bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insurance Type and Access to Health Care Providers and Appointments Under the Affordable Care Act
Authors: Alcalá Héctor E. , Roby Dylan H. , Grande David T. , McKenna Ryan M. , Ortega Alexander N. 
Published: December 2017

Background:
Millions of adults have gained insurance through the Affordable Care Act (ACA). However, disparities in access to care persist.

Objective:
This study examined differences in access to primary and specialty care among patients insured by private individual market insurance plans (both on-exchange and off-exchange) and Medicaid compared with those with employer-sponsored insurance.

Research Design:
Using data from the 2014 and 2015 California Health Interview Survey, logistic regression analyses were used to calculate the odds of being unable to access primary care providers, access specialty care providers and receive a needed doctor’s appointment in a timely manner, with insurance type serving as the independent variable. Interaction terms examined if the expiration of the ACA’s optional Medicaid primary care fee increase in 2014 modified any of these associations.

Results:
Findings showed poorer access to providers among those insured through Medicaid and the individual market (whether purchased through the state’s health insurance exchange or off-exchange) relative to employer-based insurance. Poor access to primary care providers was seen among private coverage purchased via exchanges, relative to private coverage purchased on the individual market. In addition, findings showed that reduction of Medicaid fees coincided with reduced ability to see primary care providers. However, a similar trend was seen among those with employer-based coverage, which suggests that this change may not be attributable to reductions in Medicaid fees.

Conclusion:
Despite ACA-related gains in insurance coverage, those with on-exchange and off-exchange individual private insurance plans and Medicaid encounter more barriers to care than those with employer-based insurance.
Therapeutic choices after hypomethylating agent resistance for myelodysplastic syndromes
Authors: Montalban-Bravo Guillermo , Garcia-Manero Guillermo , Jabbour Elias 
Published: December 2017

Purpose of review
Hypomethylating agents (HMAs) are the standard of care for patients with myelodysplastic syndromes (MDS). Although these agents induce responses in up to 40% of patients, most patients ultimately experience loss of response. The purpose of this review is to provide an overview of the different therapies under development for MDS after HMA therapy.

Recent findings
Recent advances in the understanding of MDS pathogenesis have led to the development of new potential therapies after HMA failure. Newer HMAs, less susceptible to in-vivo deamination, such as guadecitabine or ASTX727 have shown activity. Alterations of immune checkpoints in MDS have led to multiple clinical trials evaluating the activity of monoclonal antibodies targeting these proteins (pembrolizumab, nivolumab, ipilimumab). Different combinations and new formulations of cytotoxic agents, such as clofarabine or CPX-351, are newer options for specific subsets of patients. Finally, targeted agents inhibiting multiple kinases (rigosertib), BCL2 (venetoclax) or mutant IDH1 (ivosidenib), IDH2 (enasidenib), FLT3 (sorafenib, midostaurin) or spliceosome components (H3B-8800) are other novel options.

Summary
Despite the poor prognosis associated with HMA failure, clinical trials, new cytotoxic agents and allogeneic stem-cell transplantation, can offer therapeutic opportunities for these patients for whom there is no standard of care.
Soft-Tissue Reconstruction of the Complicated Knee Arthroplasty: Principles and Predictors of Salvage
Authors: Colen David L. , Carney Martin J. , Shubinets Valeriy , Lanni Michael A. , Liu Tiffany , Levin L. Scott , Lee Gwo-Chin , Kovach Stephen J. 
Published: December 2017

Background:
Total knee arthroplasty is a common orthopedic procedure in the United States and complications can be devastating. Soft-tissue compromise or joint infection may cause failure of prosthesis requiring knee fusion or amputation. The role of a plastic surgeon in total knee arthroplasty is critical for cases requiring optimization of the soft-tissue envelope. The purpose of this study was to elucidate factors associated with total knee arthroplasty salvage following complications and clarify principles of reconstruction to optimize outcomes.

Methods:
A retrospective review of patients requiring soft-tissue reconstruction performed by the senior author after total knee arthroplasty over 8 years was completed. Logistic regression and Fisher’s exact tests determined factors associated with the primary outcome, prosthesis salvage versus knee fusion or amputation.

Results:
Seventy-three knees in 71 patients required soft-tissue reconstruction (mean follow-up, 1.8 years), with a salvage rate of 61.1 percent, mostly using medial gastrocnemius flaps. Patients referred to our institution with complicated periprosthetic wounds were significantly more likely to lose their knee prosthesis than patients treated only within our system. Patients with multiple prior knee operations before definitive soft-tissue reconstruction had significantly decreased rates of prosthesis salvage and an increased risk of amputation. Knee salvage significantly decreased with positive joint cultures (Gram-negative greater than Gram-positive organisms) and particularly at the time of definitive reconstruction, which also trended toward an increased risk of amputation.

Conclusions:
In revision total knee arthroplasty, prompt soft-tissue reconstruction improves the likelihood of success, and protracted surgical courses and contamination increase failure and amputations. The authors show a benefit to involving plastic surgeons early in the course of total knee arthroplasty complications to optimize genicular soft tissues.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Herpes Zoster Optic Neuropathy
Authors: Kaufman Aaron R. , Myers Eileen M. , Moster Mark L. , Stanley Jordan , Kline Lanning B. , Golnik Karl C. 
Published: December 2017

Background:
Herpes zoster optic neuropathy (HZON) is a rare manifestation of herpes zoster ophthalmicus (HZO). The aim of our study was to better characterize the clinical features, therapeutic choices, and visual outcomes in HZON.

Methods:
A retrospective chart review was performed at multiple academic eye centers with the inclusion criteria of all eyes presenting with optic neuropathy within 1 month of cutaneous zoster of the ipsilateral trigeminal dermatome. Data were collected regarding presenting features, treatment regimen, and visual acuity outcomes.

Results:
Six patients meeting the HZON inclusion criteria were identified. Mean follow-up was 2.75 months (range 0.5–4 months). Herpes zoster optic neuropathy developed at a mean of 14.1 days after initial rash (range 6–30 days). Optic neuropathy was anterior in 2 eyes and retrobulbar in 4 eyes. Other manifestations of HZO included keratoconjunctivitis (3 eyes) and iritis (4 eyes). All patients were treated with systemic antiviral therapy in addition to topical and/or systemic corticosteroids. At the last follow-up, visual acuity in 3 eyes had improved relative to presentation, 2 eyes had worsened, and 1 eye remained the same. The 2 eyes that did not receive systemic corticosteroids had the best observed final visual acuity.

Conclusion:
Herpes zoster optic neuropathy is an unusual but distinctive complication of HZO. Visual recovery after HZON is variable. Identification of an optimal treatment regiment for HZON could not be identified from our patient cohort. Systemic antiviral agents are a component of HZON treatment regimens. Efficacy of systemic corticosteroids for HZON remains unclear and should be considered on a case-by-case basis.
Peripheral infrastructure vectors and an extended set of plant parts for the modular cloning system
Authors: Gantner Johannes , Ilse Theresa , Ordon Jana , Kretschmer Carola , Gruetzner Ramona , Löfke Christian , Dagdas Yasin , Bürstenbinder Katharina , Marillonnet Sylvestre , Stuttmann Johannes 
Published: December 2017

AbstractStandardized DNA assembly strategies facilitate the generation of multigene constructs from collections of building blocks in plant synthetic biology. A common syntax for hierarchical DNA assembly following the Golden Gate principle employing Type IIs restriction endonucleases was recently developed, and underlies the Modular Cloning and GoldenBraid systems. In these systems, transcriptional units and/or multigene constructs are assembled from libraries of standardized building blocks, also referred to as phytobricks, in several hierarchical levels and by iterative Golden Gate reactions. This combinatorial assembly strategy meets the increasingly complex demands in biotechnology and bioengineering, and also represents a cost-efficient and versatile alternative to previous molecular cloning techniques. For Modular Cloning, a collection of commonly used Plant Parts was previously released together with the Modular Cloning toolkit itself, which largely facilitated the adoption of this cloning system in the research community. Here, a collection of approximately 80 additional phytobricks is provided. These phytobricks comprise e.g. modules for inducible expression systems, different promoters or epitope tags, which will increase the versatility of Modular Cloning-based DNA assemblies. Furthermore, first instances of a “peripheral infrastructure” around Modular Cloning are presented: While available toolkits are designed for the assembly of plant transformation constructs, vectors were created to also use coding sequence-containing phytobricks directly in yeast two hybrid interaction or bacterial infection assays. Additionally, DNA modules and assembly strategies for connecting Modular Cloning with Gateway Cloning are presented, which may serve as an interface between available resources and newly adopted hierarchical assembly strategies. The presented material will be provided as a toolkit to the plant research community and will further enhance the usefulness and versatility of Modular Cloning.
An interpretive structural modeling approach to advertisement effectiveness in the Indian mobile phone industry
Authors: Maheshwari Prateek , Seth Nitin , Gupta Anoop Kumar 
Published: December 2017

Purpose
The mobile phone industry in India is highly competitive, fast paced and technology-driven. In such a hyper competitive era, effective advertising is considered a key success driver for a mobile phone brand. The purpose of this paper is to identify advertisement effectiveness dimensions for Indian mobile phone industry and to develop hierarchical interrelationships among these dimensions in the Indian print context.

Design/methodology/approach
Structured Delphi approach is used to derive the set of dimensions for advertisement effectiveness. Further, techniques such as interpretive structural modeling and MICMAC analysis are used to establish hierarchical linkages among identified dimensions.

Findings
On the basis of experts’ opinion, refinement through structured Delphi resulted in the identification of 14 advertisement effectiveness dimensions specific to Indian mobile phone industry. Interpretive structural modeling assisted in the development of linkages among these identified dimensions based on their interrelations. Further, attention, relevance, excitability, liking and consumer preference, etc., turned out to be the dimensions of utmost importance for measuring advertisement effectiveness for the Indian mobile phone industry.

Research limitations/implications
The present research work is limited to the recognition and development of hierarchical interrelationships among advertisement effectiveness dimensions specific to mobile phone business in the Indian print context only. Further studies may be carried out for other product or service category in some different media context.

Practical implications
The present research has several significant implications for academics and advertising practitioners involved in designing and developing promotional campaigns for mobile phone brands in India. The identified 14 dimensions and developed hierarchical model provide valuable insights for improving advertisement effectiveness.

Originality/value
This paper demonstrated successful implementation of Delphi and interpretive structural modeling technique to explore the research area of advertisement effectiveness.
How Can the CAP Promote Rural Jobs?
Authors: Matthews Alan 
Published: December 2017

SummaryPromoting rural jobs goes well beyond agricultural policy, but targeted agricultural policies can play a role. The key lesson is to invest in increasing the sector's supply of both market and non‐market goods and services, recognising that the jobs created will often be in related non‐farm sectors of the rural economy. Subsidising employment in low‐productivity agriculture is neither a sensible nor sustainable job‐creation strategy. It makes far more sense to focus on ‘smart’ agricultural support and investments which help farmers and local communities to overcome specific barriers and constraints to improve their productivity. Many investment‐promoting support measures can already be provided under CAP rules today although they are often constrained by funding limitations, for example, in Member States’ Rural Development Programmes. If policymakers want the CAP to do more to maximise its contribution to jobs and growth, these productive supports should be prioritised in the coming CAP negotiations. At the same time, there should be a greater focus on the training and skill needs for the existing agricultural workforce, including paid workers who are often forgotten in farm policy discussions.
Examining caries aetiology in adolescence with structural equation modelling
Authors: Curtis A.M. , Cavanaugh J.E. , Levy S.M. , VanBuren J. , Marshall T.A. , Warren J.J. 
Published: December 2017

AbstractObjectivesThis analysis examines the aetiology of caries development in adolescents using structural equation modelling to identify behavioural mediators of the relationship between socioeconomic status (SES) and caries incidence, and to investigate the role of sex on caries‐preventive behaviour and caries.MethodsThis analysis was based on data from the Iowa Fluoride Study, a longitudinal study of a birth cohort. We hypothesized that socioeconomic status earlier in life has a direct effect on caries development and an indirect effect from improved behavioural variables—dental visit attendance, toothbrushing frequency and percentage of beverage intake consisting of sugar‐sweetened beverages—and that sex also plays a role in behavioural variables, as well as caries. A structural equation model was developed based on these hypotheses, and direct and indirect standardized path coefficients were calculated, as well as their standard errors.ResultsBased on our proposed model, SES at birth significantly influences SES during adolescence, but not adolescent behaviours. The effect of SES during adolescence on caries in the permanent dentition is mediated by adolescent behaviours. Female participants have worse caries than male participants, despite lower self‐reported percentages of sugar‐sweetened beverage intake and more frequent brushing and dental attendance.ConclusionsThis analysis models the relationships among known causal factors for caries and suggests that the role of SES in caries may not be as important as previously thought and different behaviours that affect oral health between males and females as well as differences in caries between the sexes could begin during adolescence. These findings could help improve caries prevention programmes for adolescents.
Visit‐to‐visit HbA1c variability and systolic blood pressure (SBP) variability are significantly and additively associated with mortality in individuals with type 1 diabetes: An observational study
Authors: Wightman Stuart S. , Sainsbury Christopher A. R. , Jones Gregory C. 
Published: December 2017

AimTo investigate the relationship between variability in both visit‐to‐visit HbA1c and SBP and mortality in individuals with type 1 diabetes.MethodsThe Scottish Care Information (SCI) Diabetes dataset was used to identify 5952 individuals with type 1 diabetes for inclusion in this observational study. The SCI‐Diabetes dataset allowed access to blood pressure values, HbA1c readings, demographic information and mortality rates for all study participants. Participants were dichotomized to above and below median values for both HbA1c coefficient of variation (CV) and SBP CV, thus dividing participants into 4 cohorts for survival analysis. Survival analysis was carried out over 1430 days. A Cox proportional hazard model was used to allow comparison of mortality between the 4 cohorts.ResultsOf the 5952 patients, death occurred in 416. CV for both HbA1c and SBP were significantly associated with mortality. The median values for HbA1c CV and SBP CV were 8.0 and 8.1, respectively. The hazard ratio for high HbA1c CV only (P = .0015) was 1.78 ± 0.36. The hazard ratio for high SBP CV only (P = .0018) was 1.69 ± 0.33. The hazard ratio for both high HbA1c CV and high SBP CV (P < .00001) was 2.37 ± 0.32.ConclusionsOur findings demonstrate that variability of both HbA1c and SBP is significantly and additively associated with mortality in individuals with type 1 diabetes. The variability of these parameters might be useful for risk stratification and is a potential target for future interventional studies.
Metacommunities in river networks: The importance of network structure and connectivity on patterns and processes
Authors: Tonkin Jonathan D. , Heino Jani , Altermatt Florian 
Published: December 2017

Abstract

Rivers are spatially organised into hierarchic dendritic networks. This unique physical structure and the associated directionality of physical flows set them apart from most other environments by regulating the dispersal of resident biota and therefore the distribution of biodiversity.

The aim of this special issue is to highlight the importance of the river network on structuring biodiversity, particularly through metacommunity dynamics and associated dispersal processes.

The issue covers a wide range of topics, including disease spread, nutrient uptake, trophic dynamics, effects of anthropogenic stressors and the joint roles of dispersal and environmental filtering. Contributions employ a broad range of approaches, including field and laboratory experiments, modelling, population genetics and conceptual synthesis.

Although these studies represent just a sample of the research that is being performed on biodiversity and metacommunity dynamics in river networks, several important findings have emerged; a common theme being that the structure of the network and spatial dynamics clearly influence the dynamics of populations and communities, and their functions. By taking a broad taxonomic focus (from diatoms and protists to fish), and spanning a large geographic gradient (from the tropics to the subarctic), this special issue provides a broad look at the dynamics that occur in river networks relating to their unique makeup. We hope that this selection of studies spurs additional research on these interesting, globally important, yet severely threatened ecological systems.
Pedunculated polyp of the ileum protruding from a large diverticulum
Authors: Iwaya Yugo , Rowsell Corwyn , Grantcharov Teodor , Marcon Norman E 
Published: December 2017

IntroductionA 52-year-old woman presented with iron deficiency anaemia and postprandial right lower quadrant pain. Abdominal examination was unremarkable and laboratory results showed mild anaemia (haemoglobin 11.3 g/dL). Upper and lower endoscopies did not reveal any source of bleeding. Video capsule endoscopy was performed which showed a large polypoid lesion in the mid-ileum (figure 1). Abdominal contrast enhanced CT demonstrated a heterogeneously enhancing pedunculated polyp measuring approximately 6 cm (figure 2). Retrograde double-balloon enteroscopy was performed which revealed a large pedunculated polyp with hyperplastic-like mucosa protruding from a large diverticulum located approximately 70 cm proximal to the ileocaecal valve (figure 3A). The stalk appeared to arise from the base of the diverticulum (figure 3B). A technetium-99m pertechnetate scintigraphy revealed no ectopic gastric mucosa.Figure 1Video capsule endoscopy shows a large polypoid lesion.Figure 2CT shows a heterogeneously enhancing pedunculated polyp (arrow).Figure 3Retrograde double-balloon enteroscopy images. (A) Large pedunculated polyp protruding from a large diverticulum. (B) The stalk appears to arise from the base of the diverticulum.QuestionWhat is the diagnosis?
Marijuana use and fecundability in a North American preconception cohort study
Authors: Wise Lauren A , Wesselink Amelia K , Hatch Elizabeth E , Rothman Kenneth J , Mikkelsen Ellen M , Sørensen Henrik Toft , Mahalingaiah Shruthi 
Published: December 2017

BackgroundThe influence of marijuana use on human fertility has not been well studied. We evaluated the association between female and male use of marijuana and fecundability in Pregnancy Study Online, a prospective cohort of North American couples.MethodsFemale participants completed a baseline questionnaire on which they reported lifestyle and behavioural factors, including frequency of marijuana use within the previous 2 months. Male partners completed an optional baseline questionnaire on similar factors, including marijuana use. Women completed follow-up questionnaires every 8 weeks for 12 months or until pregnancy, initiation of fertility treatment or loss to follow-up, whichever came first. The analysis was restricted to 4194 women (1125 couples) with ≤6 cycles of pregnancy attempt time at study enrolment (2013–2017). Fecundability ratios (FR) and 95% CIs were estimated using proportional probabilities regression models, with adjustment for potential confounders.ResultsMen (14.2%) were more likely than women (11.6%) to be marijuana users. FRs for female marijuana use <1 and ≥1 time/week relative to non-use were 0.99 (95% CI 0.85 to 1.16) and 0.98 (95% CI 0.80 to 1.20), respectively. FRs for male marijuana use <1 and ≥1 time/week relative to non-use were 0.87 (95% CI 0.66 to 1.15) and 1.24 (95% CI 0.90 to 1.70), respectively. Associations for frequent marijuana use (≥1 time/week) were attenuated among non-smoking men (FR=1.21, 95% CI 0.84 to 1.74), but stronger among men reporting intercourse ≥4 times/week (FR=1.35, 95% CI 0.72 to 2.53).ConclusionsIn this preconception cohort study, there was little overall association between female or male marijuana use and fecundability.