bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteonecrosis in SLE: prevalence, patterns, outcomes and predictors
Authors: Gladman D D , Dhillon N , Su J , Urowitz M B 
Published: May 2017

Objective Osteonecrosis is a serious comorbidity in patients with systemic lupus erythematosus. The aims of this study were to describe the prevalence of symptomatic osteonecrosis, determine the pattern of joint involvement, identify the outcomes and investigate predictive factors in a large cohort of patients with systemic lupus erythematosus followed prospectively. Methods At the Toronto Lupus Clinic patients have been followed prospectively according to a standard protocol since 1970. Osteonecrosis is recorded if patients are symptomatic and is confirmed by imaging. The site of osteonecrosis is recorded and whether or not surgery was performed. For determination of prevalence, pattern and outcome of osteonecrosis a longitudinal cohort design was performed. For the predictive factors, only patients with incident osteonecrosis were included and were matched for gender, year of entry to clinic (within 5 years), year of birth (within 5 years) and disease duration (within 3 years) with systemic lupus erythematosus patients without osteonecrosis. Results Of 1729 patients with systemic lupus erythematosus registered in the database, 234 (13.5%) developed symptomatic osteonecrosis in 581 sites. Hips and knees were most commonly affected and 47% of the patients had multiple sites involved. More than half of the joints involved at first occurrence of osteonecrosis had surgery. Univariate analysis identified black race, damage, elevated cholesterol and glucocorticosteroids as predictive factors, but glucocorticosteroids remained as the primary predictor for the development of osteonecrosis on multivariable analysis. Conclusion Despite advancements in the assessment and treatment of systemic lupus erythematosus, symptomatic osteonecrosis continues to be a significant comorbidity. Strategies to minimize glucocorticosteroid use are necessary to prevent this serious complication.
Public understanding of the purpose of cancer screening: A population-based survey
Authors: Chorley Amanda J , Hirst Yasemin , Vrinten Charlotte , von Wagner Christian , Wardle Jane , Waller Jo 
Published: May 2017

Objectives In examining informed choice in cancer screening, we investigated public awareness that some screening programmes aim to prevent cancer, while others seek to detect cancer at an early stage. Methods A population-based survey of adults aged 50–70 in England (n = 1433), including data on demographic characteristics and screening experience. Participants were asked to select the main purpose of cervical, breast, and colorectal cancer screening (both faecal occult blood testing and flexible sigmoidoscopy). Results Across all four screening programmes, most people thought the main aim was to catch cancer early (71–78%). Only 18 and 14% knew that cervical screening and flexible sigmoidoscopy, respectively, are primarily preventive. Knowledge of the preventive aspect of these two programmes was low across the board, with few demographic patterns. By contrast, 78 and 73% of the sample were aware that breast screening and the faecal occult blood test, respectively, predominantly aim to detect cancer early. For these programmes, accurate knowledge was socially graded, lower in ethnic minority groups, and positively associated with previous participation in the programmes. Conclusions Our findings suggest that although awareness of the purpose of early detection screening is high, awareness that screening can prevent cancer is low across all demographic groups. Understanding the purpose of screening is a key aspect of informed choice but despite current communication strategies highlighting these differences, people do not seem to have a nuanced understanding of these differing aims. Our findings may be indicative of a broader public scepticism about the preventability of cancer.
Cost-effectiveness of strategies to increase cervical screening uptake at first invitation (STRATEGIC)
Authors: Tsiachristas Apostolos , Gittins Matthew , Kitchener Henry , Gray Alastair 
Published: May 2017

Objective To assess the cost-effectiveness of strategies to increase cervical cancer screening uptake at first invitation (STRATEGIC trial). Methods We performed an economic analysis alongside the STRATEGIC trial, comparing each of seven novel interventions for improving cervical screening uptake with control general practices in Greater Manchester and Grampian (United Kingdom). A template was developed to measure the intervention costs. Trial estimates of screening uptake were combined with data from the literature to estimate healthcare costs of each intervention. The added lifetime costs and quality adjusted life years (QALYs) of attending cervical screening were estimated by a systematic literature review, with relevant results pooled and weighted by study quality. Trial results and estimated lifetime costs and benefits of screening were then combined in a decision analytic model, giving an incremental cost per QALY gained for each intervention. Uncertainty was addressed in probabilistic and univariate sensitivity analyses. Results Intervention costs per screening round per woman attending varied from about £1.20 (2014 UK) for the nurse navigator intervention to £62 for the unrequested HPV self-sampler kit. The meta-analysis revealed a lifetime discounted benefit from screening of 0.043 QALYs per woman attending, at an additional lifetime discounted cost of £234. The incremental cost per QALY gained in all interventions was below £13,000. Probabilistic sensitivity analyses suggested that only unrequested self-sampling and timed appointments have a high probability of being cost-effective. Conclusions Unrequested self-sampling and timed appointments are likely to be cost-effective interventions. Further research is required on the duration of effects and on implementing combinations of interventions.
Does aerobic training alleviate fatigue and improve societal participation in patients with multiple sclerosis? A randomized controlled trial
Authors: Heine Martin , Verschuren Olaf , Hoogervorst Erwin LJ , van Munster Erik , Hacking Hub GA , Visser-Meily Anne , Twisk Jos WR , Beckerman Heleen , de Groot Vincent , Kwakkel Gert ,   on behalf of the TREFAMS-ACE study group
Published: May 2017

Background: Evidence supporting the effectiveness of aerobic training, specific for fatigue, in severely fatigued patients with multiple sclerosis (MS) is lacking. Objective: To estimate the effectiveness of aerobic training on MS-related fatigue and societal participation in ambulant patients with severe MS-related fatigue. Methods: Patients ( N = 90) with severe MS-related fatigue were allocated to 16-week aerobic training or control intervention. Primary outcomes were perceived fatigue (Checklist Individual Strength (CIS20r) fatigue subscale) and societal participation. An improvement of ⩾8 points on the CIS20r fatigue subscale was considered clinically relevant. Outcomes were assessed by a blinded observer at baseline, 2, 4, 6 and 12 months. Results: Of the 89 patients that started treatment (median Expanded Disability Status Scale (interquartile range), 3.0 (2.0–3.6); mean CIS20r fatigue subscale (standard deviation (SD)), 42.6 (8.0)), 43 received aerobic training and 46 received the control intervention. A significant post-intervention between-group mean difference (MD) on the CIS20r fatigue subscale of 4.708 (95% confidence interval (CI) = 1.003–8.412; p  = 0.014) points was found in favour of aerobic training that, however, was not sustained during follow-up. No effect was found on societal participation. Conclusion: Aerobic training in MS patients with severe fatigue does not lead to a clinically meaningful reduction in fatigue or societal participation when compared to a low-intensity control intervention.
Effectiveness of energy conservation management on fatigue and participation in multiple sclerosis: A randomized controlled trial
Authors: Blikman Lyan JM , van Meeteren Jetty , Twisk Jos WR , de Laat Fred AJ , de Groot Vincent , Beckerman Heleen , Stam Henk J , Bussmann Johannes BJ ,   TREFAMS-ACE study group
Published: May 2017

Background: Fatigue is a frequently reported and disabling symptom in multiple sclerosis (MS). Objective: To investigate the effectiveness of an individual energy conservation management (ECM) intervention on fatigue and participation in persons with primary MS-related fatigue. Methods: A total of 86 severely fatigued and ambulatory adults with a definite diagnosis of MS were randomized in a single-blind, two-parallel-arm randomized clinical trial to the ECM group or the information-only control group in outpatient rehabilitation departments. Blinded assessments were carried out at baseline and at 8, 16, 26 and 52 weeks after randomization. Primary outcomes were fatigue (fatigue subscale of Checklist Individual Strength – CIS20r) and participation (Impact on Participation and Autonomy scale – IPA). Results: Modified intention-to-treat analysis was based on 76 randomized patients (ECM, n = 36; MS nurse, n=40). No significant ECM effects were found for fatigue (overall difference CIS20r between the groups = −0.81; 95% confidence interval (CI), −3.71 to 2.11) or for four out of five IPA domains. An overall unfavourable effect was found in the ECM group for the IPA domain social relations (difference between the groups = 0.19; 95% CI, 0.03 to 0.35). Conclusion: The individual ECM format used in this study did not reduce MS-related fatigue and restrictions in participation more than an information-only control condition.
Effect of clutch lining frictional characteristics on take-up judder
Authors: Gkinis T , Rahmani Ramin , Rahnejat H 
Published: May 2017

Take-up judder is the first rigid body torsional mode of the clutch system, which occurs during clutch engagement. This phenomenon is induced by stick-slip oscillations at the friction lining interfaces between the clutch disc and flywheel, and the pressure plate. The phenomenon is influenced by the clutch lining friction characteristics, the topography of the mating-sliding surfaces, and the operational conditions during the engagement process. Therefore, the interfacial characteristics are affected by contact pressure, interfacial slip speed, and surface temperature. Take-up judder causes driver and vehicle occupant discomfort, as well as gradual wear of contacting surfaces. The response frequency of the system is reported to be in the range 5–20 Hz, depending on the clutch system and vehicle inertia. In this paper, the measured interfacial friction characteristics together with clamp load variation (contact pressure) under different surface temperatures are included in a multi-degree of freedom dynamic analysis to obtain torsional vibrations of the system, pertaining to take-up judder conditions. Such an in-depth investigation has not hitherto been reported in literature. The paper shows that take-up judder is omnipresent under all clutch engagement conditions, but its poignancy is most evident at cold surface temperatures. It is also shown that the transient judder response has a broader spectral content that is generally acknowledged.
The social dimensions of gambling among street youth in Mumbai: Is it really an addiction?
Authors: Saldanha Kennedy , Madangopal Dakshayani 
Published: May 2017

This mixed-methods, exploratory study investigates the gambling activities of street youth in Mumbai, India. Data from surveys and brief interviews of 70 youth aged 12–24, two focus groups, and ethnographic observations offer descriptive snapshots of the gambling behavior of participants. The article includes details about games played, popular venues, initiation patterns, time spent gambling, and interactions with the police. Street youth gamble for social benefits, such as group membership and fun; it is also a leisure activity enabling time to go by quickly. Individual benefits include intermittent rewards and a high after winning or being referred to as a gambler. The inability to save, the lack of recreation options, living in groups, and the environment of the streets structure and sustain gambling. This study discusses the group and social dimension of gambling among street youth, and how this dimension makes their participation different from adolescent gambling in general and General Addictions Theory. It contributes to the literature by emphasizing that for street youth the social/group aspects of gambling predominate the psychological. The paper concludes with a discussion of the implications for practice, highlighting the need to develop recreational, income-saving, and educational awareness programs.
Curative and adjunctive AVM Onyx embolization of AVMs through the choroidal arteries
Authors: Lv Xianli , Hu Xiulan , Li Wei , He Hongwei , Jiang Chuhan , Li Youxiang 
Published: May 2017

Objective The anterior or posterior choroidal artery is often recruited to supply deep location arteriovenous malformations (AVMs). This study is to report curative and adjunctive AVM Onyx embolization through these arteries. Methods This study retrospectively reviewed six patients with cerebral AVMs who underwent endovascular embolization through the choroidal arteries between October 2015 and October 2016. Embolization was performed as a curative procedure in five patients and adjunctive procedure in one patient. Results Four patients underwent embolization through the anterior choroidal artery (AchA), and two patients underwent embolization through the lateral posterior choroidal artery (LPchA). One of the four patients in whom embolization was from the AchA (distal to the plexal point) developed transient hemiparesis. Complete obliteration was confirmed by angiography at the last follow-up in five patients. Conclusions Onyx embolization of cerebral AVMs through the choroidal arteries is possible as a curative or adjunctive procedure.
In vivo geometry of the kissing stent and covered endovascular reconstruction of the aortic bifurcation configurations in aortoiliac occlusive disease
Authors: Groot Jebbink Erik , Ter Mors Thijs G , Slump Cornelis H , Geelkerken Robert H , Holewijn Suzanne , Reijnen Michel MPJ 
Published: May 2017

Objectives Various configurations of kissing stent (KS) configurations exist and patency rates vary. In response the covered endovascular reconstruction of the aortic bifurcation configuration was designed to minimize mismatch and improve outcome. The aim of the current study is to compare geometrical mismatch of kissing stent with the covered endovascular reconstruction of the aortic bifurcation configuration in vivo. Methods Post-operative computed tomographic data and patient demographics from 11 covered endovascular reconstruction of the aortic bifurcation and 11 matched kissing stent patients were included. A free hand region of interest and ellipse fitting method were applied to determine mismatch areas and volumes. Conformation of the stents to the vessel wall was expressed using the D-ratio. Results Patients were mostly treated for Rutherford category 2 and 3 (64%) with a lesion classification of TASC C and D in 82%. Radial mismatch area and volume for the covered endovascular reconstruction of the aortic bifurcation group was significantly lower compared to the kissing stent configuration ( P < 0.05). The D-ratio did not significantly differ between groups. Measurements were performed with good intra-class correlation. There were no significant differences in the post-procedural aortoiliac anatomy. Conclusions The present study shows that radial mismatch exists in vivo and that large differences in mismatch exist, in favour of the covered endovascular reconstruction of the aortic bifurcation configuration. Future research should determine if the decreased radial mismatch results in improved local flow profiles and subsequent clinical outcome.
The Role of Imaging in Clinical Stroke Scales That Predict Functional Outcome: A Systematic Review
Authors: Soliman Fatima , Gupta Ajay , Delgado Diana , Kamel Hooman , Pandya Ankur 
Published: May 2017

Background and Purpose: Numerous stroke scales have been developed to predict functional outcomes following acute ischemic stroke. The goal of this study was to summarize functional outcome scores in stroke that incorporate neuroimaging with those that don’t incorporate neuroimaging. Methods: Searches were conducted in Ovid MEDLINE, Ovid Embase, and the Cochrane Library Database from inception to January 23, 2015. Additional records were identified by employing the “Cited by” and “View References” features in Scopus. We included studies that described stroke prognosis models or scoring systems that predict functional outcome based on clinical and/or imaging data available on presentation. Score performance was evaluated based on area under the receiver operating characteristic curve (AUC). Results: A total of 3300 articles were screened, yielding 14 scores that met inclusion criteria. Half (7) of the scores included neuroimaging as a predictor variable. Neuroimaging parameters included infarct size on magnetic resonance diffusion-weighted imaging, infarct size defined by computed tomography hypodensity, and hemodynamic abnormality on perfusion imaging. The modified Rankin Scale at 3 months poststroke was the most common functional outcome reported (13 of 14 scores). The AUCs ranged from 0.64 to 0.84 for scores that included neuroimaging as a predictor and 0.64 to 0.94 for scores that did not include neuroimaging. External validation has been performed for 7 scores. Conclusions: Due to the marked heterogeneity in the scores and populations in which they were applied, it is unclear whether current imaging-based scores offer advantages over simpler approaches for predicting poststroke function.
Hormone replacement therapy in pre-menopausal women undergoing bilateral salpingo-oophorectomy for benign disease: A review of practice
Authors: Richardson Alison , West Emily , Cust Mike 
Published: May 2017

Introduction The National Institute for Health and Care Excellence (NICE) guideline on the diagnosis and management of the menopause states that women who are likely to go through the menopause as a result of surgical treatment should be offered information about the menopause and the importance of starting hormonal replacement therapy before they have their treatment. Objectives To determine compliance with NICE guidelines at the Royal Derby Hospital. Study design We undertook a retrospective review of all pre-menopausal women undergoing bilateral salpingo-oophorectomy for benign pathology between 1 January 2016 and 30 June 2016. Results Thirty-six cases were reviewed. Women were aged between 32.5 and 49.8 years old (median 45.13, inter-quartile range 42.6–47.6). The commonest indications for bilateral salpingo-oophorectomy were dysfunctional uterine bleeding (36.1%), chronic pelvic pain (30.5%), complex cyst (13.9%), and pre-menstrual syndrome (13.9%). Fifteen women (41.7%) did not have hormonal replacement therapy discussed. Only two (5.6%) had hormonal replacement therapy discussed pre-operatively. The remaining 19 had hormonal replacement therapy discussed post-operatively, either on the ward prior to discharge (n = 3) or, more commonly, in clinic six to eight weeks later. Although hormonal replacement therapy was only contraindicated in one woman (3%), it was only prescribed to five (24%). Results were slightly better for women under 40 but still only 28.6% had hormonal replacement therapy discussed with them pre-operatively. Conclusion This audit has demonstrated that compliance with the NICE guidelines is poor. We suspect similar results might be found in other gynaecology departments nationally. A hospital guideline to aid clinicians and a patient information sheet to educate women has been devised. A re-audit is planned six months after ratification of these documents.
Potential Role of Serum and Urinary Biomarkers in Diagnosis and Prognosis of Diabetic Nephropathy
Authors: Campion Carole G. , Sanchez-Ferras Oraly , Batchu Sri N. 
Published: May 2017

Purpose of review: Diabetic nephropathy (DN) is a progressive kidney disease caused by alterations in kidney architecture and function, and constitutes one of the leading causes of end-stage renal disease (ESRD). The purpose of this review is to summarize the state of the art of the DN-biomarker field with a focus on the new strategies that enhance the sensitivity of biomarkers to predict patients who will develop DN or are at risk of progressing to ESRD. Objective: In this review, we provide a description of the pathophysiology of DN and propose a panel of novel putative biomarkers associated with DN pathophysiology that have been increasingly investigated for diagnosis, to predict disease progression or to provide efficient personal treatment. Methods: We performed a review of the literature with PubMed and Google Scholar to collect baseline data about the pathophysiology of DN and biomarkers associated. We focused our research on new and emerging biomarkers of DN. Key findings: In this review, we summarized the critical signaling pathways and biological processes involved in DN and highlighted the pathogenic mediators of this disease. We next proposed a large review of the major advances that have been made in identifying new biomarkers which are more sensitive and reliable compared with currently used biomarkers. This includes information about emergent biomarkers such as functional noncoding RNAs, microRNAs, long noncoding RNAs, exosomes, and microparticles. Limitations: Despite intensive strategies and constant investigation, no current single treatment has been able to reverse or at least mitigate the progression of DN, or reduce the morbidity and mortality associated with this disease. Major difficulties probably come from the renal disease being heterogeneous among the patients. Implications: Expanding the proteomics screening, including oxidative stress and inflammatory markers, along with metabolomics approaches may further improve the prognostic value and help in identifying the patients with diabetes who are at high risk of developing kidney diseases.