bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigating associations between the built environment and physical activity among older people in 20 UK towns
Authors: Hawkesworth Sophie , Silverwood Richard J , Armstrong Ben , Pliakas Triantafyllos , Nanchalal Kiran , Jefferis Barbara J , Sartini Claudio , Amuzu Antoinette A , Wannamethee S Goya , Ramsay Sheena E , Casas Juan-Pablo , Morris Richard W , Whincup Peter H , Lock Karen 
Published: November 2017

BackgroundPolicy initiatives such as WHO Age Friendly Cities recognise the importance of the urban environment for improving health of older people, who have both low physical activity (PA) levels and greater dependence on local neighbourhoods. Previous research in this age group is limited and rarely uses objective measures of either PA or the environment.MethodsWe investigated the association between objectively measured PA (Actigraph GT3x accelerometers) and multiple dimensions of the built environment, using a cross-sectional multilevel linear regression analysis. Exposures were captured by a novel foot-based audit tool that recorded fine-detail neighbourhood features relevant to PA in older adults, and routine data.Results795 men and 638 women aged 69–92 years from two national cohorts, covering 20 British towns, were included in the analysis. Median time in moderate to vigorous PA (MVPA) was 27.9 (lower quartile: 13.8, upper quartile: 50.4) minutes per day. There was little evidence of associations between any of the physical environmental domains (eg, road and path quality defined by latent class analysis; number of bus stops; area aesthetics; density of shops and services; amount of green space) and MVPA. However, analysis of area-level income deprivation suggests that the social environment may be associated with PA in this age group.ConclusionsAlthough small effect sizes cannot be discounted, this study suggests that older individuals are less affected by their local physical environment and more by social environmental factors, reflecting both the functional heterogeneity of this age group and the varying nature of their activity spaces.
Tolosa-Hunt Syndrome: Appraising the ICHD-3 beta diagnostic criteria
Authors: Mullen Evan , Green Mark , Hersh Eliza , Iloreta Alfred-Marc , Bederson Joshua , Shrivastava Raj 
Published: November 2017

Introduction The term Tolosa-Hunt Syndrome was first used more than half a century ago to describe painful ophthalmoplegia accompanied by cranial nerve palsies. In the decades since, its diagnostic criteria have evolved considerably. The beta version of the 3rd Edition of the International Classification of Headache Disorders narrows these criteria to require the demonstration of granulomatous inflammation on MRI or biopsy. We believe this may introduce challenges to accurate diagnosis. Discussion Requiring the demonstration of granulomatous inflammation for a diagnosis of Tolosa-Hunt Syndrome may introduce the potential for false negative and false positive diagnoses. Although the disorder presents secondary to granulomatous inflammation, MRI technology may not be able to identify it reliably, and biopsy is not always indicated for its symptomatology. Additionally, several cases have been reported of Tolosa-Hunt Syndrome diagnosed with MRI-confirmed granulomatous inflammation that later prove to be attributable to other pathologies. The emphasis on neuroimaging may therefore exclude some true Tolosa-Hunt Syndrome cases and include others resulting from other latent pathologies that are not visible on MRI. Conclusion We wish to offer several potential modifications to the International Classification of Headache Disorders guidelines for Tolosa-Hunt Syndrome, including making the demonstration of granulomatous inflammation on MRI or biopsy non-mandatory and lengthening patient follow-up to two years for cases in which MRI is unrevealing.
Evaluation of Intravenous Vancomycin Pharmacokinetic Parameters in Patients With Acute Brain Injury
Authors: Oswalt Allison , Joseph Anny-Claude , Sima Adam , Kurczewski Lisa 
Published: November 2017

Background: Vancomycin is a glycopeptide antibiotic that is primarily cleared by renal elimination. Patients with acute brain injury often exhibit augmented renal clearance which has been associated with subtherapeutic vancomycin concentrations. Objective: To determine whether population pharmacokinetics accurately predict vancomycin empiric dose frequency in patients with acute brain injury. Methods: This was a single-center, retrospective cohort study conducted following institutional review board approval at Virginia Commonwealth University Health System. Data were collected from patients 18 years of age or older admitted with acute brain injury. The primary outcome was the difference in the elimination rate constant of vancomycin between population predicted pharmacokinetics and patient-specific pharmacokinetics. Results: A total of 158 patients were included in the analysis. A test of the paired differences between the mean population predicted and patient-specific elimination rate constants showed that the mean population predicted elimination rate constant was larger by 0.0211 h−1 (95% confidence interval [CI]: −0.028 to −0.015). The difference between the mean population predicted and patient-specific half-lives showed that the mean population predicted half-life was shorter by 1.01 hours (95% CI: 0.7-1.3). Vancomycin was administered at a mean initial dose of 15.4 mg/kg (standard deviation [SD] = 2.2), with an average frequency of 12 hours (SD = 1.1). The average trough concentration at steady state was 9.9 µg/mL (SD = 4.9). Conclusions: The small clinical difference in population and patient-specific elimination rate constants demonstrates that population pharmacokinetics may be an accurate empiric dosing strategy for determining vancomycin dose frequency in patients with acute brain injury.
Quality of Life and Compassion Satisfaction in Clinicians: A Pilot Intervention Study for Reducing Compassion Fatigue
Authors: Klein Colleen J. , Riggenbach-Hays Jami J. , Sollenberger Laura M. , Harney Diane M. , McGarvey Jeremy S. 
Published: November 2017

Background: Compassion fatigue (CF) is prevalent in healthcare professionals, particularly in those caring for chronic, acutely ill, and/or those patients who might be moving toward comfort care. Over time, CF can lead to burnout (BO) and secondary traumatic stress and an overall decrease in professional quality of life. In this pilot study, participants completed a resiliency program focused on education about CF and self-awareness of its individualized impact and were expected to develop ongoing self-care practices to prevent/address the untoward effects. Methods: Healthcare professionals ( N = 15) participated in a formalized educational program consisting of three 90-minute educational sessions held 2 weeks apart. Preassessment and postintervention data were collected electronically in survey format. A postprogram evaluation was also offered. Results: Upon completion of the program, participants noted an increase in compassion satisfaction (CS) and a small reduction in BO. Secondary traumatic stress remained unchanged. Feedback about the program was positive, and participants reported the impact on their clinical practice and life to be moderately high. At 6 months, over half of the participants continued to report positive impact on their personal/professional lives. Conclusion: While the small sample size of this pilot study limits the generalizability of the findings, there were positive effects for CS and BO in participants over time, indicating possible benefits of providing self-care education to healthcare providers. Additional research with a larger sample size is needed to address how healthcare providers might further benefit from resiliency education and interventions to improve professional quality of life.
Palliative Care Consultation for Goals of Care and Future Acute Care Costs: A Propensity-Matched Study
Authors: O’Connor Nina R. , Junker Paul , Appel Scott M. , Stetson Robert L. , Rohrbach Jeffrey , Meghani Salimah H. 
Published: November 2017

Background: Hospitals are under increasing pressure to manage costs across multiple episodes of care. Most studies of the financial impact of palliative care have focused on costs during a single hospitalization. Objective: To compare future acute health-care costs and utilization between patients who received inpatient palliative care consultation for goals of care (Palliative Care Service [PCS]) and a propensity-matched cohort of patients who did not receive palliative care consultation (non-PCS) in a single academic medical center. Methods: Data were extracted from the hospital’s electronic records for admissions and discharges between July 2014 and October 2016. A stratified propensity score matching was used to account for nonrandom assignment and potential inherent differences between PCS and non-PCS groups using variables of theoretical interest: age, gender, race, diagnosis, risk of mortality, and prior acute care costs. Results: The analytical sample for this study included 41 363 patients (PCS = 1853; non-PCS = 39 510). Future acute care costs were significantly higher in the non-PCS group after propensity score matching (highest tier = US$15 654 vs US$8831; second highest tier = US$12 200 vs US$5496; P = .0001). The non-PCS group also had significantly higher future acute care utilization across all propensity tiers and outcomes including 30-day readmission ( P = .0001), number of future hospital days ( P = .0001), and number of future intensive care unit days ( P = .0001). Conclusion: Palliative care consultations for goals of care may decrease future health-care utilization with cost savings that persist into future hospitalizations.
Weightbearing Computed Tomography of the Foot and Ankle: Emerging Technology Topical Review
Authors: Barg Alexej , Bailey Travis , Richter Martinus , de Cesar Netto Cesar , Lintz François , Burssens Arne , Phisitkul Phinit , Hanrahan Christopher J. , Saltzman Charles L. 
Published: November 2017

In the last decade, cone-beam computed tomography technology with improved designs allowing flexible gantry movements has allowed both supine and standing weight-bearing imaging of the lower extremity. There is an increasing amount of literature describing the use of weightbearing computed tomography in patients with foot and ankle disorders. To date, there is no review article summarizing this imaging modality in the foot and ankle. Therefore, we performed a systematic literature review of relevant clinical studies targeting the use of weightbearing computed tomography in diagnosis of patients with foot and ankle disorders. Furthermore, this review aims to offer insight to those with interest in considering possible future research opportunities with use of this technology. Level of Evidence: Level V, expert opinion.
Featured article: Structure moderation of gut microbiota in liraglutide-treated diabetic male rats
Authors: Zhang Qian , Xiao Xinhua , Zheng Jia , Li Ming , Yu Miao , Ping Fan , Wang Tong , Wang Xiaojing 
Published: November 2017

The change of gut microbiome is associated with a serious of metabolic disorders, such as diabetes. As a glucagon-like peptide 1 analogue, liraglutide is a potent antidiabetic drug in clinical practice. However, the effect of liraglutide on the community of gut microbiota is still unknown. We aimed to determine the influence of liraglutide on fecal microbiota in diabetic male rats. Five-week-old male Sprague-Dawley rats were fed with a control diet or a high-fat diet for four weeks. By injecting streptozotocin, the diabetic rat model was performed. Diabetic male rats were injected subcutaneously with a low dose of liraglutide (liraglutide 0.2 mg/kg/day), a high dose of liraglutide (liraglutide 0.4 mg/kg/day), or normal saline for 12 weeks. Our data showed that liraglutide effectively prevented the development of diabetes in male rats. Pyrosequencing of the V3-V4 region of 16S rRNA genes manifested a remarkable transfer of gut microbiota construction in liraglutide-treated male rats compared with that of the diabetic male rats. Further analysis identified 879 liraglutide-treated specific operational taxonomic units. Some short-chain fatty acid (SCFA)-producing bacteria, including Bacteroides, Lachnospiraceae, and probiotic bacteria, Bifidobacterium, were selectively enhanced in liraglutide-treated diabetic male rats. Lactobacillus was negatively correlated with fasting blood glucose. To sum up, our findings propose that the prevention of diabetes by liraglutide in the diabetic male rats may be associated with the structural change of the gut microbiota, inflammation alleviation, and abundantly elevated SCFA-producing bacteria in the intestine. Impact statement Our findings suggest that significant changes in gut microbiota are associated with liraglutide treatment on the diabetic male rats, including enrichment of short-chain fatty acid producers and probiotic bacteria. This may help alleviate systemic inflammation and contribute to the beneficial effects of liraglutide against diabetes.
Preclinical biomarker qualification
Authors: Sauer John-Michael , Porter Amy C ,   for the Biomarker Programs, Predictive Safety Testing Consortium
Published: November 2017

Biomarkers are ubiquitously used within drug development programs in both nonclinical species and in humans to assess safety and efficacy of novel compounds. To routinely apply such novel biomarkers with certainty, a well-defined data package is necessary for review and endorsement by regulatory agencies including the US Food and Drug Administration, European Medicines Agency, and Japanese Pharmaceuticals and Medical Devices Agency. This type of endorsement is known as regulatory qualification. Novel approaches are being applied to speed the process, lower the resource intensity, and increase the accessibility of biomarker qualification data and it is likely that consortia will continue to play a fundamental role in the qualification process by bringing together like-minded stakeholders focused on specific tools to accelerate drug development. This article will focus on learnings from the previous three nonclinical biomarker qualification projects, as well as discuss the progression of preclinical biomarker projects into the clinical qualification space and the current strategy for the use of nonclinical biomarker data in the translational qualification of clinical biomarkers; much like nonclinical information is used in the approval of drug development candidates. Impact statement This minireview provides an overview of the history of preclinical biomarker qualification by summarizing the three examples of this type of qualification with US Food and Drug Administration, European Medicines Agency, and Japanese Pharmaceuticals and Medical Devices Agency. In addition, an overview of the biomarker qualification process is included to educate key stakeholders with links to relevant white papers that provide information on current evidentiary considerations. The manuscript also provides new information on the evolution of the role that preclinical qualification plays in clinical qualification of biomarkers and the novel approaches that are being utilized to improve the process.
Effects of alteplase for acute stroke according to criteria defining the European Union and United States marketing authorizations: Individual-patient-data meta-analysis of randomized trials
Authors: Hacke Werner , Lyden Patrick , Emberson Jonathan , Baigent Colin , Blackwell Lisa , Albers Gregory , Bluhmki Erich , Brott Thomas , Cohen Geoffrey , Davis Stephen M , Donnan Geoffrey A , Grotta James C , Howard George , Kaste Markku , Koga Masatoshi , von Kummer Rüdiger , Lansberg Maarten G , Lindley Richard I , Olivot Jean-Marc , Parsons Mark , Sandercock Peter AG , Toni Danilo , Toyoda Kazunori , Wahlgren Nils , Wardlaw Joanna M , Whiteley William N , del Zoppo Gregory , Lees Kennedy R ,   on behalf of the Stroke Thrombolysis Trialists’ Collaborators Group
Published: November 2017

Background The recommended maximum age and time window for intravenous alteplase treatment of acute ischemic stroke differs between the Europe Union and United States. Aims We compared the effects of alteplase in cohorts defined by the current Europe Union or United States marketing approval labels, and by hypothetical revisions of the labels that would remove the Europe Union upper age limit or extend the United States treatment time window to 4.5 h. Methods We assessed outcomes in an individual-patient-data meta-analysis of eight randomized trials of intravenous alteplase (0.9 mg/kg) versus control for acute ischemic stroke. Outcomes included: excellent outcome (modified Rankin score 0–1) at 3–6 months, the distribution of modified Rankin score, symptomatic intracerebral hemorrhage, and 90-day mortality. Results Alteplase increased the odds of modified Rankin score 0–1 among 2449/6136 (40%) patients who met the current European Union label and 3491 (57%) patients who met the age-revised label (odds ratio 1.42, 95% CI 1.21−1.68 and 1.43, 1.23−1.65, respectively), but not in those outside the age-revised label (1.06, 0.90−1.26). By 90 days, there was no increased mortality in the current and age-revised cohorts (hazard ratios 0.98, 95% CI 0.76−1.25 and 1.01, 0.86–1.19, respectively) but mortality remained higher outside the age-revised label (1.19, 0.99–1.42). Similarly, alteplase increased the odds of modified Rankin score 0-1 among 1174/6136 (19%) patients who met the current US approval and 3326 (54%) who met a 4.5-h revised approval (odds ratio 1.55, 1.19−2.01 and 1.37, 1.17−1.59, respectively), but not for those outside the 4.5-h revised approval (1.14, 0.97−1.34). By 90 days, no increased mortality remained for the current and 4.5-h revised label cohorts (hazard ratios 0.99, 0.77−1.26 and 1.02, 0.87–1.20, respectively) but mortality remained higher outside the 4.5-h revised approval (1.17, 0.98–1.41). Conclusions An age-revised European Union label or 4.5-h-revised United States label would each increase the number of patients deriving net benefit from alteplase by 90 days after acute ischemic stroke, without excess mortality.
Endovascular embolization of branch-incorporated cerebral aneurysms
Authors: Kawabata Yasuhiro , Nakazawa Takuya , Fukuda Shunichi , Kawarazaki Satoru , Aoki Tomokazu , Morita Takumi , Tsukahara Tetsuya 
Published: November 2017

Objectives The aim of this study was to examine the feasibility, technique, and clinical and angiographic outcomes of endovascular coiling to treat a cerebral aneurysm with a branch incorporated into the aneurysmal wall. Methods From 2012 to 2016, 25 patients with 26 cerebral aneurysms having a branch incorporated into the aneurysm (9 unruptured, 17 ruptured) were treated to prevent rupture or re-bleeding from the sac while preserving the incorporated branch by using single-catheter ( n = 18), balloon-remodeling ( n = 4), stent-assisted coiling ( n = 3), or double-catheter ( n = 1) techniques. Results Endovascular coiling was conducted in 26 procedures without angiographic occlusion of the incorporated branch. Post-embolization angiography revealed near-complete occlusion ( n = 8; 30.7%), neck remnant ( n = 13; 50%), and incomplete occlusion ( n = 5; 19.3%) aneurysms. Thromboembolisms were observed in four (15.4%) patients during or after the procedure. A procedure-related neurological deficit was observed in one (3.8%) patient. When patients with a preictal modified Rankin Scale (mRS) score of 3 presenting with grade 5 subarachnoid hemorrhage were excluded, all patients had favorable outcomes (mRS 0–2). Six (23.1%) recurrent aneurysms were observed during follow-up, five of which were treated endovascularly at 5–22 months without complication. The location of an aneurysm at the ICA-posterior communicating artery associated with the dominant-type posterior communicating artery was significantly associated with recurrence ( p = 0.041). Conclusions Cerebral aneurysms with an incorporated branch were safely treated using conventional endovascular coiling. However, treatment durability was unsatisfactory, especially for dominant-type ICA-posterior communicating artery aneurysms.
Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection‐surveillance paradox
Authors: Mangas-Sanjuan Carolina , Zapater Pedro , Cubiella Joaquín , Murcia Óscar , Bujanda Luis , Hernández Vicent , Martínez-Ares David , Pellisé María , Seoane Agustín , Lanas Ángel , Nicolás-Pérez David , Herreros-de-Tejada Alberto , Chaparro María , Cacho Guillermo , Fernández-Díez Servando , Marín-Gabriel José-Carlos , Quintero Enrique , Castells Antoni , Jover Rodrigo ,   COLONPREV study investigators
Published: November 2017

BackgroundGuidelines recommend surveillance colonoscopies based exclusively on findings at baseline colonoscopy. This recommendation leads to the paradox that the higher the baseline colonoscopy quality, the more surveillance colonoscopies will be indicated according to current guidelines.ObjectiveThe aim of this study was to evaluate the effect on follow‐up findings of different quality metrics of the endoscopist performing the baseline colonoscopy.MethodsThis retrospective cohort study included individuals with advanced adenomas at baseline colonoscopy. Adenoma detection rate (ADR) and adenomas per colonoscopy rate (APCR) were determined for 44 endoscopists. Surveillance colonoscopies were checked after systematic tracking.ResultsA total of 574 individuals were diagnosed with advanced adenomas, of whom 270 received a surveillance colonoscopy. Patients whose baseline colonoscopy endoscopist had an ADR lower than the median of 33.8% had significantly higher rates of advanced neoplasia at follow‐up (13.1% vs 4.0%; p = 0.001). On univariate analysis, high‐risk advanced adenomas at baseline (HR 0.43; 95% CI 0.19–0.97) and ADR (HR 0.94; 95% CI 0.89–0.99) showed a significant relationship with advanced neoplasia at surveillance. In a multivariate Cox model, the ADR of the endoscopist who performed the baseline colonoscopy was the only independent predictor of risk for developing advanced neoplasia at follow‐up (HR 0.94; 95% CI 0.89–0.99).ConclusionsOur results suggest that the risk of identifying advanced adenomas at follow‐up is closely related to the quality metrics of the endoscopist who performs the baseline colonoscopy.
Cognitive fatigue effect on rehabilitation task performance in a haptic virtual environment system
Authors: Yang C , Lin Y , Cai MY , Qian ZQ , Kivol J , Zhang WJ 
Published: November 2017

Introduction This paper presents a study on an affordable rehabilitation approach to post-stroke patients. In this approach, a patient performs a task on a haptic virtual environment system and a physician examines the patient’s task remotely based on the performing data. Objectives The objective of this study is to test a hypothesis that an elevated cognitive fatigue state may significantly affect the patient’s task performance so as to disturb judgment by physicians. Methods The study included the development of a test-bed for the experiment and an experimental study for the hypothesis. The study took the wrist coordination function of the upper limb as an example. Result The study showed that the cognitive fatigue state has a significant influence on the patient’s task performance; in other words, there is a noise (75% discrepancy from the true performance information) in the performance data. Conclusion The study provides great potential for accurate assessment of the functional state from true patient task performance. The future work needs to focus on the removal of the noise. The limitation of this study is that the experiment was carried out on healthy subjects, although post-stroke patients are more susceptible to an elevated cognitive fatigue state from a common sense.