bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the effects of task shifting for HIV through a systems thinking lens: the case of Burkina Faso
Authors: Yaya Bocoum Fadima , Kouanda Seni , Kouyaté Bocar , Hounton Sennen , Adam Taghreed 
Published: October 2013

Abstract

Background
While the impact of task shifting on quality of care and clinical outcomes has been demonstrated in several studies, evidence on its impact on the health system as a whole is limited. This study has two main objectives. The first is to conceptualize the wider range of effects of task shifting through a systems thinking lens. The second is to explore these effects using task shifting for HIV in Burkina Faso as a case study.

Methods
We used a case study approach, using qualitative research methods. Data sources included document reviews, reviews of available data and records, as well as interviews with key informants and health workers.

Results
In addition to the traditional measures of impact of task shifting on health outcomes, our study identified 20 possible effects of the strategy on the system as a whole. Moreover, our analysis highlighted the importance of differentiating between two types of health systems effects. The first are effects inherent to the task shifting strategy itself, such as job satisfaction or better access to health services. The second are effects due to health system barriers, for example the unavailability of medicines and supplies, generating a series of effects on the various components of the health system, e.g., staff frustration.
Among the health systems effects that we found are positive, mostly unintended, effects and synergies such as increased health workers' sense of responsibility and worthiness, increased satisfaction due to using the newly acquired skills in other non-HIV tasks, as well as improved patient-provider relationships. Among the negative unintended effects are staff frustration due to lack of medicines and supplies or lack of the necessary infrastructure to be able to perform the new tasks.

Conclusion
Our analysis highlights the importance of adopting a systems thinking approach in designing, implementing and evaluating health policies to mitigate some of the design issues or system bottle-necks that may impede their successful implementation or risk to present an incomplete or misleading picture of their impact.
Elevated C-reactive protein values predict nodal metastasis in patients with penile cancer
Authors: Al Ghazal Andreas , Steffens Sandra , Steinestel Julie , Lehmann Rieke , Schnoeller Thomas J , Schulte-Hostede Anna , Wegener Gerd , Jentzmik Florian , Schrader Mark , Kuczyk Markus A , Schrader Andres J 
Published: October 2013

Abstract

Background
The nodal status is a strong predictor for cancer specific death in patients with penile carcinoma, and the C-reactive protein (CRP) level at diagnosis has recently been shown to be associated with poor clinical outcome in various solid malignancies. Therefore, this retrospective study was performed to evaluate the association between preoperative CRP levels and the incidence of nodal metastasis in patients with squamous cell carcinoma (SCC) of the penis.

Methods
The analysis included 51 penile cancer patients who underwent either radical or partial penectomy for pT1-4 penile cancer between 1990 and 2010. The nodal status was correlated with patient and tumor specific characteristics.

Results
Sixteen (31%) patients had lymph node metastasis at the time of penile cancer surgery. Nodal status was associated with tumor stage but did not correlate significantly with tumor grade. In contrast, high presurgical CRP levels were significantly associated with the diagnosis of nodal involvement (p = 0.04). The optimal CRP cut-off value to predict lymph node metastasis was set at 20 mg/l based on ROC analysis.

Conclusions
Since a high preoperative serum CRP level was closely correlated with nodal disease, it could be used as an additional marker to help identify patients with penile cancer who may benefit from inguinal lymph node dissection.
The flavokawains: uprising medicinal chalcones
Authors: Abu Nadiah , Ho Wan Yong , Yeap Swee Keong , Akhtar M Nadeem , Abdullah Mohd Puad , Omar Abdul Rahman , Alitheen Noorjahan Banu 
Published: October 2013

Abstract
Plant-based compounds have been in the spotlight in search of new and promising drugs. Flavokawain A, B and C are naturally occurring chalcones that have been isolated from several medicinal plants; namely the piper methysticum or commercially known as the kava-kava. Multiple researches have been done to evaluate the bioactivities of these compounds. It has been shown that all three flavokawains may hold promising anti-cancer effects. It has also been revealed that both flavokawain A and B are involved in the induction of cell cycle arrest in several cancer cell lines. Nevertheless, flavokawain B was shown to be more effective in treating in vitro cancer cell lines as compared to flavokawain A and C. Flavokawain B also exerts antinociceptive effects as well as anti-inflammation properties. This mini-review attempts to discuss the biological properties of all the flavokawains that have been reported.
Osteomyelitis of the femur mimicking bone tumors: a review of 10 cases
Authors: Huang Po-Yen , Wu Po-Kuei , Chen Cheng-Fong , Lee Fang-Tsai , Wu Hung-Ta , Liu Chien-Lin , Chen Tain-Hsiung , Chen Wei-Ming 
Published: October 2013

AbstractBackgroundThe clinical symptoms and radiographic appearance of osteomyelitis can mimic those of bone tumors.MethodsWe reviewed 10 patients with osteomyelitis of the femur who were initially diagnosed as having bone tumors and were subsequently transferred to our institution.ResultsNocturnal pain of moderate intensity occurred in seven patients, and all 10 patients had elevated C-reactive protein levels. The radiographic findings included the following: a permeative, moth-eaten osteolytic lesion in six patients, an osteolytic lesion with sclerotic borders in three patients, and cortical destruction with pathological fracture in one patient. Magnetic resonance imaging was performed for eight patients, and only one had a positive penumbra sign. All patients underwent a surgical biopsy to confirm the final diagnosis for histological analysis and cultures.Klebsiella pneumoniaewas detected in six patients andStaphylococcus aureus, the most common organism in osteomyelitis, was detected in three. Recurrence of infection occurred in five patients following debridement surgery; of these three had aKlebsiella pneumoniaeinfection. All patients received antibiotic treatment for an average of 20.4 weeks (range, 4 to 44) and surgical treatment an average of 1.8 times (range, 1 to 4). At the final follow-up, all patients were fully recovered with no signs of infection.ConclusionsWhen used in combination, clinical examinations, laboratory data, and radiographic findings can reliably distinguishing osteomyelitis from bone tumors.
Large-area high-performance SERS substrates with deep controllable sub-10-nm gap structure fabricated by depositing Au film on the cicada wing
Authors: Jiwei Qi , Yudong Li , Ming Yang , Qiang Wu , Zongqiang Chen , Wudeng Wang , Wenqiang Lu , Xuanyi Yu , Jingjun Xu , Qian Sun 
Published: October 2013

Abstract
Noble metal nanogap structure supports strong surface-enhanced Raman scattering (SERS) which can be used to detect single molecules. However, the lack of reproducible fabrication techniques with nanometer-level control over the gap size has limited practical applications. In this letter, by depositing the Au film onto the cicada wing, we engineer the ordered array of nanopillar structures on the wing to form large-area high-performance SERS substrates. Through the control of the thickness of the Au film deposited onto the cicada wing, the gap sizes between neighboring nanopillars are fine defined. SERS substrates with sub-10-nm gap sizes are obtained, which have the highest average Raman enhancement factor (EF) larger than 2 × 108, about 40 times as large as that of commercial Klarite® substrates. The cicada wings used as templates are natural and environment-friendly. The depositing method is low cost and high throughput so that our large-area high-performance SERS substrates have great advantage for chemical/biological sensing applications.
Is there a role for high dose chemotherapy and blood stem cell rescue in childhood hepatoblastoma presenting with lung metastases? A case report and literature review
Authors: Provenzi Massimo , Saettini Francesco , Conter Valentino , Giraldi Eugenia , Foglia Carlo , Cavalleri Laura , Colledan Michele , D’Antiga Lorenzo , Perilongo Giorgio , Da Dalt Liviana 
Published: October 2013

Abstract
We report the use of high dose chemotherapy with peripheral blood stem cell rescue as a consolidation treatment for a 3-year-old child affected by metastatic hepatoblastoma, who achieved complete lung response only after conventional treatment. The patient is presently alive 27 months after high dose chemotherapy with blood stem cell rescue with no evidence of disease.
The role of high dose chemotherapy with blood stem cell rescue to consolidate the complete clearing of lung disease in metastatic hepatoblastoma remains controversial; the data available in the literature and our experience seems to suggest to keep this treatment option open to further consideration in the clinical setting of high-risk patients.
Stereotactic biopsy of the breast using a decubitus table: comparison of histologic underestimation rates between 11- and 8-gauge vacuum-assisted breast biopsy
Authors: Lee Kyoung Eun , Kim Hak Hee , Shin Hee Jung , Cha Joo Hee 
Published: October 2013

Abstract

Purpose
To evaluate efficacy of the stereotactic vacuum-assisted breast biopsy(SVAB) using a decubitus table and to compare histologic underestimation rate between 11gauge(G)- and 8G-probes.

Materials and methods
Pathologic results of SVAB using a decubitus table of 210(120 with 11G; 90 with 8G)-procedures in 208-women(median age, 48.8 years; range, 27-73 years) were retrospectively reviewed. SVAB was performed for suspicious microcalcification without mass on MMG and US. Surgury was performed for the diagnosis of malignant or high-risk lesion (65(31.0%)). Patients with benign diagnosis (120(57.1%)) underwent MMG follow-up (mean, 340-days). Histologic underestimation was defined as the need to upgrade ADH to DCIS or IDC, and DCIS to IDC at surgery. We analyzed the difference of procedure time, core number and core weight between 11G- and 8G-groups. Statistical significance was determined with chi-square test and 95%-CI for histologic underestimation, and student T-test for comparing two-groups.

Results
Targeting was successful in all 210-biopsies on specimen radiographs. Mean core number, core weight and procedure time were 17.5 (17.5 ± 4.9), 1.57 g (1.57 ± 0.56), 34.5 min (34.5 ± 16.4) with 11G-probe, and 9.6 (9.6 ± 6.2), 1.83g (1.83 ± 0.93), 22.1 min (22.1 ± 12.5) with 8G-probe. Findings in 120 (57.1%) of the biopsies were benign, 36 (17.2%) were high-risk, and 54 (25.7%) were malignant. Two (6.25%) of 32 cases of ADH were upgraded to DCIS in 11G-group, and 2 (9.09%) of 22 in 8G-group. No case of DCIS was upgraded to IDC. There was no increase of complication in 8G-group than 11G-group.

Conclusion
SVAB using a decubitus table is safe and effective method for the evaluation of suspicious microcalcification, and there was no significant difference between 11G- and 8G-probes. But, SVAB with 8G-probe is significantly more time efficient and effective procedure.
Prevalence of HLA-B27 in the New Zealand population: effect of age and ethnicity
Authors: Roberts Rebecca L , Wallace Mary C , Jones Gregory T , van Rij Andre M , Merriman Tony R , Harrison Andrew , White Douglas , Stamp Lisa K , Ching Daniel , Highton John , Stebbings Simon M 
Published: October 2013

Abstract
Introduction
HLA-B27 genotyping is commonly used to support a diagnosis of ankylosing spondylitis (AS). A recent study has suggested that HLA-B27 may adversely affect longevity. The objectives of this study were to determine, for the first time, the prevalence of HLA-B27 in the New Zealand population, and to test whether HLA-B27 prevalence declines with age.

Methods
117 Caucasian controls, 111 New Zealand Māori controls, and 176 AS patients were directly genotyped for HLA-B27 using PCR-SSP. These participants and a further 1103 Caucasian controls were genotyped for the HLA-B27 tagging single nucleotide polymorphisms (SNPs) rs4349859 and rs116488202. All AS patients testing positive for HLA-B27 of New Zealand Māori ancestry underwent high resolution typing to determine sub-allele status.

Results
HLA-B27 prevalence was 9.2% in New Zealand Caucasian controls and 6.5% in Māori controls. No decline in HLA-B27 prevalence with age was detected in Caucasian controls (p = 0.92). Concordance between HLA-B27 and SNP genotypes was 98.7-99.3% in Caucasians and 76.9-86% in Māori. Of the 14 AS patients of Māori ancestry, 1 was negative for HLA-B27, 10 were positive for HLAB*2705, and 3 positive for HLAB*2704. All cases of genotype discordance were explained by the presence of HLAB*2704.

Conclusions
HLA-B27 prevalence in New Zealand Caucasians is consistent with that of Northern European populations and did not decline with increasing age. In Māori with AS who were HLA-B27 positive, 76.9% were positive for HLA-B*2705, suggesting that genetic susceptibility to AS in Māori is primarily due to admixture with Caucasians.
Pattern of recurrence of early breast cancer is different according to intrinsic subtype and proliferation index
Authors: Ribelles Nuria , Perez-Villa Lidia , Jerez Jose Manuel , Pajares Bella , Vicioso Luis , Jimenez Begoña , de Luque Vanessa , Franco Leonardo , Gallego Elena , Marquez Antonia , Alvarez Martina , Sanchez-Muñoz Alfonso , Perez-Rivas Luis , Alba Emilio 
Published: October 2013

Abstract
Introduction
Recurrence risk in breast cancer varies throughout the follow-up time. We examined if these changes are related to the level of expression of the proliferation pathway and intrinsic subtypes.

Methods
Expression of estrogen and progesterone receptor, Ki-67, human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR) and cytokeratin 5/6 (CK 5/6) was performed on tissue-microarrays constructed from a large and uniformly managed series of early breast cancer patients (N = 1,249). Subtype definitions by four biomarkers were as follows: luminal A (ER + and/or PR+, HER2-, Ki-67 <14), luminal B (ER + and/or PR+, HER2-, Ki-67 ≥14), HER2-enriched (any ER, any PR, HER2+, any Ki-67), triple-negative (ER-, PR-, HER2-, any Ki-67). Subtype definitions by six biomarkers were as follows: luminal A (ER + and/or PR+, HER2-, Ki-67 <14, any CK 5/6, any EGFR), luminal B (ER + and/or PR+, HER2-, Ki-67 ≥14, any CK 5/6, any EGFR), HER2-enriched (ER-, PR-, HER2+, any Ki-67, any CK 5/6, any EGFR), Luminal-HER2 (ER + and/or PR+, HER2+, any Ki-67, any CK 5/6, any EGFR), Basal-like (ER-, PR-, HER2-, any Ki-67, CK5/6+ and/or EGFR+), triple-negative nonbasal (ER-, PR-, HER2-, any Ki-67, CK 5/6-, EGFR-). Each four- or six-marker defined intrinsic subtype was divided in two groups, with Ki-67 <14% or with Ki-67 ≥14%. Recurrence hazard rate function was determined for each intrinsic subtype as a whole and according to Ki-67 value.

Results
Luminal A displayed a slow risk increase, reaching its maximum after three years and then remained steady. Luminal B presented most of its relapses during the first five years. HER2-enriched tumors show a peak of recurrence nearly twenty months post-surgery, with a greater risk in Ki-67 ≥14%. However a second peak occurred at 72 months but the risk magnitude was greater in Ki-67 <14%. Triple negative tumors with low proliferation rate display a smooth risk curve, but with Ki-67 ≥14% show sharp peak at nearly 18 months.

Conclusions
Each intrinsic subtype has a particular pattern of relapses over time which change depending on the level of activation of the proliferation pathway assessed by Ki-67. These findings could have clinical implications both on adjuvant treatment trial design and on the recommendations concerning the surveillance of patients.
Six-month survival and quality of life of intensive care patients with acute kidney injury
Authors: Nisula Sara , Vaara Suvi T , Kaukonen Kirsi-Maija , Reinikainen Matti , Koivisto Simo-Pekka , Inkinen Outi , Poukkanen Meri , Tiainen Pekka , Pettilä Ville , Korhonen Anna-Maija ,   the FINNAKI-QOL Study Group
Published: October 2013

Abstract
Introduction
Acute kidney injury (AKI) has high incidence among the critically ill and associates with dismal outcome. Not only the long-term survival, but also the quality of life (QOL) of patients with AKI is relevant due to substantial burden of care regarding these patients. We aimed to study the long-term outcome and QOL of patients with AKI treated in intensive care units.

Methods
We conducted a predefined six-month follow-up of adult intensive care unit (ICU) patients from the prospective, observational, multi-centre FINNAKI study. We evaluated the QOL of survivors with the EuroQol (EQ-5D) questionnaire. We included all participating sites with at least 70% rate of QOL measurements in the analysis.

Results
Of the 1,568 study patients, 635 (40.5%, 95% confidence interval (CI) 38.0-43.0%) had AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Of the 635 AKI patients, 224 (35.3%), as compared to 154/933 (16.5%) patients without AKI, died within six months. Of the 1,190 survivors, 959 (80.6%) answered the EQ-5D questionnaire at six months. The QOL (median with Interquartile range, IQR) measured with the EQ-5D index and compared to age- and sex-matched general population was: 0.676 (0.520-1.00) versus 0.826 (0.812-0.859) for AKI patients, and 0.690 (0.533-1.00) versus 0.845 (0.812-0.882) for patients without AKI (P <0.001 in both). The EQ-5D at the time of ICU admission was available for 774 (80.7%) of the six-month respondents. We detected a mean increase of 0.017 for non-AKI and of 0.024 for AKI patients in the EQ-5D index (P = 0.728). The EQ-5D visual analogue scores (median with IQR) of patients with AKI (70 (50–83)) and patients without AKI (75 (60–87)) were not different from the age- and sex-matched general population (69 (68–73) and 70 (68–77)).

Conclusions
The health-related quality of life of patients with and without AKI was already lower on ICU admission than that of the age- and sex-matched general population, and did not change significantly during critical illness. Patients with and without AKI rate their subjective health to be as good as age and sex-matched general population despite statistically significantly lower QOL indexes measured by EQ-5D.
Suspected ventilator-associated respiratory infection in severely ill patients: a prospective observational study
Authors: Shahin Jason , Bielinski Michael , Guichon Celine , Flemming Catherine , Kristof Arnold S 
Published: October 2013

Abstract
Introduction
Ventilator-associated respiratory infection (VARI) is an important cause of morbidity in critically-ill patients. Clinical trials performed in heterogeneous populations have suggested there are limited benefits from invasive diagnostic testing to identify patients at risk or to target antimicrobial therapy. However, multiple patient subgroups (for example, immunocompromised, antibiotic-treated) have traditionally been excluded from randomization. We hypothesized that a prospective surveillance study would better identify patients with suspected VARI (sVARI) at high risk for adverse clinical outcomes, and who might be specifically targeted in future trials.

Methods
We performed a prospective observational study in all patients ventilated for greater than 48 hours. sVARI was identified by surveillance for changes in white blood cell count, temperature, sputum, and/or new chest X-ray infiltrates. Indices of disease co-morbidity, as well as mortality, duration of mechanical ventilation, and length of hospital or ICU stay were correlated with sVARI.

Results
Of 1806 patients admitted to the ICU over 14 months, 267 were ventilated for greater than 48 hours, and 77 developed sVARI. Incidence of sVARI was associated with iatrogenic immunosuppression or admission for respiratory illness. Any sVARI, whether suspected ventilator-associated pneumonia (sVAP) or ventilator-associated tracheobronchitis (sVAT), was associated with increased length of stay and duration of mechanical ventilation.

Conclusions
Clinical surveillance for sVARI identifies patients at risk for increased morbidity. Iatrogenically immunosuppressed patients, a subgroup previously excluded from randomized clinical trials, represent a growing proportion of the critically-ill at risk for sVARI who might be targeted for future investigations on diagnostic or therapeutic modalities.
A Cerebral Recovery Index (CRI) for early prognosis in patients after cardiac arrest
Authors: Tjepkema-Cloostermans Marleen C , van Meulen Fokke B , Meinsma Gjerrit , van Putten Michel JAM 
Published: October 2013

Abstract
Introduction
Electroencephalogram (EEG) monitoring in patients treated with therapeutic hypothermia after cardiac arrest may assist in early outcome prediction. Quantitative EEG (qEEG) analysis can reduce the time needed to review long-term EEG and makes the analysis more objective. In this study, we evaluated the predictive value of qEEG analysis for neurologic outcome in postanoxic patients.

Methods
In total, 109 patients admitted to the ICU for therapeutic hypothermia after cardiac arrest were included, divided over a training and a test set. Continuous EEG was recorded during the first 5 days or until ICU discharge. Neurologic outcomes were based on the best achieved Cerebral Performance Category (CPC) score within 6 months. Of the training set, 27 of 56 patients (48%) and 26 of 53 patients (49%) of the test set achieved good outcome (CPC 1 to 2). In all patients, a 5 minute epoch was selected each hour, and five qEEG features were extracted. We introduced the Cerebral Recovery Index (CRI), which combines these features into a single number.

Results
At 24 hours after cardiac arrest, a CRI <0.29 was always associated with poor neurologic outcome, with a sensitivity of 0.55 (95% confidence interval (CI): 0.32 to 0.76) at a specificity of 1.00 (CI, 0.86 to 1.00) in the test set. This results in a positive predictive value (PPV) of 1.00 (CI, 0.73 to 1.00) and a negative predictive value (NPV) of 0.71 (CI, 0.53 to 0.85). At the same time, a CRI >0.69 predicted good outcome, with a sensitivity of 0.25 (CI, 0.10 to 0.14) at a specificity of 1.00 (CI, 0.85 to 1.00) in the test set, and a corresponding NPV of 1.00 (CI, 0.54 to 1.00) and a PPV of 0.55 (CI, 0.38 to 0.70).

Conclusions
We introduced a combination of qEEG measures expressed in a single number, the CRI, which can assist in prediction of both poor and good outcomes in postanoxic patients, within 24 hours after cardiac arrest.
Open-Phylo: a customizable crowd-computing platform for multiple sequence alignment
Authors: Kwak Daniel , Kam Alfred , Becerra David , Zhou Qikuan , Hops Adam , Zarour Eleyine , Kam Arthur , Sarmenta Luis , Blanchette Mathieu , Waldispühl Jérôme 
Published: October 2013

AbstractCitizen science games such as Galaxy Zoo, Foldit, and Phylo aim to harness the intelligence and processing power generated by crowds of online gamers to solve scientific problems. However, the selection of the data to be analyzed through these games is under the exclusive control of the game designers, and so are the results produced by gamers. Here, we introduce Open-Phylo, a freely accessible crowd-computing platform that enables any scientist to enter our system and use crowds of gamers to assist computer programs in solving one of the most fundamental problems in genomics: the multiple sequence alignment problem.