bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community Discharge of Nursing Home Residents: The Role of Facility Characteristics
Authors: Holup Amanda A. , Gassoumis Zachary D. , Wilber Kathleen H. , Hyer Kathryn 
Published: July 2015

ObjectiveUsing a socio‐ecological model, this study examines the influence of facility characteristics on the transition of nursing home residents to the community after a short stay (within 90 days of admission) or long stay (365 days of admission) across states with different long‐term services and supports systems.Data SourceData were drawn from the Minimum Data Set, the federal Online Survey, Certification, and Reporting (OSCAR) database, the Area Health Resource File, and the LTCFocUs.org database for all free‐standing, certified nursing homes in California (n = 1,127) and Florida (n = 657) from July 2007 to June 2008.Study DesignHierarchical generalized linear models were used to examine the impact of facility characteristics on the probability of transitioning to the community.Principal FindingsFacility characteristics, including size, occupancy, ownership, average length of stay, proportion of Medicare and Medicaid residents, and the proportion of residents admitted from acute care facilities are associated with discharge but differed by state and whether the discharge occurred after a short or long stay.ConclusionShort‐ and long‐stay nursing home discharge to the community is affected by resident, facility, and sometimes market characteristics, with Medicaid consistently influencing discharge in both states.
Population pharmacokinetics of edoxaban in patients with symptomatic deep‐vein thrombosis and/or pulmonary embolism—the Hokusai‐VTE phase 3 study
Authors: Niebecker Ronald , Jönsson Siv , Karlsson Mats O. , Miller Raymond , Nyberg Joakim , Krekels Elke H. J. , Simonsson Ulrika S. H. 
Published: July 2015

AimsThis study characterized the population pharmacokinetics of edoxaban in patients with symptomatic deep‐vein thrombosis and/or pulmonary embolism in the Hokusai‐VTE phase 3 study. The impact of the protocol‐specified 50% dose reductions applied to patients with body weight ≤ 60 kg, creatinine clearance (CLcr) of 30 to 50 ml min–1 or concomitant P‐glycoprotein inhibitor on edoxaban exposure was assessed using simulations.MethodsThe sparse data from Hokusai‐VTE, 9531 concentrations collected from 3707 patients, were pooled with data from 13 phase 1 studies. In the analysis, the covariate relationships used for dose reductions were estimated and differences between healthy subjects and patients as well as additional covariate effects of age, race and gender were explored based on statistical and clinical significance.ResultsA linear two‐compartment model with first order absorption preceded by a lag time best described the data. Allometrically scaled body weight was included on disposition parameters. Apparent clearance was parameterized as non‐renal and renal. The latter increased non‐linearly with increasing CLcr. Compared with healthy volunteers, inter‐compartmental clearance and the CLcr covariate effect were different in patients (+64.6% and +274%). Asian patients had a 22.6% increased apparent central volume of distribution. The effect of co‐administration of P‐glycoprotein inhibitors seen in phase 1 could not be confirmed in the phase 3 data. Model‐based simulations revealed lower exposure in dose‐reduced compared with non‐dose‐reduced patients.ConclusionsThe adopted dose‐reduction strategy resulted in reduced exposure compared with non‐dose‐reduced, thereby overcompensating for covariate effects. The clinical impact of these differences on safety and efficacy remains to be evaluated.
Achievement of complete remission predicts outcome of allogeneic haematopoietic stem cell transplantation in patients with chronic myelomonocytic leukaemia. A study of the Chronic Malignancies Working Party of the European Group for Blood and Marrow Transplantation
Authors: Symeonidis Argiris , van Biezen Anja , de Wreede Liesbeth , Piciocchi Alfonso , Finke Juergen , Beelen Dietrich , Bornhäuser Martin , Cornelissen Jan , Volin Liisa , Mufti Ghulam , Chalandon Yves , Ganser Arnold , Bruno Benedetto , Niederwieser Dietger , Kobbe Guido , Schwerdtfeger Rainer , de Witte Theo , Robin Marie , Kröger Nicolaus ,   the Chronic Malignancies Working Party of the European Group for Blood and Marrow Transplantation
Published: July 2015

SummaryThe results of allogeneic stem cell transplantation (allo‐SCT) in chronic myelomonocytic leukaemia (CMML) are usually reported together with other categories of myelodysplastic syndrome. We analysed transplantation outcome in 513 patients with CMML, with a median age of 53 years reported to the European Group for Blood and Marrow Transplantation. Conditioning was standard (n = 249) or reduced‐intensity (n = 226). Donors were human leucocyte antigen‐related (n = 285) or unrelated (n = 228). Disease status at transplantation was complete remission (CR) in 122 patients, no CR in 344, and unknown in 47. Engraftment was successful in 95%. Grades 2–4 acute graft‐versus‐host disease (GvHD) occurred in 33% of the patients and chronic GvHD was reported in 24%. The 4‐year cumulative incidence of non‐relapse mortality was 41% and 32% for relapse, resulting in a 4‐year estimated relapse‐free and overall survival (OS) of 27% and 33%, respectively. Patients transplanted in CR had lower probability for non‐relapse death (P = 0·002) and longer relapse‐free and OS (P = 0·001 and P = 0·005, respectively). In multivariate analysis the only significant prognostic factor for survival was the presence of CR at transplantation (P = 0·005). Allo‐SCT remains a curative treatment option for patients with CMML and should preferably be performed early after diagnosis or after establishing the best possible remission status.
Time to redefine Myeloma
Authors: Pratt Guy , Bowcock Stella , Chantry Andrew , Cook Gordon , Jackson Graham , Lai Maggie , Low Eric , Mulholland Nicola , Owen Roger , Rabin Neil , Ramasamy Karthik , Snowden John A , Streetly Matthew , Wechalekar Ashutosh , Yong Kwee , Bird Jenny 
Published: July 2015

SummaryIn November 2014 the International Myeloma Working Group (IMWG) revised the definition of multiple myeloma, such that asymptomatic patients with newly diagnosed multiple myeloma without any of the traditional ‘CRAB’ (hypercalcaemia, renal impairment, anaemia, bone disease) end organ damage criteria but with one of three new criteria would be recommended to start treatment. Previously, the standard of care for such patients was expectant management. These three new criteria are: greater than 60% clonal plasma cells on bone marrow biopsy, a serum free light chain (sFLC) ratio of >100 (the involved sFLC must be >100 mg/l) and greater than one unequivocal focal lesion on advanced imaging (low dose whole body computerized tomography, magnetic resonance imaging, 18F fluorodeoxyglucose positron emission tomography). Although this would appear to affect a small number of patients, the impact of these changes are broad, leading to an increased use of advanced imaging, a debate around the management of patients previously diagnosed with smouldering myeloma, changed terminology and clinical trial design and an extension of the use of biomarkers. For the first time the philosophy of treatment in myeloma will change from treatment initiation only being triggered by overt end organ damage to an era where sub clinical risk factors will also be taken into account.
Barriers in using cardiometabolic risk information among consumers with low health literacy
Authors: Damman Olga C. , Bogaerts Nina M. M. , van Dongen Diana , Timmermans Danielle R. M. 
Published: July 2015

ObjectivesTo identify the barriers from the perspective of consumers with low health literacy in using risk information as provided in cardiometabolic risk assessments.DesignA qualitative thematic approach using cognitive interviews was employed.MethodsWe performed interviews with 23 people with low health literacy/health numeracy, who were recruited through (1) several organisations and snowball sampling and (2) an online access panel. Participants completed the risk test of the Dutch national cardiometabolic risk assessment and viewed the personalized information about their risk. They were asked to answer probing questions about different parts of the information. The qualitative data were analysed by identifying main themes related to barriers in using the information, using a descriptive thematic approach.ResultsThe four main themes identified were as follows: (1) People did not fully accept the risk message, partly because numerical information had ambiguous meaning; (2) people lacked an adequate framework for understanding their risk; (3) the purpose and setting of the risk assessment was unclear; and (4) current information tells nothing new: A need for more specific risk information.ConclusionsThe main barriers were that the current presentation seemed to provoke undervaluation of the risk number and that texts throughout the test, for example about cardiometabolic diseases, did not match people's existing knowledge, failing to provide an adequate framework for understanding cardiometabolic risk. Our findings have implications for the design of disease risk information, for example that alternative forms of communication should be explored that provide more intuitive meaning of the risk in terms of good versus bad.
Statement of contribution

What is already known on this subject?

Online disease risk assessments have become widely available internationally.

People with low SES and health literacy tend to participate less in health screening.

Risk information is difficult to understand, yet little research has been carried out among people with low health literacy.

What does this study add?

People with low health literacy do not optimally use risk information in an online cardiometabolic risk assessment.

The texts provided in the cardiometabolic risk assessment do not suit to their existing knowledge.

The typical risk communication (numbers, bar graph, verbal label) seems to provoke undervaluation of risk.
Prostate carcinoma with positive margins at radical prostatectomy: role of tumour zonal origin in biochemical recurrence
Authors: O'Neil Luke M. , Walsh Shane , Cohen Ronald J. , Lee Stephen 
Published: July 2015

ObjectiveTo assess the influence of tumour zonality on biochemical recurrence (BCR) after radical prostatectomy (RP) with a histologically confirmed positive surgical margin (PSM).Patients and MethodsData from 382 patients that underwent RP with either transition zone (TZ) or peripheral zone (PZ) tumours involving PSMs between 1998 and 2010 were retrieved from the Abbott West Australian Prostatectomy Database. Statistical analysis was used to evaluate the relationship of various tumour clinicopathological parameters, e.g. zonal origin of tumour, tumour volume, Gleason score, and stage to the development of BCRResultsThere were 51 TZ and 331 PZ tumours with PSMs identified. The TZ tumours compared with PZ tumours were larger (median 5.67 vs 3.64 mL, P < 0.001), more frequently lower grade (Gleason score 6 33% vs 5%, P < 0.01), organ confined (51% vs 35.6%, P = 0.073), and preferentially involved the bladder neck (49% vs 6%, P < 0.001). Tumour zonality was not associated with BCR for the entire cohort. TZ and PZ tumours had similar 5‐year BCR‐free survival rates (58% vs 63%, P = 0.691) and comparable time to development of BCR (14.4 vs 19.2 months, P = 0.346). On univariate analysis, preoperative PSA level, PSM at the bladder neck, tumour volume, Gleason score (P < 0.001) and tumour stage were independent predictors of BCR for the entire cohort. On multivariate analysis tumour volume and Gleason score retained significance as independent predictors of BCR. Tumour zonality was not directly associated with BCR. Of the patients who received adjuvant therapy, the incidence of BCR was similar for TZ and PZ tumours (58% vs 67%, P = 0.077), although TZ tumours failed significantly earlier (mean 4.4 vs 16.4 months, P = 0.037).ConclusionsPSA recurrence in patients with histologically confirmed PSMs after RP is independent of the zonal location of the index tumour. However, tumour zonal origin may have an indirect influence on PSA relapse, as TZ tumours tend to be of large volume and more likely involve the bladder neck margin, both risk factors for BCR. Bladder neck margin involvement is associated with higher rates of BCR than other sites of PSMs. The preoperative identification of TZ tumours might aid surgical planning with appropriate alteration of RP technique to incorporate wider surgical margins at the bladder neck. Adjuvant radiotherapy appears to be associated with adverse outcome for TZ tumours, a novel finding which warrants further investigation.
Blood–brain barrier and neurological diseases
Authors: Takeshita Yukio , Ransohoff Richard M. 
Published: July 2015

AbstractThe blood–brain barrier (BBB), an anatomically and functionally unique structure, maintains the homeostasis of the central nervous system (CNS) by maintaining the optimal ionic environment for neuronal function and transporting trophins or nutrients, as well as restricting access of toxic substances, inflammatory cells, circulating antibodies, and pathogens under physiological and pathological conditions. Brain microvascular endothelial cells directly mediate BBB function. Along with a battery of efflux transporters, the tight junctions of brain microvascular endothelial cells form the anatomical and functional basis of the barrier function of the BBB. Access to the CNS by inflammatory cells is restricted, but not prohibited. Transendothelial migration through the BBB is characterized by tightly controlled multi‐step processes. BBB dysfunction in neurological autoimmune diseases is associated with autoreactive and inflammatory cells and autoantibodies that invade the CNS and induce neuroinflammation. It is still incompletely understood how these neuro‐invaders affect the BBB and gain entry into the CNS across the BBB. In the present review, we introduce current knowledge of BBB cellular components and the multistep process of inflammatory cells crossing the BBB in physiological conditions, and summarize their biological mechanisms to cross the BBB in pathological conditions in representative neurological autoimmune diseases (multiple sclerosis, neuromyelitis optica and systemic lupus erythematosus) with a particular focus on new and recent findings.
Outcomes of pregnancy during interferon beta‐1a therapy in Japanese patients with multiple sclerosis: Interim results of a postmarketing surveillance study
Authors: Shimizu Yuko , Makioka Haruki , Harada Naozumi , Nakabayashi Shoko , Saida Takahiko , Kira Jun‐ichi 
Published: July 2015

AbstractObjectivesTo evaluate pregnancy outcomes in Japanese patients with multiple sclerosis (MS) enrolled in a postmarketing surveillance study of intramuscular interferon beta‐1a (IM IFN beta‐1a).MethodsSafety data were collected from Japanese patients receiving 30 μg weekly IM IFN beta‐1a. Pregnancy outcomes and annualized relapse rates (ARR) were analyzed retrospectively in patients who registered into the postmarketing surveillance study.ResultsA total of 1110 of 1638 patients registered in the postmarketing surveillance study were women. A total of 21 pregnancies (20 patients) resulted in 17 live births, 2 induced abortions, one spontaneous abortion and one unknown outcome. Weights and lengths of the 17 newborns were similar to newborns in the general Japanese population. No complications or malformations were reported. Of these 20 patients, nine experienced relapses in the year after childbirth, two experienced relapses in the year before pregnancy, and one experienced relapses before and during pregnancy. The mean (standard deviation) ARR was 0.94 (2.18) in the year before pregnancy, 0.25 (1.00), 0 (0) and 0 (0) in the three trimesters of pregnancy, and 1.05 (1.81), 0.84 (1.68), 0.63 (2.01) and 0.21 (0.92) in the first four quarters postpartum. Of the five patients who relapsed during the first quarter postpartum, only one had resumed IFN beta‐1a treatment for 35 days.ConclusionsAlthough sample size limits our ability to draw definitive conclusions, we did not find evidence that IFN beta‐1a has adverse effects on pregnancy outcomes in Japanese patients with MS. Early IFN beta‐1a resumption might reduce the risk of relapse within the first quarter postpartum.
Probabilistic Connections for Bidirectional Path Tracing
Authors: Popov Stefan , Ramamoorthi Ravi , Durand Fredo , Drettakis George 
Published: July 2015

AbstractBidirectional path tracing (BDPT) with Multiple Importance Sampling is one of the most versatile unbiased rendering algorithms today. BDPT repeatedly generates sub‐paths from the eye and the lights, which are connected for each pixel and then discarded. Unfortunately, many such bidirectional connections turn out to have low contribution to the solution. Our key observation is that we can importance sample connections to an eye sub‐path by considering multiple light sub‐paths at once and creating connections probabilistically. We do this by storing light paths, and estimating probability mass functions of the discrete set of possible connections to all light paths. This has two key advantages: we efficiently create connections with low variance by Monte Carlo sampling, and we reuse light paths across different eye paths. We also introduce a caching scheme by deriving an approximation to sub‐path contribution which avoids high‐dimensional path distance computations. Our approach builds on caching methods developed in the different context of VPLs. Our Probabilistic Connections for Bidirectional Path Tracing approach raises a major challenge, since reuse results in high variance due to correlation between paths. We analyze the problem of path correlation and derive a conservative upper bound of the variance, with computationally tractable sample weights. We present results of our method which shows significant improvement over previous unbiased global illumination methods, and evaluate our algorithmic choices.
Allergologie – Aktuelles zur Prävention und Diagnostik von Soforttyp‐Allergien und zur Therapie der allergischen Rhinokonjunktivitis
Authors: Brehler Randolf , Stöcker Benedikt , Grundmann Sonja 
Published: July 2015

ZusammenfassungDie Inzidenz allergischer Erkrankungen ist in den letzten Jahrzehnten dramatisch gestiegen, so dass diese Erkrankungen jetzt zu den „Volkskrankheiten“ gezählt werden müssen. Allergenexpositionsmeidung galt früher als wichtigste Maßnahme der primären Prävention. Zunehmend zeigen Studien, dass für die Entwicklung immunologischer Toleranz die Auseinandersetzung des Immunsystems mit Allergenen notwendig ist.Die Diagnostik basiert auf Anamnese, Hauttests und Bestimmung von spezifischen IgE‐Antikörpern. Durch Komponenten‐basierte Diagnostik kann eine primäre Sensibilisierung gegen eine Allergenquelle von Kreuzreaktionen durch Sensibilisierung gegen Panallergene oder kreuzreagierende Kohlenhydratepitope abgegrenzt werden. Die symptomatische Behandlung führt nur zu einer vorübergehenden Linderung der klinischen Beschwerden; durch spezifische Immuntherapie dagegen kann ein dauerhafter Effekt und möglicherweise eine Heilung erzielt werden. Die Auswahl von Allergenen für die spezifische Immuntherapie (SIT) wird durch das Leitallergenprinzip beeinflusst. Verwendet werden sollten Präparate, deren Wirksamkeit und Sicherheit in kontrollierten klinischen Studien belegt worden ist. Für die subkutane Immuntherapie stehen für eine Vielzahl von Allergenen geeignete und zugelassene Präparate zur Verfügung. Die Wirksamkeit der sublingualen Therapie ist insbesondere für Gräser‐ aber auch Baumpollenextrakte durch große klinische Studien belegt, so dass Präparate mit diesen Allergenen regulär zugelassen sind.
Applying a perceptions and practicalities approach to understanding nonadherence to antiepileptic drugs
Authors: Chapman Sarah C. E. , Horne Rob , Eade Rona , Balestrini Simona , Rush Jennifer , Sisodiya Sanjay M. 
Published: July 2015

SummaryObjectiveNonadherence to antiepileptic drugs (AEDs) is a common cause of poor seizure control. This study examines whether reported adherence to AEDs is related to variables identified in the National Institute for Health and Clinical Excellence (NICE) Medicines Adherence Guidelines as being important to adherence: perceptual factors (AED necessity beliefs and concerns), practical factors (limitations in capability and resources), and perceptions of involvement in treatment decisions.MethodsThis was a cross‐sectional study of people with epilepsy receiving AEDs. Participants completed an online survey hosted by the Epilepsy Society (n = 1,010), or as an audit during inpatient admission (n = 118). Validated questionnaires, adapted for epilepsy, assessed reported adherence to AEDs (Medication Adherence Report Scale [MARS]), perceptions of AEDs (Beliefs about Medicines Questionnaire [BMQ]), and patient perceptions of involvement in treatment decisions (Treatment Empowerment Scale [TES]).ResultsLow adherence was related to AED beliefs (doubts about necessity: t(577) = 3.90, p < 0.001; and concerns: t(995) = 3.45, p = 0.001), reported limitations in capability and resources (t(589) = 7.78, p < 0.001), and to perceptions of a lack of involvement in treatment decisions (t(623) = 4.48, p < 0.001). In multiple logistic regression analyses, these factors significantly (p < 0.001) increased variance in reported adherence, above that which could be explained by age and clinical variables (seizure frequency, type, epilepsy duration, number of AEDs prescribed).SignificanceVariables identified in the NICE Medicines Adherence Guidelines as potentially important factors for adherence were found to be related to adherence to AEDs. These factors are potentially modifiable. Interventions to support optimal adherence to AEDs should be tailored to address doubts about AED necessity and concerns about harm, and to overcome practical difficulties, while engaging patients in treatment decisions.