bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors and Outcomes for Ineffective Empiric Treatment of Sepsis Caused by Gram-Negative Pathogens: Stratification by Onset of Infection
Authors: Micek Scott T. , Hampton Nicholas , Kollef Marin 
Published: November 2017

ABSTRACT

Sepsis and septic shock remain serious consequences of infections, with reported mortality rates in excess of 40 percent. Timely antibiotic therapy in cases of sepsis and septic shock is recognized as an important determinant of outcome. However, the administration of ineffective empirical treatment (IET) (an initial antibiotic regimen that is not active against the identified pathogen[s] based on
in vitro
susceptibility testing results) is associated with excess mortality compared to effective empirical treatment (EET). We examined all hospitalized patients at Barnes-Jewish Hospital with a sterile site (blood or pleural, abdominal, cerebrospinal, synovial, and pericardial fluid) culture positive for Gram-negative (GN) bacteria combined with a primary or secondary ICD-9-CM code for severe sepsis (995.92) or septic shock (785.52) between January 2010 and October 2015. Variables significantly associated with early-onset (<48 h of hospitalization) IET of GN sterile site sepsis and septic shock included age, recent hospitalization, and prior intravenous antibiotics. Late-onset IET was associated with increasing numbers of hospitalization days before infection onset and prior intravenous antibiotic administration. For patients with early-onset infection, we found no difference in rates of survival between patients receiving IET and EET. However, patients in the late-onset infection group receiving IET had a statistically lower rate of survival than those receiving EET. These data suggest that risk factors and outcomes for IET can vary based on the time of onset of infection. Our results also highlight the importance of prior intravenous antibiotic exposure as a risk factor for IET in infections by GN bacteria regardless of the time of onset of infection.
Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: a large-scale implementation study
Authors: Datiko Daniel G , Yassin Mohammed A , Theobald Sally J , Blok Lucie , Suvanand Sahu , Creswell Jacob , Cuevas Luis E 
Published: November 2017

BackgroundTuberculosis (TB) is a major cause of death in Ethiopia. One of the main barriers for TB control is the lack of access to health services.MethodsWe evaluated a diagnostic and treatment service for TB based on the health extension workers (HEW) of the Ethiopian Health Extension Programme in Sidama Zone, with 3.5 million population. We added the services to the HEW routines and evaluated their effect over 4.5 years. 1024 HEWs were trained to identify individuals with symptoms of TB, request sputum samples and prepare smears. Smears were transported to designated laboratories. Individuals with TB were offered treatment at home or the local health post. A second zone (Hadiya) with 1.2 million population was selected as control. We compared TB case notification rates (CNR) and treatment outcomes in the zones 3 years before and 4.5 years after intervention.ResultsHEWs identified 216 165 individuals with symptoms and 27 918 (12%) were diagnosed with TB. Smear-positive TB CNR increased from 64 (95% CI 62.5 to 65.8) to 127 (95% CI 123.8 to 131.2) and all forms of TB increased from 102 (95% CI 99.1 to 105.8) to 177 (95% CI 172.6 to 181.0) per 100 000 population in the first year of intervention. In subsequent years, the smear-positive CNR declined by 9% per year. There was no change in CNR in the control area. Treatment success increased from 76% before the intervention to 95% during the intervention. Patients lost to follow-up decreased from 21% to 3% (p<0.001).ConclusionA community-based package significantly increased case finding and improved treatment outcome. Implementing this strategy could help meet the Ethiopian Sustainable Development Goal targets.
Universal or targeted approach to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae in intensive care units: a cost-effectiveness analysis
Authors: Kardaś-Słoma Lidia , Lucet Jean-Christophe , Perozziello Anne , Pelat Camille , Birgand Gabriel , Ruppé Etienne , Boëlle Pierre-Yves , Andremont Antoine , Yazdanpanah Yazdan 
Published: November 2017

ObjectiveSeveral control strategies have been used to limit the transmission of multidrug-resistant organisms in hospitals. However, their implementation is expensive and effectiveness of interventions for the control of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) spread is controversial. Here, we aim to assess the cost-effectiveness of hospital-based strategies to prevent ESBL-PE transmission and infections.DesignCost-effectiveness analysis based on dynamic, stochastic transmission model over a 1-year time horizon.Patients and settingPatients hospitalised in a hypothetical 10-bed intensive care unit (ICU)in a high-income country.InterventionsBase case scenario compared with (1) universal strategies (eg, improvement of hand hygiene (HH) among healthcare workers, antibiotic stewardship), (2) targeted strategies (eg, screening of patient for ESBL-PE at ICU admission and contact precautions or cohorting of carriers) and (3) mixed strategies (eg, targeted approaches combined with antibiotic stewardship).Main outcomes and measuresCases of ESBL-PE transmission, infections, cost of intervention, cost of infections, incremental cost per infection avoided.ResultsIn the base case scenario, 15 transmissions and five infections due to ESBL-PE occurred per 100 ICU admissions, representing a mean cost of €94 792. All control strategies improved health outcomes and reduced costs associated with ESBL-PE infections. The overall costs (cost of intervention and infections) were the lowest for HH compliance improvement from 55%/60% before/after contact with a patient to 80%/80%.ConclusionsImproved compliance with HH was the most cost-saving strategy to prevent the transmission of ESBL-PE. Antibiotic stewardship was not cost-effective. However, adding antibiotic restriction strategy to HH or screening and cohorting strategies slightly improved their effectiveness and may be worthy of consideration by decision-makers.
Association of psychological distress, quality of life and costs with carpal tunnel syndrome severity: a cross-sectional analysis of the PALMS cohort
Authors: Jerosch-Herold Christina , Houghton Julie , Blake Julian , Shaikh Anum , Wilson Edward CF , Shepstone Lee 
Published: November 2017

ObjectivesThe Prediciting factors for response to treatment in carpal tunnel syndrome (PALMS) study is designed to identify prognostic factors for outcome from corticosteroid injection and surgical decompression for carpal tunnel syndrome (CTS) and predictors of cost over 2 years. The aim of this paper is to explore the cross-sectional association of baseline patient-reported and clinical severity with anxiety, depression, health-related quality of life and costs of CTS in patients referred to secondary care.MethodsProspective, multicentre cohort study initiated in 2013. We collected baseline data on patient-reported symptom severity (CTS-6), psychological status (Hospital Anxiety and Depression Scale), hand function (Michigan Hand Questionnaire) comorbidities, EQ-5D-3L (3-level version of EuroQol-5 dimension) and sociodemographic variables. Nerve conduction tests classified patients into five severity grades (mild to very severe). Data were analysed using a general linear model.Results753 patients with CTS provided complete baseline data. Multivariable linear regression adjusting for age, sex, ethnicity, duration of CTS, smoking status, alcohol consumption, employment status, body mass index and comorbidities showed a highly statistically significant relationship between CTS-6 and anxiety, depression and the EQ-5D (p<0.0001 in each case). Likewise, a significant relationship was observed between electrodiagnostic severity and anxiety (p=0.027) but not with depression (p=0.986) or the EQ-5D (p=0.257). National Health Service (NHS) and societal costs in the 3 months prior to enrolment were significantly associated with self-reported severity (p<0.0001) but not with electrodiagnostic severity.ConclusionsPatient-reported symptom severity in CTS is significantly and positively associated with anxiety, depression, health-related quality of life, and NHS and societal costs even when adjusting for age, gender, body mass index, comorbidities, smoking, drinking and occupational status. In contrast, there is little or no evidence of any relationship with objectively derived CTS severity. Future research is needed to understand the impact of approaches and treatments that address psychosocial stressors as well as biomedical factors on relief of symptoms from carpal tunnel syndrome.
Excess burden of non-communicable disease years of life lost from heat in rural Burkina Faso: a time series analysis of the years 2000–2010
Authors: Bunker Aditi , Sewe Maquins Odhiambo , Sié Ali , Rocklöv Joacim , Sauerborn Rainer 
Published: November 2017

ObjectivesInvestigate the association of heat exposure on years of life lost (YLL) from non-communicable diseases (NCD) in Nouna, Burkina Faso, between 2000 and 2010.DesignDaily time series regression analysis using distributed lag non-linear models, assuming a quasi-Poisson distribution of YLL.SettingNouna Health and Demographic Surveillance System, Kossi Province, Rural Burkina Faso.Participants18 367 NCD-YLL corresponding to 790 NCD deaths recorded in the Nouna Health and Demographic Surveillance Site register over 11 years.Main outcome measureExcess mean daily NCD-YLL were generated from the relative risk of maximum daily temperature on NCD-YLL, including effects delayed up to 14 days.ResultsDaily average NCD-YLL were 4.6, 2.4 and 2.1 person-years for all ages, men and women, respectively. Moderate 4-day cumulative rise in maximum temperature from 36.4°C (50th percentile) to 41.4°C (90th percentile) resulted in 4.44 (95% CI 0.24 to 12.28) excess daily NCD-YLL for all ages, rising to 7.39 (95% CI 0.32 to 24.62) at extreme temperature (42.8°C; 99th percentile). The strongest health effects manifested on the day of heat exposure (lag 0), where 0.81 (95% CI 0.13 to 1.59) excess mean NCD-YLL occurred daily at 41.7°C compared with 36.4°C, diminishing in statistical significance after 4 days. At lag 0, daily excess mean NCD-YLL were higher for men, 0.58 (95% CI 0.11 to 1.15) compared with women, 0.15 (95% CI −0.25 to 9.63) at 41.7°C vs 36.4°C.ConclusionPremature death from NCD was elevated significantly with moderate and extreme heat exposure. These findings have important implications for developing adaptation and mitigation strategies to reduce ambient heat exposure and preventive measures for limiting NCD in Africa.
‘Just a GP’: a mixed method study of undermining of general practice as a career choice in the UK
Authors: Alberti Hugh , Banner Kimberley , Collingwood Helen , Merritt Kymberlee 
Published: November 2017

ObjectivesFailure to recruit sufficient applicants to general practice (GP) training has been a problem both nationally and internationally for many years and undermining of GP is one possible contributing factor. The aim of our study was to ascertain what comments, both negative and positive, are being made in UK clinical settings to GP trainees about GP and to further explore these comments and their influence on career choice.MethodologyWe conducted a mixed methods study. We surveyed all foundation doctors and GP trainees within one region of Health Education England regarding any comments they experienced relating to a career in GP. We also conducted six focus groups with early GP trainees to discuss any comments that they experienced and whether these comments had any influence on their or others career choice.ResultsPositive comments reported by trainees centred around the concept that choosing GP is a positive, family-focused choice which facilities a good work–life balance. Workload was the most common negative comment, alongside the notion of being ‘just a GP’; the belief that GP is boring, a waste of training and a second-class career choice. The reasons for and origin of the comments are multifactorial in nature. Thematic analysis of the focus groups identified key factors such as previous exposure to and experience of GP, family members who were GPs, GP role models, demographics of the clinician and referral behaviour. Trainees perceived that negative comments may be discouraging others from choosing GP as a career.ConclusionOur study demonstrates that negative comments towards GP as a career do exist within clinical settings and are having a potential impact on poor recruitment rates to GP training. We have identified areas in which further negative comments could be prevented by changing perceptions of GP as a career. Additional time spent in GP as undergraduates and postgraduates, and positive GP role models, could particularly benefit recruitment. We recommend that undermining of GP as a career choice be approached with a zero-tolerance policy.
Diagnostic accuracy of emergency CT angiography for presumed tandem internal carotid artery occlusion before acute endovascular therapy
Authors: Rocha Marcelo , Delfyett William T , Agarwal Vikas , Aghaebrahim Amin , Jadhav Ashutosh , Jovin Tudor G 
Published: November 2017

BackgroundExtracranial internal carotid artery (ICA) occlusion can be overestimated on emergent single phase CT angiography (CTA) of stroke patients with isolated intracranial ICA occlusion. We aimed to measure the ability of identifying the extracranial site of presumed tandem ICA occlusions on pre-procedural CTA relative to catheter angiography during acute endovascular stroke therapy.MethodsRetrospective study of patients with intracranial ICA occlusion, with or without extracranial ICA occlusion, who underwent single phase CTA before acute endovascular treatment. Two neuroradiologists reviewed CTA images for the presence or absence of extracranial ICA occlusion, blinded to the catheter angiography results. The sensitivity, specificity, and predictive values of presumed extracranial ICA occlusions on CTA were calculated in reference to catheter angiography.Results91 stroke patients with acute intracranial ICA occlusion met the inclusion criteria for the study. 24% of patients (22/91) had tandem ICA occlusion confirmed on catheter angiography. Single phase CTA had a sensitivity of 95.5% (95% CI 77.2 to 99.9%) and a specificity of 69.6% (95% CI 57.3 to 80.1%) for concomitant extracranial ICA occlusion (false positive rate 30.4%). The positive and negative predictive values of single phase CTA for extracranial ICA occlusion in the presence of a distal ICA occlusion were 50% (95% CI 34.2 to 65.8%) and 98% (95% CI 89.1 to 100%), respectively.ConclusionsEmergency single phase CTA is highly sensitive but has reduced specificity to identify extracranial ICA occlusion in patients with intracranial ICA occlusion, which may confound planning for acute endovascular stroke therapy and cause over exclusion of patients with isolated ICA terminus occlusion from clinical trials.
Effect of prescription medications on erectile dysfunction
Authors: Razdan Shirin , Greer Aubrey B , Patel Amir , Alameddine Mahmoud , Jue Joshua S , Ramasamy Ranjith 
Published: November 2017

AbstractErectile dysfunction (ED) affects about 50% of men in the USA and is primarily attributed to physiological (organic) and psychological causes. However, a substantial portion of men suffer from ED due to iatrogenic causes. Common medications such as antihypertensives, non-steroidal anti-inflammatory drugs and antacids may cause ED. Physicians should be aware of the various prescription medications that may cause ED to properly screen and counsel patients on an issue that many may feel too uncomfortable to discuss. In this review, we discuss the physiology, data and alternative therapies for the ED caused by medications.
Advance care planning for patients with chronic respiratory diseases: a systematic review of preferences and practices
Authors: Jabbarian Lea J , Zwakman Marieke , van der Heide Agnes , Kars Marijke C , Janssen Daisy J A , van Delden Johannes J , Rietjens Judith A C , Korfage Ida J 
Published: November 2017

BackgroundAdvance care planning (ACP) supports patients in identifying and documenting their preferences and timely discussing them with their relatives and healthcare professionals (HCPs). Since the British Thoracic Society encourages ACP in chronic respiratory disease, the objective was to systematically review ACP practice in chronic respiratory disease, attitudes of patients and HCPs and barriers and facilitators related to engagement in ACP.MethodsWe systematically searched 12 electronic databases for empirical studies on ACP in adults with chronic respiratory diseases. Identified studies underwent full review and data extraction.ResultsOf 2509 studies, 21 were eligible: 10 were quantitative studies. Although a majority of patients was interested in engaging in ACP, ACP was rarely carried out. Many HCPs acknowledged the importance of ACP but were hesitant to initiate it. Barriers to engagement in ACP were the complex disease course of patients with chronic respiratory diseases, HCPs’ concern of taking away patients’ hopes and lack of continuity of care. The identification of trigger points and training of HCPs on how to communicate sensitive topics were identified as facilitators to engagement in ACP.ConclusionsIn conclusion, ACP is surprisingly uncommon in chronic respiratory disease, possibly due to the complex disease course of chronic respiratory diseases and ambivalence of both patients and HCPs to engage in ACP. Providing patients with information about their disease can help meeting their needs. Additionally, support of HCPs through identification of trigger points, training and system-related changes can facilitate engagement in ACP.Systematic review registration numberCRD42016039787.
SIGCSE 2018 new educator workshop
Authors: Danyluk Andrea , Dodds Zachary 
Published: November 2017

A successful career as a computer science educator involves more than a deep understanding of a research area. Yet many new CS educators experience relatively little educator training - and face more questions than answers, e.g., What different career-path choices do CS educators pursue? How do I choose an institution or career path that is right for me? How can I balance teaching, research, service, and a life beyond all those things? What are the balancing acts involved in working effectively with colleagues and managing the advancement and tenure process? What tips could help me organize a course, deliver engaging lectures, and build lasting relationships with students?
The New Educators Workshop (NEW) is a pre-symposium event at SIGCSE 2018 that, through presentations, discussions, and small-group community building, will tackle all of these questions. NEW is designed to assist aspiring and early-career educators in exploring the non-research facets of an academic career. It will run on February 21, 2018 from 9am to 5pm, and is open to graduate students who are considering teaching-related careers, as well as pre-tenure faculty members seeking guidance and/or networking support. The 2018 NEW is one of several career-focused, SIGCSE-affiliated workshops that have served more than 200 educators over the past decade.
CDK4/6 Inhibition Augments Antitumor Immunity by Enhancing T-cell Activation
Authors: Deng Jiehui , Wang Eric S. , Jenkins Russell W. , Li Shuai , Dries Ruben , Yates Kathleen , Chhabra Sandeep , Huang Wei , Liu Hongye , Aref Amir R. , Ivanova Elena , Paweletz Cloud P. , Bowden Michaela , Zhou Chensheng W. , Herter-Sprie Grit S. , Sorrentino Jessica A. , Bisi John E. , Lizotte Patrick H. , Merlino Ashley A. , Quinn Max M. , Bufe Lauren E. , Yang Annan , Zhang Yanxi , Zhang Hua , Gao Peng , Chen Ting , Cavanaugh Megan E. , Rode Amanda J. , Haines Eric , Roberts Patrick J. , Strum Jay C. , Richards William G. , Lorch Jochen H. , Parangi Sareh , Gunda Viswanath , Boland Genevieve M. , Bueno Raphael , Palakurthi Sangeetha , Freeman Gordon J. , Ritz Jerome , Haining W. Nicholas , Sharpless Norman E. , Arthanari Haribabu , Shapiro Geoffrey I. , Barbie David A. , Gray Nathanael S. , Wong Kwok-Kin 
Published: November 2017

Abstract
Immune checkpoint blockade, exemplified by antibodies targeting the PD-1 receptor, can induce durable tumor regressions in some patients. To enhance the efficacy of existing immunotherapies, we screened for small molecules capable of increasing the activity of T cells suppressed by PD-1. Here, we show that short-term exposure to small-molecule inhibitors of cyclin-dependent kinases 4 and 6 (CDK4/6) significantly enhances T-cell activation, contributing to antitumor effects in vivo, due in part to the derepression of NFAT family proteins and their target genes, critical regulators of T-cell function. Although CDK4/6 inhibitors decrease T-cell proliferation, they increase tumor infiltration and activation of effector T cells. Moreover, CDK4/6 inhibition augments the response to PD-1 blockade in a novel ex vivo organotypic tumor spheroid culture system and in multiple in vivo murine syngeneic models, thereby providing a rationale for combining CDK4/6 inhibitors and immunotherapies.
Significance: Our results define previously unrecognized immunomodulatory functions of CDK4/6 and suggest that combining CDK4/6 inhibitors with immune checkpoint blockade may increase treatment efficacy in patients. Furthermore, our study highlights the critical importance of identifying complementary strategies to improve the efficacy of immunotherapy for patients with cancer. Cancer Discov; 8(2); 216–33. ©2017 AACR.
See related commentary by Balko and Sosman, p. 143.
See related article by Jenkins et al., p. 196.
This article is highlighted in the In This Issue feature, p. 127