bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Prevalence of Thrombophilia in Women With Recurrent Fetal Loss and Outcome of Anticoagulation Therapy for the Prevention of Miscarriages
Authors: Nahas Rawan , Saliba Walid , Elias Adi , Elias Mazen 
Published: November 2016

Objective: To estimate the prevalence of thrombophilia in women with recurrent miscarriages and to assess the effect of antithrombotic therapy. Design: A retrospective cohort study between the years 2004 and 2010. Setting: A hypercoagulation community clinic in northern Israel. Patients: Four hundred ninety pregnant women referred for thrombophilia screening. Main Outcome Measures: Screening results for thrombophilia and antithrombotic treatment with enoxaparin, aspirin, or both and pregnancy outcomes. Results: The most common thrombophilia in our study group was factor V Leiden mutation with a prevalence of 20.9% followed by protein S deficiency with a prevalence of 19%. Live birth rate was higher in the group of women who received enoxaparin regardless of whether a specific thrombophilia could be found. This finding was more pronounced in women who had ≥4 miscarriages. Conclusion: The prevalence of thrombophilia was higher in our study group than in the general population. Furthermore, treatment with enoxaparin might improve the rate of live births in women with or without evidence of thrombophilia, especially in women with ≥4 miscarriages.
Adherence with capecitabine: A population-based analysis based on prescription refill data
Authors: Kovacic Laurel , de Haan Neil , de Lemos Mário L , Schaff Kimberly , Walisser Susan 
Published: November 2016

Background Patient adherence is important with the increasing use of oral anticancer drugs. Recent studies reported different capecitabine adherence rates based on self-reporting and microelectronic monitoring of the medication bottle. Patient’s awareness of being monitored may confound these results. Prescription records provide a larger and more objective dataset for adherence investigation. We report the use of computer algorithm and manual review of prescription and medical documentation to determine the rate of capecitabine adherence. Methods Two years of capecitabine prescription records from five ambulatory cancer centres were reviewed. Prescription data were extracted using a custom Java-based software tool to compare the predicted vs. actual dispensing date. The difference between the dates was the primary adherence measure (altered treatment date incident) and estimated using a computer algorithm and by manual review of medical charts. Results Of 4412 refill prescriptions, 45.2% was associated with an altered treatment date incident based on the initial computer algorithm. This was reduced to 29.5% after adjusting for clinic scheduling processes and 10.2% after manual chart review to adjust for valid reasons for delay. The reasons for altered treatment date incident were not identified in 52.2% of prescriptions. Conclusions Adherence rate of capecitabine based on refill data seem to be high and consistent with other findings based on patient self-report. Population analysis of prescription data with custom computer algorithm may identify trends in capecitabine adherence with some efficiency. Manual review would likely be required to verify these results. The accuracy of using altered prescription refill dates as an adherence measure requires further studies.
Multicenter study of environmental contamination with cyclophosphamide, ifosfamide, and methotrexate in 48 Canadian hospitals
Authors: Poupeau Céline , Tanguay Cynthia , Caron Nicolas J , Bussières Jean-François 
Published: November 2016

Context Oncology workers are occupationally exposed to antineoplastic drugs. This exposure can induce adverse health effects. In order to reduce their exposure, contamination on surfaces should be kept as low as possible. Objectives To monitor environmental contamination with cyclophosphamide, ifosfamide, and methotrexate in oncology pharmacy and patient care areas in Canadian hospitals. To describe the impact of some factors that may limit contamination. Methods This is a descriptive study. Twelve standardized sites were sampled in each participating center (six in the pharmacy and six in patient care areas). Samples were analyzed for the presence of cyclophosphamide, ifosfamide, and methotrexate by ultra-performance liquid chromatography tandem mass spectrometry technology. Descriptive statistical analyses were done and results were compared with a Kolmogorov–Smirnov test for independent samples. Results In 2015, 48 hospitals participated in this study (48/202, 24%). Overall, 34% (181/525) of the samples were positive for cyclophosphamide, 8% (41/525) for ifosfamide, and 6% (31/525) for methotrexate. The 75th percentile value of cyclophosphamide surface concentration was 6.9 pg/cm2. For ifosfamide and methotrexate, they were lower than the limit of detection. Centers who prepared more antineoplastic drugs per year and centers who used more cyclophosphamide per year showed significantly higher surface contamination ( p < 0.0001). Over the years, we observed a reduction in surface contamination. Conclusion In comparison with other multicenter studies that were conducted in Canada, the concentration of antineoplastic drugs measured on surfaces is decreasing. Regular environmental monitoring is a good practice in order to maintain contamination as low as reasonably achievable.
Isolated punctuate hippocampal infarction and transient global amnesia are indistinguishable by means of MRI
Authors: Förster A , Al-Zghloul M , Wenz H , Böhme J , Groden C , Neumaier-Probst E 
Published: November 2016

Background Small punctuate lesions in the hippocampus on diffusion-weighted images are a typical finding in transient global amnesia. Consequently, it has been suggested that diffusion-weighted images findings might corroborate the diagnosis of transient global amnesia. However, isolated punctuate hippocampal infarction might be a differential diagnosis of transient global amnesia. Aim Evaluation of isolated punctuate hippocampal infarction frequency and comparison of its clinical presentation and MRI findings to transient global amnesia. Methods From an MRI database, we identified 10 patients with isolated punctuate hippocampal infarction and compared these to 12 patients with transient global amnesia with diffusion-weighted images lesion with regard to clinical symptoms and MRI findings. Results Disorientation and memory deficits were more common in transient global amnesia patients, whereas dysphasia/aphasia and vertigo were more common in hippocampal infarction patients. MRI findings in isolated punctuate hippocampal infarction and transient global amnesia did not differ significantly, neither regarding the affected hemisphere, lesion distribution, size, nor relative ADC values. Conclusions Differentiation of isolated punctuate hippocampal infarction and transient global amnesia based on neuroimaging findings is not possible. Thus, in the case of isolated punctuate hippocampal diffusion-weighted images lesions the final diagnosis of hippocampal infarction or transient global amnesia should be based on the clinical presentation.
Impact of stroke education on middle school students and their parents: A cluster randomized trial
Authors: Marto João Pedro , Borbinha Cláudia , Filipe Rita , Calado Sofia , Viana-Baptista Miguel 
Published: November 2016

Background School students are an attractive target for stroke education due to the potential impact on stroke prevention and recognition. Additionally, these students can drive behavioral changes in their families. Aim To evaluate the impact of stroke education on school students, in terms of students’ and parents’ acquired stroke knowledge. Methods A structured questionnaire on knowledge of stroke was filled out by eighth-grade students and one of their parents in seven public schools. In four of these schools, students attended a stroke lecture; educational flyers and magnetic posters were distributed and parent education was encouraged. Students and parents of the other three schools were included in a control group. Students and parents, of both intervention and control groups, were resubmitted to the initial structured questionnaire within one week of the stroke lecture and three months later. Results We included 764 students and 344 parents, 383 (50.1%) and 210 (61.0%) in the intervention group. Correct test scores for students before, within one week, and three months after the intervention were 54.49% versus 55.03% (p = 0.418), 98.69% versus 60.89% (p < 0.001), and 95.58% versus 75.7% (p < 0.001) in the intervention and control groups, respectively. Correct test scores for parents at the same time points were 68.78% versus 64.47% (p = 0.107), 96.89% versus 71.42% (p < 0.001), and 94.58% versus 76.54% (p < 0.001) in the intervention and control groups, respectively. Conclusions School-based interventions may improve stroke knowledge in middle school students and their parents.
Patient Throughput in a Sports Medicine Clinic With the Implementation of an Athletic Trainer
Authors: Nicolello Timothy S. , Pecha Forrest Q. , Omdal Reed L. , Nilsson Kurt J. , Homaechevarria Alejandro A. 
Published: November 2016

Background: Orthopaedic clinics have acquired a multitude of health professionals to improve clinic efficiency. More recently, athletic trainers (ATs) have been utilized to improve clinical efficiency and patient care because of their extensive background in musculoskeletal injuries and anatomy. Improved clinical efficiency allows for increased patient visits, potentially enhancing patient access and downstream revenue via relative value units (RVUs). Hypothesis: The addition of an AT into a sports medicine physician’s clinic will increase total patient throughput and overall RVU production. Study Design: Retrospective analysis. Level of Evidence: Level 4. Methods: Patients seen by each of the 2 primary care sports medicine physicians at St Luke’s Sports Medicine for a 2-year period were retrospectively evaluated. The initial clinic model included the physician and a medical assistant; during the second year of analysis an AT was added to the clinic staffing model. Two-tailed t tests were used to determine significant differences in patient volume between the 2 periods of data collection. Results: Through the implementation of an AT, patient throughput increased by 0.7 patients per hour over 2 half-day clinics, a 25% increase ( P < 0.01). Physician B patient visits increased by 21%, or 3.8 patients per 6.5-hour clinic day ( P < 0.01). Additionally, RVU production increased by 3.23 per half-day and 4.3 per full day for physicians A and B, respectively. Conclusion: Clinical efficiency was improved with the addition of an AT. Total physician RVUs improved, thereby raising the potential revenue of both the physician and health care institution. Employing ATs in a sports medicine clinic may improve clinical productivity and financial stability, thereby validating the incorporation of ATs into the established clinical model. Clinical Relevance: Limited research exists measuring patient throughput with an AT in a sports medicine clinic. This study investigates patient throughput and the subsequent increase in work-based RVUs.
Scoring System for Identifying Impending Complete Fractures in Incomplete Atypical Femoral Fractures
Authors: Min Byung-Woo , Koo Kyung-Hoi , Park Youn-Soo , Oh Chang-Wug , Lim Seung-Jae , Kim Joon-Woo , Lee Kyung-Jae , Lee Young-Kyun 
Published: November 2016

AbstractContext:Although impending incomplete atypical femoral fractures (AFFs) require prophylactic fixation, there is still a lack of study on predicting complete fracture among the incomplete AFFs.Objective:Our purposes are to develop a scoring system to predict progression into complete fracture and to evaluate its reliability and validity.Design, Setting, and Patients:We reviewed 46 incomplete AFFs in 44 patients who did not undergo prophylactic fixation. A weighted scoring system, including four identified risk factors (the site, severity of pain, status of the contralateral femur, and the extent of radiolucent line), was developed. We evaluated its interobserver reliability by using intraclass correlation coefficiency (ICC) and its accuracy using receiver operator characteristic (ROC) curve. The validity of the scoring system was tested in a different cohort.Intervention:Observational study.Main Outcome Measure:Progression to complete fracture within 6 months.Results:Among 46 incomplete fractures, 13 developed a complete fracture within 6 months. The probability of complete fracture increased abruptly when the score was 8 points or more. The proposed scoring system showed an almost perfect reliability (ICC, 0.997; 95% confidence interval, 0.995 to 0.998) and higher accuracy than any single risk factor in ROC curve. In the different series, the positive predictive value was 100% and the sensitivity was 75%, when cutoff value was 8 points.Conclusion:The progression to complete fracture could be predicted by using our scoring system. Incomplete AFF with scores &lt;8 points can be treated conservatively, whereas lesions with scores ≥8 require prophylactic fixation.
The integrin adhesome network at a glance
Authors: Horton Edward R. , Humphries Jonathan D. , James Jenny , Jones Matthew C. , Askari Janet A. , Humphries Martin J. 
Published: November 2016

ABSTRACT
The adhesion nexus is the site at which integrin receptors bridge intracellular cytoskeletal and extracellular matrix networks. The connection between integrins and the cytoskeleton is mediated by a dynamic integrin adhesion complex (IAC), the components of which transduce chemical and mechanical signals to control a multitude of cellular functions. In this Cell Science at a Glance article and the accompanying poster, we integrate the consensus adhesome, a set of 60 proteins that have been most commonly identified in isolated IAC proteomes, with the literature-curated adhesome, a theoretical network that has been assembled through scholarly analysis of proteins that localise to IACs. The resulting IAC network, which comprises four broad signalling and actin-bridging axes, provides a platform for future studies of the regulation and function of the adhesion nexus in health and disease.
Mechanisms and functions of lysosome positioning
Authors: Pu Jing , Guardia Carlos M. , Keren-Kaplan Tal , Bonifacino Juan S. 
Published: November 2016

ABSTRACT
Lysosomes have been classically considered terminal degradative organelles, but in recent years they have been found to participate in many other cellular processes, including killing of intracellular pathogens, antigen presentation, plasma membrane repair, cell adhesion and migration, tumor invasion and metastasis, apoptotic cell death, metabolic signaling and gene regulation. In addition, lysosome dysfunction has been shown to underlie not only rare lysosome storage disorders but also more common diseases, such as cancer and neurodegeneration. The involvement of lysosomes in most of these processes is now known to depend on the ability of lysosomes to move throughout the cytoplasm. Here, we review recent findings on the mechanisms that mediate the motility and positioning of lysosomes, and the importance of lysosome dynamics for cell physiology and pathology.
Interdicting Structured Combinatorial Optimization Problems with {0, 1}-Objectives
Authors: Chestnut Stephen R. , Zenklusen Rico 
Published: November 2016

Interdiction problems ask about the worst-case impact of a limited change to an underlying optimization problem. They are a natural way to measure the robustness of a system or to identify its weakest spots. Interdiction problems have been studied for a wide variety of classical combinatorial optimization problems. Most interdiction problems are NP-hard, and furthermore, even designing efficient approximation algorithms that allow for estimating the order of magnitude of a worst-case impact has turned out to be very difficult. Not very surprisingly, the few known approximation algorithms are heavily tailored for specific problems. Inspired by previous approaches to network flow interdiction we suggest a general method to obtain pseudoapproximations for many interdiction problems. More precisely, for any α > 0, our algorithm will return either a (1 + α)-approximation or a solution that may overrun the interdiction budget by a factor of at most 1 + 1/α but is also at least as good as the optimal solution that respects the budget. Furthermore, our approach can handle submodular interdiction costs when the underlying problem is to find a maximum weight independent set in a matroid. Additionally, our approach can sometimes be refined by exploiting additional structural properties of the underlying optimization problem to obtain stronger results. We demonstrate this by presenting a polynomial-time approximation scheme for interdicting b-stable sets in bipartite graphs.
Experiences and needs of older people with end stage renal disease: bereaved carers perspective
Authors: Pungchompoo Wanicha , Richardson Alison , Brindle Lucy A 
Published: November 2016

Background: There is a growing population of older patients with End Stage Renal Disease (ESRD) managed without dialysis in Thailand, and services have yet to be developed to specifically respond to the needs of this group. As a consequence this population are likely to have unmet needs with respect to health care and suffer from symptoms that could be better managed. Objective: This qualitative study explored experiences and health care needs during the last year of life among older people with ESRD, managed without dialysis, from the perspective of bereaved carers. Methods: A retrospective post-bereavement approach was adopted to collect qualitative interview data. Purposive sampling was used to select 12 bereaved relatives of older patients with ESRD, managed without dialysis, who had died in the previous 5–10 months. Semi-structured interviews were conducted. Data were digitally recorded, transcribed and analysed through framework analysis. Results: Four main themes were identified: symptom experiences, impacts of being managed without dialysis, symptom management, and health care needs and utilisation of services. Conclusions: Findings confirmed patients' needs were not being met and identified the need to develop approaches to symptom management at home, health education, and psychological and spiritual support at the end of life.
The use of high-dose dual-impregnated antibiotic-laden cement with hemiarthroplasty for the treatment of a fracture of the hip
Authors: Sprowson† A. P. , Jensen C. , Chambers S. , Parsons N. R. , Aradhyula N. M. , Carluke I. , Inman D. , Reed M. R. 
Published: November 2016

Aims A fracture of the hip is the most common serious orthopaedic injury, and surgical site infection (SSI) is one of the most significant complications, resulting in increased mortality, prolonged hospital stay and often the need for further surgery. Our aim was to determine whether high dose dual antibiotic impregnated bone cement decreases the rate of infection. Patients and Methods A quasi-randomised study of 848 patients with an intracapsular fracture of the hip was conducted in one large teaching hospital on two sites. All were treated with a hemiarthroplasty. A total of 448 patients received low dose single-antibiotic impregnated cement (control group) and 400 patients received high dose dual-antibiotic impregnated cement (intervention group). The primary outcome measure was deep SSI at one year after surgery. Results The rate of deep SSI was 3.5% in the control group and 1.1% in the intervention group (p = 0.041; logistic regression adjusting for age and gender). The overall rate of non-infective surgical complications did not differ between the two groups (unadjusted chi-squared test; p > 0.999). Conclusion The use of high dose dual-antibiotic impregnated cement in these patients significantly reduces the rate of SSI compared with standard low dose single antibiotic loaded bone cement. Cite this article: Bone Joint J 2016;98-B:1534–1541.
A quantitative assessment of the functional recovery of flexion of the elbow after nerve transfer in patients with a brachial plexus injury
Authors: Quick T. J. , Singh A. K. , Fox M. , Sinisi M. , MacQuillan A. 
Published: November 2016

Aims Improvements in the evaluation of outcome after nerve transfers are required. The assessment of force using the Medical Research Council (MRC) grades (0 to 5) is not suitable for this purpose. A ceiling effect is encountered within MRC grade 4/5 rendering this tool insensitive. Our aim was to show how the strength of flexion of the elbow could be assessed in patients who have undergone a re-innervation procedure using a continuous measurement scale. Methods A total of 26 patients, 23 men and three women, with a mean age of 37.3 years (16 to 66), at the time of presentation, attended for review from a cohort of 52 patients who had undergone surgery to restore flexion of the elbow after a brachial plexus injury and were included in this retrospective study. The mean follow-up after nerve transfer was 56 months (28 to 101, standard deviation (sd) 20.79). The strength of flexion of the elbow was measured in a standard outpatient environment with a static dynamometer. Results In total, 21 patients (81%) gained MRC grade 4 strength of flexion of the elbow. The mean force of flexion was 7.2 kgf (3 to 15.5, sd 3.3). Conclusion This study establishes that the dynamometer may be used for assessing the strength of flexion of the elbow in the outpatient department after nerve reconstructive surgery. Cite this article: Bone Joint J 2016;98-B:1517–20.
The Exeter Universal cemented femoral stem at 20 to 25 years
Authors: Petheram T. G. , Whitehouse S. L. , Kazi H. A. , Hubble M. J. W. , Timperley A. J. , Wilson M. J. , Howell J. R. 
Published: November 2016

Aims We present a minimum 20-year follow-up study of 382 cemented Exeter Universal total hip arthroplasties (350 patients) operated on at a mean age of 66.3 years (17 to 94). Patients and Methods All patients received the same design of femoral component, regardless of the original diagnosis. Previous surgery had been undertaken for 33 hips (8.6%). During the study period 218 patients with 236 hips (62%) died, 42 hips (11%) were revised and 110 hips (29%) in 96 patients were available for review. The acetabular components were varied and some designs are now obsolete, however they were all cemented. Results With an endpoint of revision for aseptic loosening or lysis, survivorship of the stem at 22.8 years was 99.0% (95% confidence interval (CI) 97.0 to 100). One stem was revised 21 years post-operatively in a patient with Gaucher’s disease and proximal femoral osteolysis. Survivorship with aseptic loosening or lysis of the acetabular component or stem as the endpoint at 22.8 years was 89.3% (95% CI 84.8 to 93.8). With an endpoint of revision for any reason, overall survivorship was 82.9% (95% CI 77.4 to 88.4) at 22.8 years. Radiological review showed excellent preservation of bone stock at 20 to 25 years, and no impending failures of the stem. Conclusion The Exeter femoral stem continues to perform well beyond 20 years. Cite this article: Bone Joint J 2016;98-B:1441–9.