bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deutsche Leitlinie zur Diagnostik und Therapie der zirkumskripten Sklerodermie
Authors: Kreuter Alexander , Krieg Thomas , Worm Margitta , Wenzel Jörg , Moinzadeh Pia , Kuhn Annegret , Aberer Elisabeth , Scharffetter‐Kochanek Karin , Horneff Gerd , Reil Emma , Weberschock Tobias , Hunzelmann Nicolas 
Published: January 2016

ZusammenfassungBei der zirkumskripten Sklerodermie handelt es sich um eine heterogene Gruppe von sklerotischen Erkrankungen der Haut mit je nach Subtyp, Schweregrad und Lokalisation möglicher Beteiligung von hautnahen Strukturen wie Fettgewebe, Muskulatur, Gelenke und Knochen. Dies ist eine Aktualisierung der bereits bestehenden deutschen Leitlinie der AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Wissenschaften) mit dem Klassifizierungsgrad S2k. Die Leitlinie gibt einen Überblick zur Definition, Epidemiologie, Klassifikation, Pathogenese, Labordiagnostik, Histopathologie sowie klinischen Scores und apparativen Diagnostik der zirkumskripten Sklerodermie. Des Weiteren erfolgen konsensbasierte Empfehlungen zum Management der zirkumskripten Sklerodermie in Abhängigkeit vom klinischen Subtyp. Die Behandlungsempfehlungen sind in einem Therapiealgorithmus dargestellt. Eine finanzielle Unterstützung zur Erstellung der Leitlinie durch die pharmazeutische Industrie erfolgte nicht. Die Leitlinie ist bis Juli 2019 gültig.
Keratosis palmoplantaris: klinische und genetische Aspekte
Authors: Has Cristina , Technau‐Hafsi Kristin 
Published: January 2016

ZusammenfassungZu den Palmoplantarkeratosen (PPK) gehören verschiedene erworbene und angeborene Störungen, die durch übermäßige Verdickung der Epidermis an Handflächen und Fußsohlen gekennzeichnet sind. Ein früher Ausbruch und eine positive Familienanamnese weisen auf eine genetische Ursache der PPK hin. Eine angeborene PPK kann das einzige oder das dominante klinische Merkmal darstellen oder sie kann von anderen ektodermalen Dysplasien oder extrakutanen Symptomen begleitet sein. In der letzten Zeit wurden bei der Entschlüsselung der genetischen Grundlagen der PPK deutliche Fortschritte erzielt und neue Störungen und Syndrome sind bekannt geworden. Die Aufklärung der Krankheitsmechanismen öffnet neue Wege für spezifische Therapien und macht dieses Gebiet immer interessanter. Wegen der starken Heterogenität der klinischen Merkmale, genetischen Defekte und Krankheitsmechanismen können PPK auf der Grundlage unterschiedlicher Kriterien klassifiziert werden. Dazu gehören das Ausmaß der Krankheitsmanifestationen, die Morphologie der befallenen palmoplantaren Hautbereiche, das Vererbungsmuster oder die molekulare Pathogenese. Die klinische Differenzierung zwischen den PPK‐Entitäten stützt sich auf subtile Kriterien oder Anzeichen und ist nicht immer möglich. Interessanterweise haben sich scheinbar unterschiedliche Erkrankungen als allelisch erwiesen, werden also durch Mutationen im selben Gen ausgelöst. Andererseits können ähnliche Krankheitsbilder durch Mutationen in verschiedenen Genen verursacht sein. Aufgrund dieser Komplexität muss der genaue Typ der PPK durch Mutationsanalyse bestimmt werden. Die am besten definierten Entitäten werden in diesem Übersichtsartikel beschrieben.
Eignung und Probleme von Serum S100B als Biomarker zur Verlaufskontrolle bei Hochrisiko‐Melanompatienten
Authors: Gebhardt Christoffer , Lichtenberger Ramtin , Utikal Jochen 
Published: January 2016

ZusammenfassungHintergrund und ZieleDie Bestimmung der S100B‐Serumkonzentration ist eine Standardmethode zur Überwachung von Patienten mit fortgeschrittenem malignem Melanom zur Unterscheidung zwischen progressiver und nicht progressiver Krankheit. Falsch‐positive Befunde verursachen unnötiges Leid bei den Patienten und führen zu einem Anstieg kostspieliger Diagnosen. Aus diesem Grund analysierten wir beschriebene Begleitkrankheiten als mögliche Quellen überschüssiger S100B‐Freisetzung.Patientenund MethodenIn einer single‐center‐Studie wurde die Serumkonzentration von S100B in 2.664 Blutproben von 1.113 Melanompatienten (AJCC) in den Stadien IB bis IV gemessen, die während eines Zeitraums von 24 Monaten für Verlaufskontrollen in die Klinik kamen.ErgebnisseInsgesamt fand bei 295 (11 %) der Patienten eine Krankheitsprogression statt. Bei Patienten mit stark ausgeprägten Tumoren waren 30/185 (16 %) Ergebnisse falsch‐negativ und 247/2369 (12 %) falsch‐positiv. 106 falsch‐positive Ergebnisse (69 %), im Vergleich zu 46 richtig‐positiven Ergebnissen (31 %), wurden bei Patienten mit Herz‐Kreislauf‐Krankheiten wie Arrhythmie (50/32) oder vorangegangenen Myokardinfarkten (22/14) gefunden. Auch Adipositas (85/14), Leberzirrhose (31/10), Migräne (18/2), chronisches Nierenversagen (13/2) und Schlaganfall (11/1) wurden mit falsch‐positiven S100B‐Konzentrationen in Verbindung gebracht.SchlussfolgerungenSerum S100B ist als quantitativer Biomarker zur routinemäßigen Nachverfolgung von Hochrisiko‐Melanompatienten geeignet. Während falsch‐negative Ergebnisse häufig bei Patienten mit geringer Tumorlast auftreten, sind falsch‐positive Ergebnisse mit verschiedenen Komorbiditäten assoziiert und bedürfen sorgfältiger Überprüfung.
Independent evolutionary histories in allopatric populations of a threatened Caribbean land mammal
Authors: Turvey Samuel T. , Peters Stuart , Brace Selina , Young Richard P. , Crumpton Nick , Hansford James , Nuñez‐Miño Jose M. , King Gemma , Tsalikidis Katrina , Ottenwalder José A. , Timpson Adrian , Funk Stephan M. , Brocca Jorge L. , Thomas Mark G. , Barnes Ian 
Published: January 2016

AbstractAimTo determine the evolutionary history, relationships and distinctiveness of allopatric populations of Hispaniolan solenodon (Solenodon paradoxus), a highly threatened Caribbean ‘relict’ mammal, to understand spatio‐temporal patterns of gene flow and the distribution of diversity across complex large island landscapes and inform spatial conservation prioritization.LocationHistorical and modern‐day solenodon specimens were analysed from sampling localities across Hispaniola, representing this geotectonically complex island's distinct northern, south‐eastern and south‐western biogeographic provinces.MethodsWe successfully amplified mitochondrial cytochromeband control region sequences from 34 solenodon samples. Bayesian phylogenetic analyses were applied to assess the relationship between these sequence data, and coalescent simulation and approximate Bayesian computation were used to identify which model of solenodon intra‐island demographic history best explains the observed patterns of variation. We also conducted morphometric analysis of 110 solenodon specimens to investigate whether allopatric Hispaniolan populations can be differentiated using craniodental characteristics.ResultsUnique haplotypes were identified in solenodon samples from each biogeographic region, with no haplotype sharing between regions. Higher marginal posterior probability values were found for a three‐population model comprising allopatric northern, south‐eastern and south‐western Hispaniolan populations, with exceptionally low migration rates inferred between all populations, indicating that they are genetically isolated. Modal estimates of long‐term effective female population size are extremely low for south‐western and south‐eastern populations. Morphometric differentiation is observed between all three populations.Main conclusionsEvolutionary differentiation of Hispaniolan solenodons into three distinct populations is congruent with phylogenetic patterns observed in several other Hispaniolan species, with population isolation possibly associated with past marine transgression. We interpret these populations as distinct subspecies, with the two genetically impoverished southern subspecies particularly vulnerable to environmental change. Our improved understanding of Hispaniolan solenodon evolutionary history provides an important baseline for identifying wider patterns of intra‐island diversification and prioritizing conservation attention for evolutionarily significant populations.
Raising the Barriers to Access to Medicines in the Developing World – The Relentless Push for Data Exclusivity
Authors: Diependaele Lisa , Cockbain Julian , Sterckx Sigrid 
Published: January 2016

AbstractSince the adoption of the WTO‐TRIPS Agreement in 1994, there has been significant controversy over the impact of pharmaceutical patent protection on the access to medicines in the developing world. In addition to the market exclusivity provided by patents, the pharmaceutical industry has also sought to further extend their monopolies by advocating the need for additional ‘regulatory’ protection for new medicines, known as data exclusivity.Data exclusivity limits the use of clinical trial data that need to be submitted to the regulatory authorities before a new drug can enter the market. For a specified period, generic competitors cannot apply for regulatory approval for equivalent drugs relying on the originator's data. As a consequence, data exclusivity lengthens the monopoly for the original drug, impairing the availability of generic drugs.This article illustrates how the pharmaceutical industry has convinced the US and the EU to impose data exclusivity on their trade partners, many of them developing countries. The key arguments formulated by the pharmaceutical industry in favor of adopting data exclusivity and their underlying ethical assumptions are described in this article, analyzed, and found to be unconvincing. Contrary to industry's arguments, it is unlikely that data exclusivity will promote innovation, especially in developing countries. Moreover, the industry's appeal to a property rights claim over clinical test data and the idea that data exclusivity can prevent the generic competitors from ‘free‐riding’ encounters some important problems: Neither legitimize excluding all others.
Geometry‐Related Right Ventricular Systolic Function Assessed by Longitudinal and Radial Right Ventricular Contractions
Authors: Hashimoto Ikuo , Watanabe Kazuhiro 
Published: January 2016

The aim of our study was to evaluate the geometry‐related right ventricular (RV) systolic function under normal hemodynamics by assessing the longitudinal and the radial RV contractions in children. We examined 953 healthy children. We measured tricuspid annular plane systolic excursion (TAPSE), RV anterior wall displacement from the interventricular septum (RVWD), and RV to left ventricular diameter ratio (RV/LV ratio) using M‐mode echocardiography. The z‐values were calculated as geometrical parameters of the TAPSE (z‐TAPSE), the RVWD (z‐RVWD), and the RV/LV ratio (z‐RV/LV). The RV stroke volume (RVSV) was measured using Doppler echocardiography and standardized using the z‐value (z‐RVSV). The z‐TAPSE was no or weakly negatively correlated with both the z‐RVWD (r = −0.18, P < 0.0001) and the z‐RV/LV (r = −0.12, P < 0.0001). In contrast, the z‐RV/LV correlated positively with the z‐RVWD (r = 0.61, P < 0.0001). The z‐RVSV correlated only with the z‐TAPSE (r = 0.30, P < 0.0001). Although the radial RV motion increases with the progression of RV dilatation, the RVSV is not associated with radial RV motion. In contrast, the RVSV relates to the longitudinal RV motion independently of the radial RV motion under the normal physiological condition. We presume that the RV contraction patterns change related to the RV geometry under various hemodynamic conditions.
Do fewer males present to clinical high‐risk services for psychosis relative to first‐episode services?
Authors: Wilson Robin P. , Patel Rashmi , Bhattacharyya Sagnik 
Published: January 2016

AbstractAimA decline in the rate of transition to psychosis in patients presenting with clinical high‐risk has been reported in the literature. Several hypotheses have been put forward to explain this decline. In this brief report, we aimed to explore whether the demographic group presenting to clinical high‐risk services differs from the ‘end‐point’ population who present with first‐episode psychosis (FEP), by focusing on gender.MethodGender distribution was compared between clinical high‐risk (CHR) and FEP using data extracted from published study samples and clinical data from corresponding cohorts within the same catchment area in South London.ResultsThe proportion of males was significantly higher in FEP compared to CHR services in the literature describing Europe, Australia and North America and in the clinical cohort from South London.ConclusionMales are under‐represented in existing CHR services in Europe, Australia and North America. This could reflect less willingness in males to seek help if experiencing low‐level psychological distress and may be related to the declining transition.
Biomes and human distribution during the last ice age
Authors: Gavashelishvili Alexander , Tarkhnishvili David 
Published: January 2016

AbstractAimOur research attempts to provide an explicit explanation of human–biome interactions during the last glacial period and how these have influenced current human population genetics at the global scale. Publications to date have not addressed this topic.LocationWorld‐wide.MethodsUsing climate, terrain, hydrographic, fossil pollen and plant‐macrofossil data we developed a model of the distribution of biomes during climate deteriorations of the last glacial period. Subsequently, we analysed current human genetic diversity, the origins of genetic lineages and Palaeolithic human sites in relation to the inferred biomes.ResultsOur analyses indicated that: (1) current human Y‐DNA diversity, the places of origin of human Y‐DNA lineages and the distribution of Palaeolithic human settlements are best explained by distance from savanna and dry woodland during a series of glacial maxima, and (2) during periods of relatively benign climate conditions, humans dispersed through areas of high primary productivity while avoiding dense forest cover.Main conclusionsIn a metapopulation of Palaeolithic humans, the biome of savanna and dry woodland supported source populations and other biomes acted as sinks. Present‐day genetic, phenotypical and linguistic differences are largely related to discontinuity of and impeded migration between human source populations during glacial periods, rather than simply geographical distance, and in the post‐glacial period there has not been enough time for displacements and admixture of human populations to completely blur these differences.
‘Housing First’ and the Changing Terrains of Homeless Governance
Authors: Baker Tom , Evans Joshua 
Published: January 2016

AbstractOver the last fifteen years, programs based on ‘housing first’ models have swept to prominence as solutions to homelessness. Such programs serve a small subset of the overall homeless population, namely the ‘chronically’ homeless, offering direct access to permanent housing with comprehensive and flexible support services attached. Hailed as socially progressive responses to homelessness—based on their opposition to traditional emphases on client passivity, sobriety and moralised deservingness—the popularity of housing first models has often depended on congruence with wider projects of welfare retrenchment and fiscal austerity. Despite the rapid globalisation and high public profile of housing first ideas, they have been largely overlooked in geographical accounts of homeless governance. In response, this article discusses the growing importance and influence of housing first ideas, before looking to contemporary debates on homeless governance for interpretive insights. Informed by these debates, we sketch conceptual areas to which future research on housing first models and programs might attend: first, to their ambivalent politics and, second, to the processes and practices of translation that are central to their implementation and political consequence. Moving beyond questions of operational efficacy, efficiency and fidelity, we call for critical but constructive accounts focused on the constitutive relations between housing first ideas and governance transformations at and across a range of scales and sites.
Health status, geriatric syndromes and prescription of oral anticoagulant therapy in elderly medical inpatients with atrial fibrillation
Authors: Bo Mario , Sciarrillo Irene , Maggiani Guido , Falcone Yolanda , Iacovino Marina , Grisoglio Enrica , Fonte Gianfranco , Grosjean Simon , Gaita Fiorenzo 
Published: January 2016

AimThe aim of the present study was to investigate the prevalence of geriatric syndromes among older medical inpatients with atrial fibrillation, and their association with use of vitamin K antagonists.MethodsA retrospective study of patients aged ≥65 years discharged with a diagnosis of atrial fibrillation from the Acute Geriatric Ward was carried out. Stroke and bleeding risk were evaluated according to the CHA2DS2‐VASC and HAS‐BLED scores. Comorbidity, cognitive status, functional autonomy and contraindications to vitamin K antagonists were also considered.ResultsAtrial fibrillation was documented in 1078 of 3650 patients (29.5%, mean age 83.4 ± 6.6 years, 60.3% women). Contraindications to vitamin K antagonists were documented in 24.9% of patients. Prescription of vitamin K antagonists at discharge was 37.8% and 47.9%, in the overall sample and in those without contraindications, respectively. In the overall sample, prescription of vitamin K antagonists was associated with younger age, permanent/persistent atrial fibrillation, home discharge, less comorbidity, higher hemoglobin levels, better functional independence, known atrial fibrillation at admission and lower HAS‐BLED score. Among patients without contraindications to vitamin K antagonists, their use at discharge was independently associated with younger age, permanent/persistent atrial fibrillation, home discharge, higher hemoglobin levels and CHA2DS2‐VASC score, better functional autonomy, and greater number of drugs.ConclusionsWe showed a high prevalence of atrial fibrillation among older medical inpatients, who have a poor health status and a high prevalence of geriatric syndromes. Vitamin K antagonists were prescribed in less than half of the patients; underuse was mainly accounted for by a high prevalence of comorbidities/contraindications, poor health status and limited functional autonomy. Geriatr Gerontol Int 2017; 17: 416–423.
Evaluating the effectiveness of a self‐management exercise intervention on wound healing, functional ability and health‐related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial
Authors: O'Brien Jane , Finlayson Kathleen , Kerr Graham , Edwards Helen 
Published: January 2016

AbstractExercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence‐based care on the healing rates, functional ability and health‐related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12‐week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health‐related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention‐to‐treat) analysis to highlight the importance of adherence to an exercise intervention. Intention‐to‐treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health‐related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health‐related quality of life), intention‐to‐treat analyses did not support the effectiveness of the intervention. However, per protocol analyses revealed encouraging results with those participants who adhered more than 75% of the time (n = 19) showing significantly improved Range of Ankle Motion from the self‐management exercise programme (P = 0·045). This study has shown that those participants who adhere to the exercise programme as an adjunctive treatment to standard care are more likely to heal and have better functional outcomes than those who do not adhere to the exercises in conjunction with usual care.
Testing a post‐discharge nurse‐led transitional home visit in acute care pediatrics: the Hospital‐To‐Home Outcomes (H2O) study protocol
Authors: Tubbs‐Cooley Heather L. , Pickler Rita H. , Simmons Jeffrey M. , Auger Katherine A. , Beck Andrew F. , Sauers‐Ford Hadley S. , Sucharew Heidi , Solan Lauren G. , White Christine M. , Sherman Susan N. , Statile Angela M. , Shah Samir S. ,   the H2O Study Group
Published: January 2016

AbstractAimsThe aims of this study were: (1) to explore the family perspective on pediatric hospital‐to‐home transitions; (2) to modify an existing nurse‐delivered transitional home visit to better meet family needs; (3) to study the effectiveness of the modified visit for reducing healthcare re‐use and improving patient‐ and family‐centered outcomes in a randomized controlled trial.BackgroundThe transition from impatient hospitalization to outpatient care is a vulnerable time for children and their families; children are at risk for poor outcomes that may be mitigated by interventions to address transition difficulties. It is unknown if an effective adult transition intervention, a nurse home visit, improves postdischarge outcomes for children hospitalized with common conditions.Design(1) Descriptive qualitative; (2) Quality improvement; (3) Randomized controlled trial.MethodsAim 1 will use qualitative methods, through focus groups, to understand the family perspective of hospital‐to‐home transitions. Aim 2 will use quality improvement methods to modify the content and processes associated with nurse home visits. Modifications to visits will be made based on parent and stakeholder input obtained during Aims 1 & 2. The effectiveness of the modified visit will be evaluated in Aim 3 through a randomized controlled trial.DiscussionWe are undertaking the study to modify and evaluate a nurse home visit as an effective acute care pediatric transition intervention. We expect the results will be of interest to administrators, policy makers and clinicians interested in improving pediatric care transitions and associated postdischarge outcomes, in the light of impending bundled payment initiatives in pediatric care.