bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Early Surgical Decompression in Cauda Equina Syndrome Improve Bladder Outcome?
Authors: DeLong W. Bradford , Polissar Nayak L. , Neradilek Moni B. , Laam Leslie A. 
Published: April 2016

Study Design and Objectives.
This study by Srikandarajah et al is a retrospective cohort study of 200 CES patients. Although parts of the study appear to be well done we identified serious problems that impacted their conclusions.

Summary of Background Data.
There is strong consensus that patients with incomplete cauda equina syndrome (CESI) should be operated upon expeditiously to prevent progression to CES with urinary retention (CESR). There is controversy concerning optimal timing of surgery in patients who have entered CESR. Some studies conclude urgent surgery for CESR does nothing to improve chance of recovery; others conclude surgery should be done within a 48 or 24-hours window after onset of bladder paralysis. Srikandarajah et al concluded that in CESI patients, decompressive surgery within 24 hours of onset of autonomic symptoms reduces bladder dysfunction at follow-up. In CESR patients, “no statistically significant difference in outcome was observed” regarding timing of surgery.

Methods.
We analyzed the methods used by Srikandarajah et al to collect and analyze their data.

Results.
The primary problem with their study is that it does not consider deterioration to CESR that occurs in CESI patients over time. We also found serious problems with the methods, implementation (including numeric errors), and interpretation of the statistical analysis.

Conclusion.
The authors’ conclusion that in CESR patients, “no statistically significant difference in outcome was observed” regarding timing of surgery is not justified as a representation of their findings, because absence of statistical significance does not mean acceptance of the null hypothesis of “no effect”. Their numeric results do show elevated risk of delay. We do not want to detract from the basic importance of this study, because it emphasizes the importance of operating expeditiously on patients with CESI. However, the authors’ conclusions are compromised by the methodological problems.

Level of Evidence: N/A
Defining Sepsis Mortality Clusters in the United States*
Authors: Moore Justin Xavier , Donnelly John P. , Griffin Russell , Howard George , Safford Monika M. , Wang Henry E. 
Published: April 2016

Objectives:
In the United States, sepsis is a major public health problem accounting for over 200,000 annual deaths. The aims of this study were to identify U.S. counties with high sepsis mortality and to assess the community characteristics associated with increased sepsis mortality.

Design:
We performed a descriptive analysis of 2003 through 2012 Compressed Mortality File data. We defined sepsis deaths as deaths associated with an infection, classified according to the International Classification of Diseases, 10th Version.

Setting:
Three thousand one hundred and eight counties in the contiguous U.S. counties, excluding Hawaii and Alaska.

Measurements and Main Results:
Using geospatial autocorrelation methods, we defined county-level sepsis mortality as strongly clustered, moderately clustered, and nonclustered. We approximated the mean crude, age-adjusted, and community-adjusted sepsis mortality rates nationally and for clustering groups. We contrasted demographic and community characteristics between clustering groups. We performed logistic regression for the association between strongly clustered counties and community characteristics. Among 3,108 U.S. counties, the age-adjusted sepsis mortality rate was 59.6 deaths per 100,000 persons (95% CI, 58.9–60.4). Sepsis mortality was higher in the Southern U.S. and clustered in three major regions: Mississippi Valley, Middle Georgia, and Central Appalachia. Among 161 (5.2%) strongly clustered counties, age-adjusted sepsis mortality was 93.1 deaths per 100,000 persons (95% CI, 90.5–95.7). Strongly clustered sepsis counties were more likely to be located in the south (92.6%; p < 0.001), exhibit lower education, higher impoverished population, without medical insurance, higher medically uninsured rates, and had higher unemployment rates (p < 0.001).

Conclusions:
Sepsis mortality is higher in the Southern United States, with three regional clusters: “Mississippi Valley,” “Middle Georgia,” and “Central Appalachia”: Regions of high sepsis mortality are characterized by lower education, income, employment, and insurance coverage.
Differentiated Vulvar Intraepithelial Neoplasia: What Criteria Do We Use in Practice?
Authors: Reutter Jason C. , Walters Ruth A. , Selim M. Angelica 
Published: April 2016

Objectives
We sought to recognize the working diagnostic criteria for differentiated vulvar intraepithelial neoplasia (dVIN) among expert pathologists in the field. We also sought the frequency of definitive diagnosis, terminology of equivocal lesions, and views on dVIN’s biological significance.

Methods
Respondents ranked 26 histological and 8 ancillary studies and 5 clinical findings as “essential,” “nonessential but strongly supports diagnosis,” “possibly supports diagnosis,” “weighs against diagnosis” or “uncertain significance or noncontributory.” Consensus was defined as 75% agreement. They were asked about diagnosing dVIN on partially sampled lesions, terminology for uncertain lesions, frequency of diagnosis of dVIN relative to uncertain lesions, and if dVIN a is a precursor to an invasion.

Results
Twenty-three completed the survey. Only “basal layer atypia” met consensus (86%) as essential. Consensus criteria for being at least strongly supportive of dVIN were “basal layer hyperchromasia,” “presence of basal layer mitoses,” and “large keratinocytes with abundant eosinophilic cytoplasm.” Only “block-like positivity with p16” or positive HPV specific studies weighed against the diagnosis by consensus. Approximately 87% diagnosed dVIN on partially sampled lesions. Squamous cell hyperplasia with atypia was the most frequent terminology used for uncertain lesions; 87% felt dVIN is a precursor to invasion.

Conclusions
Only basal layer atypia was considered diagnostically essential by consensus. Additional criteria that strongly support the diagnosis include changes affecting the basal layer and abundant eosinophilic keratinocytic cytoplasm. There was no consensus on ancillary study findings to confirm dVIN. Most would diagnose dVIN on a partial sample. Most consider dVIN a precursor to invasion.
Correlation Between Aeroallergen Levels and New Diagnosis of Eosinophilic Esophagitis in New York City
Authors: Fahey Lisa , Robinson Guy , Weinberger Kate , Giambrone Ashley E. , Solomon Aliza B. 
Published: April 2016

ABSTRACTObjective:The relation between food allergies and eosinophilic esophagitis (EoE) is well established. Aeroallergens may also contribute to the development of EoE; however, there are limited data to support or refute this hypothesis. The objectives of this pilot study were to determine whether there is a seasonal variation in the onset of symptoms and/or diagnosis of EoE and whether these variations correlate with a specific pollen concentration within New York City.Methods:We performed a retrospective chart review to identify all pediatric patients at New York Presbyterian Weill Cornell Medical Center diagnosed with EoE between 2002 and 2012. Sixty‐six patients were identified and 28 were excluded. Cases were classified by both date of initial symptoms and date of histologic diagnosis. Pollen counts from a certified New York City counting station and the percentage of EoE cases were collated monthly and seasonally and compared.Results:There was a seasonal variation in onset of symptoms and diagnosis of EoE, with the highest number of patients reporting onset of symptoms of EoE in July to September, and those being diagnosed with EoE in October to December. There was a seasonal correlation between peak levels of grass pollen and peak onset of EoE symptoms, which were both highest in July to September. The diagnosis of EoE peaked one season later.Conclusions:The study findings suggest that there is a correlation between specific aeroallergens and both the onset of symptoms and time of diagnosis of patients with EoE.
Facilitators and Hindrances of Implementing Colorectal Cancer Screening Intervention Among Vietnamese Americans
Authors: Sin Mo-Kyung , Yip Mei-Po , Kimura Amanda , Tu Shin-Ping 
Published: April 2016

Background:
Little is published about the factors that facilitate and hinder the intervention implementation process.

Objective:
The aim of this study was to examine factors that facilitated and hindered the implementation of a culturally appropriate colorectal cancer screening intervention targeting Vietnamese Americans in a Federally Qualified Health Center located in the Puget Sound area of Washington.

Methods:
Three focus group discussions (2 during the implementation phase and 1 during the maintenance phase) with the medical assistants (N = 13) who were the intervention implementation agents were conducted at the Federally Qualified Health Center. Three research team members independently analyzed the data using content analysis and then compared for agreement. We reread and recoded the transcripts until consensus was reached. The themes were clustered by similar codes and categorized into 4 groups, each including facilitators and hindrances of implementation: identification of implementation agents, implementation environment, intervention recipients, and the colorectal cancer screening intervention.

Results:
Facilitators included medical assistants’ high motivation with a positive attitude toward the intervention, team approach, and simplicity of the intervention, whereas hindrances included lack of time, forgetfulness, staff turnover, and language barriers.

Conclusion:
The findings emphasized the importance of supporting implementation agents to ensure effective intervention program implementation.

Implications for Practice:
Oncology nurses need to particularly take into consideration the evidence-based findings when planning any intervention programs.
Posttraumatic Stress Disorder Symptoms and Social and Occupational Functioning of People With Schizophrenia
Authors: Ng Lauren C. , Petruzzi Liana J. , Greene M. Claire , Mueser Kim T. , Borba Christina P.C. , Henderson David C. 
Published: April 2016

Abstract
This study sought to clarify the contribution of posttraumatic stress disorder (PTSD) to interpersonal and occupational functioning in people with schizophrenia. Self-report questionnaires and semistructured interviews were used to evaluate PTSD and brain injury, positive symptoms, depression, substance abuse, occupational and social functioning, and intelligence. Multiple regressions assessed the relationship between predictors and functional impairment. Posttraumatic stress disorder symptoms were present in 76% of participants, with 12% of participants meeting diagnostic criteria for PTSD. Participants with PTSD had higher rates of depression and more severe positive symptoms. Results of multiple regressions indicated that PTSD symptoms were the only significant predictor of patient-rated interpersonal and occupational functioning. Posttraumatic stress disorder symptoms were not associated with interviewer-rated interpersonal or occupational functioning or employment. While more research is needed, screening and treatment for exposure to traumatic events and PTSD symptoms might be indicated for individuals with schizophrenia. Availability of PTSD assessment and evidence-based treatments for people with schizophrenia is a crucial and often unmet health service need.
Single Viral Load Measurements Overestimate Stable Viral Suppression Among HIV Patients in Care: Clinical and Public Health Implications
Authors: Marks Gary , Patel Unnati , Stirratt Michael J. , Mugavero Michael J. , Mathews William C. , Giordano Thomas P. , Crepaz Nicole , Gardner Lytt I. , Grossman Cynthia , Davila Jessica , Sullivan Meg , Rose Charles E. , O'Daniels Christine , Rodriguez Allan , Wawrzyniak Andrew J. , Golden Matthew R. , Dhanireddy Shireesha , Ellison Jacqueline , Drainoni Mari-Lynn , Metsch Lisa R. , Cachay Edward R. 
Published: April 2016

Background:
The HIV continuum of care paradigm uses a single viral load test per patient to estimate the prevalence of viral suppression. We compared this single-value approach with approaches that used multiple viral load tests to examine the stability of suppression.

Methods:
The retrospective analysis included HIV patients who had at least 2 viral load tests during a 12-month observation period. We assessed the (1) percent with suppressed viral load (<200 copies/mL) based on a single test during observation, (2) percent with suppressed viral loads on all tests during observation, (3) percent who maintained viral suppression among patients whose first observed viral load was suppressed, and (4) change in viral suppression status comparing first with last measurement occasions. Prevalence ratios compared demographic and clinical subgroups.

Results:
Of 10,942 patients, 78.5% had a suppressed viral load based on a single test, whereas 65.9% were virally suppressed on all tests during observation. Of patients whose first observed viral load was suppressed, 87.5% were suppressed on all subsequent tests in the next 12 months. More patients exhibited improving status (13.3% went from unsuppressed to suppressed) than worsening status (5.6% went from suppressed to unsuppressed). Stable suppression was less likely among women, younger patients, black patients, those recently diagnosed with HIV, and those who missed ≥1 scheduled clinic visits.

Conclusions:
Using single viral load measurements overestimated the percent of HIV patients with stable suppressed viral load by 16% (relative difference). Targeted clinical interventions are needed to increase the percent of patients with stable suppression.
Nonclotted Blood Patch Technique Reduces Pneumothorax and Chest Tube Placement Rates After Percutaneous Lung Biopsies
Authors: Clayton Joshua D. , Elicker Brett M. , Ordovas Karen G. , Kohi Maureen P. , Nguyen Janet , Naeger David M. 
Published: April 2016

Purpose:
The aim of this study was to determine whether autologous nonclotted blood patch decreases pneumothorax and chest tube placement rates in computed tomography–guided biopsies of the lung.

Materials and Methods:
Percutaneous computed tomography–guided lung biopsies performed over a period of 6 years were retrospectively reviewed to determine the overall rates of pneumothorax and chest tube placement and rates before and after the autologous nonclotted blood patch procedure was instituted as a departmental policy. The effect of the intervention was only assessed in patients in whom a blood patch could be applied, therefore only when the needle traversed an aerated lung and only when the needle remained in the lung at the end of the study.

Results:
There was a statistically significant decrease in both the rate of pneumothorax [28% (69/245) vs. 42% (80/189); P=0.002] and chest tube placement [4% (10/245) vs. 16% (30/189); P<0.001] in patients who received nonclotted blood patch versus those who did not. Blood patch was performed in 222/312 (71%) eligible patients after the introduction of the blood patch policy. After policy introduction, there was a decreased rate of pneumothorax, with a rate of 32% (101/312) versus 40% (49/122) (P=0.12) and a statistically significant decrease in departmental chest tube placement rates of 6% (20/312) versus 16% (20/122) (P=0.001).

Conclusions:
Nonclotted autologous blood patch for percutaneous lung biopsy resulted in significantly decreased pneumothorax and chest tube placement rates in our patient population.
Inferring intrinsic and extrinsic noise from a dual fluorescent reporter
Authors: van Nimwegen Erik 
Published: April 2016

AbstractDual fluorescent reporter constructs, which measure gene expression from two identical promoters within the same cell, allow total gene expression noise to be decomposed into an extrinsic component, roughly associated with cell-to-cell fluctuations in cellular component concentrations, and intrinsic noise, roughly associated with inherent stochasticity of the biochemical reactions involved in gene expression [1]. A recent paper by Fu and Pachter presented frequentist statistical estimators for intrinsic and extrinsic noise using data from dual reporters [2]. For comparison, I here present results of a Bayesian analysis of this problem. I show that the orthodox estimators suffer from pathologies such as predicting negative values for a manifestly non-negative quantity, i.e. variance, and show that the Bayesian estimators do not suffer from such pathologies. In addition, I show that the Bayesian analysis automatically identifies that optimal estimates of intrinsic and extrinsic noise depend on a subtle combination of two statistics of the data, allowing for accuracies that are up to twice the accuracy of the orthodox estimators in some parameter regimes.I hope up this little worked out example contrasting orthodox statistical analysis based on ad hoc estimators with estimators resulting from a Bayesian analysis, will be educational for others in the field. I distribute a Mathematica Notebook with this paper that allows users to easily reproduce all results and figures of the paper.
Mortality Selection in a Genetic Sample and Implications for Association Studies
Authors: Domingue Benjamin W. , Belsky Daniel W. , Harrati Amal , Conley Dalton , Weir David , Boardman Jason 
Published: April 2016

AbstractMortality selection is a general concern in the social and health sciences. Recently, existing health and social science cohorts have begun to collect genomic data. Causes of selection into a genomic dataset can influence results from genomic analyses. Selective non-participation, which is specific to a particular study and its participants, has received attention in the literature. But mortality selection—the very general phenomenon that genomic data collected at a particular age represents selective participation by only the subset of birth cohort members who have survived to the time of data collection—has been largely ignored. Here we test the hypothesis that such mortality selection may significantly alter estimates in polygenetic association studies of both health and non-health traits. We demonstrate mortality selection into genome-wide SNP data collection at older ages using the U.S.-based Health and Retirement Study (HRS). We then model the selection process. Finally, we test whether mortality selection alters estimates from genetic association studies. We find evidence for mortality selection. Healthier and more socioeconomically advantaged individuals are more likely to survive to be eligible to participate in the genetic sample of the HRS. Mortality selection leads to modest drift in estimating time-varying genetic effects, a drift that is enhanced when estimates are produced from data that has additional mortality selection. There is no general solution for correcting for mortality selection in a birth cohort prior to entry into a longitudinal study. We illustrate how genetic association studies using HRS data can adjust for mortality selection from study entry to time of genetic data collection by including probability weights that account for mortality selection. Mortality selection should be investigated more broadly in genetically-informed samples from other cohort studies.
Climate change perception and choice of adaptation strategies
Authors: Tesfaye Wondimagegn , Seifu Lemma 
Published: April 2016

Purpose
– The purpose of this paper is to analyze smallholder farmers’ perceptions of climate change and its adverse effects, identify major adaptation strategies used by farmers and analyze the factors that influence the choice of adaptation strategy by smallholder farmers in eastern Ethiopia.

Design/methodology/approach
– The study was based on a cross-sectional survey of 296 sample households selected from three districts in east Ethiopia. Data were collected with the aid of a semi-structured questionnaire and review of literature, documents and databases.

Findings
– The study provides empirical evidence that majority of farmers in the study area are aware of climate change patterns and their adverse effect on income, food security, diversity, forest resources, food prices and crop and livestock diseases. In response to these adverse effects, major adaptation strategies used by farmers include cultivating different crops, planting different crop varieties, changing planting dates, use of soil and water conservation techniques, conservation agriculture practices and engaging in non-farm income activities. Choice of adaptation strategies are influenced by gender of household head, household size, farm size, distance from market and number of farm plots.

Practical implications
– The study suggests that developing more effective climate change adaptation strategies need support from the government. Such an effort needs provision of the necessary resources such as credit, information and extension services on climate change adaptation strategies and technologies, and investing in climate smart and resilient projects.

Originality/value
– The study adopts multivariate probit model that models farmers’ simultaneous adaptation choice behavior which has been rarely addressed by previous researches.
Anticipatory adaptation and the role of decadal climate information in rural African livelihood systems
Authors: Nyamwanza Admire M. , New Mark 
Published: April 2016

Purpose
– This study aims to explore the utility of anticipatory adaptation to climate variability and related livelihood sensitivities in rural African contexts using the case of Mbire district situated in the mid-Zambezi valley region of Zimbabwe. The provision of decadal climate information (up to ten years), as part of an anticipatory adaptation package, is at the centre of analysis.

Design/methodology/approach
– The study used semi-structured and key informant interviews, with a total of 45 semi-structured interviews being conducted with randomly selected long-term communal farmers in the case study area. Whilst data from semi-structured interviews was arranged in Microsoft Excel, thematic analysis was used in analyzing all data.

Findings
– Anticipatory adaptation and decadal climate projections are shown to potentially enhance flexibility in adaptation planning vis- à-vis responding to climate variability and other challenges, as well as reduce chances of maladaptation in responding to climate challenges in the context of multiple and reinforcing stresses and shocks.

Originality/value
– Anticipatory adaptation, with its three main pillars of future analysis, flexibility of strategies and proactive action, is emerging as key in assisting adaptation planning, the harnessing of opportunities and decision-making vis- à-vis responding to climate uncertainties and related livelihood sensitivities. Yet there have not been much empirically grounded analyses in understanding the role of anticipatory adaptation in rural Africa. This study therefore adds to evidence-based analyses towards understanding the role and utility of anticipatory adaptation in local communities in Africa.