bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective study of headache and neuropeptides in patients with pituitary adenomas
Authors: Zhang Yixin , Pan Qi , Jiang Huahua , Yang Gang , Chen Lixue , Qin Guangcheng , Zhou Jiying 
Published: March 2019

Objective To evaluate clinical criteria for headache associated with pituitary adenoma (HaPA) in the International Classification of Headache Disorders (ICHD) 3rd edition version criteria and further determine whether elevations of plasma calcitonin gene-related peptide and pituitary adenylate cyclase-activating peptide 1-38 (PACAP1-38) concentration contribute to HaPA. Methods Demographic and clinical features of consecutive patients with pituitary adenoma were recorded. Plasma calcitonin gene-related peptide and PACAP1-38 concentrations in pituitary adenoma patients within 72 h pre- and post-operation were measured. Primary outcome for HaPA patients were 50% reduction of moderate-to-severe headache days at 3 months after discharge. Results Sixty-three patients with pituitary adenoma were recruited, 33 (52.4%) of whom had headache. The patients who had HaPA presented with migraine-like (32.9%), tension-type-like (12.1%), and stabbing headache (9.1%). Non-functional adenoma was present in the majority of cases (82.5%). Surgical resection improved headache in 83.3% of cases at 3 month follow-up. Pre- and post-operative calcitonin gene-related peptide and PACAP1-38 levels were significantly higher in patients with headache than in those without headache ( p < 0.05). Plasma calcitonin gene-related peptide and PACAP1-38 levels at 72 h post-operation were lower at 72 h after operation in patients who had greater improvement in headache compared with those who had little improvement, while plasma calcitonin gene-related peptide and PACAP1-38 levels were similar between these two groups preoperatively. Conclusions Most pituitary adenoma patients have non-functional adenoma, and half of this group have HaPA, indicating that the ICHD-3 criteria for HaPA with the emphasis on secretion status need further modifications. Lower plasma calcitonin gene-related peptide and PACAP1-38 concentrations at 72 h after operation may predict a better outcome in patients with HaPA.
Deep brain stimulation of chronic cluster headaches: Posterior hypothalamus, ventral tegmentum and beyond
Authors: Nowacki Andreas , Moir Liz , Owen Sarah LF , Fitzgerald James J , Green Alexander L , Aziz Tipu Z 
Published: March 2019

Objective We present long-term follow-up results and analysis of stimulation sites of a prospective cohort study of six patients with chronic cluster headaches undergoing deep brain stimulation of the ipsilateral posterior hypothalamic region. Methods The primary endpoint was the postoperative change in the composite headache severity score “headache load” after 12 months of chronic stimulation. Secondary endpoints were the changes in headache attack frequency, headache attack duration and headache intensity, quality of life measures at 12, 24, and 48 months following surgery. Stimulating contact positions were analysed and projected onto the steroetactic atlas of Schaltenbrand and Wahren. Results There was a significant reduction of headache load of over 93% on average at 12 months postoperatively that persisted over the follow-up period of 48 months ( p = 0.0041) and that was accompanied by a significant increase of reported quality of life measures ( p = 0.03). Anatomical analysis revealed that individual stimulating electrodes were located in the red nucleus, posterior hypothalamic region, mesencephalic pretectal area and centromedian nucleus of the thalamus. Conclusions Our findings confirming long-term effectiveness of deep brain stimulation for chronic cluster headaches suggest that the neuroanatomical substrate of deep brain stimulation-induced headache relief is probably not restricted to the posterior hypothalamic area but encompasses a more widespread area.
Conformity in Prescription and Administration of Respiratory Distress Protocols in a Tertiary Care Hospital in the Province of Quebec: RELIEVE Study
Authors: Dufort-Rouleau Camille , Martin Benjamin , Barré Vincent , Bédard Véronique , Rouleau Émilie Dufort , Beauchesne Marie-France , Quenneville Julie , Berteau Mathieu 
Published: March 2019

Background: Respiratory distress protocols (RDPs) are protocolized prescriptions comprised of 3 medications (a benzodiazepine, an opioid, and an anticholinergic) administered simultaneously as an emergency treatment for respiratory distress in palliative care patients in the province of Quebec, Canada. However, data on appropriate use that justifies the combination of all 3 components is scarce and based on individual pharmacodynamic properties along with expert consensus. Objectives: Our study aimed to evaluate the conformity and the effectiveness of RDPs prescribed and administered to hospitalized adult patients. Methods: This was a prospective and descriptive study conducted in a single center. Prescription and administration conformity were assessed based on predefined appropriateness criteria. Results: A total of 467 adult patients were prescribed a RDP, 175 administrations were documented, and 78 patients received at least 1 RDP. Prescription conformity was assessed on 1473 separate occasions over the trial period. Overall prescription conformity was found to be 37% (95% confidence interval [CI]: 33.6-40.4), and administration conformity was 37.7% (95% CI: 26.2-50.7). Low administration conformity was primarily explained by incorrect indications for RDP use. Seemingly important determinants of higher conformity were prescriber’s speciality in palliative care, use of preprinted orders, pharmacist involvement, and hospitalization in the palliative care unit. Conclusion: This study highlights important gaps in the use of RDPs in our institution. Health-care provider training appears necessary in order to ensure adequate conformity and allow for further evaluation of RDP effectiveness.
Optimal Licensing Contract: The Implications of Preference Function
Authors: Mukherjee Arijit 
Published: March 2019

Our analysis provides a rationale for the existence of a positive fixed-fee and output royalty in the licensing contracts. In this article, we show that the preference functions play an important role in this respect. As the market expansion effect gets weaker, it reduces the possibility of a royalty-only contract, thus increasing the possibility of the co-existence of a positive fixed-fee and output royalty in the licensing contract. Our argument is different from the existing reasons based on imitation, number of firms, product differentiation and decreasing returns to scale. JEL: D21, D43, L13
The identification of key factors predictive of traumatic brain injury in paediatric patients with a minor blunt head injury
Authors: Song Cheng Hee , Ahmad Mohammad Zikri , Siti-Azrin Ab Hamid , Wan-Nor-Asyikeen Wan Adnan 
Published: March 2019

Introduction: Traumatic brain injury (TBI) is a major public health concern, and contributes significantly to mortality and morbidity in paediatric patients. Objective: The study is aimed to identify the factors predictive of TBI in paediatric patients with a minor blunt head injury. Methods: This was a retrospective cohort study conducted on 274 paediatric patients with a minor head injury and registered to Hospital Universiti Sains Malaysia (USM) from the year 2009 to 2013. Patients with a minor blunt head injury aged less than 18 years who underwent computed tomography (CT) of the brain were included, while the patients with penetrating head injuries were excluded from the study. Simple and multiple logistic regression analysis were performed. Results: TBI occurred in 49% of the patients. Headache (adjusted odd ratio (AOR): 2.24; 95% confidence interval (CI): 1.24, 4.05, p = 0.008), dizziness (AOR: 3.08, 95% CI: 1.27, 7.51, p = 0.013) and the presence of scalp haematoma (AOR: 2.93, 95% CI: 1.60, 5.34, p < 0.001) were the most important clinical variables for predicting TBI following a minor blunt head injury in paediatric populations. Conclusion: Headache, dizziness and scalp haematoma were identified as important clinical variables that can be used to predict TBI on a CT scan of paediatric minor head injury. The presence of these factors should alert emergency physicians to the need to monitor such children closely.
Comparison of 2-Hour Oral Glucose Tolerance Test and Hemoglobin A1C in the Identification of Pre-Diabetes in Women with Infertility and Recurrent Pregnancy Loss
Authors: Shapiro Alice J , Holden Emily C , McGovern Peter G , Alderson Donald , Morelli Sara S 
Published: March 2019

Research question: Does hemoglobin A1C (HbA1C) predict pre-diabetes (pre-DM) in a population of women with infertility and/or recurrent pregnancy loss (RPL), when considering the 75 g, 2-hour oral glucose tolerance test (2h GTT) as the gold standard? Design: Retrospective study of 242 patients with infertility or RPL presenting to a university-affiliated reproductive endocrinology and infertility clinic between January 2012 and December 2016 who underwent screening for disorders of glucose metabolism with a 2h GTT. The prevalence of pre-DM as defined by HbA1C 5.7% to 6.4% and 2h GTT values of 140-199 mg/dL, and predictive values of HbA1C for the identification of pre-DM when compared with 2h GTT, were calculated and compared. Results: Of 242 patients, 188 (77.7%) women had both HbA1C and 2h GTT performed. Of these, 89 (47.3%) tested positive for pre-DM by one or both methods. Of 89 patients, 14 (15.7%) had both an abnormal 2h GTT and an abnormal HbA1C. Only 6 out of 89 (6.7%) patients tested positive for pre-DM by an abnormal 2h GTT in the setting of a normal HbA1C result. Conversely, 69 of these 89 patients (77.5%) tested positive for pre-DM by an abnormal HbA1C in the setting of a normal 2h GTT. The prevalence of pre-DM, as defined by 2h GTT, was 10.6% (20/188) (95% CI, 6.6-16.0), compared with a prevalence of 44.1% (83/188) (95% CI, 36.9-51.6) when pre-DM was defined by HbA1C alone. When the 2h GTT was considered the gold standard for the identification of pre-DM, the negative predictive value (NPV) of HbA1C compared with 2h GTT was 94.3% (95% CI, 88.0-97.9), whereas the positive predictive value (PPV) of HbA1C compared with 2h GTT was only 16.9% (95% CI, 9.5-26.7). Conclusions: Although a normal HbA1C was highly predictive of a normal 2h GTT, the two tests demonstrate poor agreement in the identification of pre-DM in women with infertility and/or RPL. Hemoglobin A1C is superior to the 2h GTT as an initial screening test for pre-DM in this population, since it identified a substantial number of women who would otherwise remain undiagnosed in the setting for a normal 2h GTT alone. However, the long-term clinical relevance of an elevated HbA1C in this population needs to be better defined.
Declining alcohol consumption among adolescents and schools in Stockholm, 2010–2016
Authors: Carlson Per 
Published: March 2019

Aims: The principle aim of this study was to investigate changes in alcohol consumption among adolescents in Stockholm from 2010 to 2016. A further aim was to investigate whether there are divergent or similar trends in alcohol consumption among elementary schools in Stockholm from 2010 to 2016 and, if there are diverging trends, to examine how the differences might be explained. Methods: Data were analysed using multilevel mixed effects linear regression, in which individual students represented one level and schools the second level. Data: Student-level data were derived from the Stockholm School Survey for the years 2010, 2012, 2014 and 2016 ( n = 15481). School-level data ( n = 132) were derived from registries of the Swedish National Agency for Education. Results: The results showed that there was an almost 45% decline in total alcohol consumption among ninth-grade students in Stockholm between 2010 and 2016. The decline was similar among all analysed consumption groups. Two factors were found to statistically explain some of the general decline: more restrictive parental attitudes towards alcohol and, more importantly, decreasing alcohol consumption among the students’ peers. The downward trends among schools between 2010 and 2016 were universal but not identical, but when parental attitudes towards alcohol and peers’ alcohol behaviour were controlled for, the diverging school trends in alcohol consumption were considerably more equal. Conclusions: School constitutes a social context for the student of which both parents and peers are important parts, and the diverging changes may be due to the norms and behaviours, influenced by parents and peers, characterising these schools.
Local delivery polymer provides sustained antifungal activity of amphotericin B with reduced cytotoxicity
Authors: Haley Rebecca M , Zuckerman Sean T , Gormley Catherine A , Korley Julius N , von Recum Horst A 
Published: March 2019

A diverse range of clinical infections are on the increase, resulting in part from disruption of the natural microbiome, or even mycobiome, as a result of many different medical interventions. Amphotericin B (AmB) is a leading drug for the treatment of clinical fungal infections. However, AmB is extremely cytotoxic to mammalian cells, making use of the drug problematic. In this work, a drug delivery system made of polymerized cyclodextrin (pCD) allows for the localized administration of AmB, reducing the toxicity to host cells while retaining antifungal activity. A slow, sustained delivery rate of AmB was achieved through exploiting molecular interactions between the CD pockets and the drug. Surface plasmon resonance (SPR) and Fourier transform infrared spectroscopy (FTIR) were used to characterize the interaction between AmB and cyclodextrins (CDs). Through these methods, it was found that amphotericin binds strongly ([Formula: see text]M−1) to β-cyclodextrin. Release studies showed slow, sustained release of AmB from pCD disks. Antifungal activity was tested against Saccharomyces cerevisiae in assays for zone of inhibition, contact killing, and solution killing. In all assays, AmB-loaded pCD disks were found to exhibit significant antifungal activity. These results indicate that AmB-loaded pCD disks are capable of both the prevention of fungal growth and the elimination of established colonies. Additionally, results suggest that AmB exhibits antifungal activity whether associated with or released from pCD. The usage of pCD as a delivery vehicle also significantly reduces the toxic side effects of AmB, as seen in mammalian cell culture studies. These results show that in addition to reducing side-effects from systemic dosing, local delivery of AmB from pCD disks has the potential to improve its usage both in antifungal efficacy and reduced mammalian cell toxicity. Impact statement Amphotericin B (AmB) is an effective and commonly used antifungal agent. However, nephrotoxicity and poor solubility limits its usage. The proposed polymerized cyclodextrin (pCD) system therefore is an attractive method for AmB delivery, as it retains the antifungal activity of AmB while decreasing toxicity, and confining drug release to the local environment. This system could potentially be used for both prevention and treatment of established fungal infections, as AmB is toxic to fungus whether associated or released from pCD.
The relationship between plaque cap morphology and access technique in lower extremity chronic total occlusion
Authors: Turkyilmaz Saygin , Kavala Ali Aycan 
Published: March 2019

Objectives To evaluate access success according to plaque cap morphology in subjects with lower limb chronic total occlusion. Methods A retrospective study was performed for a three-year period. Subjects with lower extremity chronic total occlusion (Rutherford category 3–6, ischaemia) were included in the study. Cap morphology was classified according to The chronic total occlusion crossing approach based on plaque cap morphology (CTOP) classification system. When describing the classification by a traditional antegrade approach, Types I, II, III and IV were defined as follows: Type I: concave proximal and distal caps; Type II: concave proximal and convex distal caps; Type III: convex proximal and concave distal caps; Type IV: convex proximal and distal caps. For the study, the data on demographics, access type, and direction crossed, access conversion, crossing success, crossing location, extravascular ultrasound guidance, catheter used, subjects, and localization of were recorded. The effect of cap morphology on crossing strategy and success was evaluated. Results A total of 110 subjects were enrolled in this study. The type of chronic total occlusion was determined by angiography in 100% of the subjects. The number of the subjects according to CTOP morphology for Types I, II, III and IV were 22 (20%), 39 (35.5%), 23 (20.9%) and 26 (23.6%), respectively. Superficial femoral artery, popliteal, anterior tibial, posterior tibial localizations did not differ among the CTOP types ( p = 0.649, p = 0.831, p = 0.923 and p = 0.903, respectively). Among the pre-operation parameters, lesion length was the only one that is significantly shorter in Type I (14.23 ± 1.93 cm) subjects when compared with Types II (21.77 ± 3.78 cm), III (21.17 ± 2.31 cm) and IV (19.85 ± 3.29 cm) subjects ( p < 0.001, for all comparisons). Antegrade access was significantly higher in group I than in group III. Planned dual access was also significantly lower in CTOP Type I than in CTOP Types II, III and IV. Antegrade crossed direction was significantly higher in CTOP Type I than in CTOP Types II, III and IV ( p = 0.001, for all comparisons). True lumen crossing was significantly higher in CTOP Type I than in CTOP Type II ( p = 0.002). In univariate analysis, chronic total occlusion Type IV was the only significant factor for antegrade crossing ( p = 0.001). Multivariate analysis demonstrated that chronic total occlusion Type IV (OR = 0.09, p = 0.001) was an independent risk factor for antegrade crossing. The odds of antegrade crossing for chronic total occlusion Type IV was 0.190 times that of chronic total occlusion Types I–II–III combined (OR (95% CI): 0.190 (0.070, 0.519), p = 0.001). Conclusions CTOP Type I accesses with an antegrade access, and Type IV accesses with a retrograde strategy. Type II and Type III CTOP will need planned dual access in order to prevent device bending and subintimal access.
A review of literature on substance abuse among anaesthesia providers
Authors: DeFord Stephanie , Bonom Julie , Durbin Terri 
Published: March 2019

Background Research has demonstrated that anaesthesia providers are susceptible to substance abuse. Several preventive measures are being implemented in certified registered nurse anaesthetist programmes to educate future providers about substance abuse. Given the continued prevalence and impact of the problem, more research is needed about the prevalence of substance abuse among student registered nurse anaesthetists and the implementation of preventive strategies in the educational setting. Aims The purpose of this narrative literature review was to examine the state of the science related to substance abuse among US certified anaesthesia providers. This literature review covered abuse of alcohol, tobacco, recreational drugs, opioids and anaesthetic agents. Methods This narrative review was conducted using the following search terms: anaesthesia, student, wellness, stress, substance abuse, satisfaction, personality, depression, nurse, nurse anaesthetist, propofol, isoflurane and fentanyl. References were identified using PubMed, CINAHL, Google Scholar, and the American Society of Anesthesiologists and American Association of Nurse Anesthetists websites. A total of 36 articles were identified as relevant to this literature review based on content and country of publication. This literature review was limited to articles published in the past 15 years. With one exception, our search was limited to manuscripts from the US. Results The literature underscored that various risk factors contribute to substance abuse. Board-certified anaesthesia providers fall prey to substance abuse due to ease of access, the high stress associated with administering anaesthesia, and the propensity to become addicted to opioids and other anaesthetics. A gap in the science exists about the prevalence of substance abuse among student registered nurse anaesthetists and the effectiveness of preventive strategies in the educational setting. Conclusions Anaesthesia providers are at high risk of abusing substances. To create a safer environment, future research should explore the prevalence of substance abuse among student registered nurse anaesthetists and emphasise the integration of effective preventive strategies in the educational setting.
A ‘history of problematizations’ for dementia education: a Foucauldian approach to understanding the framing of dementia
Authors: Knifton Chris , Yates Scott 
Published: March 2019

Background Debates relevant to both undergraduate and postgraduate nurse education regarding the conceptualisation and disciplinary ownership of dementia, including its framing as a neuro-psychiatric condition, a terminal illness or a consequence of ageing, are important in supporting an understanding of the lived experience of dementia for individuals and their family carers and how, as a condition, it has come to be problematised in Western society. The work of Michel Foucault is useful in setting this debate within a critical historical context. Aims Using Foucault's ‘history of problematizations’ we present such debates around dementia's conceptualisation in Western society and consider how a Foucauldian critical historical project influences nursing education by re-examining the problematisation of dementia within society, what it is to be a person with dementia, and how alternative conceptualisations shape how we see the condition – as well as how we provide learning opportunities for dementia-care professionals. Results Six differing ways of conceptualising or problematising dementia were found (as a natural consequence of ageing, a mental disorder, a bio-medical disease, a neuro-cognitive disorder, a disability and a terminal illness), each offering alternative ways we might present it in an educational context. Conclusions We argue for both undergraduate and postgraduate student nurses to engage in learning that locates what it is to be a person with dementia within particular conceptual frameworks that would allow understanding of how these ideas or constructs are reliant on historically contingent assumptions. Here, taken-for-granted assumptions are unsettled, and a more critically reflective position is adopted. This will have an impact on the type of nurse to emerge from educational institutions, thus also affecting service delivery and the dementia care provided, as well as the knock-on effects for dementia education in other medical, health and social care courses and for institutions whose role it is to approve professional practice curricula content.