bluuebunny/crossref_metadata_2025_split huggingface dataset:
The influence of physique on dose conversion coefficients for idealised external photon exposures: a comparison of doses for Chinese male phantoms with 10th, 50th and 90th percentile anthropometric parameters
Authors: Lv Wei , He Hengda , Liu Qian 
Published: March 2017

Abstract
For evaluating radiation risk, the construction of anthropomorphic computational phantoms with a variety of physiques can help reduce the uncertainty that is due to anatomical variation. In our previous work, three deformable Chinese reference male phantoms with 10th, 50th and 90th percentile body mass indexes and body circumference physiques (DCRM-10, DCRM-50 and DCRM-90) were constructed to represent underweight, normal weight and overweight Chinese adult males, respectively. In the present study, the phantoms were updated by correcting the fat percentage to improve the precision of radiological dosimetry evaluations. The organ dose conversion coefficients for each phantom were calculated and compared for four idealized external photon exposures from 15 keV to 10 MeV, using the Monte Carlo method. The dosimetric results for the three deformable Chinese reference male phantom (DCRM) phantoms indicated that variations in physique can cause as much as a 20% difference in the organ dose conversion coefficients. When the photon energy was &lt;50 keV, the discrepancy was greater. The irradiation geometry and organ position can also affect the difference in radiological dosimetry between individuals with different physiques. Hence, it is difficult to predict the conversion coefficients of the phantoms from the anthropometric parameters alone. Nevertheless, the complex organ conversion coefficients presented in this report will be helpful for evaluating the radiation risk for large groups of people with various physiques.
PARP inhibitors as precision medicine for cancer treatment
Authors: Du Yi , Yamaguchi Hirohito , Hsu Jennifer L. , Hung Mien-Chie 
Published: March 2017

AbstractPersonalized or precision medicine is an emerging treatment approach tailored to individuals or certain groups of patients based on their unique characteristics. These types of therapies guided by biomarkers tend to be more effective than traditional approaches, especially in cancer. The inhibitor against poly (ADP-ribose) polymerase (PARP), olaparib (Lynparza, AstraZeneca), which was approved by the US Food and Drug Administration (FDA) in 2014, demonstrated efficacy specifically for ovarian cancer patients harboring mutations in BRCA genes, which encode proteins in DNA double-strand break repairs. However, the response to PARP inhibitors has been less encouraging in other cancer types that also carry defects in the BRCA genes. Thus, furthering our understanding of the underlying mechanism of PARP inhibitors and resistance is critical to improve their efficacy. In this review, we summarize the results of preclinical studies and the clinical application of PARP inhibitors, and discuss the future direction of PARP inhibitors as a potential marker-guided personalized medicine for cancer treatment.
The gravitational-wave physics
Authors: Cai Rong-Gen , Cao Zhoujian , Guo Zong-Kuan , Wang Shao-Jiang , Yang Tao 
Published: March 2017

Abstract
The direct detection of gravitational wave by Laser Interferometer Gravitational-Wave Observatory indicates the coming of the era of gravitational-wave astronomy and gravitational-wave cosmology. It is expected that more and more gravitational-wave events will be detected by currently existing and planned gravitational-wave detectors. The gravitational waves open a new window to explore the Universe and various mysteries will be disclosed through the gravitational-wave detection, combined with other cosmological probes. The gravitational-wave physics is not only related to gravitation theory, but also is closely tied to fundamental physics, cosmology and astrophysics. In this review article, three kinds of sources of gravitational waves and relevant physics will be discussed, namely gravitational waves produced during the inflation and preheating phases of the Universe, the gravitational waves produced during the first-order phase transition as the Universe cools down and the gravitational waves from the three phases: inspiral, merger and ringdown of a compact binary system, respectively. We will also discuss the gravitational waves as a standard siren to explore the evolution of the Universe.
Implementation of a Quality Improvement Initiative: Improved Congenital Muscular Torticollis Outcomes in a Large Hospital Setting
Authors: Strenk Mariann L. , Kiger Michelle , Hawke Jesse L. , Mischnick Amy , Quatman-Yates Catherine 
Published: March 2017

Abstract
Background. The American Physical Therapy Association (APTA) published a guideline for congenital muscular torticollis (CMT) in 2013. Our division adopted the guideline as the institutional practice standard and engaged in a quality improvement (QI) initiative to increase the percentage of patients who achieved resolution of CMT within 6 months of evaluation.
Objective. The aims of this report are to describe the QI activities conducted to improve patient outcomes and discuss the results and implications for other institutions and patient populations.
Design. This was a quality improvement study.
Methods. In alignment with the Chronic Care Model and Model of Improvement, an aim and operationally defined key outcome and process measures were established. Interventions were tested using Plan-Do-Study-Act cycles. A CMT registry was established to store and manage data extracted from the electronic record over the course of testing. Statistical process control charts were used to monitor progress over time.
Results. The QI initiative resulted in an increase in the percentage of patients who achieved full resolution of CMT within a 6-month episode of care from 42% to 61% over an 18-month period. Themes that emerged as key drivers of improvement included: (1) timely, optimal access to care, (2) effective audit and clinician feedback, and (3) accurate, timely documentation.
Limitations. The initiative took place at a single institution with a supportive culture and strong QI resources, which may limit direct translation of interventions and findings to other institutions and patient populations.
Conclusions. Improvement science methodologies provided the tools and structure to improve division-wide workflow and increase consistency in the implementation of the APTA CMT guideline. In doing so, significant CMT population outcome improvements were achieved.
Pedicled Vascularized Clavicular Graft for Anterior Cervical Arthrodesis
Authors: Bohl Michael A. , Mooney Michael A. , Catapano Joshua S. , Almefty Kaith K. , Preul Mark C. , Chang Steve W. , Kakarla U. Kumar , Reece Edward M. , Turner Jay D. , Porter Randall W. 
Published: March 2017

Study Design.
Cadaveric feasibility study.

Objective.
To assess the anatomic and technical feasibility of rotating a clavicular segment on a sternocleidomastoid muscle (SCM) pedicle into the ventral cervical spine using a cadaveric model and to provide the first clinical case description of performing this procedure.

Summary of Background Data.
Reconstruction of the anterior cervical spine in patients with a high risk of pseudoarthrosis may require the use of a vascularized bone graft (VBG). A vascularized clavicular graft rotated on an SCM pedicle would afford all the benefits of a VBG without the added morbidity of free-tissue transfer; however, this technique has not been described.

Methods.
A multidisciplinary team hypothesized that it would be anatomically and technically feasible to rotate a pedicled clavicular bone graft from the bottom of C2 to the top of T2 via an anterior approach. Five cadavers underwent bilateral anterior neck dissections for a total of 10 clavicular graft assessments. A case report describes the use of a clavicular VBG in a patient with a 3-level corpectomy defect and a history of failed fusion.

Results.
Ten clavicles were rotated on an SCM pedicle. The grafts were either harvested as an entire segment or as the superior two-thirds of clavicle, leaving the inferior one-third in situ with pectoralis attachments intact. All grafts reached from the bottom of C2 to the top of T2. When the entire length of exposed clavicle was mobilized, it could cover five to six levels. The case report highlights technical challenges of this procedure in a living patient and provides the clinical context for its potential utility in the reconstruction of the ventral cervical spine.

Conclusion.
This surgical technique is best suited for patients with long-segment cervical defects and an increased risk of pseudarthrosis. Further clinical experience with this technique is required before definitive conclusions can be made.

Level of Evidence: 5
Depletion of Epidermal Langerhans Cells in the Skin Lesions of Pellagra Patients
Authors: Yamaguchi Sayaka , Miyagi Takuya , Sogabe Yoko , Yasuda Masahito , Kanazawa Nobuo , Utani Atsushi , Izaki Seiichi , Uezato Hiroshi , Takahashi Kenzo 
Published: March 2017

Abstract:
Pellagra is a nutrient deficiency disease caused by insufficient niacin levels. Recent studies have shown that numbers of epidermal Langerhans cells decreased in other diseases caused by nutritional deficiencies, including necrolytic migratory erythema and acrodermatitis enteropathica. Epidermal Langerhans cells are capable of modulating or even halting the inflammatory reaction. The aim of this study was to examine changes in the number of Langerhans cells and other dendritic cells, and maturation of epidermal Langerhans cells in the lesional and adjacent non-lesional skin in pellagra patients. Seven pellagra patients and 10 healthy individuals who served as controls were included. The number and distribution of dendritic cells and other cutaneous cells were examined by immunohistochemistry. Epidermal Langerhans cells decreased considerably in the skin lesions of pellagra patients, whereas other dendritic cells did not change. The decrease in the number of Langerhans cells was positively correlated with the histological severity of skin lesions. As the number of Langerhans cells was not reduced in the undisturbed neighboring skin, the depletion of epidermal Langerhans cells did not precede skin damage but was a cause of prolonged severe inflammation.
Pulsed CO2 Laser Ablation of Superficial Basal Cell of Limbs and Trunk: A Comparative Randomized Clinical Trial With Cryotherapy and Surgical Ablation
Authors: Zane Cristina , Facchinetti Elena , Arisi Mariachiara , Ortel Bernhard , Calzavara-Pinton Piergiacomo 
Published: March 2017

BACKGROUND
Pulsed CO2 laser is a treatment of superficial basal cell carcinoma (sBCC) although robust clinical evidence has not been reported so far.

OBJECTIVE
The authors investigated efficacy, safety, time to wound healing, cosmetic outcome, patient satisfaction, and cost-effectiveness ratio of pulsed CO2 laser in comparison to cryotherapy and surgery.

MATERIALS AND METHODS
BCCs of the trunk and extremities were randomized to one of the treatments. After 90 days, efficacy and cosmetic outcome were assessed. Patients recorded the time to complete healing of the wound and scored their overall satisfaction.

RESULTS
Two hundred forty patients were randomized. After 3 months, complete remission (CR) rate with pulsed CO2 laser was 78.8%. This was significantly lower than surgery, whereas the CR rate with cryotherapy was not significantly different. Cosmetic result was better with surgery. High satisfaction was reported by 65.0% of patients treated with CO2 ablation. Time of wound healing was significantly shorter with CO2 laser.

CONCLUSION
In comparison to cryotherapy, pulsed CO2 laser showed no statistically significant difference in efficacy, cosmetic outcome, and patient satisfaction. Time to healing was shorter; the cost and cost-effectiveness ratio were similar. Surgery had the greatest efficacy rate. The main limitation of this study was the short duration of follow-up (3 months).
ASSESSMENT OF DRUSEN AND OTHER RETINAL DEGENERATIVE CHANGES IN PATIENTS WITH HEREDITARY HEMOCHROMATOSIS
Authors: Menghini Moreno , Prünte Christian , Krayenbuehl Pierre A. , Nowak Albina 
Published: March 2017

Purpose:
Iron can exert oxidative damage, and increased accumulation is believed to play a role in age-related macular degeneration. Hereditary hemochromatosis leads to an increase in total body iron. Patients with HH were assessed for drusen and other retinal changes.

Methods:
Descriptive uncontrolled study of spectral-domain optical coherence tomography, short-wavelength autofluorescence, and color fundus images from patients with HH were used. Diagnosis of HH was established by measuring ferritin and transferrin saturation, and confirmed by genetic testing. Classification of the patients according to initial ferritin level was: Group A >1,032 μg/L; Group B below.

Results:
Twenty-five percent of the invited participants were enrolled. Mean age at diagnosis was 46 ± 15 years in Group A, and 38 ± 13 years in Group B, P = 0.07, whereas mean age at imaging was 60 ± 13 years in Group A, and 48 ± 15 years in Group B (P = 0.003). The median of the initial ferritin level was 1,869 (1,262–3,256) ng/mL in Group A, and 534 (439–679) ng/mL in Group B. No subject in either group revealed multiple drusen, unambiguous changes of the retinal pigment epithelium, or increased lipofuscin in any of the images.

Conclusion:
The study results did not show an increased prevalence of drusen or other retinal degenerative changes in patients with HH. Thus, it was concluded that increased intestinal iron absorption as well as increased blood iron concentration are not risk factors for the early development of retinal degenerative changes in this study population.
PPI Trial for Eosinophilic Esophagitis
Authors: Lipka Seth , Kumar Ambuj , Richter Joel E. 
Published: March 2017

Introduction:
Despite consensus eosinophilic esophagitis (EoE) statement published in 2011 calling for a 2-month trial of protons pump inhibitor (PPI), the guidelines are not followed by many. We studied the practice patterns in our community and response to a PPI retrial in patients previously diagnosed with “idiopathic EoE.”

Methods:
All patients presenting to the senior author’s practice with suspected EoE from 2011 to 2015. Two cohorts were studied: (1) patients diagnosed in the community as “idiopathic EoE”; (2) treatment naïve patients given a PPI trial at University of South Florida. PPI responsive eosinophilia was defined after 2 months of high dose PPIs after initial diagnosis of mucosal eosinophilia and histologic response of <15 eosinophils per HPF. SPSS v19.0 was used to calculate mean difference and odds ratios (OR) and 95% confidence intervals.

Results:
In total, 78 patients met inclusion criteria, 46 patients had outside diagnosis of “idiopathic EoE,” and 41 patients received a PPI trial at University of South Florida. In total, 34/46 (73.9%) community patients were placed on a PPI, 3/46 (6.5%) were placed on elimination diets, 31/46 (67.4%) steroids, and 21/46 (45.7%) were treated with both steroids/PPIs. Fewer patients received PPI trials in the community 3/46 (6.5%) versus 26/34 (76.5%) at our center [OR, 46.6 (95% CI, 11.3-191.5); P<0.0001]. In total, 12/26 (46.2%) were PPI responders on our retrial despite previously being diagnosed with idiopathic EoE. The group initially diagnosed at our center had a higher PPI response rate 12/15 (80%) versus 12/26 (46.2%) in the community group [OR, 7.58 (1.42, 40.55; P=0.018)].

Conclusions:
The importance of a PPI trial is misunderstood and may be confused with the more traditional PPI trial for gastroesophageal reflux disease. This algorithm is critical and should be done before empiric steroids/diet therapies.
Medical Student Documentation in the Emergency Department in the Electronic Health Record Era—A National Survey
Authors: Virden Ryan A. , Sonnett F. Meridith , Khan Abu N.G.A. 
Published: March 2017

Objectives
Implementation of electronic health record (EHR) has generated a new challenge in the practice of medical student documentation in the emergency department (ED). This study discerns both the current practices and consensus opinions of pediatric ED directors and Association of American Medical Colleges (AAMC) student representatives regarding best practices for documentation by medical students in the ED EHR nationwide.

Methods
The authors conducted a cross-sectional Web-based survey of the directors of academic pediatric EDs and AAMC student representatives using Qualtric survey engine. The survey asked participants to describe their current practices and their opinion regarding the utility of and best practices for medical student documentation in the ED.

Results
Approximately 47% (35/74) of pediatric ED directors and 54% (70/129) of AAMC medical schools’ student representatives responded to the survey. Both groups demonstrated similar opinions of the critical importance and advantage of medical students’ documentation in the ED (P ≥ 0.99). However, these 2 groups differed in opinion on the impact of medical student documentation on clinical care of the ED patients (P = 0.008). The survey found that 83% of medical students and 74% of ED directors believe that medical students should be documenting in the EHR. The majority of both groups (51% of medical students and 65% of ED directors) preferred a single, combined attending physician–medical student note for clinical documentation.

Conclusions
This study presents data describing the current practice of medical student documentation in academic pediatric EDs in the United States. There is a strong consensus among educators and students on the usefulness of medical student documenting patient encounters in the ED.
Binky Bites and Other Oronasal Pressure Injuries
Authors: Mook Louisa B. , Metz James B. , Boos Stephen C. , Feldman Kenneth W. 
Published: March 2017

Abstract
Initial examination and exploration of childhood injuries may not lead to an obvious explanation of abuse. Although abusive oronasal injuries have been described, ones including nasal destruction are rare. We describe 4 children abused using implements that ultimately were thought to have caused significant nasal tissue destruction. In 2 of the cases, a forced pacifier placement was implicated in causing pressure injuries. In the other 2 cases, gags were part of the children's injuries. All 4 children had other findings of abuse and neglect.
First-Line Antiretroviral Treatment Outcomes and Durability in HIV-Infected Children Treated Through the Universal Coverage Health Program in Thailand
Authors: Teeraananchai Sirinya , Bunupuradah Torsak , Puthanakit Thanyawee , Kerr Stephen J. , Ruxrungtham Kiat , Chaivooth Suchada , Bhakeecheep Sorakij , Law Matthew G. , Chokephaibulkit Kulkanya 
Published: March 2017

Background:
We assessed the treatment outcomes on first-line antiretroviral therapy (ART), and factors associated with switching regimen in HIV-infected children treated through the universal coverage health program (UC) in Thailand.

Methods:
Children aged <15 years at ART initiation who had been receiving ART for at least 6 months between 2008 and 2014 through UC were included in the analysis. The Kaplan–Meier method was used to estimate immunological recovery (IMR), immunological failure, and virological failure (VF). Cox models were used to assess predictors of IMR and VF. Competing risk models were used to assess factors associated with switching to a second-line regimen, with death considered as a competing risk.

Results:
A total of 4120 children initiated ART at a median (interquartile range) age of 9.3 (5.8–12.0) years. The median duration of ART was 3.7 years with 17,950 person-years of follow-up. Two thousand eight hundred five children achieved IMR, and the probability of IMR increased to 76% by 3 years after ART initiation. Among 1054 children switched to second-line regimens, 84% had VF and 19% had immunological failure. The cumulative rate of switching regimen increased from 4% to 20% from 1 to 3 years after treatment. Children aged ≥12 years at ART initiation, starting with nonnucleoside reverse-transcriptase inhibitors, and baseline CD4% <10% had an increased risk of switching to second-line regimens.

Conclusions:
Children receiving ART through UC had good treatment outcomes, although a fifth required switching regimen by 3 years. Earlier treatment initiation and avoiding nonnucleoside reverse-transcriptase inhibitor first-line regimens in high-risk children may prevent treatment failure.
Thirty-day Readmission Rates in an HIV-infected Cohort From Rio de Janeiro, Brazil
Authors: Coelho Lara E. , Ribeiro Sayonara R. , Japiassu Andre M. , Moreira Ronaldo I. , Lara Priscila C. , Veloso Valdilea G. , Grinsztejn Beatriz , Luz Paula M. 
Published: March 2017

Background:
The 30-day readmission rate is an indicator of the quality of hospital care and transition to the outpatient setting. Recent studies suggest HIV infection might increase the risk of readmission although estimates of 30-day readmission rates are unavailable among HIV-infected individuals living in middle/low-income settings. Additionally, factors that may increase readmission risk in HIV-infected populations are poorly understood.

Methods:
Thirty-day readmission rates were estimated for HIV-infected adults from the Instituto Nacional de Infectologia Evandro Chagas/Fiocruz cohort in Rio de Janeiro, Brazil, from January 2007 to December 2013. Cox regression models were used to evaluate factors associated with the risk of 30-day readmission.

Results:
Between January 2007 and December 2013, 3991 patients were followed and 1861 hospitalizations were observed. The estimated 30-day readmission rate was 14% (95% confidence interval: 12.3 to 15.9). Attending a medical visit within 30 days after discharge (adjusted hazard ratio [aHR] = 0.73, P = 0.048) and being hospitalized in more recent calendar years (aHR = 0.89, P = 0.002) reduced the risk of 30-day readmission. In contrast, low CD4 counts (51–200 cells/mm³: aHR = 1.70, P = 0.024 and ≤ 50 cells/mm³: aHR = 2.05, P = 0.003), time since HIV infection diagnosis ≥10 years (aHR = 1.58, P = 0.058), and leaving hospital against medical advice (aHR = 2.67, P = 0.004) increased the risk of 30-day readmission.

Conclusions:
Patients with advanced HIV/AIDS are most at risk of readmission and should be targeted with prevention strategies to reduce this risk. Efforts to reduce discharge against medical advice and to promote early postdischarge medical visit would likely reduce 30-day readmission rates in our population.
Brief Report: Antibody Responses to Quadrivalent HPV Vaccination in HIV-Infected Young Women as Measured by Total IgG and Competitive Luminex Immunoassay
Authors: Kahn Jessica A. , Xu Jiahong , Kapogiannis Bill G. , Sleasman John W. 
Published: March 2017

Abstract:
We compared antibody responses of HIV-infected young women to the human papillomavirus (HPV) 6, 11, 16, and 18 vaccine using total immunoglobulin (Ig) G Luminex immunoassay (LIA) and competitive Luminex immunoassay (cLIA) assays. HPV18 seropositivity after HPV vaccination as measured with IgG LIA remained high (98%) 48 weeks after vaccination, in contrast with seropositivity as measured with cLIA (73%). Seropositivity rates at week 48 as measured by both IgG LIA and cLIA remained high for HPV6, 11, and 16 (93.5%–100%). These results suggest that the lower rate of seropositivity to HPV18 when cLIA vs. IgG LIA is used is a function of the assay and does not imply lower vaccine immunogenicity.