bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of involving certified healthcare assistants in primary care in Germany: a cross-sectional study
Authors: Senft Jonas D , Wensing Michel , Poss-Doering Regina , Szecsenyi Joachim , Laux Gunter 
Published: December 2019

ObjectivesGrowing prevalence of chronic diseases and limited resources are the key challenges for future healthcare. As a promising approach to maintain high-quality primary care, non-physician healthcare professionals have been trained to broaden qualifications and responsibilities. This study aimed to assess the influence of involving certified healthcare assistants (HCAs, German: Versorgungsassistent/in in der Hausarztpraxis) on quality and efficacy of primary care in Germany.DesignCross-sectional study.SettingPrimary care.ParticipantsPatients insured by the Allgemeine Ortskrankenkasse (AOK) statutory health insurer (AOK, Baden-Wuerttemberg, Germany).InterventionsSince 2008 practice assistants in Germany can enhance their professional education to become certified HCAs.Primary and secondary outcome measuresClaims data related to patients treated in practices employing at least one HCA were compared with data from practices not employing HCAs to determine frequency of consultations, hospital admissions and readmissions. Economic analysis comprised hospitalisation costs, prescriptions of follow-on drugs and outpatient medication costs.ResultsA total of 397 493 patients were treated in HCA practices, 463 730 patients attended to non-HCA practices. Patients in HCA practices had an 8.2% lower rate of specialist consultations (p<0.0001), a 4.0% lower rate of hospitalisations (p<0.0001), a 3.5% lower rate of readmissions (p=0.0463), a 14.2% lower rate of follow-on drug prescriptions (p<0.0001) and 4.7% lower costs of total medication (p<0.0001). No difference was found regarding the consultation rate of general practitioners and hospital costs.ConclusionsFor the first time, this high-volume claims data analysis showed that involving HCAs in primary care in Germany is associated with a reduction in hospital admissions, specialist consultations and medication costs. Consequently, broadening qualifications may be a successful strategy not only to share physicians’ work load but to improve quality and efficacy in primary care to meet future challenges. Future studies may explore specific tasks to be shared with non-physician workforces and standardisation of the professional role.
Cost-effectiveness analysis of a physician deployment program to improve access to healthcare in rural and underserved areas in the Philippines
Authors: Avanceña Anton L.V. , Tejano Kim Patrick S , Hutton David W. 
Published: December 2019

ObjectivesThe objective of this study is to explore the cost-effectiveness of Doctor to the Barrios (DTTB), a physician deployment program in the Philippines.DesignCost-effectiveness analysis using decision tree models with a lifetime time horizon and probabilistic sensitivity analysis.SettingSocietal and healthcare perspectives.PopulationHypothetical cohort of children under 5 years in two provinces (Aklan and Nueva Ecija) and in a representative rural municipality.ParticipantsNone.InterventionsDTTB’s impact on paediatric pneumonia and diarrhoea outcomes compared with a scenario without DTTB.Main outcome measuresCosts, effectiveness (in terms of lives saved and quality-adjusted life years (QALYs) gained) and incremental cost-effectiveness ratio (ICER).ResultsDTTB is cost-effective in the two provinces that were included in the study from societal and healthcare perspectives. Looking at a representative rural municipality, base case analysis and probabilistic sensitivity analyses suggest that DTTB has an ICER of 27 192 per QALY gained from a societal perspective. From a healthcare perspective, the base case ICER of DTTB is Philippine pesos (PHP) 71 839 per QALY gained and PHP 2 064 167 per life saved, and 10 000 Monte Carlo simulations produced similar average estimates. The cost per QALY of DTTB from a healthcare perspective is lower than the WHO recommended willingness-to-pay threshold of 100% of the country’s per-capita gross domestic product.ConclusionsDTTB can be a cost-effective intervention, but its value varies by setting and the conditions of the municipality where it is implemented. By focusing on a narrow set of paediatric outcomes, this study has likely underestimated the health benefits of DTTB. Additional research is needed to understand the full extent of DTTB’s impact on the health of communities in rural and remote areas. Future cost-effectiveness analysis should empirically estimate various parameters and include other health conditions in addition to pneumonia and diarrhoea in children.
Supporting people with type 2 diabetes in effective use of their medicine through mobile health technology integrated with clinical care (SuMMiT-D Feasibility): a randomised feasibility trial protocol
Authors: Farmer Andrew , Allen Julie , Bartlett Kiera , Bower Peter , Chi Yuan , French David , Gudgin Bernard , Holmes Emily A , Horne Robert , Hughes Dyfrig A , Kenning Cassandra , Locock Louise , McSharry Jenny , Miles Lisa , Newhouse Nikki , Rea Rustam , Riga Evgenia , Tarassenko Lionel , Velardo Carmelo , Williams Nicola , Williams Veronika , Yu Ly-Mee 
Published: December 2019

IntroductionType 2 diabetes is common, affecting over 400 million people worldwide. Risk of serious complications can be reduced through use of effective treatments and active self-management. However, people are often concerned about starting new medicines and face difficulties in taking them regularly. Use of brief messages to provide education and support self-management, delivered through mobile phone-based text messages, can be an effective tool for some long-term conditions. We have developed messages aiming to support patients’ self-management of type 2 diabetes in the use of medications and other aspects of self-management, underpinned by theory and evidence. The aim of this trial is to determine the feasibility of a large-scale clinical trial to test the effectiveness and cost-effectiveness of the intervention, compared with usual care.Methods and analysisThe feasibility trial will be a multicentre individually randomised, controlled trial in primary care recruiting adults (≥35 years) with type 2 diabetes in England. Consenting participants will be randomised to receive short text messages three times a week with messages designed to produce change in medication adherence or non-health-related messages for 6 months. The aims are to test recruitment methods, retention to the study, the feasibility of data collection and the mobile phone and web-based processes of a proposed definitive trial and to refine the text messaging intervention. The primary outcome is the rate of recruitment to randomisation of participants to the trial. Data, including patient reported measures, will be collected online at baseline and the end of the 6-month follow-up period. With 200 participants (100 in each group), this trial is powered to estimate 80% follow-up within 95% CIs of 73.8% to 85.3%. The analysis will follow a prespecified plan.Ethics and disseminationEthics approval was obtained from the West of Scotland Research Ethics Committee 05. The results will be disseminated through conference presentations, peer-reviewed journals and will be published on the trial website: www.summit-d.org (SuMMiT-D (SUpport through Mobile Messaging and digital health Technology for Diabetes)).Trial registration numberISRCTN13404264.
Realist evaluation of UK medical education quality assurance
Authors: Crampton Paul , Mehdizadeh Leila , Page Michael , Knight Laura , Griffin Ann 
Published: December 2019

ObjectivesThe aim of the study was to explore what components of the General Medical Council’s (GMC) Quality Assurance Framework work, for whom, in what circumstances and how?SettingUK undergraduate and postgraduate medical education and training.ParticipantsWe conducted interviews with a stratified sample of 36 individuals. This included those who had direct experiences, as well as those with external insights, representing local, national and international organisations within and outside medicine.InterventionThe GMC quality assure education to protect patient and public safety utilising complex intervention components including meeting standards, institutional visits and monitoring performance. However, the context in which these are implemented matters. We undertook an innovative realist evaluation to test an initial programme theory. Data were analysed using framework analysis.ResultsAcross components of the intervention, we identified key mechanisms, including transparent reporting to promote quality improvement; dialogical feedback; partnership working facilitating interactions between regulators and providers, and role clarity in conducting proportionate interventions appropriate to risk. The GMC’s framework was commended for being comprehensive and enabling a broad understanding of an organisation’s performance. Unintended consequences included confusion over roles and boundaries in different contexts which often undermined effectiveness.ConclusionsThis realist evaluation substantiates the literature and reveals deeper understandings about quality assuring medical education. While standardised approaches are implemented, interventions need to be contextually proportionate. Routine communication is beneficial to verify data, share concerns and check risk; however, ongoing partnership working can foster assurance. The study provides a modified programme theory to explicate how education providers and regulators can work more effectively together to uphold education quality, and ultimately protect public safety. The findings have influenced the GMC’s approach to quality assurance which impacts on all medical students and doctors in training.
Effect of cold rolling on microstructural and mechanical properties of MG-7LI alloy
Authors: Cai Xiang , Qiao Yanxin , Wang Baojie , Zhou Huiling , Wang Yuxin 
Published: December 2019

The influence of rolling on nanomechanical and mechanical behavior of Mg-7Li alloy was investigated by nanoindentation, tensile test and scanning electron microscopy (SEM), respectively. The [Formula: see text]-Mg phase elongated along the rolling direction and gradually cracked. As the rolling ratio increased from 3 to 10, the hardness of [Formula: see text]-Mg and [Formula: see text]-Li phase increased by 7.35% and 20.75%, respectively. The fracture of alloys changed from ductile fracture to quasi-cleavage fracture. The yield strength and ultimate tensile strength increased by 23 MPa and 12 MPa, respectively, while elongation reduced by 12.5%.
Investigation of PTCR characteristics in Nb2O5-doped BaTiO3-based chip-type ceramics prepared by reduction sintering-reoxidation method
Authors: Cheng Xuxin , Chen Xiaoming , Cui Haining , Wang Yuxin , Xiong Chao 
Published: December 2019

This study investigates the influence of sintering conditions on electrical properties and positive temperature coefficient of resistance (PTCR) of [Formula: see text] (BTNO) ceramics, fired at [Formula: see text]C for different times from 1 to 6 h in a reducing atmosphere and reoxidised within the temperature range of [Formula: see text]–[Formula: see text]C for 1 h. The results showed that the room-temperature (RT) resistance and the resistance jump of the multilayer BTNO ceramics decreased with an increase in the firing time. Furthermore, the RT resistance of the BTNO samples gradually increased at first and then rapidly increased with increasing reoxidation temperature. In addition, the influence of sintering times on the microstructure of ceramics was also investigated.
Differential expression of angiotensin II type 1 receptor subtypes within the cerebral microvasculature
Authors: Yamasaki Evan , Thakore Pratish , Krishnan Vivek , Earley Scott 
Published: December 2019

Arteries and arterioles constrict in response to intraluminal pressure to generate myogenic tone, but the molecular nature of the vascular force-sensing mechanism is not fully characterized. Here, we investigated the role of angiotensin II type 1 receptors (AT1Rs) on vascular smooth muscle cells in the development of myogenic tone in cerebral parenchymal arterioles from mice. We found that pretreatment with the AT1R blocker losartan inhibited the development of myogenic tone in these vessels but did not alter the luminal diameter of arterioles with preestablished tone. Rodents express two AT1R isotypes: AT1Ra and AT1Rb. We previously demonstrated that AT1Rb is expressed at much higher levels compared with AT1Ra in cerebral pial arteries and is required for myogenic contractility in these vessels, whereas AT1Ra is unnecessary for this function. Here, we found that AT1Ra and AT1Rb are expressed at similar levels in parenchymal arterioles and that genetic knockout of AT1Ra blunted the ability of these vessels to generate myogenic tone. We also found that AT1Rb and total AT1R expression levels are much lower in parenchymal arterioles compared with pial arteries and that parenchymal arterioles are less sensitive to the vasoconstrictive effects of the endogenous AT1R ligand angiotensin II (ANG II). We conclude that 1) AT1Rs are critical for the initiation, but not the maintenance, of myogenic tone in parenchymal arterioles, and 2) lower levels of AT1Rb and total AT1R in parenchymal arterioles compared with pial arteries result in differences in myogenic and ANG II-induced vasoconstriction between these vascular segments. NEW & NOTEWORTHY Myogenic tone is critical for appropriate regulation of cerebral blood flow, but the mechanisms used by vascular smooth muscle cells to detect changes in intraluminal pressure are not fully characterized. Here, we demonstrate angiotensin II receptor type 1 (AT1R) is indispensable to initiation, but not maintenance, of myogenic tone in cerebral parenchymal arterioles. Furthermore, we demonstrate differences in AT1R expression levels lead to critical differences in contractile regulation between parenchymal arterioles and cerebral pial arteries.
Two-Year Outcomes After Deferral of Revascularization Based on Fractional Flow Reserve
Authors: Kuramitsu Shoichi , Matsuo Hitoshi , Shinozaki Tomohiro , Horie Kazunori , Takashima Hiroaki , Terai Hidenobu , Kikuta Yuetsu , Ishihara Takayuki , Saigusa Tatsuya , Sakamoto Tomohiro , Suematsu Nobuhiro , Shiono Yasutsugu , Mizuno Atsushi , Tsujita Kenichi , Masamura Katsuhiko , Yokoi Hiroyoshi , Tanaka Nobuhiro ,   on behalf of the J-CONFIRM Registry Investigators
Published: December 2019

Background:
The safety of fractional flow reserve (FFR)-based deferral of revascularization remains to be fully established in real-world practice. We sought to assess clinical outcomes after deferral of revascularization based on FFR.

Methods:
The J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry) prospectively enrolled 1263 patients with 1447 lesions in whom revascularization was deferred based on FFR at 28 Japanese centers. The primary study end point was the cumulative 2-year incidence of target vessel failure, including cardiac death, target-vessel related myocardial infarction, and clinically driven target vessel revascularization.

Results:

The mean FFR was 0.86±0.06. At 2 years, the target vessel failure rate was 5.5% in deferred lesions, mainly driven by a high rate of clinically driven target vessel revascularization (5.2%), and significantly increased with decreasing FFR, especially in the proximal location. Cardiac death and target-vessel related myocardial infarction rarely occurred during the 2-year follow-up (0.41% and 0.41%, respectively). Independent predictors of 2-year target vessel failure were FFR value (per 0.01 decrease; hazard ratio [HR] 1.07 [95% CI, 1.04–1.11],
P
<0.001), left main coronary artery lesion (HR, 5.89 [95% CI, 2.72–12.8],
P
<0.001), moderately to severely calcified lesion (HR, 2.49 [95% CI, 1.36–4.58];
P
=0.003), hemodialysis (HR, 2.90 [95% CI, 1.11–7.58];
P
=0.03), and right coronary artery lesion (HR, 1.78 [95% CI, 1.02–3.11],
P
=0.042).

Conclusions:
The J-CONFIRM registry demonstrated the 2-year target vessel failure rate was 5.5% in deferred lesions, highlighting the safety of FFR-based deferral of revascularization in daily practice.

Clinical Trial Registration:

URL:
http://www.umin.ac.jp
. Unique identifier: UMIN000014473.
Caravan Trade in the Late Ottoman Empire: the ʿAqīl Network and the Institutionalization of Overland Trade
Authors: Pétriat Philippe 
Published: December 2019

AbstractBuilding on recent works on Central Asia and using Ottoman, Arabic and European sources, this article challenges the idea that caravan trade was declining in the 19th and 20th-century Ottoman Middle East. It explores the caravan trade’s economic and political dimensions from the Gulf to Syria. This trade’s resurgence was simultaneous with the reassertion of imperial control over the steppe. In that changing context, the institutionalization of caravan trade by groups such as the ʿAqīl traders kept overland trade lively and arguably competitive.
Health promotion and students’ well-being in secondary schools in Catalonia
Authors: Soler-Masó Pere , Serdà Bernat-Carles , Planas-Lladó Anna 
Published: December 2019

Objective: The aim of this study was to analyse the views of different members of the school community regarding the health and well-being of young people and health promotion in schools. Design: Case study design was used, in which the Personal Wellbeing Index–School Children’s Questionnaire was administered to young people, and focus groups were held with other members of the school community (students, teachers, families, tutors and stakeholders). Setting: Five secondary schools in Catalonia (Spain). Method: Sequential triangulation between methods. Quantitative methods evaluated the students’ perception of health and well-being, while qualitative methods described school community perceptions of health promotion in school. Results: The results revealed a generally good perception of health among young people. Reported perceptions of health were lower among students in the later years of secondary education. Findings suggest that health promotion actions do not always translate into healthy behaviours among young people. Lack of resources and school overcrowding are key contextual factors influencing the promotion of health. Conclusion: Findings advance knowledge related to health education during the secondary years of schooling. In addition, they provide professionals with relevant data for developing and implementing health and well-being actions to include as part of a holistic curriculum.
Activation of autophagy during farnesyl pyrophosphate synthase inhibition is mediated through PI3K/AKT/mTOR signaling
Authors: Han Jie , Huang Chaoyang , Jiang Jiukun , Jiang Dongmei 
Published: December 2019

Objectives Autophagy is divided into three phases: autophagosome engulfment of intracellular organelles and proteins, autophagosome fusion with lysosomes, and autolysosome degradation. The farnesyl pyrophosphate synthase inhibitor ibandronate (IBAN) has in vivo cardioprotective properties, potentially via anti-oxidant effects. Whether autophagy is involved in the cardioprotective effect of IBAN remains unexplored. Methods Human umbilical vein endothelial cells (HUVECs) were treated in vitro with IBAN to assess autophagy induction. Lysosomal activation and phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling were assessed using a LysoTracker assay, acridine orange staining and western blotting. An MTS assay was used to assess cellular proliferation. Autophagy was inhibited using chloroquine or RNA silencing of autophagy-related 7 (Atg7) expression. Results IBAN induced autophagy in HUVECs. Moreover, IBAN activated lysosomal function, which is pivotal to autophagy induction. PI3K/AKT/mTOR activity was inhibited in IBAN-treated HUVECs, indicating the involvement of this pathway in IBAN-induced autophagy. Inhibition of autophagy using either chloroquine or Atg7 siRNA potentiated inhibition of HUVEC growth by IBAN, suggesting the involvement of non-autophagy pathways in the antiproliferative effects of IBAN. Conclusions These findings provide insights into the role of autophagy in the cardioprotective effects of IBAN and the molecular mechanisms underlying autophagy induction by IBAN.
Reduction and fixation of anterior inferior tibiofibular ligament avulsion fracture without syndesmotic screw fixation in rotational ankle fracture
Authors: Bae Kee Jeong , Kang Seung-Baik , Kim Jihyeung , Lee Jaewoo , Go Tae Won 
Published: December 2019

Objective We aimed to present the radiographic and functional outcomes of anatomical reduction and fixation of anterior inferior tibiofibular ligament (AITFL) avulsion fracture without syndesmotic screw fixation in rotational ankle fracture. Methods We retrospectively reviewed 66 consecutive patients with displaced malleolar fracture combined with AITFL avulsion fracture. We performed reduction and fixation for the AITFL avulsion fracture when syndesmotic instability was present after malleolar fracture fixation. A syndesmotic screw was inserted only when residual syndesmotic instability was present even after AITFL avulsion fracture fixation. The radiographic parameters were compared with those of the contralateral uninjured ankles. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were assessed 1 year postoperatively. Results Fifty-four patients showed syndesmotic instability after malleolar fracture fixation and underwent reduction and fixation for AITFL avulsion fracture. Among them, 45 (83.3%) patients achieved syndesmotic stability, while 9 (16.7%) patients with residual syndesmotic instability needed additional syndesmotic screw fixation. The postoperative radiographic parameters were not significantly different from those of the uninjured ankles. The mean AOFAS score was 94. Conclusion Reduction and fixation of AITFL avulsion fracture obviated the need for syndesmotic screw fixation in more than 80% of patients with AITFL avulsion fracture and syndesmotic instability.
miR-147a suppresses the metastasis of non-small-cell lung cancer by targeting CCL5
Authors: Lu Yan , Luan Xiao Rong 
Published: December 2019

Objective MicroRNA (miR)-147a acts as an inhibitory miRNA in many cancers. However, its potential roles in non-small-cell lung cancer (NSCLC) remain unclear. Methods Levels of miR-147a and C-C motif chemokine ligand 5 (CCL5) were measured using a quantitative real-time PCR assay. Cell growth, migration, and invasion of NSCLC cells were assessed by colony formation, wound healing, and Transwell invasion assays, respectively. The role of miR-147a in the growth and metastatic ability of NSCLC in vivo was detected using a xenograft model and experimental lung metastasis model. Results miR-147a was downregulated in NSCLC cell lines as well as in tissues. Gain-of-function and loss-of-function analyses demonstrated that upregulation of miR-147a decreased the aggressiveness of NSCLC cells in vitro. In addition, CCL5 was identified as a target of miR-147a. We also demonstrated the effect of miR-147a in the progression of NSCLC cells via targeting CCL5. Finally, the in vivo mouse xenograft model showed that miR-147a inhibited progression of NSCLC cells. Conclusions Overall, expression of miR-147a was downregulated in NSCLC. Importantly, upregulation of miR-147a suppressed the growth and metastasis of NSCLC cells in vivo by targeting CCL5.