bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding fear and anxiety in patients at the time of an exacerbation of chronic obstructive pulmonary disease: a qualitative study
Authors: Halpin David , Hyland Michael , Blake Susan , Seamark Clare , Pinnuck Margaret , Ward David , Whalley Ben , Greaves Colin , Hawkins Adam , Seamark David 
Published: December 2015

Objectives To determine the importance of fear and anxiety at the time of an exacerbation of chronic obstructive pulmonary disease. To assess the influence of carers and health professionals on this fear and anxiety. Design A qualitative study to elicit the views of patients and their carers during a hospital admission for exacerbations of chronic obstructive pulmonary disease. Setting Interviews were conducted in a District General Hospital. Participants Twenty patients were interviewed shortly after admission to hospital with an exacerbation. Main outcome measures Key themes were identified using cross-sectional thematic analysis of transcripts where commonalities and differences were identified. Results Four themes emerged: panic and fear; anxiety management techniques used during an exacerbation; intervention from family members and carers; response to medical services. Conclusion Panic and fear are important emotions prior to admission. Many patients recognised the link between panic-fear and a worsening of symptoms, and some were able to use self-management techniques to reduce their panic-fear. Some relatives were seen as helping and others exacerbating the symptoms of panic-fear. The emergency services were seen as positive: providing reassurance and a sense of safety. How best to help patients with chronic obstructive pulmonary disease manage panic and fear remains a challenge.
Doctors’ views about their work, education and training three years after graduation in the UK: questionnaire survey
Authors: Lambert Trevor , Smith Fay , Goldacre Michael J 
Published: December 2015

Objectives Doctors who graduated in the UK after 2005 have followed a restructured postgraduate training programme (Modernising Medical Careers) and have experienced the introduction of the European Working Time Regulation and e-portfolios. In this paper, we report the views of doctors who graduated in 2008 three years after graduation and compare these views with those expressed in year 1. Design Questionnaires about career intentions, destinations and views sent in 2011 to all medical graduates of 2008. Participants 3228 UK medical graduates. Main outcome measures Comments on work, education and training. Results Response was 49% (3228/6538); 885 doctors wrote comments. Of these, 21.8% were unhappy with the standard of their training; 8.4% were positive. Doctors made positive comments about levels of supervision, support, morale and job satisfaction. Many doctors commented on poor arrangements for rotas, cover and leave, which had an adverse effect on work-life balance, relationships, morale and health. Some doctors felt pressured into choosing their future specialty too early, with inadequate career advice. Themes raised in year 3 that were seldom raised in year 1 included arrangements for flexible working and maternity leave, obtaining posts in desired locations and having to pay for courses, exams and conferences. Conclusions Many doctors felt training was available, but that European Working Time Regulation, rotas and cover arrangements made it difficult to attend. Three years after graduation, doctors raised similar concerns to those they had raised two years earlier, but the pressures of career decision making, family life and job seeking were new issues.
Persistent right aortic arch with an aberrant left subclavian artery, Kommerell’s diverticulum and bicarotid trunk in a 3-year-old cat
Authors: Shannon Dylan , Husnik Roman , Fletcher Jon M , Middleton Grant , Gaschen Lorrie 
Published: December 2015

Case summary A 3-year-old male, neutered, domestic shorthair cat with a history of chronic regurgitation since being obtained as a kitten was presented for weight loss and regurgitation of all ingested food. The cat was in poor body condition and had a firm swelling in the ventral neck at the time of presentation. Thoracic radiographs showed severe dilation of the entire cervical and cranial intrathoracic esophagus to the level of the heart base. Computed tomographic angiography (CTA) showed a persistent right aortic arch with an aberrant left subclavian artery and severe dilation of the cervical and intrathoracic esophagus cranial to the heart base. CTA also showed a bicarotid trunk and Kommerell’s diverticulum to be present, which are rare vascular structures in the cat. Esophagoscopy showed esophageal dilation and multiple compact trichobezoars obstructing the esophagus. Removal of the obstructing trichobezoars resulted in resolution of clinical signs, and the cat was able to drink water and eat a canned food slurry without regurgitation. Surgical correction was not pursued. Relevance and novel information Vascular ring anomaly (VRA) should be considered in all cats with a history of regurgitation, regardless of their age at the time of presentation. CTA is a valuable diagnostic imaging procedure that allows differentiation of a VRA from other causes of esophageal obstruction and provides information about the VRA that can be used to determine amenability to surgical correction.
Primary goitrous hypothyroidism in a young adult domestic longhair cat: diagnosis and treatment monitoring
Authors: Peterson Mark E 
Published: December 2015

Case summary Primary goitrous hypothyroidism was diagnosed in a 12-month-old cat examined because of small stature, mental dullness, severe lethargy, generalized weakness and gait abnormalities. Radiographs of the long bones and spine revealed delayed epiphyseal ossification and epiphyseal dysgenesis. Diagnosis of primary hypothyroidism was confirmed by low serum concentrations of total and free thyroxine (T4) with high thyroid-stimulating hormone (TSH) concentrations. Thyroid scintigraphy revealed severe enlargement of both thyroid lobes, as evidenced by a seven-fold increase in calculated thyroid volume above the reference interval. In addition, this bilateral goiter had an extremely high radionuclide uptake, about 10-fold higher than the normal feline thyroid gland. Treatment with twice-daily levothyroxine (L-T4), administered on an empty stomach, resulted in increased alertness, playfulness, strength and improvement in gait, as well as an increase in body length and weight. L-T4 replacement also led to normalization of serum thyroid hormone and TSH concentrations, and complete resolution of goiter. Relevance and novel information Spontaneous hypothyroidism is rarely reported in cats, with congenital hypothyroidism in kittens diagnosed most frequently. Despite the fact that this cat was a young adult, it likely had a form of congenital hypothyroidism caused by dyshormonogenesis (defect in thyroid hormone synthesis) that led to compensatory development of goiter. In hypothyroid cats, treatment with L-T4 is best given twice daily on an empty stomach to ensure adequate absorption. Normalization of serum TSH and shrinkage of goiter, as well as improvement in clinical signs, is the goal of treatment for cats with goitrous hypothyroidism.
Tetrathyridiosis in a domestic shorthair cat
Authors: Dahlem Dorothee , Bangoura Berit , Ludewig Eberhard , Glowienka Nicole , Baldauf Katrin , Stoeckel Frank , Burgener Iwan 
Published: December 2015

Case summary This report describes the clinical and parasitological findings in a domestic shorthair cat with isolated thoracic tetrathyridiosis. The cat was a stray from Malta that had lived in Germany for several years since as an indoor-only cat. Therefore, the process of infection remains very unusual. In this case it must be considered that the cat had been infected years previously while in Malta, and had lived at least 4 years without any clinical signs. It was possible to diagnose this uncommon disease and initiate an effective treatment with fenbendazole, praziquantel and supportive care. Clinical signs, as well as radiographic findings, were regressive with this treatment. Relevance and novel information Tetrathyridiosis is a rare finding in cats, especially in Germany, but it seems to be a potential differential diagnosis of pleural effusion. Mesocestoides corti, which was the causative parasite in this case, has not previously been isolated in Germany. Because tetrathyridiosis is only diagnosed post mortem in most cases, little is known about effective therapeutic options. Furthermore, clinical signs of this disease can be absent for several years and can potentially be triggered by neoplastic conditions or immunosuppression. Tetrathyridiosis seems to be a treatable disease that can be controlled by adequate antiparasitic therapy.
Report from the Standards for Pathogen Identification via Next-Generation Sequencing (SPIN) Workshop
Authors: Olson Nathan D. , Jackson Scott A. , Lin Nancy J. 
Published: December 2015

AbstractNext-generation sequencing (NGS) is not routinely used in applied settings due to lack of confidence in results. This workshop convened experts to identify measurement challenges impeding NGS implementation and potential standards-based solutions to address these challenges.
Outcomes After Stereotactic Body Radiotherapy or Radiofrequency Ablation for Hepatocellular Carcinoma
Authors: Wahl Daniel R. , Stenmark Matthew H. , Tao Yebin , Pollom Erqi L. , Caoili Elaine M. , Lawrence Theodore S. , Schipper Matthew J. , Feng Mary 
Published: December 2015

Purpose Data guiding selection of nonsurgical treatment of hepatocellular carcinoma (HCC) are lacking. We therefore compared outcomes between stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) for HCC. Patients and Methods From 2004 to 2012, 224 patients with inoperable, nonmetastatic HCC underwent RFA (n = 161) to 249 tumors or image-guided SBRT (n = 63) to 83 tumors. We applied inverse probability of treatment weighting to adjust for imbalances in treatment assignment. Freedom from local progression (FFLP) and toxicity were retrospectively analyzed. Results RFA and SBRT groups were similar with respect to number of lesions treated per patient, type of underlying liver disease, and tumor size (median, 1.8 v 2.2 cm in maximum diameter; P = .14). However, the SBRT group had lower pretreatment Child-Pugh scores (P = .003), higher pretreatment alpha-fetoprotein levels (P = .04), and a greater number of prior liver-directed treatments (P < .001). One- and 2-year FFLP for tumors treated with RFA were 83.6% and 80.2% v 97.4% and 83.8% for SBRT. Increasing tumor size predicted for FFLP in patients treated with RFA (hazard ratio [HR], 1.54 per cm; P = .006), but not with SBRT (HR, 1.21 per cm; P = .617). For tumors ≥ 2 cm, there was decreased FFLP for RFA compared with SBRT (HR, 3.35; P = .025). Acute grade 3+ complications occurred after 11% and 5% of RFA and SBRT treatments, respectively (P = .31). Overall survival 1 and 2 years after treatment was 70% and 53% after RFA and 74% and 46% after SBRT. Conclusion Both RFA and SBRT are effective local treatment options for inoperable HCC. Although these data are retrospective, SBRT appears to be a reasonable first-line treatment of inoperable, larger HCC.
Preoperative Breast Magnetic Resonance Imaging and Contralateral Breast Cancer Occurrence Among Older Women With Breast Cancer
Authors: Wang Shi-Yi , Long Jessica B. , Killelea Brigid K. , Evans Suzanne B. , Roberts Kenneth B. , Silber Andrea , Gross Cary P. 
Published: December 2015

Purpose Preoperative magnetic resonance imaging (MRI) detects occult contralateral breast cancers (CBCs) in women with breast cancer, but the impact of detection on long-term CBC events is unclear. We examined whether MRI use decreases the occurrence of CBCs and the detection of stages II to IV disease among women who develop a CBC. Patients and Methods Analyzing the SEER-Medicare database, we assessed overall, synchronous (< 6 months after primary cancer diagnosis), and subsequent (ie, metachronous) stage-specific CBC occurrences in women who were diagnosed with stages I and II breast cancer during 2004-2009 and who were observed through 2011. Results Among 38,971 women with breast cancer, 6,377 (16.4%) received preoperative MRI. After propensity score matching, and compared with women who did not undergo MRI, preoperative MRI use was significantly associated with a higher synchronous CBC detection rate (126.4 v 42.9 per 1,000 person-years, respectively; hazard ratio, 2.85; P < .001) but a lower subsequent CBC detection rate (3.3 v 4.5 per 1,000 person-years, respectively; hazard ratio, 0.68; P = .002). However, the 5-year cumulative incidence of CBC remained significantly higher among women undergoing MRI compared with those not undergoing MRI (7.2% v 4.0%, respectively; P < .001). The analyses of projected CBC events for 10,000 patients who receive MRI indicated that, after a 5-year follow-up, MRI use would detect an additional 192 in situ CBCs (95% CI, 125 to 279) and 120 stage I CBCs (95% CI, 62 to 193) but would not have a significant impact on stages II to IV CBC occurrences (∼ 6; 95% CI, −21 to 47). Conclusion An increased synchronous CBC detection rate, attributable to MRI, was not offset by a decrease of subsequent CBC occurrence among older women with early-stage breast cancer, suggesting that preoperative MRI in women with breast cancer may lead to overdiagnosis.
Associations of Breast Cancer Risk Prediction Tools With Tumor Characteristics and Metastasis
Authors: Holm Johanna , Li Jingmei , Darabi Hatef , Eklund Martin , Eriksson Mikael , Humphreys Keith , Hall Per , Czene Kamila 
Published: December 2015

Purpose The association between established risk factors for breast cancer and subtypes or prognosis of the disease is not well known. We analyzed whether the Tyrer-Cuzick–predicted 10-year breast cancer risk score (TCRS), mammographic density (MD), and a 77-single nucleotide polymorphism polygenic risk score (PRS) were associated with breast cancer tumor prognosticators and risk of distant metastasis. Patients and Methods We used a case-only design in a population-based cohort of 5,500 Swedish patients with breast cancer. Logistic and multinomial logistic regression of outcomes, estrogen receptor (ER) status, lymph node involvement, tumor size, and grade was performed with TCRS, PRS, and percent MD as exposures. Cox proportional hazard models were used to estimate hazard ratios (HRs) of distant metastasis. Results Women at high risk for breast cancer based on PRS and/or TCRS were significantly more likely to be diagnosed with favorable prognosticators, such as ER-positive and low-grade tumors. In contrast, PRS weighted on ER-negative disease was associated with ER-negative tumors. When stratifying by age, the associations of TCRS with favorable prognosticators were restricted to women younger than age 50. Women scoring high in both TCRS and PRS had a lower risk of distant metastasis (HR, 0.69; 95% CI, 0.49 to 0.98). MD was not associated with any of the examined prognosticators. Conclusion Women at high risk for breast cancer based on genetic and lifestyle factors were significantly more likely to be diagnosed with breast cancers with a favorable prognosis. Better knowledge of subtype-specific risk factors could be vital for the success of prevention programs aimed at lowering mortality.
Unexplored Reactivity of N-Alkyl Unsaturated Imines: A Simple Procedure for Producing Optically Active 1,3-Diamines via a Stereocontrolled Formal [4+2] and [4+2+2] Iminocycloaddition
Authors: Pradipta Ambara R , Tanaka Katsunori 
Published: December 2015

Abstract
Imines are among the most ubiquitous species in organic and bioorganic chemistry; however, the reactivities of N-alkyl unsaturated imines have not been thoroughly explored due to their instability profiles. Here, we describe the novel reactivity of N-alkyl unsaturated imines derived from substituted aldehydes, a chiral aminoalcohol, and paraformaldehyde to produce hexahydropyrimidines and 1,3,5-triazacyclooctanes through a formal asymmetric [4+2] and [4+2+2] cycloaddition reaction in a stereocontrolled manner. The reaction products were successfully transformed via simple functional group manipulations to the variously substituted chiral 1,3-diamines, which could not be simply accessed by other methods.
Update on Neuromodulation for Treatment-Resistant Depression
Authors: Bewernick Bettina , Schlaepfer Thomas E 
Published: December 2015

About 30% of patients suffering from a major depressive disorder do not respond sufficiently to established pharmacological, psychotherapeutic, or somatic treatments. Advances in technology and emerging knowledge about the dysfunctional brain circuits underlying depression have led to the development of different neuromodulation techniques. The aim of the present review is to give an update on noninvasive techniques, such as electroconvulsive therapy (ECT), magnetic seizure therapy (MST), transcranial magnetic stimulation (TMS), and invasive techniques requiring brain surgery, such as vagus nerve stimulation (VNS) and deep brain stimulation (DBS). First, the clinical relevance for therapy-resistant depression, including the current level of evidence, are presented.Neuroethics is concerned with the ethical, legal and social policy implications of neuroscience. A second focus of the review is the application of fundamental ethical principles, such as patient autonomy, patient well-being and justice to neuromodulation therapies. Due to reduced availability and lacking long-term efficacy data, most patients with treatment-resistant depression face a trial-and-error approach to therapeutics. This contravenes the ethical criteria of patient autonomy and justice. In order to raise the level of evidence, financial support of long-term studies, including large samples and randomized control trials, are necessary.
Temporal and spatial variability in sea-ice carbon:nitrogen ratios on Canadian Arctic shelves
Authors: Niemi Andrea , Michel Christine 
Published: December 2015

Abstract
To enhance the accuracy of carbon cycling models as applied to sea ice in the changing Arctic, we analyzed a large data set of particulate organic carbon (POC) and nitrogen (PON) measurements in first-year bottom sea ice (n = 257) from two Arctic shelves, the Canadian Arctic Archipelago and Beaufort Sea shelf, including dark winter and spring seasonal measurements. Wide ranges of sea-ice POC:PON ratios were observed during both the dark winter (12–46 mol:mol) and spring (3–24 mol:mol) periods. Sea-ice POC:PON ratios and chlorophyll a concentrations were significantly higher in the Archipelago versus the Beaufort Sea shelf (p &lt; 0.01), yet there was a highly significant relationship between sea-ice POC and PON during spring for both shelves (r2 = 0.94). POC:PON ratios were not consistent over the range of measured POC and PON concentrations, justifying the use of a power function model to best describe the relationship between POC and PON. Distinct relationships between POC:PON ratios and chlorophyll-based biomass were observed for the dark winter and the spring: dark winter sea-ice POC:PON ratios decreased with increasing sea-ice biomass whereas spring POC:PON ratios increased with increasing sea-ice biomass. The transition from the dark period to the spring growth period in first-year sea ice represented a distinct stoichiometric shift in POC:PON ratios. Our results demonstrate that the Redfield ratio has limited applicability over the four-order of magnitude range of biomass concentrations observed in first-year sea ice on Arctic shelves. This study emphasizes the need for variable POC:PON stoichiometry in sea-ice biogeochemical models and budget estimates, in particular at high biomass concentrations and when considering seasonality outside of the spring period in first year ice. The use of a power function model for POC:PON relationships in sea ice is also recommended to better constrain carbon estimates in biogeochemical sea-ice models.
Canine nutrition for a healthy old age
Authors: Moyers Tamberlyn 
Published: December 2015

Ageing dogs are commonly seen in veterinary practices. Small breed dogs may be considered geriatric at 12–14 years whereas large and giant breed dog would be geriatric at 7–9 years. When dogs begin to transition from adult to senior or geriatric, it is important that their nutrition is monitored by a veterinary professional so that they maintain health and a high quality of life. The veterinary nurse plays an important role in monitoring patients from the time they are puppies through their senior years assuring that appropriate nutrition is maintained for a long, healthy life. The veterinary nurse's role in helping the owner to achieve his or her goals of having a healthy older dog begins the minute the patient enters the clinic for the first time. Mature dogs are more prone than younger dogs to certain disease processes such as obesity, degenerative joint disease, cognitive dysfunction, and cardiac, renal, liver, and metabolic diseases. A beneficial feeding plan should be based on risk factors and any disease process affecting the individual dog. The aim is to establish a long healthy old age for the canine.
Spectrum bias, a common unrecognised issue in orthopaedic agreement studies
Authors: Kleinlugtenbelt Y. V. , Hoekstra M. , Ham S. J. , Kloen P. , Haverlag R. , Simons M. P. , Bhandari M. , Goslings J. C. , Poolman R. W. , Scholtes V. A. B. 
Published: December 2015

Objectives Current studies on the additional benefit of using computed tomography (CT) in order to evaluate the surgeons’ agreement on treatment plans for fracture are inconsistent. This inconsistency can be explained by a methodological phenomenon called ‘spectrum bias’, defined as the bias inherent when investigators choose a population lacking therapeutic uncertainty for evaluation. The aim of the study is to determine the influence of spectrum bias on the intra-observer agreement of treatment plans for fractures of the distal radius. Methods Four surgeons evaluated 51 patients with displaced fractures of the distal radius at four time points: T1 and T2: conventional radiographs; T3 and T4: radiographs and additional CT scan (radiograph and CT). Choice of treatment plan (operative or non-operative) and therapeutic certainty (five-point scale: very uncertain to very certain) were rated. To determine the influence of spectrum bias, the intra-observer agreement was analysed, using Kappa statistics, for each degree of therapeutic certainty. Results In cases with high therapeutic certainty, intra-observer agreement based on radiograph was almost perfect (0.86 to 0.90), but decreased to moderate based on a radiograph and CT (0.47 to 0.60). In cases with high therapeutic uncertainty, intra-observer agreement was slight at best (-0.12 to 0.19), but increased to moderate based on the radiograph and CT (0.56 to 0.57). Conclusion Spectrum bias influenced the outcome of this agreement study on treatment plans. An additional CT scan improves the intra-observer agreement on treatment plans for a fracture of the distal radius only when there is therapeutic uncertainty. Reporting and analysing intra-observer agreement based on the surgeon’s level of certainty is an appropriate method to minimise spectrum bias. Cite this article: Bone Joint Res 2015;4:190–194.