bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations between diagnostic pathways and care experience in colorectal cancer: evidence from patient-reported data
Authors: Salika Theodosia , Abel Gary A , Mendonca Silvia C , von Wagner Christian , Renzi Cristina , Herbert Annie , McPhail Sean , Lyratzopoulos Georgios 
Published: April 2018

ObjectiveTo examine how different pathways to diagnosis of colorectal cancer may be associated with the experience of subsequent care.DesignPatient survey linked to information on diagnostic route.English patients with colorectal cancer (analysis sample n=6837) who responded to a patient survey soon after their hospital treatment.Main outcome measuresOdds Ratios and adjusted proportions of negative evaluation of key aspects of care for colorectal cancer, including the experience of shared decision-making about treatment, specialist nursing and care coordination, by diagnostic route (ie, screening detection, emergency presentation, urgent and elective general practitioner referral).ResultsFor 14 of 18 questions, there was evidence (p≤0.02) for variation in patient experience by diagnostic route, with 6–31 percentage point differences between routes in adjusted proportions of negative experience. Emergency presenters were more likely to report a negative experience for most questions, including those about adequacy of information about their diagnosis and sufficient explanation before operations. Screen-detected patients were least likely to report negative experiences except for support from primary care. Patients diagnosed through elective primary care referrals were most likely to report worse experience for questions for which overall variation by route was generally small.ConclusionsScreening-detected patients tend to report the best and emergency presenters the worst experience of subsequent care. Improvement efforts can target care integration for screening-detected patients and provision of information about the diagnosis and treatment of emergency presenters.
Ondansetron blocks wild-type and p.F503L variant small-conductance Ca2+-activated K+ channels
Authors: Ko Jum-Suk , Guo Shuai , Hassel Jonathan , Celestino-Soper Patricia , Lynnes Ty C. , Tisdale James E. , Zheng James J. , Taylor Stanley E. , Foroud Tatiana , Murray Michael D. , Kovacs Richard J. , Li Xiaochun , Lin Shien-Fong , Chen Zhenhui , Vatta Matteo , Chen Peng-Sheng , Rubart Michael 
Published: April 2018

Apamin-sensitive small-conductance Ca2+-activated K+ (SK) current ( IKAS) is encoded by Ca2+-activated K+ channel subfamily N ( KCNN) genes. IKAS importantly contributes to cardiac repolarization in conditions associated with reduced repolarization reserve. To test the hypothesis that IKAS inhibition contributes to drug-induced long QT syndrome (diLQTS), we screened for KCNN variants among patients with diLQTS, determined the properties of heterologously expressed wild-type (WT) and variant KCNN channels, and determined if the 5-HT3 receptor antagonist ondansetron blocks IKAS. We searched 2,306,335 records in the Indiana Network for Patient Care and found 11 patients with diLQTS who had DNA available in the Indiana Biobank. DNA sequencing discovered a heterozygous KCNN2 variant (p.F503L) in a 52-yr-old woman presenting with corrected QT interval prolongation at baseline (473 ms) and further corrected QT interval lengthening (601 ms) after oral administration of ondansetron. That patient was also heterozygous for the p.S38G and p.P2835S variants of the QT-controlling genes KCNE1 and ankyrin 2, respectively. Patch-clamp experiments revealed that the p.F503L KCNN2 variant heterologously expressed in human embryonic kidney (HEK)-293 cells augmented Ca2+ sensitivity, increasing IKAS density. The fraction of total F503L-KCNN2 protein retained in the membrane was higher than that of WT KCNN2 protein. Ondansetron at nanomolar concentrations inhibited WT and p.F503L SK2 channels expressed in HEK-293 cells as well as native SK channels in ventricular cardiomyocytes. Ondansetron-induced IKAS inhibition was also demonstrated in Langendorff-perfused murine hearts. In conclusion, the heterozygous p.F503L KCNN2 variant increases Ca2+ sensitivity and IKAS density in transfected HEK-293 cells. Ondansetron at therapeutic (i.e., nanomolar) concentrations is a potent IKAS blocker. NEW & NOTEWORTHY We showed that ondansetron, a 5-HT3 receptor antagonist, blocks small-conductance Ca2+-activated K+ (SK) current. Ondansetron may be useful in controlling arrhythmias in which increased SK current is a likely contributor. However, its SK-blocking effects may also facilitate the development of drug-induced long QT syndrome.
Ethnic Diversity and Access to Healthcare from a Human Rights Perspective: The Case of the Roma in Europe
Authors: Alexiadou Elisavet Athanasia 
Published: April 2018

Abstract
Roma, the largest and oldest ethnic group in Europe, systematically encounter difficulties in healthcare settings, while they are often exposed to high levels of poverty and social exclusion, adversely affecting their health and well-being. In light of this disturbing situation, this paper sets out to examine Roma access to healthcare in Europe from a human rights perspective. This will be followed by an assessment of the status of the Roma right to health (care) within a particular national reality (resource constraints and rising health inequalities). In fact, this case study tends to serve as a piece of discussion about issues relating to Roma access to healthcare, many of which exist (to some extent) in every country across Europe. Finally, practical recommendations are proposed as a way for remedying human rights abuses against Roma in healthcare settings and ultimately, for effectively realizing the Roma right to health (care).
Objective Characterization of Rain Microphysics: Validating a Scheme Suitable for Weather and Climate Models
Authors: Tapiador F. J. , Berne A. , Raupach T. , Navarro A. , Lee G. , Haddad Z. S. 
Published: April 2018

Abstract
Improving the atmospheric component of hydrological models is beneficial for applications such as water resources assessment and hydropower operations. Within this goal, precise characterization of rain microphysics is key for climate and weather modeling, and thus for hydrometeorological applications. Such characterization can be achieved by analyzing the evolution in time of the particle size distribution (PSD) of hydrometeors, which can be measured at ground using disdrometers for validation. The estimation, however, depends on the choice of the PSD form (the shape) and on the parameters to define the exact shape. In the case of modeling rain microphysics, two approaches compete: the use of the number concentration of drops decoupled from the shape of the distribution (the [NT, E(D), E(D2)] and the {NT, E(D), E[log(D)]} models), and the (N0, Λ, μ) model that embeds in N0 both the shape of the distribution and the number concentration of drops. Here we use a comprehensive dataset of disdrometer measurements to show that the NT-based approaches allow a more precise characterization of the drop size distribution (DSD) and also a physically based modeling of the microphysical processes of rain since NT is analytically independent of the shape of the DSD {parameterized by E(D), and E(D2) or E[log(D)]}. The implication is that numerical models would benefit from decoupling the number of drops from the shape of distribution in their modules of precipitation microphysics in order to improve outputs that eventually feed hydrological models.
Subseasonal Forecasting with an Icosahedral, Vertically Quasi-Lagrangian Coupled Model. Part II: Probabilistic and Deterministic Forecast Skill
Authors: Sun Shan , Green Benjamin W. , Bleck Rainer , Benjamin Stanley G. 
Published: April 2018

Abstract
Subseasonal forecast skill of the global hydrostatic atmospheric Flow-Following Icosahedral Model (FIM) coupled to an icosahedral-grid version of the Hybrid Coordinate Ocean Model (iHYCOM) is evaluated through 32-day predictions initialized weekly using a four-member time-lagged ensemble over the 16-yr period 1999–2014. Systematic biases in forecasts by the coupled system, referred to as FIM–iHYCOM, are described in a companion paper (Part I). This present study (Part II) assesses probabilistic and deterministic model skill for predictions of surface temperature, precipitation, and 500-hPa geopotential height in different seasons at different lead times ranging from 1 to 4 weeks. The coupled model appears to have reasonable agreement with reanalysis in terms of simulated weekly variability in sea surface temperatures, except in extratropical regions because the ocean model cannot explicitly resolve eddies there. This study also describes the ability of the model to simulate midlatitude tropospheric blocking frequency, Madden–Julian oscillation patterns, and sudden stratospheric warming events—all of which have been shown to be relevant on subseasonal time scales. The metrics used here indicate that the subseasonal forecast skill of the model is comparable to that of several operational models, including the National Oceanic and Atmospheric Administration’s (NOAA’s) operational Climate Forecast System version 2 and the European Centre for Medium-Range Weather Forecasts model. Therefore, FIM–iHYCOM—as a participant in NOAA’s Subseasonal Experiment—is expected to add value to multimodel ensemble forecasts produced through this effort.
Symptoms of prolonged grief and posttraumatic stress following loss: A latent class analysis
Authors: Maccallum Fiona , Bryant Richard A 
Published: April 2018

Objective: Individuals vary in how they respond to bereavement. Those who experience poor bereavement outcomes often report symptoms from more than one diagnostic category. This study sought to identify groups of individuals who share similar patterns of prolonged grief disorder and posttraumatic stress disorder symptoms to determine whether these profiles are differentially related to negative appraisals thought to contribute to prolonged grief disorder and posttraumatic stress disorder symptomatology. Methods: Participants were 185 bereaved adults. Latent class analysis was used to identify subgroups of individuals who showed similar patterns of co-occurrence of prolonged grief disorder and posttraumatic stress disorder symptoms. Multinomial regression was used to examine the extent to which appraisal domains and sociodemographic and loss factors predicted class membership. Results: Latent class analysis revealed three classes of participants: a low symptom group, a high prolonged grief disorder symptom group, and a high prolonged grief disorder and posttraumatic stress disorder symptom group. Membership of the prolonged grief disorder group and prolonged grief disorder and posttraumatic stress disorder group was predicted by higher mean negative self-related appraisals. Demographic and loss-related factors did not predict group membership. Conclusion: These findings have implications for understanding co-occurrence of prolonged grief disorder and posttraumatic stress disorder symptoms following bereavement. Findings are consistent with theoretical models highlighting the importance of negative self-related beliefs in prolonged grief disorder.
Is diabetes a marker of higher risk after carotid revascularization? Experience from a single centre
Authors: Casana Renato , Malloggi Chiara , Odero Andrea , Tolva Valerio , Bulbulia Richard , Halliday Alison , Silani Vincenzo 
Published: April 2018

Purpose: This single centre study investigates the influence of diabetes mellitus on outcomes following carotid artery endarterectomy or stenting. Methods: In total, 752 carotid revascularizations (58.2% carotid artery stenting and 41.8% carotid endarterectomy) were performed in 221 (29.4%) patients with diabetes and 532 (70.6%) patients without diabetes. The study outcomes were death, disabling and non-disabling stroke, transient ischaemic attack and restenosis within 36 months after the procedure. Results: Patients with diabetes had higher periprocedural risk of any stroke or death (3.6% diabetes vs 0.6% no diabetes; p < 0.05), transient ischaemic attack (1.8% diabetes vs 0.2% no diabetes; p > 0.05) and restenosis (2.7% diabetes vs 0.6% no diabetes; p < 0.05). During long-term follow-up, there were no significant differences in Kaplan–Meier estimates of freedom from death, any stroke and transient ischaemic attack, between people with and without diabetes for each carotid artery stenting and carotid endarterectomy subgroup. Patients with diabetes showed higher rates of restenosis during follow-up than patients without diabetes (36-months estimate risk of restenosis: 21.2% diabetes vs 12.5% no diabetes; p < 0.05). Conclusion: The presence of diabetes was associated with increased periprocedural risk, but no further additional risk emerged during longer term follow-up. Restenosis rates were higher among patients with diabetes.
Immunotherapy of experimental and human stroke with agents approved for multiple sclerosis: a systematic review
Authors: Dreikorn Mirjam , Milacic Zeljko , Pavlovic Vladimir , Meuth Sven G. , Kleinschnitz Christoph , Kraft Peter 
Published: April 2018

Background: ‘Thromboinflammation’ describes a novel concept in stroke pathophysiology that has opened up the possibility of immunotherapeutic approaches which could become promising strategies for targeted stroke therapies in the future. Methods: We reviewed current evidence for agents approved for multiple sclerosis in preclinical and clinical stroke studies. A systematic review was performed in accordance with the PRISMA statement, searching MEDLINE, the Cochrane Central Register of Controlled Trials, and reference lists of articles published until 16 October 2017. Results: The review included 52 of 629 identified studies, consisting of 5 clinical and 47 preclinical trials. Most of the studies showed beneficial effects of the evaluated immunotherapeutic drugs in terms of reduction in morphological lesion size and improvement in functional outcome. Nevertheless, the significance of these findings is limited due to the high degree of heterogeneity. Conclusions: Immunotherapy of stroke might be effective and could become a promising treatment strategy, but larger clinical trials with standardized interventions and outcome measures are needed.
Severe oesophageal constriction due to an aberrant right subclavian artery with Kommerell’s diverticulum in a cat
Authors: Suzuki Ryohei , Mochizuki Yohei , Yoshimatsu Hiroki , Niina Ayaka , Teshima Takahiro , Matsumoto Hirotaka , Koyama Hidekazu 
Published: April 2018

Case summary A 6-month-old female cat with a history of chronic regurgitation presented with weight loss. CT angiography (CTA) showed severe constriction of the oesophagus due to an aberrant right subclavian artery and Kommerell’s diverticulum. The cat was surgically treated and remained clinically normal. More than 1 year after surgery, the general condition of the cat was stable and body weight had increased. Relevance and novel information This case report describes the clinical findings and surgical management of a cat diagnosed with severe oesophageal constriction caused by an aberrant right subclavian artery with Kommerell’s diverticulum (markedly dilated origin of the aberrant right subclavian artery), which are rare vascular anomalies in veterinary medicine and specifically in cats. The Kommerell’s diverticulum compressed the oesophagus and contributed to the severe oesophageal constriction in this case. Preoperative CTA was useful in the diagnosis and treatment planning.
Treatment Efficacy, Clinical Utility, and Cost-Effectiveness of Multidisciplinary Biopsychosocial Rehabilitation Treatments for Persistent Low Back Pain: A Systematic Review
Authors: Salathé Cornelia Rolli , Melloh Markus , Crawford Rebecca , Scherrer Stephanie , Boos Norbert , Elfering Achim 
Published: April 2018

Study Design: Systematic review. Objectives: To review the current literature on the treatment efficacy, clinical utility, and cost-effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) for patients suffering from persistent (nonspecific) lower back pain (LBP) in relation to pain intensity, disability, health-related quality of life, and work ability/sick leave. Methods: We carried out a systematic search of Web of Science, Cochrane Library, PubMed Central, EMBASE, and PsycINFO for English- and German-language literature published between January 2010 and July 2017. Study selection consisted of exclusion and inclusion phases. After screening for duplication, studies were excluded on the basis of criteria covering study design, number of participants, language of publication, and provision of information about the intervention. All the remaining articles dealing with the efficacy, utility, or cost-effectiveness of intensive (more than 25 hours per week) MBR encompassing at least 3 health domains and cognitive behavioral therapy–based psychological education were included. Results: The search retrieved 1199 publications of which 1116 were duplicates or met the exclusion criteria. Seventy of the remaining 83 articles did not meet the inclusion criteria; thus 13 studies were reviewed. All studies reporting changes in pain intensity or disability over 12 months after MBR reported moderate effect sizes and/or p-values for both outcomes. The effects on health-related quality of life were mixed, but MBR substantially reduced costs. Overall MBR produced an enduring improvement in work ability despite controversy and variable results. Conclusions: MBR is an effective treatment for nonspecific LBP, but there is room for improvement in cost-effectiveness and impact on sick leave, where the evidence was less compelling.
Spinal Reconstruction Techniques for Traumatic Spinal Injuries: A Systematic Review of Biomechanical Studies
Authors: Joaquim Andrei F. , Maslak Joseph P. , Patel Alpesh A. 
Published: April 2018

Study Design: Systematic literature review. Objectives: Many studies have provided evidence that short-segment posterior fixation (SSPF—1 level above and 1 below) with screws at the fracture level (SFL) are enough to achieve stability in some injury patterns, such as burst fractures, avoiding the need for circumferential reconstruction and long-segment instrumented fusion (LSIF—at least 2 levels above and 2 below). Given the potential benefits of avoiding unnecessary fusion in mobile healthy spinal segments, we performed a systematic review of biomechanical studies comparing different spinal reconstruction techniques for fractures of the thoracolumbar spine. Methods: A systematic literature review was performed in the PubMed and OVID databases of biomechanical studies comparing biomechanical differences between techniques of spine reconstructions. Results: Eight studies were included and evaluated. Five of 6 studies reported stiffness improvement with SSPF and SFL, even comparable to circumferential fusion for a burst fracture. Two studies reported that LSPF has higher stiffness and restricts range of motion better than SSPF, but inclusion of screws in the fracture level is similar to LSPF (1 study). Finally, although SSPF is less stiff than anterior reconstruction, adding a SFL in SSPF results in similar stiffness than circumferential fusion for unstable burst fractures. Conclusions: Biomechanical studies analyzed generally suggested that SFL in SSPF may improve construction stiffness, and can even be compared with long-segment fixation or circumferential reconstruction in some scenarios. This construct option may be used to enhance stiffness in selected injury patterns, avoiding the needs of an additional anterior approach.
A Review of Perforator Flaps for Burn Scar Contractures of Joints
Authors: Lewinson Ryan T. , Capozzi Lauren C. , Johnson Kody , Harrop Alan Robertson , Fraulin Frankie O. G. , Nickerson Duncan 
Published: April 2018

Objective: Perforator flaps are one possible surgical treatment for burn scar contractures; however, a review of evidence on this topic is lacking. Methods: MEDLINE was searched for articles related to perforator flaps for burn contractures. Following title and abstract screen, full texts were searched to identify articles describing perforator flaps for burn scar joint contractures. Data were extracted and summarized descriptively. Only articles that contained ≥10 patients with burn scar contracture were considered. Results: Two hundred forty-eight articles were identified, of which 17 met criteria for review. Of these, 16 were low-quality case series, while 1 was an open randomized controlled trial. In total, perforator flaps were performed on 339 patients (age range: 3-75 years), with the most common contracture locations being cervical (n = 218) and knee (n = 41). Nine of the 17 articles described a rehabilitation strategy. In general, functional outcomes were excellent, with the majority of patients experiencing return of normal joint range of motion and no recontracture. Compared to full-thickness skin grafts, perforator flaps showed greater improvements in joint range of motion. Cosmetically, perforator flaps were shown to have good color match with surrounding tissue, good contour around anatomical landmarks, and improved overall patient appearance. The most common complications were marginal flap necrosis (n = 26 patients) and venous congestion (n = 17 patients). Conclusions: Preliminary evidence from low-quality case series and 1 high-quality trial suggests perforator flaps may be successful for resurfacing released burn scar contractures; however, there is a need for additional trials comparing perforator flaps to other approaches.