bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Therapy
Authors: Hess Gregory P. , Natarajan Pradeep , Faridi Kamil F. , Fievitz Anna , Valsdottir Linda , Yeh Robert W. 
Published: October 2017

Background:
Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are a novel class of medications for patients with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease requiring additional lipid lowering beyond dietary measures and statin use. Because of the drugs’ high cost, rates of prescription approval by payers may be low. We aimed to identify payer approval and rejection rates for PCSK9i prescriptions and the potential factors influencing these rates.

Methods:
This is a retrospective, descriptive cohort study using nationwide pharmacy claims linked to electronic medical records from a nationwide data warehouse. The data set includes >220 million patients from all 50 states and all payer types with 5140 distinct health plans. PCSK9i prescriptions were submitted for 51 466 patients in the pharmacy data set. The main outcome was approval or rejection of PCSK9i prescription claims. Factors associated with approval and rejection of these medications in the United States were assessed.

Results:

Among patients who were prescribed a PCSK9i, 47.0% were approved for coverage by the payer. Variables that were associated with PCSK9i approval included age >65 years (
P
<0.01), history of atherosclerotic cardiovascular disease (
P
<0.01), prescription by a cardiologist or nonprimary care provider (
P
<0.01), statin intolerance (
P
=0.03), longer statin duration (
P
=0.01), and noncommercial payers (
P
<0.01). Higher low-density lipoprotein cholesterol levels were not associated with higher approval rates. Commercial third-party payers had the lowest approval rates (24.4%) and Medicare had the highest (60.9%).

Conclusions:
Rates of approval for PCSK9i therapy are low, even for patients who appear to meet labeled indications. Although a combination of clinical characteristics increases the likelihood of approval, payer type is the most significant factor.
Frequency, Predictors, and Impact of Combined Antiplatelet Therapy on Venous Thromboembolism in Patients With Symptomatic Atherosclerosis
Authors: Cavallari Ilaria , Morrow David A. , Creager Mark A. , Olin Jeffrey , Bhatt Deepak L. , Steg P. Gabriel , Storey Robert F. , Cohen Marc , Scirica Benjamin S. , Piazza Gregory , Goodrich Erica L. , Braunwald Eugene , Sabatine Marc S. , Bonaca Marc P. 
Published: October 2017

Background:
Observational studies suggest that symptomatic atherosclerosis may be associated with risk of venous thromboembolism (VTE). Prior randomized studies have demonstrated a significant reduction in recurrent VTE with aspirin monotherapy. Whether VTE risk is associated with more severe symptomatic atherosclerosis and more intensive antiplatelet therapy reduces VTE risk beyond aspirin monotherapy is unknown.

Methods:
TRA2P-TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events–Thrombolysis in Myocardial Infarction) (vorapaxar) and PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis in Myocardial Infarction 54) (ticagrelor) were blinded, randomized placebo-controlled trials of antiplatelet therapy for the prevention of ischemic events in stable patients with symptomatic atherosclerosis. Two blinded vascular specialists systematically identified symptomatic venous thromboembolic events in both trials.

Results:

Of 47 611 patients with stable vascular disease followed for 3 years in both studies there were 343 VTE events in 301 patients (Kaplan-Meier rate at 3 years, 0.9% for placebo). The risk of VTE was independently associated with age, body mass index, polyvascular disease, chronic obstructive pulmonary disease, and malignancy. The burden of atherosclerosis manifested as an increasing number of symptomatic vascular territories was associated with a graded increase in the 3-year rates of VTE (0.76% for 1, 1.53% for 2, and 2.45% for 3 territories). More intensive antiplatelet therapy (vorapaxar and ticagrelor pooled) significantly reduced the risk of VTE by 29% compared with background antiplatelet therapy, from 0.93% to 0.64% at 3 years (hazard ratio, 0.71; 95% confidence interval, 0.56–0.89;
P
=0.003).

Conclusions:
The rate of VTE in patients with atherosclerosis is ≈0.3% per year while on treatment with ≥1 antiplatelet agent, with increased risk independently associated with the number of symptomatic vascular territories. More intensive antiplatelet therapy reduces the risk of VTE. These data suggest a relationship between atherosclerosis burden and VTE risk, and they support inclusion of VTE as a prospective end point in long-term secondary prevention trials evaluating the risks and benefits of antiplatelet therapies in patients with atherosclerosis.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01225562.
Cutting and Blending Trees of Life (African Cultural Context and the Bible)
Authors: Ramantswana Hulisani 
Published: October 2017

Abstract
This paper is a critical engagement with Dorothy Bea Akoto-Abutiate’s book Proverbs and the African Tree of Life: Grafting Biblical Proverbs onto Ghanaian Eve Folk Proverbs (Leiden: Brill 2014). In the book, Akoto-Abutiate grafts together the African Ghanaian folk proverbs and the proverbial sayings in Proverbs 25:1-29:27 in order to appropriate the Biblical message in the Ghanaian context. For Akoto-Abutiate the Biblical book of Proverbs or the Bible in general is a ‘tree of life’ and so is/are the African cultural context(s). She, therefore, suggests the ‘hermeneutic of grafting’ as the most appropriate model through which engagement between African cultural context(s) and the Biblical text can productively happen without undermining the former. The African cultural context in this model is regarded as the dominant and pre-existing tree of life onto which the Biblical shoot(s) are grafted. This paper engages ‘hermeneutic of grafting’ from a decolonial perspective thereby highlighting the pros and cons of Akoto-Abutiate’s approach.
A Climate for Art: Enhancing Scientist–Citizen Collaboration in Bangladesh
Authors: Stiller-Reeve Mathew , Naznin Zakia 
Published: October 2017

Abstract
In our climate research project in Bangladesh, we work closely with local rural communities. The communities have designed their own citizen science projects in close dialogue with the project’s climate scientists. The climate scientists have also directed their research based on the stories the communities previously shared in longer narrative interviews. In order for the citizen science to be a success, a sense of community and good team spirit is essential. We collaborated with a Bangladeshi artist to achieve some important goals. Not only did we want to create new and exciting outreach materials, but, more importantly, we also wanted to see how the artistic process could nurture a sense of community for the local participants. Despite being limited by time, we saw some promising outcomes from the collaboration. The artist successfully interacted with the project researchers and the local participants. The final artwork was a real collaboration between the artist and the participants, who felt pride and ownership in the results.
Elevated Mixed Layers and Associated Severe Thunderstorm Environments in South and North America
Authors: Ribeiro Bruno Z. , Bosart Lance F. 
Published: October 2017

Abstract
This study presents a climatological and composite analysis of elevated mixed layers (EMLs) in South and North America derived from the NCEP Climate Forecast System Reanalysis. The EMLs are identified based on objective criteria applied to the reanalysis data. Composite analyses of synoptic-scale conditions and severe weather parameters associated with spring EML cases are presented. EMLs are more frequent immediately to the east of the Andes and the Rockies. The North American EMLs form by surface heating over the higher terrain of the Rockies, with peak frequency occurring in spring and summer. EMLs in South America are generated by differential temperature advection due to ageostrophic circulations east of the Andes, as indicated by the temperature lapse rate tendency equation, which relates to the higher frequency of EMLs during the cold season in South America. EMLs over North America are about 100 hPa lower than over South America due to the lower height of the Rockies in comparison to the Andes. The synoptic conditions associated with EMLs in South and North America are characterized by an upper-level trough upstream and low-level moisture flux convergence due to poleward-directed flow, favoring synoptic-scale ascent poleward of the EML location, where the convective inhibition is relatively low. When EMLs occur, higher surface-based convective available potential energy and low-level storm-relative helicity, in association with lower lifting condensation level heights observed in North America, indicate that surface-based supercell storms and tornadoes are more likely to occur on this continent in comparison with South America, corroborating observations.
A scoping review of the needs of children and other family members after a child’s traumatic injury
Authors: Jones Samantha , Davis Naomi , Tyson Sarah F 
Published: October 2017

Objective: To review children’s and their families’ needs after a child’s traumatic injury and assessment tools to measure needs. Data sources: Medline, Embase, CINAHL and PsycINFO databases (2005–September 2017) were searched and screened for papers (of any design) investigating children’s and families’ needs after a child’s traumatic physical injury. Review methods: Data regarding children’s and families’ needs were extracted by two independent raters. Methodological quality of the identified papers was not assessed. Thematic content analysis drew out the key needs. Results: A total of 12 studies were identified, involving 932 participants including 105 injured adolescents and 827 family members or professionals. The needs of children under 12 years were identified indirectly from families or professionals. Most studies focussed on traumatic brain injuries. Two groups of needs were identified: person-related and service-related. Person-related needs were categorized into adolescent-specific needs, need for support with cognitive, emotional, social and physical problems and help with practical problems. Service-related needs were categorized into the need for information, educational needs and support during care transitions (specifically access to community-based services). These needs were largely unmet, particularly regarding information, emotional support and care transitions, which were compounded by professionals’ limited understanding of the children’s difficulties. We found no published measurement tools to assess children’s and families’ needs after a child’s traumatic injury. Conclusion: The evidence about children’s and families’ needs following a child’s traumatic injury was limited, but needs for information, emotional support and access to community-based services were consistently unmet.
Measuring changes in functional ability in older children and young people with acquired brain injury using the UK FIM + FAM
Authors: Austin Dalya , Frater Tai , Wales Lorna , Dunford Carolyn 
Published: October 2017

Introduction There is a need for validated and responsive measurement tools to demonstrate changes in functional ability. Existing outcome measurement tools have significant limitations for children and young people with acquired brain injury (ABI). Aim This study examines the potential of the UK Functional Independence Measure + Functional Assessment Measure (UK FIM + FAM) to detect clinical change in older children and young people with ABI. Method This is a secondary retrospective pretest–post test analysis of 72 children and young people age 8–17 years. Internal responsiveness was examined using Wilcoxon signed-rank tests and effect sizes indices; external responsiveness was examined in relation to the Neurological Impairment Scale (NIS) using Spearman’s correlation coefficient. Results Highly significant changes were detected from admission to discharge on motor, cognitive and total UK FIM + FAM scores ( p < 0.001). Medium to large effect sizes were found on the total scale indicating good internal responsiveness. There was a significant, negative correlation between UK FIM + FAM change scores and NIS change scores ( p < 0.01) indicating good external responsiveness. Conclusion The UK FIM + FAM was able to detect clinically meaningful change in functional ability in children and young people with ABI over 8 years. Further validity and reliability must be established before recommending its use in this client group.
Variation in the Medial Patellofemoral Ligament Origin in the Skeletally Immature Knee: An Anatomic Study
Authors: Shea Kevin G. , Martinson W. Duncan , Cannamela Peter C. , Richmond Connor G. , Fabricant Peter D. , Anderson Allen F. , Polousky John D. , Ganley Theodore J. 
Published: October 2017

Background: The medial patellofemoral ligament (MPFL) is frequently reconstructed to treat recurrent patellar instability. The femoral origin of the MPFL is well described in adults but not in the skeletally immature knee. Purpose: To identify a radiographic landmark for the femoral MPFL attachment in the skeletally immature knee and study its relationship to the distal femoral physis. Study Design: Descriptive laboratory study. Methods: Thirty-six cadaveric specimens between 2 and 11 years old were dissected and examined (29 male and 7 female). Metallic markers were placed at the proximal and distal borders of the MPFL femoral origin footprint. Computed tomography scans with 0.625-mm slices in the axial, coronal, and sagittal planes were used to measure the maximum ossified height and ossified depth. The measurements were used to describe the position of the midpoint MPFL attachment with respect to the posterior-anterior and distal-proximal dimensions of the femoral condyle on the sagittal view and to describe the distance from the physis to the femoral origin of the MPFL. Results: In 23 of 36 specimens, the femoral origin of the MPFL was distal to the physis. Thirteen of the 36 specimens had an MPFL origin at or proximal to the physis, with a more proximal MPFL origin consistently seen in older specimens. The distance of the MPFL origin to the physis ranged from 15.1 mm distal to the physis to 8.3 mm proximal to the physis. The mean midpoint of the MPFL femoral origin was located 3.0 ± 5.5 mm distal to the physis for all specimens. For specimens aged <7 years, the mean MPFL origin was 4.7 mm distal to the physis, and for specimens aged ≥7 years, the mean MPFL origin was 0.8 mm proximal to the femoral physis. The MPFL origin was more proximal and anterior for those aged ≥7 years and more distal and posterior for those aged <7 years. Conclusion: Surgical reconstruction of the MPFL is a common treatment to restore patellar stability. There appears to be significant variability in the origin of the MPFL in skeletally immature specimens. This study demonstrated that the MPFL origin was more proximal and anterior with respect to the physis in the older age group. The MPFL origin footprint may be customized for different age groups. Clinical Relevance: This information shows anatomic variation of the MPFL origin with age, with older specimens having a footprint that was more proximal and anterior than younger specimens. Customization of the surgical technique might be considered based on patient age.
Foundation trainees and changes in career intentions
Authors: Joiner Adam B , Mahmood Shamsa , Dearman Samuel P , Maddicott Sarah 
Published: October 2017

Objectives: To understand whether foundation trainees change their career intentions during psychiatry placements and explore what factors influence such changes. Methods: Over a two-year period, foundation trainees completed questionnaires at the beginning, middle and end of their four-month placement. There were two questions, the first as to how likely they were to pursue a career in psychiatry and the second openly asked them to elaborate on their reasons. Results: Twenty-one out of 41 eligible trainees returned all three questionnaires. The number of trainees ‘highly likely’ to choose psychiatry increased over the four-month period, from 4.5% to 19%. The number of trainees ‘highly unlikely’ to choose psychiatry decreased, from 27.3% to 9.5%. An increasingly positive intention towards a psychiatry career appeared to relate to enjoyment of the placement and the quality of supervision. The most common reason for not choosing psychiatry was a pre-existing interest in another specialty. Conclusions: Undertaking a psychiatry placement during the foundation programme continues to increase the likelihood of a positive attitude towards psychiatry as a career. The findings of our study suggest good practice in providing foundation placements in psychiatry includes identifying medical school experience, enjoyment, quality weekly supervision and mindful experiential design of placements.
Indication for Computed Tomography Scan in Shoulder Instability: Sensitivity and Specificity of Standard Radiographs to Predict Bone Defects After Traumatic Anterior Glenohumeral Instability
Authors: Delage Royle Audrey , Balg Frédéric , Bouliane Martin J. , Canet-Silvestri Fanny , Garant-Saine Laurianne , Sheps David M. , Lapner Peter , Rouleau Dominique M. 
Published: October 2017

Background: Quantifying glenohumeral bone loss is key in preoperative surgical planning for a successful Bankart repair. Hypothesis: Simple radiographs can accurately measure bone defects in cases of recurrent shoulder instability. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A true anteroposterior (AP) view, alone and in combination with an axillary view, was used to evaluate the diagnostic properties of radiographs compared with computed tomography (CT) scan, the current gold standard, to predict significant bone defects in 70 patients. Sensitivity, specificity, and positive and negative predictive values were evaluated and compared. Results: Detection of glenoid bone loss on plain film radiographs, with and without axillary view, had a sensitivity of 86% for both views and a specificity of 73% and 64% with and without the axillary view, respectively. For detection of humeral bone loss, the sensitivity was 8% and 17% and the specificity was 98% and 91% with and without the axillary view, respectively. Regular radiographs would have missed 1 instance of significant bone loss on the glenoid side and 20 on the humeral side. Interobserver reliabilities were moderate for glenoid detection (κ = 0.473-0.503) and poor for the humeral side (κ = 0.278-0.336). Conclusion: Regular radiographs showed suboptimal sensitivity, specificity, and reliability. Therefore, CT scan should be considered in the treatment algorithm for accurate quantification of bone loss to prevent high rates of recurrent instability.
Movement coordination patterns between the foot joints during walking
Authors: Arnold John B. , Caravaggi Paolo , Fraysse François , Thewlis Dominic , Leardini Alberto 
Published: October 2017

AbstractBackgroundIn 3D gait analysis, kinematics of the foot joints are usually reported via isolated time histories of joint rotations and no information is provided on the relationship between rotations at different joints. The aim of this study was to identify movement coordination patterns in the foot during walking by expanding an existing vector coding technique according to an established multi‐segment foot and ankle model. A graphical representation is also described to summarise the coordination patterns of joint rotations across multiple patients.MethodsThree‐dimensional multi‐segment foot kinematics were recorded in 13 adults during walking. A modified vector coding technique was used to identify coordination patterns between foot joints involving calcaneus, midfoot, metatarsus and hallux segments. According to the type and direction of joints rotations, these were classified as in‐phase (same direction), anti‐phase (opposite directions), proximal or distal joint dominant.ResultsIn early stance, 51 to 75% of walking trials showed proximal‐phase coordination between foot joints comprising the calcaneus, midfoot and metatarsus. In‐phase coordination was more prominent in late stance, reflecting synergy in the simultaneous inversion occurring at multiple foot joints. Conversely, a distal‐phase coordination pattern was identified for sagittal plane motion of the ankle relative to the midtarsal joint, highlighting the critical role of arch shortening to locomotor function in push‐off.ConclusionsThis study has identified coordination patterns between movement of the calcaneus, midfoot, metatarsus and hallux by expanding an existing vector cording technique for assessing and classifying coordination patterns of foot joints rotations during walking. This approach provides a different perspective in the analysis of multi‐segment foot kinematics, and may be used for the objective quantification of the alterations in foot joint coordination patterns due to lower limb pathologies or following injuries.
Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda
Authors: Rubagumya Fidel , Xu Mary Jue , May Leana , Driscoll Caitlin , Uwizeye Frank Regis , Shyirambere Cyprien , Larrabee Katherine , Fehr Alexandra E. , Gilbert Umuhizi Denis , Muhayimana Clemence , Hategekimana Vedaste , Elmore Shekinah , Mpunga Tharcisse , Moore Molly , Shulman Lawrence N. , Lehmann Leslie 
Published: October 2017

Purpose Children with acute lymphoblastic leukemia (ALL) in low-income countries have disproportionately lower cure rates than those in high-income countries. At Butaro Cancer Center of Excellence (BCCOE), physicians treated patients with ALL with the first arm of the Hunger Protocol, a graduated-intensity method tailored for resource-limited settings. This article provides the first published outcomes, to our knowledge, of patients with ALL treated with this protocol. Methods This is a retrospective descriptive study of patients with ALL enrolled at BCCOE from July 1, 2012 to June 30, 2014; data were collected through December 31, 2015. Descriptive statistics were used to calculate patient demographics, disease characteristics, and outcomes; event-free survival was assessed at 2 years using the Kaplan-Meier method. Results Forty-two consecutive patients with ALL were included. At the end of the study period, 19% (eight) were alive without evidence of relapse: three completed treatment and five were continuing treatment. Among the remaining patients, 71% (30) had died and 10% (four) were lost to follow-up. A total of 83% (25) of the deaths were disease related, 3% (one) treatment-related, and 13% (four) unclear. Event-free survival was 22% (95% CI, 11% to 36%), considering lost to follow-up as an event, and 26% (95% CI, 13% to 41%) if lost to follow-up is censored. Conclusion As expected, relapse was the major cause of failure with this low-intensity regimen. However, toxicity was acceptably low, and BCCOE has decided to advance to intensity level 2. These results reflect the necessity of a data-driven approach and a continual improvement process to care for complex patients in resource-constrained settings.