bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review
Authors: Budhathoki Shyam Sundar , Zwanikken Prisca A C , Pokharel Paras K , Scherpbier Albert J 
Published: February 2017

ObjectivesThere is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is influenced by many factors. Motivation developed as a medical student is one key determinant of this choice. This study explores influences on medical students' motivation to practise in rural areas of low-income and middle-income countries following graduation.DesignA systematic review was conducted to identify influences on medical students' motivation to work in rural areas in low-income and middle-income countries. Papers reporting influences on motivation were included, and content analysis was conducted to select the articles. Articles not published in English were excluded from this review.ResultsA rural background (ie, being brought up in a rural area), training in rural areas with a community-based curriculum, early exposure to the community during medical training and rural location of medical school motivate medical students to work in rural areas. Perceived lack of infrastructure, high workload, poor hospital management and isolation are among the health facility factors that demotivate medical students for medical practice in rural areas.ConclusionsMedical school selection criteria focusing on a rural background factor and medical education curriculum focusing on rural area are more relevant factors in low-income and middle-income countries. The factors identified in this review may assist the planners, medical educators and policymakers in low-income and middle-income countries in designing relevant interventions to positively influence rural choices where the shortage of rural physicians is an ongoing and increasing concern.
The application of microtextural and heavy mineral analysis to discriminate between storm and tsunami deposits
Authors: Costa Pedro J. M. , Gelfenbaum G. , Dawson S. , La Selle S. , Milne F. , Cascalho J. , Lira C. Ponte , Andrade C. , Freitas M. C. , Jaffe B. 
Published: February 2017

Abstract
Recent work has applied microtextural and heavy mineral analyses to sandy storm and tsunami deposits from Portugal, Scotland, Indonesia and the USA. We looked at the interpretation of microtextural imagery (scanning electron microscopy) of quartz grains and heavy mineral compositions. We consider inundation events of different chronologies and sources (the AD 1755 Lisbon and 2004 Indian Ocean tsunamis, the Great Storm of 11 January 2005 in Scotland, and Hurricane Sandy in 2012) that affected contrasting coastal and hinterland settings with different regional oceanographic conditions. Storm and tsunami deposits were examined along with potential source sediments (alluvial, beach, dune and nearshore sediments) to determine provenance.
Results suggest that tsunami deposits typically exhibit a significant spatial variation in grain sizes, microtextures and heavy minerals. Storm deposits show less variability, especially in vertical profiles. Tsunami and storm quartz grains had more percussion marks and fresh surfaces compared to potential source material. Moreover, in the studied cases, tsunami samples had fewer fresh surfaces than storm deposits.
Heavy mineral assemblages are typically site-specific. The concentration of heavy minerals decreases upwards in tsunamigenic units, whereas storm sediments show cyclic concentrations of heavy minerals, reflected in the laminations observed macroscopically in the deposits.
Effect of Race and Ethnicity on Antihypertensive Medication Utilization Among Women in the United States: Study of Women's Health Across the Nation (SWAN)
Authors: Jackson Elizabeth A. , Ruppert Kristine , Derby Carol A. , Lian Yinjuan , Neal‐Perry Genevieve , Habel Laurel A. , Tepper Ping G. , Harlow Siobán D. , Solomon Daniel H. 
Published: February 2017

Background
Antihypertensive medication use may vary by race and ethnicity. Longitudinal antihypertensive medication use patterns are not well described in women.

Methods and Results

Participants from the Study of Women's Health Across the Nation (SWAN), a prospective cohort of women (n=3302, aged 42–52), who reported a diagnosis of hypertension or antihypertensive medication use at any annual visit were included. Antihypertensive medications were grouped by class and examined by race/ethnicity adjusting for potential confounders in logistic regression models. A total of 1707 (51.7%) women, mean age 50.6 years, reported hypertension or used antihypertensive medications at baseline or during follow‐up (mean 9.1 years). Compared with whites, blacks were almost 3 times as likely to receive a calcium channel blocker (odds ratio, 2.92; 95%
CI
, 2.24–3.82) and twice as likely to receive a thiazide diuretic (odds ratio, 2.38; 95%
CI
, 1.93–2.94). Blacks also had a higher probability of reporting use of ≥2 antihypertensive medications (odds ratio, 1.95; 95%
CI
, 1.55–2.45) compared with whites. Use of angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers and thiazide diuretics increased over time for all racial/ethnic groups. Contrary to our hypothesis, rates of β‐blocker usage did not decrease over time.

Conclusions
Among this large cohort of multiethnic midlife women, use of antihypertensive medications increased over time, with angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers becoming the most commonly used antihypertensive medication, even for blacks. Thiazide diuretic utilization increased over time for all race/ethnic groups as did use of calcium channel blockers among blacks; both patterns are in line with guideline recommendations for the management of hypertension.
“The Readiness is All”
Authors: Azize Joseph 
Published: February 2017

The most important of Gurdjieff’s still little-known contemplative techniques was the daily exercise his pupils called the “Preparation.” No notes or recordings of a Preparation given by Gurdjieff himself are known to exist. The chief aim of this article is to publish a transcript of the Preparation as given by George M. Adie (1901–1989), according to indications he had received from Gurdjieff. Other personal pupils of Gurdjieff have attested to the accuracy with which Adie passed on the tradition of the Preparation. Further references to the Preparation are examined, clarifying its various aspects. The study closes by tracing the roots of the Preparation in Gurdjieff’s thought, and its almost complete disappearance from the Gurdjieff tradition; a victim, as it were, of close secrecy and a shift in practices in many Gurdjieff groups.
“Turning Ourselves”
Authors: Robertson David G. 
Published: February 2017

In 1974, Robert Fripp—leader of the progressive rock group King Crimson—had a spiritual experience in which “the top of [his] head blew off.” He became a student of J. G. Bennett, himself a former student of G. I. Gurdjieff, at Sherborne House in Gloucestershire, and remains a member of the Bennett Foundation to this day. When Fripp returned to the music industry, it was with an approach that favored disciplined and geometric compositions over the jagged improvisation of the earlier period. This article explores the influence of Gurdjieff and Bennett’s teaching upon Fripp and his work, and his apparent attempts to realize the former’s idea of “objective art” through his music. I pay particular attention to the development of Guitar Craft, in which Fripp applies Gurdjieff’s techniques through the teaching of the guitar. I argue that Fripp’s teaching is a little examined scion of the Gurdjieff lineage, and a case study of discrete cultural production.
Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature
Authors: Ende-Verhaar Yvonne M. , Cannegieter Suzanne C. , Vonk Noordegraaf Anton , Delcroix Marion , Pruszczyk Piotr , Mairuhu Albert T.A. , Huisman Menno V. , Klok Frederikus A. 
Published: February 2017

The incidence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is relevant for management decisions but is currently unknown.We performed a meta-analysis of studies including consecutive PE patients followed for CTEPH. Study cohorts were predefined as “all comers”, “survivors” or “survivors without major comorbidities”. CTEPH incidences were calculated using random effects models.We selected 16 studies totalling 4047 PE patients who were mostly followed up for >2-years. In 1186 all comers (two studies), the pooled CTEPH incidence was 0.56% (95% CI 0.1–1.0). In 999 survivors (four studies) CTEPH incidence was 3.2% (95% CI 2.0–4.4). In 1775 survivors without major comorbidities (nine studies), CTEPH incidence was 2.8% (95% CI 1.5–4.1). Both recurrent venous thromboembolism and unprovoked PE were significantly associated with a higher risk of CTEPH, with odds ratios of 3.2 (95% CI 1.7–5.9) and 4.1 (95% CI 2.1–8.2) respectively. The pooled CTEPH incidence in 12 studies that did not use right heart catheterisation as the diagnostic standard was 6.3% (95% CI 4.1–8.4).The 0.56% incidence in the all-comer group probably provides the best reflection of the incidence of CTEPH after PE on the population level. The ∼3% incidences in the survivor categories may be more relevant for daily clinical practice. Studies that assessed CTEPH diagnosis by tests other than right heart catheterisation provide overestimated CTEPH incidences.
CEOP-IMVP-Dexa in the treatment of aggressive lymphomas: an Austrian multicenter trial.
Authors: Fridrik M A , Hausmaninger H , Linkesch W , Stöger M , Sill H , Neubauer M , Seewann H L , Klocker J , Haidinger R , Schiller L , Pont J , Raudaschl G , Falk M , Radaszkiewicz T 
Published: February 2017

PURPOSE This trial evaluated the efficacy, toxicity, and practicability of a new intensive chemotherapy regimen in a multicenter setting of university and community hospitals. PATIENTS AND METHODS We tested a hybrid protocol of two non-cross-resistant regimens, cyclophosphamide, epirubicin, vincristine, and prednisolone (CEOP) and ifosfamide, etoposide (VP-16), methotrexate, and dexamethasone (IMVP-Dexa) given every fourth week, three to six times according to response, in patients with untreated intermediate- and high-grade non-Hodgkin's lymphoma. Ten Austrian centers entered 81 patients onto this multicenter trial. Eleven patients were excluded. The median age was 55 years. Twenty-six of 70 patients had stage III or IV disease. The distribution among international risk categories low, intermediate-low, intermediate-high, and high was 20%, 34%, 23%, and 23%, respectively. RESULTS Of 70 eligible patients, 56 (80%) had a complete remission and seven (10%) a partial remission. After a median observation time of 36 months, the estimated time to relapse and overall survival rates are 67% and 72%, respectively. Age and Karnofsky index were the only independent risk factors for survival. Toxicity was primarily hematologic, with a median granulocyte nadir of 0.56 x 10(9)/L. Sixty-seven percent of patients had infections; 25.7% were severe World Health Organization (WHO) grade III or IV. There were three treatment-related deaths. CONCLUSION CEOP-IMVP-Dexa chemotherapy is safe and feasible on a groupwide basis even when used in community hospitals. Neutropenic infections are the major complications. A 72% 3-year survival rate in patients with intermediate- and high-grade non-Hodgkin's lymphoma warrants further studies. These data are the basis for a randomized trial to compare cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) with CEOP/IMVP-Dexa.
Phase I/II study of combined granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor administration for the mobilization of hematopoietic progenitor cells.
Authors: Winter J N , Lazarus H M , Rademaker A , Villa M , Mangan C , Tallman M , Jahnke L , Gordon L , Newman S , Byrd K , Cooper B W , Horvath N , Crum E , Stadtmauer E A , Conklin E , Bauman A , Martin J , Goolsby C , Gerson S L , Bender J , O'Gorman M 
Published: February 2017

PURPOSE To study the toxicity and efficacy of combined granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) administration for mobilization of hematopoietic progenitor cells (HPCs). MATERIALS AND METHODS Cohorts of a minimum of five patients each were treated subcutaneously as follows: G-CSF 5 micrograms/kg on days 1 to 12 and GM-CSF at .5, 1, or 5 micrograms/kg on days 7 to 12 (cohorts 1, 2, and 3); GM-CSF 5 micrograms/kg on days 1 to 12 and G-CSF 5 micrograms/kg on days 7 to 12 (cohort 4); and G-CSF and GM-CSF 5 micrograms/kg each on days 1 to 12 (cohort 5). Ten-liter aphereses were performed on days 1 (baseline, pre-CSF), 5, 7, 11, and 13. Colony assays for granulocyte-macrophage colony-forming units (CFU-GM) and erythroid burst-forming units (BFU-E) were performed on each harvest. RESULTS The principal toxicities were myalgias, bone pain, fever, nausea, and mild thrombocytopenia, but none was dose-limiting. Four days of treatment with either G-CSF or GM-CSF resulted in dramatic and sustained increases in the numbers of CFU-GM per kilogram collected per harvest that represented 35.6 +/- 8.9- and 33.7 +/- 13.0-fold increases over baseline, respectively. This increment was attributable both to increased numbers of mononuclear cells collected per 10-L apheresis and to increased concentrations of progenitors within each collection. The administration of G-CSF to patients already receiving GM-CSF (cohort 4) caused the HPC content to surge to nearly 80-fold the baseline (P = .024); the reverse sequence, ie, the addition of GM-CSF to G-CSF, was less effective. The CFU-GM content of the baseline aphereses correlated with the maximal mobilization achieved (r = .74, P = .001). CONCLUSION Combined G-CSF and GM-CSF administration effectively and predictably mobilizes HPCs and facilitates apheresis.
Role of interstitial radiotherapy in the management of clinically organ-confined prostate cancer: the jury is still out.
Authors: D'Amico A V , Coleman C N 
Published: February 2017

PURPOSE AND DESIGN To discuss the evolution of the use of brachytherapy in the treatment of clinically organ-confined prostate cancer and to review modern techniques, results of therapy, and optimal patient selection criteria. RESULTS Using modern localization and immobilization techniques, interstitial prostate radiotherapy for patients with a prostate-specific antigen (PSA) level less than 10 ng/mL yields an at least 87% rate of freedom from biochemical relapse at 3 years, which is numerically equivalent to results achieved with external-beam radiotherapy or radical prostatectomy. With a minimum median follow-up time of 24 months, 81% to 85% (2-year actuarial and 3-year crude) potency rates have been reported concomitant with 2-year actuarial rates of 12% for grade > or = 2 rectal complications and 10% for grade > or = 3 urethral complications. CONCLUSION The combination of clinical stage, PSA level, and biopsy Gleason sum allows for selection of patients with the highest probability of having all of the prostate cancer encompassed by the high-dose implant volume, while simultaneously respecting the normal-tissue tolerance doses of the juxtaposed normal tissues (rectum and bladder). In particular, patients with nonpalpable (T1c) lesions, a biopsy Gleason sum < or = 6 (ideally < or = 4), and a PSA level less than 10 ng/mL represent the optimal implant candidates. Differential loading of the implant away from the geometric center and not accepting patients with large prostate glands (> or = 60 cm3) or history of a transurethral resection of the prostate (TURP) as implant candidates, may reduce urethral toxicity. Further follow-up evaluation of prostate cancer patients treated with interstitial radiotherapy will verify if favorable potency preservation rates and rates of freedom from biochemical failure equivalent to those achieved with radical prostatectomy or external-beam radiation therapy are maintained.
Quality-of-life-adjusted survival analysis of interferon alfa-2b adjuvant treatment of high-risk resected cutaneous melanoma: an Eastern Cooperative Oncology Group study.
Authors: Cole B F , Gelber R D , Kirkwood J M , Goldhirsch A , Barylak E , Borden E 
Published: February 2017

PURPOSE To evaluate the quality-of-life effects of adjuvant high-dose interferon alfa-2b (IFN alpha 2b) treatment of high-risk melanoma. PATIENTS AND METHODS A quality-of-life-adjusted survival analysis (Quality-Adjusted Time Without Symptoms, and Toxicity [Q-TWiST]) was applied to the Eastern Cooperative Oncology Group Trial E1684, which compared high-dose IFN alpha 2b treatment for 1 year versus observation in 280 high-risk patients. IFN alpha 2b was administered at a dosage of 20 mU/m2 intravenously daily for 5 days per week for 4 weeks, and then three times weekly at 10 mU/m2 subcutaneously for 48 weeks. RESULTS After 84 months of median follow-up time, the IFN alpha 2b group gained a mean of 8.9 months without disease relapse (P = .03) and 7.0 months of overall survival (P = .07) as compared with the observation group, but had severe treatment-related toxicity for 5.8 months, on average. The IFN alpha 2b group had more quality-of-life-adjusted time than the observation group regardless of the relative valuations placed on time with toxicity (Tox) and time with relapse (Rel). This gain was significant (P < .05) for patients who consider Tox to have a high relative value and Rel to have a low relative value. In contrast, for patients who value Tox about the same as Rel, the quality-adjusted gain for IFN alpha 2b was not statistically significant. An analysis stratified according to tumor burden indicated that the benefit of IFN alpha 2b was greatest in the node-positive strata. CONCLUSION For patients with high-risk melanoma, the clinical benefits of high-dose IFN alpha 2b can offset the toxic effects. The optimal treatment for an individual patient depends on the patient's tumor burden and preferences regarding toxicity and disease relapse.
Fluorouracil and leucovorin with or without interferon alfa-2b in advanced colorectal cancer: analysis of a prospective randomized phase III trial. Hellenic Cooperative Oncology Group.
Authors: Kosmidis P A , Tsavaris N , Skarlos D , Theocharis D , Samantas E , Pavlidis N , Briassoulis E , Fountzilas G 
Published: February 2017

PURPOSE To investigate if double modulation of fluorouracil (5-FU) with leucovorin (folinic acid [FA]) and interferon alfa-2b (IFN 2b) improves responses and survival in comparison to single modulation of 5-FU with FA. PATIENTS AND METHODS One hundred six patients with histologically confirmed advanced colorectal cancer, measurable disease, and without previous chemotherapy were prospectively randomized into two groups. Patients in group A received 5-FU 450 mg/m2 as an intravenous bolus in the midinfusion of FA weekly. FA was given at a dose of 200 mg/m2 in 500 mL 0.9% normal saline solution in 2-hour infusion. Patients in group B received exactly the same regimen plus IFN 2b 5 million units subcutaneously three times weekly. RESULTS All patients were well balanced in both groups regarding age, sex, performance status, number, and site of metastasis. One hundred two patients were assessable. All patients have died. There was no difference in response between the two groups (7.8% v 9.8%). Median survival was 10.1 months in group A, and 7.2 months in group B (P = .00189). Median time to progression was 8.4 and 5.2 months, respectively (P = .00196). Overall, better performance status and older age had a positive impact on survival. Toxicity was the most important and catastrophic aspect of this study. Patients who received IFN 2b had significantly worse anemia, neutropenia, diarrhea, anorexia, weight loss, flu-like syndrome, and psychological reactions. CONCLUSION Based on this final analysis, the addition of IFN 2b to the combination of 5-FU and FA enhances toxicity and contributes to decreased survival.
The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study.
Authors: Sprangers M A , Groenvold M , Arraras J I , Franklin J , te Velde A , Muller M , Franzini L , Williams A , de Haes H C , Hopwood P , Cull A , Aaronson N K 
Published: February 2017

PURPOSE To construct a breast cancer-specific quality-of-life questionnaire (QLQ) module to be used in conjunction with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and to test its reliability and validity cross-culturally. PATIENTS AND METHODS Module construction took place after the EORTC guidelines for module development. The module--the QLQ-BR23--consists of 23 items covering symptoms and side effects related to different treatment modalities, body image, sexuality, and future perspective. This module was tested in 170 Dutch, 168 Spanish, and 158 American cancer patients at two points in time. The timing for the Dutch and Spanish patients was before and during treatment with radiotherapy or chemotherapy. For the American patients, the questionnaire was administered at admission at the breast clinic and 3 months after the first assessment. RESULTS Multitrait scaling analysis confirmed the hypothesized structure of four of the five scales. Cronbach's alpha coefficients were, in general, lowest in Spain (range; .46 to .94) and highest in the United States (range; .70 to .91). On the basis of known-groups comparisons, selective scales distinguished clearly between patients differing in disease stage, previous surgery, performance status, and treatment modality, according to expectation. Additionally, selective scales detected change over time as a function of changes in performance status and treatment-induced change. CONCLUSION These results lend support to the clinical and cross-cultural validity of the QLQ-BR23 as a supplementary questionnaire for assessing specific quality-of-life issues relevant to patients with breast cancer.