bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in access to and costs of overseas treatment after the introduction of universal health coverage in the Maldives: Findings from surveys and the analysis of claims data
Authors: Suzana Mariyam , Chongsuvivatwong Virasakdi 
Published: October 2015

Background Shortages in resources for health and health service delivery in small island states make it inevitable for islanders to seek medical treatment out of the country. This study aimed to assess the changes in access to treatment overseas and its disparities before and after universal health care was introduced in 2012 in the island state of Maldives. Methods Using primary and secondary data, two analyses were performed: 1. Analysis of beneficiary data on public subsidy for medical treatment overseas 2010–2013; 2. A comparative analysis of two independent cross-sectional surveys conducted in 2010 and 2013. Public subsidy, financial protection, usage, and costs of medical treatment overseas were analyzed using descriptive statistics and the concentration curve and index. Results Number of beneficiaries subsidized for treatment overseas has increased by 199% and the average expenditure per beneficiary has increased by 49.7% during 2010–2013. Average number of visits abroad in a year has slightly decreased from 1.6 in 2009 to 1.4 visits in 2013, but among travelers who made more than one trip abroad, average visits remained at 2.7 per year. Median medical costs have increased by 26.9% and the proportion of household spending on overseas treatment in annual household spending has remained around 20% over the years. The proportion of travelers belonging to average households (household spending below $650) has increased by 107%, and the concentration index decreased from 0.08 in 2009 to 0.04 in 2013 indicating a change towards a more uniform distribution of MTO use. Conclusions Despite the fact that the objectives of the two surveys differed which may have led to differences in measurements, it can be concluded that UHC has narrowed the gap between the rich and poor in utilizing medical treatment overseas. However, median out of pocket spending on MTO has increased over the years indicating the need to broaden the benefit package of the UHC program. Further research is needed on the most deprived populations who have not accessed care abroad despite the change in the health financing system in the country.
Vitamin D exposures reported to US poison centers 2000–2014
Authors: Spiller HA , Good TF , Spiller NE , Aleguas A 
Published: October 2015

There has been an increased use of vitamin D both by prescription and by the public as a widely available supplement. We evaluated 15 years of single-substance vitamin D exposures to US poison centers. Methods: Retrospective analysis of data from the National Poison Data System (NPDS) to evaluate clinical effects, trends, and outcomes of exposures to vitamin D over the period January 1, 2000 through June 30, 2014. Cases were limited to exposures involving vitamin D as a single substance. Multiple vitamin products that may have included vitamin D were not included in this study. Results: From 2000 through June 30, 2014, there were 25,397 human exposures to vitamin D reported to NPDS. There was a mean of 196 cases per year from 2000 to 2005, followed by a 1600% increase in exposures between 2005 and 2011 to a new annual mean of 4535 exposures per year. The mean and median ages were 23.4 years and 10 years, respectively. There were no fatalities, but five (0.02%) major effect outcomes. Serious medical outcomes (major or moderate outcome) were infrequent, ranging from 2 patients/year to 22 patients/year. Clinical effects were primarily gastrointestinal (0.7–1.5%) and mild neurological effects (0.2–0.4%). There was a decline in the percentage of patients treated in a health care facility and of patients with serious medical outcome. Conclusion: Despite the enormous increase in number of exposures, there was not a significant increase in patients with a serious medical outcome. Rare severe outcomes may occur.
A mechanistic approach for modulation of chlorpyrifos-induced toxicity in human lymphocytes by melatonin, coenzyme Q10, and vinpocetine
Authors: Ghayomi F , Navaei-Nigjeh M , Baeeri M , Rezvanfar MA , Abdollahi M 
Published: October 2015

Background: Chlorpyrifos (CP) is an organophosphorus pesticide that induces oxidative stress through the production of free radicals and depletes intracellular antioxidant reserves. In this study, the efficacy of three antioxidants (melatonin, coenzyme Q10 (CoQ10), and vinpocetine) on alleviation of toxic effects of CP was evaluated. Materials and Methods: Cytotoxicity of CP, in the presence or absence of effective doses of melatonin, CoQ10, and vinpocetine, was determined in human peripheral blood lymphocytes after 72-h exposure. The levels of acetylcholinesterase (AChE) activity along with tumor necrosis factor α (TNF-α), as inflammatory index, were measured. Further, the viability and oxidative stress markers including cellular mitochondrial activity, cell death modes (apoptosis vs. necrosis), total antioxidant power (TAP), total thiol molecules (TTM), lipid peroxidation (LPO), and myeloperoxidase (MPO) activity were measured. Results: CoQ10 and also the combination of the three antioxidants were the most notable in opposing toxicity of CP and led to increasing TAP and TTM; improvement of AChE activity; and lowering LPO, MPO, TNF-α, and apoptosis compared to CP alone. Conclusion: CP toxicity overwhelms the intracellular antioxidant defense mechanisms. Exogenous supplementation with antioxidants, such as the ones we have investigated, seems to be effective in the prevention of cytotoxicity of CP.
The Effect of Using an Electric Fan on Dyspnea in Chinese Patients With Terminal Cancer
Authors: Wong Sio Leng , Leong Sok Man , Chan Cheng Man , Kan Sut Peng , Cheng Hon Wai Benjamin 
Published: October 2015

Background: Fan therapy is often suggested for relieving the symptom of dyspnea in patients with advanced cancer, but relevant literature among Asians is limited. Objective: Phase 2 clinical trial to assess the clinical feasibility and outcome of using an electric fan to alleviate the symptom of dyspnea in Chinese patients with advanced cancer. Methods: Thirty patients with advanced cancer having unresolved breathlessness were recruited from Hospice and Palliative Care Centre of Kiang Wu Hospital in Macau. Participants were randomly and equally allocated to the experimental group and the control group, respectively. Outcome Measures: Verbal numerical rating scale (NRS) of breathlessness, respiratory rate (RR), and saturation of peripheral oxygen (SpO2) was collected before and after the intervention. Results: T test was used to analyze the data collected. There was a significant difference in the NRS scores of the experimental group ( P < .01), indicating a significant reduction in the patients’ sensation of breathlessness after fan therapy, whereas no significant difference was found in the objective statistic results of RR and SpO2. No significant difference ( P > .05) was found in the control group for all the 3 variables before and after routine treatment. Conclusion: The results of the study suggested that fan therapy could be effective in alleviating dyspnea in Chinese patients with advanced cancer. It should be considered as one of the nonpharmacological treatment option. Future large-scale phase 3 clinical trials are warranted.
Quantitative and Qualitative Change of Collagen of Achilles Tendons in Rats With Systemic Administration of Glucocorticoids
Authors: Taguchi Tetsuya , Kubota Makoto , Saito Mitsuru , Hattori Hidekazu , Kimura Tadashi , Marumo Keishi 
Published: October 2015

Background: It is unclear whether glucocorticoid (GC) therapy is directly related to Achilles tendon rupture (ATR), because many of the reported patients were receiving long-term GC therapy for underlying diseases. This study aimed to elucidate the mechanism by which systemic GC administration causes weakening of the Achilles tendon by biochemically, mechanically, and morphologically evaluating quantitative and qualitative changes in collagen. Methods: Male 8-week-old mice were subcutaneously treated with either prednisolone (10 mg/mL/kg; GC group) or saline (1 mL/kg; control group) for 8 weeks and then subjected to the following experiments: (1) a tensile strength test; (2) quantification of the gene expressions of type 1 collagen and lysyl oxidase; (3) quantification of collagen content, enzymatic crosslinks (immature + mature), and senescent crosslinks; and (4) measurement of collagen fiber diameter by electron microscopy. Results: The maximum tensile load and gene expressions of type 1 collagen and lysyl oxidase were decreased in the GC group. Collagen content was significantly decreased in the GC group compared with the control group. The content of enzymatic crosslinks was significantly lower in the GC group than in the control group. The corresponding amount of senescent crosslinks was not significantly different. The mean collagen fiber diameter was significantly smaller in the GC group than in the control group. Histogram analysis showed a decreased number of thick fibers and an increased number of thin fibers in the GC group. Conclusion: These observations suggest that systemic GC administration causes decreased strength of the Achilles tendon by decreasing its collagen content, hindering the formation of enzymatic crosslinks and thereby keeping collagen fibers in an immature state with smaller diameters. Clinical Relevance: This animal study showed that systemic GC administration directly prevents maturation of tendon collagen fibers and decreases tendon strength, regardless of the presence or absence of underlying disease.
PRescriptiOn PattERns of Oral Anticoagulants in Nonvalvular Atrial Fibrillation (PROPER study)
Authors: Basaran Ozcan , Filiz Basaran Nesrin , Cekic Edip Guvenc , Altun Ibrahim , Dogan Volkan , Mert Gurbet Ozge , Mert Kadir Ugur , Akin Fatih , Soylu Mustafa Ozcan , Memic Sancar Kadriye , Biteker Murat 
Published: October 2015

Introduction: Inappropriate use of oral anticoagulants (OACs) have not been well investigatedand, however, may be frequent in real-world practice in patients with nonvalvular atrial fibrillation (NVAF). This study was designed to evaluate the prescription patterns and appropriateness of OACs in patients with NVAF in real-world clinical settings. Methods: We performed a prospective, observational study (NCT02366338). A total of 148 patients with NVAF were screened for OAC prescription. Appropriateness of prescribing was evaluated using 9 criteria of the Medication Appropriateness Index (MAI): indication, choice, dosage, modalities and practicability of administration, drug–drug interactions, drug–disease interactions, duplication, and duration. For each criterion, the evaluator has to rate whether the medication is (A) appropriate, (B) inappropriate but with limited clinical importance, and (C) inappropriate. Results: Of 148 patients, 73 (50%) were on warfarin (group 1), 39 (26%) were on rivaroxaban (group 2), and 36 (24%) were on dabigatran therapy (group 3). The MAI showed that 83% of group 1, 28% of group 2, and 47% of group 3 patients had at least 1 inappropriate criterion. Moreover, according to the choice criterion, 37% of group 1, 8% of group 2 and 5% of group 3 were rated as inappropriate, and dosage was not appropriate in 77% of group 1, 23% of group 2, and 42% of group 3. Conclusion: Inappropriate drug use is frequent among patients with NVAF not only for warfarin but also for NOACs. Although there is an apparent improvement in thromboprophylaxis of NVAF, much more effort is needed for appropriate use of OACs.
Use of mobile technology in a community mental health setting
Authors: Glick Gretl , Druss Benjamin , Pina Jamie , Lally Cathy , Conde Mark 
Published: October 2015

Introduction mHealth holds promise in transforming care for people with serious mental illness (SMI) and other disadvantaged populations. However, information about the rates of smartphone ownership and usage of mobile health apps among people with SMI is limited. The objective of this research is to examine the current ownership, usage patterns, and existing barriers to mobile health interventions for people with SMI treated in a public sector community mental health setting and to compare the findings with national usage patterns from the general population. Methods A survey was conducted to determine rates of ownership of smartphone devices among people with SMI. Surveys were administered to 100 patients with SMI at an outpatient psychiatric clinic. Results were compared with respondents to the 2012 Pew Survey of mobile phone usage. Results A total of 85% of participants reported that they owned a cell phone; of those, 37% reported that they owned a smartphone, as compared with 53% of respondents to the Pew Survey and 44% of socioeconomically disadvantaged respondents to the Pew Survey. Discussion While cell phone ownership is common among people with SMI, their adoption of smartphone technology lags behind that of the general population primarily due to cost barriers. Efforts to use mHealth in these populations need to recognize current mobile ownership patterns while planning for anticipated expansion of new technologies to poor populations as cost barriers are reduced in the coming years.
Durability of aneurysm treatments in patients with active Behcet’s disease
Authors: Elsharawy Mohamed A , Elsaid Aymen , Al-Dhafery Bander , Alghnimi Ibrahim , Almabyouq Fatimah 
Published: October 2015

Objective Aneurysms in Behcet’s disease are rare, serious, and recurrent. To achieve durable treatment, patients should receive immunosuppressive therapy before intervention to induce remission. We present early and long-term results of emergency cases of active Behcet’s disease, which did not permit waiting for suppressive treatment. Patients and methods The study was undertaken on all cases admitted to the vascular unit, King Fahd Hospital of University for aneurysm treatment in patients with active Behcet’s disease over about 10 years. All patients had exclusion of the aneurysm either by open surgery or endovascular intervention. Morbidities and mortality were recorded within the hospital admission and on the follow-up. Results During the study period, three cases were included. All interventions were successful and lifesaving. However, two cases, treated with surgical interposition grafts, were blocked in the intermediate term follow-up (2–12 months) and one case, treated with endovascular treatment, complicated with pseudoaneurysm at femoral puncture site after six months. Conclusion Although early results were good, intermediate ones were not satisfactory because of progressive graft thrombosis and formation of new aneurysms. Awareness of these rare cases help for early identification and proper immunosuppressive before emergency vascular intervention is warranted.
Sports Specialization, Part II
Authors: Myer Gregory D. , Jayanthi Neeru , DiFiori John P. , Faigenbaum Avery D. , Kiefer Adam W. , Logerstedt David , Micheli Lyle J. 
Published: October 2015

Context: Many coaches, parents, and children believe that the best way to develop elite athletes is for them to participate in only 1 sport from an early age and to play it year-round. However, emerging evidence to the contrary indicates that efforts to specialize in 1 sport may reduce opportunities for all children to participate in a diverse year-round sports season and can lead to lost development of lifetime sports skills. Early sports specialization may also reduce motor skill development and ongoing participation in games and sports as a lifestyle choice. The purpose of this review is to employ the current literature to provide evidence-based alternative strategies that may help to optimize opportunities for all aspiring young athletes to maximize their health, fitness, and sports performance. Evidence Acquisition: Nonsystematic review with critical appraisal of existing literature. Study Design: Clinical review. Level of Evidence: Level 4. Conclusion: Based on the current evidence, parents and educators should help provide opportunities for free unstructured play to improve motor skill development and youth should be encouraged to participate in a variety of sports during their growing years to influence the development of diverse motor skills. For those children who do choose to specialize in a single sport, periods of intense training and specialized sport activities should be closely monitored for indicators of burnout, overuse injury, or potential decrements in performance due to overtraining. Last, the evidence indicates that all youth should be involved in periodized strength and conditioning (eg, integrative neuromuscular training) to help them prepare for the demands of competitive sport participation, and youth who specialize in a single sport should plan periods of isolated and focused integrative neuromuscular training to enhance diverse motor skill development and reduce injury risk factors. Strength of Recommendation Taxonomy (SORT): B.
Platelet transactivation by monocytes promotes thrombosis in heparin-induced thrombocytopenia
Authors: Tutwiler Valerie , Madeeva Daria , Ahn Hyun Sook , Andrianova Izabella , Hayes Vincent , Zheng X. Long , Cines Douglas B. , McKenzie Steven E. , Poncz Mortimer , Rauova Lubica 
Published: October 2015

Key PointsThe procoagulant nature of HIT can be simulated in a microfluidic model using human blood and its components. PF4/glycosaminoglycans/immunoglobulin G complexes activate monocytes through FcγRIIA to generate TF and thrombin, leading to coated platelets in HIT.
ST2 contributes to T-cell hyperactivation and fatal hemophagocytic lymphohistiocytosis in mice
Authors: Rood Julia E. , Rao Sheila , Paessler Michele , Kreiger Portia A. , Chu Niansheng , Stelekati Erietta , Wherry E. John , Behrens Edward M. 
Published: October 2015

Key PointsBlockade of ST2 improves morbidity and mortality in murine FHL. Danger signals such as IL-33 may be required to amplify antigen-specific immune responses above the threshold for FHL disease in mice.
Diagnostic value of immunoassays for heparin-induced thrombocytopenia: a systematic review and meta-analysis
Authors: Nagler Michael , Bachmann Lucas M. , ten Cate Hugo , ten Cate-Hoek Arina 
Published: October 2015

Key PointsImmunoassays used to diagnose heparin-induced thrombocytopenia vary substantially with regard to the specific test characteristics. High sensitivity (>95%) in combination with high specificity (>90%) was found in only 5 tests.
Bird naming systems by Akan people in Ghana follow scientific nomenclature with potentials for conservation monitoring
Authors: Deikumah Justus P. , Konadu Vida Asieduwaa , Kwafo Richard 
Published: October 2015

Abstract
Background
Studies on indigenous knowledge of fauna particular birds and its potential use in biodiversity conservation and management are rare globally. Characteristics used in creating indigenous bird names in many Ghanaian languages are undocumented. The main aim of this study is to answer the question “whether indigenous bird naming systems by the Akan tribes in Ghana follow scientific nomenclature and whether indigenous Akan bird knowledge can potentially help improve bird conservation efforts in Ghana.

Methods
Purposive sampling technique was employed in selecting 10 respondents from 25 communities in the five administrative districts in the Central Region. The study was conducted between November 2014 and March 2015. A mixed method approach was adopted in the data collection including key person interviews, focus group discussion, and structured interview supported by a participatory field observation.

Results
Indigenous people in the study area have reported 143 species of birds belonging to 44 families representing 57 % of total number of species with known local names in Ghana. The study revealed that just as Latin and common English naming systems, indigenous Akan bird names originated from features of the bird, including plumage, vocalizations or behavioural characteristics and belief systems of the indigenous people. The study also discovered that indigenous people in the study area have distinct names for different species within a particular family for most of the birds they could identify. However, they occasionally assign a single general name for either the entire family or all species therein.

Conclusions
The study found evidence to support the prediction that indigenous bird naming systems in the Akan language follow scientific nomenclature. Indigenous knowledge and understanding of birds in the study area can be tapped and used in conservation planning and monitoring of birds. This research thus provides sufficient evidence to prove that indigenous knowledge by the Akan tribes in the study area can be useful in bird conservation and monitoring programs in Ghana. Further research in other Ghanaian languages is recommended.
Pax6 is required intrinsically by thalamic progenitors for the normal molecular patterning of thalamic neurons but not the growth and guidance of their axons
Authors: Clegg James M. , Li Ziwen , Molinek Michael , Caballero Isabel Martín , Manuel Martine N. , Price David J. 
Published: October 2015

Abstract

Background
In mouse embryos, the Pax6 transcription factor is expressed in the progenitors of thalamic neurons but not in thalamic neurons themselves. Its null-mutation causes early mis-patterning of thalamic progenitors. It is known that thalamic neurons generated by Pax6

−/−
progenitors do not develop their normal connections with the cortex, but it is not clear why. We investigated the extent to which defects intrinsic to the thalamus are responsible.

Results
We first confirmed that, in constitutive Pax6

−/−
mutants, the axons of thalamic neurons fail to enter the telencephalon and, instead, many of them take an abnormal path to the hypothalamus, whose expression of Slits would normally repel them. We found that thalamic neurons show reduced expression of the Slit receptor Robo2 in Pax6

−/−
mutants, which might enhance the ability of their axons to enter the hypothalamus. Remarkably, however, in chimeras comprising a mixture of Pax6

−/−
and Pax6

+/+
cells, Pax6

−/−
thalamic neurons are able to generate axons that exit the diencephalon, take normal trajectories through the telencephalon and avoid the hypothalamus. This occurs despite abnormalities in their molecular patterning (they express Nkx2.2, unlike normal thalamic neurons) and their reduced expression of Robo2. In conditional mutants, acute deletion of Pax6 from the forebrain at the time when thalamic axons are starting to grow does not prevent the development of the thalamocortical tract, suggesting that earlier extra-thalamic patterning and /or morphological defects are the main cause of thalamocortical tract failure in Pax6

−/−
constitutive mutants.

Conclusions
Our results indicate that Pax6 is required by thalamic progenitors for the normal molecular patterning of the thalamic neurons that they generate but thalamic neurons do not need normal Pax6-dependent patterning to become competent to grow axons that can be guided appropriately.