bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of support for government involvement in obesity control among American adults
Authors: Moore Ami R , Amey Foster , Mpofu Elias 
Published: July 2018

Abstract
Obesity takes a substantial toll on society as a whole. Obesity and its health-related complications contribute significantly to healthcare costs and negatively affects almost every aspect of human life. It is therefore reasonable for the government to be involved in finding solutions to control the epidemic. This article examined factors that influence support for government intervention in the obesity epidemic in the United States. We used data from Obesity in the United States: Public Perceptions, a survey of a nationally representative sample of American adults. We conducted OLS regression analysis, to understand how three main covariates that described beliefs about causes of obesity and a series of controls impact support for government intervention in obesity control. There was a significant negative relationship between support for government intervention and beliefs about causes of obesity. Also, political ideology and party affiliation significantly influenced support for government intervention. For instance, while Democrats were more supportive of government interventions to control obesity, Republicans were not supportive of such intervention. Additionally, race and environmental characteristics of place of residence significantly influenced support for government intervention. Further, there were significant joint effects of political affiliation, race, and weight status on support for government intervention. Unlike previous studies, we find that one of the important factors that drive people to either support or abhor government intervention is the perception of what causes obesity. It is important that public health officials and other stakeholders understand the intricacies of public support for obesity control.
Update on the Comprehensive Approach to Fragility Fractures
Authors: Cohn Matthew R. , Gianakos Arianna L. , Grueter Kirsten , Rosen Natalie , Cong Guang-Ting , Lane Joseph M. 
Published: July 2018

Summary:
The prevention and treatment of fragility fractures continuously evolve. Adequate fracture care should involve treating the fracture itself and the underlying bone disease. Although effective treatments of osteoporosis are available, a large proportion of patients with fragility fractures are not prescribed antiosteoporotic medications after their injury. Recent advances in diagnostic tools, medications, and implementation of Fracture Liaison Services allow for more effective and comprehensive treatment or fragility fractures. In the Fracture Liaison Service model, a physician and physician extenders coordinate care. This includes a thorough medical and surgical history, metabolic bone disease laboratory testing, dual-energy x-ray absorptiometry screening, treatment, and long-term follow-up. Treatment options include nonpharmacologic treatment with calcium and vitamin D and antiresorptive and anabolic agents. Antiresorptive agents such as bisphosphonates and denosumab are first-line treatments for osteoporosis and anabolic agents such as teriparatide are effective in reducing bone density loss and have implications in fracture healing. In addition, new anabolic agents including antisclerostin antibodies and parathyroid hormone-related protein show promise as potential treatments to increase bone density.
Gram Stain is Not Clinically Relevant in Treatment of Pediatric Septic Arthritis
Authors: Bram Joshua T. , Baldwin Keith D. , Blumberg Todd J. 
Published: July 2018

Background:
The diagnosis of pediatric septic arthritis (SA) can be challenging due to wide variability in the presentation of musculoskeletal infection. Synovial fluid Gram stain is routinely obtained and often used as an initial indicator of the presence or absence of pediatric SA. The purpose of this study was to examine the clinical utility of the Gram stain results from a joint aspiration in the diagnosis and management of pediatric SA.

Methods:
All patients with suspected SA who underwent arthrocentesis and subsequent surgical irrigation and debridement at an urban tertiary care children’s hospital between January 2007 and October 2016 were identified. Results of the synovial fluid Gram stain, as well as synovial cell count/differential and serum markers, were evaluated.

Results:
A total of 302 patients that underwent incision and drainage for suspected SA were identified. In total, 102 patients (34%) had positive synovial fluid cultures and 47 patients (16%) had a microorganism detected on Gram stain. Gram stain sensitivity and specificity for the detection of SA were 0.40 and 0.97, respectively. This yielded a number needed to misdiagnose of 4.5 (ie, every fifth patient was misdiagnosed by Gram stain). For gram-negative organisms, the sensitivity dropped further to 0.13, with only 2/16 gram-negative organisms identified on Gram stain. Stepwise regression showed that age, serum white blood cell, and absolute neutrophil count were significant independent predictors for having a true positive Gram stain result. Elevated synovial white blood cell count was a significant predictor of having an accurate (culture matching the Gram stain) result.

Conclusions:
The Gram stain result is a poor screening tool for the detection of SA and is particularly ineffective for the detection of gram-negative organisms. The clinical relevance of the Gram stain and cost-effectiveness of this test performed on every joint aspiration sent for culture requires additional evaluation. Patients with gram-negative SA may be at high risk for inadequate coverage with empiric antibiotics due to poor detection of gram-negative organisms on initial Gram stain.

Level of Evidence:
Level III—case-control study.
New insights in the pathogenesis of T-cell lymphomas
Authors: Lemonnier François , Gaulard Philippe , de Leval Laurence 
Published: July 2018

Purpose of review
Peripheral T-cell lymphomas (PTCLs) represent diverse and aggressive malignancies, with few recent therapeutic improvements. Recent high-throughput genomic studies have revealed the complex mutational landscape of these rare diseases. These novel findings provide the grounds to a more comprehensive classification of these diseases, reflected in the 2017 WHO classification.

Recent findings
Our review is focused on selected PTCL entities. Angioimmunoblastic T-cell lymphoma and other lymphomas derived from T follicular helper cells feature a rather homogeneous mutational landscape. These neoplasms recapitulate a multistep oncogenic process associating epigenetic deregulation, and second hit mutations affecting the T-cell receptor signaling pathway. This model inferred from comprehensive analyses of patients samples, was confirmed in mouse models. Among ALK-negative anaplastic large-cell lymphomas, translocation-associated subsets are found in both systemic and cutaneous types, and the newly described breast implant-associated type is usually indolent. Extranodal lymphomas of the innate immune system also harbor a combination of mutations affecting different classes of epigenetic modifiers, and mutation-induced activation of the Janus Kinase/signal transduction and activator of transcription pathway.

Summary
Understanding of PTCL pathogenesis has substantially improved, and oncogenic events have been identified. The current challenge is to mount efficient therapeutic strategies targeting these aberrations to improve patients’ outcome.
The Optimal Diameter for Circumpapillary Retinal Nerve Fiber Layer Thickness Measurement by SD-OCT in Glaucoma
Authors: Heindl Ludwig M. , Adler Werner , El-Malahi Ouahiba , Schaub Friederike , Hermann Manuel M. , Dietlein Thomas S. , Cursiefen Claus , Enders Philip 
Published: July 2018

Purpose:
To evaluate the diagnostic power for glaucoma detection using circumpapillary retinal nerve fiber layer (cRNFL) thickness in 3 diameter sizes from the center of the optic nerve head (ONH) by spectral domain optical coherence tomography.

Patients and Methods:
In this cross-sectional study, case-control, 437 eyes diagnosed with glaucoma and 183 eyes of healthy controls underwent spectral domain optical coherence tomography of the ONH, visual field testing, and a clinical examination. cRNFL was measured by circular scans in 3.5 (C1), 4.1 (C2), and 4.7 mm (C3) distance from the center of the ONH. Receiver-operator characteristic analysis was used to assess diagnostic power to detect glaucoma; furthermore, patient-specific maximum localized damage was analyzed.

Results:
In C1, mean global cRNFL was 70.03±18.2 μm in glaucomatous eyes and 93.46±9.9 μm in controls. Respectively, cRNFL in C2 was 61.39±14.9 and 80.43±8.4 μm as well as 55.25±12.8 and 70.70±6.7 μm in C3. Using receiver-operator characteristic analysis, the area under the curve (AUC) for cRNFL was 0.855 in C1, 0.850 in C2, and 0.843 in C3. Mean AUCs in ONH sectors ranged from 0.699 to 0.846 and did not exceed AUC of the best scoring global parameter.

Conclusions:
Comparing 3.5, 4.1, and 4.7 mm diameters for cRNFL measurement, the inner circle at 3.5 mm distance showed the highest AUC to differentiate glaucoma from healthy controls. However, levels of diagnostic power from wider circular scans were not significantly different and were comparable. Moreover, sectorial cRNFL measurements were nonsuperior. The use of the ONH sector with the highest localized damage seems not to increase diagnostic power.
Acuity-based Scheduling in Primary Care
Authors: Candon Molly , Rhodes Karin , Polsky Daniel 
Published: July 2018

Objectives:
Triage algorithms are ubiquitous in emergency care settings, but the extent of their use in primary care is unknown. This study asks whether primary care practices prioritize patients with more acute service needs.

Methods:
We used an audit study in which simulated patients were randomized to 2 clinical scenarios—a new patient seeking a routine check-up or a new patient seeking treatment for newly diagnosed hypertension—and attempted to schedule appointments with thousands of randomly selected primary care physicians across 10 states. We estimated the difference in appointment availability by clinical scenario. For scheduled appointments, we also estimated the difference in wait times by clinical scenario.

Results:
While there was no difference in appointment availability, the mean wait time for simulated patients seeking a routine check-up was nearly 5 days longer than the mean wait time for simulated patients with hypertension.

Conclusions:
As demand for primary care increases while the supply remains stable, it will be important for practices to identify and prioritize patients with more acute service needs. Our results show that primary care physicians are already adopting such practices.
The plasma contact system as a modulator of innate immunity
Authors: Wu Yi 
Published: July 2018

Purpose of review
The contact system is a plasma protease cascade, which activates the proinflammatory kallikrein–kinin system and the procoagulant intrinsic coagulation pathway. Recent advances demonstrating the novel functions of this system as a key player of innate immune system will be introduced in the present review.

Recent findings
The role of the contact system is to initiate and participate in pathophysiological responses to injury, mainly the processes of coagulation and inflammation. The past few years have seen substantial progress, showing a new role of this system in regulation of innate immunity. The relationship between high-molecular-weight kininogen and lipopolysaccharide (LPS) has been investigated and a new function of high-molecular-weight kininogen has been identified as the critical LPS carrier supporting endotoxemia. In contrast, the role of high-molecular-weight kininogen in Klebsiella pneumoniae sepsis is limited. Coagulation factor XII (FXII) plays a detrimental role in murine wound healing and host defense against K. pneumoniae sepsis. In the pathogenesis of arthritis and colitis, the activation of plasma kallikrein and downstream cleavage of high-molecular-weight kininogen and release of bradykinin constitutes a critical pathway in the innate immune mechanism, whereas FXII is not important.

Summary
Current findings indicate that the plasma contact system functions as an important constituent of innate immune system, contributing to the pathogenesis of the immunological and infectious diseases.
Lack of Uptake of Prophylactic Human Papilloma Virus Vaccine Among Women With Systemic Lupus Erythematosus Seen at a Regional Medical Center
Authors: Dhar Josephine Patricia , Essenmacher Lynnette , Dhar Renee , Ragina Neli , Sokol Robert J. 
Published: July 2018

Background/Objective
Women with systemic lupus erythematosus (SLE) are at increased risk for cervical neoplasia likely due to infection with high-risk human papillomavirus (HR-HPV) and should be considered for HPV vaccination. We sought to determine the frequency of HR-HPV infection and uptake of HPV vaccination in our regional female lupus population.

Methods
For this medical records review study, data were analyzed from our electronic health records EPIC for women with International Classification of Diseases-10 or International Classification of Diseases -9 billing codes for SLE seen June 6, 2007, to May 1, 2017. This study was approved by the Central Michigan University/Covenant Medical Center institutional review board. Statistical analyses consisted of Student t test, χ2, and Z test for proportions using SPSS v. 24 software.

Results
A total of 1349 women with SLE were identified, mean age of 53 years, 70.8% white, 20.8% African American, with 49% exposed to cigarette smoke. High-risk HPV testing performed in 195 (14.5%; mean age, 50 years) showed 16.9% (33/195) were positive, with those testing positive for HR-HPV being slightly younger (p < 0.05).
Comparing our proportion testing positive for HR-HPV (0.169) versus National Health and Nutrition Examination Survey (0.088), we calculated a Z = 3.99 (p < 0.001) indicating HPV infection is significantly higher (2×) in our female SLE cohort. Only 16.0% (38/238) of the 238 women eligible to receive an HPV vaccine were tested for HR-HPV with 9 being positive and only 4.6% (11/238) vaccinated.

Conclusions
Human papillomavirus infection is a serious health issue in women with SLE, but HPV testing and vaccination rates remain low. Efforts should be directed to promote awareness of the importance of HPV vaccination in this high-risk population.
The Montreal Cognitive Assessment Test
Authors: Paez-Venegas Nicolas , Jordan-Estrada Bethel , Chavarria-Avila Efrain , Perez-Vazquez Felipe , Gómez-Bañuelos Eduardo , Medina-Dávalos Rafael , Ontiveros-González José-Ángel , Diaz-Rubio Gustavo-Ignacio , Navarro-Hernandez Rosa E. , Vázquez-Del Mercado Mónica 
Published: July 2018

Background/Objective
Systemic lupus erythematosus (SLE) is an inflammatory, chronic, and multisystemic disease, which may be associated with a wide range of neuropsychiatric manifestations, including cognitive impairment. Cognitive evaluations based on screening tests might identify early SLE-related cognitive alterations. The aim of this study was to evaluate and to compare the efficacy of three screening tests (Montreal Cognitive Assessment [MoCA], Mini Mental State Examination [MMSE], Cognitive Symptom Inventory [CSI]) against the gold standard (neuropsychological battery), in order to identify the most efficient screening test for cognitive impairment in patients with SLE.

Methods
This observational cross-sectional study recruited 44 patients, from August to December 2017, who were diagnosed with SLE according to the Systemic Lupus International Collaborating Clinics (SLICC) Criteria 2012, and had no medical or psychiatric comorbidities. The patients were evaluated using the MoCA, MMSE, CSI, and the gold standard. Spearman’s correlation and area under the curve analysis were performed; p < 0.05 was considered significant.

Results
The MoCA test showed the highest correspondence with the gold standard (AUC = 99.4%, p < 0.001), sensitivity (84%), and specificity (100%). This was followed by the MMSE (AUC = 92.6%, p < 0.001; sensitivity, 54.8%; specificity, 100%) and the CSI (AUC = 30.6%, p < 0.05; sensitivity, 54.8%; specificity, 30.76%).

Conclusion
The MoCA is a brief, easily applied screening test that is highly effective for detecting cognitive impairment in SLE patients. It could be useful in clinical follow-up as a tool for early detection of cognitive alterations.
Half-dose Coronary Artery Calcium Scoring
Authors: Caruso Damiano , De Santis Domenico , Biondi Tommaso , Panvini Nicola , Zerunian Marta , Rivosecchi Flaminia , Montesano Marta , Bellini Davide , Rengo Marco , Laghi Andrea 
Published: July 2018

Purpose:
The purpose of this study was to assess the impact of adaptive statistical iterative reconstruction (ASiR) on half-dose coronary artery calcium scoring (CACS) acquisition protocol.

Materials and Methods:
Between September 2016 and October 2017, 89 patients (54 male patients, mean age 64.6±10.7 y) with a clinically indicated coronary computed tomography angiography were prospectively enrolled. On a 64-row computed tomography scanner, patients underwent a standard CACS protocol (120 kVp, 170 mAs) reconstructed by filtered-back projection, and a half-dose CACS protocol (120 kVp, 85 mAs) reconstructed by ASiR at different percentages, from 10% to 100%, in 10% increments. CACS determinants (Agatston score, number of plaques, volume, and mass), signal-to-noise ratio, contrast-to-noise ratio, and radiation dose of both protocols were calculated. Patient risk categories based on CACS were determined for each protocol, and analysis of risk reclassification of half-dose protocol was performed. Depending on their body mass index (BMI), patients were divided into nonobese (BMI<30 kg/m2) and obese (BMI≥30 kg/m2) groups to investigate the influence of BMI on CACS determinants and risk reclassification.

Results:
Half-dose protocol reconstructed with ASiR 70% showed no significant differences in any CACS determinant compared with the standard protocol for both nonobese and obese patients (all P≥0.070 and ≥0.066, respectively) and reclassified 1 (1.7%) and 6 (20.0%) patients, respectively, with excellent (κ=0.91) and good (κ=0.74) agreement with standard protocol, respectively. ASiR 70% also resulted in a higher signal-to-noise ratio (1.88±0.78) and contrast-to-noise ratio (7.10±2.73) compared with standard protocol (all P≤0.001). Half-dose protocol provided 52% less radiation dose than standard acquisition (0.31±0.06 vs. 0.64±0.10 mSv; P<0.001).

Conclusions:
ASIR 70% coupled with reduction of tube current by 50% allowed for significant dose reduction and no detrimental effects on image quality, with minimal patient reclassification in nonobese patients. In obese patients, excessive noise may lead to a clinically significant reclassification rate.
Integrin and PD-1 Ligand Expression on Circulating Extracellular Vesicles in Systemic Inflammatory Response Syndrome and Sepsis
Authors: Kawamoto Eiji , Masui-Ito Asami , Eguchi Akiko , Soe Zay Yar , Prajuabjinda Onmanee , Darkwah Samuel , Park Eun Jeong , Imai Hiroshi , Shimaoka Motomu 
Published: July 2018

ABSTRACT
Extracellular vesicles (EVs) in the plasma mediate important intercellular communications in the pathogenesis of cancer and inflammatory diseases. EVs express integrins that regulate target specificities and programmed cell death ligand 1 and 2 (PD-L1 and 2) that suppress lymphocyte activation. However, the roles of these molecules on EVs in systemic inflammatory response syndrome (SIRS) and sepsis remain little understood. This study aimed to investigate how the EV expression of integrins and PD-1 ligands might differ in SIRS and sepsis, compared with healthy controls, and to correlate their expression with the clinical parameters reflecting pathogenesis. Twenty-seven SIRS patients without sepsis, 27 sepsis patients, and 18 healthy volunteers were included. EVs were isolated from plasma samples. The expression of three major integrins (β1, β2, β3 integrins) and PD-L1 and 2 were measured. The EV expression of β2 integrin and PD-L2 was significantly increased in sepsis patients compared with healthy controls. EV expression of PD-L1 was not elevated in sepsis and SIRS; however, circulating soluble PD-L1 levels were significantly higher in sepsis. Furthermore, EV expression of β2 integrin in sepsis patients correlated with hypotension and reduced kidney function. In addition, soluble PD-L1 levels correlated with sepsis severity, impaired kidney function, and impaired central nervous system function. These results suggest the potential involvements of the EV β2 integrin, as well as EV PD-L2 and soluble PD-L1, in the septic pathogenesis that occurs with the systemic immune activation leading to multiple organ dysfunctions.
Outcomes of Adult Intestinal Transplant Recipients Requiring Dialysis and Renal Transplantation
Authors: Puttarajappa Chethan M. , Hariharan Sundaram , Humar Abhinav , Paliwal Yuvika , Gao Xiaotian , Cruz Ruy J. , Ganoza Armando J. , Landsittel Douglas , Bhattarai Manoj , Sogawa Hiroshi 
Published: July 2018

Background
Data on dialysis and renal transplantation (RT) after intestinal transplantation (IT) are sparse. Whether changes in immunosuppression and surgical techniques have modified these outcomes is unknown.

Methods
Two hundred eighty-eight adult intestinal transplants performed between 1990 and 2014 at the University of Pittsburgh were analyzed for incidence, risk factors and outcomes after dialysis and RT. Cohort was divided into 3 eras based on immunosuppression and surgical technique (1990-1994, 1995-2001, and 2001-2014). Receiving RT, or dialysis for 90 days or longer was considered as end-stage renal disease (ESRD).

Results
During a median follow-up of 5.7 years, 71 (24.7%) patients required dialysis, 38 (13.2%) required long-term dialysis and 17 (6%) received RT after IT. One-, 3-, and 5-year ESRD risk was 2%, 7%, and 14%, respectively. No significant era-based differences were noted. Higher baseline creatinine (hazard ratio [HR], 3.40 per unit increase, P < 0.01) and use of liver containing grafts (HR, 2.01; P = 0.04) had an increased ESRD risk. Median patient survival after dialysis initiation was 6 months, with a 3-year survival of 21%. Any dialysis (HR, 12.74; 95% CI 8.46-19.20; P < 0.01) and ESRD (HR, 9.53; 95% CI, 5.87-15.49; P < 0.01) had higher mortality after adjusting for covariates. For renal after IT, 1- and 3-year kidney and patient survivals were 70% and 49%, respectively. All graft losses were from death with a functioning graft, primarily related to infectious complications (55%).

Conclusions
In intestinal transplant recipients, renal failure requiring dialysis or RT is high and is associated with increased mortality. Additionally, the outcomes for kidney after IT are suboptimal due to death with a functioning graft.