bluuebunny/crossref_metadata_2025_split huggingface dataset:
Household Debt and Business Cycles Worldwide*
Authors: Mian Atif , Sufi Amir , Verner Emil 
Published: May 2017

Abstract
An increase in the household debt to GDP ratio predicts lower GDP growth and higher unemployment in the medium run for an unbalanced panel of 30 countries from 1960 to 2012. Low mortgage spreads are associated with an increase in the household debt to GDP ratio and a decline in subsequent GDP growth, highlighting the importance of credit supply shocks. Economic forecasters systematically over-predict GDP growth at the end of household debt booms, suggesting an important role of flawed expectations formation. The negative relation between the change in household debt to GDP and subsequent output growth is stronger for countries with less flexible exchange rate regimes. We also uncover a global household debt cycle that partly predicts the severity of the global growth slowdown after 2007. Countries with a household debt cycle more correlated with the global household debt cycle experience a sharper decline in growth after an increase in domestic household debt.
Managing kidney transplant recipients in primary care
Authors: Roth Shira 
Published: May 2017

ABSTRACT
Patients who have undergone kidney transplant are at increased risk for heart disease, new-onset diabetes, metabolic syndrome, and certain malignancies, in addition to opportunistic infections associated with immunosuppression. This article describes guidelines for routine management of kidney transplant recipients in primary care, as well as how to recognize risk factors and complications.
An Interprofessional Course on Substance Use Disorders for Health Professions Students
Authors: Muzyk Andrew J. , Tew Chris , Thomas-Fannin Allie , Dayal Sanjai , Maeda Reina , Schramm-Sapyta Nicole , Andolsek Kathryn M. , Holmer Shelley 
Published: May 2017

Problem
Substance use disorders (SUDs) affect millions of Americans. Nevertheless, there is insufficient health care resource allocation for these patients. One reason may be the lack of education and training about SUDs in health professions programs.

Approach
The authors developed a required, interprofessional SUDs course for health professions students completing a one-month psychiatry clerkship within the Duke University Health System starting in November 2015. Students participated in six 1-hour class sessions led by an interdisciplinary faculty. Sessions focused on core areas in SUDs education and used either a lecture with discussion or a small-group team-based learning format. Students completed one motivational interview, attended a 12-step recovery meeting, and wrote a reflection paper. On the first and last day of the clerkship, students measured their attitudes toward individuals with SUDs using the Substance Abuse Attitude Scale (SAAS) and toward interprofessionalism using the Interprofessional Attitudes Scale (IPAS).

Outcomes
Seventy-one students participated in the course from November 2015 to May 2016. Fifty-nine (83%) students had paired pre- and postcourse SAAS and IPAS data. On the SAAS, students showed significant improvement in their median total score and nonmoralizing, treatment optimism, and treatment intervention scores. On the IPAS, students showed significant improvement in their median score on the teamwork, roles, and responsibilities domain.

Next Steps
The authors will continue to assess the course. Starting in academic year 2016–2017, the course will include four additional elements, and beginning in July 2016, accelerated bachelor of science in nursing students will participate in the course.
Omega-6:Omega-3 PUFA Ratio, Pain, Functioning, and Distress in Adults With Knee Pain
Authors: Sibille Kimberly T. , King Christopher , Garrett Timothy J. , Glover Toni L. , Zhang Hang , Chen Huaihou , Reddy Divya , Goodin Burel R. , Sotolongo Adriana , Petrov Megan E. , Cruz-Almeida Yenisel , Herbert Matthew , Bartley Emily J. , Edberg Jeffrey C. , Staud Roland , Redden David T. , Bradley Laurence A. , Fillingim Roger B. 
Published: May 2017

Objectives:
Osteoarthritis (OA) is associated with inflammation, chronic pain, functional limitations, and psychosocial distress. High omega-3 (n-3) polyunsaturated fatty acids (PUFAs) are associated with lower levels of inflammatory mediators, anti-nociception, and adaptive cognitive/emotional functioning. High omega-6 (n-6) PUFAs are associated with inflammation, nociception, and psychological distress. While findings related to n-3 supplementation in knee OA are mixed, consideration of the n-6:n-3 ratio and additional outcome measures may provide improved understanding of the potential relevance of these fatty acids in OA. On the basis of recommended and typical ranges of the n-6:n-3 ratio, we hypothesized that in adults with knee pain, those with a high n-6:n-3 ratio would have greater pain/functional limitations, experimental pain sensitivity, and psychosocial distress compared with those with a low n-6:n-3 ratio.

Materials and Methods:
A cross-sectional investigation of clinical and experimental pain and physical and psychosocial functioning was completed in 167 adults ages 45 to 85 meeting knee OA screening criteria. Blood samples were collected and the plasma n-6:n-3 PUFA ratio determined. Quartile splits were computed and low (n=42) and high (n=41) ratio groups were compared.

Results:
The high ratio group reported greater pain and functional limitations, (all Ps<0.04), mechanical temporal summation (hand and knee, P<0.05), and perceived stress (P=0.008) but not depressive symptoms.

Discussion:
In adults with knee pain, a high n-6:n-3 ratio is associated with greater clinical pain/functional limitations, experimental pain sensitivity, and psychosocial distress compared with a low ratio group. Findings support consideration of the n-6:n-3 PUFA ratio and additional clinical endpoints in future research efforts.
Continuous Femoral Nerve Catheters Decrease Opioid-Related Side Effects and Increase Home Disposition Rates Among Geriatric Hip Fracture Patients
Authors: Arsoy Diren , Gardner Michael J. , Amanatullah Derek F. , Huddleston James I. , Goodman Stuart B. , Maloney William J. , Bishop Julius A. 
Published: May 2017

Objective:
To evaluate the effect of continuous femoral nerve catheter (CFNC) for postoperative pain control in geriatric proximal femur fractures compared with standard analgesia (SA) treatment.

Design:
Retrospective comparative study.

Setting:
Academic Level 1 trauma center.

Patients/Participants:
We retrospectively identified 265 consecutive geriatric hip fracture patients who underwent surgical treatment.

Intervention:
One hundred forty-nine patients were treated with standard analgesia without nerve catheter whereas 116 patients received an indwelling CFNC.

Main Outcome Measurement:
Daily average preoperative and postoperative pain scores, daily morphine equivalent consumption, opioid-related side effects and discharge disposition.

Results:
Patients with CFNC patients reported lower average pain scores preoperatively (1.9 ± 1.7 for CFNC vs. 4.7 ± 2 for SA; P < 0.0001), on postoperative day 1 (1.5 ± 1.6 for CFNC vs. 3 ± 1.7 for SA; P < 0.0001) and postoperative day 2 (1.2 ± 1.5 for CFNC vs. 2.6 ± 2.1 for SA; P < 0.0001). CFNC group consumed 39% less morphine equivalents on postoperative day 1 (4.4 ± 5.8 mg for CFNC vs. 7.2 ± 10.8 mg for SA; P = 0.005) and 50% less morphine equivalent on postoperative day 2 (3.4 ± 4.4 mg for CFNC vs. 6.8 ± 13 mg for SA; P = 0.105). Patients with CFNC had a lower rate of opioid-related side effects compared with patients with SA (27.5% for CFNC vs. 47% for SA; P = 0.001). More patients with CFNC were discharged to home with or without health services than patients with SA (15% for CFNC vs. 6% for SA; P = 0.023).

Conclusion:
Continuous femoral nerve catheter decreased daily average patient-reported pain scores, narcotic consumption while decreasing the rate of opioid-related side effects. Patients with CFNC were discharged to home more frequently.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Immediate Regrafting of the Split Thickness Skin Graft Donor Site Assists Healing
Authors: Bradow Brian P. , Hallock Geoffrey G. , Wilcock Samuel P. 
Published: May 2017

Background:
Delayed or even lack of healing of a split-thickness skin graft (STSG) donor site is a potential problem with elderly patients or those with poor wound healing capabilities. A proactive solution that may minimize this risk is to regraft that donor site using otherwise discarded skin graft remnants.

Methods:
A prospective, nonrandomized, consecutive study was designed to compare the time to healing of the commonly used anterior thigh STSG donor site in patients who had routine dressings (n = 113) versus those with comorbidities known to adversely affect wound healing and had planned regrafting (n = 204). Those comorbidities included age (≥65 years), diabetes mellitus, peripheral vascular disease, chronic renal disease, and chronic steroid use.

Results:
The average number of comorbidities in the regrafted subgroup versus those not regrafted was 1.41 and 0.31, respectively. This was considered to be a significant difference (P < 0.0001) confirming the validity in predicting patients at risk for adverse donor-site healing that would benefit by regrafting. The mean time required for donor-site reepithelialization of those regrafted was 17.2 days compared with 17.8 days for those not regrafted (P = 0.2395), which was not significantly different.

Conclusions:
Regrafting the STSG donor site of patients with known comorbidities, that is, those expected to have delayed healing in general, had a mean time to reepithelialization comparable with conventionally treated individuals. This was considered a direct consequence of recycling rather than discarding any excess skin graft materials when so indicated and can be a proactive solution to a potentially cumbersome dilemma.
An Unusual Etiology of Chest Pain in a Patient With a History of Left-Sided Congenital Diaphragmatic Hernia
Authors: Paton Elizabeth A. , Long Leslie J. , Eubanks James W. 
Published: May 2017

Abstract
Congenital diaphragmatic hernia (CDH) is a discontinuity of the diaphragm in which abdominal viscera herniates into the chest (Hedrick & Adzick, 2016). A 16-year-old female patient with a past medical history of a left-sided CDH presented with severe pain to her left upper quadrant and chest. An initial diagnosis was made of a recurrent CDH and subsequent herniation of the left kidney into the thoracic space. Intraoperatively, her previous diaphragmatic repair was found to be intact, but a sharp bony protrusion, determined to be an exostosis of the posterior lateral aspect of one of her ribs, was noted. Rongeurs of this lesion resulted in resolution of this patient's symptoms.
Retrospective population-based study of emergency medical services-attended out-of-hospital cardiac arrests in children in Belgium
Authors: Vandeplassche Sophie , van de Voorde Patrick 
Published: May 2017

Objective
This study presents an analysis of clinical data of the circumstances and outcome of paediatric (0–16 years) out-of-hospital cardiac arrests (p-OHCA) in Belgium.

Methods
This was a retrospective study of a prospective population-based registration of physician-attended [mobile emergency group (MUG)] emergency medical services (EMS) interventions of p-OHCA in Belgium between 2010 and 2012.

Results
We identified 365 OHCA in 18 295 paediatric MUG interventions (2%). Cardiopulmonary resuscitation was performed in 260 (71.2%) cases. In 59.2%, a medical problem was presumed to be underlying. In 106 (40.7%) cases, an ‘external’ cause (e.g. trauma) was the reason for the OHCA. Eventually, 133 children were transported to the emergency department, with return-of-spontaneous-circulation (ROSC) in 42 cases. In the group with initial shockable rhythm (n=13), sustained ROSC was obtained in 69.2%. For those with an initial nonshockable rhythm, the prognosis was much more reserved (13.4% sustained ROSC). This number is in contrast to the high number of children who are transported from scene (51.2%). Importantly, 40.6% of the latter were proclaimed ‘dead’ during transport.

Conclusion
p-OHCA remains rare. Typically, Belgian MUGs each encounter less than two p-OHCA yearly, thus inducing a risk of being insufficiently prepared. Compared with other countries, cardiopulmonary resuscitation was not started in more cases. Even so, in many other cases, children were transported from scene to be proclaimed ‘dead’ very soon after, pointing to a practice of ‘slow code’. This study provides ‘real-life’ data on p-OHCA in Belgium. As it is based on an administrative registry, it lacks information on individual cases. Large population-based registries are needed to further guide our decision making.
Assessing Self-concept as a Mediator Between Anger and Resilience in Adolescents With Cancer in Taiwan
Authors: Wu Wei-Wen , Chang Joanne T. , Tsai Shao-Yu , Liang Shu-Yuan 
Published: May 2017

Background:
Anger is considered a common method used by patients to relieve emotional frustrations. However, this emotional response is not a common research focus for adolescents with cancer.

Objective:
The aim of this study was to determine whether self-concept mediated the relationship between anger and resilience for adolescent patients currently being treated for cancer.

Methods:
A cross-sectional study of 40 adolescents with cancer was conducted. The instruments included the Chinese Beck Self-Concept Inventory, the Chinese Beck Anger Inventory, and the Chinese Resilience Scale. Mediation analysis was also conducted.

Results:
The results indicate that (1) variations in anger significantly account for 6.86% of observed variations in self-concept, (2) variations in self-concept significantly account for 52.83% of observed variations in resilience, (3) variations in anger significantly account for 10.96% of observed variations in resilience, and (4) when paths in conditions 1 and 2 were controlled, variations in anger through self-concept significantly account for 54.04% of observed variations in resilience, and variations in anger did not significantly account for observed variations in resilience.

Conclusions:
Gender and age might affect anger control. Despite worse physical functioning and an impacted appearance, participants had normative-to-positive self-concept levels, suggesting that their self-concept might not be affected by cancer. Self-concept might play a mediating role between anger and resilience, thus helping to bridge this knowledge gap.

Implications for Practice:
The current gap in knowledge regarding the mediating relationship necessitates the implementation of a large-scale study designed to verify the mediating role of self-concept between anger and resilience.
Virtual Monoenergetic Imaging and Iodine Perfusion Maps Improve Diagnostic Accuracy of Dual-Energy Computed Tomography Pulmonary Angiography With Suboptimal Contrast Attenuation
Authors: Leithner Doris , Wichmann Julian L. , Vogl Thomas J. , Trommer Jesko , Martin Simon S. , Scholtz Jan-Erik , Bodelle Boris , De Cecco Carlo N. , Duguay Taylor , Nance John W. , Schoepf U. Joseph , Albrecht Moritz H. 
Published: May 2017

Objectives
The aim of this study was to investigate the impact of virtual monoenergetic imaging (VMI+) and dual-energy computed tomography perfusion maps (DECT-PMs) on reader confidence and diagnostic accuracy in dual-energy computed tomography pulmonary angiography (DE-CTPA) studies with suboptimal contrast attenuation, compared with standard linearly blended reconstruction series.

Materials and Methods
Dual-energy computed tomography pulmonary angiography examinations with suboptimal contrast attenuation of 68 patients with suspected pulmonary embolism (PE) were included in this institutional review board–approved retrospective study. Virtual monoenergetic imaging series at 40 keV, DECT-PM, and linearly blended images (M_0.6, 60% 90-kV spectrum) were reconstructed. Contrast-to-noise ratio and signal-to-noise ratio within the pulmonary trunk were calculated. Four independent radiologists assessed the presence of PE and their diagnostic confidence using 3 DE-CTPA reconstruction protocols: protocol 1, M_0.6 images; protocol 2, M_0.6 series and DECT-PM; and protocol 3, M_0.6, DECT-PM, and VMI+ series. Receiver operating characteristic (ROC) analysis was performed.

Results
Fourteen patients showed central and 29 segmental PE. Greater contrast-to-noise ratio and signal-to-noise ratio values were measured in VMI+ series at 40 keV in comparison to M_0.6 images (P < 0.001). Diagnostic accuracy for segmental PE detection was as follows: protocol 1 (69.1%); protocol 2 (86.8%); and protocol 3 (92.6%). Protocol 3 resulted in a significantly greater area under the curve for diagnosing segmental PE (0.991, P ≤ 0.033), compared with protocol 1 and 2 (0.897 and 0.951, respectively), and provided the highest diagnostic confidence (P < 0.001).

Conclusions
A reconstruction protocol including 40-keV VMI+ series and DECT-PM improves reader confidence and diagnostic accuracy for segmental PE detection compared with standard M_0.6 images in DE-CTPA with suboptimal contrast attenuation.
A Dimensional Approach to Assessing Psychiatric Risk in Adults Born Very Preterm
Authors: Kroll Jasmin , Froudist-Walsh Sean , Brittain Philip J. , Tseng Chieh-En Jane , Karolis Vyacheslav , Murray Robin M , Nosarti Chiara 
Published: May 2017

AbstractBackgroundIndividuals who were born very preterm have higher rates of psychiatric diagnoses compared to term-born controls; however, it remains unclear whether they also display increased sub-clinical psychiatric symptomatology. Hence our objective is to utilise a dimensional approach to assess psychiatric symptomatology in adults who were born very preterm.Methods152 adults who were born very preterm (before 33 weeks’ gestation; gestational range 24–32 weeks) and 96 term-born controls. We examined participants’ clinical profile using the Comprehensive Assessment of At-Risk Mental States (CAARMS), a measure of sub-clinical symptomatology that yields seven subscales including general psychopathology, positive, negative, cognitive, behavioural, motor and emotional symptoms, in addition to a total psychopathology score. Intellectual abilities were examined using the Wechsler Abbreviated Scale of Intelligence.ResultsBetween-group differences on the CAARMS showed elevated symptomatology in very preterm participants compared to controls in positive, negative, cognitive and behavioural symptoms. Total psychopathology scores were significantly correlated with IQ in the very preterm group only. In order to examine the characteristics of participants’ clinical profile a principal component analysis was conducted. This revealed two components, one reflecting a non-specific psychopathology dimension, and the other indicating a variance in symptomatology along a positive-to-negative symptom axis. K-means (k=4) were used to further separate the study sample into clusters. Very preterm adults were more likely to belong to the high non-specific psychopathology cluster compared to controls.Conclusion and RelevanceVery preterm individuals demonstrated elevated psychopathology compared to full-term controls. Psychiatric risk was characterised by a non-specific clinical profile and was associated with lower IQ.
Low-level carbon monoxide exposure affects BOLD FMRI
Authors: Bendell Caroline , Moosavi Shakeeb H. , Herigstad Mari 
Published: May 2017

ABSTRACTBlood Oxygen Level Dependent (BOLD) FMRI is a common technique for measuring brain activation that could be affected by low-level carbon monoxide (CO) exposure from e.g. smoking. This study aimed to probe the vulnerability of BOLD FMRI to CO and determine whether it constitutes a significant confound in neuroimaging and clinical trials. Low-level (6ppm exhaled) CO effects on BOLD signal were assessed in 12 healthy never-smokers on two separate experimental days (CO and air control). FMRI tasks were breath-holds (hypercapnia), visual stimulation and fingertapping. CO significantly dampened global BOLD FMRI signal during hypercapnia and visual cortex activation during visual stimulation. During fingertapping, CO reduced visual cortex activation but increased premotor cortex activation. Behavioural and physiological measures remained unchanged. We conclude that BOLD FMRI is vulnerable to CO, possibly through baseline increases in CBF, and suggest exercising caution when imaging populations exposed to elevated CO levels, e.g. with high smoking prevalence.
MitoCore: A curated constraint-based model for simulating human central metabolism
Authors: Smith Anthony C. , Eyassu Filmon , Mazat Jean-Pierre , Robinson Alan J. 
Published: May 2017

AbstractBackgroundThe complexity of metabolic networks can make the origin and impact of profound changes in central metabolism occurring during disease difficult to understand. Computer simulations can help unravel this complexity, and progress has advanced in genome-scale metabolic models. However, many current models produce unrealistic results when challenged to simulate abnormal metabolism as they include incorrect specification and localization of reactions and transport steps, incorrect reaction parameters, and confounding of prosthetic groups and free metabolites in reactions. Other common drawbacks are due to their scale, such as being difficult to parameterise and simulation results being hard to interpret. Therefore, it remains important to develop smaller, manually curated models to represent central metabolism accurately.ResultsWe present MitoCore, a manually curated constraint-based computer model of human metabolism that incorporates the complexity of central metabolism and simulates this metabolism successfully under normal and abnormal conditions, including hypoxia and mitochondrial diseases. MitoCore describes 324 metabolic reactions, 83 transport steps between mitochondrion and cytosol, and 74 metabolite inputs and outputs through the plasma membrane, to produce a model of manageable scale for easy data interpretation. Its key innovations include accurate partitioning of metabolism between cytosol and mitochondrial matrix; correct modelling of connecting transport steps; proper differentiation of prosthetic groups and free co-factors in reactions; and a new representation of the respiratory chain and the proton motive force. MitoCore’s default parameters simulate normal cardiomyocyte metabolism, and to improve usability and allow comparison with other models and types of analysis, its reactions and metabolites have extensive annotation, and cross-reference identifiers from Virtual Metabolic Human database and KEGG. These innovations—including over 100 reactions absent or modified from Recon 2—are essential to model central metabolism accurately.ConclusionWe anticipate MitoCore as a research tool for scientists, from experimentalists looking to interpret data and generate further hypotheses, to experienced modellers predicting the consequences of disease or using computationally intensive methods that are infeasible with larger models, as well as a teaching tool for those new to modelling and needing a small manageable model on which to learn and experiment.