bluuebunny/crossref_metadata_2025_split huggingface dataset:
Customer-Base Concentration, Profitability, and the Relationship Life Cycle
Authors: Irvine Paul J. , Park Shawn Saeyeul , Yıldızhan Çelim 
Published: August 2015

ABSTRACT
Using a recently expanded dataset on supplier-customer links, we introduce a dynamic relationship life-cycle hypothesis. We hypothesize that the relation between customer-base concentration and profitability is significantly negative in the early years of the relationship, but becomes positive as the relationship matures. The key driver of this dynamic is the customer-specific investments that the relationship entails. These investments result in larger fixed costs, greater operating leverage, and a higher probability of losses early in the relationship, but can significantly benefit the firm as the relationship matures. Although many of these money-losing firms in early-stage relationships were not studied in Patatoukas (2012), we find a market reaction to increases in customer concentration similar to that in his paper. This result provides powerful confirmatory evidence of the value of customer concentration. We document one of the intangible benefits of customer concentration, technology sharing, and show how this benefit increases as the relationship matures.
JEL Classifications: L25; M41; G31; G33.
Dendritic cell–based immunotherapy targeting Wilms’ tumor 1 in patients with recurrent malignant glioma
Authors: Sakai Keiichi , Shimodaira Shigetaka , Maejima Shinya , Udagawa Nobuyuki , Sano Kenji , Higuchi Yumiko , Koya Terutsugu , Ochiai Takanaga , Koide Masanori , Uehara Shunsuke , Nakamura Midori , Sugiyama Haruo , Yonemitsu Yoshikazu , Okamoto Masato , Hongo Kazuhiro 
Published: August 2015

OBJECT
Dendritic cell (DC)-based vaccination is considered a potentially effective therapy against advanced cancer. The authors conducted a Phase I study to investigate the safety and immunomonitoring of Wilms’ tumor 1 (WT1)-pulsed DC vaccination therapy for patients with relapsed malignant glioma.

METHODS
WT1-pulsed and/or autologous tumor lysate-pulsed DC vaccination therapy was performed in patients with relapsed malignant gliomas. Approximately 1 × 107 to 2 × 107 pulsed DCs loaded with WT1 peptide antigen and/or tumor lysate were intradermally injected into the axillary areas with OK-432, a streptococcal preparation, at 2-week intervals for at least 5–7 sessions (1 course) during an individual chemotherapy regimen.

RESULTS
Ten patients (3 men, 7 women; age range 24–64 years [median 39 years]) with the following tumors were enrolled: glioblastoma (6), anaplastic astrocytoma (2), anaplastic oligoastrocytoma (1), and anaplastic oligodendroglioma (1). Modified WT1 peptide–pulsed DC vaccine was administered to 7 patients, tumor lysate-pulsed DC vaccine to 2 patients, and both tumor lysate–pulsed and WT1-pulsed DC vaccine to 1 patient. The clinical response was stable disease in 5 patients with WT1-pulsed DC vaccination. In 2 of 5 patients with stable disease, neurological findings improved, and MR images showed tumor shrinkage. No serious adverse events occurred except Grade 1–2 erythema at the injection sites. WT1 tetramer analysis detected WT1-reactive cytotoxic T cells after vaccination in patients treated with WT1-pulsed therapy. Positivity for skin reaction at the injection sites was 80% (8 of 10 patients) after the first session, and positivity remained for these 8 patients after the final session.

CONCLUSIONS
This study of WT1-pulsed DC vaccination therapy demonstrated safety, immunogenicity, and feasibility in the management of relapsed malignant gliomas.
The use of artificial dermis for corrective surgery on burn scars
Authors: Praditsuktavorn Banjerd , Muangman Pornprom 
Published: August 2015

Abstract

Background
Hypertrophic scarring from burn injuries on large skin areas is of great concern for both patients and attending physicians because of significant functional and cosmetic impairment. Surgery for scar corrections is challenging because of limitations on the availability of normal tissue. An alternative method for scar correction using artificial dermis is now possible. Artificial dermis can be used in the reconstruction of scars, burn injuries on large skin areas and in patients who do not have sufficient donor sites for skin grafts after scar excisions.

Objective
To report the efficacy of artificial dermis on a 20 years old Thai man with severe scar contracture from burn injuries.

Method
An open-label case study, the severe contracture case underwent scar excision and was applied with artificial dermis.

Result
A 20-year-old man had severe scar contractures on his left arm, forearm, and elbow, and a shearing wound with a scar at his left elbow. Total scar excision was done on his left arm, forearm, elbow, and hand, and then followed by application of artificial dermis on to the wounds. After 2 weeks, neodermis formation was observed, after which an ultrathin split thickness skin graft was applied to the wounds. One month after sugery, the patient could extend his left elbow fully and the cosmetic result is satisfactory.

Conclusion
Use of artificial dermis should be a new alternative modality in improving our strategy in correcting scar issues from burn injuries, especially on large burn scar areas with limited donor sites for skin grafts.
Development of an instrument for patient-reported outcomes in Thai patients with type 2 diabetes mellitus (PRO-DM-Thai)
Authors: Chuayruang Kanisshanone , Sriratanaban Jiruth , Hiransuthikul Narin , Suwanwalaikorn Sompongse 
Published: August 2015

Abstract

Background
Effectiveness of self-care and treatment of diabetes mellitus depends upon patient awareness of their own health and disease outcomes. Physician decisions are improved by insight into patient perspectives.

Objective
To develop an instrument for patient-reported outcomes in Thai patients with type 2 diabetes mellitus (PRO-DM-Thai).

Methods
The study consisted of: (1) content development using a literature review and in-depth interviews of providers and patients, and validity testing using a content validity index (CVI); (2) construct validity and reliability testing by confirmatory factor and Cronbach’s α analyses of data from a cross-sectional descriptive survey of 500 participants from May to June, 2011; and, (3) criterion-related validity from a cross-sectional analytical survey of 200 participants from September to November, 2011.

Results
PRO-DM-Thai passed all of the validity tests. The instrument comprises seven dimensions and 44 items, including physical function, symptoms, psychological well-being, self-care management, social well-being, global judgments of health, and satisfaction with care and flexibility of treatment. The CVI at the item-level (I-CVI) were between 0.83 to 1.00 and the scale-level average agreement (S-CVI/Ave) was 0.98. All dimension models had overall fit with empirical data, while the hypothesized model demonstrated a good fit (χ2 = 5.23; (df = 6), P > 0.05, AGFI = 0.986, RMSEA = 0.000). Cronbach’s α for the total scale was 0.91 and for the subscales was 0.72-0.90. The total scores effectively discriminated groups of patients with different levels of disease control.

Conclusion
PRO-DM-Thai showed satisfactory levels of validity and reliability when applied to Thai diabetic patients.
Cost-effectiveness analysis of highly concentrated n-3 polyunsaturated fatty acids in secondary prevention after myocardial infarction
Authors: Permpanich Adawan , Kulsomboon Vithaya , Udol Kamol 
Published: August 2015

Abstract

Background
Acute myocardial infarction (MI) is a leading cause of cardiovascular (CV) mortality and hospitalization. Survivors of acute MI have higher risk of subsequent CV events and death, compared to individuals without MI. Evidences have demonstrated the CV benefits of n-3 polyunsaturated fatty acids (PUFAs) in patients who experienced MI.

Objectives
We assessed the cost-effectiveness of highly concentrated n-3 polyunsaturated fatty acids (PUFAs) in addition to standard therapy compared with standard therapy alone in post-MI patients in Thailand.

Methods
A Markov model was constructed to assess costs, life years, and quality-adjusted life years (QALYs) with lifetime horizon in post-MI patients, on the basis of provider perspective. Input data were based on information from the Thai Acute Coronary Syndrome (ACS) Registry, a meta-analysis of mortality data and published articles. Outcomes have been presented as incremental cost-effectiveness ratios of life expectancy and quality-adjusted life expectancy. Deterministic and probabilistic sensitivity analyses were performed for key variables in the model.

Results
n-3 PUFAs increased life expectancy by 2.34 life-years at an incremental cost-effectiveness ratio (ICER) of 256,199 Thai baht (THB) per life-year gained (LYG), compared to the standard therapy alone in the base case analysis. The quality-adjusted life years (QALY) increased by 2.01 with ICER of 297,193 THB per QALY from n-3 PUFAs supplementation. Both ICER/QALY and ICER/LYG decreased as the age of patients increased. The incremental cost per QALY gained in post-MI patients aged 45 to 85 years old ranged from 216,200 THB to 414,049 THB.

Conclusion
Considering the current willingness-to-pay threshold of 160,000 THB/QALY, highly concentrated n-3 PUFAs as secondary prevention of MI appears not to be cost-effective compared to standard treatment alone in Thailand.
Is the SNAP-II score useful for predicting mortality in mechanically ventilated in neonates within the first 12 hours of admission?
Authors: Nakwan Narongsak , Wannaro Jeerawan , Chaiwiriyawong Pornpreenun 
Published: August 2015

Abstract

Background
Respiratory failure is a most serious neonatal disorder. A severity of illness assessment should be performed for mechanically ventilated infants to predict the probability of hospital mortality and to assist clinical decision making.

Objectives
To evaluate the ability of the Score for Neonatal Acute Physiology, version II (SNAP-II) to predict the mortality risk for the infants who are mechanically ventilated with positive pressure ventilation (PPV) at a neonatal intensive care unit (NICU).

Methods
A prospective observational cohort study was performed in a 12-bed level III NICU at Hat Yai Hospital between January 2010 and December 2010.

Results
During the study period, 46 infants were ventilated with PPV at admission. Of these, 8 died (17%) and 30 survived (83%). The overall mean SNAP-II score was significantly higher in the group of infants who died compared with those who survived (36.5 ± 11.5 vs. 22.3 ± 13.6, P < 0.01, respectively).The area under the receiver operating characteristic curve for the SNAP-II was 0.79 (95% confidence interval (CI) 0.66 to 0.92, P = 0.01). Every one-point increment of SNAP-II was associated with an odds ratio of 1.08 (95% CI 1.02 to 1.14, P < 0.01). The stratification of the two sets of scores when compared between groups showed that infants who had SNAP-II scores of ≥32 had the highest mortality risk with an odds ratio of 9.7 (95% CI 1.7 to 56.5) with sensitivity of 75.0% and specificity of 76.3%.

Conclusion
SNAP-II scores can significantly predict mortality in infants requiring mechanical PPV.
Comparison of exercise treadmill test, flow mediated dilatation, and inflammation in individuals with low risk of adverse cardiovascular events
Authors: Toprak Muhammed Sait , Ozturk Zeynep Gungor , Ekmekci Ozlem Balci , Ekmekci Hakan , Ikitimur Baris , Karadag Bilgehan , Cakmak Huseyin Altug , Ilerigelen Baris , Sonmez Huseyin 
Published: August 2015

Abstract

Background
The relationship between endothelial dysfunction, a risk factor for coronary artery disease, and the incidence of cardiovascular disease (CVD) in the general population is not well known.

Objectives
To determine the utility of an exercise treadmill test (ETT) combined with inflammatory markers to show endothelial dysfunction for individuals with a low risk of adverse cardiovascular (CV) events.

Methods
Biomarkers of inflammation (lipoprotein-related phospholipase A2 (Lp-PLA2) and high-sensitive C-reactive protein (hs-CRP)) and biomarkers of endothelial dysfunction (nitric oxide, oxidized low-density lipoprotein (Ox-LDL), and sialic acid) were assessed in 60 apparently healthy patients with a positive (+) or negative (−) ETT and across endothelial function assessed by flow mediated dilatation (FMD) and Lp-PLA2 tertiles.

Results
Lp-PLA2 levels were increased in ETT (−) compared with ETT (+) patients. Half of ETT (−) patients were found to have levels of Lp-PLA2 in the highest tertile. There was a significant inverse relationship between ETT and inflammatory biomarkers when adjusted for age, Lp-PLA2 (r = −0.28, P = 0.04), or hs-CRP (r = −0.35, P = 0.01). No differences were found for biomarkers of endothelial dysfunction. All variables were reassessed across FMD tertiles. Total lipids, Ox-LDL, triglyceride, and Lp-PLA2 were higher for the lowest FMD tertile.

Conclusion
The elevation of Lp-PLA2 in ETT (−) patients and the inverse relationship with inflammatory biomarkers, suggest that ETT cannot address endothelial dysfunction for individuals with apparently low risk of adverse CV events, and cannot be used for risk stratification of the general population.
Hepatic resection using ultrasonic surgical aspirator
Authors: Sriussadaporn Suvit , Sriussadaporn Sukanya , Pak-art Rattaplee , Kritayakirana Kritaya , Prichayudh Supparerk , Samorn Pasurachate 
Published: August 2015

Abstract

Background
Hepatic resections conducted for malignant tumors can be difficult because of the need to create cancer-free margins.

Objectives
To examine the outcome of hepatic resections after the introduction of a Cavitron Ultrasonic Surgical Aspirator (CUSA).

Methods
A retrospective study of patients who underwent hepatic resection by a single surgeon between April 1999 to March 2013.

Results
We included 101 patients with 104 hepatectomies. Most hepatic parenchymal transections were performed using a CUSA under intermittent hepatic inflow occlusion (Pringle maneuver). Thirty-five patients underwent a right hepatectomy, 11 a left hepatectomy, 6 a right hepatectomy and segment I resection, 6 a right lobectomy, and 46 underwent segmentectomies, wedge resections, or other types of hepatic resections. Biliary-enteric reconstruction with a Roux-en-Y limb of the jejunum to a hepatic duct of the hepatic remnant was performed in 28 patients. Operative time was 90–720 min (median 300 min, mean 327 ± 149 min). Operative blood transfusion was 0–17 units (median 3 units, mean 3.9 ± 3.6 units). Twenty-one hepatectomies were conducted without blood transfusion. Thirty-four postoperative complications occurred in 30 patients with a 9% reoperation rate. Perioperative mortality was 6%. Age, operative time, operative blood transfusion, reoperation, and complications were significantly associated with mortality.

Conclusion
Careful preoperative diagnosis and evaluation of patients, faultless surgical techniques, and excellent postoperative care are important to avoid potentially serious postoperative complications and mortality. The CUSA is an effective assisting device during hepatic parenchymal transection with a concomitant Pringle maneuver, apparently reducing operative blood loss.
Testicular function in patients with regular blood transfusion for thalassemia major
Authors: Siripunthana Sukumarn , Sahakitrungruang Taninee , Wacharasindhu Suttipong , Sosothikul Darintr , Supornsilchai Vichit 
Published: August 2015

Abstract

Background
Regular blood transfusion and iron chelation therapy have improved the quality of life of patients with thalassemia and increased their longevity, but transfusion also increases the frequency of endocrine complications, possibly because of iron deposition in the pituitary gland or the gonads, or both.

Objective
To evaluate testicular function in patients with thalassemia major by basal hormonal study, and identify risk factors for dysfunction.

Methods
We performed a cross-sectional study of 28 patients with thalassemia major aged 11.7 ± 1.8 (8–14.9) years (15 in prepuberty, 13 in puberty with no delayed puberty) who had regular blood transfusions. A normal control group comprised 64 boys who were matched for age and Tanner genital stage.

Results
The mean level of serum ferritin in the previous year was 1,575 ± 642 ng/mL, and the onset of blood transfusion was at 3.8 ± 2.3 years and iron chelation therapy was 6.6 ± 2.8 years. The trend for anti-Müllerian hormone levels in patients and controls was similar with age, and although higher in the patients, particularly at Tanner stage II, was not significantly different. Testosterone levels were lower in the patients compared with controls; particularly at Tanner stages IV–V (290.88 vs. 537.4 ng/dL, P < 0.05). Serum follicle-stimulating hormone and luteinizing hormone levels were not significantly different between the groups at any Tanner stage.

Conclusion
Patients who received regular blood transfusions had normal Sertoli cell function. Leydig cell dysfunction may occur, even though the patients had a normal pubertal onset.
Time course of concurrent infection with dengue virus serotypes 2 and 4 detected in urine
Authors: Sriprapun Methee , Laosakul Chalinee , Krajiw Sunisa , Arunyingmongkol Kesinee , Siriyasatien Padet , Kulwichit Wanla 
Published: August 2015

Abstract

Background
In hyperendemic areas, concurrent multiserotype dengue virus (DENV) infections commonly occur in both humans and in mosquito vectors. Previous studies have focused on single blood specimens.

Objectives
To illustrate and characterize the time course of mixed infection with DENV serotypes 2 (DENV2) and 4 (DENV4) in a single case.

Materials and methods
Plasma, saliva, and urine were collected from a patient diagnosed with dengue hemorrhagic fever grade II and secondary DENV infection on days 7, 18, and 31 of his illness. DENV RNA detection was performed using 2 DENV-specific reverse transcriptase-polymerase chain reaction protocols. Cloning and sequencing were performed to quantify the major and minor viral populations in dual-serotype-infected specimen(s). Genotypes of both DENV serotypes were characterized.

Results
DENV genome was detected in plasma and saliva only at the first time point (day 7 of illness), but in urine at both the first and second time points (days 7 and 18 of illness). DENV4 serotype was found in all DENV genome-positive specimens. DENV2 serotype was unexpectedly also detected in the first urine specimen. DENV4 as the major and DENV2 as the minor population. The DENV2 serotype was clustered in genotype Asian I and DENV4 serotype in genotype I.

Conclusion
To our knowledge, this is the first report of concurrent multiserotype DENV infection detected solely in urine. Prospective noninvasive investigations may determine the prevalence of this phenomenon. Clinical and public health implications of this finding need to be explored.
The age of onset of pubertal development in healthy Thai boys in Khon Kaen, Thailand
Authors: Kiatsopit Noppol , Panamonta Ouyporn , Suesirisawat Chatchai , Panamonta Manat 
Published: August 2015

Abstract

Background
There is variation of the age of onset of puberty in a population. The secular trends in the timing of pubertal development have decreased in some parts of the world.

Objective
To determine the age of pubertal development in healthy Thai boys in Khon Kaen, Thailand and compare it with that in previous studies of Thai boys.

Methods
A descriptive, cross-sectional study was performed in 316 school boys aged 5–16 years between May and July 2011. Development of the genitals and pubic hair was determined by Tanner staging, and testicular volume was assessed using a Prader orchidometer. All boys were examined by a male pediatrician.

Results
Genital stage of puberty in boys occurred at a median age of 11.3 years and a mean ± SD age of 11.3 ± 1.3 (mean ± SD, range 8.0–14.9) years, and pubarche occurred at a median age of 12.8 years and a mean ± SD of 12.5 ± 1.2 years (range 9.1–14.9) years.

Conclusions
No secular trend towards earlier age at pubertal onset for gonadarche in Khon Kaen boys, but pubarche seems to be later than found in previous studies in Thai boys.
Resident and Fellow Perspectives on Family Planning and Building During Training
Authors: Dason E. Shirin , Kapsack Abby , Baxter Nancy N. , Gesink Dionne , Shapiro Heather , Simpson Andrea N. 
Published: August 2024

ImportancePhysicians, especially surgeons, delay family building, and face age-related complications of pregnancy.ObjectiveTo explore factors that are associated with family building decisions among residents and fellows and to understand their thoughts on accessing family building supports, workplace culture, and attitudes toward family planning.Design, Setting, and ParticipantsThis qualitative study was conducted from May to August 2022 at postgraduate training sites across Ontario, Canada. Participants included 29 postgraduate learners. Purposive sampling from 80 eligible trainees was used to ensure diverse demographics, including sex, specialty, and institution. Semi-structured individual interviews lasting 30 to 90 minutes were conducted over a virtual platform. Participants were asked to share their thoughts and experiences on family planning in a medical career, family building goals, the role of mentorship, and knowledge of current family planning supports.Main Outcomes and MeasuresThemes associated with residents’ perception of family planning within the context of a medical career.ResultsTwenty-nine trainees, ages 25 to 37 years old (22 [75.9%] were female, 26 [89.7%] were heterosexual; median [range] age, 30 [25-37] years) from various institutions took part in this study. The participants included both 24 residents (82.8%) and 5 fellows (17.2%) and 8 (27.6%) were from surgical specialties, 3 (10.3%) from pediatrics and subspecialties, 4 (13.8%) from internal medicine and subspecialties, 2 (6.9%) from obstetrics and gynecology, 3 (10.3%) family medicine, 2 (6.9%) from anesthesia, and 7 (24.1%) other medical specialties. Four themes were identified: (1) tension between role as a physician and role as a parent; (2) impact of role models and mentorship on family planning choices; (3) family building is discouraged during training, especially in surgical specialties; and (4) need for tangible family planning supports in training.Conclusions and RelevanceIn this qualitative study of residents’ and fellows’ perspectives on family building, trainees did not perceive residency and fellowship programs as supportive for individuals who want to family build during training leading to personal and professional dissonance. Trainees identified that more tangible supports, transparent information, and mentorship may improve a trainees’ feeling of support.