bluuebunny/crossref_metadata_2025_split huggingface dataset:
Naming the Tiger in the Early Modern World
Authors: Thorley David 
Published: September 2017

AbstractThe English wordtigerhas an uncertain etymology and a curious history of use. Probably first seen in Europe in the fourth century BCE, the tiger, by the early modern age, had acquired a long history of folkloric associations. This article examines early modern uses of the wordtigerin the context of the period’s linguistic debates about natural and conventional meaning. It seeks to present a history in which the word, through use, develops closer (if not necessarily natural) associations with the qualities of its referent.
Thinking and Reasoning: A Very Short Introduction
Authors: Evans Jonathan St B. T. 
Published: September 2017

Abstract
Thinking and Reasoning: A Very Short Introduction explores cognitive psychological approaches to understanding the nature of thinking and reasoning, problem solving, and decision making. It shows how humans’ unique problem-solving capabilities are hugely dependent on having the imagination to ask the right questions, and the ability to see things from a completely new perspective. Beginning by considering the approaches of the behaviourists and the gestalt psychologists, it moves on to modern explorations of thinking, including hypothetical thinking, conditionals, deduction, rationality, and intuition. Covering the role of past learning, IQ, and cognitive biases, this VSI also discusses the idea that there may be two different ways of thinking, arising from our evolutionary history.
Medication-related clinical decision support alert overrides in inpatients
Authors: Nanji Karen C , Seger Diane L , Slight Sarah P , Amato Mary G , Beeler Patrick E , Her Qoua L , Dalleur Olivia , Eguale Tewodros , Wong Adrian , Silvers Elizabeth R , Swerdloff Michael , Hussain Salman T , Maniam Nivethietha , Fiskio Julie M , Dykes Patricia C , Bates David W 
Published: September 2017

Abstract

Objective
To define the types and numbers of inpatient clinical decision support alerts, measure the frequency with which they are overridden, and describe providers’ reasons for overriding them and the appropriateness of those reasons.

Materials and Methods
We conducted a cross-sectional study of medication-related clinical decision support alerts over a 3-year period at a 793-bed tertiary-care teaching institution. We measured the rate of alert overrides, the rate of overrides by alert type, the reasons cited for overrides, and the appropriateness of those reasons.

Results
Overall, 73.3% of patient allergy, drug-drug interaction, and duplicate drug alerts were overridden, though the rate of overrides varied by alert type (P &lt; .0001). About 60% of overrides were appropriate, and that proportion also varied by alert type (P &lt; .0001). Few overrides of renal- (2.2%) or age-based (26.4%) medication substitutions were appropriate, while most duplicate drug (98%), patient allergy (96.5%), and formulary substitution (82.5%) alerts were appropriate.

Discussion
Despite warnings of potential significant harm, certain categories of alert overrides were inappropriate &gt;75% of the time. The vast majority of duplicate drug, patient allergy, and formulary substitution alerts were appropriate, suggesting that these categories of alerts might be good targets for refinement to reduce alert fatigue.

Conclusion
Almost three-quarters of alerts were overridden, and 40% of the overrides were not appropriate. Future research should optimize alert types and frequencies to increase their clinical relevance, reducing alert fatigue so that important alerts are not inappropriately overridden.
BRAF V600E Mutation-Assisted Risk Stratification of Solitary Intrathyroidal Papillary Thyroid Cancer for Precision Treatment
Authors: Huang Yueye , Qu Shen , Zhu Guangwu , Wang Fei , Liu Rengyun , Shen Xiaopei , Viola David , Elisei Rossella , Puxeddu Efisio , Fugazzola Laura , Colombo Carla , Jarzab Barbara , Czarniecka Agnieszka , Lam Alfred K , Mian Caterina , Vianello Federica , Yip Linwah , Riesco-Eizaguirre Garcilaso , Santisteban Pilar , O’Neill Christine J , Sywak Mark S , Clifton-Bligh Roderick , Bendlova Bela , Sýkorová Vlasta , Xing Mingzhao 
Published: September 2017

Abstract

Background
Precise risk stratification-based treatment of solitary intrathyroidal papillary thyroid cancer (SI-PTC) that is larger than 1.0 cm and 4.0 cm or less is undefined.

Methods
A genetic-clinical risk study was performed on BRAF V600E in 955 patients (768 women and 187 men) with SI-PTC, with median age of 46 years and median clinical follow–up time of 64 months at 11 medical centers in six countries. The chi-square test or, for analyses with small numbers, Fisher’s exact test was performed to compare recurrence rates. Recurrence-free probability was estimated by Kaplan-Meier (KM) analysis, and the independent effect of BRAF mutation on the recurrence was analyzed by Cox regression and Cox proportional hazard analyses. All statistical tests were two-sided.

Results
Recurrence of SI-PTC larger than 1.0 cm and 4.0 cm or less was 9.5% (21/221) vs 3.4% (11/319) in BRAF mutation vs wild-type BRAF patients, with a hazard ratio (HR) of 3.03 (95% confidence interval [CI] = 1.46 to 6.30) and a patient age- and sex-adjusted hazard ratio of 3.10 (95% CI = 1.49 to 6.45, P = .002). Recurrence rates of SI-PTC larger than 2.0 cm and 4.0 cm or less were 16.5% (13/79) vs 3.6% (5/139) in mutation vs wild-type patients (HR = 5.44, 95% CI = 1.93 to 15.34; and adjusted HR = 5.58, 95% CI = 1.96 to 15.85, P = .001). Recurrence rates of SI-PTC larger than 3.0 cm and 4 cm or less were 30.0% (6/20) vs 1.9% (1/54) in mutation vs wild-type patients (HR = 18.40, 95% CI = 2.21 to 152.98; and adjusted HR = 14.73, 95% CI = 1.74 to 124.80, P = .01). Recurrences of mutation-positive SI-PTC were comparable with those of counterpart invasive solitary PTC, around 20% to 30%, in tumors larger than 2.0 cm to 3.0 cm. BRAF mutation was associated with a statistically significant decrease in recurrence-free patient survival on KM analysis, particularly in SI-PTC larger than 2.0 cm and 4.0 cm or less. Similar results were obtained in conventional SI-PTC. The negative predictive values of BRAF mutation for recurrence were 97.8% (95% CI = 96.3% to 98.8%) for general SI-PTC and 98.2% (95% CI = 96.3% to 99.3%) for conventional SI-PTC.

Conclusions
BRAF V600E identifies a subgroup of SI-PTC larger than 1.0 cm and 4.0 cm or less, particularly tumors larger than 2.0 cm and 4.0 cm or less, that has high risk for recurrence comparable with that of invasive solitary PTC, making more aggressive treatment reasonable.
Testing a Model of Consultation-based Reassurance and Back Pain Outcomes With Psychological Risk as Moderator
Authors: Holt Nicola , Mansell Gemma , Hill Jonathan C. , Pincus Tamar 
Published: September 2017

Objectives:
Reassurance is an essential part of treatment for low back pain (LBP), but evidence on effective methods to deliver reassurance remains scarce. The interaction between consultation-based reassurance and patients’ psychological risk is unknown. Our objective was to investigate the relationship between consultation-based reassurance and clinical outcomes at follow-up, in people with and without psychological risk.

Methods:
We tested the associations between specific reassurance components (data gathering, relationship building, generic reassurance, and cognitive reassurance), patients’ psychological risk (the presence of depression, anxiety, catastrophizing, or fear-avoidance), and postconsultation outcomes including, satisfaction and enablement, disability, pain, and mood at 3-month follow-up.

Results:
Adjusted linear regression models using data from patients who had recently consulted for LBP in primary care (n=142 in 43 practices) indicated that all reassurance components were strongly associated with increased satisfaction, whereas generic reassurance was significantly associated with postconsultation enablement. Generic reassurance was also associated with lower pain at 3 months, whereas cognitive reassurance was associated with increased pain. A significant interaction was observed between generic reassurance and psychological risk for depression at 3 months: high rates of generic reassurance were associated with lower depression in low-risk patients, but with higher rates of depression for high-risk groups.

Discussion:
The findings support the hypothesis that different components of reassurance are associated with specific outcomes, and that psychological risk moderates this relationship for depression. Clinicians reassuring behaviors might therefore have the potential to improve outcomes in people with LBP, especially for patients with higher psychological risk profiles.
An update on the role of epigenetics in systemic vasculitis
Authors: Coit Patrick , Direskeneli Haner , Sawalha Amr H. 
Published: September 2017

Purpose of review
The purpose of this review is to discuss recent observations of epigenetic changes related to the complex pathogenesis of systemic vasculitides and their contribution to the field.

Recent findings
There have been new observations of epigenetic changes in vasculitis and their potential role in disease pathogenesis in antineutrophil cytoplasmic antibody-associated vasculitis, giant-cell arteritis, Kawasaki disease, Behçet's disease, and IgA vasculitis. Some of this recent work has focused on the efficacy of using DNA methylation and miRNA expression as clinical biomarkers for disease activity and how DNA methylation and histone modifications interact to regulate disease-related gene expression.

Summary
DNA methylation, histone modification, and miRNA expression changes are all fruitful ground for biomarker discovery and therapeutic targets in vasculitis. Current knowledge has provided targeted and suggested effects, but in many cases, has relied upon small cohorts, cosmopolitan cell populations, and limited knowledge of functional interactions. Expanding our knowledge of how these epigenetic mechanisms interact in a disease-specific and cell-specific manner will help to better understand the pathogenesis of systemic vasculitis.
Targeting aging for disease modification in osteoarthritis
Authors: Collins John A. , Diekman Brian O. , Loeser Richard F. 
Published: September 2017

Purpose of review
Age is a key risk factor for the development of osteoarthritis and age-related changes within the joint might represent targets for therapy. The recent literature was reviewed to find studies that provide new insight into the role of aging in osteoarthritis, with a focus on the potential for disease modification.

Recent findings
Preclinical studies using isolated cells and animal models provide evidence that two hallmarks of aging (cellular senescence and mitochondrial dysfunction) contribute to the development of osteoarthritis. Senescent cells secrete pro-inflammatory mediators and matrix degrading enzymes, and killing these cells with ‘senolytic’ compounds has emerged as a potential disease-modifying therapy. Mitochondrial dysfunction is associated with increased levels of reactive oxygen species (ROS) that can promote osteoarthritis by disrupting homeostatic intracellular signaling. Reducing ROS production in the mitochondria, stimulating antioxidant gene expression through Nrf2 activation, or inhibiting specific redox-sensitive signaling proteins represent additional approaches to disease modification in osteoarthritis that require further investigation.

Summary
Although no human clinical trials for osteoarthritis have specifically targeted aging, preclinical studies suggest that targeting cellular senescence and/or mitochondrial dysfunction and the effects of excessive ROS may lead to novel interventions that could slow the progression of osteoarthritis.
Incidence, Risk Factors, and Impact of Clostridium difficile Colitis After Spine Surgery
Authors: Bovonratwet Patawut , Bohl Daniel D. , Russo Glenn S. , Ondeck Nathaniel T. , Singh Kern , Grauer Jonathan N. 
Published: September 2017

Study Design.
A retrospective study of prospectively collected data.

Objective.
The aim of this study was to utilize a large national database with post-hospitalization follow-up data [National Surgical Quality Improvement Program (NSQIP)] to determine the incidence, risk factors, timing, and clinical impact of Clostridium difficile colitis in spine surgery patients.

Summary of Background Data.
Recent literature has suggested an increased incidence of C. difficile infections. However, there has been a lack of large cohort studies defining the incidence and impact of C. difficile colitis in patients undergoing spine surgery.

Methods.
Patients who underwent spine surgical procedures in the 2015 NSQIP database were identified. The primary outcome was a diagnosis of C. difficile colitis within the 30-day postoperative period. Independent risk factors for development of C. difficile colitis were identified using multivariate regression. Postoperative length of stay and rate of 30-day readmission were compared between patients who did and did not develop C. difficile colitis.

Results.
A total of 23,981 patients who underwent spine surgical procedures were identified. The incidence of C. difficile colitis was approximately 0.11% [95% confidence interval (95% CI), 0.07–0.16]. Of the cases that developed C. difficile colitis, 70% were diagnosed postdischarge and 88% had not had a pre-existing infection diagnosed. Independent risk factors for the development of C. difficile colitis were combined anterior/posterior lumbar fusion procedures [odds ratio (OR) = 12.29, 95% CI = 2.22–68.13, P = 0.010], greater age (most notably ≥76 years old, OR = 10.31, 95% CI = 3.06–34.76, P < 0.001), hypoalbuminemia (OR = 6.40, 95% CI = 2.49–16.43, P < 0.001), and anemia (OR = 2.39, 95% CI = 1.13–5.05, P = 0.023). The development of C. difficile colitis was associated with greater length of stay (2.2 vs. 12.5 days; P < 0.001) and increased 30-day readmission (OR = 8.21, 95% CI = 3.14–21.45, P < 0.001).

Conclusion.

C. difficile was diagnosed in 0.11% of patients undergoing spine surgery. The majority of these cases occurred after discharge and in patients not having prior infection diagnoses. High-risk patients should be monitored and targeted with preventative interventions accordingly.

Level of Evidence: 3
Cardiovascular origins of preeclampsia
Authors: Kalafat Erkan , Thilaganathan Basky 
Published: September 2017

Purpose of review
To review the current data on maternal cardiovascular adaptation in normal pregnancy and preeclampsia.

Recent findings
Defective placentation causes early-onset preeclampsia, a disease entity that is considered more or less distinct from late-onset preeclampsia. The latter has been attributed as ‘maternal’ preeclampsia. There are inconsistencies with the placental origins hypothesis, especially when considering the lack of a causative association with abnormal placental histology or impaired fetal growth. An alternative explanation is that placental dysfunction is secondary to maternal cardiovascular maladaptation in pregnancy. The concept that placental dysfunction is secondary to a maternal disorder is not new when one considers the clinical similarities between preeclampsia and gestational diabetes – both pregnancy-specific conditions that are cured by birth. It is accepted that gestational diabetes develops when the maternal pancreas is unable to manage the increasing glucose load of pregnancy. It is now apparent that pregnancy presents a substantial cardiovascular load on the maternal heart, and that cardiovascular dysfunction precedes the disorder, predominates in the clinical syndrome and persists for several decades postpartum. It is time to consider the evidence that failure of the maternal cardiovascular system to adapt to pregnancy may well be the primary mechanism leading to secondary placental dysfunction in preeclampsia.

Summary
Many of the existing paradoxes of preeclampsia challenge the placental origin hypothesis and are explained if one considered preeclampsia to be a cardiovascular syndrome.
Management of Reverse Pellucid Type Topography
Authors: Çakir Hanefi , Utine Canan Asli 
Published: September 2017

Purpose:
Evaluation of the etiopathogenesis and management of topographic reverse pellucid pattern after rigid intraocular lens (IOL) implantation with wide limbal clear corneal incision (CCI).

Methods:
Fifteen eyes with a history of gradual decrease in vision after IOL surgery with at least 6.5-mm CCI were diagnosed with wound dehiscence and were managed with tight resuturation, delayed, and selective suture removal. The improvement in uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively) and refractive errors were analyzed, at least 6 months postoperatively.

Results:
Postoperatively, UDVA improved in 13/15 eyes (86.7%), whereas CDVA also improved for at least 2 Snellen lines in 11/15 eyes (73.3%) (P<0.01 for both). In all patients, against-the-rule astigmatism changed to with-the-rule astigmatism pattern and the amount of cylinder decreased as the sutures are removed progressively. Vector analysis of astigmatism showed an arithmetic mean of corrected amount of cylinder of 4.17±2.10 D using manifest refraction data and 4.90±2.83 D using keratometric data at the last follow-up.

Conclusion:
Low visual acuity together with high astigmatism after rigid IOL surgery should prompt the surgeon for considering wound dehiscence that could be managed by careful and deliberate wound revision.
Meta-Analysis of Postoperative Outcome Parameters Comparing Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty
Authors: Pavlovic Ivana , Shajari Mehdi , Herrmann Eva , Schmack Ingo , Lencova Anna , Kohnen Thomas 
Published: September 2017

Purpose:
This meta-analysis compares Descemet membrane endothelial keratoplasty (DMEK) with Descemet stripping automated endothelial keratoplasty (DSAEK) to evaluate their strength and weakness profiles.

Design:
Meta-analysis.

Methods:
We performed a meta-analysis and searched the peer-reviewed literature in PubMed, Cochrane Library, Web of Science, and Embase following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective and retrospective trials performing and comparing DMEK and DSAEK were included. Effects were calculated as odds ratios or standardized mean differences.

Results:
A total of 11 studies with a total of 723 eyes (350 DMEK and 373 DSAEK) were included. No significant difference was found regarding the total detachment rate, graft failure, and rejection. One of 340 eyes undergoing DMEK showed total detachment and 5 of 363 eyes undergoing DSAEK showed total detachment (P = 0.28). Six of 280 eyes undergoing DMEK showed graft failure; 1 of 313 eyes undergoing DSAEK developed this complication (P = 0.18). No rejection was observed in 158 eyes undergoing DMEK; 4 cases of rejection occurred in 196 eyes undergoing DSAEK (P = 0.37). No significant difference was found regarding endothelial cell loss (P = 0.48). There was a significantly higher partial detachment rate with DMEK: 88 of 340 eyes undergoing DMEK showed partial detachment; 16 of 363 eyes undergoing DSAEK showed this complication (P < 0.00001). DMEK was superior in best-corrected visual acuity after 6 months (P < 0.001), subjective evaluation of visual acuity (P = 0.001), patient satisfaction (P < 0.001), and was the method preferred by patients (P = 0.001).

Conclusions:
DMEK and DSAEK have a similar complication profile. However, the superiority in the visual outcome and patient satisfaction makes DMEK the preferred option for most patients.
Should the Risk of Invasive Cancer in Pregnancy and the Safety of Loop Electrosurgical Excision Procedure During the First 15 Weeks Change Our Practice?
Authors: Siegler Efraim , Lavie Ofer , Amit Amnon , Vaknin Zvi , Auslander Ron , Blumenfeld Zeev 
Published: September 2017

Objective
The aim of this article was to describe the outcome of women diagnosed with cervical intraepithelial neoplasia (CIN) grades 2 or 3 in pregnancy either observed or treated by loop electrosurgical excision procedure (LEEP) in the first 15 weeks of gestation.

Methods
Loop electrosurgical excision procedure during the first 15 gestational weeks compared with observation of CIN2/3. This is a retrospective analysis of a nonrandomized study at tertiary, academic, and referring centers in Israel. Ninety-three pregnant women diagnosed with CIN2/3 between 2006 and 2016 were included in this study. Fifty patients with CIN2/3 on cervical biopsy were conservatively followed-up, and 43 patients have undergone LEEP during the first 15 gestational weeks. Main outcome measures were ultimate diagnosis of invasive cancer or CIN, pregnancy outcome, and complications.

Results
In 5.4% of CIN2/3 during pregnancy, the final diagnosis was invasive cancer. The postpartum results of 50 women who were conservatively observed were as follows: 3 (6.0%) had cervical cancer and undergone radical hysterectomy, 33 (66.6%) had CIN2/3, and 14 (28%) had CIN1 or normal histology. The diagnoses of the 43 patients who have undergone LEEP were invasive cancer in 2 patients (4.6%) but did not undergo hysterectomy, CIN2/3 or adenocarcinoma in situ (AIS) in 38 patients (88.4%), and 3 women (7%) had CIN1 or normal histology. None of them suffered severe bleeding. Thirty-seven women continued their pregnancy, 34 (91.9%) had term deliveries, 2 (5.4%) gave birth at 34 and 36 weeks, and 1 patient had missed abortion (2.7%).

Conclusions
The LEEP procedure during the first 15 weeks of pregnancy is safe. A total of 5.4% of the women with CIN2/3 during pregnancy were diagnosed with invasive cancer. It is time to reconsider the recommendations about CIN2/3 in early gestation.
Outcomes of Early Versus Delayed Colonoscopy in Lower Gastrointestinal Bleeding Using a Hospital Administrative Database
Authors: Nigam Neha , Patel Parita , Sengupta Neil 
Published: September 2017

Background:
Limited data exist on whether early colonoscopy for lower gastrointestinal bleeding (LGIB) alters 30-day mortality, performance of endoscopic intervention, or need for blood transfusion. Our primary objective was to determine whether early colonoscopy in LGIB is associated with decreased 30-day mortality using a large hospital administrative database.

Methods:
Patients hospitalized between January 2008 and September 2015 were identified using a validated, machine learning algorithm for identifying patients with LGIB. “Early” colonoscopy occurred by day 2 of admission and “late” colonoscopy between days 3 and 5. A propensity score for early colonoscopy was constructed using plausible confounders. Univariable and multivariable logistic regression were used to determine factors associated with 30-day mortality, endoscopic intervention, and transfusion need. The propensity score was included as a confounding factor for mortality analysis in the multivariable model.

Results:
In total, 1204 patients underwent colonoscopy for LGIB. Of these, 295 patients (25%) underwent early colonoscopy, and these patients had a lower Charlson Comorbidity Index (P=0.001) and shorter length of stay (3 vs. 5 d, P=0.0001). Early colonoscopy was not associated with decreased 30-day mortality [odds ratio (OR), 0.73; confidence interval (CI), 0.27-1.69], but was associated with increased endoscopic intervention (OR, 2.62; CI, 1.37-4.95) and decreased need for transfusion (OR, 0.65; CI, 0.49-0.87). On multivariable analysis adjusting for timing of colonoscopy, age, and propensity score for early colonoscopy, early colonoscopy was not associated with a decrease in 30-day mortality (OR, 1.37; CI, 0.50-3.79).

Conclusions:
Early colonoscopy does not affect 30-day mortality but may allow for earlier endoscopic intervention and decreased transfusion need.