bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biological Markers Predictive of Invasive Recurrence in DCIS
Authors: Nofech-Mozes Sharon , Spayne Jacqueline , Rakovitch Eileen , Kahn Harriette J , Seth Arun , Pignol Jean-Phillippe , Lickley Lavina , Paszat Lawrence , Hanna Wedad 
Published: September 2017

DCIS is a heterogeneous group of non-invasive cancers of the breast characterized by various degrees of differentiation and unpredictable propensity for transformation into invasive carcinoma. We examined the expression and prognostic value of 9 biological markers with a potential role in tumor progression in 133 patients with pure DCIS treated with breast conserving surgery alone, between 1982–2000. Histology was reviewed and immunohistochemical staining was performed. Pearson correlation coefficient was used to determine the associations between markers and histopathological features. Univariate and multivariate analysis examined associations between time to recurrence and clinico-pathologic features and biological markers. Median age at diagnosis was 55 years (25–85). With a median follow up of 8.91 years, 41/133 patients recurred (21 as invasive recurrence). In this cohort 13.5% had low, 43% intermediate and 42% high nuclear grade. Comedo necrosis was found in 65% of cases. Expression of ER (62.4%), PR (55.6%), HER2/neu (31.6%), MIB1 (39.8%), p53 (22.6%), p21 (39.8%), Cyclin D1 (95.5%) calgranulin (20.5%), psoriasin (12%), was found in DCIS. HER2/neu was overexpressed in 45% that recurred as DCIS and 42.9% that recurred as invasive cancer, and only in 26.1% in cases that never recurred. On univariate analysis, HER2/neu overexpression was the only marker associated with an increased risk for any recurrence (p = 0.044). The hazard ratio for recurrence for HER2/neu positive DCIS was 1.927 (confidence interval 1.016–3.653) compared to HER2 negative DCIS. On multivariate analysis, HER2/neu overexpression remained the only independent variable significantly associated with any recurrence (p = 0.014) and with invasive recurrence (p = 0.044). This data suggest that HER2/neu testing may become an important parameter in the management of DCIS and the treatment of cases with positive HER2/neu status could be modified accordingly, similar to the current approach for HER2/neu positive invasive disease.
An exploratory study of Behavioural Specialist experiences of involving service users in the development of their positive behavioural support plans
Authors: Kruger Bethany , Northway Ruth 
Published: September 2017

There is limited research that explores the experiences of how behavioural specialists actively involve people with a learning disability and challenging behaviour in the development of their positive behavioural support (PBS) plan. Accordingly, this exploratory research study aimed to explore this little understood area of practice. Methods: The study included semi-structured interviews comprised of nine Behavioural Specialists in three focus groups across two health boards. A descriptive thematic analysis study. Findings: Three major themes and 11 minor themes were identified illustrating how people with learning disabilities and behaviours that challenge were involved in developing their PBS plan. Significantly, the themes illustrated the complexity of truly involving service users in the process. Conclusion: Inclusion of people with a learning disability and behaviours that challenge in their PBS plan poses significant challenges. Person-centred care struggles to be truly embedded in the PBS model.
Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination
Authors: Blair Gordon W , Appleton Jason P , Law Zhe Kang , Doubal Fergus , Flaherty Katie , Dooley Richard , Shuler Kirsten , Richardson Carla , Hamilton Iona , Shi Yulu , Stringer Michael , Boyd Julia , Thrippleton Michael J , Sprigg Nikola , Bath Philip M , Wardlaw Joanna M 
Published: September 2017

Rationale The pathophysiology of most lacunar stroke, a form of small vessel disease, is thought to differ from large artery atherothrombo- or cardio-embolic stroke. Licensed drugs, isosorbide mononitrate and cilostazol, have promising mechanisms of action to support their testing to prevent stroke recurrence, cognitive impairment, or radiological progression after lacunar stroke. Aim LACI-1 will assess the tolerability, safety, and efficacy, by dose, of isosorbide mononitrate and cilostazol, alone and in combination, in patients with ischemic lacunar stroke. Sample size A sample of 60 provides 80+% power (significance 0.05) to detect a difference of 35% (90% versus 55%) between those reaching target dose on one versus both drugs. Methods and design LACI-1 is a phase IIa partial factorial, dose-escalation, prospective, randomized, open label, blinded endpoint trial. Participants are randomized to isosorbide mononitrate and/or cilostazol for 11 weeks with dose escalation to target as tolerated in two centers (Edinburgh, Nottingham). At three visits, tolerability, safety, blood pressure, pulse wave velocity, and platelet function are assessed, plus magnetic resonance imaging to assess cerebrovascular reactivity in a subgroup. Study outcomes Primary: proportion of patients completing study achieving target maximum dose. Secondary symptoms whilst taking medications; safety (hemorrhage, recurrent vascular events, falls); blood pressure, platelet function, arterial stiffness, and cerebrovascular reactivity. Discussion This study will inform the design of a larger phase III trial of isosorbide mononitrate and cilostazol in lacunar stroke, whilst providing data on the drugs’ effects on vascular and platelet function. Trial registration ISRCTN (ISRCTN12580546) and EudraCT (2015-001953-33).
Decision Support for Diabetes in Scotland: Implementation and Evaluation of a Clinical Decision Support System
Authors: Conway Nicholas , Adamson Karen A. , Cunningham Scott G. , Emslie Smith Alistair , Nyberg Peter , Smith Blair H. , Wales Ann , Wake Deborah J. 
Published: September 2017

Background: Automated clinical decision support systems (CDSS) are associated with improvements in health care delivery to those with long-term conditions, including diabetes. A CDSS was introduced to two Scottish regions (combined diabetes population ~30 000) via a national diabetes electronic health record. This study aims to describe users’ reactions to the CDSS and to quantify impact on clinical processes and outcomes over two improvement cycles: December 2013 to February 2014 and August 2014 to November 2014. Methods: Feedback was sought via patient questionnaires, health care professional (HCP) focus groups, and questionnaires. Multivariable regression was used to analyze HCP SCI-Diabetes usage (with respect to CDSS message presence/absence) and case-control comparison of clinical processes/outcomes. Cases were patients whose HCP received a CDSS messages during the study period. Closely matched controls were selected from regions outside the study, following similar clinical practice (without CDSS). Clinical process measures were screening rates for diabetes-related complications. Clinical outcomes included HbA1c at 1 year. Results: The CDSS had no adverse impact on consultations. HCPs were generally positive toward CDSS and used it within normal clinical workflow. CDSS messages were generated for 5692 cases, matched to 10 667 controls. Following clinic, the probability of patients being appropriately screened for complications more than doubled for most measures. Mean HbA1c improved in cases and controls but more so in cases (–2.3 mmol/mol [–0.2%] versus –1.1 [–0.1%], P = .003). Discussion and Conclusions: The CDSS was well received; associated with improved efficiencies in working practices; and large improvements in guideline adherence. These evidence-based, early interventions can significantly reduce costly and devastating complications.
Utilization of Interspinous Devices Throughout the United States Over a Recent Decade: An Analysis of the Nationwide Inpatient Sample
Authors: Laratta Joseph L. , Reddy Hemant , Lombardi Joseph M. , Shillingford Jamal N. , Saifi Comron , Fischer Charla R. , Lehman Ronald A. , Lenke Lawrence G. 
Published: September 2017

Study Design: Retrospective database study. Objectives: Analysis of economic and demographic data concerning interspinous device (ID) placement throughout the United States to improve value-based care and health care utilization. Methods: The National Inpatient Sample (NIS) database was queried for patients who underwent insertion of an interspinous process spinal stabilization device (ICD-9-CM 84.80) between 2008 and 2014 across 44 states. Demographic and economic data were obtained which included the annual number of surgeries, age, sex, insurance type, location, and frequency of routine discharge. The NIS database represents a 20% sample of discharges from US hospitals, which is weighted to provide national estimates. Results: There was a 73% decrease in ID implanted from 2008 to 2014. The mean cost associated with insertion of the device increased 28% from $13 653 in 2008 to $17 515 in 2014. The mean length of stay (LOS) increased from 1.8 to 2.4 days. Patients aged 45 to 64 years increased from 14.1% to 34.3% while patients aged 65 to 84 years decreased from 74.4% to 60.6%. By region, 34% of ID placement occurred in the South followed by 19.7% that occured in the Northeast. When stratifying by median income for patient zip code, the procedure was performed more in cities designated as higher rather than lower income areas (74.2% and 19.5%, respectively). Conclusions: Throughout the United States, there was a progressive decline in the insertion of interspinous spacers by 73% over the study period. The total costs for the procedure increased by 28% while the aggregate national charges decreased by 55.6% between 2008 and 2014.
Verification of Neonatal Tetanus Surveillance Systems in Katsina State, Nigeria
Authors: Nass Shafique Sani , Danawi Hadi , Cain Loretta , Sharma Monoj 
Published: September 2017

Background: The incidence and mortality rates of neonatal tetanus (NNT) remain underreported in Nigeria. The goal of the study was to compare the NNT prevalence and the mortality rates from the existing surveillance system and active surveillance of health facility records in 7 selected health facilities from 2010 to 2014 in Katsina State, Nigeria. Methods: The study is a retrospective record review using extracted data from NNT records and analyzed using descriptive statistics. Results: The prevalence of NNT and mortality rate were 336 cases and 3.4 deaths per 100 000 population, respectively, whereas the prevalence of NNT and mortality rate reported through the Integrated Disease Surveillance and Response (IDSR) system were 111 cases and 1.0 death per 100 000 population, respectively. Conclusion: The study shows underreporting of NNT in the existing IDSR system. Implications: Active surveillance is a good strategy for verifying underreporting of NNT in the surveillance system. The IDSR system should be strengthened with the capacity to detect events associated with a disease toward global elimination.
Nadler’s fixed point theorem in ν-generalized metric spaces
Authors: Suzuki Tomonari 
Published: September 2017

AbstractWe extend Nadler’s fixed point theorem to ν-generalized metric spaces. Through the proof of the above extension, we understand more deeply the mathematical structure of a ν-generalized metric space. In particular, we study the completeness of the space. We also improve Caristi’s and Subrahmanyam’s fixed point theorems in the space.
The aetiology of the non-ossifying fibroma of the distal femur and its relationship to the surrounding soft tissues
Authors: Goldin A. , Muzykewicz D. A. , Dwek J. , Mubarak S. J. 
Published: September 2017

Purpose We aim to retrospectively evaluate patients with non-ossifying fibroma (NOF) of the distal femur by radiographs, CT and MRI, and to provide a theory describing the reasoning for the distal femur NOF's location and aetiology. Methods Charts of patients with NOFs between 2003 and 2014 were retrospectively reviewed. Inclusion criteria encompassed a diagnosis of NOF of the distal femur by imaging, and histologically, if available. Radiographs, CT and MRI were used to characterise the relationship of the NOF lesions with the surrounding soft tissues. Results The 68 NOFs from 60 patients were included. By radiograph, 41 (60.3%) of the 68 lesions appeared at the medial and 25 (36.7%) at the lateral aspect of the distal femur. In total, 41 lesions had CT scans, showing 22 NOFs (53.7%) attached to the origin of the medial gastrocnemius, 12 (29.3%) to the origin of the lateral gastrocnemius and four (9.8%) at the attachment of the adductor magnus. Of the CT scans, 93% identified the NOF's relationship with an adjoining tendon of the distal femur. Six had MRIs, all of which showed attachment at the medial gastrocnemius. Conclusion The study reveals a relationship between tendinous structures and NOFs. NOFs of the distal femur occur most commonly at the origin of the medial and lateral gastrocnemius. They may originate from the physis/metaphysis but they do not always attach to the physis, as we observe them ‘migrating’ as patients grow. More research is required to understand the exact aetiology of NOFs.
HOW TO WRITE A CONTRACT WITH THE AHP
Authors: Vargas Luis G 
Published: September 2017

In this paper, we show how the Analytic Hierarchy Process could be used to develop a legal contract in the process of a negotiation. We illustrate the process with a well-known case used routinely in negotiation courses to illustrate that the AHP is particularly well suited for this type of applications where most of the dimensions and criteria are intangibles, and the scales used to measure the gains and costs of parties involved in the negotiation do not always exist. https://doi.org/10.13033/ijahp.v9.i2.490
Evaluation of Lipoprotein(a) Electrophoretic and Immunoassay Methods in Discriminating Risk of Calcific Aortic Valve Disease and Incident Coronary Heart Disease: The Multi-Ethnic Study of Atherosclerosis
Authors: Cao Jing , Steffen Brian T , Guan Weihua , Budoff Matthew , Michos Erin D , Kizer Jorge R , Post Wendy S , Tsai Michael Y 
Published: September 2017

AbstractBACKGROUNDA number of lipoprotein(a) [Lp(a)] analytical techniques are available that quantify distinct particle components, yet their clinical efficacy has not been comprehensively evaluated. This study determined whether Lp(a) mass [Lp(a)-M], Lp(a) cholesterol content [Lp(a)-C], and particle concentration [Lp(a)-P] differentially discriminated risk of calcific aortic valve disease (CAVD) or incident coronary heart disease (CHD) among 4679 participants of the Multi-Ethnic Study of Atherosclerosis (MESA).METHODSLp(a)-M, Lp(a)-C, and Lp(a)-P were measured in individuals without clinical evidence of CHD at baseline. Relative risk regression and Cox proportional analysis determined associations between Lp(a) and the presence of CAVD or 12-year risk of CHD, respectively. To control for the relatively high lower limits of quantification for Lp(a)-C and Lp(a)-P assays, the upper 25th and 15th percentiles were selected as analytical cutoff points.RESULTSRegardless of method or analytical cutoff, high Lp(a) concentrations were significantly associated with CAVD and CHD in MESA participants following adjustment for typical cardiovascular risk factors. Stratifying by race/ethnicity rendered most associations nonsignificant after correction for multiple comparisons, but Lp(a) remained associated with CAVD in whites irrespective of method (all P &lt; 0.0001).CONCLUSIONSAssociations of Lp(a)-C, Lp(a)-P, and Lp(a)-M with CAVD or incident CHD were similar in this entire MESA sample using a dichotomized statistical approach. However, the high lower limits of quantification and imprecision of the Lp(a)-C and Lp(a)-P assays limited their usefulness in our analyses and would likely do so in research and clinical settings.
Cardiovascular Biomarkers in Hypertensive Patients with Medical Treatment—Results from the Randomized TEAMSTA Protect I Trial
Authors: Jagodzinski Annika , Neumann Johannes Tobias , Ojeda Francisco , Sörensen Nils Arne , Wild Philipp , Münzel Thomas , Zeller Tanja , Westermann Dirk , Blankenberg Stefan 
Published: September 2017

AbstractBACKGROUNDHigh blood pressure (BP) is associated with an increased rate of cardiovascular events and mortality. Cardiovascular biomarkers are able to predict long-term risk in the general population, particularly in diseased cohorts. We undertook an investigation of the effect of 2 different antihypertensive treatments on cardiovascular biomarkers in a randomized trial.METHODSThe TEAMSTA study included 481 hypertensive patients. They were randomized to either 80-mg telmisartan + 5-mg amlodipine (TA) or 40-mg olmesartan + 12.5-mg hydrochlorothiazide (OH). The trial was performed as a prospective, randomized, double-blinded, controlled, single-center study. We measured BP, high-sensitivity cardiac troponin I (hs-cTnI), high-sensitivity cardiac troponin T (hs-cTnT), B-type natriuretic peptide (BNP), and N-terminal-pro-BNP (NT-proBNP) before randomization and after 6 months.RESULTSIndividuals were randomized into 2 groups: 230 individuals to the OH-group and 251 to the TA-group. After 6 months of treatment, a reduction in BP (systolic/diastolic) was seen, from 135.2/85.2 mmHg to 122.5/75.7 mmHg with similar effects in both groups. hs-cTnT concentrations were measureable in 26.2% of the study population, while hs-cTnI was detected in 98.3%. hs-cTnI concentrations were significantly reduced from 4.6 to 4.2 ng/L in the overall population, from 4.7 to 4.4 ng/L in the OH-group, and from 4.6 to 4.0 ng/L in the TA-group (all P &lt; 0.001). No significant changes of hs-cTnT were observed. BNP and NT-proBNP concentrations decreased from 15.0 to 12.4 ng/L (P &lt; 0.001) and from 64.8 to 53.3 ng/L (P &lt; 0.001), respectively, after 6 months.CONCLUSIONSThe reduction in BP was associated with a decrease of high-sensitivity troponin I, BNP, and NT-proBNP concentrations, which might represent a cardiovascular risk reduction.CLINICAL TRIAL REGISTRATIONEudraCT 2009-017010-68
Balance Evaluation of Prefrail and Frail Community-Dwelling Older Adults
Authors: Marques Larissa Tomasauskas , Rodrigues Natalia Camargo , Angeluni Emanuella Oliveira , dos Santos Pessanha Fernanda Pinheiro Amador , da Cruz Alves Natália Maira , Freire Júnior Renato Campos , Ferriolli Eduardo , de Abreu Daniela Cristina Carvalho 
Published: September 2017

Background and Purpose:
With the increase in the percentage of the population in older adulthood, issues such as frailty syndrome need to be considered. The aim of the present study was to evaluate the ability of the Balance Evaluation Systems Test (BESTest) and center of pressure (COP) in their ability to discriminate between nonfrail, prefrail, and frail older adults. The proposed hypothesis is that frail older adults would show poorer performance in BESTest tasks and higher oscillation of COP on a force platform.

Methods:
Sixty older adults 65 years or older were divided into 3 groups of 20: group 1, nonfrail; group 2, prefrail; and group 3, frail. The prefrail and frail identifications were made by Fried's 5 frailty phenotype criteria. Balance was assessed using the BESTest and a force platform in 6 positions: (1) fixed platform with eyes open; (2) fixed platform with eyes closed; (3) unstable platform with foam, with eyes open; (4) unstable platform, with eyes closed; (5) semitandem with eyes open; and (6) semitandem with eyes closed.

Results:
Frail older adults had lower scores in all sections and in the total score of the BESTest, indicating worse performance in the tasks. However, on the force platform, the frail older adults did not show higher oscillations, having similar mean values when compared with the prefrail and nonfrail older adults, indicating similar behavior of COP.

Conclusion:
The BESTest seems to be more appropriate than a force plate for assessing postural control impairment and discriminating balance performance among frail, prefrail, and nonfrail older adults, providing information about different components of postural control rather than the force plate, which evaluates sensory orientation.
Sodium Dynamics in Pyramidal Neuron Dendritic Spines: Synaptically Evoked Entry Predominantly through AMPA Receptors and Removal by Diffusion
Authors: Miyazaki Kenichi , Ross William N. 
Published: September 2017

Dendritic spines are key elements underlying synaptic integration and cellular plasticity, but many features of these important structures are not known or are controversial. We examined these properties using newly developed simultaneous sodium and calcium imaging with single-spine resolution in pyramidal neurons in rat hippocampal slices from either sex. Indicators for both ions were loaded through the somatic patch pipette, which also recorded electrical responses. Fluorescence changes were detected with a high-speed, low-noise CCD camera. Following subthreshold electrical stimulation, postsynaptic sodium entry is almost entirely through AMPA receptors with little contribution from entry through NMDA receptors or voltage-gated sodium channels. Sodium removal from the spine head is through rapid diffusion out to the dendrite through the spine neck with a half-removal time of ∼16 ms, which suggests the neck has low resistance. Peak [Na+]ichanges during single EPSPs are ∼5 mm. Stronger electrical stimulation evoked small plateau potentials that had significant longer-lasting localized [Na+]iincreases mediated through NMDA receptors.SIGNIFICANCE STATEMENTDendritic spines, small structures that are difficult to investigate, are important elements in the fundamental processes of synaptic integration and plasticity. The main tool for examining these structures has been calcium imaging. However, the kinds of information that calcium imaging reveals is limited. We used newly developed, high-speed, simultaneous sodium and calcium imaging to examine ion dynamics in spines in hippocampal pyramidal neurons. We found that following single subthreshold synaptic activation most sodium entry was through AMPA receptors and not through NMDA receptors or through voltage-gated sodium channels and that the spine neck is not a significant resistance barrier. Most spine mechanisms are linear. However, regenerative NMDA conductances can be activated with stronger stimulation.
Ingesta de productos naturales o macrobióticos: una llamada de atención a la salud pública
Authors: Hernandez Rivera Patricia 
Published: September 2017

Este trabajo aborda la importancia de prevenir el uso indiscriminado de productos naturales o macrobióticos, sus posibles efectos perjudiciales en la salud, así concienciar a profesionales en el área de la salud sobre la importancia de incluir este tema durante la historia médica. Se analiza el incremento en el uso de productos naturales o macrobióticos, las ventajas de la etnomedicina como un resurgimiento de la industria farmacéutica y las desventajas que acarrea este tipo de productos. Las hierbas ofrecen una alternativa terapéutica como la creación de nuevos fármacos, aunque poseen efectos secundarios que podrían arriesgar la salud de los pacientes.