bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experiences and meanings of integration of TCAM (Traditional, Complementary and Alternative Medical) providers in three Indian states: results from a cross-sectional, qualitative implementation research study
Authors: Nambiar D , Narayan V V , Josyula L K , Porter J D H , Sathyanarayana T N , Sheikh K 
Published: November 2014

ObjectivesEfforts to engage Traditional, Complementary and Alternative Medical (TCAM) practitioners in the public health workforce have growing relevance for India's path to universal health coverage. We used an action-centred framework to understand how policy prescriptions related to integration were being implemented in three distinct Indian states.SettingHealth departments and district-level primary care facilities in the states of Kerala, Meghalaya and Delhi.ParticipantsIn each state, two or three districts were chosen that represented a variation in accessibility and distribution across TCAM providers (eg, small or large proportions of local health practitioners, Homoeopaths, Ayurvedic and/or Unani practitioners). Per district, two blocks or geographical units were selected. TCAM and allopathic practitioners, administrators and representatives of the community at the district and state levels were chosen based on publicly available records from state and municipal authorities. A total of 196 interviews were carried out: 74 in Kerala, and 61 each in Delhi and Meghalaya.Primary and secondary outcome measuresWe sought to understand experiences and meanings associated with integration across stakeholders, as well as barriers and facilitators to implementing policies related to integration of Traditional, Complementary and Alternative (TCA) providers at the systems level.ResultsWe found that individual and interpersonal attributes tended to facilitate integration, while system features and processes tended to hinder it. Collegiality, recognition of stature, as well as exercise of individual personal initiative among TCA practitioners and of personal experience of TCAM among allopaths enabled integration. The system, on the other hand, was characterised by the fragmentation of jurisdiction and facilities, intersystem isolation, lack of trust in and awareness of TCA systems, and inadequate infrastructure and resources for TCA service delivery.ConclusionsState-tailored strategies that routinise interaction, reward individual and system-level individual integrative efforts, and are fostered by high-level political will are recommended.
Observed high incidence of buried bumper syndrome associated with Freka PEG tubes
Authors: Dowman Joanna K , Ditchburn Linda , Chapman Warren , Lidder Par , Wootton Nicola , Ryan Nicola , Cooney Rachel M 
Published: November 2014

BackgroundBuried bumper syndrome (BBS) is an uncommon but significant complication of percutaneous endoscopic gastrostomy (PEG), which occurs due to overgrowth of gastric mucosa over the inner bumper of the gastrostomy tube. A high incidence of BBS was observed in patients with Freka PEG tubes.ObjectiveTo review case numbers of BBS and confirm the observed association with Freka tubes to determine whether change of practice should be considered.DesignData was collected on the number of cases of BBS reported to the community nutrition team Birmingham, UK. Data on type of PEG kit and total number of PEGs inserted between 2009 and 2013 were collected. The electronic endoscopy reporting database was used to compare case numbers of BBS in our Trust in years when Corflo and Freka PEG tubes were used, respectively. Data from our Trust were also compared with that from a Trust using Corflo only.ResultsFifty-eight cases of BBS were reported in the area covered by the Birmingham community nutrition team between 2009 and 2013, all of which were associated with Freka PEG tubes. An estimated 1000–1200 PEGs were inserted during this period, representing an incidence of BBS of 4.8–5.8%. No cases of BBS occurred over the same period in the comparison Trust (451 Corflo PEGs inserted).ConclusionsOur review confirmed our observation of an increased risk of BBS with Freka PEG tubes. Clinicians should be aware of our findings when deciding which brand of PEG tube to insert, particularly in patients with a previous history of BBS.
The High-Dose Aldesleukin “Select” Trial: A Trial to Prospectively Validate Predictive Models of Response to Treatment in Patients with Metastatic Renal Cell Carcinoma
Authors: McDermott David F. , Cheng Su-Chun , Signoretti Sabina , Margolin Kim A. , Clark Joseph I. , Sosman Jeffrey A. , Dutcher Janice P. , Logan Theodore F. , Curti Brendan D. , Ernstoff Marc S. , Appleman Leonard , Wong Michael K.K. , Khushalani Nikhil I. , Oleksowicz Leslie , Vaishampayan Ulka N. , Mier James W. , Panka David J. , Bhatt Rupal S. , Bailey Alexandra S. , Leibovich Bradley C. , Kwon Eugene D. , Kabbinavar Fairooz F. , Belldegrun Arie S. , Figlin Robert A. , Pantuck Allan J. , Regan Meredith M. , Atkins Michael B. 
Published: November 2014

Abstract
Purpose: High-dose aldesleukin (HD IL2) received FDA approval for the treatment of metastatic renal cell carcinoma (MRCC) in 1992, producing a 14% objective response rate (ORR) and durable remissions. Retrospective studies suggested that clinical and pathologic features could predict for benefit. The Cytokine Working Group conducted this prospective trial to validate proposed predictive markers of response to HD IL2.
Experimental Design: Standard HD IL2 was administered to prospectively evaluate whether the ORR of patients with mRCC with “good” predictive pathologic features based on an “integrated selection” model [ISM (e.g., clear-cell histology subclassification and carbonic anhydrase-9 (CA-9) IHC staining] was significantly higher than the ORR of a historical, unselected population. Archived tumor was collected for pathologic analysis including tumor programmed death-ligand 1 (PD-L1) expression.
Results: One hundred and twenty eligible patients were enrolled between June 11 and September 7; 70% were Memorial Sloan Kettering Cancer Center (New York, NY) intermediate risk, 96% had clear cell RCC, and 99% had prior nephrectomy. The independently assessed ORR was 25% (30/120, 95% CI, 17.5%–33.7%, P = 0.0014; 3 complete responses, 27 partial responses) and was higher than a historical ORR. Thirteen patients (11%) remained progression free at 3 years and the median overall survival was 42.8 months. ORR was not statistically different by ISM classification (“good-risk” 23% vs. “poor-risk” 30%; P = 0.39). ORR was positively associated with tumor PD-L1 expression (P = 0.01) by IHC.
Conclusions: In this prospective, biomarker validation study, HD IL2 produced durable remissions and prolonged survival in both “good” and “poor-risk” patients. The proposed ISM was unable to improve the selection criteria. Novel markers (e.g., tumor PD L1 expression) appeared useful, but require independent validation. Clin Cancer Res; 21(3); 561–8. ©2014 AACR.
Implementasi Metode Studio-Based Learning dalam Pengelolaan dan Prosedur Pembelajaran Studio Perancangan Arsitektur
Authors: Rijal Muhammad , Aldy Pedia 
Published: November 2014

Learning Model studio known as Studio - Based Learning (SBL) has the main features hands-on or first hand experience or learning by doing. Ideally, most of the SBL activities, either individually or in groups, conducted in a studio which was accompanied by a number of teachers / assistants. Student’s evaluation efficiently when using the method of correlational research conducted with data collection and analysis of questionnaire data with the statistics. Questions in the questionnaire were arranged by following structure: the ability of professors, lecturer’s attitudes, organization of the studio system, the ability of students, and student attitudes. Penelitian Tindakan Kelas (PTK) was conducted on students of Architectural Engineering, Faculty of Engineering UR S1 are taking courses in Architectural Design Studio 2010/2011 academic year, are 22 students. Four cycles of study procedures are planning, action, observation and reflection. Quantitive analysis was used to data analysis. The result of the research was the assessment of knowledge of the supervisor, supervisor attitudes, and the studio administration systems are good category.
Critical Analysis of a Website: A Critique based on Critical Applied Linguistics and Critical Discourse Analysis
Authors: Agustina Rina 
Published: November 2014

E-learning was easily found through browsing internet, which was mostly free of charge and provided various learning materials. Spellingcity.com was one of e-learning websites for teaching and learning English to learn spelling, vocabulary and writing, which offered various games and activities for young learners, 6 until 8 year old learners in particular. Having considered those constraints, this paper aimed to analyse the website from two different views: (1) critical applied linguistics (CAL) aspects and (2) critical discourse analysis (CDA). After analysing the website using CAL and CDA, it was found that the website was adequate for beginner, in which it provided fun learning through games as well as challenged learners’ to test their vocabulary. Despite of these strengths, there were several issues required further thinking in terms of learners’ broad knowledge, such as, some of learning materials focused on states in America. It was quite difficult for EFL learners if they did not have adequate general knowledge. Thus, the findings implied that the website could be used as a supporting learning material, which accompanied textbooks and vocabulary exercise books.
Leadership Skills Development Through Service Learning
Authors: A. Ejiwale James 
Published: November 2014

The engagement of students in service learning will help them acquire and improve on necessary leadership skills required of them upon graduation. This is essential to help prepare and put the graduates of STEM programs at the forefront of employment in the new industrial revolution. It is therefore important that STEM majors should participate in service learning so as to discharge their civic responsibility and to improve their leadership skills. This paper addresses the forms, assessment and the need for service learning in STEM programs and how it can help develop the leadership skills of Â the participants.
Implementation of Collaborative Learning in Higher Education Environment
Authors: Wicaksono Soetam Rizky 
Published: November 2014

The need of improvement in learning process, especially in higher education environment, has already begun a dilemma for many lecturers. Many experts has already agreed that one of the success factor in learning process improvement is creating collaboration among students. This pre-eliminary action research tried to implement collaborative learning from small groups using simple task and escalating into large group with more complicated collaborative framework. Although there is no quantification result in this research, the questionnaire result has already proven that collaborative learning is feasible in higher education environment. However, further research in term of collaborative learning can be done easier using the result from this research.
The Development of Writing Learning Model Based on the Arces Motivation for Students of Senior High School
Authors: Kosasih Andreas 
Published: November 2014

This research obtains some of the findings which in a word can be described as follows: (1) the step of Introduction (exploration): through study library and observation, it can be found that the quality of writing learning and the need of a better writing learning model, and it is formulated the prototype of writing learning model based on the ARCES motivation, serta dirumuskan prototipe model pembelajaran menulis berbasis motivasi ARCES after the draft is validated by the Indonesian language experts and education technology experts. (2) The step of model development: through development of preliminary model and development of main model and after it is done by monitoring, evaluation, focus group discussion and revision, then it is produced a better writing learning model based on ARCES motivation. (3) The step of model effectiveness examination: through pre-test, treatment, and post-test which is produced writing learning model based on ARCES motivation. From the effectiveness test result of model, it can be concluded that writing learning based on ARCES motivation is more effective (in average value of post test is 83,94) than writing learning conventionally (in average value of post-test is 75,79).
Transcatheter Closure of Large Atrial Septal Defects
Authors: Baruteau Alban-Elouen , Petit Jérôme , Lambert Virginie , Gouton Marielle , Piot Dominique , Brenot Philippe , Angel Claude-Yves , Houyel Lucile , Le Bret Emmanuel , Roussin Régine , Ly Mohamedou , Capderou André , Belli Emre 
Published: November 2014

Background—
Data are needed on the safety and efficacy of device closure of large atrial septal defects.

Methods and Results—

Between 1998 and 2013, 336 patients (161 children <15 years) with large, isolated, secundum atrial septal defects (balloon-stretched diameter ≥34 mm in adults or echocardiographic diameter >15 mm/m
2
in children) were managed using the Amplatzer device, at the Marie Lannelongue Hospital. Transthoracic echocardiographic guidance was used starting in 2005 (n=219; 65.2%). Balloon-stretched diameter was >40 mm in 36 adults; mean values were 37.6±3.3 mm in other adults and 26.3±6.3 mm/m
2
in children. Amplatzer closure was successful in 311 (92.6%; 95% confidence interval, 89%–95%) patients. Superior and posterior rim deficiencies were more common in failed than in successful procedures (superior, 24.0% versus 4.8%;
P
=0.002; and posterior, 32.0% versus 4.2%;
P
<0.001). Device migration occurred in 4 adults (2 cases each of surgical and transcatheter retrieval); in the 21 remaining failures, the device was unreleased and withdrawn. After a median follow-up of 10.0 years (2.5–17 years), all patients were alive with no history of late complications.

Conclusions—
Closure of large atrial septal defects using the Amplatzer device is safe and effective in both adults and children. Superior and posterior rim deficiencies are associated with procedural failure. Closure can be performed under transthoracic echocardiographic guidance in experienced centers. Early device migration is rare and can be safely managed by device extraction. Long-term follow-up showed no deaths or major late complications in our population of 311 patients.
Cardiovascular Lifetime Risk Predicts Incidence of Coronary Calcification in Individuals With Low Short‐Term Risk: The Dallas Heart Study
Authors: Paixao Andre R. M. , Ayers Colby R. , Rohatgi Anand , Das Sandeep R. , de Lemos James A. , Khera Amit , Lloyd‐Jones Donald , Berry Jarett D. 
Published: November 2014

Background

The absence of coronary artery calcium (
CAC
) in middle age is associated with very low short‐term risk for coronary events. However, the long‐term implications of a
CAC
score of 0 are uncertain, particularly among individuals with high cardiovascular lifetime risk. We sought to characterize the association between predicted lifetime risk and incident
CAC
among individuals with low short‐term risk.

Methods and Results

We included 754 Dallas Heart Study participants with serial
CAC
scans (6.9 years apart) and both low short‐term risk and baseline
CAC
=0. Lifetime risk for cardiovascular disease was estimated according to risk factor burden. Among this group, 365 individuals (48.4%) were at low lifetime risk and 389 (51.6%) at high lifetime risk. High lifetime risk was associated with higher annualized
CAC
incidence (4.2% versus 2.7%;
P
< 0.001). Similarly, mean follow‐up
CAC
scores were higher among participants with high lifetime risk (7.8 versus 2.4 Agatston units). After adjustment for age, sex, and race, high lifetime risk remained independently associated with incident
CAC
(
OR
1.60; 95%
CI
1.12 to 2.27;
P
=0.01). When assessing risk factor burden at the follow‐up visit, 66.7% of
CAC
incidence observed in the low lifetime risk group occurred among individuals reclassified to a higher short‐ or long‐term risk category.

Conclusion

Among individuals with low short‐term risk and
CAC
scores of 0, high lifetime risk is associated with a higher incidence of
CAC
. These findings highlight the importance of lifetime risk even among individuals with very low short‐term risk.
Stroke and Major Bleeding Risk in Elderly Patients Aged ≥75 Years With Atrial Fibrillation
Authors: Lip Gregory Y.H. , Clementy Nicolas , Pericart Lauriane , Banerjee Amitava , Fauchier Laurent 
Published: November 2014

Background and Purpose—
Atrial fibrillation (AF) is increasingly prevalent in the elderly, but such patients tend to be under-represented in clinical trials. Increasing age confers a higher risk of stroke and bleeding when antithrombotic therapy is used. We examined risk factors for stroke and bleeding among elderly (age, >75 years) patients within a real world hospitalized cohort from the Loire Valley AF project.

Methods—
We identified elderly (age, >75 years) patients with AF, assessed their risk factors, and followed up for stroke, thromboembolism, death, or major bleeding. The effect of vitamin K antagonist (VKA) use on these end points was assessed.

Results—

We studied 8962 patients with AF, and we identified 4130 elderly (age, ≥75 years) patients. Using Kaplan–Meier analyses, event rates of death, stroke/thromboembolism, the composite of stroke/thromboembolism/death, and major bleeding increased with increasing age. For mortality, VKA-treated patients did better than non-VKA–treated patients. The risk of death and stroke/thromboembolism/death increased with increasing age. The risk of major bleeding did not increase with increasing age strata. VKA treatment was associated with lower mortality in those aged <75 years (adjusted hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.45–0.72), and the effect size was maintained with increasing age strata (
P
int
=0.67). For stroke/thromboembolism/death, VKA also has a significant benefit in those aged <75 years (adjusted HR, 0.69; [0.57–0.83]), and the effect size was maintained with increasing age strata (
P
int
=0.58). For major bleeding, there was no statistically significant difference between age strata (
P
int
=0.67). In elderly patients, age and previous stroke emerged as the main predictors of stroke and thromboembolism. Renal impairment and VKA use were predictors of major bleeding.

Conclusions—
Elderly patients with AF have a higher risk of stroke and bleeding, but the benefits of VKA therapy for stroke/thromboembolism or mortality were present regardless of increasing age.
25-Hydroxyvitamin D Status Is Associated With Chronic Cerebral Small Vessel Disease
Authors: Chung Pil-Wook , Park Kwang-Yeol , Kim Jeong-Min , Shin Dong-Woo , Park Moo-Seok , Chung Yun Jae , Ha Sam-Yeol , Ahn Suk-Won , Shin Hae-Won , Kim Yong Bum , Moon Heui-Soo 
Published: November 2014

Background and Purpose—
The aim of this study was to determine the association between 25-hydroxyvitamin D (25(OH)D) and neuroimaging correlates of cerebral small vessel disease.

Methods—
We identified 759 consecutive patients with acute ischemic stroke or transient ischemic attack. Lacunes, white matter hyperintensity, and cerebral microbleed (CMB) were assessed using MR images. Deep CMB was defined as the presence of CMB in basal ganglia, thalamus, or brain stem. The association between 25(OH)D and small vessel disease was tested using linear and logistic regression analyses.

Results—
Mean age was 68 (±13) years. Mean level of 25(OH)D was 34.1±17.8 nmol/L. On bivariate analysis, a 25-nmol/L decrease in 25(OH)D was associated with lacunes (regression coefficient, 0.23; 95% confidence interval [CI], 0.02–0.45), severe white matter hyperintensity (odds ratio, 2.05; 95% CI, 1.41–3.08), and deep CMB (odds ratio, 1.28; 95% CI, 1.01–1.63). Also, 25(OH)D deficiency (≤25 nmol/L) was associated with lacunes (regression coefficient, 0.5; 95% CI, 0.04–0.95), severe white matter hyperintensity (odds ratio, 2.74; 95% CI, 1.31–6.45), and deep CMB (odds ratio, 1.68; 95% CI, 1.03–2.78). The association remained significant even after multivariable adjustment and in the subgroup of previously healthy patients.

Conclusions—
25(OH)D is inversely associated with lacunes, white matter hyperintensity, and deep CMB. Our findings suggest that 25(OH)D is linked to small vessel disease, and in future trials it should be tested whether 25(OH)D supplementation can prevent small vessel disease.
Love, Lust, and Loss in the Daoist Nunnery as Presented in Yuan Drama
Authors: Zhao Xiaohuan 
Published: November 2014

Most studies of either Daoist influences and features or love and romance in Yuan drama concentrate on the male-dominated theme of deliverance (dutuo) or center on the “scholar-beauty” or “scholar-courtesan” romantic relationship, with little attention given to Daoist women involved in love affairs or marriage arrangements. This article aims to bring to light life and love in the Daoist nunnery as featured in Yuan drama, by focusing on transgressive Daoist nuns longing for secular life and sensual love and on lay women whose marriages are arranged by Daoist nuns. Four zaju plays have been selected for textual and thematic analysis, namely, Yuanyang bei (The Mandarin-Duck Quilt), Wangjiang ting (The River-viewing Pavilion), Nüzhen guan (The Cloister of Female Daoists), and Zhuwu ting qin (Listening to the Zither from a Bamboo-Thicketed Cottage). La majorité des études consacrées, suivant les cas, aux influences et aux éléments taoïstes ou aux intrigues romantiques dans le théâtre Yuan, se concentrent soit sur le thème masculin de la délivrance (dutuo), soit sur les idylles entre “lettrés et beautés” ou “lettrés et courtisanes”. En revanche on s’est peu intéressé aux exemples de femmes taoïstes impliquées dans des relations amoureuses ou dans des négociations matrimoniales. Cet article cherche à mettre en évidence la vie et l’amour dans les couvents taoïstes tels que les donne à voir le théâtre Yuan en évoquant des nonnes poussées à transgresser les règles par leur désir de vie laïque et d’amour sensuel et des femmes laïques dont le mariage est arrangé par des nonnes. Quatre pièces de zaju ont été choisies pour une analyse textuelle et thématique : Yuanyuan bei (La couverture aux canards mandarins), Wangjiang ting (Le pavillon donnant sur le fleuve), Nüzhen guan (Le couvent taoïste) et Zhuwu ting qin (Écouter la cithare dans la chaumière).
HPV Status Determines the Efficacy of Adjuvant Chemotherapy With S-1, an Oral Fluorouracil Prodrug, in Oropharyngeal Cancer
Authors: Wakisaka Naohiro , Yoshida Shinya , Kondo Satoru , Kita Makiko , Endo Kazuhira , Tsuji Akira , Murono Shigeyuki , Muramatsu Masamichi , Yoshizaki Tomokazu 
Published: November 2014

Objectives: A subgroup of oropharyngeal squamous cell carcinoma (OPC) is infected with high-risk human papillomavirus (HPV). The object of this study is to evaluate the efficacy of adjuvant chemotherapy with S-1, an oral 5-fluorouracil prodrug, on survival of patients with OPC according to HPV status. Methods: Among OPC patients of stage III or IV who received definitive treatment from 1998 to 2008, 38 who were confirmed tumor-free after primary treatment were analyzed. Before 2003, none of the patients received S-1 adjuvant chemotherapy (S-1(-)-group); however, all patients who were eligible were administered S-1 (S-1(+)-group) after 2003. The expression of thymidylate synthase (TYMS) involved in 5-FU metabolism was also examined in protein and mRNA levels. Results: Although there was a trend to disease-free and overall survival benefit in HPV-negative patients with S-1, it did not achieve statistical significance ( P = .082 and P = .065, respectively). For the HPV-positive patients, the survivals were similar with or without S-1 administration. TYMS-expression in HPV-positive OPC tissues was significantly higher than in HPV-negative ones in both protein and mRNA levels ( P = .0489 and P = .0446, respectively). Conclusion: The current study provides a rationale to plan a randomized trial to compare the efficacy of S-1 according to the HPV status in OPCs.