bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Mortality in Severe Malaria: A Two-Year Experience in a Non-Endemic Area
Authors: Blumberg L. , Lee R. P. , Lipman J. , Beards S. 
Published: January 2019

Management of severe malaria is an increasing problem worldwide. This paper reviews the pathophysiology and management documenting two years’ experience of admissions of severe malaria to an ICU in a non-endemic area. Clinical and laboratory features of severe malaria were analysed for predictors of mortality. Twenty-eight patients had clinical or laboratory features compatible with the WHO criteria for severe malaria and, despite treatment with intravenous quinine and supportive ICU care, mortality was 28.5% (8/28). The three pregnant patients died with 100% foetal mortality and the four paediatric patients survived. Of the non-survivors, 8/8 developed ARDS (defined by worst ALI score >2.5), 7/8 developed shock requiring inotropic support and 7/8 developed acute renal failure requiring CVVHD. Admission haemoglobin, platelet count, parasite count, and lowest Glasgow Coma Score in the first 24 hours were shown not to be predictors of mortality.
Single Quadrant Sub-Tenon's Block. Evaluation of a New Local Anaesthetic Technique for Eye Surgery
Authors: Guise P. A. 
Published: January 2019

The sub-Tenon's technique uses blunt dissection and a blunt probe to inject local anaesthetic into the posterior sub-Tenon's space. This avoids the potentially catastrophic complications which result from passing a sharp needle blindly into the orbit and retrobulbar space. The anatomy of Tenon's capsule and the block technique is described. Results of the block quality and degree of patient comfort from 300 consecutive sub-Tenon's blocks are also described. No significant complications occurred in this series. Single-quadrant sub-Tenon's block offers an excellent quality of anaesthesia, is virtually painless to perform and avoids complications due to passage of a sharp needle into the orbit.
The Development Process of Bipolar Bone Defects From Primary to Recurrent Instability in Shoulders With Traumatic Anterior Instability
Authors: Nakagawa Shigeto , Iuchi Ryo , Hanai Hiroto , Hirose Takehito , Mae Tatsuo 
Published: January 2019

Background: Recurrence of glenohumeral joint instability after primary traumatic anterior instability is not rare, and bipolar bone loss is one of the most critical factors for recurrent instability, but the development process of bipolar bone defects is still unclear. Purpose: To investigate the development process of bipolar bone defects from primary to recurrent instability among shoulders with traumatic anterior instability evaluated at least twice by computed tomography (CT). Study Design: Case series; Level of evidence, 4. Methods: There were 44 patients (47 shoulders) with recurrence after primary instability in which bone morphology was evaluated by 3-dimensional reconstructed CT at primary instability (initial CT) and after recurrence. As CT was performed 3 times for 3 shoulders including primary injury and the second episode of instability (first recurrence), there were 50 CT evaluations. Morphological changes between the initial CT evaluation at primary instability and the second CT evaluation at first recurrence were investigated for 25 shoulders, with the mean interval since initial CT being 9.8 months (range, 2-23 months). Changes between initial CT evaluation and final CT evaluation after ≥2 recurrences were also investigated for 25 shoulders, while the mean number of instability episodes including primary instability was 8.0 (range, 3-40) and the mean interval since initial CT was 18.5 months (range, 5-56 months). Results: At primary instability, the prevalence of Hill-Sachs lesions (66.0%) was almost double that of glenoid defects (34.0%), but their prevalence was different between shoulders with primary subluxation (42.3% and 23.8%, respectively) and those with primary dislocation (84.7% and 42.3%, respectively). After recurrence, glenoid defects became significantly more frequent (at first recurrence, 72%; after ≥2 recurrences, 76%), while Hill-Sachs lesions showed a smaller increase (88% and 80%, respectively), so there was no difference between the prevalence of the 2 lesions. The sizes of glenoid defects and Hill-Sachs lesions also enlarged after recurrence, and large bone defects were frequently recognized after recurrence. While bipolar bone loss was not so frequent at primary instability (29.8%), bipolar bone loss increased significantly after recurrence (at first recurrence, 72%; after ≥2 recurrences, 72%). All Hill-Sachs lesions were on track at primary instability, but off-track lesions were recognized in 3 of 47 shoulders (6.4%) after recurrence. Conclusion: In most shoulders with recurrent instability, a Hill-Sachs lesion developed first, followed by a glenoid defect, leading to bipolar bone loss. Off-track Hill-Sachs lesions were detected only after recurrence.
Inquest on a Failure: The Dual Entry Kindergarten Experiment in British Columbia
Authors: Glegg Alastair R. L. 
Published: January 2019

And now they tried the deed to hide; For a little bird whisper'd, ‘Perchance you may swing; Here's a corpse in the case with a sad swell'd face, And a Medical Crowner's a queer sort of thing! (Barham, 1911, p. 146)
Input and literacy effects in simultaneous and sequential bilinguals: The performance of Albanian–Greek-speaking children in sentence repetition
Authors: Kaltsa Maria , Prentza Alexandra , Tsimpli Ianthi Maria 
Published: January 2019

Aim: The present study examines input and literacy effects in simultaneous and sequential bilinguals with the aim of (a) investigating the differences between bilingual and monolingual populations and (b) disentangling the individual contribution of different factors in bilingual syntactic abilities. Methodology: A sentence repetition task (SRT) in Greek with eight structures (Subject Verb Object [SVO], negative clauses, clitic structures, complement clauses, coordinated sentences, adverbial clauses, wh-questions and relative clauses) was employed. All bilinguals additionally participated in a standardized expressive vocabulary task in Greek to measure their lexical ability. Data: Sixty 8–10-year-old children (20 monolingual, 20 simultaneous and 20 late sequential bilinguals) were tested. Findings: The analysis showed that (a) monolinguals outperform sequential bilinguals in sentence repetition, (b) clitic structures are highly problematic for all participants, (c) vocabulary and syntactic skills are closely related for simultaneous but not for sequential bilinguals, (d) home language practices in the early years affect SRT performance and (e) sequential bilinguals benefit from literacy practices that support syntactic skills in the language tested. Overall, we found that the effect of input overrides the effect of a traditionally categorical factor in bilingualism: age of onset (AoO) of exposure to L2. Originality: The contribution of this study includes (a) the examination of syntactic abilities in bilinguals in connection with language input early in life and at the time of testing, (b) the non-pervasive role of age of exposure to the L2 in SRT performance and (c) the role of literacy measures as key factors affecting syntactic skills in bilinguals. Implications: Quality of input and literacy in particular have been shown to affect bilingual syntactic skills, suggesting that enhancing literacy exposure as a language policy for bilinguals has a significantly positive impact on language development.
Computerized tomographic prediction of flexor tendon injuries complicating hamate hook fractures
Authors: Takeda Shinsuke , Tatebe Masahiro , Ishii Hisao , Morita Akimasa , Wakai Kenji , Hirata Hitoshi 
Published: January 2019

We reviewed computerized axial tomography of 28 patients with hamate hook fractures who had surgical resection of the hook. We analysed the relationship between the fragment height ratio, fragment gap, and intraoperative findings of the tendons. We determined whether parameters in the images can predict complication of tear or disruption of the flexor tendons to the ring or little fingers. Of 28 patients, 16 had fragment height ratios between 50–74; ten among them had worn (eight patients) or ruptured (two patients) flexor tendons. Nine of the ten patients had fragment gaps greater than 2 mm. The remaining 12 patients had fragment height ratios between 75–100 and had intact tendons. We conclude that a fragment height ratio greater than 75 and fragment gap less than 2 mm in computer tomography may rule out tear or disruption of the flexor tendons of the ring and little fingers after hamate hook fractures, and a fragment height ratio between 50–74 with fragment gap greater than 2 mm indicates a high risk of flexor tendon tear or disruption. Level of evidence: IV
Health informal payments and their main determinants: The case of Iran
Authors: Meskarpour Amiri Mohammad , Teymourzadeh Ehsan , Ravangard Ramin , Bahadori Mohammadkarim 
Published: January 2019

Introduction: Informal payments are a serious obstacle to equitable access and universal health coverage in developing countries. This study aimed to identify the most important factors affecting health informal payments in Iran. Methodology: The cross-sectional and descriptive-analytical study was carried out on a study population of all Iranians who, at least once over the past year (i.e. 2017), had received healthcare services and were exposed to paying health informal payments. A sample of 1477 households was selected using a multi-stage stratified-cluster sampling method. The required data were collected using a researcher-made questionnaire and completed by face-to-face interviews with the heads of households. The main factors affecting the odds of making informal payments were identified using the Ordered Logistic Regression model. Results: Having basic health insurance coverage, awareness of health insurance entitlements, education, perceived behavioral control, and the pattern of health service utilization had, respectively, the highest effects on the odds of making informal payments for healthcare. The odds of making informal payments for patients with no awareness of the health insurance entitlements were 3.5, 3.6, and 6.7 times more than those with low, medium, and high awareness, respectively (Odds Ratio = 3.58, 3.69, 6.74; P < 0.001). Conclusion: The health policymakers, in addition to improving service financing, should plan to increase patients’ awareness, correct their false beliefs, change their attitudes, and improve social participation regarding health informal payments in order to reduce such transactions.
Exercise stress test in apparently healthy individuals − where to place the finish line? The Ferrari corporate wellness programme experience
Authors: Sirico Felice , Fernando Fredrick , Di Paolo Fernando , Adami Paolo Emilio , Signorello Maria Grazia , Sannino Giuseppe , Bianco Antonio , Cerrone Annunziata , Baioccato Veronica , Filippi Nicola , Ferrari Umberto , Tuzi Manuel , Nurzynska Daria , Di Meglio Franca , Castaldo Clotilde , D’Ascenzi Flavio , Montagnani Stefania , Biffi Alessandro 
Published: January 2019

Aims The aim of our study was to assess the clinical significance of the exercise stress testing endpoints, namely 85% of maximal theoretical heart rate (MTHR), metabolic equivalent of task, and rating of perceived exertion (RPE), and their relation to electrocardiographic (ECG) changes in a healthy adult population. Methods A cross-sectional study was conducted on 408 males and 52 females (mean age 39.4 ± 8.6 years) who performed the maximal cycle ergometer exercise stress test until volitional exhaustion, reporting the RPE score at 85% of MTHR and at peak exercise. Metabolic equivalents of task were indirectly calculated from the maximum workload and compared with the predicted values. Sitting torso-lead ECG and blood pressure were recorded at rest, during exercise and during recovery. Results Of 460 participants, 73% exceeded 85% of MTHR. The RPE score represented the overall most significant endpoint of exercise stress testing, with the median value of 17 at peak exercise. ECG events were detected in 23/124 (18.5%) who reached ≤ 85% of MTHR and in 61/336 (18.2%) who achieved >85% of MTHR ( p = 0.92). In the latter group, 54% of ECG changes occurred at < 85% of MTHR and 46% at > 85% of MTHR ( p = 0.51). If the exercise stress testing had been interrupted at ≤ 85% of MTHR, almost half of the ECG events would have remained undetected and 35% of the cardiovascular abnormalities observed at the diagnostic follow-up would have remained undiagnosed. Conclusion Terminating exercise stress testing before volitional exhaustion and an RPE score of 17 limits the test accuracy and reduces the possibility to detect cardiovascular abnormalities in apparently healthy adult populations.
Use of Multislice CT for Investigation of Occult Geriatric Hip Fractures and Impact on Timing of Surgery
Authors: Williams John , Allen Felix , Kedrzycki Marta , Shenava Yathish , Gupta Renu 
Published: January 2019

Introduction: The National Institute of Health and Clinical Excellence guidelines in the United Kingdom recommend magnetic resonance imaging (MRI) as the first-line investigation for radiographically occult hip fractures, if available within 24 hours. In our department, however, multislice computerized tomography (MSCT) is instead used as a first-line investigation due to significant delays associated with obtaining MRI. Our aim was to determine the validity and practicality of MSCT for diagnosis of occult hip fractures and its impact on timing of surgery. Materials and Methods: We retrospectively analyzed medical records and imaging for consecutive patients who underwent MSCT to investigate occult hip fractures between January 2014 and October 2016. We reviewed subsequent imaging and reattendances for patients with negative MSCT to exclude initially missed fractures. Results: Two hundred six patients underwent MSCT to investigate occult hip fracture during the study period. Hip fractures were identified in 59 patients, comprising 35 (59.3%) subcapital, 12 (20.0%) intertrochanteric, 8 (13.6%) transcervical, and 4 (6.8%) basicervical fractures. One missed hip fracture was identified: a patient with a negative MSCT was further investigated with MRI that demonstrated acute subcapital hip fracture. Multislice computerized tomography was obtained within 24 hours of initial radiograph in 145 (70.4%) patients. A total of 44.5% of occult hip fractures had surgery within the nationally recommended 36 hours of admission (hospital average for all hip fractures was 76.4% over the same period). Discussion and Conclusions: Multislice computerized tomography is a pragmatic approach to investigate the majority of occult hip fractures in a timely manner and minimize associated delay to surgery. However it cannot completely exclude the diagnosis, especially in abnormal anatomy. The lack of a true gold standard comparison (ie, MRI) means a true sensitivity and specificity cannot be calculated, although can be cautiously estimated by lack of subsequent reattendance or investigation. Further prospective randomized CT versus MRI trials are required.
A long-term prospective observational study in 31 patients with hemicrania continua
Authors: Prakash Sanjay , Rathore Chaturbhuj , Rana Kaushik , Joshi Hemant , Patel Jay , Rawat Kalu Singh 
Published: January 2019

Introduction: Till date, there is no prospective study in patients with hemicrania continua (HC). Methods: Patients fulfilling the international classification of headache disorders criteria for HC were evaluated prospectively. All patients were subjected to a detailed clinical interview, based on a structured questionnaire. Before starting indomethacin, all patients were instructed to fill a headache diary for at least 5 days. Gradual tapering of indomethacin was done at regular intervals. Results: We enrolled 41 patients over 4.5 years, 31 of whom met the criteria after confirming the indomethacin response. The mean age was 41 years, and 55% were female. The mean duration of headache was 43.6 months. All patients had continuous strictly unilateral pain with episodic exacerbations. At least one cranial autonomic feature was noted in 81% of patients. Twenty-five patients (81%) felt a sense of restlessness during exacerbations. The mean follow-up was 2.5 years. Three-fourths of patients noted a reduction in indomethacin dose after an average 2.5 of years follow-up. The mean reduction of the dose in the follow-up was statistically significant (172 mg vs. 110 mg, p < 0.001). All patients missed the drug for various reasons over the observation period. The headache reappeared within 48 h in 97% of patients. Conclusion: Misdiagnosis of HC is still very common. Patients may not volunteer about the background pain and will focus only on the exacerbations. HC rarely remits, but indomethacin requirements may decrease over time. Skipping of the effective drug leads to the immediate reappearance of pain.
Acid solution decreases the compressional wave velocity of sandstone from the Yungang Grottoes, Datong, China
Authors: Geng Hong , Zhang Shijie , Zhi Jianhui , Zhang Runping , Ren Jianguang , Ro Chul-Un 
Published: January 2019

Abstract
To understand the effects of an acidic environment on the internal structure of sandstone from the Yungang Grottoes, Datong, China, the physicochemical properties of fresh and weathered sandstone samples and their compressional wave (P-wave) velocities in response to different concentrations of H2SO4 and HNO3 solution were investigated. X-ray diffraction (XRD) and a scanning electron microscope equipped with energy dispersive X-ray spectrometer (SEM–EDX) were used to determine grain morphology and chemical composition. The results show that the sandstone, which mainly consists of silicon dioxide and calcium carbonate, became more complicated in composition after weathering. A nonmetallic ultrasonic detector was used to measure the P-wave velocities of sandstones in a natural state and soaked with ultrapure water and with H2SO4 and HNO3 at concentrations of 0.2 mol L−1, 0.4 mol L−1, and 0.8 mol L−1, respectively. For the acid-treated groups, with increasing acidity, P-wave velocity decreased significantly, compressive strength decreased and effective porosity increased; these behaviours are different from those of the water-treat group, implying that the acid solutions damaged the microstructure of the sandstone. The results suggest that the deterioration risk of H2SO4 and HNO3, or sulfates and nitrates converted from ambient SO2, NO
x
and PM2.5, on the stone relics in the Yungang Grottoes should be a cause for concern.
Tamoxifen Pharmacogenetics and Metabolism: Results From the Prospective CYPTAM Study
Authors: Sanchez-Spitman Anabel , Dezentjé Vincent , Swen Jesse , Moes Dirk Jan A.R. , Böhringer Stefan , Batman Erdogan , van Druten Edith , Smorenburg Carolien , van Bochove Aart , Zeillemaker Anneke , Jongen Lynn , Los Maartje , Neven Patrick , Gelderblom Hans , Guchelaar Henk-Jan 
Published: January 2019

PURPOSE Tamoxifen is widely prescribed as adjuvant therapy in patients with early-stage breast cancer. It has been postulated that concentrations of endoxifen, the active metabolite of tamoxifen, are a better predictor of tamoxifen efficacy than CYP2D6 genotypes. Although in a retrospective study, an endoxifen threshold of 5.9 ng/mL for efficacy was described, confirmation based on prospective studies is lacking. The objective of the prospective CYPTAM (The Netherlands National Trial Register: NTR1509) study was to associate endoxifen concentrations and CYP2D6 genotypes with clinical outcome in patients with early-stage breast cancer receiving tamoxifen. PATIENTS AND METHODS From February 2008 to December 2010, patients with breast cancer treated with adjuvant tamoxifen were included. Patients could be enrolled up to a maximum of 12 months after tamoxifen initiation. Blood samples were retrieved for CYP2D6 genotyping and endoxifen measurements by Amplichip (Roche Diagnostics, Indianapolis, IN) and high-performance liquid chromatography–tandem mass spectrometry, respectively. Endoxifen concentrations were analyzed as a continuous variable, classifying patients into quartiles and using an endoxifen threshold of 5.9 ng/mL. Endoxifen concentrations and CYP2D6 genotypes were associated with relapse-free survival (censored at the time of tamoxifen discontinuation; RFSt) by Cox regression analysis. RESULTS A total of 667 pre- and postmenopausal patients were enrolled and had received tamoxifen for a median time of 0.37 years (range, 0.23 to 0.6 years) before study entry. No association was found between endoxifen concentrations and RFSt (adjusted hazard ratio, 0.991; 95% CI, 0.946 to 1.038; P = .691). Also, neither categorizing endoxifen concentrations into quartiles nor using 5.9 ng/mL as threshold altered these results. In addition, no association was found between CYP2D6 genotype and RFSt (adjusted hazard ratio, 0.929; 95% CI, 0.525 to 1.642; P = .799). CONCLUSION This prospective clinical study shows no association between endoxifen concentrations or CYP2D6 genotypes and clinical outcome in patients with early-stage breast cancer receiving adjuvant tamoxifen.
Clinical prognostic models for severe dengue: a systematic review protocol
Authors: Dao Phuoc Thang , Khuong Quynh Long , Vien Dang Khanh Linh , Ong Phuc Thinh , Le Sy Hieu , Le Ngoc Tu , Phung Khanh Lam 
Published: January 2019

Background: Dengue is a common mosquito-borne, with high morbidity rates recorded in the annually. Dengue contributes a major disease burden in many tropical countries. This demonstrates the urgent need in developing effective approaches to identify severe cases early. For this purpose, many multivariable prognostic models using multiple prognostic variables were developed to predict the risk of progression to severe outcomes. The aim of the planned systematic review is to identify and describe the existing clinical multivariable prognostic models for severe dengue as well as examine the possibility of combining them. These findings will suggest directions for further research of this field. Methods: This protocol has followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta – Analyses Protocol (PRISMA-P). We will conduct a comprehensive search of Pubmed, Embase and Web of Science. Eligiblity criteria include being published in peer-review journals, focusing on human subjects and developing the multivariable prognostic model for severe dengue, without any restriction on language, location and period of publication, and study design. The reference list will be captured and removed from duplications. We will use the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist to extract data and Prediction study risk of bias assessment tool (PROBAST) to assess the study quality. Discussion: This systematic review will describe the existing prediction models, summarize the current status of prognostic research on dengue, and report the possibility to combine the models to optimize the power of each paradigm. PROSPERO registration: CRD42018102907