bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: systematic review and meta-analysis
Authors: Hao Qiukui , Tampi Malavika , O’Donnell Martin , Foroutan Farid , Siemieniuk Reed AC , Guyatt Gordon 
Published: December 2018

AbstractObjectiveTo assess the effectiveness and safety of dual agent antiplatelet therapy combining clopidogrel and aspirin to prevent recurrent thrombotic and bleeding events compared with aspirin alone in patients with acute minor ischaemic stroke or transient ischaemic attack (TIA).DesignSystematic review and meta-analysis of randomised, placebo controlled trials.Data sourcesMedline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, ClinicalTrials.gov, WHO website, PsycINFO, and grey literature up to 4 July 2018.Eligibility criteria for selecting studies and methodsTwo reviewers independently screened potentially eligible studies according to predefined selection criteria and assessed the risk of bias using a modified version of the Cochrane risk of bias tool. A third team member reviewed all final decisions, and the team resolved disagreements through discussion. When reports omitted data that were considered important, clarification and additional information was sought from the authors. The analysis was conducted in RevMan 5.3 and MAGICapp based on GRADE methodology.ResultsThree eligible trials involving 10 447 participants were identified. Compared with aspirin alone, dual antiplatelet therapy with clopidogrel and aspirin that was started within 24 hours of symptom onset reduced the risk of non-fatal recurrent stroke (relative risk 0.70, 95% confidence interval 0.61 to 0.80, I2=0%, absolute risk reduction 1.9%, high quality evidence), without apparent impact on all cause mortality (1.27, 0.73 to 2.23, I2=0%, moderate quality evidence) but with a likely increase in moderate or severe extracranial bleeding (1.71, 0.92 to 3.20, I2=32%, absolute risk increase 0.2%, moderate quality evidence). Most stroke events, and the separation in incidence curves between dual and single therapy arms, occurred within 10 days of randomisation; any benefit after 21 days is extremely unlikely.ConclusionsDual antiplatelet therapy with clopidogrel and aspirin given within 24 hours after high risk TIA or minor ischaemic stroke reduces subsequent stroke by about 20 in 1000 population, with a possible increase in moderate to severe bleeding of 2 per 1000 population. Discontinuation of dual antiplatelet therapy within 21 days, and possibly as early as 10 days, of initiation is likely to maximise benefit and minimise harms.
The importance of interfacial instability for viscous folding in mechanically heterogeneous layers
Authors: Moulas Evangelos , Schmalholz Stefan M. 
Published: December 2018

Abstract
Viscous folding in mechanically heterogeneous layers is modelled numerically in two dimensions for linear and power-law viscous fluids. Viscosity heterogeneities are expressed as circular-shaped variations of the effective viscosity inside and outside the layers. The layers are initially perfectly flat and are shortened in the layer-parallel direction. The viscosity heterogeneities cause a perturbation of the velocity field from the applied bulk pure shear, which perturb geometrically the initially flat-layer interfaces from the first numerical time step. This geometrical perturbation triggers interfacial instabilities, resulting in high-amplitude folding. We compare simulations with heterogeneities with corresponding simulations in which the heterogeneities are removed after the first time step, and, hence, only the initial small geometrical perturbations control wavelength selection and high-amplitude folding. Results for folding in heterogeneous and homogeneous layers are similar, showing that viscosity heterogeneities have a minor to moderate impact on fold wavelength selection and high-amplitude folding. Our results indicate that the interfacial instability is the controlling process for the generation of buckle folds in heterogeneous rock layers. Therefore, existing analytical and numerical solutions for folding in homogeneous layers, in which folding was triggered by geometrical perturbations, are useful and applicable to study folding in natural, heterogeneous rock layers.
esiCancer: Evolutionary In Silico Cancer Simulator
Authors: Minussi Darlan Conterno , Henz Bernardo , dos Santos Oliveira Mariana , Filippi-Chiela Eduardo C. , Oliveira Manuel M. , Lenz Guido 
Published: December 2018

Abstract

The evolution of cancer is inferred mainly from samples taken at discrete points that represent glimpses of the complete process. In this study, we present esiCancer as a cancer-evolution simulator. It uses a branching process, randomly applying events to a diploid oncogenome, altering probabilities of proliferation and death of the affected cells. Multiple events that occur over hundreds of generations may lead to a gradual change in cell fitness and the establishment of a fast-growing population. esiCancer provides a platform to study the impact of several factors on tumor evolution, including dominance, fitness, event rate, and interactions among genes as well as factors affecting the tumor microenvironment. The output of esiCancer can be used to reconstruct clonal composition and Kaplan-Meier–like survival curves of multiple evolutionary stories. esiCancer is an open-source, standalone software to model evolutionary aspects of cancer biology.

Significance:
This study provides a customizable and hands-on simulation tool to model the effect of diverse types of genomic alterations on the fate of tumor cells.
Current Status of Patient Radiation Exposure of Cardiac Positron Emission Tomography and Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging
Authors: Desiderio Michael C. , Lundbye Justin B. , Baker William L. , Farrell Mary Beth , Jerome Scott D. , Heller Gary V. 
Published: December 2018

Background:
Radiation exposure during nuclear cardiology procedures has received much attention and has prompted citations for radiation reduction. In 2010, the American Society of Nuclear Cardiology recommended reducing the average patient study radiation exposure to <9 mSv in 50% of studies by 2014. Cardiac positron emission tomography (PET) for myocardial perfusion imaging (MPI) has emerged within recent years, but current radiation exposure in cardiac nuclear PET laboratories is unknown. This study evaluated current reported patient radiation exposure from nuclear laboratories in the United States applying for Intersocietal Accreditation Commission accreditation for MPI using single photon emission computed tomography (SPECT) or PET.

Methods and Results:

This was an analysis of nuclear cardiology studies submitted to the Intersocietal Accreditation Commission for either or both cardiac PET and SPECT accreditation. Cardiac SPECT data represented year 2015 while PET data combined years 2013 to 2015. Data was analyzed with χ
2
and Mann-Whitney
U
tests (reported as median, 25th percentile, and 75th percentile). Reported PET MPI radiation exposure for 111 laboratories (532 patient cases) was 3.7 (3.2–4.1) mSv per study with no geographic variation. Reported SPECT MPI radiation exposure for 665 laboratories (3067 patient studies) was 12.8 (12.2–14.3) mSv. Highest radiation exposure was found in the South region. Technetium-only studies resulted in a median of 12.2 mSv per study.

Conclusions:
Radiation exposure from cardiac PET MPI in US laboratories applying for Intersocietal Accreditation Commission accreditation is low (111 laboratories, 3.7 mSv) and substantially lower than cardiac SPECT (665 laboratories, 12.8 mSv).
High Variability in Neuronal Loss
Authors: Desai Shashvat M. , Rocha Marcelo , Jovin Tudor G. , Jadhav Ashutosh P. 
Published: December 2018

Background and Purpose—
In the setting of acute ischemic stroke because of large-vessel occlusion (LVO) there is progressive loss of brain tissue which occurs in a time-dependent fashion previously quantified to be ≈1.9 million neurons per minute. However, this number represents an average and accumulating evidence suggests large individual variation. In this study, we aim to quantify the distribution and range in the rate of loss brain tissue across the entire spectrum of clinical phenotypes of anterior circulation LVO strokes encountered in clinical practice.

Methods—
Retrospective review of a prospectively acquired database of consecutive patients with anterior circulation stroke because of proximal LVO and appropriate ischemic core imaging was performed. Ischemic core volume was measured using automated software processing and time from last known well to imaging was recorded. Applying previously published methodology for brain loss quantification, we computed rate of brain tissue elements loss in proximal LVO stroke patients.

Results—
We studied 415 patients with internal carotid artery or middle cerebral artery (M1 segment) occlusion. Mean ischemic core volume was 50.4 mL and mean time to imaging from time from last known well (TLKW) was 8.7 hours, which is similar to previously published data, translates into a mean loss per minute of 2.03 million neurons, 14.8 billion synapses, and 12.8 km of myelinated fibers. However, the distribution of neuron loss was highly variable, ranging from <35 000 to >27 million cells per minute.

Conclusions—
Widely spread rates of infarct growth are observed in acute ischemic stroke because of proximal LVO with rate of neuron loss per minute ranging from <35 000 per minute in slow progressors to >27 million per minute in fast progressors, with a mean and median of 2 million and 0.9 million, respectively.
A Radar-Based Climatology of Mesoscale Convective Systems in the United States
Authors: Haberlie Alex M. , Ashley Walker S. 
Published: December 2018

Abstract
This research applies an automated mesoscale convective system (MCS) segmentation, classification, and tracking approach to composite radar reflectivity mosaic images that cover the contiguous United States (CONUS) and span a relatively long study period of 22 years (1996–2017). These data afford a novel assessment of the seasonal and interannual variability of MCSs. Additionally, hourly precipitation data from 16 of those years (2002–17) are used to systematically examine rainfall associated with radar-derived MCS events. The attributes and occurrence of MCSs that pass over portions of the CONUS east of the Continental Divide (ECONUS), as well as five author-defined subregions—North Plains, High Plains, Corn Belt, Northeast, and Mid-South—are also examined. The results illustrate two preferred regions for MCS activity in the ECONUS: 1) the Mid-South and Gulf Coast and 2) the Central Plains and Midwest. MCS occurrence and MCS rainfall display a marked seasonal cycle, with most of the regions experiencing these events primarily during the warm season (May–August). Additionally, MCS rainfall was responsible for over 50% of annual and seasonal rainfall for many locations in the ECONUS. Of particular importance, the majority of warm-season rainfall for regions with high agricultural land use (Corn Belt) and important aquifer recharge properties (High Plains) is attributable to MCSs. These results reaffirm that MCSs are a significant aspect of the ECONUS hydroclimate.
2017 National Standards for Diabetes Self-Management Education and Support
Authors: Beck Joni , Greenwood Deborah A. , Blanton Lori , Bollinger Sandra T. , Butcher Marcene K. , Condon Jo Ellen , Cypress Marjorie , Faulkner Priscilla , Fischl Amy Hess , Francis Theresa , Kolb Leslie E. , Lavin-Tompkins Jodi M. , MacLeod Janice , Maryniuk Melinda , Mensing Carolé , Orzeck Eric A. , Pope David D. , Pulizzi Jodi L. , Reed Ardis A. , Rhinehart Andrew S. , Siminerio Linda , Wang Jing 
Published: December 2018

Purpose The purpose of this study is to review the literature for Diabetes Self-Management Education and Support (DSMES) to ensure the National Standards for DSMES (Standards) align with current evidence-based practices and utilization trends. Methods The 10 Standards were divided among 20 interdisciplinary workgroup members. Members searched the current research for diabetes education and support, behavioral health, clinical, health care environment, technical, reimbursement, and business practice for the strongest evidence that guided the Standards revision. Results Diabetes Self-Management Education and Support facilitates the knowledge, skills, and ability necessary for diabetes self-care as well as activities that assist a person in implementing and sustaining the behaviors needed to manage their condition on an ongoing basis. The evidence indicates that health care providers and people affected by diabetes are embracing technology, and this is having a positive impact of DSMES access, utilization, and outcomes. Conclusion Quality DSMES continues to be a critical element of care for all people with diabetes. The DSMES services must be individualized and guided by the concerns, preferences, and needs of the person affected by diabetes. Even with the abundance of evidence supporting the benefits of DSMES, it continues to be underutilized, but as with other health care services, technology is changing the way DSMES is delivered and utilized with positive outcomes.
Discrete Perineural Invasion Focus Number in Quantification for T1‐T2 Oral Squamous Cell Carcinoma
Authors: Wei Pei‐Yin , Li Wing‐Yin , Tai Shyh‐Kuan 
Published: December 2018

ObjectivePerineural invasion (PNI) has been an established poor prognostic feature for T1‐T2 oral squamous cell carcinoma (OSCC). Different presentations and amounts of PNI are commonly observed, but PNI is currently recorded as being present or absent. This study asked whether the quantification of PNI provides additional information for early OSCC.Study DesignRetrospective cohort study.SettingTertiary referral medical center.Subjects and MethodsPathologic reevaluations were performed for 314 patients with T1‐T2 OSCC who underwent curative surgery from June 2001 to August 2009. A novel parameter, PNI focus number, was defined for PNI quantification. With 5 PNI foci as the cutoff, patients were categorized into 3 groups: no PNI (0 PNI foci), low PNI (PNI foci, 1‐5), and high PNI (PNI foci >5). Rate of cervical lymph node metastasis (LN+), 5‐year disease‐specific survival (DSS), and 5‐year overall survival (OS) were analyzed among these groups.ResultsPNI focus number independently predicted for LN+, poor DSS, and poor OS in multivariate analysis after controlling for T classification, lymphovascular invasion, differentiation, margin, and tumor thickness. The 5‐year DSS demonstrated a dose‐dependent decrease among the 3 groups (no PNI, 88.6%; low PNI, 75.2%; high PNI, 33.8%; P <. 001). Moreover, the 5‐year DSS of the high PNI group was significantly worse than that of the low PNI group.ConclusionPNI focus number can be a novel parameter for PNI quantification in early OSCC. Although optimal quantification methods still require further investigation, this study offers clear clinical support for the nerve‐tumor interaction hypothesis and advocates further mechanistic research for the exploration of PNI‐related treatment concepts for OSCC.
Measuring the quality of dying and death in advanced cancer: Item characteristics and factor structure of the Quality of Dying and Death Questionnaire
Authors: Mah Kenneth , Hales Sarah , Weerakkody Isuri , Liu Lucy , Fernandes Samantha , Rydall Anne , Vehling Sigrun , Zimmermann Camilla , Rodin Gary 
Published: December 2018

Background: Ensuring a good death in individuals with advanced disease is a fundamental goal of palliative care. However, the lack of a validated patient-centered measure of quality of dying and death in advanced cancer has limited quality assessments of palliative-care interventions and outcomes. Aim: To examine item characteristics and the factor structure of the Quality of Dying and Death Questionnaire in advanced cancer. Design: Cross-sectional study with pooled samples. Setting/participants: Caregivers of deceased advanced-cancer patients ( N = 602; mean ages = 56.39–62.23 years), pooled from three studies involving urban hospitals, a hospice, and a community care access center in Ontario, Canada, completed the Quality of Dying and Death Questionnaire 8–10 months after patient death. Results: Psychosocial and practical item ratings demonstrated negative skewness, suggesting positive perceptions; ratings of symptoms and function were poorer. Of four models evaluated using confirmatory factor analyses, a 20-item, four-factor model, derived through exploratory factor analysis and comprising Symptoms and Functioning, Preparation for Death, Spiritual Activities, and Acceptance of Dying, demonstrated good fit and internally consistent factors (Cronbach’s α = 0.70–0.83). Multiple regression analyses indicated that quality of dying was most strongly associated with Symptoms and Functioning and that quality of death was most strongly associated with Preparation for Death ( p < 0.001). Conclusion: A new four-factor model best characterized quality of dying and death in advanced cancer as measured by the Quality of Dying and Death Questionnaire. Future research should examine the value of adding a connectedness factor and evaluate the sensitivity of the scale to detect intervention effects across factors.
Role of contrast-enhanced spectral mammography in the post biopsy management of B3 lesions: Preliminary results
Authors: Bicchierai Giulia , Nori Jacopo , De Benedetto Diego , Boeri Cecilia , Vanzi Ermanno , Bianchi Simonetta , Kaur Gill Maninderpal , Cirone Donatello , Miele Vittorio 
Published: December 2018

Purpose To evaluate the role of contrast-enhanced spectral mammography (CESM) in the post biopsy management of breast lesions classified as lesions of uncertain malignant potential (B3) by core needle biopsy and vacuum-assisted biopsy (VAB). Methods The local ethics committee approved this retrospective study and for this type of study formal consent is not required. A total of 42 B3 lesions in 40 women aged 41–77 years were included in our study. All patients underwent CESM 2–3 weeks after the biopsy procedure and surgical excision was subsequently performed within 60 days of the CESM procedure. Three radiologists reviewed the images independently. The results were then compared with histologic findings. Results The sensitivity, specificity, and positive and negative predictive values for confirmed demonstration of malignancy at CESM were 33.3%, 87.2%, 16.7%, and 94.4% for reader 1; 66.7%, 76.9%, 18.2%, and 96.7% for reader 2; 66.7%, 74.4%, 16.7%, and 96.7% for reader 3. Overall agreement on detection of malignant lesions using CESM among readers ranged from moderate to substantial (κ = .451–.696), for categorization of BPE from moderate to substantial (κ = .562–.711), and for evaluation of lesion intensity enhancement from fair to moderate (κ = .346–.459). Conclusion In cases of Breast Imaging Reporting and Data System (BI-RADS) 1, BI-RADS 2, or BI-RADS 3 results at CESM, follow-up or VAB rather than surgical biopsy might be performed.
Development and Testing of the interRAI Acute Care: A Standardized Assessment Administered by Nurses for Patients Admitted to Acute Care
Authors: Gray Leonard C , Beattie Elizabeth , Boscart Veronique M , Henderson Amanda , Hornby-Turner Yvonne C , Hubbard Ruth E , Wood Susan , Peel Nancye M 
Published: December 2018

Background: Underpinning standards for developing comprehensive care in hospital is the need to identify, early in the admission process, functional and psychosocial issues which affect patient outcomes. Despite the value of comprehensive assessment of patients on admission, the process is often sub-optimal due to a lack of standardized assessment practices. This project aimed to develop a concise, integrated assessment for patients admitted to acute care and test its psychometric properties. Methods: Two international expert panels of clinicians and health scientists collaborated to establish design parameters. Using clinical observations and a variety of derivative applications sourced from the interRAI research collaborative repository, the panels constructed a draft instrument to examine feasibility, resource requirements, and inter-rater reliability. Field testing was conducted in Australia and Canada. Next, the system was revised to its final form, the interRAI Acute Care, after feedback and review from international interRAI members. Results: Constructed using 56 items, the interRAI Acute Care required a median of 15 minutes to complete. Inter-rater reliability tested on 130 paired assessments was substantial to almost perfect for 78% of the clinical items and moderate for the remaining 22% of items. A subset of 30 items from the admission assessment comprised the discharge assessment. Discussion: The interRAI Acute Care has been shown to be an efficient nursing assessment instrument with good psychometric properties. Implementation in a digital environment will enable documentation and care planning to comply with standards for quality of care in the general adult hospital population.
Midostaurin added to chemotherapy and continued single-agent maintenance therapy in acute myeloid leukemia with FLT3-ITD
Authors: Schlenk Richard F. , Weber Daniela , Fiedler Walter , Salih Helmut R. , Wulf Gerald , Salwender Hans , Schroeder Thomas , Kindler Thomas , Lübbert Michael , Wolf Dominik , Westermann Jörg , Kraemer Doris , Götze Katharina S. , Horst Heinz-August , Krauter Jürgen , Girschikofsky Michael , Ringhoffer Mark , Südhoff Thomas , Held Gerhard , Derigs Hans-Günter , Schroers Roland , Greil Richard , Grießhammer Martin , Lange Elisabeth , Burchardt Alexander , Martens Uwe , Hertenstein Bernd , Marretta Lore , Heuser Michael , Thol Felicitas , Gaidzik Verena I. , Herr Wolfgang , Krzykalla Julia , Benner Axel , Döhner Konstanze , Ganser Arnold , Paschka Peter , Döhner Hartmut 
Published: December 2018

Abstract
Patients with acute myeloid leukemia (AML) and a FLT3 internal tandem duplication (ITD) have poor outcomes to current treatment. A phase 2 hypothesis-generating trial was conducted to determine whether the addition of the multitargeted kinase inhibitor midostaurin to intensive chemotherapy followed by allogeneic hematopoietic cell transplantation (alloHCT) and single-agent maintenance therapy of 12 months is feasible and favorably influences event-free survival (EFS) compared with historical controls. Patients 18 to 70 years of age with newly diagnosed AML and centrally confirmed FLT3-ITD were eligible: 284 patients were treated, including 198 younger (18-60 years) and 86 older (61-70 years) patients. Complete remission (CR) rate, including CR with incomplete hematological recovery (CRi) after induction therapy, was 76.4% (younger, 75.8%; older, 77.9%). The majority of patients in CR/CRi proceeded to alloHCT (72.4%). Maintenance therapy was started in 97 patients (34%): 75 after alloHCT and 22 after consolidation with high-dose cytarabine (HiDAC). Median time receiving maintenance therapy was 9 months after alloHCT and 10.5 months after HiDAC; premature termination was mainly a result of nonrelapse causes (gastrointestinal toxicity and infections). EFS and overall survival at 2 years were 39% (95% confidence interval [CI], 33%-47%) and 34% (95% CI, 24%-47%) and 53% (95% CI, 46%-61%) and 46% (95% CI, 35%-59%) in younger and older patients, respectively. EFS was evaluated in comparison with 415 historical controls treated within 5 prospective trials. Propensity score-weighted analysis revealed a significant improvement of EFS by midostaurin (hazard ratio [HR], 0.58; 95% CI, 0.48-0.70; P &lt; .001) overall and in older patients (HR, 0.42; 95% CI, 0.29-0.61). The study was registered at www.clinicaltrials.gov as #NCT01477606.