bluuebunny/crossref_metadata_2025_split huggingface dataset:
Probability Distribution of Dose and Dose-Rate Effectiveness Factor for use in Estimating Risks of Solid Cancers From Exposure to Low-Let Radiation
Authors: Kocher David C. , Apostoaei A. Iulian , Hoffman F. Owen , Trabalka John R. 
Published: April 2018

Abstract
This paper presents an analysis to develop a subjective state-of-knowledge probability distribution of a dose and dose-rate effectiveness factor for use in estimating risks of solid cancers from exposure to low linear energy transfer radiation (photons or electrons) whenever linear dose responses from acute and chronic exposure are assumed. A dose and dose-rate effectiveness factor represents an assumption that the risk of a solid cancer per Gy at low acute doses or low dose rates of low linear energy transfer radiation, R
L, differs from the risk per Gy at higher acute doses, R
H; R
L is estimated as R
H divided by a dose and dose-rate effectiveness factor, where R
H is estimated from analyses of dose responses in Japanese atomic-bomb survivors. A probability distribution to represent uncertainty in a dose and dose-rate effectiveness factor for solid cancers was developed from analyses of epidemiologic data on risks of incidence or mortality from all solid cancers as a group or all cancers excluding leukemias, including (1) analyses of possible nonlinearities in dose responses in atomic-bomb survivors, which give estimates of a low-dose effectiveness factor, and (2) comparisons of risks in radiation workers or members of the public from chronic exposure to low linear energy transfer radiation at low dose rates with risks in atomic-bomb survivors, which give estimates of a dose-rate effectiveness factor. Probability distributions of uncertain low-dose effectiveness factors and dose-rate effectiveness factors for solid cancer incidence and mortality were combined using assumptions about the relative weight that should be assigned to each estimate to represent its relevance to estimation of a dose and dose-rate effectiveness factor. The probability distribution of a dose and dose-rate effectiveness factor for solid cancers developed in this study has a median (50th percentile) and 90% subjective confidence interval of 1.3 (0.47, 3.6). The harmonic mean is 1.1, which implies that the arithmetic mean of an uncertain estimate of the risk of a solid cancer per Gy at low acute doses or low dose rates of low linear energy transfer radiation is only about 10% less than the mean risk per Gy at higher acute doses. Data were also evaluated to define a low acute dose or low dose rate of low linear energy transfer radiation, i.e., a dose or dose rate below which a dose and dose-rate effectiveness factor should be applied in estimating risks of solid cancers.
SURGICAL OUTCOMES AFTER INVERTED INTERNAL LIMITING MEMBRANE FLAP VERSUS CONVENTIONAL PEELING FOR VERY LARGE MACULAR HOLES
Authors: Narayanan Raja , Singh Sumit R. , Taylor Stanford , Berrocal Maria H. , Chhablani Jay , Tyagi Mudit , Ohno-Matsui Kyoko , Pappuru Rajeev R. , Apte Rajendra S. 
Published: April 2018

Purpose:
To evaluate the anatomical and visual outcomes of inverted flap technique of peeling of internal limiting membrane (ILM) versus standard peeling of ILM for macular holes of basal diameter more than 800 μm.

Methods:
Patients with very large idiopathic macular holes more than 800 μm in basal diameter (ranging from 243 μm to 840 μm in minimum diameter) were retrospectively included in the study. In Group A, 18 eyes of 18 patients underwent ILM peeling using the inverted flap technique. In Group B, 18 eyes of 18 patients underwent conventional ILM peeling. The primary endpoint was the rate of hole closure at 6 months after surgery. The secondary outcome measure was the change in best-corrected visual acuity at 6 months after surgery.

Results:
There were no significant differences in ocular characteristics of the study groups at baseline except for the age distribution. Mean macular hole diameter was 1,162.8 ± 206.0 μm and 1,229.6 ± 228.1 μm in Group A and Group B, respectively. The hole closure rate was 88.9% (16/18) in Group A and 77.8% (14/18) in Group B (P = 0.66). The mean gain in best-corrected visual acuity was higher in Group A than in Group B (P = 0.12) at 6 months, but this was not statistically significant. There were no severe ocular adverse events in either group.

Conclusion:
In this multicenter series, inverted ILM flap technique did not lead to significantly higher anatomical closure rates than conventional ILM peeling in large macular holes more than 800 μm in diameter.
Chemokine (c-c motif) receptor 2 mediates mechanical and cold hypersensitivity in sickle cell disease mice
Authors: Sadler Katelyn E. , Zappia Katherine J. , O'Hara Crystal L. , Langer Sarah N. , Weyer Andy D. , Hillery Cheryl A. , Stucky Cheryl L. 
Published: April 2018

AbstractApproximately one-third of individuals with sickle cell disease (SCD) develop chronic pain. This debilitating pain is inadequately treated because the underlying mechanisms driving the pain are poorly understood. In addition to persistent pain, patients with SCD are also in a tonically proinflammatory state. Previous studies have revealed that there are elevated plasma levels of many inflammatory mediators including chemokine (c-c motif) ligand 2 (CCL2) in individuals with SCD. Using a transgenic mouse model of SCD, we investigated the contributions of CCL2 signaling to SCD-related pain. Inhibition of chemokine receptor 2 (CCR2), but not CCR4, alleviated the behavioral mechanical and cold hypersensitivity in SCD. Furthermore, acute CCR2 blockade reversed both the behavioral and the in vitro responsiveness of sensory neurons to an agonist of TRPV1, a neuronal ion channel previously implicated in SCD pain. These results provide insight into the immune-mediated regulation of hypersensitivity in SCD and could inform future development of analgesics or therapeutic measures to prevent chronic pain.
Stigmatization of Overweight and Obese Women During Forensic Examinations
Authors: Davis Karis M. , Sekula L. Kathleen 
Published: April 2018

ABSTRACT
Stigma and discrimination toward overweight and obese people pose consequences to their psychological and physical health. In the United States, overweight and obesity and affects over 34% of the population. This frequently ignored public health issue often sees overweight and obese individuals blamed for their weight, thereby justifying the bias. During a post-sexual-assault examination, sexual assault nurse examiners and other forensic examiners must be cognizant of the specific issues and challenges related to the care of these victims. Forensic nurses may need to refine their techniques such as positioning overweight and obese patients on an appropriate-sized table, obtaining equipment for better visualization, and requiring assistance during the examination (e.g., lifting the victim's pendulous skin folds for assessment and evidence collection). Moreover, they may need to recognize and reflect on their own weight related biases. Addressing these important issues may lead to decreasing stigmatization during examinations, thereby providing quality care to victims of sexual assault, regardless of their weight.
Clinical Implications of the Association Between Temporal Bone Tegmen Defects and Superior Semicircular Canal Dehiscence
Authors: Handzel Ophir , Brenner-Ullman Adi , Cavel Oren , Oron Yahav , Wasserzug Oshri , Fliss Dan M. , Ungar Omer J. 
Published: April 2018

Objective:
To discuss the clinical implications of the association between temporal bone tegmen dehiscence (TD) necessitating surgical correction and the adjacent dehiscent superior semicircular canal (SSCD).

Study Design:
Retrospective.

Setting:
Tertiary referral center.

Patients:
Sixteen patients with idiopathic TD, with or without SSCD, requiring surgical correction.

Interventions:
Corrective surgery for TD. High-resolution temporal bone-targeted computed tomography.

Main Outcome Measures:
The impact of the minimal distance between TD and SSCD or the arcuate eminence on the choice of surgical approach to TD.

Results:
The patients’ median age was 58 years and 5 were males. The median body mass index was 31.8 kg/m2. The average distance from the TD and the SSC was 4.9 mm (range 2.1–14.2 mm). Three of the 14 patients who were operated via a temporal craniotomy to fix a cerebrospinal fluid-leaking TD required plugging of an asymptomatic SSCD due to its close proximity (3–5 mm) to the defect, and two of them had relatively protracted vestibular recuperation. Two patients were operated via a transmastoid approach for sealing a cerebrospinal fluid-leaking TD coexisting with a bilateral asymptomatic SSCD. No patient had a hearing loss.

Conclusion:
The close proximity of a TD and an SSCD might not allow selective exposure. As a result, asymptomatic SSCD may become symptomatic during TD correction via the temporal craniotomy approach. The need to plug an asymptomatic SSCD that is proximal to a TD should be factored in planning for surgery and rehabilitation. The choice of surgical approach (middle fossa vs. transmastoid) could be influenced by this relationship, especially in cases of bilateral lesions.
Effects of inflammatory bowel disease treatment on the risk of nonalcoholic fatty liver disease: a meta-analysis
Authors: Lapumnuaypol Kamolyut , Kanjanahattakij Napatt , Pisarcik David , Thongprayoon Charat , Wijarnpreecha Karn , Cheungpasitporn Wisit 
Published: April 2018

Background
Epidemiological studies have demonstrated an association between inflammatory bowel disease (IBD) and an increased risk for the development of nonalcoholic fatty liver disease (NAFLD). However, the risk of NAFLD in IBD patients who receive different medical treatments including glucocorticoids, immunomodulators, and tumor necrosis factor-α inhibitors remains unclear. We aimed to assess whether the use of certain IBD medications is associated with the development of NAFLD.

Materials and methods
A systematic review was carried out in Medline, Embase, and Cochrane databases from inception through October 2017 to identify studies that assessed the association between the use of IBD medications and the risk of developing NAFLD. Effect estimates from the individual study were derived and combined using random-effect, generic inverse variance method of DerSimonian and Laird.

Results
Seven observational studies with a total of 1610 patients were enrolled. There was no significant association between the use of IBD medications and the incidence of NAFLD. The pooled odds ratios of NAFLD in patients who use biological agents, immunomodulators, methotrexate, and steroids were 0.85 [95% confidence interval (CI): 0.49–1.46], 1.19 (95% CI: 0.70–2.01), 3.62 (95% CI: 0.48–27.39), and 1.24 (95% CI: 0.85–1.82), respectively. Egger’s regression asymmetry test was performed and showed no publication bias.

Conclusion
Our study demonstrates no significant association between medications used in the treatment of IBD and the risk of developing NAFLD. The findings of our study suggest a complex, multifactorial relationship between IBD and the development of NAFLD beyond the scope of current pharmacological intervention.
Advances in the role of the aryl hydrocarbon receptor to regulate early hematopoietic development
Authors: Angelos Mathew G. , Kaufman Dan S. 
Published: April 2018

Purpose of review
We summarize current advances to define the role the aryl hydrocarbon receptor (AHR) plays in mammalian hematopoiesis. We emphasize approaches to modulate AHR throughout human hematopoietic development in vitro to support the production of clinically relevant blood products suitable for patient care.

Recent findings
Initial data demonstrate that both pharmacologic AHR inhibition and genetic deletion from human pluripotent stem cells provide useful strategies to enhance the yield of hematopoietic stem and progenitor cells. AHR hyperactivation following the induction of CD34+ megakaryocyte–erythroid progenitors skews developed toward erythroid lineages, whereas AHR inhibition supports platelet production. At the level of lymphoid specification, AHR inhibition enhances the proliferation and differentiation of functional human natural killer cells, whereas hyperactivation leads to production of Group 3 innate lymphoid cells and provides a novel platform for studying human innate lymphoid cell development.

Summary
Modulation of AHR in human hematopoietic cells in vitro is a promising tool to mediate development of terminal hematopoietic cell populations with significant clinical implications to generate cells suitable for antitumor immunotherapy and bone marrow transplantation.
A sustainable model for cochlear implantation in the developing world: perspectives from the Indian subcontinent
Authors: Sampath Kumar Raghunandhan , Kameswaran Mohan 
Published: April 2018

Purpose of reviewThe overall prevalence of deafness in India is 0.2%, but the prevalence in the southern state of Tamil Nadu is much higher (around 0.6%) because of consanguinity. Especially in India, establishing cochlear implantation as a treatment modality for hearing loss has been a daunting task, but in the last decade, the cochlear implantation program has emerged as an unqualified success in many states, with over 20 000 cochlear implantations done till date. Several states are sponsoring free implants to children under the age of 6 years and below poverty line.Recent findingsNearly 3000 cochlear implantations have been performed in Tamil Nadu under the Chief Minister's Comprehensive Health Insurance Scheme, with the goal to have a ‘deafness free Tamil Nadu’ by 2025. This scheme covers nearly 40 million people in rural areas. Valuable lessons have been learnt from this social experiment. One of the cornerstones of this scheme is the method to deliver habilitation via satellite centers in rural areas at the doorstep of the patient. The outcomes in peripheral centers were found to be statistically similar to those in the main center and correlated well with duration of habilitation.SummaryOpening up satellite centers for habilitation across the state of Tamil Nadu has greatly helped to improve the attendance and outcomes. The Indian model has been hugely successful and has helped start similar cochlear implantation programs in neighboring countries such as Nepal, Sri Lanka and Bangladesh.
An Unlikely Cause of a Blunt Pancreatic Injury
Authors: Cully Matthew , Perry Jonathan , Titus M. Olivia 
Published: April 2018

Abstract
We report the case of a 17-year-old male football player with blunt abdominal trauma. Careful evaluation, including computed tomography and laboratory, revealed a pancreatic body laceration. Pancreatic injuries are relatively uncommon and associated with significant morbidity and mortality and require early diagnosis for optimal management and outcome.
Early Hospital Discharge After Helicopter Transport of Pediatric Trauma Patients
Authors: Fahy Aodhnait S. , Polites Stephanie F. , Thiels Cornelius A. , Parker Maile , Ishitani Michael B. , Moir Christopher R. , Berns Kathleen , Zietlow Scott P. , Jenkins Donald H. , Zielinski Martin D. 
Published: April 2018

Objectives
Helicopter air ambulance (HAA) of pediatric trauma patients is a life-saving intervention. Triage remains a challenge for both scene transport and interhospital transfer of injured children. We aimed to understand whether overtriage or undertriage was a feature of scene or interhospital transfer and how in or out of state transfers affected these rates.

Methods
Children (<18 years) who underwent trauma activation at a level I trauma center between 2011 and 2013 were identified and reviewed. Patients transported by HAA were compared with those transported by ground ambulance (GA).

Results
Of 399 pediatric patients (median age, 10.4 years; range, 0.1–17 years; 264 male [66%]), 71 (18%) were transported by HAA. Seventy-two percent of HAA patients went to the intensive care unit or the operating room from the trauma bay or suffered in-hospital mortality (vs 42% GA, P < 0.001). More patients were overtriaged (HAA with injury severity score [ISS] of <15) from interhospital transfers than from the scene (25% vs 3%, P = 0.002). Undertriage (GA with ISS >15) was acceptable at 5% from the scene and 14% from interhospital transfers (P = 0.08). Overtriage of patients with ISS less than 15 to HAA was significantly lower from in-state hospitals (22%) than out-of-state hospitals (45%) (P = 0.02). Undertriage of patients with ISS greater than 15 to GA was also lower from in-state hospitals (20%) versus out-of-state hospitals (38%) (P = 0.03).

Conclusions
Triage of pediatric trauma patients to HAA remains difficult. There remains potential for improvement, particularly as regards interhospital HAA overtriage, but well developed transfer protocols (such in-state protocols) may help.
Accuracy of Bedside Ultrasound for the Diagnosis of Skull Fractures in Children Aged 0 to 4 Years
Authors: Choi Jea Yeon , Lim Yong Su , Jang Jae Ho , Park Won Bin , Hyun Soung Youl , Cho Jin Seong 
Published: April 2018

Objectives
The aim of this study was to investigate the accuracy of bedside ultrasound (US) performed by emergency physicians for diagnosing skull fractures in children 0 to 4 years old compared with the accuracy of head computed tomography (CT). We also sought to investigate characteristics and precautions associated with US.

Methods
This single-center prospective study involved children 0 to 4 years old who had a history of head trauma. Bedside US was performed by emergency medicine physicians, and the results were compared with CT scan interpretations provided by attending radiologists. The accuracy of US for the diagnosis of skull fractures was calculated, and the errors were reviewed.

Results
A total of 87 patients were enrolled. Skull fracture was present in 13 patients (14.9%), according to CT. Bedside US had a sensitivity and specificity of 76.9% (95% confidence interval [CI], 46.0%–93.8%) and 100% (95% CI, 93.9%–100%), respectively. Overall positive predictive value was 100% (95% CI, 65.5%–100%), and negative predictive value was 96.1% (95% CI, 88.3%–99.0%). Three false-negative cases were observed.

Conclusions
Bedside US performed by emergency medicine physicians with short focused US training is a useful tool for diagnosing skull fractures in children 0 to 4 years of age. However, there were 3 false-negative cases. A meticulous examination is needed in the area adjacent to the orbital wall and skull base.
Disparities in Adherence to Pediatric Diabetic Ketoacidosis Management Guidelines Across a Spectrum of Emergency Departments in the State of Indiana
Authors: Abulebda Kamal , Abu-Sultaneh Samer , White Erin E. , Kirby Michele L. , Phillips Brian C. , Frye Courtney T. , Murphy Lee D. , Lutfi Riad 
Published: April 2018

Background
Diabetic ketoacidosis (DKA) is a common presentation to an emergency department (ED), with the majority presenting to community EDs. Adherence to clinical guidelines in these EDs can reduce morbidity and mortality. Few methods to describe practice gaps for DKA management have been reported.

Objectives
We hypothesized that high-fidelity in situ simulation can be used to measure and compare the quality of the care provided to pediatric patients with DKA presenting to community EDs in the state of Indiana.

Methods
This observational study examined multiprofessional teams caring for a simulated pediatric patient who presented with DKA to community EDs. The primary outcome was overall adherence to pediatric DKA guidelines as measured by a validated performance checklist. A composite adherence score (CAS) was calculated using the sum of 9 checklist performance parameters. Multivariable logistic regression was used to examine the impact of ED volume and characteristics on the scores.

Results
A 49 multiprofessional teams from 13 sites were enrolled. Of the 252 participants, 26 (10.3%) were physicians, 143 (56.7%) registered nurses, 25 (9.9%) respiratory therapists, and 58 (23.0%) were other. The overall CAS for all sites was 55.6% (25th, 75th interquartile range, 44.4%, 66.7%). Excessive intravenous fluid boluses were given by 53.1%, whereas 30.6% and 26.5% incorrectly administered insulin and sodium bicarbonate boluses, respectively. Only 10.2% used an appropriate intravenous fluid rate, and 57.1% performed an hourly glucose. No significant difference in the CAS was found due to pediatric ED volume or presence of an inpatient pediatric service.

Conclusions
Using validated in situ simulation; we revealed high variability in adherence to the pediatric DKA management guidelines at a wide range of community EDs. A statewide education initiative focused on decreasing variation and improving adherence to pediatric DKA guidelines is necessary for patient safety.
Long-term Outcomes of Laparoscopic Versus Open Surgery for Clinical Stage II/III Gastric Cancer
Authors: Kinoshita Takahiro , Uyama Ichiro , Terashima Masanori , Noshiro Hirokazu , Nagai Eishi , Obama Kazutaka , Tamamori Yutaka , Nabae Toshinaga , Honda Michitaka , Abe Takayuki 
Published: April 2018

Objective:
A large-scale multicenter historical cohort study was conducted to investigate the efficacy of laparoscopic gastrectomy (LG) in comparison to open gastrectomy (OG) for locally advanced gastric cancer.

Background:
LG is now practiced widely, but its applicability for advanced gastric cancer is still controversial. As oncologic outcomes of randomized trials are still pending, there is an urgent need for information that would be relevant to current practice.

Methods:
Through a consensus meeting involving surgeons and biostatisticians, 30 preoperative variables possibly influencing the choice of surgical approach and associated with outcome were identified to enable rigorous estimation of propensity scores. A total of 1948 consecutive patients who underwent gastrectomy for clinical stage II/III gastric adenocarcinoma between 2008 and 2014 were identified, and their clinical data were collected from 8 participating hospitals. After propensity score matching, 610 cases (OG = 305, LG = 305) were finally selected for comparison of long-term outcomes.

Results:
In the propensity-matched OG and LG populations, the mean observation period was 3.5 and 3.4 years, and the 5-year overall survival was 53.0% and 54.2%, respectively. The hazard ratio (LG/OG) for overall survival was 1.01 (95% confidence interval, 0.80–1.29), and noninferiority of LG was demonstrated statistically as the upper 95% confidence limit was less than the prespecified margin (1.33). The recurrence rate was 30.8% and 29.8% for OG and LG, respectively, and the hazard ratio for recurrence was 0.98 (95% confidence interval, 0.74–1.31). The patterns of recurrence in the 2 groups were similar.

Conclusions:
This observational study strictly adjusted for confounding factors has provided evidence to suggest that LG is oncologically comparable to OG for locally advanced gastric cancer. The validity of this result will be examined in ongoing randomized trials.