bluuebunny/crossref_metadata_2025_split huggingface dataset:
The neutrophil to lymphocyte ratio in patients supported with extracorporeal membrane oxygenation
Authors: Yost Gardner , Bhat Geetha , Pappas Patroklos , Tatooles Antone 
Published: April 2018

Introduction: The neutrophil to lymphocyte ratio (NLR) has proven to be a robust predictor of mortality in a wide range of cardiovascular diseases. This study investigated the predictive value of the NLR in patients supported by extracorporeal membrane oxygenation (ECMO) systems. Methods: This study included 107 patients who underwent ECMO implantation for cardiogenic shock. Median preoperative NLR was used to divide the cohort, with Group 1 NLR <14.2 and Group 2 with NLR ≥14.2. Survival, the primary outcome, was compared between groups. Results: The study cohort was composed of 64 (60%) males with an average age 53.1 ± 14.9 years. Patients in Group 1 had an average NLR of 7.5 ± 3.5 compared to 27.1 ± 19.9 in Group 2. Additionally, those in Group 2 had significantly higher preoperative blood urea nitrogen (BUN) and age. Survival analysis indicated a thirty-day survival of 56.2%, with significantly worsened mortality in patients with NLR greater than 14.2, p=0.047. Discussion: Our study shows the NLR has prognostic value in patients undergoing ECMO implantation. Leukocytes are known contributors to myocardial damage and neutrophil infiltration is associated with damage caused by myocardial ischemia.
The femoral vein diameter and its correlation with sex, age and body mass index – An anatomical parameter with clinical relevance
Authors: Keiler Jonas , Seidel Ronald , Wree Andreas 
Published: April 2018

Background The femoral vein diameter is a critical factor when assessing endoprosthetic valve size for the treatment of chronic venous insufficiency. To examine the previously stated correlation between body mass index and femoral vein diameter and to re-assess the anatomical and physiological demands for a valve implant for chronic venous insufficiency treatment, we measured the femoral vein diameter in 82 subjects. Method Femoral vein diameters (164 legs) were measured with B-mode sonography both in supine position at rest and in upright position during Valsalva maneuver. Result The mean femoral vein diameter differed significantly between supine position (13.6 ± 3.0 mm) and upright position (16.4 ± 2.6 mm). Males possessed a significant bigger diameter than females. A significant positive correlation between femoral vein diameter and body mass index was observed. Conclusion Assuming an increased femoral vein diameter due to obesity would further impair valve functionality by increasing distance between both valve cusps. For the development of artificial venous valves, it is crucial to consider patient- and condition-dependent vein dilation.
Lower Respiratory Tract Infection and Short-Term Outcome in Patients With Acute Respiratory Distress Syndrome
Authors: Zampieri Fernando G. , Póvoa Pedro , Salluh Jorge I. , Rodriguez Alejandro , Valade Sandrine , Andrade Gomes José , Reignier Jean , Molinos Elena , Almirall Jordi , Boussekey Nicolas , Socias Lorenzo , Ramirez Paula , Viana William N. , Rouzé Anahita , Nseir Saad , Martin-Loeches Ignacio 
Published: April 2018

Objective: To assess whether ventilator-associated lower respiratory tract infections (VA-LRTIs) are associated with mortality in critically ill patients with acute respiratory distress syndrome (ARDS). Materials and Methods: Post hoc analysis of prospective cohort study including mechanically ventilated patients from a multicenter prospective observational study (TAVeM study); VA-LRTI was defined as either ventilator-associated tracheobronchitis (VAT) or ventilator-associated pneumonia (VAP) based on clinical criteria and microbiological confirmation. Association between intensive care unit (ICU) mortality in patients having ARDS with and without VA-LRTI was assessed through logistic regression controlling for relevant confounders. Association between VA-LRTI and duration of mechanical ventilation and ICU stay was assessed through competing risk analysis. Contribution of VA-LRTI to a mortality model over time was assessed through sequential random forest models. Results: The cohort included 2960 patients of which 524 fulfilled criteria for ARDS; 21% had VA-LRTI (VAT = 10.3% and VAP = 10.7%). After controlling for illness severity and baseline health status, we could not find an association between VA-LRTI and ICU mortality (odds ratio: 1.07; 95% confidence interval: 0.62-1.83; P = .796); VA-LRTI was also not associated with prolonged ICU length of stay or duration of mechanical ventilation. The relative contribution of VA-LRTI to the random forest mortality model remained constant during time. The attributable VA-LRTI mortality for ARDS was higher than the attributable mortality for VA-LRTI alone. Conclusion: After controlling for relevant confounders, we could not find an association between occurrence of VA-LRTI and ICU mortality in patients with ARDS.
Single-Family Housing Value Resilience of Walkable Versus Unwalkable Neighborhoods During a Market Downturn: Causal Evidence and Policy Implications
Authors: Xu Minjie , Yu Chia-Yuan , Lee Chanam , Frank Lawrence D. 
Published: April 2018

Objectives: This study investigated the resilience of single-family housing values in walkable versus unwalkable neighborhoods during the economic downturn from 2008 to 2012 in Dallas, Texas. Methods: Using propensity score matching and difference in differences methods, this study established a natural experimental design to compare before-and-after value changes of single-family (SF) homes in walkable neighborhoods with unwalkable neighborhoods during the Great Recession. Two thousand seven hundred ninety-nine SF homes within 18 Tax Increment Financing (TIF) districts were categorized into walkable (Walk Score ≥50) and unwalkable (<50) groups. Six hundred twenty-four dwellings in walkable neighborhoods were matched with the most identical ones in the unwalkable neighborhoods by controlling for the selected structural and residential location variables. Relative average treatment effects were examined for SF values in walkable and unwalkable neighborhoods. Results: On average, the SF homes in walkable neighborhoods held $4566 (2.08%) more value than their how walkable counterparts. Conclusions: This study aims to help planners and decision-makers by documenting the unmet demand for walkable communities and their sustained economic benefit. Increased awareness of the sustained value of walkable communities can be used by lenders who finance and by policy makers who regulate placemaking. Results from this study can be integrated with research that demonstrates health-care cost savings of walkable environments to create an even more comprehensive set of evidence-based interventions to increase their supply.
Work and Home Neighborhood Design and Physical Activity
Authors: Carlson Jordan A. , Frank Lawrence D. , Ulmer Jared , Conway Terry L. , Saelens Brian E. , Cain Kelli L. , Sallis James F. 
Published: April 2018

Purpose: To investigate relations of perceived worksite neighborhood environments to total physical activity and active transportation, over and above home neighborhood built environments. Design: Observational epidemiologic study. Setting: Baltimore, Maryland-Washington, DC, and Seattle-King County, Washington metropolitan areas. Participants: One thousand eighty-five adults (mean age = 45.0 [10.2]; 46% women) recruited from 32 neighborhoods stratified by high/low neighborhood income and walkability. Measures: The Neighborhood Environment Walkability Survey assessed perceptions of worksite and home neighborhood environments. Accelerometers assessed total moderate-to-vigorous physical activity (MVPA). The International Physical Activity Questionnaire assessed total active transportation and active transportation to and around work. Analysis: Mixed-effects regression tested relations of home and worksite neighborhood environments to each physical activity outcome, adjusted for demographics. Results: Home and worksite mixed land use and street connectivity had the most consistent positive associations with physical activity outcomes. Worksite traffic and pedestrian safety were also associated with multiple physical activity outcomes. The worksite neighborhood explained additional variance in physical activity outcomes than explained by the home neighborhood. Worksite and home neighborhood environments interacted in explaining active transportation to work, with the greatest impacts occurring when both neighborhoods were activity supportive. Conclusion: Both worksite and home neighborhood environments were independently related to total MVPA and active transportation. Community design policies should target improving the physical activity supportiveness of worksite neighborhood environments and integrating commercial and residential development.
Evaluation of hospital length of stay and revenues as a function of admission mode, clinical pathways including observation unit stay and hospitalization characteristics
Authors: Casalino Enrique , Perozziello Anne , Choquet Christophe , Curac Sonia , Leroy Christophe , Hellmann Romain 
Published: April 2018

Objectives Hospital length of stay (days) and revenues per day (euros) could be different depending on admission mode. To determine the impact of admission mode as a function of clinical pathway, we conducted the present study. Data sources: We included 159,206 admissions to three academic hospitals during a four-year period. Data were obtained from the electronic system of the hospital trust. Study design A case (through-emergency department)–control (elective (EA)) study was conducted (77,052), matched by age, stay severity and type, disease-related group, and discharge mode. Principal findings: Through-emergency department were significantly elderly, more severe, had more intensive care stays, a higher mortality rate, longer length of stay (days) (9.5 ± 12 vs. 6.8 ± 9.5; p < 0.0001), and lower revenues per day (647 ± 451 vs. 721 ± 422; p = 0.01). In case–control study, mean differences between cases and controls were: longer length of stay −0.64 and revenues per day −75.6; for ≥75 years −1.2 and −102.1; medical −0.9 and −90.4; and discharge to facilities care centers −1.5 and −81.8. Among cases, 40% had a stay in observation unit before being admitted in hospital ward. Differences were strongly reduced for patients who did not go to observation unit before being admitted. Differences were reduced from 0.64 to 0.2 days for length of stay and from 79 to 41 euros for revenues per day when patients did not stay in observation unit before being admitted. Conclusions We conclude that admission mode is associated with length of stay and revenues. However, as differences are weak, elective admissions should not be prioritized on economic arguments. Otherwise, our study indicates that among through-emergency department admissions, observation unit stay is associated with longer length of stay and lower revenues.
A Nonrandomized Controlled Trial of Strengths Model Case Management in Hong Kong
Authors: Tsoi Emily W. S. , Tse Samson , Yu Chong-Ho , Chan Sau-Kam , Wan Eppie , Wong Stephen , Liu Lucia 
Published: April 2018

Purpose: This study evaluates the effectiveness of the strengths model of case management (SMCM) for people with severe mental illness in Hong Kong. This is the first controlled trial outside the United States to investigate the impacts of SMCM on caseworkers as well as service users alongside fidelity measures. Method: Service users and their caseworkers were recruited from three types of supported accommodation for this 12-month nonrandomized controlled trial. Mixed modeling was used to investigate within-subject differences. Results: Results indicated that SMCM was effective in helping users progress toward their recovery goals and in alleviating emotional exhaustion among caseworkers. However, it was ineffective in improving, hope, well-being, work alliance, and psychiatric symptoms. High intervention fidelity was associated with positive outcomes. Conclusions: Conceptually, SMCM has the potential to improve service users’ functional but not personal recovery. It is also potentially conducive to the well-being of caseworkers.
Role of Early Palliative Care Interventions in Hematological Malignancies and Bone Marrow Transplant Patients: Barriers and Potential Solutions
Authors: Ruiz Marco , Reynolds Patrick , Marranzini Regina , Khan Alina , Ketterer Jessica , Brahim Amanda 
Published: April 2018

Introduction: Despite advances in palliative care management of physical, psychological, and emotional symptoms along the spectrum of chronic conditions, early palliative care interventions are not used frequently and comprehensively in bone marrow transplant units. Methods: The literature review of PubMed articles in English published until December 2017. Results: Patients with hematologic malignancies and bone marrow transplant interventions are a heterogeneous group. The majority experience symptoms associated with induction or condition regimens. Curative intent of treatment is the norm. Pain, mucositis, nausea and vomiting, diarrhea, psychological, spiritual, and emotional concerns may not be properly and comprehensively tackled by primary oncology and bone marrow transplant teams. Quality of life may be decreased due to the presence of these symptoms. Obstacles to early palliative care interventions include overestimation of survival, focus on curative intent with underestimation of palliative care needs, lack of a comprehensive understanding of hematologic malignancies and bone marrow transplant process on the side of palliative care providers, and logistical restrictions. Potential interventions include education of oncologists, palliative care providers, patients, integration of models of care pre- and posttreatment and bone marrow transplantation, development of guidelines, institutional commitment and leadership in creating new initiatives, clinical research activities to measure outcomes, and community-based participatory research. Conclusions: Early palliative care interventions are beneficial for patients with hematologic malignancies and bone marrow transplant processes. Better understanding of barriers to its implementation and development of creative initiatives is of paramount importance. New research endeavors should focus on providers’ attitudes toward patients and communities.
Short- and Long-Term Effects of Late Maxillary Advancement With the Liou-Alt-RAMEC Protocol in Unilateral Cleft Lip and Palate
Authors: Meazzini Maria Costanza , Zappia Laura B. , Tortora Chiara , Autelitano Luca , Tintinelli Roberto 
Published: April 2018

Objective: The objective of this retrospective longitudinal study was to evaluate short- and long-term results of the application of the Liou Alt-RAMEC (alternate rapid maxillary expansion and constriction) technique, a late orthopedic maxillary protraction technique, with intraoral anchorage, in patients with cleft. Materials and Methods: Twenty-six patients with unilateral cleft lip and palate (UCLP) were consecutively treated with the Alt-RAMEC technique. The average age of the patients was 11.7 years (10.3-13.2 years) before protraction and 18.3 years (17.4-21.1 years) at long-term follow-up. A sample of nontreated patients with UCLP was used as a control group. It was matched for sex, skeletal class III, and age (11.3 years). The control sample had records at the end of growth (18.7 years). Results: The sagittal advancement of A-point, after the application of the technique, was 5.7 (2.17) mm. Some mandibular dentoalveolar and positional adaptation was noted. The position of the maxilla was stable in the long term. On the other hand, the UCLP control group showed hardly any growth at the maxillary level during the long-term follow-up period. Conclusion: Our results showed that the Alt-RAMEC technique, performed at the correct time, with a double-hinged expander, followed by class III spring or elastic traction, 24 hours per day, allows for satisfactory maxillary protraction, with, at this stage, apparently stable long-term results. Nevertheless, as only 50% of the patients had long-term follow-up data, we are still unable to predict the percentage of patients which will not eventually need orthognathic surgery.
Comparison of two types of catheters through femoral vein catheterization in patients with lung cancer undergoing chemotherapy: A retrospective study
Authors: Xu Binbin , Zhang Jinghui , Tang Siyuan , Hou Jianmei , Ma Mengdan 
Published: April 2018

Purpose: This study aimed to investigate the effects and complications of different types of peripherally inserted central catheters through femoral vein catheterization in patients with lung cancer undergoing chemotherapy. Methods: A retrospective analysis of 158 patients with lung cancer undergoing implantation of a venous access through femoral vein catheterization was performed. The patients were divided into two groups by convenience sampling: the single-lumen silicone Groshong peripherally inserted central catheters with valved tip were used in patients in group A, the single-lumen power-injectable polyurethane peripherally inserted central catheters with no valve were used in patients in group B. The gravity flow rate and indwelling time of the catheter and incidences of total obstruction, transient obstruction, irreversible obstruction, catheter-related thrombosis, catheter breakage, and accidental dislodgment were compared between the two groups. Results: The catheter indwelling time and incidences of irreversible obstruction, catheter-related thrombosis, and accidental dislodgment in the two groups were not statistically significantly different ( p > 0.05). The catheter gravity flow rate and incidences of total obstruction, transient obstruction, and catheter breakage were statistically significantly different between the two groups ( p < 0.01). Conclusion: Single-lumen power-injectable peripherally inserted central catheters with no valve had a high gravity flow rate, were strong and not prone to rupture, tolerant to high-pressure injection, and were more suitable for femorally inserted central venous catheterization in patients with lung cancer undergoing chemotherapy.
An Explore Transplant Group Randomized Controlled Education Trial to Increase Dialysis Patients’ Decision-Making and Pursuit of Transplantation
Authors: Waterman Amy D. , Peipert John Devin 
Published: April 2018

Introduction: Dialysis centers must provide transplant education to patients but often do not address the risks and benefits of living and deceased donor transplant. Research Questions: In a group randomized controlled trial of 20 dialysis centers and 253 patients, we assessed whether the Explore Transplant education program increased patients’ readiness to pursue transplant, transplant knowledge, informed transplant decision-making, discussions about transplant with potential living donors, pursuit and receipt of living or deceased donor transplant, and whether these effects varied by race. Methods: Patients at participating dialysis centers were randomized to receive either (1) a 4-module Explore Transplant education program, including videos, printed materials, and transplant educator discussions or (2) standard-of-care transplant education provided by dialysis centers. The trial had 3 phases: (1) pre- and postsurveying and dialysis center education (2007-2008), (2) follow-up to determine whether patients restarted or began transplant evaluation (2008-2010), and (3) assessment of participants’ receipt of a renal transplant (2012-2015). Results: Compared to patients in standard-of-care dialysis centers, patients who received the intervention were more likely to increase in their stage of readiness for living donor transplantation (odds ratio: 2.50; 95% confidence interval: 1.10-5.66), had greater increases in their transplant knowledge ( P < .001), and were more likely to call to restart/begin transplant evaluation (38% vs 24%, P = .006). When analyses were stratified by race, black patients were more likely to take several steps toward transplant in comparison to whites. Discussion: The Explore Transplant helps dialysis patients make informed decisions and increases their pursuit of transplant, particularly among black patients.
A review of epidemiological research on stroke and dementia and exposure to air pollution
Authors: Béjot Yannick , Reis Jacques , Giroud Maurice , Feigin Valery 
Published: April 2018

Background Outdoor air pollution is now a well-known risk factor for morbidity and mortality, and is increasingly being identified as a major risk factor for stroke. Methods A narrative literature review of the effects of short and long-term exposure to air pollution on stroke and dementia risk and cognitive functioning. Results Ten papers on stroke and 17 on dementia were selected. Air pollution, and in particular small particulate matter, contributes to about one-third of the global stroke burden and about one-fifth of the global burden of dementia. It particularly affects vulnerable patients with other vascular risk factors or a prior history of stroke in low- and medium-income countries. New pathophysiological mechanisms of the cause-effect associations are suggested. Conclusion Air pollution should be considered as a new modifiable cerebrovascular and neurodegenerative risk factor. This massive worldwide public health problem requires environmental health policies able to reduce air pollution and thus the stroke and dementia burden.
Efficacy of gamification-based smartphone application for weight loss in overweight and obese adolescents: study protocol for a phase II randomized controlled trial
Authors: Timpel Patrick , Cesena Fernando Henpin Yue , da Silva Costa Christiane , Soldatelli Matheus Dorigatti , Gois Emanuel , Castrillon Eduardo , Díaz Lina Johana Jaime , Repetto Gabriela M. , Hagos Fanah , Castillo Yermenos Raul E. , Pacheco-Barrios Kevin , Musallam Wafaa , Braid Zilda , Khidir Nesreen , Romo Guardado Marcela , Roepke Roberta Muriel Longo 
Published: April 2018

Background: Overweight and obesity are significant public health concerns that are prevalent in younger age cohorts. Preventive or therapeutic interventions are difficult to implement and maintain over time. On the other hand, the majority of adolescents in the United States have a smartphone, representing a huge potential for innovative digitized interventions, such as weight loss programs delivered via smartphone applications. Although the number of available smartphone applications is increasing, evidence for their effectiveness in weight loss is insufficient. Therefore, the proposed study aims to assess the efficacy of a gamification-based smartphone application for weight loss in overweight and obese adolescents. The trial is designed to be a phase II, single-centre, two-arm, triple-blinded, randomized controlled trial (RCT) with a duration of 6 months. Method: The intervention consists of a smartphone application that provides both tracking and gamification elements, while the control arm consists of an identically designed application solely with tracking features of health information. The proposed trial will be conducted in an urban primary care clinic of an academic centre in the United States of America, with expertise in the management of overweight and obese adolescents. Eligible adolescents will be followed for 6 months. Changes in body mass index z score from baseline to 6 months will be the primary outcome. Secondary objectives will explore the effects of the gamification-based application on adherence, as well as anthropometric, metabolic and behavioural changes. A required sample size of 108 participants (54 participants per group) was calculated. Discussion: The benefits of the proposed study include mid-term effects in weight reduction for overweight and obese adolescents. The current proposal will contribute to fill a gap in the literature on the mid-term effects of gamification-based interventions to control weight in adolescents. This trial is a well-designed RCT that is in line with the Consolidated Standards of Reporting Trials statement.