nils-herrmann/clean_scirepeval huggingface dataset:
Evolution in cardiovascular care for elderly patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative.

This study evaluated the impact of age on care and outcomes for non-ST-segment elevation acute coronary syndromes (NSTE ACS).



Recent clinical trials have expanded treatment options for NSTE ACS, now reflected in guidelines. Elderly patients are at highest risk, yet have previously been shown to receive less care than younger patients.



In 56,963 patients with NSTE ACS at 443 U.S. hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) National Quality Improvement Initiative from January 2001 to June 2003, we compared use of guidelines-recommended care across four age groups: <65, 65 to 74, 75 to 84, and > or =85 years. A multivariate model tested for age-related differences in treatments and outcomes after adjusting for patient, provider, and hospital factors.



Of the study population, 35% were > or =75 years old, and 11% were > or =85 years old. Use of acute anti-platelet and anti-thrombin therapy within the first 24 h decreased with age. Elderly patients were also less likely to undergo early catheterization or revascularization. Whereas use of many discharge medications was similar in young and old patients, clopidogrel and lipid-lowering therapy remained less commonly prescribed in elderly patients. In-hospital mortality and complication rates increased with advancing age, but those receiving more recommended therapies had lower mortality even after adjustment than those who did not.



Age impacts use of guidelines-recommended care for newer agents and early in-hospital care. Further improvements in outcomes for elderly patients by optimizing the safe and early use of therapies are likely.
Prostate cancer in men aged less than 50 years at diagnosis

Prostate cancer (CaP) in younger men (age ≤50 years) appears to present differently compared with older men. This study describes CaP characteristics and outcomes in Australian young men. The South Australian Prostate Cancer Clinical Outcomes Collaborative database was used to identify men diagnosed with CaP 1998–2012. Men were stratified by age at diagnosis into groups ≤50, 50–70 and ≥70 years. Primary outcomes of cumulative biochemical recurrence (BCR) and cumulative prostate cancer-specific mortality (PCSM) were assessed at 5 and 10 years. In total, 7018 men were included. At time of diagnosis, 182 (2.6 %) were aged ≤50 years. Median follow-up exceeded 4 years. Younger men had a greater proportion of T stage <2 disease, lower median PSA and higher rates of Gleason score <7 (all p < 0.001). They were more likely to experience active surveillance (AS) (4.9, 3.1, 1.5 %) or radical prostatectomy (RP) (70, 55, 8 %) and less likely radiotherapy (13, 24, 29 %) as their principal modality (all p < 0.001). Although only 4.9 % underwent AS, 48 % of men ≤50 years were eligible for AS. Men ≤50 years had both the lowest unadjusted cumulative BCR and PCSM at 10 years. After multivariate analysis, BCR was not significantly different. Sample size limited multivariate analysis of PCSM. In our cohort, men ≤50 years with CaP had less aggressive clinical characteristics, but were more likely to undergo RP. They appear to experience lower unadjusted PCSM, but similar rates of adjusted BCR. Further studies are needed to assess whether AS is appropriately utilised in these men.
Impact of sugar beet pectin and polydextrose on fasting and postprandial glycemia and fasting concentrations of serum total and lipoprotein lipids in middle-aged subjects with abnormal glucose metabolism

To examine the effects of sugar beet pectin (SBP) and polydextrose (PDX) on fasting plasma glucose concentration, serum lipid profile and postprandial glycemia in middle-aged subjects with abnormal glucose metabolism.A placebo-controlled, randomized, parallel double-blinded study.Subjects were recruited via newspaper announcements. Seventy subjects were recruited of which 66 completed the study.The intervention period lasted for 12 weeks during which the subjects consumed a drink enriched with either SBP (n=22) or PDX (n=22) or without fiber enrichment (control group, n=22). The daily dose of the drinks was 4 dl. The subjects were also given nutrition counseling. Postprandial glycemia was examined in 24 subjects (n=8 in each group) at 0 and 12 weeks after a standardized breakfast.Fasting plasma glucose concentration did not change in the SBP and PDX groups, whereas it increased in the control group (P=0.007). On the contrary, the glycosylated hemoglobin A1c increased marginally but significantly (P⩽0.05) in the intervention groups without a change in the control group. In postprandial glycemia, no differences between the groups were found. In both the SBP and PDX groups, fasting serum High-density lipoprotein (HDL)-cholesterol concentration increased (P⩽0.05) without a change in the control group. Total to HDL-cholesterol ratio decreased in all groups (It was found that SBP and PDX do not have positive effects on fasting or postprandial plasma glucose concentrations or serum lipid profile in subjects with abnormal glucose metabolism.
Severe Wound of the Head by a Bear

SEVERE W0U2TD OF THE HEAD BY A BEAR. Reported by V. Richards,  Bolai Dey, a Ilindoo, aged 22 years, was admitted into the Bancoorah Charitable Dispensary, on the 30th of December, 1870. The elder brother, who accompanied the patient, stated that while they were cutting wood in the jungle, a bear rushed out and attacked Bolai, inflicting severe wounds. He (the elder brother) struck the bear with an axe so vigorously, that it turned upon him, but, owing to the density of the jungle, he was able to make his escape. Bolai in the meantime retreated, and ran and walked one mile towards home.
Short-term triglyceride lowering with fenofibrate improves vasodilator function in subjects with hypertriglyceridemia.

The objective of this study was to investigate the effects of lowering plasma triglycerides (TGs) on endothelial function and gain insight into the role played by free fatty acids (FFAs) in hypertriglyceridemia-associated vascular dysfunction.



Eleven hypertriglyceridemic subjects without coronary artery disease, diabetes, elevated low-density lipoprotein cholesterol, tobacco use, or hypertension were studied using a randomized, double-blinded, crossover design (fenofibrate and placebo, 14 days). After each regimen, forearm blood flow was assessed by plethysmography in response to arterial acetylcholine, nitroprusside, and verapamil infusion. Hourly plasma TGs, FFA, glucose, and insulin were measured during a 24-hour feeding cycle to characterize the metabolic environment. Changes in plasma FFA after intravenous heparin were used to estimate typical FFA accumulation in the luminal endothelial microenvironment. Fenofibrate lowered plasma TG (P<0.001), total cholesterol (P<0.01), and apolipoprotein B (P<0.01) without altering high-density lipoprotein or low-density lipoprotein cholesterol concentrations. Forearm blood flow in response to acetylcholine (P<0.0001), nitroprusside (P<0.001), and verapamil (P<0.0001) improved after fenofibrate. Fenofibrate lowered 24-hour (P<0.0001) and post-heparin (P<0.001) TG and tended to lower 24-hour (P=0.054) and post-heparin (P=0.028) FFA.



Vascular smooth muscle function significantly improves after lowering plasma TG without changes in confounding lipoproteins or insulin resistance. The data raise additional questions regarding the role of FFA in hypertriglyceridemia-associated vascular dysfunction.
Struggling to survive: the experiences of women sexually assaulted while intoxicated.

Approximately half of all sexual assault cases involve substance abuse or misuse, yet no studies have focused specifically on women who were under the influence of a substance when assaulted. The aim of this study was to explore the experiences of women who were sexually assault while under the influence of a substance. A phenomenological approach was used to gather data using individual, in-depth interviews with women following a sexual assault while intoxicated. Interviews were conducted using open-ended and probing questions to explore participants' life experiences from childhood to the present. The study uncovered a continuous struggle to survive among the participants. Five themes including previous victimization, substance misuse, struggling with feelings, finding support, and struggling to break the cycle were found. This research revealed lives complicated by substance misuse and histories of victimization. Intoxication raises vulnerability and risk for sexual assault. Effective nursing interventions designed to address the women's history of victimization and substance misuse may benefit women sexually assaulted while intoxicated.
Safety and Efficacy of Percutaneous Mitral Valve Repair Using the MitraClip® System in Patients with Diabetes Mellitus

Patients with diabetes mellitus show a negative outcome in percutaneous coronary intervention, aortic valve replacement and cardiac surgery. The impact of diabetes on patients undergoing treatment of severe mitral regurgitation (MR) using the MitraClip system is not known. We therefore sought to assess whether percutaneous mitral valve repair with the MitraClip system is safe and effective in patients with diabetes mellitus.



We included 58 patients with severe and moderate-to-severe MR in an open-label observational single-center study. Ninteen patients were under oral medication or insulin therapy for type II diabetes mellitus. MitraClip devices were successfully implanted in all patients with diabetes and in 97.4% (n = 38) of patients without diabetes (p = 0.672). Periprocedural major cardiac adverse and cerebrovascular events (MACCE) occurred in 5.1% (n = 2) of patients without diabetes whereas patients with diabetes did not show any MACCE (p = 0.448). 30-day mortality was 1.7% (n = 1) with no case of death in the diabetes group. Short-term follow up of three months showed a significant improvement of NYHA class and quality of life evaluated by the Minnesota Living with Heart Failure Questionnaire in both groups, with no changes in the 6-minute walk test.



Mitral valve repair with the MitraClip system is safe and effective in patients with type II diabetes mellitus.
Bone marrow myeloid cell kinetics during treatment of small cell carcinoma of the lung with chemotherapy not associated and associated with granulocyte-macrophage colony-stimulating factor

Information on the kinetics of bone marrow (BM) myeloid precursors (BMMP) is required for integrating cancer chemotherapy with granulocyte-macrophage colony-stimulating factor (rhGM-CSF), with the aim of reducing neutropenia. Using bivariate flow-cytometric analysis of the in vivo incorporation of bromodeoxyuridine (BUDR) vs DNA content we have studied the kinetics of BMMP in 21 patients with SCLC during the first of six chemotherapy courses (etoposide, epirubicin, andcis-platinum, days 1–3, every 21 days), given alone (eight patients) or followed by rhGM-CSF (10μg/kg/day s.c, days 4–14) as BM rescue (eight patients) or both preceded (days -17 to -7, as BM priming) and followed by rhGM-CSF (five patients). At 11–14 days after the start of these therapies there was an increase in the baseline proliferative activity of proliferating BMMP and a shortening in the time needed by the metamyelocyte to mature and to leave the marrow. Both effects were greater and were maintained to a significantly greater degree a week later in patients who received chemotherapy plus rhGM-CSF rescue than in those who received chemotherapy alone or rhGM-CSF priming alone. At day 11–14 the pretreatment median cell production rate of pBMMP was increased by 340%, 150%, and 183% and the maturation time was reduced by 80%, 45%, and 57%, respectively, in the three groups. A week later, the corresponding figures were 206%, 111%, and 157% and 50%, 18%, and 45%. Hence, an identical rhGM-CSF schedule is more effective in increasing the neutrophil production by BMMP when given following chemotherapy as BM rescue than before it as BM priming. In both the rescue and the priming schedule, the increase in proliferative activity of BMMP just at the end of rhGM-CSF stimulation was linked to both an increase in the labeling index and a reduction in duration of S-phase (TS), while a week later it was linked solely to reduction in TS. This could actually reduce one of the two kinetic targets of subsequently administered cytostatics, i.e., a high LI and a long time spent in S phase. From this study, accurate kinetic data can be obtained with the in vivo BUDR technique that are useful in scheduling rhGM-CSF.
On maintaining multiple versions in STM

An effective way to reduce the number of aborts in software transactional memory (STM) is to keep multiple versions of transactional objects. In this paper, we study inherent properties of STMs that use multiple versions to guarantee successful commits of all read-only transactions.
 We first show that these STMs cannot be disjoint-access parallel. We then consider the problem of garbage collecting old object versions, and show that no STM can be optimal in the number of previous versions kept. Moreover, we show that garbage collecting useless versions is impossible in STMs that implement invisible reads. Finally, we present an STM algorithm using visible reads that efficiently garbage collects useless object versions.
The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment.

Difficulty with pain assessment in individuals who cannot self-report their pain poses a significant barrier to effective pain management. However, available assessment tools lack consistent reliability as pain measures in children with cognitive impairment (CI). This study evaluated the validity and reliability of the revised and individualized Face Legs Activity Cry and Consolability (FLACC) behavioral pain assessment tool in children with CI.



Children with CI scheduled for elective surgery were studied. The FLACC was revised to include specific descriptors and parent-identified, unique behaviors for individual children. The child's ability to self-report pain was evaluated. Postoperatively, two nurses scored pain using the revised FLACC scale before and after analgesic administration, and, children self-reported a pain score, if able. Observations were videotaped and later viewed by experienced nurses blinded to analgesic administration.



Eighty observations were recorded in 52 children aged 4-19 years. Twenty-one parents added individualized pain behaviors to the revised FLACC. Interrater reliability was supported by excellent intraclass correlation coefficients (ICC, ranging from 0.76 to 0.90) and adequate kappa statistics (0.44-0.57). Criterion validity was supported by the correlations between FLACC, parent, and child scores (rho = 0.65-0.87; P < 0.001). Construct validity was demonstrated by the decrease in FLACC scores following analgesic administration (6.1 +/- 2.6 vs 1.9 +/- 2.7; P < 0.001).



Findings support the reliability and validity of the FLACC as a measure of pain in children with CI.
Phase II study of biweekly paclitaxel and cisplatin combination chemotherapy in advanced gastric cancer: Korea Japan Collaborative Study Group Trial.

Benefits of chemotherapy have generally been modest in gastric cancer, although those regimens developed more recently have produced higher response rates. Paclitaxel plus cisplatin is one such regimen and divided administration of paclitaxel has been suggested to be associated with lower neurological and hematologic toxicities and be able to achieve higher paclitaxel dose intensities than paclitaxel administration at 175 mg/m2 every 3 weeks. This study was undertaked to assess the efficacy and toxicity of a biweekly paclitaxel and cisplatin combination treatment in advanced gastric cancer.



Twenty-five patients from Japan and Korea, 50 patients in total, were entered into this trial which was conducted from October 2004 to June 2005. Median age of the patients was 57 years (range: 26-78). Paclitaxel 140 mg/m2 was administered intravenously on days 1 and 15 of each 4-week cycle. Cisplatin 30 mg/m2 was also administered on days 1 and 15 with standard hydration. A total of 278 courses of treatment (two treatment courses per cycle) were conducted for 50 patients. The median number of treatment cycles per patient was two with a range of one to six.



Nine of the 50 patients responded to the treatment, with an overall objective response rate of 18% (95% CI, 12-41), which included one complete response. Two patients were not evaluable and 14 patients had stable disease as best response. The median survival duration of the 50 patients was 333 days (range: 52-637+ days). The main toxicity was neutropenia. Significant toxicity (NCI-CTC grade 3 or 4) included neutropenia in 19 patients (38%), anorexia in four (8%), infection in three (6%), anemia in three (6%), and abdominal pain in three (6%).



Biweekly paclitaxel and cisplatin combination chemotherapy showed modest activity in advanced gastric carcinoma with a favorable toxicity pattern.
Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention

Task shifting and the integration of human immunodeficiency virus (HIV) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment (ART). This paper describes the development and content of an intervention involving these two strategies, as part of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) pragmatic randomised controlled trial.



DEVELOPING THE INTERVENTION: The intervention was developed following discussions with senior management, clinicians, and clinic staff. These discussions revealed that the establishment of separate antiretroviral treatment services for HIV had resulted in problems in accessing care due to the large number of patients at ART clinics. The intervention developed therefore combined the shifting from doctors to nurses of prescriptions of antiretrovirals (ARVs) for uncomplicated patients and the stepwise integration of HIV care into primary care services.



COMPONENTS OF THE INTERVENTION: The intervention consisted of regulatory changes, training, and guidelines to support nurse ART prescription, local management teams, an implementation toolkit, and a flexible, phased introduction. Nurse supervisors were equipped to train intervention clinic nurses in ART prescription using outreach education and an integrated primary care guideline. Management teams were set up and a STRETCH coordinator was appointed to oversee the implementation process.



Three important processes were used in developing and implementing this intervention: active participation of clinic staff and local and provincial management, educational outreach to train nurses in intervention sites, and an external facilitator to support all stages of the intervention rollout.The STRETCH trial is registered with Current Control Trials ISRCTN46836853.
Phase I study of weekly DN-101, a new formulation of calcitriol, in patients with cancer

DN-101 is a new, high-dose, oral formulation of calcitriol under investigation for the treatment of cancer. We sought to evaluate the tolerability and pharmacokinetics (PK) of weekly doses of DN-101 in patients with advanced cancer. Patients who completed a previously reported single dose escalation study of DN-101 [Beer et al. (2005)  were eligible for this continuation weekly dosing study. Cohorts of 3–10 patients were treated at doses of 15, 30, 45, 60, and 75 μg calcitriol. Once 45 μg was established as the maximum tolerated dose (MTD), this cohort was expanded to include 18 patients. Dose limiting toxicity (DLT) was defined as ≥grade 2 hypercalcemia or ≥grade 3 persistent treatment-related toxicities. Thirty-seven patients were recruited. DLT of transient reversible grade 2 hypercalcemia (serum calcium of 11.6–12.5 mg/dL) occurred in two of six patients treated with 60 μg of DN-101. No DLT was observed in the 18 patients who received DN-101 weekly at 45 μg. Overall, DN-101 was well tolerated. The most frequent adverse events were fatigue (27%), hypercalcemia (19%, including five grade 1, two grade 2, and no grade 3 or 4 events), and grade 1 nausea (16%). PK parameters following repeat dosing were comparable to those for the initial dose (n = 4). The MTD for weekly DN-101 was established as 45 μg. The DLTs observed were two episodes of rapidly reversible grade 2 hypercalcemia in two of the six patients treated at 60 μg weekly. Repeat doses of DN-101 at 45 μg weekly are well tolerated and this dose is suitable for studies of weekly DN-101 in cancer patients.
A double-blind, placebo-controlled study of remacemide hydrochloride in patients with refractory epilepsy following pre-surgical assessment

This multicentre, randomised, double-blind, placebo-controlled, parallel-group study investigated the efficacy, safety and pharmacokinetics of remacemide hydrochloride in adult patients ( n= 59) with refractory epilepsy, undergoing reduced or discontinued antiepileptic drug (AED) usage, as part of an evaluation for epilepsy surgery. On discontinuation or reduction of maintenance AEDs, patients received remacemide hydrochloride, up to 600 mg daily, or placebo, for up to ten days or until they experienced a fourth complex partial (CPS) or a generalised tonic-clonic (GTC) seizure. Pre- and post-study blood and urine samples were taken for analysis. Remacemide hydrochloride showed a significantly ( P= 0.045) longer median time to fourth seizure compared with placebo (6.8 vs. 3.8 days). Median nine-day seizure counts were significantly ( P= 0.0327) lower with remacemide hydrochloride than placebo (6.2 vs. 12.8). Eleven remacemide hydrochloride patients and six placebo patients completed ten days' treatment. Remacemide and desglycinyl metabolite levels were lower in patients receiving concomitant carbamazepine or phenytoin than in those receiving non-inducing AEDs or remacemide hydrochloride alone. No serious adverse events occurred; all patients receiving remacemide hydrochloride completed the study. Remacemide hydrochloride was well tolerated and showed significant therapeutic activity in this patient population.