bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender and Racial Disparities in Initial Hemodialysis Access and Outcomes in Incident End-Stage Renal Disease Patients
Authors:   Shah, Leonard Anthony C. , Meganathan Karthikeyan , Christianson Annette L. , Thakar Charuhas V. 
Published: July 2018

<b><i>Background:</i></b> Arteriovenous (AV) access confers survival benefits over central venous catheters (CVC) in hemodialysis patients. Although chronic kidney disease disproportionately affects women and racial minorities, disparities in the ­utilization of hemodialysis access across Asians, Native Americans, Hispanics, blacks, and whites among males and females after accounting for pre-dialysis health are not well studied. <b><i>Methods:</i></b> We evaluated 885,699 patients with end-stage renal disease who initiated hemodialysis between January 1, 2004 and December 31, 2014 using the US Renal Data System. Multivariable logistic regression models ­adjusted for pre-dialysis health were used to test the associations between gender and race on type of vascular access (AV access vs. CVC, and AV fistula vs. AV graft) at hemodialysis initiation as primary outcome, and on 1-year mortality as a secondary outcome. <b><i>Results:</i></b> Mean age was 65 ± 14 years. Females were less likely to use AV access for hemodialysis initiation than were males (OR 0.85; 95% CI 0.84–0.86). Compared to whites, adjusted odds of AV access for hemodialysis initiation were higher in blacks (OR 1.08; 95% CI 1.07–1.70), Asians (OR 1.11; 95% CI 1.07–1.14); and lower in Hispanics (OR 0.89; 95% CI 0.87–0.90). There was no ­significant difference in mortality between males and females. Compared to whites, 1-year adjusted mortality was lower in Asians (OR 0.55; 95% CI 0.53–0.56), blacks (OR 0.67; 95% CI 0.66–0.68), Hispanics (OR 0.62; 95% CI 0.61–0.63), and Native Americans (OR 0.62; 95% CI 0.58–0.66). <b><i>Conclusion:</i></b> Females had lower odds of using AV access than do males for hemodialysis initiation. As compared to whites, blacks and Asians were more likely, and Hispanics were less likely to use AV access for first outpatient hemodialysis. Further investigation of biological and process of care factors may help in developing ways to reduce these disparities.
Defining Exposure in Observational Studies Comparing Outcomes of Treatment Discontinuation
Authors: Krumme Alexis A. , Glynn Robert J. , Schneeweiss Sebastian , Choudhry Niteesh K. , Tong Angela Y. , Gagne Joshua J. 
Published: July 2018

Background:
Continuation of antiplatelet therapy beyond 12 months after a drug-eluting stent procedure reduced the risk of a major adverse cardiovascular and cerebrovascular event (MACCE) in the DAPT trial (Dual Antiplatelet Therapy). Observational studies have evaluated outcomes related to different durations of therapy but are susceptible to bias.

Methods and Results:
Using deidentified claims from commercially insured and Medicare populations in the United States, we compared how increasingly stringent definitions of exposure affect associations between antiplatelet continuation versus discontinuation and MACCE, myocardial infarction, and intracerebral hemorrhage or gastrointestinal bleeding in patients meeting DAPT trial inclusion criteria between 2004 and 2013. Therapy continuation at 12 months was defined as (1) having antiplatelet supply on hand versus not (landmark time); (2) refilling within 30 days versus not among individuals with antiplatelet supply; (3) criteria 2 plus continuous prior antiplatelet use; and (4) criteria 2 and 3 plus a cardiologist visit in months 10 to 12. Propensity score-adjusted hazard ratios were compared. Cohort sizes were 53 679, 27 524, 16 971, and 7948, respectively, of which 20% were discontinuers on average. Increasing restriction led to progressively larger associations with continued treatment: cohort 1 MACCE hazard ratio, 0.79 (0.73, 0.87); myocardial infarction, 0.74 (0.65, 0.83); bleed, 1.03 (0.96, 1.11) versus cohort 4 MACCE hazard ratio, 0.66 (0.48, 0.91); myocardial infarction, 0.56 (0.37, 0.86); bleed, 1.24 (0.95, 1.61). Estimates trended toward DAPT trial estimates and were associated with reduced levels of exposure misclassification.

Conclusions:
In an example of long-term antiplatelet use, increasing restrictions on the definition of therapy continuation yielded results consistent with trial estimates by reducing exposure misclassification.
Regional Intervention of Stroke Care to Increase Thrombolytic Therapy for Acute Ischemic Stroke
Authors: Damani Rahul H. , Anand Samyuktha , Asgarisabet Parisa , Bissell Catherine , Savitz Sean , Suarez Jose I. 
Published: July 2018

Background and Purpose—
The aims of this study were to investigate the effect of an intervention to unblind data on r-tPA (recombinant tissue-type plasminogen activator) administration and sharing data with chief executive officers of participating hospitals, on r-tPA administration rates postintervention and on potential healthcare cost savings implemented at 26 Southeast Texas Regional Advisory Council hospitals.

Methods—
Retrospective analysis of prospective data on thrombolytic therapy from 26 Southeast Texas Regional Advisory Council hospitals, collected between April 2014 and June 2016. The control (blinded) period (Q2-2014 to Q2-2015) was followed by unblinding (Q3-2015).

Results—
Intervention was associated with 21.1% increase in r-tPA administration rates, with 38.5% increase in r-tPA administration with door-to-needle time ≤60 minutes. An absolute increase in r-tPA administration of 2.1% was seen with an average lifetime cost savings of $3.6 million.

Conclusions—
Transparent regional data sharing was associated with improved r-tPA administration and healthcare cost savings.
Statin Pretreatment and Microembolic Signals in Large Artery Atherosclerosis
Authors: Safouris Apostolos , Katsanos Aristeidis H. , Kerasnoudis Antonios , Krogias Christos , Kinsella Justin A. , Sztajzel Roman , Lambadiari Vaia , Deftereos Spyridon , Kargiotis Odysseas , Sharma Vijay K. , Demchuk Andrew M. , Saqqur Maher , McCabe Dominick J.H. , Tsivgoulis Georgios 
Published: July 2018

Background and Purpose—
Scarce data indicate that statin pretreatment (SP) in patients with acute cerebral ischemia because of large artery atherosclerosis may be related to lower risk of recurrent stroke because of a decreased incidence of microembolic signals (MES) during transcranial Doppler monitoring.

Methods—
We performed a systematic review and meta-analysis of available observational studies reporting MES presence/absence or MES burden, categorized according to SP status, in patients with acute cerebral ischemia because of symptomatic (≥50%) large artery atherosclerosis. In studies with partially-published data, authors were contacted for previously unpublished information. We also performed a sensitivity analysis of studies with data on MES burden categorized according to SP status, and an additional subgroup analysis in patients receiving higher-dose SP (atorvastatin 80 mg or rosuvastatin 40 mg daily).

Results—

Seven eligible study protocols were identified (610 patients, 54% with SP). SP was associated with a reduced risk of MES detection during transcranial Doppler monitoring (risk ratio=0.67; 95% CI, 0.45–0.98), with substantial heterogeneity between studies (
I
2
=52%). In studies reporting MES burden (n=4), a significantly lower number of MES were identified in patients with compared with those without SP (mean difference=−0.92; 95% CI, −1.64 to –0.19), with no evidence of heterogeneity between studies (
I
2
=49%). Subgroup analysis revealed that higher-dose SP reduced the risk of detecting MES (risk ratio=0.23; 95% CI, 0.06–0.88), with no evidence of heterogeneity between studies (
I
2
=0%).

Conclusions—
SP seems to be associated with a lower incidence and burden of MES in patients with acute cerebral ischemia because of large artery atherosclerosis.
Autobiographical Storytelling and African Narrative Queer Theology
Authors: van Klinken Adriaan 
Published: July 2018

Abstract
This article addresses a methodological question: How to develop African queer theology? That is, a theology that interrogates and counter-balances popular representations of queer sexuality as being “un-African” and “un-Christian”. Answering this question, the article specifically engages with African feminist theological work on storytelling as politically empowering and theologically significant. Where African feminist theologians have used her-stories to develop her-theologies, this article suggests that similarly, queer autobiographical storytelling can be a basis for developing queer theologies. It applies this methodology to the Kenyan queer anthology Stories of Our Lives (2015), which is a collection of autobiographical stories narrated by people identifying as lesbian, gay, bisexual, transgender, intersex (LGBTI) or otherwise queer in Kenya. The article concludes with an intertextual reading of Stories of Our Lives and Mercy Oduyoye’s autobiographical essay about childlessness, pointing towards an African narrative queer theology of fruitfulness.
The protagonist projection hypothesis
Authors: Colonna Dahlman Roberta 
Published: July 2018

Abstract
The protagonist projection hypothesis was formulated by Holton (1997) in order to account for cases where the speaker seems to utter contradictory statements. Holton argues that in these cases the speaker projects herself into the mind of someone else. Three different sentence-types have been classified as examples of protagonist projection: (i) sentences with factive verbs (tell+wh, know), (ii) sentences that realize free indirect discourse, and (iii) sentences that do not realize free indirect discourse, but are still assumed to be instances of speaking from someone else’s perspective. Regarding the sentences in (i), I argue, following Tsohatzidis (1993, 1997, 2012), that neither tell+wh nor know must be considered as factive predicates. As for the sentences of type (ii), I conclude that free indirect discourse is an instance of protagonist projection. Finally, the sentences of type (iii) are accounted for as cases of utterances whose syntax is partially unpronounced.
Vertically Propagating Mountain Waves—A Hazard for High-Flying Aircraft?
Authors: Bramberger Martina , Dörnbrack Andreas , Wilms Henrike , Gemsa Steffen , Raynor Kevin , Sharman Robert 
Published: July 2018

AbstractStall warnings at flight level 410 (12.5 km) occurred unexpectedly during a research flight of the High Altitude and Long Range Research Aircraft (HALO) over Italy on 12 January 2016. The dangerous flight situation was mitigated by pilot intervention. At the incident location, the stratosphere was characterized by large horizontal variations in the along-track wind speed and temperature. On this particular day, strong northwesterly winds in the lower troposphere in concert with an aligned polar front jet favored the excitation and vertical propagation of large-amplitude mountain waves at and above the Apennines in Italy. These mountain waves carried large vertical energy fluxes of 8 W m−2 and propagated without significant dissipation from the troposphere into the stratosphere. While turbulence is a well-acknowledged hazard to aviation, this case study reveals that nonbreaking, vertically propagating mountain waves also pose a potential hazard, especially to high-flying aircraft. It is the wave-induced modulation of the ambient along-track wind speed that may decrease the aircraft speed toward the minimum needed stall speed.
Value of SPECT/CT for Sentinel Lymph Node Localization in the Parotid and External Jugular Chain
Authors: Sethi Rosh K.V. , Abt Nicholas B. , Remenschneider Aaron , Wang Yingbing , Emerick Kevin S. 
Published: July 2018

ObjectivePreoperative single‐photon emission computed tomography/computed tomography (SPECT/CT) imaging may aid in the localization of sentinel lymph nodes (SLNs) in cutaneous head and neck malignancy and has been rigorously evaluated for deep cervical lymph nodes. The purpose of this study was to assess the sensitivity, specificity, and positive predictive value (PPV) of SPECT/CT for preoperative localization of nodal basins superficial to the sternocleidomastoid muscle, with comparison to deep nodal basins of the neck.Study DesignRetrospective review.SettingTertiary care center.Subjects and MethodsSPECT/CT images obtained preoperatively for patients undergoing SLN biopsy for cutaneous head and neck malignancy between June 2015 and June 2016 were reviewed by a blinded nuclear medicine physician and head and neck surgeon. SPECT/CT imaging was compared to intraoperatively determined SLN location via gamma probe. Sensitivity, specificity, and positive and negative predictive values were determined and compared for superficial (external jugular [EJ] and parotid) nodes vs level II nodes.ResultsFifty‐three patients were included in the study. Most had cutaneous melanoma (69.8%). The PPV of EJ/parotid node identification by SPECT/CT imaging was 85.7%, specificity was 88.9%, and sensitivity was 69.2%. Comparatively, the PPV for level II nodes was 76.9%, specificity was 50%, and sensitivity was 85.7%. No significant difference in SPECT/CT predictive value was identified between EJ/parotid and level II node identification (P >. 05).ConclusionSPECT/CT imaging has strong specificity and positive predictability for preoperative localization of SLN superficial to the sternocleidomastoid muscle in cutaneous head and neck malignancy. SPECT/CT imaging may be a useful radiographic aid for preoperative SLN mapping in this patient population.
The putative lithium-mimetic ebselen reduces impulsivity in rodent models
Authors: Barkus Chris , Ferland Jacqueline-Marie N , Adams Wendy K , Churchill Grant C , Cowen Philip J , Bannerman David M , Rogers Robert D , Winstanley Catharine A , Sharp Trevor 
Published: July 2018

Background: Deficits in impulse control feature in many psychiatric conditions including bipolar disorder, suicidality and addictions. Lithium lowers impulsivity in clinical populations and decreases pathological gambling in experimental medicine studies, but suffers from adverse effects, poor compliance and a low therapeutic index. Aims: Recently we identified that the neuroprotective agent ebselen, which is reportedly safe in humans, inhibited inositol monophosphatase (IMPase), a candidate lithium mechanism. Ebselen also reduced 5-HT receptor (5-HT2A) function which predicts impulsivity lowering properties. Here we investigated the effect of ebselen in rat models of impulsive behaviour. Methods: Ebselen was tested in two models of impulsivity with human analogues: the five-choice serial reaction time task (5-CSRTT) and rodent gambling task (rGT). The main outcome measures were premature responses (5-CSRTT and rGT) and choice behaviour (rGT), which model motor impulsivity and choice impulsivity, respectively. Results: At doses that decreased 5-HT2A receptor function (DOI-induced wet dog shakes), ebselen decreased premature responding in the 5-CSRTT both in the absence and presence of cocaine. The 5-HT2A receptor antagonist MDL 100,907 also reduced premature responding in the 5-CSRTT although not in the presence of cocaine. In the rGT ebselen showed a tendency to reduce premature responding but had no effect on choice behaviour. Conclusions: These findings suggest that ebselen preferentially reduces motor impulsivity over choice impulsivity, and that inhibition of 5-HT2A receptor function is a contributing mechanism. Collectively, these data support the repurposing of ebselen as an anti-impulsive treatment and fast-tracking to clinical trials in patient groups characterised by poor impulse control.
Ultrasound-guided vacuum-assisted breast biopsy with a small-caliber device: A multicenter consecutive study of 162 biopsied lesions
Authors: Tourasse Christophe , Khasanova Elina , Sebag Philippe , Beregi Jean Paul 
Published: July 2018

Objective: In this study, we aimed to analyze technical and diagnostic potential, and safety of the small-caliber vacuum-assisted biopsy (SCVAB) device in a multicenter consecutive study taking into consideration the type and location of breast lesion. Methods: We collected data from 5 breast imaging centers where radiologists used the SCVAB device for biopsies in 162 patients. We analyzed the conditions for using the SCVAB device according to the characteristics of the lesions, the volume of excision, and the analyzability obtained by biopsy samples. Results: The biopsies of 80 circumscribed masses, 61 complex lesions, and 24 microcalcification foci were included in the study. The reasons for choosing SCVAB as an initial technique were identified. A total of 47 lesions were removed with SCVAB; among them, 24 lesions were initially chosen for total excision. SCVAB was used as a second-choice biopsy method after core-needle biopsy failure in 20 cases. If SCVAB had not been available, vacuum-assisted biopsy would have been the most frequently used technique (106 under ultrasound, and 18 under stereotactical guidance). Conclusions: The SCVAB system is an alternative to classical vacuum biopsy, enabling representative samples to be obtained from lesions that are difficult to access, complex, small, or in cases of unsuccessful previous biopsy. The SCVAB system was determined as the chosen technique by the radiologists in this study due to feasibility, ergonomics and absence of side effects detected in this study.
Outcomes of Closed Versus Open Technique of Rhinoplasty During Primary Repair of Unilateral Cleft Lip: A Systematic Review
Authors: Jayarajan Rajshree , Natarajan Anantharajan , Nagamuttu Ravindranathan 
Published: July 2018

Objective: Primary cleft rhinoplasty has almost become the norm in cleft practice. Although various closed and open rhinoplasty techniques are in use, there is no consensus as to which technique is superior in terms of outcome. The authors hypothesized that the long-term outcomes of open rhinoplasty during primary cleft lip repair in unilateral cleft is better than that of the closed method. This systematic review has been done to evaluate the hypothesis by a review and analysis of literature. Methods: Protocol was registered on the PROSPERO register of systematic reviews. PRISMA-P guidelines for the conduct of systematic review were followed. Literature search was done in various databases. The inclusion criteria were patients with nonsyndromic unilateral cleft lip undergoing rhinoplasty with primary cleft lip repair and preference given to studies comparing the 2 procedures. Results: Sixteen articles were selected based on inclusion criteria after screening 522 articles—1 randomized controlled trial, 2 retrospective cohorts, and 13 case series. Both closed and open techniques have achieved good symmetry of nostrils with no impairment of growth. No advantage of one technique over the other was noted. Conclusions: There is a paucity of randomized controlled trials and prospective studies on the subject to arrive at an evidence-based recommendation as to whether open or closed rhinoplasty during primary cleft lip repair gives better long-term outcomes. Due to insufficient evidence, the authors are not able to support or refute the hypothesis put forward in the review.
Mid-term outcome after arthroscopic treatment of femoroacetabular impingement: development of a predictive score
Authors: Pierannunzii Luca , Di Benedetto Paolo , Carulli Christian , Fiorentino Gennaro , Munegato Daniele , Panascì Manlio , Potestio Domenico , Randelli Filippo , Della Rocca Federico , Rosolen Valentina , Giangreco Manuela , Santori Nicola 
Published: July 2018

Purpose: To build a post-arthroscopy outcome-predictive score (POPS) associated with the likelihood of lasting benefit after arthroscopic treatment of femoroacetabular impingement (FAI) and based solely on unambiguous preoperative information. Methods: A population of 220 FAI patients, operated on with standard techniques by orthopaedic surgeons trained in hip arthroscopy in 6 different centres, was evaluated physically or by telephone interview 2 to 5 years after surgery. The criteria of successful mid-term outcome (SMO) were agreed upon by all authors. A multivariate logistic regression, adjusted for patient’s age and centre, was applied to predict SMO. In the model, the variables associated with the outcome were included and the relative ORs (odds ratios) were used to compute the FAI-POPS (FAI - post-arthroscopy outcome-predictive score). A ROC (receiver operating characteristic) curve was plotted and the optimum cut-off was calculated. Results: 155 patients out of 220 showed a successful mid-term outcome. The optimum cut-off of FAI-POPS was calculated to be 6.3 and with this threshold it proved a sensitivity of 0.66 and a specificity of 0.69, a positive predictive value of 0.84 and a negative predictive value of 0.46. Conclusions: The standard arthroscopic treatment of FAI resulted in satisfactory persistent symptom relief for about 70% of patients. No or minimal osteoarthritis, short time elapsed from the appearance of symptoms and high preoperative modified Harris Hip Score are independent predictive factors of SMO. The FAI-POPS is obtained as sum of 3 odds ratios corresponding to the above prognostic factors and is a useful predictor of mid-term outcome after conventional arthroscopic FAI treatment.
Effectiveness and feasibility of deprescribing of symptomatic medications in a Singapore rehabilitation hospital
Authors: Ee Charissa Ann Jia Ming , Lee Kheng Hock , Tan Hee Lim , Low Lian Leng 
Published: July 2018

Introduction: This study aims to determine the effectiveness, cost savings and feasibility of implementing a systematic process of deprescribing medications for symptomatic management, namely, acid suppressants, laxatives, analgesics and antiemetics for patients of a Singapore rehabilitation hospital. Methods: A total of 200 patients were randomized to a deprescribing intervention ( n = 100) or control (usual care) group ( n = 100). The patient-centred deprescribing process was utilized. Symptomatic medications were deprescribed following initial pharmacist assessment, discussion with doctors and consideration of patients’ preferences regarding discontinuation or dose reduction. Symptom recurrence, adverse drug withdrawal events (ADWEs) and the need for drug re-initiation or initiation of new symptomatic medications after deprescribing were monitored in the first, second and sixth weeks. Results: The mean age of patients was 72.8 years and 68.6 years in the intervention and control groups. There were no significant reductions in the monthly cost and total number of medications between both intervention and control groups. Systematic deprescribing of acid suppressants was the highest among the four target drug classes. Recurrence of pain and re-initiation of analgesics occurred in two out of seven cases of discontinuation. However, no ADWEs or constipation were noted in the intervention group. On average, a total of 19 minutes was required by pharmacists and doctors to complete the deprescribing process. Conclusion: The systematic deprescribing of symptomatic medications did not reduce costs nor the total number of medications. The risk of symptom recurrence and adverse events was negligible. Knowledge, attitudes and collaboration among healthcare professionals regarding deprescribing are critical. Trial registration: Clinicaltrials.gov, number NCT03354845.
Gastrointestinal microbiota contributes to the development of murine transfusion-related acute lung injury
Authors: Kapur Rick , Kim Michael , Rebetz Johan , Hallström Björn , Björkman Jonas T. , Takabe-French Alisa , Kim Noel , Liu Jonathan , Shanmugabhavananthan Shanjeevan , Milosevic Stefan , McVey Mark J. , Speck Edwin R. , Semple John W. 
Published: July 2018

Key Points
Gastrointestinal flora contributes to development of antibody-mediated murine TRALI. Depletion of gastrointestinal flora prevents TRALI by inhibiting MIP-2 secretion and pulmonary neutrophil accumulation.