bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients
Authors: Ge Youlin , Liu Dong , Zhang Zhiyuan , Li Yanhe , Lin Yiguang , Wang Guokai , Zong Yongqing , Liu Enhu 
Published: June 2019

OBJECTIVEThe authors retrospectively analyzed the follow-up data in 130 patients with intracranial benign meningiomas after Gamma Knife radiosurgery (GKRS), evaluated the tumor progression-free survival (PFS) rate and neurological function preservation rate, and determined the predictors by univariate and multivariate survival analysis.METHODSThis cohort of 130 patients with intracranial benign meningiomas underwent GKRS between May 2012 and May 2015 at the Second Hospital of Tianjin Medical University. The median age was 54.5 years (range 25–81 years), and women outnumbered men at a ratio of 4.65:1. All clinical and radiological data were obtained for analysis. No patient had undergone prior traditional radiotherapy or chemotherapy. The median tumor volume was 3.68 cm3 (range 0.23–45.78 cm3). A median margin dose of 12.0 Gy (range 10.0–16.0 Gy) was delivered to the tumor with a median isodose line of 50% (range 50%–60%).RESULTSDuring a median follow-up of 36.5 months (range 12–80 months), tumor volume regressed in 37 patients (28.5%), was unchanged in 86 patients (66.2%), and increased in 7 patients (5.4%). The actuarial tumor progression-free survival (PFS) rate was 98%, 94%, and 87% at 1, 3, and 5 years, respectively, after GKRS. Tumor recurred in 7 patients at a median follow-up of 32 months (range 12–56 months). Tumor volume ≥ 10 cm3 (p = 0.012, hazard ratio [HR] 8.25, 95% CI 1.60–42.65) and pre-GKRS Karnofsky Performance Scale score < 90 (p = 0.006, HR 9.31, 95% CI 1.88–46.22) were independent unfavorable predictors of PFS rate after GKRS. Of the 130 patients, 101 (77.7%) presented with one or more neurological symptoms or signs before GKRS. Neurological symptoms or signs improved in 40 (30.8%) patients, remained stable in 83 (63.8%), and deteriorated in 7 (5.4%) after GKRS. Two (1.5%) patients developed new cranial nerve (CN) deficit. Tumor volume ≥ 10 cm3 (p = 0.042, HR = 4.73, 95% CI 1.06–21.17) and pre-GKRS CN deficit (p = 0.045, HR = 4.35, 95% CI 0.84–22.48) were independent unfavorable predictors for improvement in neurological symptoms or signs. Six (4.6%) patients developed new or worsening peritumoral edema with a median follow-up of 4.5 months (range 2–7 months).CONCLUSIONSGKRS provided good local tumor control and high neurological function preservation in patients with intracranial benign meningiomas. Patients with tumor volume < 10 cm3, pre-GKRS Karnofsky Performance Scale score ≥ 90, and no pre-GKRS CN deficit (I–VIII) can benefit from stereotactic radiosurgery. It can be considered as the primary or adjuvant management of intracranial benign meningiomas.
Fractionated Gamma Knife radiosurgery for skull base meningiomas: a single-institution experience
Authors: Joshi Krishna C. , Raghavan Alankrita , Muhsen Baha’eddin , Hsieh Jason , Borghei-Razavi Hamid , Chao Samuel T. , Barnett Gene H. , Suh John H. , Neyman Gennady , Kshettry Varun R. , Recinos Pablo F. , Mohammadi Alireza M. , Angelov Lilyana 
Published: June 2019

OBJECTIVEGamma Knife radiosurgery (GKRS) has been successfully used for the treatment of intracranial meningiomas given its steep dose gradients and high-dose conformality. However, treatment of skull base meningiomas (SBMs) may pose significant risk to adjacent radiation-sensitive structures such as the cranial nerves. Fractionated GKRS (fGKRS) may decrease this risk, but until recently it has not been practical with traditional pin-based systems. This study reports the authors’ experience in treating SBMs with fGKRS, using a relocatable, noninvasive immobilization system.METHODSThe authors performed a retrospective review of all patients who underwent fGKRS for SBMs between 2013 and 2018 delivered using the Extend relocatable frame system or the Icon system. Patient demographics, pre- and post-GKRS tumor characteristics, perilesional edema, prior treatment details, and clinical symptoms were evaluated. Volumetric analysis of pre-GKRS, post-GKRS, and subsequent follow-up visits was performed.RESULTSTwenty-five patients met inclusion criteria. Nineteen patients were treated with the Icon system, and 6 patients were treated with the Extend system. The mean pre-fGKRS tumor volume was 7.62 cm3 (range 4.57–13.07 cm3). The median margin dose was 25 Gy delivered in 4 (8%) or 5 (92%) fractions. The median follow-up time was 12.4 months (range 4.7–17.4 months). Two patients (9%) experienced new-onset cranial neuropathy at the first follow-up. The mean postoperative tumor volume reduction was 15.9% with 6 patients (27%) experiencing improvement of cranial neuropathy at the first follow-up. Median first follow-up scans were obtained at 3.4 months (range 2.8–4.3 months). Three patients (12%) developed asymptomatic, mild perilesional edema by the first follow-up, which remained stable subsequently.CONCLUSIONSfGKRS with relocatable, noninvasive immobilization systems is well tolerated in patients with SBMs and demonstrated satisfactory tumor control as well as limited radiation toxicity. Future prospective studies with long-term follow-up and comparison to single-session GKRS or fractionated stereotactic radiotherapy are necessary to validate these findings and determine the efficacy of this approach in the management of SBMs.
Feasibility of local bone dust as a graft material in anterior cervical discectomy and fusion
Authors: Park Sehan , Lee Dong-Ho , Hwang Saemin , Oh Soohyun , Hwang Do-yon , Cho Jae Hwan , Hwang Chang Ju , Lee Choon Sung 
Published: June 2019

OBJECTIVELocal bone dust has been used previously as a substitute cage filling material for iliac bone grafts during anterior cervical discectomy and fusion (ACDF). However, the impacts of local bone dust on fusion rate and clinical results remain unclear. Extragraft bone bridging (ExGBB) is a reliable CT finding indicating segmental fusion. This study was conducted to compare fusion rates for the use of local bone dust or an iliac auto bone graft during ACDF surgery and to evaluate the effect of implanting bone graft outside the cage.METHODSNinety-three patients who underwent ACDF at a single institution were included. An iliac bone graft was used as the polyetheretherketone (PEEK) cage filling graft material in 43 patients (iliac crest [IC] group). In the IC group, bone graft material was inserted only inside the cage. Local bone dust was used in 50 patients (local bone [LB] group). Bone graft material was inserted both inside and outside the cage in the LB group. Segmental fusion was assessed by 1) interspinous motion (ISM), 2) intragraft bone bridging (InGBB), and 3) ExGBB. Fusion rates, visual analog scale (VAS) scores for neck and arm pain, and Neck Disability Index (NDI) scores were compared between the 2 groups.RESULTSThe neck and arm pain VAS scores and NDI score improved significantly in both groups. Fusion rates assessed by ISM and InGBB did not differ significantly between the groups. However, the fusion rate in the LB group was significantly higher than that in the IC group when assessed by ExGBB (p = 0.02).CONCLUSIONSUsing local bone dust as cage filling material resulted in fusion rates similar to those for an iliac bone graft, while avoiding potential complications and pain caused by iliac bone harvesting. A higher rate of extragraft bone bridge formation was achieved by implanting local bone dust outside the cage.
DIVERSITY OF BIRDS IN KUMARASAMY LAKE AND SINGANALLUR LAKE
Authors: Sharon S. Abanah , Roopavathy Dr. J. , Geetha S. 
Published: June 2019

A bird survey is carried out in lakes of Coimbatore (kumarasamy and singanallur) to examine the diversity and richness distribution of bird species in wetland region. This survey was taken from july 2018 to December 2018 to suitably access the bird diversity. A total number of 50 species from 13 orders and 34 families were recorded. The month of October and November maximum numbers of birds were identified. Pelicaniformes contributed maximum number of species. Finally, least number of birds recorded in Gruiformes, Strigiformes, Psittaciformes, Gariformes, Columbiformes and Podicipitiformes. Maximum bird species were recorded in Singanallur Lake and minimum in Kumarasamy Lake. The study revealed that Kumarasamy and Singanallur Lake acts as a refuge site for many water birds. Hence it is recommended that protection of the wetland from the human disturbance is of urgent need.
Key words: Kumarasamy, Threatened, Gariformes
FORMULATION AND EVALUATION OF SUBLINGUAL FILMS OF APIXABAN
Authors: Joshi Arjun L. , Raval Anil G 
Published: June 2019

The concept of sublingual film dosage form has become popular as new delivery system. This system will provide maximum therapeutic efficacy, increased bioavailability and maximum stability by reducing the frequency of dosage. It will also avoid first pass metabolism of the drugs. This system provides more rapid drug absorption from the pre gastric area which may provide quick onset of action. The present research aimed to prepare sublingual films of apixaban reduces the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. The film was prepared using solvent casting method and optimized employing 32 factorial design considering two independent variables film forming polymer (HPMC E5) and PEG 400. Disintegration time, drug release and folding endurance were taken as dependent variables. The prepared optimized formulation showed minimum disintegration time (35 s), highest dissolution rate (99 %) and satisfactory physicochemical properties. It is evident from the above results that the developed formulation can be an innovative dosage form to improve the drug delivery, onset of action as well as improve patient compliance.
Key Words: Apixaban, Sublingual films, HPMC
FORMULATION AND EVALUATION OF ORALLY DISINTEGRATING TABLETS OF MIRABEGRON
Authors: Prajapati Kajal A , Patel Dhara B , Raval Anil G 
Published: June 2019

Mirabegron Orally Disintegrating Tablets were prepared using a direct compression approach with a novel approach of combining effervescence agents and super disintegrants to achieve a rapid disintegration. A screening study was performed using Crospovidone XL 10, Croscarmellose Sodium and Sodium Starch Glycolate at two levels to least Disintegration Time, which was achieved by Croscarmellose Sodium. The prepared tablets were evaluated for Weight variation, Thickness, Hardness, Disintegration time, Dissolution, and Water uptake study. A full factorial statistical optimization was carried out on the best optimized formulation to establish the design space for selected factors i.e., Level of Effervescence agents and Croscarmellose Sodium against Response Disintegration Time and Dissolution. A significant effect of both factors was found on DT as well as Dissolution rate, which justifies the use and rationale of the excipients.
Key words: Mirabegron, ODT, Direct Compression, Effervescence agents, Super disintegrants
Cartilla digital régimen sancionatorio
Authors: Beltrán Cardona María Teresa , Castellanos Noreña Natalia , López Londoño Anna Paola , Morales García Leidy Milena , Rodas Restrepo Danna Melissa 
Published: June 2019

La Constitución Política de Colombia, en su artículo 93, establece los deberes de los ciudadanos encaminados a la armonía y colaboración ciudadana, velando por los derechos de los ciudadanos. Cada individuo cuenta con una posición en la sociedad y de acuerdo a ello, se le exige un desempeño reglado por la moralidad y la legalidad. Es así como la ley impone sanciones por la conducta de las personas y en cada una de las posiciones en que se ubica, por ello la falta en los deberes de los profesionales es sancionada y que se aplican a los profesionales en derecho se encuentran estipuladas en el Capítulo III de la Ley 1123 de 2017, Código Disciplinario del Abogado.
A randomised controlled trial of the effect of providing online risk information and lifestyle advice for the most common preventable cancers
Authors: Masson Golnessa , Mills Katie , Griffin Simon J , Sharp Stephen J , Klein William MP , Sutton Stephen , Usher-Smith Juliet A 
Published: June 2019

BackgroundPrevention offers an effective public health strategy for cancer control. One approach that could be incorporated within general practice is the provision of personalised risk information. Few trial data are available concerning the impact of cancer risk information on behaviour.AimTo assess the short-term effects on computed cancer risk and self-reported health-related behaviours of providing personalised cancer risk information.MethodA total of 1018 participants, recruited through the online platform Prolific, were randomised to either a control group receiving cancer-specific lifestyle advice alone or one of three intervention groups receiving the same lifestyle advice alongside their estimated 10-year risk of developing one of the five most common preventable cancers. Cancer risk was calculated from self-reported behavioural risk factors and presented in one of three formats: bar-chart, pictograph, or qualitative scale. The primary outcome was change from baseline in computed risk relative to an individual with a recommended lifestyle (RRI) at 3 months. Secondary outcomes included: self-reported health-related behaviours, accuracy of risk perception, risk conviction, anxiety, worry, intention to change behaviour, self-efficacy, and response-efficacy.ResultsAt immediate follow-up, accuracy of risk perception (P<0.001), risk conviction (P <0.001), and response-efficacy (P = 0.04) increased in all intervention groups. After 3 months there were no between-group differences in change in RRI (P = 0.68) or any of the secondary outcomes.ConclusionThis study has shown that a risk communication intervention can increase short-term risk accuracy and response efficacy and for the first time that risk conviction can be manipulated through risk communication. However, these effects were not sustained over time or associated with behaviour change.
Health experiences of asylum seekers and refugees in Wales
Authors: Russell Ian , Khanom Ashrafunessa , Richardson Gill , Russell Daphne , Scott Rebecca , Snooks Helen 
Published: June 2019

BackgroundThe numbers of asylum seekers and refugees in Wales have recently increased sharply, but we know little of their health experiences.AimTo investigate asylum seekers’ and refugees’ experiences of health care, especially what helped or hindered.MethodEight volunteer peer researchers were recruited from asylum-seeking and refugee communities; and trained to run the quantitative survey. They worked in small groups with support from team members. The Statistical Package for Social Sciences (SPSS) was used to describe, analyse, and present results.ResultsThe 210 responders included 90 known refugees, 89 known asylum seekers, and 11 known to have been refused asylum. Although 79% of responders reported attending an initial health assessment on arriving in Wales, and 94% reported that they were currently registered with a GP, only 36% found it easy or very easy to make an appointment with their GPs. Awareness of services was mixed: best known was the 999 service, with 77% reporting that they knew how to access it. Sixty-six per cent reported using health care in working hours, and 28% reported use out of hours. Key influences on these statistics included knowledge of the NHS and how to navigate it, language barriers, and cultural factors.ConclusionThis study provides valuable insight into asylum seekers’ and refugees’ experiences of health care. Together with our complementary qualitative study it suggests that a compassionate approach to providing care, building on existing good practice, and with additional resources for training and support services, can reduce healthcare inequalities for asylum seekers and refugees.
Can a mobile app improve mental health service use in 16–25-year olds? An analysis of Afloat
Authors: Chadha Komal 
Published: June 2019

BackgroundSeventy-five per cent of mental health conditions arise before the age of 18 years. However, 18–24-year olds are the least likely to receive care. Barriers to accessing treatment in this group are thought to include a lack of awareness of available services and stigma. eHealth is a strong means of connecting with this vulnerable group.AimTo develop a mobile app which facilitates access to mental health care for young people and to assess its potential impact on service use.MethodIn total 127 participants aged 16–25 years and living in the UK were recruited. Questionnaires were used to assess their mental health status, mental health literacy, resource use, barriers to support, and confidence levels. They were then each invited to download the new Afloat app. After using the app for 3 months these parameters were reassessed via follow-up questionnaires.ResultsPreliminary results from 57 participants showed that 50% of users said they would be more likely to seek help for mental health issues and 50% had more confidence to do so as a result of Afloat. The majority of users said that the app had no impact on their service use. For all services including mental health specialist, GP, medication, online support/apps and hospital/A&E Afloat was more likely to increase rather than decrease service use. The remaining responses are being analysed.ConclusionThe app may help to increase mental health service use in this cohort. A longer trial with qualitative analysis would help to ascertain if these changes were sustained and appropriate.
Socioeconomic deprivation and benzodiazepine/Z-drug prescribing: a cross-sectional study of practice-level data in England
Authors: Soyombo Stephanie , Aujla Harpal , Stanbrook Rhian , Capewell David , Shantikumar Mary , Todkill Daniel , Shantikumar Saran 
Published: June 2019

BackgroundBenzodiazepines and Z-drugs (such as zopiclone) are widely prescribed in primary care in England. Prescribed for various indications, such as anxiolysis and insomnia, it has been previously reported that an association may exist with deprivation.AimTo determine whether there was an association between benzodiazepine/Z-drug prescribing (overall, and by individual drug) and practice-level socioeconomic deprivation in England.MethodMonthly primary care prescribing data for 2017, as well as practice age and sex profile, were downloaded from NHS Digital. Prescribing was aggregated by year. Drug doses were converted to their milligram-equivalent of diazepam to allow comparison. Practice-level Index of Multiple Deprivation (IMD 2015) scores were obtained from Public Health England. Multiple linear regression was used to examine the association between IMD and prescribing (for all benzodiazepines/Z-drugs, and individually), after adjusting for practice sex (% male) and older age (% >65 years) distribution. Practice-level prescribing was defined as milligrams of diazepam-equivalent per 1000 registered patients in 2017.ResultsOn univariate analysis, overall benzodiazepine prescribing was positively associated with practice-level IMD score, with more prescribing in more deprived practices (P<0.001). After adjusting for practice age and sex profile, IMD score remained an independent predictor of prescribing levels (P<0.001). These associations were consistent for all benzodiazepines/Z-drugs when analysed separately.ConclusionHigher practice-level socioeconomic deprivation, as described by IMD score, was associated with increased benzodiazepine/Z-drug prescribing. This may, in part, be a reflection of an underlying association of the indications for prescribing and socioeconomic deprivation. Further work is required to more accurately define the underlying reasons for these associations.
MEMORABLE: MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation
Authors: Maidment Ian 
Published: June 2019

BackgroundOlder people are major users of medication. As people get age, the balance between benefits and harms for medication changes. Medication management by healthcare practitioners (for example, pharmacists, doctors, and nurses) is designed to help older people take the appropriate medication. Current evidence indicates that medication management is a complex process that is not easy to do well.AimThe aim of MEMORABLE, funded by the NIHR, is to understand how medication management works and how it might be implemented effectively.MethodMEMORABLE uses realism to understand how, why, for whom, and in what circumstances medicines management works. Realism is a theory-driven approach using primary and secondary data to make sense of complex interventions (for example medicines management), where outcomes are context sensitive. This is the first-time worldwide that realism has been used for this long-standing problem. MEMORABLE uses the literature (secondary data) and interviews (primary data). Data will be synthesised across datasets to set out and refine programme theories, about how medication management works, and develop a framework to improve practice.ResultsThree candidate programme theories (older people, informal carers, and practitioners) were identified from the literature and interviews. These programme theories will be explored against a 5-stage medication management process, conceived as a framework for analysis of the data. Emerging mechanisms of interest, burden, capacity, and needs/concerns are being explored.ConclusionMEMORABLE, which ended in December 2018, is using an innovative methodology, applied collaboratively, to develop an outcome-focused, evidence-based framework enhance medication management.
Understanding the learning needs of London-based GP trainees in conducting telephone consultations
Authors: Chaudhry Umar , Ibison Judith , Harris Tess , Rafi Imran , Johnston Miles , Fawns Tim 
Published: June 2019

BackgroundTelehealth care and telephone consultations are increasingly used in primary care for daily triage, patient reviews, and providing clinical information; however little is known about the perceptions of GP trainees.AimTo investigate the knowledge and skills of GP trainees in conducting telephone consultations; evaluate their current experiences and learning needs; and identify future training considerations based on feedback received.MethodUsing a mixed-methods approach, a cross-sectional quantitative survey of North Central and East London (NCEL) GP trainees was initially performed. This was followed-up by qualitative semi-structured interviews, which allowed deeper exploration of themes.ResultsIn total 100 trainees responded to the survey, and eight proceeded with interviews. Trainees were least confident in independently undertaking more complex aspects of telephone consulting, and there was a positive correlation between training received and confidence to work independently. Despite positive and negative experiences, trainees felt that there were gaps in their training and significant differences in overall confidence, supervision and feedback among different training grades and between in-hours and out-of-hours practice. Future considerations included curricular promotion, increased trainer-trainee observations using audio-clinical observation tools or simulated practice, and consideration of formal training.ConclusionThis project has shed light on the current learning, feedback, and assessment practices of GP trainees in conducting telephone consultations. Further evaluation will provide a helpful guide to various stakeholders, foresee any challenges and inform a wider debate among postgraduate learners regarding their training for the use of technology in healthcare.