bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mortality and loss to follow‐up among HIV‐infected persons on long‐term antiretroviral therapy in Latin America and the Caribbean
Authors: Carriquiry Gabriela , Fink Valeria , Koethe John Robert , Giganti Mark Joseph , Jayathilake Karu , Blevins Meridith , Cahn Pedro , Grinsztejn Beatriz , Wolff Marcelo , Pape Jean William , Padgett Denis , Madero Juan Sierra , Gotuzzo Eduardo , McGowan Catherine Carey , Shepherd Bryan Earl 
Published: July 2015

IntroductionLong‐term survival of HIV patients after initiating highly active antiretroviral therapy (ART) has not been sufficiently described in Latin America and the Caribbean, as compared to other regions. The aim of this study was to describe the incidence of mortality, loss to follow‐up (LTFU) and associated risk factors for patients enrolled in the Caribbean, Central and South America Network (CCASAnet).MethodsWe assessed time from ART initiation (baseline) to death or LTFU between 2000 and 2014 among ART‐naïve adults (≥18 years) from sites in seven countries included in CCASAnet: Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru. Kaplan‐Meier techniques were used to estimate the probability of mortality over time. Risk factors for death were assessed using Cox regression models stratified by site and adjusted for sex, baseline age, nadir pre‐ART CD4 count, calendar year of ART initiation, clinical AIDS at baseline and type of ART regimen.ResultsA total of 16,996 ART initiators were followed for a median of 3.5 years (interquartile range (IQR): 1.6–6.2). The median age at ART initiation was 36 years (IQR: 30–44), subjects were predominantly male (63%), median CD4 count was 156 cells/µL (IQR: 60–251) and 26% of subjects had clinical AIDS prior to starting ART. Initial ART regimens were predominantly non‐nucleoside reverse transcriptase inhibitor based (86%). The cumulative incidence of LTFU five years after ART initiation was 18.2% (95% confidence interval (CI) 17.5–18.8%). A total of 1582 (9.3%) subjects died; the estimated probability of death one, three and five years after ART initiation was 5.4, 8.3 and 10.3%, respectively. The estimated five‐year mortality probability varied substantially across sites, from 3.5 to 14.0%. Risk factors for death were clinical AIDS at baseline (adjusted hazard ratio (HR)=1.65 (95% CI 1.47–1.87); p<0.001), lower baseline CD4 (HR=1.95 (95% CI 1.63–2.32) for 50 vs. 350 cells/µL; p<0.001) and older age (HR=1.47 (95% CI 1.29–1.69) for 50 vs. 30 years at ART initiation; p<0.001).ConclusionsIn this large, long‐term study of mortality among HIV‐positive adults initiating ART in Latin America and the Caribbean, overall estimates of mortality were heterogeneous, generally falling between those reported in high‐income countries and sub‐Saharan Africa.
Increase in Utilization of Afterhours Medical Imaging: A Study of Three Canadian Academic Centers
Authors: Chaudhry Shivani , Dhalla Irfan , Lebovic Gerald , Rogalla Patrik , Dowdell Timothy 
Published: July 2015

Objectives The objectives of our study were to assess trends in afterhours medical imaging utilization for emergency department (ED) and inpatient (IP) patient populations from 2006-2013, including analysis by modality and specialty and with adjustment for patient volume. Methods For this retrospective study, we reviewed the number of CT, MRI, and ultrasound studies performed for the ED and IP patients during the afterhours time period (5pm - 8am on weekdays and 24 hours on weekends and statutory holidays) from 2006-2013 at three different Canadian academic hospitals. We used the Jonckheere-Terpstra (JT) test to determine statistical significance of imaging and patient volume trends. A regression model was used to examine whether there was an increasing trend over time in the volume of imaging tests per 1000 patients. Results For all three sites from 2006-2013 during the afterhours time period: There was a statistically significant increasing trend in total medical imaging volume, which also held true when the volumes were assessed by modality and by specialty. There was a statistically significant increasing trend in ED and IP patient volume. When medical imaging volumes were adjusted for patient volumes, there was a statistically significant increasing trend in imaging being performed per patient. Conclusion Afterhours medical imaging volumes demonstrated a statistically significant increasing trend at all three sites from 2006-2013 when assessed by total volume, modality, and specialty. During the same time period and at all three sites, the ED and IP patient volumes also demonstrated a statistically significant increasing trend with more medical imaging, however, being performed per patient.
Contrast-Enhanced Computed Tomography Evaluation of Hepatic Metastases in Breast Cancer Patients before and after Cytotoxic Chemotherapy or Targeted Therapy
Authors: He Hongying , Cai Chunyan , Charnsangavej Chusilp , Theriault Richard L. , Green Marjorie , Quraishi Mohammad A. , Yang Wei T. 
Published: July 2015

Purpose To evaluate change in size vs computed tomography (CT) density of hepatic metastases in breast cancer patients before and after cytotoxic chemotherapy or targeted therapy. Methods A database search in a single institution identified 48 breast cancer patients who had hepatic metastases treated with either cytotoxic chemotherapy alone or targeted therapy alone, and who had contrast-enhanced CT (CECT) scans of the abdomen at baseline and within 4 months of initiation of therapy in the past 10 years. Two radiologists retrospectively evaluated CT scans and identified up to 2 index lesions in each patient. The size (centimeters) of each lesion was measured according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria, and CT density (Hounsfield units) was measured by drawing a region of interest around the margin of the entire lesion. The percent change in sum of lesion size and mean CT density on pre- and post-treatment scans was computed for each patient; results were compared within each treatment group. Results Thirty-nine patients with 68 lesions received cytotoxic chemotherapy only; 9 patients with 15 lesions received targeted therapy only. The mean percent changes in sum of lesion size and mean CT density were statistically significant within the cytotoxic chemotherapy group before and after treatment, but not significant in the targeted therapy group. The patients in the targeted therapy group tend to have better 2-year survival. The patients who survived at 2 years tend to have more decrease in tumour size in the cytotoxic chemotherapy group. Conclusion Cytotoxic chemotherapy produced significant mean percent decrease in tumour size and mean CT density of hepatic metastases from breast cancer before and after treatment, whereas targeted therapy did not. Nonetheless, there is a trend that the patients in the targeted therapy group had better 2-year survival rate. This suggests that RECIST is potentially inadequate in evaluating tumour response in breast cancer liver metastases treated with targeted therapy alone, calling for an alternative marker for response evaluation in this subset of patients.
A Novel Method to Decontaminate Surgical Instruments for Operational and Austere Environments
Authors: Knox Randy W. , Demons Samandra T. , Cunningham Cord W. 
Published: July 2015

Objective The purpose of this investigation was to test a field-expedient, cost-effective method to decontaminate, sterilize, and package surgical instruments in an operational (combat) or austere environment using chlorhexidine sponges, ultraviolet C (UVC) light, and commercially available vacuum sealing. Methods This was a bench study of 4 experimental groups and 1 control group of 120 surgical instruments. Experimental groups were inoculated with a 106 concentration of common wound bacteria. The control group was vacuum sealed without inoculum. Groups 1, 2, and 3 were first scrubbed with a chlorhexidine sponge, rinsed, and dried. Group 1 was then packaged; group 2 was irradiated with UVC light, then packaged; group 3 was packaged, then irradiated with UVC light through the bag; and group 4 was packaged without chlorhexidine scrubbing or UVC irradiation. The UVC was not tested by itself, as it does not grossly clean. The instruments were stored overnight and tested for remaining colony forming units (CFU). Results Data analysis was conducted using analysis of variance and group comparisons using the Tukey method. Group 4 CFU was statistically greater ( P < .001) than the control group and groups 1 through 3. There was no statistically significant difference between the control group and groups 1 through 3. Conclusions Vacuum sealing of chlorhexidine-scrubbed contaminated instruments with and without handheld UVC irradiation appears to be an acceptable method of field decontamination. Chlorhexidine scrubbing alone achieved a 99.9% reduction in CFU, whereas adding UVC before packaging achieved sterilization or 100% reduction in CFU, and UVC through the bag achieved disinfection.
Prolonged Exposure Dermatosis: Reporting High Incidence of an Undiagnosed Facial Dermatosis on a Winter Wilderness Expedition
Authors: Totten Jodie E. , Brock Douglas M. , Schimelpfenig Tod D. , Hopkin Justin L. , Colven Roy M. 
Published: July 2015

Objective Previously unclassified inflammatory skin lesions referred to as sun bumps have been observed throughout the year on participants of wilderness trips; however, the underlying cause and diagnosis remain unclear. The purpose of this prospective observational study was to document the incidence, characteristics, and risk factors associated with these skin lesions as they occurred on a winter wilderness expedition. Methods For this study, the lesions were defined as pruritic or erythematous skin lesions occurring while in the wilderness. Seventy-four participants in a wilderness ski touring course in Wyoming fully completed a 44-question written survey concerning occurrence and risk factors for these lesions. Weather information and photographs were collected. Results Twenty-six percent of participants had similar lesions. The lesions were described as edematous pale papules and plaques with erosions and crusts on an erythematous background. The face was involved in 90% of affected persons. Lesions occurred after an average of 8.7 days in the wilderness and resolved 10.6 days later. Skin that was less prone to sunburn was associated with a decreased incidence (odds ratio 0.44). No association could be found between lesion incidence and history of polymorphous light eruption, sun exposure, ambient temperature, affected contacts, sex, or body mass index. Conclusions Overall, the lesions were common among study participants but occurred only after prolonged exposure to wilderness conditions. It was not possible to classify the skin condition as an example of any known diagnosis. We propose the name “prolonged exposure dermatosis” for this condition until further studies better define its etiology, prevention, and treatment.
Epidural Hematoma Treated Conservatively: When to Expect the Worst
Authors: Basamh Mohammed , Robert Antony , Lamoureux Julie , Saluja Rajeet Singh , Marcoux Judith 
Published: July 2015

ABSTRACTBackground: The Brain Trauma Foundation’s 2006 surgical guidelines have objectively defined the epidural hematoma (EDH) patients who can be treated conservatively. Since then, the literature has not provided adequate clues to identify patients who are at higher risk for EDH progression (EDHP) and conversion to surgical therapy. The goal of our study was to identify those patients. Methods: We carried a retrospective review over a 5-year period of all EDH who were initially triaged for conservative management. Demographic data, injury severity and history, neurological status, use of anticoagulants or anti-platelets, radiological parameters, conversion to surgery and its timing, and Glasgow Outcome Scale were analyzed. Bivariate association and further logistic regression were used to point out the significant predictors of EDHP and conversion to surgery. Results: 125 patients (75% of all EDH) were included. The mean age was 39.1 years. The brain injury was mild in 62.4% of our sample and severe in 14.4%. Only 11.2% of the patients required surgery. Statistical comparison showed that younger age (p< 0.0001) and coagulopathy (p=0.009) were the only significant factors for conversion to surgery. There was no difference in outcomes between patients who had EDHP and those who did not. Conclusions: Most traumatic EDH are not surgical at presentation. The rate of conversion to surgery is low. Significant predictors of EDHP are coagulopathy and younger age. These patients need closer observation because of a higher risk of EDHP. Outcome of surgical conversion was similar to successful conservative management.
Civil-Military Engagement: An Empirical Account of Humanitarian Perceptions of Civil-Military Coordination During the Response to Typhoon Haiyan
Authors: Bollettino Vincenzo 
Published: July 2015

AbstractObjectiveThis study sought to identify how humanitarian actors in natural disasters coordinate (or communicate) with the military to identify the needs of disaster-affected populations, identify how coordination should be undertaken for the delivery of relief goods, perceive the effectiveness of such coordination, perceive the role that training played in preparation for coordinating with the military and the effectiveness of this training, and view the overall civil-military engagement and its implications for the independence of the humanitarian sector.MethodsA survey instrument focused on participant perceptions of the civil-military engagement in response to Typhoon Haiyan in the Philippines was sent to country directors and agency leads who played a role in the response.ResultsAlthough the data supported anecdotal accounts that the coordination between civilian and military actors during the disaster relief efforts in Typhoon Haiyan worked well, they also revealed that fewer than half of the respondents were familiar with the Guidelines on the Use of Foreign Military and Civil Defence Assets in Disaster Relief (the “Oslo Guidelines”) and only 12% of respondents thought that the Oslo Guidelines were used to develop organizational policy on humanitarian aid agency engagement with military actors.ConclusionsHumanitarians felt that international militaries and the Philippines Armed Forces played an important role in ensuring that aid reached people in need, particularly in the early days of the response. However, less than half of the respondents were familiar with the Oslo Guidelines. (Disaster Med Public Health Preparedness. 2016;10:7-10)
Nonlinear optimal suppression of vortex shedding from a circular cylinder
Authors: Mao X. , Blackburn H. M. , Sherwin S. J. 
Published: July 2015

This study is focused on two- and three-dimensional incompressible flow past a circular cylinder for Reynolds number $\mathit{Re}\leqslant 1000$. To gain insight into the mechanisms underlying the suppression of unsteadiness for this flow we determine the nonlinear optimal open-loop control driven by surface-normal wall transpiration. The spanwise-constant wall transpiration is allowed to oscillate in time, although steady forcing is determined to be most effective. At low levels of control cost, defined as the square integration of the control, the sensitivity of unsteadiness with respect to wall transpiration is a good approximation of the optimal control. The distribution of this sensitivity suggests that the optimal control at small magnitude is achieved by applying suction upstream of the upper and lower separation points and blowing at the trailing edge. At high levels of wall transpiration, the assumptions underlying the linearized sensitivity calculation become invalid since the base flow is eventually altered by the size of the control forcing. The large-magnitude optimal control is observed to spread downstream of the separation point and draw the shear layer separation towards the rear of the cylinder through suction, while blowing along the centreline eliminates the recirculation bubble in the wake. We further demonstrate that it is possible to completely suppress vortex shedding in two- and three-dimensional flow past a circular cylinder up to $\mathit{Re}=1000$, accompanied by 70 % drag reduction when a nonlinear optimal control of moderate magnitude (with root-mean-square value 8 % of the free-stream velocity) is applied. This is confirmed through linearized stability analysis about the steady-state solution when the nonlinear optimal wall transpiration is applied. While continuously distributed wall transpiration is not physically realizable, the study highlights localized regions where discrete control strategies could be further developed. It also highlights the appropriate range of application of linear and nonlinear optimal control to this type of flow problem.
Genetic gains in grain yield under nitrogen stress following three decades of breeding for drought tolerance andStrigaresistance in early maturing maize
Authors: BADU-APRAKU B. , FAKOREDE M. A. B. , OYEKUNLE M. , AKINWALE R. O. 
Published: July 2015

SUMMARYBreeding for resistance toStriga hermonthicaDel. (Benth) and tolerance to drought has been a major strategy to improve maize (Zea maysL.) production and productivity in West and Central Africa during the last three decades. The three decades consisted of three breeding periods or eras based on the germplasm and methodologies used; that is, 1988–2000, 2001–06 and 2007–11. A total of 50 early maturing cultivars, combiningStrigaresistance with drought tolerance were developed, including 15, 16 and 19 cultivars for the three periods, respectively. Although the cultivars were not selected intentionally for low-nitrogen (N) tolerance, it was hypothesized that tolerance to low-N had been significantly improved while selecting for drought tolerance andStrigaresistance. This hypothesis was tested by evaluating the 50 cultivars in 2010 and 2011 in Nigeria at Mokwa and Ile-Ife under both low-N (30 kg N/ha) and high-N (90 kg N/ha) levels. Under low-N conditions, grain yield improved from 2280 kg/ha during the first period to 2610 kg/ha during the third period, an increase of 165 kg/ha per period withr2of 0·99. Under high-N, yield increased from 3200 to 3650 kg/ha, an increase of 225 kg/ha andr2of 0·93. Relative gain per period was 30 kg/ha for the two N rates withr2values of 0·99 and 0·94 respectively. Grain yield performance of the 50 cultivars under low-N conditions adequately predicted their performance under high-N. Selection forStrigaresistance and drought tolerance in early maturing maize populations enhanced low-N tolerance in the maize cultivars derived from the populations. The improvement was higher in later than earlier breeding periods.
Calibration using adaptive model complexity for parallel and fiber-driven mechanisms
Authors: Skopec Tomáš , Šika Zbyněk , Valášek Michael 
Published: July 2015

SUMMARYThe paper deals with the development and application of a new adaptive calibration method that extends the geometrical calibration of mechanisms from calibration of only dimensions and kinematical joint positions into the calibration of kinematic joint shape imperfections. Originally unknown nonlinear properties of the kinematical pairs are adaptively included into the kinematical models that are used during the calibration calculation. The method uses description by local linear models and validity functions in order to identify and describe nonlinear properties of the kinematical pairs. During each calibration step, various models with growing complexity are considered before the best model variant is selected to improve calibration results. The method is mainly devoted to the structures with many loops like parallel and fiber-driven parallel mechanisms. The method is applied to parallel mechanism Sliding Star and parallel fiber-driven mechanism Quadrosphere.
Type synthesis of spatial 3-DoF parallel mechanisms with planar sub-chains using revised digital topological graphs and arrays
Authors: Lu Yi , Ye Nijia , Ding Ling 
Published: July 2015

SUMMARYType synthesis of spatial 3-DoF (degree of freedom) parallel mechanisms (PMs) with planar sub-chains is studied using the revised digital topology graph (r-DTGs) and arrays. First, many DTGs for type synthesis of spatial 3-DoF PMs are derived from their contracted graphs (CGs). Second, a complicated derivation of the DTG and an identification of an isomorphic DTG are transformed into a simple derivation of an array and an identification of an isomorphic array using a compiled program. Third, one or more spatial closed-loop chains in the derived DTGs are changed into the planar closed-loop chains by modifying digits marked in closed-loop chains, and the DTGs are transformed into the r-DTGs for the type synthesis of the spatial 3-DoF PMs with planar sub-chains. Finally, the 52 novel spatial 3-DoF PMs with the planar sub-chains are synthesized and verified by simulation mechanisms.
Challenges for the Aging Family in the People’s Republic of China
Authors: Phillips David R. , Feng Zhixin 
Published: July 2015

RÉSUMÉLa République populaire de Chine a la plus grande population de personnes âgées de tous les pays du monde. Il est une nation qui a subi d'énormes changements économiques, sociaux et démographiques au cours des dernières trois et demi-décennies. Traditionnellement, la famille a fourni le soutien social principal pour les personnes âgées; sous le socialisme précoce, cela a changé quelque peu, mais au cours des dernières années, l'importance du soutien de la famille a été réaffirmé. Cet article examine quatre questions essentielles (changements démographiques, le système du hukou, le réforme économique, et les caractéristiques générales entourant la modernisation) qui ont peu à peu changé la capacité des familles à fournir un soutien pour leur membres plus âgés. Domaines de recherche et orientations de politique publique sont considérés en vertu de lesquelles l'État pourrait prendre quelques responsabilités de la famille, soutenir la capacité des soins, et aussi améliorer la qualité et la quantité de l'aide pour les citoyens âgés.
Changing risk of environmental Campylobacter exposure with emerging poultry production systems in Ethiopia
Authors: BRENA M. C. , MEKONNEN Y. , BETTRIDGE J. M. , WILLIAMS N. J. , WIGLEY P. , SISAY TESSEMA T. , CHRISTLEY R. M. 
Published: July 2015

SUMMARYCampylobacter is a leading cause of diarrhoea, and its presence in chickens is a significant risk for zoonotic infection. Poultry production is becoming increasingly intensive in Ethiopia and is incorporating more high-producing breeds into traditionally managed smallholdings, especially in peri-urban areas. This cross-sectional study sampled 219 household environments in one peri-urban and two rural areas of Ethiopia, and an additional 20 semi-intensive farms in the peri-urban district. Campylobacter was detected by polymerase chain reaction (PCR)-specific assays in 44 samples; 16 of which could be identified as C. jejuni. Flocks in the peri-urban area were at significantly greater odds of detection, including those which only kept indigenous birds under a scavenging system. It was also noted that scavenging flocks of exotic high-production birds (Rhode Island Red) were at slightly greater risk, perhaps as exotic birds are under more stress when kept under traditional management systems. We suggest that changes to the system of chicken production may alter the ecology and epidemiology of Campylobacter in the environment, chickens and people, which may drive emergence of new epidemiological patterns of disease. Further research is needed to determine the extent to which the current management intensification and the distribution programmes of exotic and/or improved indigenous birds may alter Campylobacter epidemiology, ecology and public health risk, before their widespread adoption.