains better academic performance and fosters very positive attitudes among the students as a whole.
Learning styles, study habits and academic performance of Filipino University students in applied science courses: Implications for instruction
Authors: Magulod Gilbert 
Published: March 2019

In order to better prepare university students as proficient, versatile and productive information and industrial technologists in the 21st century, the need to implement instructional strategies and activities naturally align with their predispositions will make them better learners. This study examined the learning style preferences, study habits and level of academic achievement of students enrolled in applied science courses of Cagayan State University at Lasam, Philippines. The study employed descriptive correlational research design to a total of seventy-five respondents who were purposively sampled. Two sets of standardized instruments were utilized by the researcher. Results of the study revealed that the students of applied sciences courses preferred visual, group and kinesthetic as major learning styles while they manifest a moderate level of study habits. They also have a good level of academic achievement. Test of difference revealed that academic performance, father's occupation and type of high school graduated from spelled significant differences in their perceptual learning styles. They also spelled differences in their study habits when grouped according to academic standing in high school, writing skills, mothers’ education, and test anxiety. Finally, there were significant relationships between learning styles, study habits and academic performance of students in applied science courses. The implications of the study can guide instructors plan and deliver suitable instructional interventions.
Citizen Science Observations Reveal Long-Term Population Trends of Common and Pacific Loon in Urbanized Alaska
Authors: McDuffie Laura A. , Hagelin Julie C. , Snively Marian L. , Pendleton Grey W. , Taylor Audrey R. 
Published: March 2019

AbstractFor more than 30 y, the Alaska Loon Watch (1985–1999) and the Alaska Loon and Grebe Watch (2000–2015) engaged citizen scientist participants to record more than 10,000 observations of common loons Gavia immer and Pacific loons Gavia pacifia at 346 lakes in five subregions of southcentral Alaska. We used generalized linear mixed models to estimate long-term trends in adult loon counts and chick survival and examined environmental variables associated with loon abundance. Adult common loon counts increased in all five subregions by 0.6–3.6% annually, whereas Pacific loons decreased 3% in the Anchorage subregion, but otherwise had trends not distinguishable from zero. Lake area was positively associated with common loon abundance and negatively associated with Pacific loon abundance. We also noted an inverse relationship between common loon and Pacific loon presence, consistent with the premise of interspecific competition. We did not find strong relationships between loon presence and predictor variables indicative of human disturbance or lakeshore development. Estimates of chick survival over time also revealed no clear pattern, although common loon chicks showed a decline in survival over the study period in one subregion. Citizen science programs provide agencies with a cost-effective tool to collect data over large spatial and temporal extents, which may not be feasible otherwise. However, there are ramifications of common data deficiencies associated with casual or unstructured observations, which can violate the assumptions required for rigorous statistical analysis. The implementation of a carefully predefined sampling protocol can avoid sampling bias, eliminate stringent assumptions, and ensure higher information content of citizen science data.
Patients’ Perception of Stressful Events in the Intensive Care Unit After Cardiac Surgery
Authors: Carey Mary G. , Qualls Brandon W. , Burgoyne Colleen 
Published: March 2019

Background
Subjecting patients to stress has potentially detrimental effects on their physical and psychological recovery.

Objective
To identify stress-generating experiences that occur in an intensive care unit for patients after cardiac surgery.

Methods
A sample of 16 patients in a 14-bed cardiovascular intensive care unit at a university hospital in upstate New York completed a questionnaire (based on an established survey) asking them to rate 23 experiences on a Likert scale of 0 to 4. All patients were adults and had undergone coronary artery bypass graft surgery. After surgery, they were extubated and completed the questionnaire within 12 to 24 hours.

Results
Patients reported pain to be the most stressful experience, followed by presence of an endotracheal tube and sleeplessness.

Conclusions
With pain, endotracheal intubation, and sleeplessness identified as highly distressing to patients, further research can be done to elicit interventions that could alleviate some of the stress involved with a postoperative stay in an intensive care unit.
Surrogates’ and Researchers’ Assessments of Prehospital Frailty in Critically Ill Older Adults
Authors: Hope Aluko A. , Munoz Missiel , Hsieh S. J. , Gong Michelle Ng 
Published: March 2019

Background
Prehospital frailty has been associated with adverse hospital outcomes in critically ill adults. Although frailty assessment in intensive care units depends on patients’ surrogates, frailty assessments by surrogates and researchers have not been compared.

Objectives
To compare agreement and validity between surrogates’ and researchers’ assessments of frailty in critically ill older adults.

Methods
An observational cohort study of adults (aged ≥ 50 years) admitted to a medical/surgical intensive care unit was conducted. On admission, patients’ surrogates quantified prehospital frailty by using the Clinical Frailty Scale (range, 1–9; scores &gt; 4 defined as frail). Researchers blinded to surrogates’ assessments also quantified frailty. Agreement was described with κ scores, McNemar tests, and Bland-Altman plots; validity was compared by using χ2 tests and logistic regression.

Results
For 298 patients (mean [SD] age, 67.2 [10.5] years), both surrogates’ and researchers’ frailty assessment scores ranged from 1 to 9, with moderate to substantial agreement between scores (g ≥ 0.40). Surrogates’ frailty assessment scores were significantly lower than researchers’ (mean difference, −0.62; 95% CI, −0.77 to −0.48; P &lt; .001). Surrogates were less likely than researchers to identify as frail those patients who experienced adverse hospital outcomes (death, prolonged stay, or disability newly identified at discharge).

Conclusions
Surrogates identified fewer patients as frail than did researchers. Factors involved in surrogates’ assessments of patients’ prehospital frailty status should be studied to see if the Clinical Frailty Scale can be modified to facilitate more accurate surrogate assessments.
Safety and Patients’ Response to Ambulation With a Pulmonary Artery Catheter in the Cardiac Intensive Care Unit
Authors: Mattioli Elisa , Tabuzo Bienvenido , Sangkachand Prasama , Parkosewich Janet , Reyes Liberty , Funk Marjorie 
Published: March 2019

Background
Early mobilization of patients in the intensive care unit can be beneficial, but evidence is insufficient to indicate whether allowing patients with an indwelling pulmonary artery catheter to walk is safe.

Objective
To describe the physiological and emotional responses to ambulation in patients with heart failure and a pulmonary artery catheter.

Methods
This prospective, descriptive study included 19 patients with heart failure monitored with a pulmonary artery catheter in a cardiac intensive care unit. Each patient, accompanied by a nurse, walked with continuous observation of heart rate and rhythm and pulmonary artery tracing on a transport monitor. Pulmonary artery catheter position and waveform, arrhythmias, and perceived levels of exertion and fatigue were recorded before and after each walk. The distance ambulated was documented. One to 3 times per week, nurses administered a questionnaire addressing patients’ sense of well-being.

Results
The 19 patients had 303 walks (range, 1–68; median, 7). During 7 patient walks (2.4%), catheter migration of 1 to 5 cm occurred, but no arrhythmias or waveform changes were observed. Changes in exertion and fatigue were significant (P &lt; .001, paired t test), but levels of both were minimal after walking. Patients expressed physical and emotional benefits of walking.

Conclusions
This study provides preliminary evidence that for hemodynamically stable patients with heart failure, ambulating with a pulmonary artery catheter is safe and enhances their sense of well-being. The presence of an indwelling pulmonary artery catheter should not preclude walking.
The feasibility of national parks in South Africa endorsing a community development agenda: The case of Mokala National Park and two neighbouring rural communities
Authors: Coetzee Hendri , Nell Werner 
Published: March 2019

This article explores the feasibility of South African National Parks (SANParks) endorsing a community development agenda, using Mokala National Park (MNP) and two neighbouring rural communities as case study. A three-phase sequential exploratory, mixed-methods approach was followed: an initial exploratory qualitative phase aimed at identifying the development needs of the two communities; a quantitative phase aimed at verifying and quantifying the identified needs; and a final qualitative phase (with a minor quantitative component) to determine what parks can reasonably achieve in terms of community development based on their available resources, capacity and expertise. Qualitative data were collected via semi-structured interviews (Phase 1: n = 22; Phase 3: n = 6), which were thematically analysed. Quantitative data were collected via a structured questionnaire (Phase 2: n = 484; Phase 3: n = 6) and analysed using SPSS 23. Findings revealed that the communities’ most significant needs centred on employment opportunities; improved healthcare, service delivery and waste management; and education. Community members also expressed the need for improved community policing, safety and security; social services; agricultural support and training; general skills development and training; local leadership; recreational facilities; local economic development and conservation initiatives. Results from the third phase of the study suggest that parks such as MNP can realistically only address some of the identified community needs significantly; primarily job creation (via temporary employment), skills development, local economic development, support of local conservation (especially via environmental education) and, to a lesser extent, agricultural support and training and permanent job creation.Conservation implications: The findings could be of practical use to SANParks to steer its community development initiatives towards attaining a more optimal balance between actual community needs and what the organisation can realistically offer, thus rendering SANParks’ efforts more efficient and effective in supporting the establishment of equitable and sustainable rural communities.
Vehicle Modification Prescription: Australian Occupational Therapy Consensus-Based Guidelines
Authors: Di Stefano Marilyn , Stuckey Rwth , Kinsman Natasha , Lavender Katrina 
Published: March 2019

Abstract
Vehicle modifications are often essential to ensure that drivers with disabilities can drive independently and safely. Occupational therapy driver assessors and driver rehabilitation specialists routinely prescribe vehicle modifications on the basis of individualized evaluations and support by rehabilitation interventions. After a literature review and consultation with stakeholders, we identified a resource gap in information to support an evidence-based process for vehicle modification prescription. Using an action research approach, we established content validity for draft guideline items and developed consensus-based draft guidelines for vehicle modification prescription that are ready for trialing by occupational therapy driver assessors. We also propose a practice model for vehicle modification prescription that is applicable to international contexts.
Occupational Therapists’ Perceptions of Online Competence Assessment and Evidence-Based Resources
Authors: Myers Christine T. 
Published: March 2019

Abstract
OBJECTIVE. This study explored U.S. occupational therapists’ perceptions of online competence assessment and associated evidence-based resources.
METHOD. The study used a cross-sectional design with a survey. Respondents were occupational therapists certifying or recertifying with the National Board for Certification in Occupational Therapy in March 2016.
RESULTS. The response rate was 88.6%, with 58.5% indicating they had used the online competence assessment platform. A majority agreed that the platform’s tools helped them identify clinical knowledge (n = 211; 79.9%) and skill needs (n = 160; 60.8%). Of those who obtained copies of the evidence-based resources (n = 98; 45.6%), 72.5% (n = 71) read at least one. Chi-square analysis demonstrated negative relationships between years as an occupational therapist and clinical skills assessment and between highest degree and use of evidence-based practices.
CONCLUSION. Online competence assessment assisted participants in identifying competence needs and evidence-based resources for improving clinical knowledge and skills.
Cognitive, Emotional, and Physical Functioning as Predictors of Paid Employment in People With Stroke, Traumatic Brain Injury, and Spinal Cord Injury
Authors: Wong Alex W. K. , Chen Cynthia , Baum M. Carolyn , Heaton Robert K. , Goodman Berrit , Heinemann Allen W. 
Published: March 2019

Abstract
OBJECTIVE. Our objective was to examine demographic, cognitive, emotional, and physical factors that predict return to paid employment for people after neurological injury.
METHOD. Four hundred eighty adults with stroke (n = 149), traumatic brain injury (n = 155), and spinal cord injury (n = 176) completed an occupational outcome questionnaire and physical, emotional, and cognitive assessments at three rehabilitation facilities.
RESULTS. Odds of employment were predicted by being married or partnered, having more education, requiring fewer prompts for task sequencing, and having higher inhibitory control (but were not predicted by specific type of injury). Participants who returned to work within 3 mo were more likely to work with the same employer and to take a full-time position than those who returned later.
CONCLUSION. Executive functioning, in particular sequencing and inhibitory control, strongly predicts employment and highlights the importance of cognitive strategy training during occupational therapy with people who have sustained neurological injuries.