bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnancy Outcomes in Women With Rheumatic Mitral Valve Disease
Authors: van Hagen Iris M. , Thorne Sara A. , Taha Nasser , Youssef Ghada , Elnagar Amro , Gabriel Harald , ElRakshy Yahia , Iung Bernard , Johnson Mark R. , Hall Roger , Roos-Hesselink Jolien W. 
Published: February 2018

Background:
Cardiac disease is 1 of the major causes of maternal mortality. We studied pregnancy outcomes in women with rheumatic mitral valve disease.

Methods:
The Registry of Pregnancy and Cardiac Disease is an international prospective registry, and consecutive pregnant women with cardiac disease were included. Pregnancy outcomes in all women with rheumatic mitral valve disease and no prepregnancy valve replacement is described in the present study (n=390). A maternal cardiac event was defined as cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, and hospitalization for other cardiac reasons or cardiac intervention. Associations between patient characteristics and cardiac outcomes were checked in a 3-level model (patient–center–country).

Results:

Most patients came from emerging countries (75%). Mitral stenosis (MS) with or without mitral regurgitation (MR) was present in 273 women, isolated MR in 117. The degree of MS was mild in 20.9%, moderate in 39.2%, severe in 19.8%, and severity not classified in the remainder. Maternal death during pregnancy occurred in 1 patient with severe MS. Hospital admission occurred in 23.1% of the women with MS, and the main reason was heart failure (mild MS 15.8%, moderate 23.4%, severe 48.1%;
P
<0.001). Heart failure occurred in 23.1% of patients with moderate or severe MR. An intervention during pregnancy was performed in 16 patients, 14 had percutaneous balloon mitral commissurotomy, and 2 had surgical valve replacement (1 for MS, 1 for MR). In multivariable modeling, prepregnancy New York Heart Association class >1 was an independent predictor of maternal cardiac events. Follow-up at 6 months postpartum was available for 53%, and 3 more patients died (1 with severe MS, 1 with moderate MS, 1 with moderate to severe MR).

Conclusions:
Although mortality was only 1.9% during pregnancy, ≈50% of the patients with severe rheumatic MS and 23% of those with significant MR developed heart failure during pregnancy. Prepregnancy counseling and considering mitral valve interventions in selected patients are important to prevent these complications.
Predictors of Thrombolysis Administration in Mild Stroke
Authors: Asdaghi Negar , Wang Kefeng , Ciliberti-Vargas Maria A. , Gutierrez Carolina Marinovic , Koch Sebastian , Gardener Hannah , Dong Chuanhui , Rose David Z. , Garcia Enid J. , Burgin W. Scott , Zevallos Juan Carlos , Rundek Tatjana , Sacco Ralph L. , Romano Jose G. 
Published: February 2018

Background and Purpose—
Mild stroke is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable among different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD registry (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities).

Methods—
Among 73 712 prospectively enrolled patients with a final diagnosis of ischemic stroke or TIA from January 2010 to April 2015, we identified 7746 cases with persistent neurological symptoms and National Institutes of Health Stroke Scale ≤5 who arrived within 4 hours of symptom onset. Multilevel logistic regression analysis with generalized estimating equations was used to identify independent predictors of thrombolytic administration in the subgroup of patients without contraindications to thrombolysis.

Results—
We included 6826 cases (final diagnosis mild stroke, 74.6% and TIA, 25.4%). Median age was 72 (interquartile range, 21); 52.7% men, 70.3% white, 12.9% black, 16.8% Hispanic; and median National Institutes of Health Stroke Scale, 2 (interquartile range, 3). Patients who received thrombolysis (n=1281, 18.7%) were younger (68 versus 72 years), had less vascular risk factors (hypertension, diabetes mellitus, and dyslipidemia), had lower risk of prior vascular disease (myocardial infarction, peripheral vascular disease, and previous stroke), and had a higher presenting median National Institutes of Health Stroke Scale (4 versus 2). In the multilevel multivariable model, early hospital arrival (arrive by 0–2 hours versus ≥3.5 hours; odds ratio [OR], 8.16; 95% confidence interval [CI], 4.76–13.98), higher National Institutes of Health Stroke Scale (OR, 1.87; 95% CI, 1.77–1.98), aphasia at presentation (OR, 1.35; 95% CI, 1.12–1.62), faster door-to-computed tomography time (OR, 1.81; 95% CI, 1.53–2.15), and presenting to an academic hospital (OR, 2.02; 95% CI, 1.39–2.95) were independent predictors of thrombolysis administration.

Conclusions—
Mild acutely presenting stroke patients are more likely to receive thrombolysis if they are young, white, or Hispanic and arrive early to the hospital with more severe neurological presentation. Identification of predictors of thrombolysis is important in design of future studies to assess the use of thrombolysis for mild stroke.
Civil Forensic Psychiatry – part 3: practical aspects of managing a medico-legal practice
Authors: Samuels Anthony H 
Published: February 2018

Objectives: This is the third in a series of papers on Civil Forensic Psychiatry and provides practical advice for forensic psychiatrists, general psychiatrists and trainees who are expanding or contemplating a medico-legal aspect to their practice. Conclusions: Attention to the practice setting, office layout, recording of information, management of documentation, screening of briefs and proper timetabling can improve safety, quality, reliability and workload manageability.
Going the distance: reviewing antipsychotic depot or long-acting injectable treatments in Australasia
Authors: Theodoros Theo , Taylor Mark , Huang Hannah Chu-Han , Wang Nancy , Motamarri Balaji 
Published: February 2018

Objectives: The aim of this study is to provide an opinion paper reviewing the role of depot or long-acting injectable (LAI) antipsychotic medications, with comments on individual newer LAIs such aripiprazole maintena and paliperidone palmitate. In particular, we share our recent experience of using paliperidone three-monthly LAI. We also reflect on the associated benefits and potential harms of LAIs, and when they may be used. Conclusions: LAI antipsychotics are an important and arguably under-utilised therapeutic option, particularly where medication adherence is a priority, and where an informed patient opts for this formulation. Paliperidone is the first three-monthly LAI antipsychotic, and as such represents a significant advance in the range of treatment choices.
Beck Depression Inventory as a screening tool for depression in chronic haemodialysis patients
Authors: Bautovich Alison , Katz Ivor , Loo Colleen Ken , Harvey Samuel B 
Published: February 2018

Objectives: To evaluate the psychometric properties of the Beck Depression Inventory (BDI) and Cognitive Depression Index (CDI) as a potential screening tool for major depression in haemodialysis (HD) patients. Methods: Forty-five HD patients completed both the BDI/CDI and diagnostic interview. The interview was conducted by two experienced clinicians and was based on DSM-IV criteria. The sensitivity, specificity and positive (PPV) and negative (NPV) predictive values were then calculated. Results: A diagnosis of depression was found in 6 of the 45 participants (13.3%). Optimal cut-offs were ≥18 for the BDI (sensitivity 1.0, specificity 0.90, PPV 0.60, NPV 1.0) and ≥11 for the CDI (sensitivity 1.0, specificity 0.92, PPV 0.67, NPV 1.0). Conclusions: Both the BDI and CDI were shown to be acceptable screening tools for depression in this population of chronic HD patients. The recommended cut-off scores for both scales are higher than those suggested for the general population and slightly higher than previously found in the chronic kidney disease literature, suggesting that altered thresholds are required when using these screening tools amongst HD patients.
Enabling choice, recovery and participation: evidence-based early intervention support for psychosocial disability in the National Disability Insurance Scheme
Authors: Hayes Laura , Brophy Lisa , Harvey Carol , Tellez Juan Jose , Herrman Helen , Killackey Eoin 
Published: February 2018

Objectives: The aim of this study was to identify the most effective interventions for early intervention in psychosocial disability in the National Disability Insurance Scheme (NDIS) through an evidence review. Methods: A series of rapid reviews were undertaken to establish possible interventions for psychosocial disability, to develop our understanding of early intervention criteria for the NDIS and to determine which interventions would meet these criteria. Results: Three interventions (social skills training, supported employment and supported housing) have a strong evidence base for effectiveness in early intervention in people with psychosocial disability, with the potential for adoption by the NDIS. They support personal choice and recovery outcomes. Illness self-management, cognitive remediation and cognitive behavioural therapy for psychosis demonstrate outcomes to mitigate impairment. The evidence for family psycho-education is also very strong. Conclusions: This review identified evidence-based, recovery-oriented approaches to early intervention in psychosocial disability. They meet the criteria for early intervention in the NDIS, are relevant to participants and consider their preferences. Early intervention has the potential to save costs by reducing participant reliance on the scheme.
Referral patterns and implementation costs of the Partners in Recovery initiative in Gippsland: learnings for the National Disability Insurance Scheme
Authors: Isaacs Anton N , Dalziel Kim , Sutton Keith , Maybery Darryl 
Published: February 2018

Objective: The purpose of this paper is to provide some learnings for the NDIS from the referral pattern and cost of implementing the Partners in Recovery initiative of Gippsland. Method: Information on referral areas made for each consumer was collated from support facilitators. Cost estimates were determined using budget estimates, administrative costs and a literature review and are reported from a government perspective. Results: Sixty-three per cent of all referrals were made to organisations that provided multiple types of services. Thirty-one per cent were to Mental Health Community Support Services. Eighteen per cent of referrals were made to clinical mental health services. The total cost of providing the service for a consumer per year (set-up and ongoing) was estimated to be AUD$15,755 and the ongoing cost per year was estimated to be AUD$13,434. The cost of doing nothing is likely to cost more in the longer term, with poor mental health outcomes such as hospital admission, unemployment benefits, prison, homelessness and psychiatric residential care. Conclusions: Supporting recovery in persons with Severe and Persistent Mental Illness is likely to be economically more beneficial than not doing so. Recovery can be better supported when frequently utilised services are co-located. These might be some learnings for the NDIS.
Apixaban or Rivaroxaban Versus Warfarin for Treatment of Submassive Pulmonary Embolism After Catheter-Directed Thrombolysis
Authors: Groetzinger Lara M. , Miller Taylor J. , Rivosecchi Ryan M. , Smith Roy E. , Gladwin Mark T. , Rivera-Lebron Belinda N. 
Published: February 2018

Background: Little data exist on the use of direct oral anticoagulant (DOAC) factor Xa inhibitors for submassive pulmonary embolism (PE) after catheter-directed thrombolysis (CDT). The objective of this evaluation was to determine whether the transition from parenteral anticoagulation to DOACs for submassive PE after CDT would decrease hospital length of stay (LOS) compared to warfarin. Methods: A retrospective review of patients diagnosed with submassive PE who underwent CDT was conducted from January 1, 2012, to February 28, 2017. Hospital LOS and major and minor bleeding events were recorded during hospitalization and at 90 days. Results: Sixty-two patients met the inclusion criteria, 36 in warfarin group and 26 in the DOAC group. Overall, patients receiving rivaroxaban or apixaban had a shorter median hospital LOS compared to warfarin (4.0 vs 6.1 days, P = .002). In the multivariate regression analysis, administration of DOAC was an independent predictor of decreased hospital LOS, β: −2.1, 95% confidence interval (−3.5 to −0.7). Conclusion: Among patients with submassive PE, initiation of a DOAC shortly after CDT may result in a decreased hospital LOS compared to parenterally bridged warfarin.
Optimal safe implantation corridors in feline cervical vertebrae (C2–T1): CT study in 16 domestic shorthair cats
Authors: Espadas Irene , Maddox Thomas W , de Vicente Felipe 
Published: February 2018

Objectives The objective of this study was to define safe corridors for the optimal placement of bicortical implants in the feline cervical spine (C2–T1) using CT. Methods CT images of feline cervical spines (n = 16) were reviewed retrospectively. Multiplanar reconstructions were used to define the optimal safe corridors. Safe corridors were defined by their angle of insertion, width and length. The insertion point within the vertebral body was also described. Vertebral measurements were compared between vertebrae using multilevel linear regression, and left and right measurements within vertebrae were compared with the paired samples Wilcoxon signed-rank test. A P value <0.05 was considered significant for all analyses. Results The safe corridor insertion points were located within the caudal third of the vertebral body in C2 (mean cranial vertebral ratio 0.73) and in the cranial third of the vertebral bodies from C3–T1 (mean cranial vertebral ratios 0.34–0.38). Mean safe corridor widths ranged from 1.04 mm in C2 to 2.30 mm in C7 and T1. The mean right and left optimal angles of implantation were, respectively, 21.79° and 21.49° for C2, 45.26° and 46.19° for C3, 51.48° and 51.04° for C4, 53.52° and 54.30° for C5, 56.36° and 56.65° for C6, 63.40° and 64.92° for C7, and 53.90° and 52.90° for T1. There were statistically significant differences between vertebrae in almost every measurement. Conclusions and relevance Cervical vertebral safe corridors in cats are narrow and differ to those reported in dogs. Safe corridors are located in the caudal third of C2 and cranial third of the C3–T1 vertebral bodies. Current recommendations for implant sizes should be reviewed, as 1.5–2 mm implants would be oversized for bicortical implantation in most of the feline cervical vertebrae.
Low serum zinc levels predict presence of depression symptoms, but not overall disease outcome, regardless of ATG16L1 genotype in Crohn’s disease patients
Authors: Greuter Thomas , Franc Yannick , Kaelin Matthias , Schoepfer Alain M. , Schreiner Philipp , Zeitz Jonas , Scharl Michael , Misselwitz Benjamin , Straumann Alex , Vavricka Stephan R. , Rogler Gerhard , von Känel Roland , Biedermann Luc 
Published: February 2018

Background: Zinc deficiency (ZD) in Crohn’s disease (CD) is considered a frequent finding and may exacerbate CD activity. ZD is associated with depression in non-CD patients. We aimed to assess the prevalence of ZD in CD patients in clinical remission, its association with mood disturbances and to analyze a potential impact on future disease course. Methods: Zinc levels from CD patients in clinical remission at baseline and an uncomplicated disease course within the next 3 years ( n = 47) were compared with those from patients developing complications ( n = 50). Baseline symptoms of depression and anxiety were measured with the Hospital Anxiety and Depression scale. Results: Mean zinc level in the 97 patients (40.4 ± 15.7 years, 44.3% males) was 18.0 ± 4.7 μmol/l. While no ZD (<11 μmol/l) was observed, we found low zinc levels (<15.1 μmol/l) in 28 patients (28.9%). Males had higher zinc levels compared with females (19.4 ± 5.7 versus 16.8 ± 3.3, p = 0.006). Patients with low zinc levels more often reported depression symptoms compared with patients with higher levels (27.3 versus 9.4%, p = 0.047). In a multivariate analysis, zinc levels were an independent negative predictor for depression symptoms [odds ratio (OR) 0.727, 95% confidence interval (CI) 0.532–0.993, p = 0.045]. Zinc levels of patients with a complicated disease course were not different from those of patients without (17.7 ± 4.3 versus 18.3 ± 5.1, n.s.). Baseline zinc levels did not predict disease outcome regardless of ATG16L1 genotype. Conclusion: Low–normal zinc levels were an independent predictor for the presence of depression symptoms in CD patients. Zinc levels at baseline did not predict a complicated disease course, neither in CD patients overall, nor ATG16L1T300A carriers.
Open cystectomy is still alive and well: Outcomes from a single-centre 6-year review
Authors: Dosis Alexios , Dhliwayo Blessing , Jones Patrick , Kovacevic Iva , Yee Jonathan , Ali Omer , Javle Pradip , Blades Rosie 
Published: February 2018

Objectives: To compare perioperative and oncological outcomes between open and laparoscopic radical cystectomy in a single-centre setting. Materials and methods: This study was a retrospective cohort (level 2b evidence) non-randomised review of 228 radical cystectomies that were performed between January 2010 and February 2016. Primary outcome measures were operative time, complications, blood loss and length of hospital stay. Statistical analysis was performed using the SPSS v21.0. Quantitative values were compared with Student’s t-test; categorical variables with the chi-square test. Statistical significance was considered a result of an alpha value less than 0.05. A Kaplan–Meier survival analysis was also conducted. Results: Intraoperative blood loss was lower in laparoscopic surgery (855±673 vs. 716±570 mL, P=0.15), which had a significant impact on transfusion rates ( P=0.02). Operative times were lower in open surgery (339±52.9 vs. 353.1±67.1 minutes, P=0.10), while hospital stay was lower in the laparoscopic group (14.2±11.2 vs. 16.0±13.6 days, P=0.28). Five-year survival rates were superior for patients who underwent an open procedure but were not statistically significant ( P=0.10). Conclusion: This is, so far, the largest cohort to compare laparoscopic and open radical cystectomy. The laparoscopic approach can reduce the need for transfusion; however, there was no statistically significant difference in complication rates, duration of surgery, length of hospital stay or intraoperative blood loss, survival and margin positivity. Level of evidence: Not applicable for this multicentre audit.
A qualitative study of the perspectives of key stakeholders on the delivery of clinical academic training in the East Midlands
Authors: Green Ruth H , Evans Val , MacLeod Sheona , Barratt Jonathan 
Published: February 2018

Objective Major changes in the design and delivery of clinical academic training in the United Kingdom have occurred yet there has been little exploration of the perceptions of integrated clinic academic trainees or educators. We obtained the views of a range of key stakeholders involved in clinical academic training in the East Midlands. Design A qualitative study with inductive iterative thematic content analysis of findings from trainee surveys and facilitated focus groups. Setting The East Midlands School of Clinical Academic Training. Participants Integrated Clinical Academic Trainees, clinical and academic educators involved in clinical academic training. Main outcome measures The experience, opinions and beliefs of key stakeholders about barriers and enablers in the delivery of clinical academic training. Results We identified key themes many shared by both trainees and educators. These highlighted issues in the systems and process of the integrated academic pathways, career pathways, supervision and support, the assessment process and the balance between clinical and academic training. Conclusions Our findings help inform the future development of integrated academic training programmes.
The dog that barks doesn’t bite: coverage and compliance of sectoral minimum wages in Italy
Authors: Garnero Andrea 
Published: February 2018

AbstractThis paper provides a comprehensive portrait of the level and compliance with sectoral minimum wages in Italy between 2008 and 2015. The results show that wage floors in Italy are relatively high both in absolute terms and relative to the median wage. However, non-compliance rates are not negligible: on average, around 10% of workers are paid 20% less than the minimum wage established in their reference collective agreement. Non-compliance is particularly high in the South and in micro and small firms, and it affects especially women and temporary workers. Overall, wages in the bottom of the distribution appear to be largely unaffected by minimum wage increases. More effective enforcement practices are therefore needed to safeguard a level playing field for firms and ensure that minimum wage increases are effectively reflected in pay increases for workers at the bottom of the distribution.JEL ClassificationJ08, J31, J52, J83
The alignment of law, practice and need in suicide prevention
Authors: Stallman Helen M. , Ohan Jeneva L. 
Published: February 2018

SummaryHelp-seeking is important for patients with suicidal ideation. Currently, a risk management paradigm is used with patients who express suicidality; however, this may limit support and increase stigma, reducing future help-seeking. Coping planning is proposed as a paradigm shift that overcomes these problems by focusing on patient needs and strengths.Declaration of interestNone.
USP8 Mutations in Pituitary Cushing Adenomas—Targeted Analysis by Next-Generation Sequencing
Authors: Ballmann Cora , Thiel Anne , Korah Hannah E , Reis Anna-Carinna , Saeger Wolfgang , Stepanow Stefanie , Köhrer Karl , Reifenberger Guido , Knobbe-Thomsen Christiane B , Knappe Ulrich J , Scholl Ute I 
Published: February 2018

Abstract
Gain-of-function somatic mutations in the ubiquitin specific protease 8 (USP8) gene have recently been reported as a cause of pituitary adenomas in Cushing disease. Molecular diagnostic testing of tumor tissue may aid in the diagnosis of specimens obtained through therapeutic transsphenoidal surgery; however, for small tumors, availability of fresh tissue is limited, and contamination with normal tissue is frequent. We performed molecular testing of DNA isolated from single formalin-fixed and paraffin-embedded (FFPE) tissue sections of 42 pituitary adenomas from patients with Cushing disease (27 female patients and 15 male patients; mean age at surgery, 42.5 years; mean tumor size, 12.2 mm). By Sanger sequencing, we identified previously reported USP8 missense mutations in six tumors. Targeted next-generation sequencing (NGS) revealed known or previously undescribed missense mutations in three additional tumors (two with two different mutations each), with mutant allele frequencies as low as 3%. Of the nine tumors with USP8 mutations (mutation frequency, 21.4%), seven were from female patients (mutation frequency, 25.9%), and two were from male patients (mutation frequency, 13.3%). Mutant tumors were on average 11.4 mm in size, and patients with mutations were on average 43.9 years of age. The overall USP8 mutation frequency in our cohort was lower than in previously described cohorts, and we did not observe USP8 deletions that were frequent in other cohorts. We demonstrate that testing for USP8 variants can be performed from small amounts of FFPE tissue. NGS showed higher sensitivity for USP8 mutation detection than did Sanger sequencing. Assessment for USP8 mutations may complement histopathological diagnosis.