bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pseudohallucinations versus hallucinations: wherein lies the difference?
Authors: Wearne Deborah , Genetti Amanda 
Published: May 2015

Objective: This paper firstly explores the historical concept of pseudohallucinations and their phenomenology. It then examines the experience of hallucinosis in two subject groups, one with post-traumatic stress disorder with dissociative symptoms and the second with schizophrenia. Method: The two groups were assessed using the Psychotic Symptoms Rating Scale with a view to identifying differences in the hallucinatory and delusional experience. Results: There was no significant difference between the groups in loudness, control, position, duration, or frequency of the voices. Delusions and negative content differed significantly, however. Conclusions: Researchers have started to describe pseudohallucinations along a continuum. We build on this dimensional approach and suggest a collaborative nomenclature for subtyping.
Ankle Joint Contact Loads and Displacement With Progressive Syndesmotic Injury
Authors: Hunt Kenneth J. , Goeb Yannick , Behn Anthony W. , Criswell Braden , Chou Loretta 
Published: May 2015

Background: Ligamentous injuries to the distal tibiofibular syndesmosis are predictive of long-term ankle dysfunction. Mild and moderate syndesmotic injuries are difficult to stratify, and the impact of syndesmosis injury on the magnitude and distribution of forces within the ankle joint during athletic activities is unknown. Methods: Eight below-knee cadaveric specimens were tested in the intact state and after sequential sectioning of the following ligaments: anterior-inferior tibiofibular, anterior deltoid (1 cm), interosseous/transverse (IOL/TL), posterior-inferior tibiofibular, and whole deltoid. In each condition, specimens were loaded in axial compression to 700 N and then externally rotated to 20 N·m torque. Results: During axial loading and external rotation, both the fibula and the talus rotated significantly after each ligament sectioning as compared to the intact condition. After IOL/TL release, a significant increase in posterior translation of the fibula was observed, although no syndesmotic widening was observed. Mean tibiotalar contact pressure increased significantly after IOL/TL release, and the center of pressure shifted posterolaterally, relative to more stable conditions, after IOL/TL release. There were significant increases in mean contact pressure and peak pressure along with a reduction in contact area with axial loading and external rotation as compared to axial loading alone for all 5 conditions. Conclusion: Significant increases in tibiotalar contact pressures occur when external rotation stresses are added to axial loading. Moderate and severe injuries are associated with a significant increase in mean contact pressure combined with a shift in the center of pressure and rotation of the fibula and talus. Clinical Relevance: Considerable changes in ankle joint kinematics and contact mechanics may explain why moderate syndesmosis injuries take longer to heal and are more likely to develop long-term dysfunction and, potentially, ankle arthritis.
Effects of Fibrinogen Concentrate on Thrombin Generation, Thromboelastometry Parameters, and Laboratory Coagulation Testing in a 24-Hour Porcine Trauma Model
Authors: Zentai Christian , Solomon Cristina , van der Meijden Paola E. J. , Spronk Henri M. H. , Schnabel Jonas , Rossaint Rolf , Grottke Oliver 
Published: May 2015

Introduction: In a 24-hour porcine model of liver injury, we showed that fibrinogen supplementation does not downregulate endogenous fibrinogen synthesis. Here we report data from the same study showing the impact of fibrinogen on coagulation variables. Materials and Methods: Coagulopathy was induced in 20 German land race pigs by hemodilution and blunt liver injury. Animals randomly received fibrinogen concentrate (100 mg/kg) or saline. Coagulation parameters were assessed and thromboelastometry (ROTEM) was performed. Results: Fibrinogen concentrate significantly reduced the prolongations of EXTEM clotting time, EXTEM clot formation time, and prothrombin time induced by hemodilution and liver injury. A decrease in clot strength was also ameliorated. Endogenous thrombin potential was significantly higher in the fibrinogen group than in the control group, 20 minutes (353 ± 24 vs 289 ± 22 nmol/L·min; P < .05) and 100 minutes (315 ± 40 vs 263 ± 38 nmol/L·min; P < .05) after the start of infusion. However, no significant between-group differences were seen in other thrombin generation parameters or in d-dimer or thrombin–antithrombin levels. Fibrinogen–platelet binding was reduced following liver injury, with no significant differences between groups. No significant between-group differences were observed in any parameter at ∼12 and ∼24 hours. Conclusion: This study suggests that, in trauma, fibrinogen supplementation may shorten some measurements of the speed of coagulation initiation and produce a short-lived increase in endogenous thrombin potential, potentially through increased clotting substrate availability. Approximately 12 and 24 hours after starting fibrinogen concentrate/saline infusion, all parameters measured in this study were comparable in the 2 study groups.
Corticospinal tract integrity measured using transcranial magnetic stimulation and magnetic resonance imaging in neuromyelitis optica and multiple sclerosis
Authors: Manogaran Praveena , Vavasour Irene , Borich Michael , Kolind Shannon H , Lange Alex P , Rauscher Alexander , Boyd Lara , Li David KB , Traboulsee Anthony 
Published: May 2015

Background: Both multiple sclerosis (MS) and neuromyelitis optica (NMO) can present with transverse myelitis; however, NMO symptoms are usually more severe and may present with more extensive axonal loss. Transcranial magnetic stimulation (TMS)-based input–output recruitment curves can quantitatively assess the excitability of corticospinal tract pathways and myelin water imaging can quantify the amount of myelin within this same pathway. Objective: To compare differential effects of MS and NMO on TMS recruitment curves and myelin water imaging. Methods: Ten healthy controls, 10 individuals with MS and 10 individuals with NMO completed clinical assessments, a TMS assessment and magnetic resonance imaging scan to measure recruitment curves and myelin water fraction in the corticospinal tract. Results: Individuals with NMO had lower recruitment curve slopes (mean 13.6±6 μV/%) than MS (23.6±11 μV/%) and controls (21.9±9 μV/%, analysis of variance (ANOVA) P=0.05). Corticospinal tract myelin water fraction was lower in individuals with NMO (mean 0.17±0.02) compared to MS (0.19±0.02) and controls (0.20±0.02, ANOVA P=0.0006). Conclusion: Corticospinal pathway damage in individuals with NMO was evident by reduced recruitment curve slope and lower myelin water fraction. These specific measures of corticospinal function and structure may be used to obtain a better understanding and monitor brain injury caused by inflammatory central nervous system disorders.
Cognitive reserve in multiple sclerosis: Protective effects of education
Authors: Martins Da Silva Ana , Cavaco Sara , Moreira Inês , Bettencourt Andreia , Santos Ernestina , Pinto Cláudia , Gonçalves Alexandra , Coutinho Ester , Samões Raquel , Dias Cláudia C , Teixeira-Pinto Armando , Da Silva Berta Martins , Montalban Xavier 
Published: May 2015

Background: Recent data suggest that cognitive reserve modulates the adverse effects of multiple sclerosis (MS) pathology on cognitive functioning; however, the protective effects of education in MS are still unclear. Objective: To explore education as an indicator of cognitive reserve, while controlling for demographic, clinical and genetic features. Methods: A total of 419 MS patients and 159 healthy comparison (HC) subjects underwent a comprehensive neuropsychological (NP) assessment, and answered the Hospital Anxiety and Depression Scale. Based on the HC data, MS patients’ NP scores were adjusted for sex, age and education; and the estimated 5th percentile (or 95th percentile, when appropriate) was used to identify any deficits. Patients also performed the Mini-Mental State Examination (MMSE); and their human leucocyte antigen HLA-DRB1 and apolipoprotein E ( ApoE) genotypes were investigated. Results: Patients with higher education were less likely ( p < 0.05) to have cognitive deficits than those with lower education, even when controlling for other covariates. Other significant predictors of cognitive deficit were: age, Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Scale (MSSS), and a progressive course. No significant association was found with the HLA-DRB1*15:01 or ApoE ε4 alleles. Conclusions: These results provide support to the use of education as a proxy of cognitive reserve in MS and stress the need to take into account education when approaching cognition in MS.
The Parotid Gland is an Underrecognized Organ at Risk for Craniospinal Irradiation
Authors: King Martin T. , Modlin Leslie , Million Lynn , Donaldson Sarah S. , Gibbs Iris C. , Choi Clara Y. H. , Soltys Scott G. 
Published: May 2015

Purpose: Current craniospinal irradiation (CSI) protocols do not include the parotid gland as an organ at risk, potentially leading to late effects of xerostomia and secondary parotid malignancies. We analyzed the effect of CSI treatment parameters on parotid dose. Materials and Methods: We retrospectively reviewed 50 consecutive patients treated with CSI to an intracranial dose >26 Gy. Parotid dose was compared to a Radiation Therapy Oncology Group (RTOG) dose constraint (at least 1 parotid with mean dose <26 Gy). The effects of CSI dose (≤24 Gy vs 24 Gy), volumetric-modulated arc therapy (VMAT) versus 3-dimensional (3D) CSI technique, boost dose (≤24 Gy vs 24 Gy), supratentorial versus infratentorial boost location, intensity-modulated radiation therapy (IMRT)-based versus 3D boost technique, supine versus prone position, and age on parotid dose were analyzed using multivariate regression analysis. Results: The RTOG parotid dose constraint was exceeded in 22 (44%) of 50 patients. On multivariate regression analysis, lower CSI dose and VMAT CSI technique were associated with reduced parotid dose for the CSI fields. For the boost fields, lower boost dose and supratentorial boost location were associated with lower parotid dose. All 5 patients who underwent VMAT CSI met dose constraints. Furthermore, for infratentorial lesions with a total (CSI plus boost) dose prescription dose >50 Gy (n = 24), 11 of 16 patients who received low-dose CSI (18-23.4 Gy) were able to meet dose constraints, when compared to only 2 of 8 patients who received high dose CSI (36 Gy). Conclusion: Given the large number of patients exceeding the parotid dose constraint, the parotid gland should be considered an organ at risk. CSI dose de-escalation and IMRT-based CSI techniques may minimize the risk of xerostomia.
Identifying optimal biomarker combinations for treatment selection through randomized controlled trials
Authors: Huang Ying 
Published: May 2015

Background/Aims Biomarkers associated with treatment-effect heterogeneity can be used to make treatment recommendations that optimize individual clinical outcomes. To accomplish this, statistical methods are needed to generate marker-based treatment-selection rules that can most effectively reduce the population burden due to disease and treatment. Compared to the standard approach of risk modeling to derive treatment-selection rules, a more robust approach is to directly minimize an unbiased estimate of total disease and treatment burden among a pre-specified class of rules. This problem is one of minimizing a weighted sum of 0–1 loss function, which is computationally challenging to solve due to the nonsmoothness of 0–1 loss. Huang and Fong, among others, proposed a method that uses the Ramp loss to approximate the 0–1 loss and solves the minimization problem through repetitive constrained optimizations. The algorithm was shown to have comparable or better performance than other comparative estimators in various settings. Our aim in this article is to further extend the algorithm to allow for variable selection in the presence of a large number of candidate markers. Methods We develop an alternative method to derive marker combinations to minimize the weighted sum of Ramp loss in Huang and Fong, based on data from randomized trials. The new algorithm estimates treatment-selection rules by repetitively minimizing a smooth and differentiable objective function. Through the use of an L1 penalty, we expand the method to allow for feature selection and develop an algorithm based on the coordinate descent method to build the treatment-selection rule. Results Through extensive simulation studies, we compared performance of the proposed estimator to four existing approaches: (1) a logistic regression risk modeling approach, and three other “direct optimizing” approaches including (2) the estimator in Huang and Fong, (3) the weighted support vector machine, and (4) the weighted logistic regression. The proposed estimator performs comparably to that of Huang and Fong, and comparably or better than other estimators. Allowing for variable selection using the proposed estimator in the presence of a large number of markers further improves treatment-selection performance. The proposed estimator is also advantageous for selecting variables relevant to treatment selection compared to L1 penalized logistic regression and weighted logistic regression. We illustrate the application of the proposed methods in host-genetics data from an HIV vaccine trial. Conclusion The proposed estimator is appealing considering its effectiveness and conceptual simplicity. It has significant potential to contribute to the selection and combination of biomarkers for treatment selection in clinical practice.
Surrogate markers for time-varying treatments and outcomes
Authors: Hsu Jesse Y , Kennedy Edward H , Roy Jason A , Stephens-Shields Alisa J , Small Dylan S , Joffe Marshall M 
Published: May 2015

Background: A surrogate marker is a variable commonly used in clinical trials to guide treatment decisions when the outcome of ultimate interest is not available. A good surrogate marker is one where the treatment effect on the surrogate is a strong predictor of the effect of treatment on the outcome. We review the situation when there is one treatment delivered at baseline, one surrogate measured at one later time point, and one ultimate outcome of interest and discuss new issues arising when variables are time-varying. Methods: Most of the literature on surrogate markers has only considered simple settings with one treatment, one surrogate, and one outcome of interest at a fixed time point. However, more complicated time-varying settings are common in practice. In this article, we describe the unique challenges in two settings, time-varying treatments and time-varying surrogates, while relating the ideas back to the causal-effects and causal-association paradigms. Conclusion: In addition to discussing and extending popular notions of surrogacy to time-varying settings, we give examples illustrating that one can be misled by not taking into account time-varying information about the surrogate or treatment. We hope this article has provided some motivation for future work on estimation and inference in such settings.
An evaluation of subjective experiences, effects and overall satisfaction with clozapine treatment in a UK forensic service
Authors: Qurashi Inti , Stephenson Paul , Chu Simon , Duffy Chris , Husain Nusrat , Chaudhry Imran 
Published: May 2015

Objectives: Patients prescribed clozapine were surveyed to assess (a) the effects, both positive and adverse, and overall satisfaction with clozapine in comparison to previously prescribed antipsychotics and (b) the relative significance of effects experienced, both positive and adverse, in terms of impact on subjective well-being. Methods: A total of 56 male patients prescribed clozapine at a forensic psychiatric hospital were surveyed using a 27-item questionnaire. All patients had been prescribed clozapine for a minimum of 3 months. Respondents were asked to rate effects and satisfaction with clozapine treatment in comparison with previously prescribed antipsychotic medication on a five-point scale. Respondents were also asked to rate effects experienced with clozapine treatment in terms of impact on subjective well-being on a five-point scale. Results: A total of 89% of respondents reported greater satisfaction with clozapine than with previously prescribed antipsychotic medication. A majority of patients reported positive effects in terms of an improvement in their quality of life (68%) and social abilities (52%) with clozapine in comparison with previously prescribed antipsychotics. Nocturnal hypersalivation (84%) and weight gain (57%) were the most common adverse effects. Hedonic responses were assessed for each effect in order to determine the associated subjective experiences. The most positive hedonic responses were for quality of life, mood and alertness. In terms of adverse impact on subjective well-being, nocturnal hypersalivation ranked highest. Conclusions: Patients in a UK forensic sample are largely satisfied with clozapine treatment. The subjective effects of clozapine treatment should be taken into account by clinicians when assessing response. This may provide an opportunity to highlight the positive changes and prioritize management of the most undesirable adverse effects, which is likely to promote compliance and improve longer term treatment outcomes.
Pharmacy students screening for pre-diabetes/diabetes with a validated questionnaire in community pharmacies during their experiential rotation in Alberta, Canada
Authors: Banh Hoan Linh , Chow Sheldon , Li Shuai , Letassy Nancy , Cox Cheryl , Cave Andrew 
Published: May 2015

Purpose: Type 2 diabetes is a major condition impacting morbidity, mortality, and health care costs in Canada. Pharmacists are very accessible and are in an ideal position to promote public health education. The primary goal of this study was to incorporate public health promotion and education into a community pharmacy experiential education rotation for fourth year pharmacy students to screen for the risk of pre-diabetes/diabetes in adults. A secondary goal was to determine the frequency of common risk factors for pre-diabetes/diabetes in adults in the community setting. Method: Fourth year pharmacy students were invited to recruit all adults 25 years or older attending community pharmacies to complete a pre-diabetes/diabetes risk assessment questionnaire. If the participants were at risk, the participants were provided education about risk reduction for developing pre-diabetes/diabetes. Results: A total of 340 participants completed a risk assessment questionnaire. Over 90% of people approached agreed to complete a risk assessment questionnaire. The common risk factors were overweight (154/45%), hypertension (102/30%), taking medications for hypertension (102/30%), and having symptoms of diabetes (111/33%). The ethnic minorities have 2.56 (confidence interval = 1.48–44.1) times greater odds of having a family history of diabetes compared to non-minority subjects. Conclusion: Pharmacy students are able to screen community-based patients for pre-diabetes/diabetes risks. The most common risk factors presented were overweight, hypertension, and taking medications for hypertension.
Teaching as Reconciliation
Authors: Hill Brian V. 
Published: May 2015

THIS ARTICLE WAS first published thirty years ago and is republished here both in recognition of its seminal use of a biblical concept as a metaphor for the role of the teacher and for the way in which it forms an instructive whole together with the other articles in this issue, adding a further perspective on the use of reconciliation language to describe education. It uses the writing style of the time in which it was written rather than that of the present day but, to maintain the integrity of the article as originally written and published, no alterations have been made. The article proposes that the biblical concept of reconciliation provides a helpful metaphor for teaching. Three points are identified at which the concept can be specially helpful: first, in bringing the child to terms with society, with the hopes and enmities in himself and others, so that he may develop with a realistic view of his options; second, in achieving a better balance between thinking and feeling in the curriculum; and third, in being involved with, and mediating between, the various groups interested in making educational policy. In these ways, the appropriate professional stance of the teacher is that of a reconciler.
What Matters
Authors: Purpel David E. 
Published: May 2015

DAVID PURPEL, PROFESSOR EMERITUS in the School of Education of the University of North Carolina at Greensboro, delivered the keynote address at a conference hosted by the Kuyers Institute in October 2007. Entitled “Reimagining Educational Excellence,” the conference explored how the call of Micah 6:8 can reframe our visions of educational excellence. Dr. Purpel's presentation, “What Matters: A Riff on Micah 6:8,” is reproduced here in slightly edited form. Though it overtly emphasizes technique and process, education holds a hidden curriculum—the implicit values and attitudes that are being communicated to students. A concern for excellence too often ends up mirroring the culture's preoccupation with consumerism, hierarchy, and competition and winning, merely serving the individualistic ends of social and economic advantage. Micah, on the other hand, urges us to seek justice, loving-kindness, reverence, and joy. A truly excellent education forms students who are morally responsible, dwell in community, seek justice, and care for others.
Functional Improvement in Geriatric Hip Fractures
Authors: Seng W. R. D. , Belani M. H. , Ramason R. , Naidu G. , Doshi H. K. 
Published: May 2015

Introduction: The “Integrated Care Pathway” for geriatric intertrochanteric (IT) fractures in Singapore’s Tan Tock Seng Hospital has shown significant functional recovery in patients’ activities of daily living. However, the influence of preoperative vitamin D on functional recovery remains equivocal. This retrospective study therefore aims to determine whether patients with preoperative vitamin D deficiency have poorer functional outcomes. Method: A total of 171 patients who had surgical treatment for IT fractures were recruited in the study. They were categorized into group A (vitamin D deficient) and group B (normal vitamin D). Charlson Comorbidity Index (CCI) score and nutritional parameters including hemoglobin, albumin, and adjusted calcium levels on admission were recorded. The Modified Barthel Index (MBI) score was used to measure functional recovery at the following time intervals: at pre-fall, at discharge after surgery, at 6 months, and at 1-year follow-up. Results: The mean age of both the groups (A: 79.7 years, n = 45; B: 83.0 years, n = 126) was statistically different ( P < .05). However, the mean CCI (A: 9.42 and B: 10.13), hemoglobin (A: 12.4 and B 11.1), adjusted calcium (A: 2.39 and B: 2.38), and mean albumin (A: 33.6 and B: 33.0) of the groups were not significantly different. Furthermore, the MBI scores were not significantly different for both groups at preinjury (A: 91.5 and B: 89.4), at discharge (A: 55.2 and B: 58.9), at 6 months (A: 70.9 and B: 75.1), and at 1 year (A: 75.8 and B: 79.4). Conclusion: In our cohort, patients with vitamin D deficiency were younger. However, vitamin D deficiency at time of injury had no significant influence on functional recovery in patients with surgically treated hip fracture in our Integrated Care Pathway. In addition, patients who had a normal vitamin D levels had similar functional scores and improvement postoperatively and at 1 year (A: 82.8% and B: 88.9%).