bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiation delivered to patients during endourological surgery – are they overexposed?
Authors: Hennessey DB , Martin J , Tyson M , Lawrentschuk N , Young M , Pahuja A 
Published: December 2015

Introduction: Ionising radiation is commonly used in urological practice in the form of fluoroscopy. To date there is a remarkable scarcity of information concerning patient exposure to ionising radiation during urological procedures and the potential risk of developing of a lethal malignancy due to excessive radiation exposure. Objectives: We aimed to determine the radiation exposure for a patient during the most commonly performed urological procedures, and to assess the potential risk of developing a fatal cancer as a result of endourological fluoroscopy. Methods: Data was collected prospectively in two institutions on endoscopic urological operations. Procedures were classified as retrographic, semi-rigid ureteroscopic and flexible ureterorenoscopic (FURS). Data collected included procedure type and difficulty, Dose Area Product [DAP (Gy*Cm2)]. The effective dose (ED) measured in millisievert (mSv) was determined from the DAP by using the Monte Carlo calculation. Results: In total 395 consecutive operations from two institutions were assessed. The mean ED for all procedures in this study was 0.394 mSv, IQR (0.1184–0.7583). The maximum ED was 5.93 mSv. The radiation exposure for all procedures was relatively small; for diagnostic retrographic procedures the median ED was 0.112 mSv. For retrograde procedures that involved stent insertion, the median ED was 0.438 mSv. The median ED for all ureteroscopic surgeries was 0.295 mSv, and the median ED for all FURS procedures was 0.491. Conclusion: The findings of this study are reassuring. Endoscopic urological procedures appear to expose patients to relatively small radiation compared with other procedures requiring fluoroscopy, thus conferring a very low lifetime risk of malignancy.
Transurethral biopsy of the prostatic urethra is associated with final apical margin status at radical cystoprostatectomy
Authors: von Rundstedt Friedrich-Carl , Mata Douglas A , Shen Steven , Li Yi , Godoy Guilherme , Lerner Seth P 
Published: December 2015

Purpose: Biopsy of the prostatic urethra is an integral part of clinical staging in patients prior to radical cystoprostatectomy (RC) and urinary diversion. We examined whether preoperative transurethral resection (TUR) biopsy was associated with final apical urethral margin status and hypothesized that a negative biopsy could replace intraoperative frozen section for decision making regarding the feasibility of orthotopic neobladder reconstruction. Methods: TUR biopsy, frozen section, urethrectomy, and final apical urethral margin pathologic data were extracted from the charts of men who had undergone RC at the Houston Methodist Hospital between 1987 and 2013. TUR biopsies were performed at five and seven o’clock adjacent to the verumontanum. A positive biopsy was defined as the presence of in situ or invasive urothelial carcinoma. Clinical and perioperative variables were analyzed using descriptive and inferential statistics. Results: We reviewed the medical records of 272 men. Preoperative TUR biopsies of the prostatic urethra were negative in 74% (200/272) and positive in 26% (72/272) of men. The overall incidence of apical urethral margin positivity on final pathology was 2.2% (six of 272). Four men underwent primary or secondary urethrectomy. TUR biopsy negative and positive predictive values for apical urethral margin positivity were 99.5% (95% confidence interval (CI): 97.2 to 99.9) and 6.9% (95% CI: 2.3 to 15.5), respectively. Conclusions: The incidence of a positive apical urethral margin was low in patients undergoing RC. A negative preoperative TUR biopsy of the prostatic urethra was reliably associated with a negative final margin, obviating the need for intraoperative frozen section. Furthermore, a positive biopsy was not reliably associated with final margin status. These data will aid in the counseling of patients regarding the feasibility of neobladder reconstruction.
Teaching Legal Ethics to Law Students: Why, What, How and Who Might Teach?
Authors: Beca Juan 
Published: December 2015

The article explores what a specific course on ethics should be in a law school, and what is the impact of such curricular changes on this field. Learning of ethics is not always regarded as something important in the law curriculum, but it is crucial to education of future lawyers. Teaching ethics in law schools is also necessary to deal with public perception about the legal profession. Lawyers have to make choices all the time, so students need to be prepared to do so. Ethical decision making should be taught to students, giving them the necessary tools to go through a discernment process. It is also essential to cultivate students’ autonomy to make decisions. An active-participative paradigm might enhance learning among students. They can learn more while doing different activities, and especially working in groups with their peers, to solve ethical dilemmas. In order to be prepared to solve those dilemmas, students need to learn a discernment method. We offer one in particular: the See–Judge–Act method. There are three approaches to what students should be challenged to learn: knowing the rules, working with dilemmas and judging. We advocate for the third one. We explore the necessary relation of an ethics course with legal clinics and other courses, stating that teaching legal ethics needs a context, and that the context may be given by the other courses. Having an interdisciplinary approach to ethics is beneficial for students, and this can be achieved by sharing the class with a non-lawyer professor.
Innovation Management Theory and Practice: Part 1
Authors: Miller William L. 
Published: December 2015

This article identifies the root cause of a group of wicked global problems which is lack of value creation from radical innovation that has existed over the last four decades. This article describes the essential part of a solution which is adoption of a new fourth generation of innovation management (4G) to emerge as best practice since 1900. 4G effectively enables radical innovation. Radical innovation is required for sustained, adequate rates of economic growth driven by improvements in productivity, quality and cost in industries such as health care, education, construction and energy. As a result of inadequate radical innovation for decades, a group of major economic, social and environmental wicked problems , such as, income inequality and global warming, remain unsolved, and these problems exist in all countries including the United States. In his landmark book Capital in the Twenty-first Century, Thomas Piketty linked inadequate economic growth to income inequality. A distinguished economist and professor at Northwestern University, Robert Gordon, has identified the current global situation as a period of potentially permanently stalled economic growth unless value creation driven by radical innovation is resumed at a level and with rates similar to what occurred in the three industrial/information revolutions since 1750. Since 1900, there have been three separate and successive periods of time in which a new generation of innovation management was created and then adopted as best practice to replace, augment and improve the practices in earlier generations. The root cause of the global problem is that none of the three generations have been effective in creating an adequate amount of radical innovation which requires a new dominant design to transform (a) capabilities in organizations based on knowledge, tools (which include purchased products and services), technology and processes, (b) business models and (c) the structure of markets and industries. 4G is guided by 12 new principles and practices to effectively and efficiently create radical innovation based on new dominant designs while also improving the efficient creation of incremental innovation. Part 1 of this article describes 4G and the first four principles of 4G in detail. Another companion article, Part 2, will later describe the remaining eight principles in detail as essential part of a solution.
Polymicrobial intensive care unit-acquired pneumonia: prevalence, microbiology and outcome
Authors: Ferrer Miquel , Difrancesco Leonardo Filippo , Liapikou Adamantia , Rinaudo Mariano , Carbonara Marco , Li Bassi Gianluigi , Gabarrus Albert , Torres Antoni 
Published: December 2015

Abstract
Background
Microbial aetiology of intensive care unit (ICU)-acquired pneumonia (ICUAP) determines antibiotic treatment and outcomes. The impact of polymicrobial ICUAP is not extensively known. We therefore investigated the characteristics and outcomes of polymicrobial aetiology of ICUAP.

Method
Patients with ICUAP confirmed microbiologically were prospectively compared according to identification of 1 (monomicrobial) or more (polymicrobial) potentially-pathogenic microorganisms. Microbes usually considered as non-pathogenic were not considered for the etiologic diagnosis. We assessed clinical characteristics, microbiology, inflammatory biomarkers and outcome variables.

Results
Among 441 consecutive patients with ICUAP, 256 (58 %) had microbiologic confirmation, and 41 (16 %) of them polymicrobial pneumonia. Methicillin-sensitive Staphylococcus aureus, Haemophilus influenzae, and several Enterobacteriaceae were more frequent in polymicrobial pneumonia. Multi-drug and extensive-drug resistance was similarly frequent in both groups. Compared with monomicrobial, patients with polymicrobial pneumonia had less frequently chronic heart disease (6, 15 % vs. 71, 33 %, p = 0.019), and more frequently pleural effusion (18, 50 %, vs. 54, 25 %, p = 0.008), without any other significant difference. Appropriate empiric antimicrobial treatment was similarly frequent in the monomicrobial (185, 86 %) and the polymicrobial group (39, 95 %), as were the initial response to the empiric treatment, length of stay and mortality. Systemic inflammatory response was similar comparing monomicrobial with polymicrobial ICUAP.

Conclusion
The aetiology of ICUAP confirmed microbiologically was polymicrobial in 16 % cases. Pleural effusion and absence of chronic heart disease are associated with polymicrobial pneumonia. When empiric treatment is frequently appropriate, polymicrobial aetiology does not influence the outcome of ICUAP.
vCCL2/vMIP-II, the viral master KEYmokine
Authors: Szpakowska Martyna , Chevigné Andy 
Published: December 2015

Abstract
Viral CC motif chemokine or viral macrophage inflammatory protein-II is 1 of the 3 chemokines encoded by the human herpesvirus-8 to interfere with the host chemokine receptor network, facilitate the immune escape, and promote its survival. Viral CC motif chemokine 2 binds to a broad spectrum of viral and human chemokine receptors of all 4 classes and, depending on the receptor, acts either as an agonist or an antagonist, inducing or blocking the recruitment of specific immune cell subsets. These atypical binding and signaling properties make this viral chemokine not only a useful tool to investigate the complexity of the chemokine–receptor interaction network or the virus–host interplay but also for the development of receptor inhibitors. This mini-review summarizes the knowledge currently available on viral CC motif chemokine 2 binding, signaling, and structural mimicry and discusses its role and importance for the virus, the therapeutic potential, and the open questions regarding the biology of this fascinating chemokine.
Cortisol regulates the paracrine action of macrophages by inducing vasoactive gene expression in endometrial cells
Authors: Thiruchelvam Uma , Maybin Jacqueline A , Armstrong Gregory M , Greaves Erin , Saunders Philippa T K , Critchley Hilary O D 
Published: December 2015

Abstract
The human endometrium undergoes inflammation and tissue repair during menstruation. We hypothesized that the local availability of bioactive glucocorticoids plays an important role in immune cell–vascular cell interactions in endometrium during tissue repair at menstruation, acting either directly or indirectly via tissue resident macrophages. We sought to determine whether endometrial macrophages are direct targets for glucocorticoids; whether cortisol-treated macrophages have a paracrine effect on angiogenic gene expression by endometrial endothelial cells; and whether endometrial macrophages express angiogenic factors. Human endometrium (n = 41) was collected with ethical approval and subject consent. Donor peripheral blood monocyte-derived macrophages were treated with estradiol, progesterone, or cortisol. The effect of peripheral blood monocyte-derived macrophage secretory products on the expression of angiogenic RNAs by endothelial cells was examined. Immunofluorescence was used to examine localization in macrophages and other endometrial cell types across the menstrual cycle. Endometrial macrophages express the glucocorticoid receptor. In vitro culture with supernatants from cortisol-treated peripheral blood monocyte-derived macrophages resulted in altered endometrial endothelial cell expression of the angiogenic genes, CXCL2, CXCL8, CTGF, and VEGFC. These data highlight the importance of local cortisol in regulating paracrine actions of macrophages in the endometrium. CXCL2 and CXCL8 were detected in endometrial macrophages in situ. The expression of these factors was highest in the endometrium during the menstrual phase, consistent with these factors having a role in endometrial repair. Our data have indicated that activation of macrophages with glucocorticoids might have paracrine effects by increasing angiogenic factor expression by endometrial endothelial cells. This might reflect possible roles for macrophages in endometrial repair of the vascular bed after menstruation.
Breast Cancer Risk in Childhood Cancer Survivors Without a History of Chest Radiotherapy: A Report From the Childhood Cancer Survivor Study
Authors: Henderson Tara O. , Moskowitz Chaya S. , Chou Joanne F. , Bradbury Angela R. , Neglia Joseph Phillip , Dang Chau T. , Onel Kenan , Novetsky Friedman Danielle , Bhatia Smita , Strong Louise C. , Stovall Marilyn , Kenney Lisa B. , Barnea Dana , Lorenzi Elena , Hammond Sue , Leisenring Wendy M. , Robison Leslie L. , Armstrong Gregory T. , Diller Lisa R. , Oeffinger Kevin C. 
Published: December 2015

Purpose Little is known about the breast cancer risk among childhood cancer survivors who did not receive chest radiotherapy. We sought to determine the magnitude of risk and associated risk factors for breast cancer among these women. Patients and Methods We evaluated cumulative breast cancer risk in 3,768 female childhood cancer survivors without a history of chest radiotherapy who were participants in the Childhood Cancer Survivor Study. Results With median follow up of 25.5 years (range, 8 to 39 years), 47 women developed breast cancer at a median age of 38.0 years (range, 22 to 47 years) and median of 24.0 years (range, 10 to 34 years) from primary cancer to breast cancer. A four-fold increased breast cancer risk (standardized incidence ratio [SIR] = 4.0; 95% CI, 3.0 to 5.3) was observed when compared with the general population. Risk was highest among sarcoma and leukemia survivors (SIR = 5.3; 95% CI, 3.6 to 7.8 and SIR = 4.1; 95% CI, 2.4 to 6.9, respectively). By the age of 45 years, the cumulative incidence of breast cancer in sarcoma and leukemia survivors was 5.8% (95% CI, 3.7 to 8.4) and 6.3% (95% CI, 3.0 to 11.3), respectively. No other primary cancer diagnosis was associated with an elevated risk. Alkylators and anthracyclines were associated with an increased breast cancer risk in a dose-dependent manner (P values from test for trend were both < .01). Conclusions Women not exposed to chest radiotherapy who survive childhood sarcoma or leukemia have an increased risk of breast cancer at a young age. The data suggest high-dose alkylator and anthracycline chemotherapy increase the risk of breast cancer. This may suggest a possible underlying gene-environment interaction that warrants further study.
Randomized Trial of a Web-Based Intervention to Address Barriers to Clinical Trials
Authors: Meropol Neal J. , Wong Yu-Ning , Albrecht Terrance , Manne Sharon , Miller Suzanne M. , Flamm Anne Lederman , Benson Al Bowen , Buzaglo Joanne , Collins Michael , Egleston Brian , Fleisher Linda , Katz Michael , Kinzy Tyler G. , Liu Tasnuva M. , Margevicius Seunghee , Miller Dawn M. , Poole David , Roach Nancy , Ross Eric , Schluchter Mark D. 
Published: December 2015

Purpose Lack of knowledge and negative attitudes have been identified as barriers to participation in clinical trials by patients with cancer. We developed Preparatory Education About Clinical Trials (PRE-ACT), a theory-guided, Web-based, interactive computer program, to deliver tailored video educational content to patients in an effort to overcome barriers to considering clinical trials as a treatment option. Patients and Methods A prospective, randomized clinical trial compared PRE-ACT with a control condition that provided general clinical trials information produced by the National Cancer Institute (NCI) in text format. One thousand two hundred fifty-five patients with cancer were randomly allocated before their initial visit with an oncologist to PRE-ACT (n = 623) or control (n = 632). PRE-ACT had three main components: assessment of clinical trials knowledge and attitudinal barriers, values assessment with clarification back to patients, and provision of a video library tailored to address each patient’s barriers. Outcomes included knowledge and attitudes and preparation for decision making about clinical trials. Results Both PRE-ACT and control interventions improved knowledge and attitudes (all P < .001) compared with baseline. Patients randomly allocated to PRE-ACT showed a significantly greater increase in knowledge (P < .001) and a significantly greater decrease in attitudinal barriers (P < .001) than did their control (text-only) counterparts. Participants in both arms significantly increased their preparedness to consider clinical trials (P < .001), and there was a trend favoring the PRE-ACT group (P < .09). PRE-ACT was also associated with greater patient satisfaction than was NCI text alone. Conclusion These data show that patient education before the first oncologist visit improves knowledge, attitudes, and preparation for decision making about clinical trials. Both text and tailored video were effective. The PRE-ACT interactive video program was more effective than NCI text in improving knowledge and reducing attitudinal barriers.
Financial Concerns About Participation in Clinical Trials Among Patients With Cancer
Authors: Wong Yu-Ning , Schluchter Mark D. , Albrecht Terrance L. , Benson Al Bowen , Buzaglo Joanne , Collins Michael , Flamm Anne Lederman , Fleisher Linda , Katz Michael , Kinzy Tyler G. , Liu Tasnuva M. , Manne Sharon , Margevicius Seunghee , Miller Dawn M. , Miller Suzanne M. , Poole David , Raivitch Stephanie , Roach Nancy , Ross Eric , Meropol Neal J. 
Published: December 2015

Purpose The decision to enroll in a clinical trial is complex given the uncertain risks and benefits of new approaches. Many patients also have financial concerns. We sought to characterize the association between financial concerns and the quality of decision making about clinical trials. Methods We conducted a secondary data analysis of a randomized trial of a Web-based educational tool (Preparatory Education About Clinical Trials) designed to improve the preparation of patients with cancer for making decisions about clinical trial enrollment. Patients completed a baseline questionnaire that included three questions related to financial concerns (five-point Likert scales): “How much of a burden on you is the cost of your medical care?,” “I'm afraid that my health insurance won't pay for a clinical trial,” and “I’m worried that I wouldn’t be able to afford the costs of treatment on a clinical trial.” Results were summed, with higher scores indicating greater concerns. We used multiple linear regressions to measure the association between concerns and self-reported measures of self-efficacy, preparation for decision making, distress, and decisional conflict in separate models, controlling for sociodemographic characteristics. Results One thousand two hundred eleven patients completed at least one financial concern question. Of these, 27% were 65 years or older, 58% were female, and 24% had a high school education or less. Greater financial concern was associated with lower self-efficacy and preparation for decision making, as well as with greater decisional conflict and distress, even after adjustment for age, race, sex, education, employment, and hospital location (P < .001 for all models). Conclusion Financial concerns are associated with several psychological constructs that may negatively influence decision quality regarding clinical trials. Greater attention to patients’ financial needs and concerns may reduce distress and improve patient decision making.
Racial and Ethnic Variations in Lung Cancer Incidence and Mortality: Results From the Women’s Health Initiative
Authors: Patel Manali I. , Wang Ange , Kapphahn Kristopher , Desai Manisha , Chlebowski Rowan T. , Simon Michael S. , Bird Chloe E. , Corbie-Smith Giselle , Gomez Scarlett Lin , Adams-Campbell Lucile L. , Cote Michele L. , Stefanick Marcia L. , Wakelee Heather A. 
Published: December 2015

Purpose This study aimed to evaluate racial/ethnic differences in lung cancer incidence and mortality in the Women’s Health Initiative Study, a longitudinal prospective cohort evaluation of postmenopausal women recruited from 40 clinical centers. Methods Lung cancer diagnoses were centrally adjudicated by pathology review. Baseline survey questionnaires collected sociodemographic and health information. Logistic regression models estimated incidence and mortality odds by race/ethnicity adjusted for age, education, calcium/vitamin D, body mass index, smoking (status, age at start, duration, and pack-years), alcohol, family history, oral contraceptive, hormones, physical activity, and diet. Results The cohort included 129,951 women—108,487 (83%) non-Hispanic white (NHW); 10,892 (8%) non-Hispanic black (NHB); 4,882 (4%) Hispanic; 3,696 (3%) Asian/Pacific Islander (API); 534 (< 1%) American Indian/Alaskan Native; and 1,994 (1%) other. In unadjusted models, Hispanics had 66% lower odds of lung cancer compared with NHW (odds ratio [OR], 0.34; 95% CI, 0.2 to 0.5), followed by API (OR, 0.45; 95% CI, 0.27 to 0.75) and NHB (OR, 0.75; 95% CI, 0.59 to 0.95). In fully adjusted multivariable models, the decreased lung cancer risk for Hispanic compared with NHW women attenuated to the null (OR, 0.59; 95% CI, 0.35 to 0.99). In unadjusted models Hispanic and API women had decreased risk of death compared with NHW women (OR, 0.30 [95% CI, 0.15 to 0.62] and 0.34 [95% CI, 0.16 to 0.75, respectively); however, no racial/ethnic differences were found in risk of lung cancer death in fully adjusted models. Conclusion Differences in lung cancer incidence and mortality are associated with sociodemographic, clinical, and behavioral factors. These findings suggest modifiable exposures and behaviors may contribute to differences in incidence of and mortality by race/ethnicity for postmenopausal women. Interventions focused on these factors may reduce racial/ethnic differences in lung cancer incidence and mortality.