bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of vibration exposure and physiological responses of crew members during Infantry Combat Vehicle (ICV) operation: a pilot study
Authors: Malhari Archana A , Bhattacharyya D , Arya K , Chatterjee T , Pal M 
Published: October 2018

BackgroundOperation of infantry combat vehicle (ICV) influences the cardiorespiratory responses as well as the risk of vibration exposure on the crew members which adversely affect their performance and health.AimTo assess the effect of stress factors, that is, ICV’s compartmental temperature, relative humidity (RH) and vehicular vibration on the physiological parameters (heart rate (HR), respiratory frequency (RF), estimated core body temperature (ECT)) of the crew members during the ICV operation.MethodsA 1 hour run trial of the ICV operation was conducted with its crew members at their respective positions. Compartmental temperature and RH were monitored at an interval of every 15 min during the run trial. Physiological parameters were monitored continuously during the run trial. Whole body vibration (WBV) and hand-arm vibration (HAV) of the crew members were also measured during the run trial time.ResultsThe findings showed a strong positive correlation (p<0.05) between the increasing compartmental temperature and RH with its run trial time. Significant changes were observed in the physiological parameters (p<0.05) along with the increasing run trial time. Additionally, the physiological parameters showed a strong positive correlation with compartmental temperature and RH, respectively (p<0.05). Also, a significant increase (p<0.05) in the muscle strength was recorded after their exposure to ICV operation. The study also confirmed high level of WBV exposure of the crew members during the ICV operation.ConclusionIncrease in HR, RF and ECT along with increase in temperature and RH is a predictive indicator of physiological stress. Moreover, high levels of vibration exposure of various operations may bring deleterious effect on soldiers’ health as well as their performance. Proper ergonomic intervention can reduce exposure to vibration, physiological stress and increase comfort which may ultimately ensure an optimum performance of soldiers and successful completion of mission.
Interventional Therapy Versus Medical Therapy for Secundum Atrial Septal Defect: A Systematic Review (Part 2) for the 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Authors: Oster Matthew , Bhatt Ami B. , Zaragoza-Macias Elisa , Dendukuri Nandini , Marelli Ariane 
Published: October 2018

Secundum atrial septal defect (ASD) is the most common adult congenital heart defect and can present with wide variation in clinical findings. With the intention of preventing morbidity and mortality associated with late presentation of ASD, consensus guidelines have recommended surgical or percutaneous ASD closure in adults with right heart enlargement, with or without symptoms. The aim of the present analysis was to determine if the protective effect of secundum ASD closure in adults could be qualified by pooling data from published studies.
A systematic review and meta-analysis were performed by using EMBASE, MEDLINE (through PubMed), and the Cochrane Library databases to assess the effect of secundum ASD percutaneous or surgical closure in unoperated adults ≥18 years of age. Data were pooled across studies with the DerSimonian-Laird random-effects model or a Bayesian meta-analysis model. Between-study heterogeneity was assessed with Cochran’s Q test. Bias assessment was performed with the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool, and statistical risk of bias was assessed with Begg and Mazumdar’s test and Egger’s test.
A total of 11 nonrandomized studies met the inclusion criteria, contributing 603 patients. Pooled analysis showed a protective effect of ASD closure on New York Heart Association functional class and on right ventricular systolic pressure, volumes, and dimensions. Two additional studies comprising 652 patients were reviewed separately for mortality outcome and primary outcome of interest because they did not meet the inclusion criteria. Those studies showed that ASD closure was associated with a weak protective effect on adjusted mortality rate but no significant impact on atrial arrhythmias in patients >50 years of age. Across all studies, there was significant heterogeneity between studies for nearly all clinical outcomes. The overall body of evidence was limited to observational cohort studies, the limitations of which make for low-strength evidence. Even within the parameters of the included studies, quality of evidence was further diminished by the lack of well-defined clinical outcomes.
In conclusion, pooled data analysis on the impact of secundum ASD closure in adults was notably limited because of the lack of randomized controlled trials in patients with only secundum ASD. The few cohort studies in this population demonstrated improvement in functional status and right ventricular size and function as shown by echocardiogram. However, our findings suggest that at the time of this publication, insufficient data are available to determine the impact of ASD repair on mortality rate in adults.
Does vertical administrative integration of environmental monitoring at the provincial level effectively motivate firms to improve environmental behaviour in China?
Authors: Liu Yong 
Published: October 2018

A few cities and provinces in China have implemented vertical administrative integration of environmental monitoring to the provincial level as a response to severe environmental pollution. This study used an adaptive agent-based simulation model to explore whether the reform might effectively motivate polluting industrial firms to improve their environmental behaviour. Simulation results found that the reform might not effectively motivate the desired improvements in environmental behaviour unless policy-makers improve individual enterprises’ financial capacities, enhance their subsidies, and encourage managers to improve their environmental awareness. These findings could be used in the vertical administrative reform efforts to help achieve the reform’s success. Points for practitioners The vertical reform needs to be sufficiently systematic across its governmental structure because it cannot operate in isolation. It is a part of the country’s complex economic, social, and environmental societal system. Combining administrative restructuring with regulation of micro-agents’ behaviour might increase the reform’s likelihood of success, and financial policies might improve preventive/enthusiastic environmental behaviour. A sophisticated policy approach, such as encouraging preventive/enthusiastic environmental behaviour through business opportunities, might ease behavioural change.
Assessment of uveal melanomas using advanced diffusion-weighted imaging techniques: value of reduced field of view DWI (“zoomed DWI”) and readout-segmented DWI (RESOLVE)
Authors: Seeger Achim , Batra Marion , Süsskind Daniela , Ernemann Ulrike , Hauser Till-Karsten 
Published: October 2018

Background Diffusion-weighted imaging (DWI) has become an important tool for lesion characterization. Advanced techniques of DWI may be used to improve image quality. Purpose To evaluate multi-shot segmented DWI (rs-EPI, RESOLVE) and reduced field-of view DWI (rFOV-EPI, “zoomed” EPI) in patients with ocular melanoma and to compare image quality and diagnostic performance in differentiation of melanoma from retinal detachment. Material and Methods In this prospective and IRB-approved trial, we examined 26 patients using methods including conventional single-shot echo-planar DWI (ss-EPI), rs-EPI, and rFOV-EPI. Subjective image quality was compared using a four-point score and the maximum tumor length was measured in all sequences. Apparent diffusion coefficient (ADC) measurements were performed using a region-of interest analysis. Tumor delineation and differences in ADC values between melanomas and retinal detachments were compared. Results Diffusion restriction was markedly reduced in melanomas in all applied image techniques. Subjective image quality was significantly higher for rFOV-EPI (score = 3.5 ± 0.5) compared with rs-EPI (score = 3.3 ± 0.6) and ss-EPI (score = 2.5 ± 0.9). Regarding tumor diameter measurements, rFOV-EPI showed the best agreement compared with high-resolution conventional sequences. ADC measurements of the tumor and retinal detachment differed significantly ( P < 0.001) with the rFOV-EPI performing best (sensitivities and specificities compared with T1-weighted ss-EPI 61%/82%; rFOV-EPI 86%/92%; rs-EPI 79%/92%, respectively). Conclusion rFOV-EPI showed improved image quality compared with ss-EPI and rs-EPI, the most accurate tumor delineation and the best differentiation from retinal detachments in our patients.
Formestane as Treatment of Advanced Breast Cancer in Elderly Women
Authors: Zilembo Nicoletta , Buzzoni Roberto , Celio Luigi , Noberasco Cristina , Ferrari Leonardo , Laffranchi Alberto , Vicario Giovanni , Dolci Stella , Bajetta Emilio 
Published: October 2018

Aims and background The number of elderly people is increasing, and the proportion of breast cancer in female cancer patients older than 65 years is 26%. In elderly patients, hormone therapy is widely accepted as the treatment of choice, because of its efficacy and good tolerability compared to chemotherapy. The aim of this study was to evaluate the endocrinologic and clinical activity of formestane (4-hydroxyandrostenedione), a selective aromatase inhibitor, in elderly patients with advanced breast cancer. Methods Thirty-five patients older than 65 years, selected from a larger group, were given formestane (250 mg or 500 mg i.m. fortnightly). Patients were evaluable for tumor response after 4 doses of formestane. Blood samples were collected to evaluate E2, FSH, LH, SHBG and DHEAS serum levels at baseline and after 2, 4, 8,12 and 24 weeks. Results Thirty patients had PS ≤ 1 (ECOG) and only 5 patients had PS = 2. Twenty-six patients were ER positive. Previous hormonal treatment for metastatic disease had been given to 17 patients; only 1 case had received chemotherapy. The overall response rate was 51% (95% C.I. 35–67%) and the median response duration was 9.5 months. Three complete responses were observed on viscera. The best responses were obtained on soft tissues (59%); on bone and viscera the response was respectively 45% and 47%. Local and systemic tolerability was highly satisfactory. Formestane induced prolonged suppression of E2 levels in all of the patients, and a significant reduction in SHBG levels was also observed from month 2 onward. A statistically significant ( P = 0.0001) rise in serum FSH was also observed during the therapy. Conclusions The study showed that formestane induced a long-lasting suppression of E2 levels and a satisfactory overall response. In our opinion, the drug is an effective and well-tolerated approach in the management of advanced breast cancer in elderly patients.
Effects of Keto-analogues on Phosphocalcic and Aminoacid Metabolism in Dialysed Patients: A Crossover Study
Authors: Mahmoud M.D. , Bouche V. , Collin Ph. , Girault A. 
Published: October 2018

It has been suggested that calcium salts of keto-analogues (KA) have beneficial effects on phosphocalcic and aminoacid (AA) metabolism. To confirm this, their short-term effects were evaluated on chronic dialyzed patients. In a prospective, randomised, crossover study, eight and seven patients were put on KA (200 mg/kg/d) and assigned either a low-protein diet (LP:0.4 g/kg/d) or a normal one (NP: 1 g/kg/d) for 15 days. The two treatments were interchanged after 15 days of washout. KA.LP was accompanied by: a) decreases in calorie intake (12%; p = 0.001) and in blood concentrations of albumin (5%, p = 0.004), urea (32 %, p = 0.001), phosphate (29%, p = 0.001), parathormone (27%, p = 0.008), isoleucine (24%, p = 0.04), 1 and 3 methyl-histidine (71%, p = 0.03,; 24%, p = 0.005), valine (19%, p = 0.004) and hydroxyproline (85%, p = 0.009); b) increases in calcemia (9%, p = 0.002), cystathionine (991%, p = 0.0001) and threonine (22%, p = 0.04). KA.NP was accompanied by: a) decreases in phosphatemia (15%, p = 0.03) and parathormone (18 %, p = 0.06); b) increases in calcemia (9%, p = 0.002), cystathionine (427 %, p = 0.0001), and phenylalanine (28%, p = 0.013). Calcium salts of keto-analogues together with a low or normal protein diet thus seem to reduce blood concentrations of phosphates and parathormone, and raise calcium; however their action on aminoacids needs further investigation.
Location of Vertical Limb of Extensile Lateral Calcaneal Approach and Risk of Injury of the Calcaneal Branch of Peroneal Artery
Authors: Sirisreetreerux Norachart , Sa-ngasoongsong Paphon , Kulachote Noratep , Apivatthakakul Theerachai 
Published: October 2018

Background: The extensile lateral calcaneal approach is a standard method for accessing a joint depression calcaneal fracture. However, the operative wound complication rate is high. Previous studies showed a calcaneal branch of the peroneal artery contributing to the calcaneal flap blood supply. This study focuses on the location of the vertical limb in this approach correlating to the aforementioned artery and flap perfusion. Methods: Ten pairs of fresh-frozen cadaveric lower extremities were used. Extensile lateral calcaneal approach (ELCA) was carried out on both calcanei, where the vertical limb was placed at the line between the posterior border of lateral malleolus and lateral edge of the Achilles tendon for the right side (standard ELCA; sELCA) and at the lateral edge of the Achilles tendon for the left side (modified ELCA; mELCA). The identified vessel in the vertical limb incision was ligated and cut, and the horizontal limb of the incision was carried out as usual. After completion of flap elevation, 80°C water was injected into the popliteal vessel. In addition, thermal images were taken pre- and postinjection. Dye was injected subsequently, and perfusion was recorded in video format. Results: Mean pre- and postinjection skin flap temperature difference was significantly higher in mELCA (5.36°C vs 0.72°C, P = .0002). Dye perfusion patterns were significantly better in mELCA ( P = .0013). The calcaneal branch of peroneal artery was found in the vertical incision in 9 of 10 sELCA, with average distance 22.04 mm anterior to the calcaneal tuberosity and 8.22 mm proximal to superior border of the calcaneus, whereas one was found in mELCA, in which perfusion tests still appeared normal. Conclusion: The vertical limb of incision during extensile lateral calcaneal approach should be placed at the lateral edge of the Achilles tendon to avoid injuring the calcaneal branch of peroneal artery, which supplies the lateral calcaneal flap. However, further clinical research might be needed to confirm the results of this study. Clinical relevance: This study demonstrates a likely safest position for the proper incision for exposing the lateral calcaneus.
A decreased and less sustained desmopressin response in hemophilia A carriers contributes to bleeding
Authors: Candy Victoria , Whitworth Hilary , Grabell Julie , Thibeault Lisa , Harpell Lori , Bowman Mackenzie , Good David , Hopman Wilma M. , Sidonio Robert F. , James Paula D. 
Published: October 2018

Abstract
The cause of hemophilia A carrier bleeding is not well established. Desmopressin (DDAVP), used clinically to treat or prevent bleeding, can also be used as a medical stress surrogate. This study’s objective was to compare the response to DDAVP in hemophilia A carriers with that in normal control patients. Bleeding was assessed by the International Society on Thrombosis and Hemostasis Bleeding Assessment Tool (ISTH-BAT). DDAVP (0.3 μg/kg) was administered either IV or subcutaneously (SC), and blood was drawn at baseline and 1, 2, and 4 hours postadministration. Blood was assessed for factor VIII (FVIII) level, von Willebrand factor (VWF) antigen (VWF:Ag), VWF activity (VWF:RCo or VWF:GPIbM), thromboelastography (TEG), and thrombin generation assay (TGA) at all points, and for VWF propeptide (VWFpp):Ag ratio and ABO blood type at baseline. Carriers were older than control patients (median age, 34 and 21 years, respectively; P = .003) and had higher ISTH-BAT bleeding scores (median bleeding score, 8 and 0, respectively; P = .001). Carriers had a significantly reduced FVIII response to DDAVP compared with control patients (P ≤ .0001). When only carriers with normal baseline FVIII levels (n = 10) were included, carriers maintained a reduced FVIII response (P ≤ .0001). Furthermore, participants with abnormal bleeding scores had a significantly lower FVIII response to DDAVP compared with those with normal bleeding scores (P = .036). Hemophilia A carriers have a lower and less sustained FVIII response to DDAVP, suggesting an impaired ability to respond to hemostatic stress, which contributes to bleeding.
The role of induction chemotherapy followed by surgery in unresectable stage IVb laryngeal and hypopharyngeal cancers: A case series
Authors: Sittitrai Pichit , Reunmarkkaew Donyarat , Chaiyasate Saisaward 
Published: October 2018

Background The purpose of this study was to evaluate the benefit of induction chemotherapy followed by surgery in locally advanced unresectable stage IVb laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC). Methods Data of patients with stage IVb LHSCC who received induction chemotherapy for the purpose of tumor resection between January 2007 and January 2016 were retrospectively collected. Definitive surgery with postoperative adjuvant therapy was performed in patients whose tumors became resectable (resectable group). Chemoradiotherapy, radiotherapy, or supportive care was considered in patients whose tumors remained unresectable (unresectable group). Results Thirty-two patients were identified; the tumor resectability rate after induction chemotherapy was approximately 56%. The median overall survival (OS) rates of the resectable and unresectable groups were 20.0 months (range, 16.0–35.5 months) and 9.5 months (range, 6.0–15.0 months), respectively ( p = 0.008). The estimated 2-year OS rates of the resectable and unresectable groups were 59.5% (95% confidence interval [CI], 33.2–78.3%) and 10.7% (95% CI, 1.1–35.4%), respectively ( p = 0.008). The estimated 2-year disease-free survival (DFS) rates of the resectable and unresectable groups were 53.5% (95% CI, 27.9–73.6%), and 14.3% (95% CI, 2.3–36.6%), respectively ( p = 0.009). On multivariate analysis, factors positively impacting OS and DFS in all patients were surgical resection, a laryngeal primary site, and induction chemotherapy with docetaxel, cisplatin, and fluorouracil. Conclusions In advanced unresectable stage IVb LHSCC patients, surgical resection following induction chemotherapy appears to improve survival outcomes.
Recommendations for the Nomenclature of Cognitive Change Associated With Anaesthesia and Surgery—2018
Authors: Evered L. , Silbert B. , Knopman D. S. , Scott D. A. , DeKosky S. T. , Rasmussen L. S. , Oh E. S. , Crosby G. , Berger M. , Eckenhoff R. G. 
Published: October 2018

Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions.
Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) and National Institute for Aging and the Alzheimer Association (NIA-AA)] are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that ‘perioperative neurocognitive disorders’ be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).
Improving patient flow in an emergency department
Authors: Ameh Victor , Nasir Hamza , Ahmed Sarah , Abbasi Ayaz 
Published: October 2018

Background: The emergency department at Wrightington, Wigan and Leigh NHS Foundation Trust treats more than 90 000 patients every year. It is a sizable emergency department based in a large district general hospital. The department welcomes both adults and children and is also a designated major trauma unit. The case mix and demographics of these patients vary widely; however, a large proportion of these patients are elderly with multiple comorbidities. The smooth running of this emergency department depends on an unimpeded patient flow through the unit in a timely manner while ensuring that high quality care is provided. The ‘initial senior assessment and treatment’ model is designed to address some of the difficulties and challenges faced by the department. Methods: Two audits were undertaken four months apart in July and November 2015. In total, the first audit involved 200 adult patients, 100 of which were randomly allocated to the initial senior assessment and treatment and 100 to the non-initial senior assessment and treatment category. Patients were seen by a dedicated initial senior assessment and treatment team led by either an emergency department consultant, or an emergency department middle grade doctor. The parameters audited include: times to assessment, investigation, treatment and disposal. The second audit of 60 patients explored the staff perception to the process. In total, 20 were allocated to the initial senior assessment and treatment and 40 to the non-initial senior assessment and treatment. Results: The results of both audits showed a significant reduction in all the parameters investigated; however, there was a mixed staff perception to the process. Conclusion: The initial senior assessment and treatment process significantly improved the patients' journey.