bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging
Authors: Kanzaria Hemal K. , Hoffman Jerome R. , Probst Marc A. , Caloyeras John P. , Berry Sandra H. , Brook Robert H. 
Published: March 2015

AbstractObjectivesThe objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice.MethodsAs part of a larger study to engage physicians in the delivery of high‐value health care, two multispecialty focus groups were conducted to explore the topic of decision‐making around resource utilization, after which qualitative analysis was used to generate survey questions. The survey was extensively pilot‐tested and refined for emergency medicine (EM) to focus on advanced diagnostic imaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]). The survey was then administered to a national, purposive sample of EPs and EM trainees. Simple descriptive statistics to summarize physician responses are presented.ResultsIn this study, 478 EPs were approached, of whom 435 (91%) completed the survey; 68% of respondents were board‐certified, and roughly half worked in academic emergency departments (EDs). Over 85% of respondents believe too many diagnostic tests are ordered in their own EDs, and 97% said at least some (mean = 22%) of the advanced imaging studies they personally order are medically unnecessary. The main perceived contributors were fear of missing a low‐probability diagnosis and fear of litigation. Solutions most commonly felt to be “extremely” or “very” helpful for reducing unnecessary imaging included malpractice reform (79%), increased patient involvement through education (70%) and shared decision‐making (56%), feedback to physicians on test‐ordering metrics (55%), and improved education of physicians on diagnostic testing (50%).ConclusionsOverordering of advanced imaging may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high‐yield solutions that must be addressed simultaneously to curb overimaging.
The health consequences of injecting tablet preparations: foreign body pulmonary embolization and pulmonary hypertension among deceased injecting drug users
Authors: Darke Shane , Duflou Johan , Torok Michelle 
Published: March 2015

AbstractAimsTo determine: (1) the characteristics of cases presenting to the Department of Forensic Medicine Sydney (1997–2013) with foreign body pulmonary embolization; (2) the extent and locations of embolization; and (3) the relationship between extent, and use of other injection sites, with pathology.DesignAnalysis of consecutive case presentations with foreign body pulmonary embolization.Setting/participantsSydney, Australia, with a total of 373 cases (271 males, 102 females).MeasurementsFull autopsy reports, microscopy of tissue samples, and full toxicology. The extent and locations of embolization, inflammatory responses, clinical signs of pulmonary hypertension and signs of right‐sided heart failure were examined.FindingsCases increased from three (1997) to 58 (2013). In 43.4%, foreign particles were moderate–abundant in extent. Cases with moderate–abundant emboli were more likely to have injection sites other than the cubital fossa [odds ratio (OR) = 2.4]. In 6.9% of cases emboli were also found in other organs. A foreign body inflammatory response was present in 45.3%, vascular scarring in 8.0%, signs of pulmonary hypertension in 10.2% and signs of right‐sided heart pathology in 5.4%. Cases with moderate–abundant deposition were more likely to have emboli in other organs (OR = 7.9), a foreign body inflammatory response (OR = 5.3), vascular scarring (OR = 3.4), signs of pulmonary hypertension (OR = 5.4) and right‐sided heart pathology (OR = 5.3).ConclusionsCases of foreign body pulmonary embolization (resulting from injecting crushed tablets meant for oral use, such as benzodiazepines and pharmaceutical opioids) in Sydney, Australia increased markedly from 1997 to 2013. In a large proportion there were clinical consequences. More extensive embolization was associated with higher levels of pulmonary hypertension and right‐sided heart pathology.
4‐Fluoroamphetamine in the Netherlands: more than a one‐night stand
Authors: Linsen Felix , Koning Raoul P. J. , van Laar Margriet , Niesink Raymond J. M. , Koeter Maarten W. , Brunt Tibor M. 
Published: March 2015

AbstractAimsTo investigate the temporal pattern of appearance of a new psychoactive substance (4‐fluoroamphetamine) on the Dutch drug market, as well as its patterns of use and effects.DesignData from the Drug Information and Monitoring System (DIMS) was used to investigate the emergence of 4‐fluoroamphetamine on the Dutch drug market. An on‐line questionnaire was used to study its patterns of use and effects.SettingDutch drug‐related websites and social media.ParticipantsA convenience sample of 249 life‐time 4‐fluoroamphetamine users was recruited through the internet.MeasurementsSamples containing 4‐fluoroamphetamine were extracted from the DIMS database for further investigation. Patterns of use, settings of use and the subjective effects of 4‐fluoroamphetamine, amphetamine and 3,4‐methylenedioxymethamphetamine (MDMA) were investigated with the on‐line questionnaire.Findings4‐Fluoroamphetamine was first encountered on the Dutch drug market, sold mainly as amphetamine or ecstasy (MDMA), between 2007 and 2009. These misrepresented drug samples declined when the MDMA and amphetamine markets recovered after a period of shortage, whereas purposefully bought 4‐fluoroamphetamine samples showed an increase. Survey results showed that 4‐fluoroamphetamine is used predominantly [77.1%, 95% confidence interval (CI) = 72.0–82.3] for its specific effects, rather than its legal status (17.7%, 95% CI = 10.7–22.1). The subjective effects of 4‐fluoroamphetamine were compared with those of amphetamine and MDMA. Subjective effect scores of 4‐fluoroamphetamine ranged between those of amphetamine and MDMA.ConclusionsThe stimulant 4‐fluoroamphetamine is increasingly popular in the Netherlands, which might be due to its subjective effects profile, which lies intermediate between amphetamine and MDMA.
Effects of density and predation risk on leaf litter processing by Phylloicus sp.
Authors: Rezende Renan de Souza , Leite Gustavo Figueiredo Marques , De‐Lima Anderson Kennedy Soares , Silva Filho Luis Antonio Braga Da , Chaves Camila Vilarinho Costa , Prette Ana Cecilia Holler , Freitas June Spriger , Gonçalves Júnior José Francisco 
Published: March 2015

AbstractThe allochthonous detritus that accumulates in the substrate of streams is used by aquatic invertebrate shredders for shelter and food. Shredders are considered rare in tropical systems, and little information is available about the role of density effects and predation risk (associated with the perception of predators by prey) in relationship to the resources used by these organisms. The aim of this study was to examine experimentally the effects of increased predation risk and of the density of Phylloicus sp. (i.e. of two types of biological relationships) on the processing of the leaf litter of Nectandra megapotamica (Spreng.) Mez. Phylloicus sp. can use leaf litter for case building and as a food resource. The density effect was measured using four treatments that differed only in the number of individuals (one, two, three or four). A second experiment with five treatments was performed to test the risk of non‐lethal predation on detritus consumption (shelter and food) by Phylloicus sp. (T1: Caddisfly; T2: Mayfly; T3: Astyanax sp./fish; T4: Damselflies; T5: Stonefly). A single Phylloicus and one other organism (a potential predator blocked with 0.5 mm fine mesh) were placed in each tank (0.002 m3 volume). We observed a negative effect of density on per capita litter consumption (experiment 1). The low density of Phylloicus may be a natural factor that decreases intraspecific competition. In the presence of fish, Phylloicus showed the lowest amount of litter processing observed in the experiment, indicating top‐down control (experiment 2). In treatments that involved the presence of invertebrates (non‐predatory and predatory), Phylloicus showed the highest amount and an intermediate amount of leaf litter processing, respectively (experiment 2). This observation also suggests that the predation effect is more probable for specific predator–prey pairs. Population density and predation risk in Phylloicus may be important factors controlling leaf litter processing.
Socio‐contextual factors are linked to differences in the course of problem drinking in midlife: A discordant‐twin study
Authors: M. Blonigen Daniel , Burroughs Thomas , Randolph Haber Jon , Jacob Theodore 
Published: March 2015

BackgroundCourse of alcohol use disorders (AUD) during midlife is understudied, and most research designs are unable to attribute an unambiguous environmental explanation to observed findings.Objectives & MethodsTest whether socio‐contextual factors are linked to differences in the course of problem drinking during midlife. Participants were 163 monozygotic and dizygotic twin pairs concordant for a history of AUD but discordant on problem drinking in the past 10 years.ResultsFrequency of drinking with spouse, and peer and emotional problems were associated with discordance.Conclusions and Scientific SignificanceSocio‐contextual factors are linked to differences in course of problem drinking in midlife and are not confounded by genetic effects. (Am J Addict 2015;24:193–196)
Precautionary allergen labelling: perspectives from key stakeholder groups
Authors: DunnGalvin A. , Chan C.‐H. , Crevel R. , Grimshaw K. , Poms R. , Schnadt S. , Taylor S. L. , Turner P. , Allen K. J. , Austin M. , Baka A. , Baumert J. L. , Baumgartner S. , Beyer K. , Bucchini L. , Fernández‐Rivas M. , Grinter K. , Houben G. F. , Hourihane J. , Kenna F. , Kruizinga A. G. , Lack G. , Madsen C. B. , Clare Mills E. N. , Papadopoulos N. G. , Alldrick A. , Regent L. , Sherlock R. , Wal J.‐M. , Roberts G. 
Published: March 2015

AbstractPrecautionary allergen labelling (PAL) was introduced by the food industry to help manage and communicate the possibility of reaction from the unintended presence of allergens in foods. However, in its current form, PAL is counterproductive for consumers with food allergies. This review aims to summarize the perspectives of all the key stakeholders (including clinicians, patients, food industry and regulators), with the aim of defining common health protection and risk minimization goals. The lack of agreed reference doses has resulted in inconsistent application of PAL by the food industry and in levels of contamination that prompt withdrawal action by enforcement officers. So there is a poor relationship between the presence or absence of PAL and actual reaction risk. This has led to a loss of trust in PAL, reducing the ability of consumers with food allergies to make informed choices. The result has been reduced avoidance, reduced quality of life and increased risk‐taking by consumers who often ignore PAL. All contributing stakeholders agree that PAL must reflect actual risk. PAL should be transparent and consistent with rules underpinning decision‐making process being communicated clearly to all stakeholders. The use of PAL should indicate the possible, unintended presence of an allergen in a consumed portion of a food product at or above any proposed action level. This will require combined work by all stakeholders to ensure everyone understands the approach and its limitations. Consumers with food allergy then need to be educated to undertake individualized risk assessments in relation to any PAL present.
Effect of Slip Time in Forming Neo‐Esophageal Stenosis After Replacement of a Thoracic Esophagus With Nitinol Artificial Esophagus
Authors: Liang Xian‐Liang , Liang Jian‐Hui 
Published: March 2015

AbstractAttempts have been made to investigate the effect of slip time of nitinol artificial esophagus for forming neo‐esophageal stenosis after replacement of a thoracic esophagus with nitinol artificial esophagus in 20 experimental pigs. The pigs whose slip time was less than 90 days postoperatively had severe dysphagia (Bown's III) immediately after they were fed, and the dysphagia aggravated gradually later on (Bown's III–IV). The pigs whose slip time was more than 90 days postoperatively had mild/moderate dysphagia (Bown's I–II) immediately after they were fed, and the dysphagia relieved gradually later on (Bown's II‐I‐0). The ratios between the diameter of neo‐esophagus in different slip time and normal esophagus were 25% (at 2 months postoperatively), 58% (at 4 months postoperatively), and 93% (at 6 months postoperatively), respectively. The relationship between nitinol artificial esophagus slip time and neo‐esophageal stenosis showed a positive correlation. After replacement of a thoracic esophagus with nitinol artificial esophagus, the artificial esophageal slip time not only affected the original diameter of the neo‐esophagus immediately, but also affected the neo‐esophageal scar stricture forming process later on. The narrowing of neo‐esophagus is caused by overgrowth of scar tissue. But there is the positive correlation between artificial esophagus slip time and neo‐esophageal stenosis, so this can be a way of overcoming neo‐esophageal stenosis by delaying slip time of artificial esophagus.
Numerical and In Vitro Investigation of a Novel Mechanical Circulatory Support Device Installed in the Descending Aorta
Authors: Rezaienia Mohammad Amin , Rahideh Akbar , Alhosseini Hamedani Borhan , Bosak Dawid Emanuel Maximilian , Zustiak Silviya , Korakianitis Theodosios 
Published: March 2015

AbstractTraditional implantation techniques of assist devices from the apex of left ventricle to the ascending or descending aorta are highly invasive and carry substantial complications for end‐stage heart failure patients. This study has shown that the descending aorta can be a promising location to install an implantable mechanical circulatory support with minimally invasive surgery. Herein, the hemodynamic effect of an in‐house prototyped pump implanted in the descending aorta was investigated numerically as well as experimentally. The objective of the experimental study is met by using the in‐house simulator of the cardiovascular loop replicating congestive heart failure conditions. The objective of the numerical study was met by using the modified version of the concentrated lumped parameter model developed by the same team. The results show that the pump placement in the descending aorta can lead to an improvement in pulsatility. The pressure drop, generated at the upstream of the pump, facilitates the cardiac output as a result of after‐load reduction, but at the same time, it induces a slight drop in the carotid as well as the coronary perfusion. The pressure rise, generated at the downstream of the pump, improves the blood perfusion in the renal circulation.
Optimal Design of Litz Wire Coils With Sandwich Structure Wirelessly Powering an Artificial Anal Sphincter System
Authors: Ke Lei , Yan Guozheng , Yan Sheng , Wang Zhiwu , Li Xiaoyang 
Published: March 2015

AbstractTranscutaneous energy transfer system (TETS) is widely used to energize implantable biomedical devices. As a key part of the TETS, a pair of applicable coils with low losses, high unloaded Q factor, and strong coupling is required to realize an efficient TETS. This article presents an optimal design methodology of planar litz wire coils sandwiched between two ferrite substrates wirelessly powering a novel mechanical artificial anal sphincter system for treating severe fecal incontinence, with focus on the main parameters of the coils such as the wire diameter, number of turns, geometry, and the properties of the ferrite substrate. The theoretical basis of optimal power transfer efficiency in an inductive link was analyzed. A set of analytical expressions are outlined to calculate the winding resistance of a litz wire coil on ferrite substrate, taking into account eddy‐current losses, including conduction losses and induction losses. Expressions that describe the geometrical dimension dependence of self‐ and mutual inductance are derived. The influence of ferrite substrate relative permeability and dimensions is also considered. We have used this foundation to devise an applicable coil design method that starts with a set of realistic constraints and ends with the optimal coil pair geometries. All theoretical predictions are verified with measurements using different types of fabricated coils. The results indicate that the analysis is useful for optimizing the geometry design of windings and the ferrite substrate in a sandwich structure as part of which, in addition to providing design insight, allows speeding up the system efficiency‐optimizing design process.
Simulation of Ventricular, Cavo‐Pulmonary, and Biventricular Ventricular Assist Devices in Failing Fontan
Authors: Di Molfetta Arianna , Amodeo Antonio , Fresiello Libera , Trivella Maria Giovanna , Iacobelli Roberta , Pilati Mara , Ferrari Gianfranco 
Published: March 2015

AbstractConsidering the lack of donors, ventricular assist devices (VADs) could be an alternative to heart transplantation for failing Fontan patients, in spite of the lack of experience and the complex anatomy and physiopathology of these patients. Considering the high number of variables that play an important role such as type of Fontan failure, type of VAD connection, and setting (right VAD [RVAD], left VAD [LVAD], or biventricular VAD [BIVAD]), a numerical model could be useful to support clinical decisions. The aim of this article is to develop and test a lumped parameter model of the cardiovascular system simulating and comparing the VAD effects on failing Fontan. Hemodynamic and echocardiographic data of 10 Fontan patients were used to simulate the baseline patients’ condition using a dedicated lumped parameter model. Starting from the simulated baseline and for each patient, a systolic dysfunction, a diastolic dysfunction, and an increment of the pulmonary vascular resistance were simulated. Then, for each patient and for each pathology, the RVAD, LVAD, and BIVAD implantations were simulated. The model can reproduce patients’ baseline well. In the case of systolic dysfunction, the LVAD unloads the single ventricle and increases the cardiac output (CO) (35%) and the arterial systemic pressure (Pas) (25%). With RVAD, a decrement of inferior vena cava pressure (Pvci) (39%) was observed with 34% increment of CO, but an increment of the single ventricle external work (SVEW). With the BIVAD, an increment of Pas (29%) and CO (37%) was observed. In the case of diastolic dysfunction, the LVAD increases CO (42%) and the RVAD decreases the Pvci, while both increase the SVEW. In the case of pulmonary vascular resistance increment, the highest CO (50%) and Pas (28%) increment is obtained with an RVAD with the highest decrement of Pvci (53%) and an increment of the SVEW but with the lowest VAD power consumption. The use of numerical models could be helpful in this innovative field to evaluate the effect of VAD implantation on Fontan patients to support patient and VAD type selection personalizing the assistance.
Codeine should not be prescribed for breastfeeding mothers or children under the age of 12
Authors: Lazaryan Moran , Shasha‐Zigelman Chen , Dagan Zachi , Berkovitch Matitiahu 
Published: March 2015

AbstractMedical regulatory authorities, including the Food and Drug Administration and European Medicine Agency, have published restrictions regarding the use of codeine in paediatric patients and breastfeeding mothers. This review explored the various parameters that are involved in the metabolism and toxicology of codeine in these two populations.ConclusionThe growing volume of data on potential serious adverse events and questionable efficacy indicates that codeine should not be prescribed for children under 12 years of age and breastfeeding mothers.
Decreased stress resilience in young men significantly increases the risk of subsequent peptic ulcer disease – a prospective study of 233 093 men in Sweden
Authors: Melinder C. , Udumyan R. , Hiyoshi A. , Brummer R. J. , Montgomery S. 
Published: March 2015

SummaryBackgroundPsychosocial stress may influence peptic ulcer disease (PUD) risk, but it can be difficult to identify reliably whether stressful exposures pre‐dated disease. The association of stress resilience (susceptibility to stress) with subsequent PUD risk has been incompletely investigated.AimTo assess if stress resilience in adolescence is associated with subsequent PUD risk.MethodsThe participants comprised of 233 093 men resident in Sweden, born 1952–1956 and assessed for compulsory military conscription during 1969–1976, with data provided by national Swedish registers. Stress resilience was evaluated through semi‐structured interviews by a certified psychologist. Cox regression assessed the association between stress resilience in adolescence and the risk of PUD from 1985 to 2009, between ages 28 and 57 years, with adjustment for parental socioeconomic index, household crowding and number of siblings in childhood, as well as cognitive function and erythrocyte sedimentation rate in adolescence.ResultsIn total, 2259 first PUD diagnoses were identified. Lower stress resilience in adolescence is associated with a higher risk of PUD in subsequent adulthood: compared with high resilience, the adjusted hazard ratios (and 95% CI) are 1.84 (1.61–2.10) and 1.23 (1.09–1.38) for low and moderate stress resilience, respectively.ConclusionStress may be implicated in the aetiology of PUD and low stress resilience is a marker of risk.
The pharmacokinetics of peginterferon lambda‐1a following single dose administration to subjects with impaired renal function
Authors: Hruska Matthew W. , Adamczyk Robert , Colston Elizabeth , Hesney Michael , Stonier Michele , Myler Heather , Bertz Richard 
Published: March 2015

AbstractAimsThis open label study was conducted to assess the effect of renal impairment (RI) on the pharmacokinetics (PK) of peginterferon lambda‐1a (Lambda).MethodsSubjects (age 18–75 years, BMI 18–35 kg m–2) were enrolled into one of five renal function groups: normal (n = 12), mild RI (n = 8), moderate RI (n = 8), severe RI (n = 7), end‐stage renal disease (ESRD, n = 8) based on estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease (MDRD) equation. Subjects received a single dose of Lambda (180 µg) subcutaneously on day 1 followed by PK serum sample collections through day 29. Safety, tolerability and immunogenicity data were collected through day 43. PK parameters were estimated and summarized by group. Geometric mean ratios (GMR) and 90% confidence intervals (CIs) were calculated between normal and RI groups.ResultsWith decreasing eGFR, Lambda exposure (Cmax, AUC) increased while apparent clearance (CL/F) and apparent volume of distribution (V/F) decreased. Relative to subjects with normal renal function (geometric mean AUC = 99.5 ng ml–1 h), Lambda exposure estimates (AUC) were slightly increased in the mild RI group (geometric mean [90% CI]: 1.20 [0.82, 1.77]) and greater in the moderate (1.95 [1.35, 2.83]), severe RI (1.95 [1.30, 2.93]) and ESRD (1.88 [1.30, 2.73]) groups. Lambda was generally well tolerated.ConclusionsThe results demonstrated that RI reduces the clearance of Lambda and suggests that dose modifications may not be required in patients with mild RI but may be required in patients with moderate to severe RI or ESRD.