bluuebunny/crossref_metadata_2025_split huggingface dataset:
Conformational flexibility of an anti-IL-13 DARPin†
Authors: Teplyakov Alexey , Malia Thomas J. , Obmolova Galina , Jacobs Steven A. , O'Neil Karyn T. , Gilliland Gary L. 
Published: October 2016

Abstract
Designed ankyrin repeat proteins (DARPin®) are artificial non-immunoglobulin binding proteins with potential applications as therapeutic molecules. DARPin 6G9 binds interleukin-13 with high affinity and blocks the signaling pathway and as such is promising for the treatment of asthma and other atopic diseases. The crystal structures of DARPin 6G9 in the unbound form and in complex with IL-13 were determined at high resolution. The DARPin competes for the same epitope as the IL-13 receptor chain 13Rα1 but does not interfere with the binding of the other receptor chain, IL-4Rα. Analysis of multiple copies of the DARPin molecule in the crystal indicates the conformational instability in the N-terminal cap that was predicted from molecular dynamics simulations. Comparison of the DARPin structures in the free state and in complex with IL-13 reveals a concerted movement of the ankyrin repeats upon binding resulted in the opening of the binding site. The induced-fit mode of binding employed by DARPin 6G9 is very unusual for DARPins since they were designed as particularly stable and rigid molecules. This finding shows that DARPins can operate by various binding mechanisms and suggests that some flexibility in the scaffold may be an advantage.
Procedural Pain in Palliative Care
Authors: Magnani Caterina , Giannarelli Diana , Casale Giuseppe 
Published: October 2016

Objective:
To assess the prevalence of breakthrough pain (BTP) provoked by 6 common procedures in patients with advanced disease.

Methods:
A prospective, cross-sectional, multicenter, national study was performed in 23 palliative care units in Italy. Patients were recruited if they were undergoing one of the following procedures as part of normal care: turning, personal hygiene care, transfer from bed to chair, bladder catheterization, pressure ulcer care, and subcutaneous drug administration. The Numerical Rating Scale was used to measure pain intensity before, during, and after the procedure.

Results:
One thousand seventy-nine eligible patients were enrolled: 49.7% were male and their mean age was 78.0±11.2 years. Of all patients, 20.9% had experienced a BTP episode within the 24 hours before recruitment. The overall prevalence of procedure-induced BTP was 11.8%, and the mean intensity score (Numeric Rating Scale) was 4.72±1.81. Notably, patients experienced a significant increase in pain intensity during all procedures (P<0.0001). A small proportion of patients (12.7%) received analgesics before undergoing any of the procedures, and almost none (1.7%) received analgesics during the procedures to alleviate acute pain.

Discussion:
Our findings highlight that simple daily care procedures can lead to BTP among patients with advanced disease. Because such procedures are performed very often during palliative care, more individualized attention to procedural pain control is necessary. Additional research on procedural pain in patients with advanced disease should be encouraged to provide further evidence-based guidance on the use of the available medication for predictable pain flares.
USE OF FIBEROPTIC-GUIDED CO2 LASER IN THE TREATMENT OF UVEAL EFFUSION
Authors: Bausili Maria M. , Raja Harish , Kotowski Jacek , Nadal Jeroni , Salomao Diva R. , Keenum Deborah , Pulido Jose S. 
Published: October 2016

Background/Purpose:
To report a new technique for treating patients with uveal effusion syndrome by the fiberoptic-guided CO2 laser.

Methods:
Interventional case report. A 74-year-old man presented with exudative detachment of the choroid secondary to uveal effusion syndrome. Partial-thickness sclerotomy and full-thickness sclerotomy were performed to treat the disease using a fiberoptic-guided CO2 laser.

Results:
After the surgery, the patient's visual acuity improved and choroidal folds disappeared.

Conclusion:
This technique allows concomitant coagulation and cutting, thereby reducing the risk of bleeding and providing better depth control.
Long-Term Outcome of Bodily Distress Syndrome in Primary Care: A Follow-Up Study on Health Care Costs, Work Disability, and Self-Rated Health
Authors: Rask Mette Trollund , Ørnbøl Eva , Rosendal Marianne , Fink Per 
Published: October 2016

ABSTRACT

Objective
The upcoming International Classification of Diseases, 11th Revision for primary care use suggests inclusion of a new diagnostic construct, bodily (di)stress syndrome (BDS), for individuals with medically unexplained symptoms. We aimed to explore the long-term outcome of BDS in health care costs, work disability, and self-rated health.

Methods
Consecutive patients consulting their family physician for a new health problem were screened for physical and mental symptoms by questionnaires (n = 1785). A stratified subsample was examined with a standardized diagnostic interview (n = 701). Patients with single-organ BDS (n = 124) and multiorgan BDS (n = 35), and a reference group with a family physician–verified medical condition (n = 880) were included. All included patients completed a questionnaire at 3, 12, and 24 months of follow-up. Register data on health care costs and work disability were obtained after 2 and 10 years of follow-up, respectively.

Results
Patients with BDS displayed poorer self-rated health and higher illness worry at index consultation and throughout follow-up than the reference group (p ≤ .001). The annual health care costs were higher in the BDS groups (2270 USD and 4066 USD) than in the reference group (1392 USD) (achieved significance level (ASL) ≤ 0.001). Both BDS groups had higher risk of sick leave during the first 2 years of follow-up (RRsingle-organ BDS = 3.0; 95% confidence interval [CI] = 1.8–5.0; RRmultiorgan BDS = 3.4; 95% CI = 1.5–7.5) and substantially higher risk of newly awarded disability pension than the reference group (HRsingle-organ BDS = 4.9; 95% CI = 2.8–8.4; HRmultiorgan BDS = 8.7; 95% CI = 3.7–20.7).

Conclusions
Patients with BDS have poor long-term outcome of health care costs, work disability, and subjective suffering. These findings stress the need for adequate recognition and management of BDS.
Measures to Improve Diagnostic Safety in Clinical Practice
Authors: Singh Hardeep , Graber Mark L. , Hofer Timothy P. 
Published: October 2016

Abstract
Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of “diagnostic safety” related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health-care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm.
Virtual Global Transplant Laboratory Standard Operating Protocol for Donor Alloantigen-specific Interferon-gamma ELISPOT Assay
Authors: Carroll Robert , Troelnikov Alexander , Chong Anita S. 
Published: October 2016

Abstract
The quantification of frequency of IFN-γ–producing T cells responding to donor alloantigen using the IFN-γ enzyme linked immunosorbent spot (ELISPOT) holds potential for pretransplant and posttransplant immunological risk stratification. The effectiveness of this assay, and the ability to compare results generated by different studies, is dependent on the utilization of a standardized operating procedure (SOP). Key factors in assay standardization include the identification of primary and secondary antibody pairs, and the reading of the ELISPOT plate with a standardized automated algorithm. Here, we describe in detail, an SOP that should provide low coefficient of variation results. For multicenter trials, it is recommended that groups perform the ELISPOT assays locally but use a centralized ELISPOT reading facility, as this has been shown to be beneficial in reducing coefficient of variation between laboratories even when the SOP is strictly adhered to.
Ethno-nationalism and impediments to cooperation in tourism in a post-settlement Cyprus?
Authors: Webster Craig , Jacobson David , Shapiro Kelsey 
Published: October 2016

Purpose
The purpose of this paper is to clarify the position of Greek Cypriot and Turkish Cypriot professionals in the hotel and tourism industry on the island of Cyprus with regards to their expectations regarding the benefit of a political solution to the Cyprus problem on the island.

Design/methodology/approach
The paper uses data from two surveys in both political entities of the island. One survey is a survey of hotel owners, managers of hotels and travel agencies in both political entities on the island. The other is semi-structured interview with leading professionals in the hospitality and tourism industry in both political entities.

Findings
The surveys indicate that there is an expectation from professionals in both entities that tourism will benefit all following a solution, with large increases in incoming tourism to Cyprus.

Practical implications
The findings indicate that there are substantial expectations that there will be benefits for all following a solution to the Cyprus problem.

Originality/value
This is a first future-oriented paper regarding the expectations of major players in the hotel and tourism industry in both political entities on the island.
Multi‐Sector Nonparametric Production‐Frontier Analysis of the Economic Growth and the Convergence of the European Countries
Authors: Walheer Barnabé 
Published: October 2016

AbstractIn this paper, I apply the recent nonparametric multi‐sector production‐frontier methodology of Walheer (), tailored to analyse the economic growth and convergence of countries taking the sector heterogeneity and interdependence into account, to the European countries from 1995 to 2014. Thanks to a simple rewriting of his initial model, I also provide results at the sector level, which was not possible with the initial version of the methodology. My results confirm the non‐neutrality of technological change and highlight that human capital accumulation plays the biggest role in the increase of labour productivity. Technological change and capital accumulation also play an important, if smaller, role in the increase of output‐labour productivity. My results also confirm the presence of heterogeneity between sectors in Europe, which supports the use of multi‐sector analysis. Finally, my results confirm the presence of two groups, in terms of labour productivity, within the European counties: Eastern and Central European countries and the EU12. These two groups diverge over time. The results are not affected by robustness checks.
Cultural unconscious in research: integrating multicultural and depth paradigms in qualitative research
Authors: Yakushko Oksana , Miles Pekti , Rajan Indhushree , Bujko Biljana , Thomas Douglas 
Published: October 2016

AbstractCulturally focused research has gained momentum in many disciplines, including psychology. However, much of this research fails to pay attention to the unconscious dynamics that underlie the study of culture and culturally influenced human beings. Such dynamics may be especially significant when issues of marginalization and oppression are present. Therefore, this paper seeks to contribute a framework for understanding cultural dynamics, especially unconscious cultural dynamics, within depth psychological qualitative research influenced by Jungian and post‐Jungian scholarship. Inquiry that is approached with a commitment to making the unconscious conscious seeks to empower and liberate not only the subject/object studied but also the researchers themselves. Following a brief review of multiculturalism in the context of analytically informed psychology, this paper offers several case examples that focus on researchers' integration of awareness of the cultural unconscious in their study of cultural beings and topics.
Falling into language life: a montage of pre‐faces in search of a text‐ual body
Authors: Schenk Ronald 
Published: October 2016

AbstractClinical work, as all of consciousness, is steeped in and emerges out of language. Language is the medium of our knowing, and knowing the medium of our relating. Language has us; words dream us. For the mythical Navajo as for John of the New Testament, in the Beginning was the Word. Before any kind of distinction of thought, feeling, sensation or intuition comes language – language, not as ‘just words’, but as image. Words are images, and images as encompassing worlds present themselves as and through language. As a determinant of identity, language undermines all cues as to individual subjectivity, Yahweh's ‘I am here’ rendering time and place relative, and subjectivity co‐constituted. This paper is a meditation on language for clinicians in the form that language presents itself, as a meandering flow of consciousness with associations and signposts leading onward.
Premenopausal abnormal uterine bleeding and risk of endometrial cancer
Authors: Pennant ME , Mehta R , Moody P , Hackett G , Prentice A , Sharp SJ , Lakshman R 
Published: October 2016

BackgroundEndometrial biopsies are undertaken in premenopausal women with abnormal uterine bleeding but the risk of endometrial cancer or atypical hyperplasia is unclear.ObjectivesTo conduct a systematic literature review to establish the risk of endometrial cancer and atypical hyperplasia in premenopausal women with abnormal uterine bleeding.Search strategySearch of PubMed, Embase and the Cochrane Library from database inception to August 2015.Selection criteriaStudies reporting rates of endometrial cancer and/or atypical hyperplasia in women with premenopausal abnormal uterine bleeding.Data collection and analysisData were independently extracted by two reviewers and cross‐checked. For each outcome, the risk and a 95% CI were estimated using logistic regression with robust standard errors to account for clustering by study.Main resultsSixty‐five articles contributed to the analysis. Risk of endometrial cancer was 0.33% (95% CI 0.23–0.48%, n = 29 059; 97 cases) and risk of endometrial cancer or atypical hyperplasia was 1.31% (95% CI 0.96–1.80, n = 15 772; 207 cases). Risk of endometrial cancer was lower in women with heavy menstrual bleeding (HMB) (0.11%, 95% CI 0.04–0.32%, n = 8352; 9 cases) compared with inter‐menstrual bleeding (IMB) (0.52%, 95% CI 0.23–1.16%, n = 3109; 14 cases). Of five studies reporting the rate of atypical hyperplasia in women with HMB, none identified any cases.ConclusionsThe risk of endometrial cancer or atypical hyperplasia in premenopausal women with abnormal uterine bleeding is low. Premenopausal women with abnormal uterine bleeding should first undergo conventional medical management. Where this fails, the presence of IMB and older age may be indicators for further investigation. Further research into the risks associated with age and the cumulative risk of co‐morbidities is needed.Tweetable abstractContrary to practice, premenopausal women with heavy periods or inter‐menstrual bleeding rarely require biopsy.
Access to Care for Medicare‐Medicaid Dually Eligible Beneficiaries: The Role of State Medicaid Payment Policies
Authors: Zheng Nan Tracy , Haber Susan , Hoover Sonja , Feng Zhanlian 
Published: October 2016

Study ObjectivesMedicaid programs are not required to pay the full Medicare coinsurance and deductibles for Medicare‐Medicaid dually eligible beneficiaries. We examined the association between the percentage of Medicare cost sharing paid by Medicaid and the likelihood that a dually eligible beneficiary used evaluation and management (E&M) services and safety net provider services.Data SourcesMedicare and Medicaid Analytic eXtract enrollment and claims data for 2009.Study DesignMultivariate analyses used fee‐for‐service dually eligible and Medicare‐only beneficiaries in 20 states. A comparison group of Medicare‐only beneficiaries controlled for state factors that might influence utilization.Principal FindingsPaying 100 percent of the Medicare cost sharing compared to 20 percent increased the likelihood (relative to Medicare‐only) that a dually eligible beneficiary had any E&M visit by 6.4 percent. This difference in the percentage of cost sharing paid decreased the likelihood of using safety net providers, by 37.7 percent for federally qualified health centers and rural health centers, and by 19.8 percent for hospital outpatient departments.ConclusionsReimbursing the full Medicare cost‐sharing amount would improve access for dually eligible beneficiaries, although the magnitude of the effect will vary by state and type of service.
Endoscopic radiofrequency ablation may be preferable in the management of malignant biliary obstruction: A systematic review and meta‐analysis
Authors: Zheng Xiao , Bo Zhi Yuan , Wan Wei , Wu Ye Chen , Wang Tian Tian , Wu Jun , Gao Dao Jian , Hu Bing 
Published: October 2016

AbstractObjectiveEndoscopic biliary radiofrequency ablation (RFA) has been increasingly used to treat unresectable malignant biliary obstruction (MBO). We aimed to perform this systematic review and meta‐analysis to evaluate the efficacy and safety for the treatment of malignant biliary obstruction (MBO) and its impact on patient's survival.MethodsA comprehensive search of the Cochrane Library, PubMed and EMBASE databases was conducted. A meta‐analysis was performed by extracting the data from the included studies with regard to technical effectiveness, overall survival, adverse events and mortality of endoscopic RFA.ResultsA total of nine studies comprising 263 patients with MBO were included in the analysis. There was a significant increase in the diameter of stricture (3.446 mm, 95% confidence interval [CI] 3.356–3.536 mm) after the endoscopic biliary RFA. The overall survival time was 9.62 months, with pooled 30‐day, 90‐day and 2‐year mortality rates of 2% (95% CI 0.5–5.9%), 21% (95% CI 5–37%), and 48% (95% CI 37–59%), respectively. The pooled rate of adverse events was 17% (95% CI 10–25%), and most complications were mild and managed conservatively. Severe adverse events occurred in three patients (two deaths due to hemobilia and one with partial liver infarction).ConclusionsEndoscopic biliary RFA is effective and generally safe in the management of unresectable biliary malignancies, and may improve patients’ overall survival. Prospective, randomized controlled studies are required to further support the results.
The sequence capture by hybridization: a new approach for revealing the potential of mono‐aromatic hydrocarbons bioattenuation in a deep oligotrophic aquifer
Authors: Ranchou‐Peyruse Magali , Gasc Cyrielle , Guignard Marion , Aüllo Thomas , Dequidt David , Peyret Pierre , Ranchou‐Peyruse Anthony 
Published: October 2016

SummaryThe formation water of a deep aquifer (853 m of depth) used for geological storage of natural gas was sampled to assess the mono‐aromatic hydrocarbons attenuation potential of the indigenous microbiota. The study of bacterial diversity suggests that Firmicutes and, in particular, sulphate‐reducing bacteria (Peptococcaceae) predominate in this microbial community. The capacity of the microbial community to biodegrade toluene and m‐ and p‐xylenes was demonstrated using a culture‐based approach after several hundred days of incubation. In order to reveal the potential for biodegradation of these compounds within a shorter time frame, an innovative approach named the solution hybrid selection method, which combines sequence capture by hybridization and next‐generation sequencing, was applied to the same original water sample. The bssA and bssA‐like genes were investigated as they are considered good biomarkers for the potential of toluene and xylene biodegradation. Unlike a PCR approach which failed to detect these genes directly from formation water, this innovative strategy demonstrated the presence of the bssA and bssA‐like genes in this oligotrophic ecosystem, probably harboured by Peptococcaceae. The sequence capture by hybridization shows significant potential to reveal the presence of genes of functional interest which have low‐level representation in the biosphere.
A framework for developing and validating taxon‐specific primers for specimen identification from environmental DNA
Authors: MacDonald Anna J. , Sarre Stephen D. 
Published: October 2016

AbstractTaxon‐specific DNA tests are applied to many ecological and management questions, increasingly using environmental DNA (eDNA). eDNA facilitates noninvasive ecological studies but introduces additional risks of bias and error. For effective application, PCR primers must be developed for each taxon and validated in each system. We outline a nine step framework for the development and validation of taxon‐specific primers for eDNA analysis in ecological studies, involving reference database construction, phylogenetic evaluation of the target gene, primer design, primer evaluation in silico, and laboratory evaluation of primer specificity, sensitivity and utility. Our framework makes possible a rigorous evaluation of likely sources of error. The first five steps can be conducted relatively rapidly and (where reference DNA sequences are available) require minimal laboratory resources, enabling assessment of primer suitability before investing in further work. Steps six to eight require more costly laboratory analyses but are essential to evaluate risks of false‐positive and false‐negative results, while step 9 relates to field implementation. As an example, we have developed and evaluated primers to specifically amplify part of the mitochondrial ND2 gene from Australian bandicoots. If adopted during the early stages of primer development, our framework will facilitate large‐scale implementation of well‐designed DNA tests to detect specific wildlife from eDNA samples. This will provide researchers and managers with an understanding of the strengths and limitations of their data and the conclusions that can be drawn from them.