bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in clinico-pathological characteristics and outcomes between proteinase 3-ANCA positivity and myeloperoxidase-ANCA positivity in lupus nephritis
Authors: Li C , Wang J -J , Zhou M -L , Liang D -D , Yang J , Zhu H -X , Hu W -X , Zhang H -T 
Published: July 2019

Background Owing to the low prevalence of anti-neutrophil cytoplasmic antibodies (ANCA) in lupus nephritis (LN), there is no study about the differences between proteinase 3 (PR3)-ANCA positivity and myeloperoxidase (MPO)-ANCA positivity in LN until now. Methods Here we perform a retrospective study to determine whether there are differences in clinic-pathological characteristics and renal outcomes between PR3-ANCA-positive LN patients and MPO-ANCA-positive LN patients. Results A total of 26 (27.4%) PR3-ANCA-positive LN patients and 69 (72.6%) MPO-ANCA-positive LN patients ( p < 0.001) were eligible for this study. Compared with PR3-ANCA-positive LN patients, MPO-ANCA-positive LN patients had significantly higher levels of serum creatinine (109.6 µmol/l vs. 74.3 µmol/l, p = 0.02), lower titers of antinuclear antibodies (ANA) (128 vs. 256, p = 0.01), and higher serum concentrations of C3 and C4 (0.54 g/l vs. 0.36 g/l, p = 0.002; 0.12 g/l vs. 0.06 g/l, p < 0.001; respectively). Furthermore, the MPO-ANCA-positive group had higher scores for chronicity index ( p = 0.007), including interstitial fibrosis ( p = 0.001) and tubular atrophy ( p = 0.03) on biopsy specimens. The renal survival rates for MPO-ANCA-positive LN patients were 94.1% at 1 year, 83.2% at 5 years and 79.6% at 10 years; these values were worse when compared with those of the PR3-ANCA-positive group, which were 100%, 100% and 100%, respectively. Conclusion MPO-ANCA-positive LN patients had more severely impaired baseline renal function and less active lupus serology. More severely chronic pathological changes, including interstitial fibrosis and tubular atrophy on renal specimens, occurred in MPO-ANCA-positive LN patients. We found that MPO-ANCA-positive LN patients had worse renal outcomes.
Factors related to privacy of Somali refugees in health care
Authors: Eklöf Niina , Hupli Maija , Leino-Kilpi Helena 
Published: July 2019

Background: Privacy is one of the key principles in health care and requires understanding of the cultural aspects of patients’ privacy. In Western cultures privacy is focused on the individual, however, in some non-Western cultures, privacy is linked to the collectivism of the community or religion. Objectives: The objective of this study is to describe the factors related to the realisation of privacy of Somali refugees in health care by describing the factors related to the patient, healthcare professional and interpreter. Research design: The data were collected from Somali refugees (N = 29) using a qualitative questionnaire and were analysed by deductive content analysis based on factors related to the patient, healthcare professional and interpreter. Ethical consideration: Ethical approval was obtained from the University of Turku, and research permissions were obtained from all participating institutions. Findings: Factors related to the patient were as follows: privacy was realised when the patient had self-determination; was able to act according to Somali culture; had knowledge and understanding of treatment; and trusted the healthcare professional. Factors related to the healthcare professional were as follows: the healthcare professional was expected to be of the same gender as the patient, act professionally, focus on the health issues, and to have knowledge and understanding of the Somali culture. Factors related to the interpreter were as follows: the presence and Somali background of the interpreter decreased privacy; the interpreter was expected to be of the same gender as the patient; to have competence and to behave professionally. Discussion: Gender congruence, professionalism and caring attitude and common understanding between the Somali patient and Finnish provider increase the privacy of Somali patients. Conclusion: Somali patients’ privacy can be improved by increasing healthcare professionals’ understanding of Somali culture, acknowledging the importance of gender concordance in relation to healthcare professionals and interpreters, and the effect of the presence of the interpreter on patients’ privacy.
Clinical capacity of Australian and New Zealand psychiatrists who work with people with intellectual and developmental disabilities
Authors: Davies Kimberley , Eagleson Claire , Weise Janelle , Cvejic Rachael C , Trollor Julian N 
Published: July 2019

Objective: To describe the characteristics and clinical capacity of Australian and New Zealand psychiatrists working in intellectual and developmental disability mental health (IDDMH). Method: Consultant psychiatrists (n=71) with an interest or expertise in IDDMH completed an online survey about their roles, experience and time spent in intellectual developmental disability (IDD)-related activities. Results: Psychiatrists had worked in IDDMH for a median of 11.34 years and half (53.5%) reported expertise in the area. One-fifth of psychiatrists reported IDDMH as their main area of practice. The majority of respondents (85.1%) reported that they were working clinically with people with IDD. Respondents practicing clinically worked a median of 8 hours in clinical and 3 hours in non-clinical IDD-related work per week. Conclusions: Surveyed psychiatrists had considerable experience in IDDMH. However, their work in IDDMH represented a relatively small proportion of their overall work hours, and a minority of respondents were responsible for a large proportion of clinical work. Exploring ways to broaden capacity is crucial to ensuring the mental health needs of people with IDD are met.
Touch-and-Go: Interior Tactile Communication in Armored Fighting Vehicles
Authors: Katzman Nuphar , Oron-Gilad Tal 
Published: July 2019

In armored fighting vehicles (AFVs), the vehicle commander (VC) and crew communicate through an audio system that all crew members inside the AFV can hear. This can be distracting and inconvenient, especially for effective communication between the VC and the driver. We assessed the feasibility and usability of a tactile system for direct communication between the VC and the driver in addition to (or instead of) the existing auditory system. Field experiment results show that, with or without auditory commands, tactile cues can be utilized to direct AFV drivers during operational tasks. Hence, specific design and implementation of a tactile interface should be considered for internal communication traffic.
Health needs, utilization of services and access to care among Medicaid and uninsured patients with chronic disease in health centres
Authors: Liang Hailun , Beydoun May A. , Eid Shaker M. 
Published: July 2019

Introduction Understanding the role of Medicaid for health centre patients with chronic diseases can aid policymakers in designing and improving programmes to effectively meet the needs of this vulnerable segment of the population. This study compares the number of chronic conditions, health services utilization and access to care between patients with Medicaid coverage and uninsured patients seen at US health centres. Methods We used data from the 2014 Health Center Patient Survey. Measures included number of chronic conditions, number of physician visits, number of prescription drugs used, access to a usual source of care, the receipt of a routine checkup, unmet need for care and unmet need for prescription drugs. We conducted bivariate analyses to determine differences of outcome measures between the Medicaid and uninsured patient groups. Multiple linear and logistic regression models were conducted to test associations of Medicaid and other health-related factors with outcome measures. Results Bivariate results indicated there were no differences between Medicaid and uninsured patients in number of chronic diseases, having a usual source of care and receipt of a routine checkup. Significant differences existed in health services utilization measures and unmet health needs measures. After controlling for confounding factors, the differences in these measures were still apparent. Uninsured status was linked to a reduced physician visit frequency by −3.03 (95% CI: −4.05, −2.00) as compared with Medicaid patients (p < 0.001) and was associated with a reduced frequency of prescription drugs used by −0.38 (95% CI: −0.67, −0.10, p < 0.01) after controlling for the other covariates. Conclusion Despite having comparable needs to Medicaid patients, uninsured patients with chronic conditions continue to have substantial unmet needs for health care services and limited access to the health care system. Health centres serve an important role in eliminating such disparity regardless of insurance status. In addition, Medicaid eligibility may also have a substantial and positive impact on improving health services utilization and access to care among these low-income patients.
Burnout Syndrome in UK Intensive Care Unit staff: Data from all three Burnout Syndrome domains and across professional groups, genders and ages
Authors: Vincent Laura , Brindley Peter G , Highfield Julie , Innes Richard , Greig Paul , Suntharalingam Ganesh 
Published: July 2019

Introduction This is the first comprehensive evaluation of Burnout Syndrome across the UK Intensive Care Unit workforce and in all three Burnout Syndrome domains: Emotional Exhaustion, Depersonalisation and lack of Personal Accomplishment. Methods A questionnaire was emailed to UK Intensive Care Society members, incorporating the 22-item Maslach Burnout Inventory Human Services Survey for medical personnel. Burnout Syndrome domain scores were stratified by ‘risk’. Associations with gender, profession and age-group were explored. Results In total, 996 multi-disciplinary responses were analysed. For Emotional Exhaustion, females scored higher and nurses scored higher than doctors. For Depersonalisation, males and younger respondents scored higher. Conclusion Approximately one-third of Intensive Care Unit team-members are at ‘high-risk’ for Burnout Syndrome, though there are important differences according to domain, gender, age-group and profession. This data may encourage a more nuanced understanding of Burnout Syndrome and more personalised strategies for our heterogeneous workforce.
Renovation in Hospitals: Pressurization Strategies by Healthcare Contractors in the United States
Authors: Mousavi Ehsan S. , Bausman Dennis 
Published: July 2019

Objective: The objective of the study was to identify current practices utilized by contractors in healthcare renovation projects. Background: Renovation in healthcare facilities comprises nearly half of all healthcare construction. Since a complete shutdown of the healthcare facility during renovation is typically not feasible, efforts must be taken to isolate ongoing functions of the hospital from activities in the construction zone. There are numerous documented cases of morbidity and mortality related to construction activities in the hospital. Hence, guidelines recommend negative pressurization of the construction zone to prevent the migration of dust and potential pathogenic agents into the functioning zone. Method: To accomplish the paper objective, a questionnaire was developed to address pressurization strategies, the use of backup systems and anterooms, and workforce training for healthcare projects. One hundred twenty-nine project managers and superintendents from top healthcare construction companies in the United States participated in the study. Results: Results show that owners influence pressurization strategy, but contractors typically assume a primary role in establishing pressurization levels, monitoring conformance, and training construction personnel. However, without solid evidence of effectiveness, pressurization levels often vary from Center for Disease Control standards. Conclusion: Further research is needed to establish evidence-based practices and to develop training modules for construction crews to support these best practices. Promoting evidence-based training can improve patient safety and minimize adverse patient outcomes.
Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management
Authors: Zadran Spogmai , Pedersen Peter Heide , Eiskjær Søren 
Published: July 2019

Study Design: Retrospective cohort study. Objectives: To compare the mortality between patients treated for vertebral osteomyelitis (VO) with either surgical or conservative management and to construct a predictive model for mortality after VO. Methods: All patients with a diagnosis of VO in Region North Denmark from 2004 to 2014 were followed for at least 2 years or until death. They were all treated according to a standardized guideline for the choice of treatment modality. Nineteen dichotomized variables with possible influence on the mortality were registered for all patients in the study. LASSO (least absolute shrinkage and selection operator) penalized Cox regression analysis was used to build a predictive model for 2-year survival after VO. Results: A total of 125 patients were eligible for inclusion, mean age 67 years, 36 women. 75 were treated surgically. Twenty-one patients were dead 2 years after the diagnosis. Kaplan-Meier estimate of 2-year survival was 0.82 [0.75, 0.88]. Any difference in mortality between surgically and conservatively treated patients was nonsignificant at 1 and 2 years (univariate Cox regression analysis). Significant factors included in the predictive model after LASSO penalized Cox regression analysis was Charlson Comorbidity Index (CCI), cardiovascular disease, C-reactive protein (CRP) normalization, thoracic infection, and Karnofsky score. The area under the curve (AUC) for the predictive model ranged from 0.74 to 0.77. Conclusion: Patients undergoing surgical management for vertebral osteomyelitis according to standardized and agreed-upon guidelines had no higher mortality than those allocated to conservative treatment. The predictive model included 5 variables associated with an increased mortality: CCI, CRP normalization, cardiovascular disease, thoracic infection, and Karnofsky score.
Treatment of Facial Dog Bite Injuries in the Emergency Department Compared to the Operating Room
Authors: Essig Garth F. , Sheehan Cameron C. , Niermeyer Weston L. , Lopez Joseph J. , Elmaraghy Charles A. 
Published: July 2019

ObjectiveTo assess factors associated with repair of facial dog bites in the emergency department (ED) versus the operating room (OR) and to compare rates of surgical site infection and reoperation for each venue.Study DesignCase series with chart review.SettingSingle institution.Subjects and MethodsAll patients younger than 18 years of age who underwent surgical repair by a consulting surgical service within 24 hours of presentation for facial dog bites between 2010 and 2013 were included. Demographics, site of injury, associated evidence of complex injury, surgical site infections within 30 days, and reoperation within 2 years were compared between patients undergoing surgical repair in the ED versus the OR.ResultsOne hundred sixty‐five patients were evaluated; 75 patients underwent repair in the ED, and 90 patients were treated in the OR. Patients treated in the ED underwent surgery more promptly than patients treated in the OR (median time from arrival to procedure start 3.3 vs 6.8 hours, P <. 001). Patients treated in the OR were more likely to have longer lacerations (3.0 cm vs 7.8 cm, P <. 001), lacerations of the eyelid (17% vs 42%, P =. 001), involvement of multiple regions of the face (11% vs 22%, P =. 039), and multiple indicators of severe injury (3% vs 12%, P =. 024). There were no differences in surgical site infections (1% vs 1%, P =. 721) or reoperation rates (5% vs 13%, P =. 071).ConclusionsSurgical management of pediatric facial dog bites may be successfully performed in both the ED and OR settings. Severity of the injury should dictate the choice for management.
Characterizing the T cell repertoire in lung squamous cell premalignancy and its association with lesion outcome.
Authors: Maoz Asaf , Merenstein Carter , Mazzilli Sarah , Campbell Joshua , Liu Gang , Zhang Sherry , Dhillon Samjot S. , Stevenson Christopher , Reid Mary E. , Lenburg Marc , Avi Spira , Beane Jennifer 
Published: July 2019

102 Background: The immune response to frank malignancy has been the focus of published work, but little is known about the adaptive immune response to bronchial premalignant lesions (PMLs), precursors of lung squamous cell carcinoma. This study was designed to characterize the T cell receptor (TCR) repertoire in PMLs and its association with clinical, pathological and molecular features. Methods: Endobronchial biopsies (n=294) and brushings (n=137) from high-risk subjects (n=50), undergoing lung cancer screening at approximately 1-year intervals via auto fluorescence bronchoscopy and CT, were profiled by RNA-Seq as part of the Pre-Cancer Genome Atlas (PCGA). We applied the TCR Repertoire Utilities for Solid Tissue/Tumor (TRUST) tool to identify TCR CDR3 sequences in the RNA-Seq data. We quantified the ratio of private (i.e., found in one patient only) and public (i.e. found in two or more patients) TCRs that are found in curated databases with known antigen specificities. We measured the correlation of TCR diversity with previously derived PML transcriptional signatures and molecular subtypes; and with mutational burden among a subset of biopsies (n=115) also profiled with whole exome sequencing. Results: We detected 40,421 unique TCR sequences, of which 3,396 (8.4%) were found in more than one sample and 1,057 (2.6%) were found in two or more patients (i.e. Public). TCRs with known antigen specificities were enriched among public TCRs (p < 0.001). In PMLs with a proliferative molecular subtype reflective of dysplasia (n=80), TCR diversity was decreased in PMLs that regressed versus PMLs that progressed (p=0.045). TCR diversity was negatively associated with a transcriptional signature of T-cell mediated immune activation (Spearman’s rho -0.26, p < 0.001) but was not associated with mutational burden. Conclusions: To our knowledge, this is the first characterization of the TCR repertoire associated with bronchial premalignant lesions. TCR diversity may help predict the efficacy of the host immune response to PMLs but it is not associated with mutational burden. Further studies are needed to leverage these findings and explore the potential for immunoprevention of PMLs.
Cancer-immune checkpoint inhibition and autoimmune-related adverse events.
Authors: Rathmann Joerg , Vredenburgh James J. , Demesropian Racha , Wakefield Dorothy , Williams Kendra , Purushothaman Archana , Bello Jessica , Dulipsingh Latha 
Published: July 2019

107 Background: Immunotherapies effect adaptive or innate immune responses. Programmed-death 1 (PD-1), a cell surface protein on activated T cells, which, when bound to its ligands PD-L1 and PD-L2, inhibits T-cell activation. Inhibition can be associated with complicating immune-related adverse events (IRAEs). Immune checkpoint inhibitors (ICIs) are FDA approved for advanced NSCLC. Study aims: (1) determine if the use of ICIs nivolumab (N) and pembrolizumab (P) is associated with development of autoimmune diabetes and thyroid disease and (2) determine the impact of (N) and (P) on pre-existing autoimmunity. Methods: Prospective, biological and clinical end-point-driven study in subjects with NSCLC considered for 1st or 2nd-line treatment with N or P. Subjects were assessed for thyroid stimulation hormone (TSH), hemoglobin A1c (HbA1c), thyroid peroxidase antibodies (TPO), glutamic acid decarboxylase (GAD) antibodies and islet cell antibodies (IC) at time of treatment start and wk 16 end point. Results: 29 subjects enrolled with base-line laboratory testing of which 14 subjects could be assessed at wk 16. At baseline, 1/14 subject had abnl TSH but at week 16 all subjects had a nl TSH (p 0.0687). Subjects had nl TPO at baseline and only 1/14 had an abnl TPO at 16 weeks (p 0.1634 ) but TSH remained nl. All 14 subjects had nl GAD and IC antibodies at baseline and at 16 wks; however, 2/14 of subjects had abnl IC antibodies at 16 wks but had nl HbA1c. 6/14 had nl HbA1c at baseline and 1/6 went on to develop pre-diabetes and 1/6 developed diabetes at the 16 wks. 5/14 subjects had pre-diabetes at baseline: 1/5 had nl HbA1c while 1/5 developed diabetes at 16 wks. 2 subjects developing diabetes had no positive GAD or IC antibodies. 3/14 had diabetes at study start with no worsening of the HbA1c or diabetes-related complications at wk 16. Conclusions: ICIs can cause IRAEs. Study result suggests that treatments with N and P can cause new onset of non-immune diabetes mellitus. Clinical awareness is important while managing NSCLC patients on ICIs. Patient should be screened for diabetes and thyroid disease prior to therapy and with repeat testing so as to avoid treatment complications. Longer follow-up and further study of ICI-mediated auto-immune endocrinopathies is needed.
Correlation of circulating tumor enumeration and immune checkpoint marker expression on CD103+, CD4+ T cells in non-small cell lung cancer tissue.
Authors: WANG Xiaoyang , Chen Pin-I , Jaimes Maria , Gu Humin , Shults Keith , Putta Santosh , Fazeli Fariba , Fernandez Janine , Sharma Vishal , Chow Will , Gogoi Priya , Handique Kalyan , Patterson Bruce Kendrick 
Published: July 2019

109 Background: Non-small cell lung cancer (NSCLC) has a poor prognosis as most patients are at advanced stage when diagnosed. Targeted therapy and immunotherapy in recent years has significantly improved NSCLC patient outcome. In this study, we employed cell-by-cell immune and cancer marker profiling of the primary tumor cells to investigate possible signatures that might predict the presence or absence of circulating tumor cells (CTCs). Methods: We performed a comprehensive study on 10 NSCLC patient tissue samples with paired blood samples. The solid tissue biopsy samples were dissociated into single cells by non-enzymatic tissue homogenization. The single cell suspensions were stained with a total 25 immune, cancer markers and a DNA content dye and analyzed with advanced, high-parameter flow cytometry. CTCs were isolated and analyzed from the paired peripheral blood. Results: Out of the 26 unique cell markers stained, we investigated a total of 72 biomarkers for their correlation with CTC number. Strong correlations were observed between CTC number and the frequency of immune checkpoint marker expressing lymphocytes, especially with the immune checkpoint marker expressing CD103+CD4+ T lymphocytes. CTC number is also correlated with the frequency of PD-L1 expressing cancer cells and cancer cell DNA content. In contrast, CTC number inversely correlated to the frequency of CD44+E-cadherin- cancer cells. Unsupervised clustering analysis based on the biomarker analysis separated the CTC negative patients from the CTC positive patients. Conclusions: Profiling multiple immune and cancer markers on cancer samples with multi-parametric flow cytometry allowed us to obtain protein expression information at the single cell level. Clustering analysis of the proteomic data revealed a signature driven by checkpoint marker expression on CD103+CD4+ T cells that could potentially be predictive of CTCs.