bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining ambulatory care sensitive conditions for adults in Portugal
Authors: Sarmento João , Rocha João Victor Muniz , Santana Rui 
Published: August 2020

Abstract
Background
Ambulatory Care Sensitive Conditions (ACSCs) are health conditions for which adequate management, treatment and interventions delivered in the ambulatory care setting could potentially prevent hospitalization. Which conditions are sensitive to ambulatory care varies according to the scope of health care services and the context in which the indicator is used. The need for a country-specific validated list for Portugal has already been identified, but currently no national list exists. The objective of this study was to develop a list of Ambulatory Care Sensitive Conditions for Portugal.

Methods
A modified web-based Delphi panel approach was designed, in order to determine which conditions can be considered ACSCs in the Portuguese adult population. The selected experts were general practitioners and internal medicine physicians identified by the most relevant Portuguese scientific societies. Experts were presented with previously identified ACSC and asked to select which could be accepted in the Portuguese context. They were also asked to identify other conditions they considered relevant. We estimated the number and cost of ACSC hospitalizations in 2017 in Portugal according to the identified conditions.

Results
After three rounds the experts agreed on 34 of the 45 initially proposed items. Fourteen new conditions were proposed and four achieved consensus, namely uterine cervical cancer, colorectal cancer, thromboembolic venous disease and voluntary termination of pregnancy. In 2017 133,427 hospitalizations were for ACSC (15.7% of all hospitalizations). This represents a rate of 1685 per 100,000 adults. The most frequent diagnosis were pneumonia, heart failure, chronic obstructive pulmonary disease/chronic bronchitis, urinary tract infection, colorectal cancer, hypertensive disease atrial fibrillation and complications of diabetes mellitus.

Conclusions
New ACSC were identified. It is expected that this list could be used henceforward by epidemiologic studies, health services research and for healthcare management purposes. ACSC lists should be updated frequently. Further research is necessary to increase the specificity of ACSC hospitalizations as an indicator of healthcare performance.
Boosting toxic protein biosynthesis: transient in vivo inactivation of engineered bacterial alkaline phosphatase
Authors: Krawczun Natalia , Bielawa Marta , Szemiako Kasjan , Łubkowska Beata , Sobolewski Ireneusz , Zylicz-Stachula Agnieszka , Skowron Piotr M. 
Published: August 2020

Abstract
Background
The biotechnology production of enzymes is often troubled by the toxicity of the recombinant products of cloned and expressed genes, which interferes with the recombinant hosts’ metabolism. Various approaches have been taken to overcome these limitations, exemplified by tight control of recombinant genes or secretion of recombinant proteins. An industrial approach to protein production demands maximum possible yields of biosynthesized proteins, balanced with the recombinant host’s viability. Bacterial alkaline phosphatase (BAP) from Escherichia coli (E. coli) is a key enzyme used in protein/antibody detection and molecular cloning. As it removes terminal phosphate from DNA, RNA and deoxyribonucleoside triphosphates, it is used to lower self-ligated vectors’ background. The precursor enzyme contains a signal peptide at the N-terminus and is secreted to the E. coli periplasm. Then, the leader is clipped off and dimers are formed upon oxidation.

Results
We present a novel approach to phoA gene cloning, engineering, expression, purification and reactivation of the transiently inactivated enzyme. The recombinant bap gene was modified by replacing a secretion leader coding section with a N-terminal His6-tag, cloned and expressed in E. coli in a PBAD promoter expression vector. The gene expression was robust, resulting in accumulation of His6-BAP in the cytoplasm, exceeding 50% of total cellular proteins. The His6-BAP protein was harmless to the cells, as its natural toxicity was inhibited by the reducing environment within the E. coli cytoplasm, preventing formation of the active enzyme. A simple protocol based on precipitation and immobilized metal affinity chromatography (IMAC) purification yielded homogeneous protein, which was reactivated by dialysis into a redox buffer containing reduced and oxidized sulfhydryl group compounds, as well as the protein structure stabilizing cofactors Zn2+, Mg2+ and phosphate. The reconstituted His6-BAP exhibited high activity and was used to develop an efficient protocol for all types of DNA termini, including problematic ones (blunt, 3′-protruding).

Conclusions
The developed method appears well suited for the industrial production of ultrapure BAP. Further, the method of transient inactivation of secreted toxic enzymes by conducting their biosynthesis in an inactive state in the cytoplasm, followed by in vitro reactivation, can be generally applied to other problematic proteins.
Accuracy of various criteria for lymph node staging in ductal adenocarcinoma of the pancreatic head by computed tomography and magnetic resonance imaging
Authors: Loch Florian N. , Asbach Patrick , Haas Matthias , Seeliger Hendrik , Beyer Katharina , Schineis Christian , Degro Claudius E. , Margonis Georgios A. , Kreis Martin E. , Kamphues Carsten 
Published: August 2020

Abstract
Background
Lymph node staging of ductal adenocarcinoma of the pancreatic head (PDAC) by cross-sectional imaging is limited. The aim of this study was to determine the diagnostic accuracy of expanded criteria in nodal staging in PDAC patients.

Methods
Sixty-six patients with histologically confirmed PDAC that underwent primary surgery were included in this retrospective IRB-approved study. Cross-sectional imaging studies (CT and/or MRI) were evaluated by a radiologist blinded to histopathology. Number and size of lymph nodes were measured (short-axis diameter) and characterized in terms of expanded morphological criteria of border contour (spiculated, lobulated, and indistinct) and texture (homogeneous or inhomogeneous). Sensitivities and specificities were calculated with histopathology as a reference standard.

Results
Forty-eight of 66 patients (80%) had histologically confirmed lymph node metastases (pN+). Sensitivity, specificity, and Youden’s Index for the criterion “size” were 44.2%, 82.4%, and 0.27; for “inhomogeneous signal intensity” 25.6%, 94.1%, and 0.20; and for “border contour” 62.7%, 52.9%, and 0.16, respectively. There was a significant association between the number of visible lymph nodes on preoperative CT and lymph node involvement (pN+, p = 0.031).

Conclusion
Lymph node staging in PDAC is mainly limited due to low sensitivity for detection of metastatic disease. Using expanded morphological criteria instead of size did not improve regional nodal staging due to sensitivity remaining low. Combining specific criteria yields improved sensitivity with specificity and PPV remaining high.
Clinical implications of prospective genomic profiling of metastatic breast cancer patients
Authors: van Geelen Courtney T. , Savas Peter , Teo Zhi Ling , Luen Stephen J. , Weng Chen-Fang , Ko Yi-An , Kuykhoven Keilly S. , Caramia Franco , Salgado Roberto , Francis Prudence A. , Dawson Sarah-Jane , Fox Stephen B. , Fellowes Andrew , Loi Sherene 
Published: August 2020

Abstract
Background
Metastatic breast cancer remains incurable. Next-generation sequencing (NGS) offers the ability to identify actionable genomic alterations in tumours which may then be matched with targeted therapies, but the implementation and utility of this approach is not well defined for patients with metastatic breast cancer.

Methods
We recruited patients with advanced breast cancer of any subtype for prospective targeted NGS of their most recent tumour samples, using a panel of 108 breast cancer-specific genes. Genes were classified as actionable or non-actionable using the European Society of Medical Oncology Scale for Clinical Actionability of Molecular Targets (ESCAT) guidelines.

Results
Between February 2014 and May 2019, 322 patients were enrolled onto the study, with 72% (n = 234) of patients successfully sequenced (n = 357 samples). The majority (74%, n = 171) of sequenced patients were found to carry a potentially actionable alteration, the most common being a PIK3CA mutation. Forty-three percent (n = 74) of patients with actionable alterations were referred for a clinical trial or referred for confirmatory germline testing or had a change in therapy outside of clinical trials. We found alterations in AKT1, BRCA2, CHEK2, ESR1, FGFR1, KMT2C, NCOR1, PIK3CA and TSC2 to be significantly enriched in our metastatic population compared with primary breast cancers. Concordance between primary and metastatic samples for key driver genes (TP53, ERBB2 amplification) was > 75%. Additionally, we found that patients with a higher number of mutations had a significantly worse overall survival.

Conclusion
Genomic profiling of patients with metastatic breast cancer can have clinical implications and should be considered in all suitable patients.
Geographical variation in determinants of high-risk fertility behavior among reproductive age women in Ethiopia using the 2016 demographic and health survey: a geographically weighted regression analysis
Authors: Tessema Zemenu Tadesse , Azanaw Melkalem Mamuye , Bukayaw Yeaynmarnesh Asmare , Gelaye Kassahun Alemu 
Published: August 2020

Abstract
Background
Maternal and child mortalities are the main public health problems worldwide and both are the major health concern in developing countries such as Africa and Asia. The fertility behavior of women characterized by maternal age, birth spacing, and order, impacts the health of women and children. The aim of this study was to assess the geographically variation in risk factors of high-risk fertility behavior (HRFB) among reproductive-age women in Ethiopia using the 2016 Demographic and Health Survey.

Methods
A total of 11,022 reproductive-age women were included in this study. The data were cleaned and weighted by STATA 14.1 software. Bernoulli based spatial scan statistics was used to identify the presence of pure high-risk fertility behavior spatial clusters using Kulldorff’s SaTScan version 9.6 software. ArcGIS 10.7 was used to visualize the spatial distribution of high-risk fertility behavior. Geographically weighted regression analysis was employed by multiscale geographical using Multiscale geographical weighted regression version 2.0 software. A p-value of less than 0.05 was used to declare statistically significant predictors (at a local level).

Results
Overall, 76% with 95% confidence interval of 75.60 to 77.20 of reproductive age women were faced with high-risk fertility problems in Ethiopia. High-risk fertility behavior was highly clustered in the Somali and Afar regions of Ethiopia. SaTScan identified 385 primary spatial clusters (RR = 1.13, P <  0.001) located at Somali, Afar, and some parts of Oromia Regional Stateregional state of Ethiopia. Women who are living in primary clusters were 13% more likely venerable to high-risk fertility behavior than outside the cluster. In geographically weighted regression, not using contraceptives and home delivery were statistically significant vary risk factors affecting high- risk fertility behavior spatially. No contraceptive use and home delivery were statistically significant predictors (at the local level) in different regions of Ethiopia.

Conclusion
In Ethiopia, HRFB varies across regions. Statistically, a significant-high hot spot high-risk fertility behavior was identified at Somali and Afar. No contraceptive use and home delivery were statistically significant predictors (at a local level) in different regions of Ethiopia. Therefore, policymakers and health planners better to design an effective intervention program at Somali, and Afar to reduce high-risk fertility behavior and Special attention needs about health education on the advantage of contraceptive utilization and health facility delivery to reduce high-risk fertility behavior.
Decomposing socioeconomic inequality in dental caries in Iran: cross-sectional results from the PERSIAN cohort study
Authors: Najafi Farid , Rezaei Satar , Hajizadeh Mohammad , Soofi Moslem , Salimi Yahya , Kazemi Karyani Ali , Soltani Shahin , Ahmadi Sina , Homaie Rad Enayatollah , Karami Matin Behzad , Pasdar Yahya , Hamzeh Behrooz , Nazar Mehdi Moradi , Mohammadi Ali , Poustchi Hossein , Motamed-Gorji Nazgol , Moslem Alireza , Khaleghi Ali Asghar , Fatthi Mohammad Reza , Aghazadeh-Attari Javad , Ahmadi Ali , Pourfarzi Farhad , Somi Mohammad Hossein , Sohrab Mehrnoush , Ansari-Moghadam Alireza , Edjtehadi Farhad , Esmaeili Ali , Joukar Farahnaz , Lotfi Mohammad Hasan , Aghamolaei Teamur , Eslami Saied , Tabatabaee Seyed Hamid Reza , Saki Nader , Haghdost Ali Akbar 
Published: August 2020

Abstract
Background
The current study aimed to measure and decompose socioeconomic-related inequalities in DMFT (decayed, missing, and filled teeth) index among adults in Iran.

Methods
The study data were extracted from the adult component of Prospective Epidemiological Research Studies in IrAN (PERSIAN) from 17 centers in 14 different provinces of Iran. DMFT score was used as a measure of dental caries among adults in Iran. The concentration curve and relative concentration index (RC) was used to quantify and decompose socioeconomic-related inequalities in DMFT.

Results
A total of 128,813 adults aged 35 and older were included in the study. The mean (Standard Deviation [SD]) score of D, M, F and DMFT of the adults was 3.3 (4.6), 12.6 (10.5), 2.1 (3.4) and 18.0 (9.5), respectively. The findings suggested that DMFT was mainly concentrated among the socioeconomically disadvantaged adults (RC = − 0.064; 95% confidence interval [CI), − 0.066 to − 0.063). Socioeconomic status, being male, older age and being a widow or divorced were identified as the main factors contributing to the concentration of DMFT among the worse-off adults.

Conclusions
It is recommended to focus on the dental caries status of socioeconomically disadvantaged groups in order to reduce socioeconomic-related inequality in oral health among Iranian adults. Reducing socioeconomic-related inequalities in dental caries should be accompanied by appropriate health promotion policies that focus actions on the fundamental socioeconomic causes of dental disease.
Prostaglandin insert dinoprostone versus trans-cervical balloon catheter for outpatient labour induction: a randomised controlled trial of feasibility (PROBIT-F)
Authors: Bhide Amarnath , Sedgwick Philip , Barrett Barbara , Cupples Georgina , Coates Rose , Goode Rosie , Linton Sandra , McCourt Christine 
Published: August 2020

Abstract
Background
The aim was to assess the feasibility of conducting a randomised controlled trial (RCT) of induction of labour comparing use of two methods in the outpatient setting.

Methods
An open-label feasibility RCT was conducted in two UK maternity units from October 2017 to March 2019. Women aged ≥ 16 years, undergoing induction of labour (IOL) at term, with intact membranes and deemed suitable for outpatient IOL according to local guidelines were considered eligible. They were randomised to cervical ripening balloon catheter (CRB) or vaginal dinoprostone (Propess). The participants completed a questionnaire and a sub-group underwent detailed interview. Service use and cost data were collected via the Adult Service Use Schedule (AD-SUS). Women who declined to participate were requested to complete a decliners’ questionnaire.

Results
During the study period, 274 eligible women were identified. Two hundred thirty (83.9%) were approached for participation of whom 84/230 (36.5%) agreed and 146 did not. Of these, 38 were randomised to Propess (n = 20) and CRB (n = 18). Decliner data were collected for 93 women. The reasons for declining were declining IOL (n = 22), preference for inpatient IOL (n = 22) and preference for a specific method, Propess (n = 19). The intended sample size of 120 was not reached due to restrictive criteria for suitability for outpatient IOL, participant preference for Propess and shortage of research staff.
The intervention as randomised was received by 29/38 (76%) women. Spontaneous vaginal delivery was observed in 9/20 (45%) women in the dinoprostone group and 11/18 (61%) women in the CRB group. Severe maternal adverse events were recorded in one woman in each group. All babies were born with good condition and all except one (37/38, 97.4%) remained with the mother after delivery. No deaths were recorded. − 21% of women in the dinoprostone group were re-admitted prior to diagnosis of active labour compared to 12% in the CRB group.

Conclusions
A third of the approached eligible women agreed for randomisation. An RCT is not feasible in the current service context. Modifications to the eligibility criteria for outpatient IOL, better information provision and round the clock availability of research staff would be needed to reach sufficient numbers.

Trial registration
NCT03199820. Registered on June 27, 2017
Improved comprehensive analytical method for assessment of satranidazole in drug and product
Authors: Mazumder Rana , Mahanti Beduin , Majumdar Subhabrota , Pal Rabindranath , Chowdhury Ashok Dhar 
Published: August 2020

Abstract
Background
The aim of the present investigation was to improve comprehensive analytical method for the assessment of satranidazole in drug and product with simple, economic, sensitive, and reproducible spectrophotometric method. The drug was analyzed in three different methods by using various solvents where satranidazole (STZ) showed different absorbance maxima (s) and sharp peaks in the first order derivative spectra. Beer’s law range, correlation coefficient, apparent molar absorptivity, etc., were determined for each solvent using all the three methods.

Results
All the results of analysis were found to be satisfactory which was validated statistically for various parameters and by performing recovery studies in accordance with international conference on harmonization (ICH) guidelines. The developed methods were also compared statistically using one way analysis of variance (ANOVA).

Conclusion
Three different spectrophotometric methods were developed for satranidazole (STZ) using various inorganic and organic solvents. The analytical methods are found to be simple, sensitive, rapid, specific, and economic, and it can be conveniently employed for the routine analysis, quality control. The sample recoveries from the formulation were in good agreement with its respective label claim.
Defining what a ‘carer’ is and the role they play in in-patient mental healthcare: A focus group study with patients, carers and clinicians
Authors: Dirik Aysegul , Kaselionyte Justina , Giacco Domenico , Priebe Stefan 
Published: August 2020

Background
The value of carer involvement has been extensively researched and promoted. However, the field lacks exploration of conceptual issues, which might help to explain why there are widespread difficulties in putting policy into practice in this area, as implementation rates remain low internationally.

Aims
This qualitative study explored patients’, carers’ and clinicians’ perspectives on the role of carers in mental healthcare, particularly with regards to in-patient settings.

Method
Sixteen focus groups were conducted with patients, carers and clinicians who have current or previous experience of in-patient settings. A thematic analysis was conducted on the transcripts, exploring two key domains: (a) what a ‘carer’ is, and (b) how the ‘carer’ role is described within the context of the hospital environment.

Results
Participants diverged in their opinions of what the ‘carer’ role entails, and the perceived helpfulness of it. Issues unique to the in-patient setting were identified, such as the role of the hospital environment in enabling or being a barrier to carer involvement. These differing perspectives and contextual factors had an impact on the position of carers in the hospital setting, as they could be viewed as helpful, a hindrance or as passive visitors, depending on the perspectives of clinicians.

Conclusions
More clarity and agreement is needed between patients, carers and clinicians in terms of how the ‘carer’ role is defined. This has the potential to improve carers’ experience of involvement in hospital settings.
Validation of the Swedish Diabetes Re-Grouping Scheme in Adult-Onset Diabetes in China
Authors: Li Xia , Yang Shuting , Cao Chuqing , Yan Xiang , Zheng Lei , Zheng Lanbo , Da Jiarui , Tang Xiaohan , Ji Linong , Yang Xilin , Zhou Zhiguang 
Published: August 2020

Abstract

Context
This study applied the Swedish novel data-driven classification in Chinese newly diagnosed diabetic patients and validated its adoptability.

Objective
This study aimed to validate the practicality of the Swedish diabetes regrouping scheme in Chinese adults with newly diagnosed diabetes.

Design
Patients were classified into 5 subgroups by K-means and Two-Step methods according to 6 clinical parameters.

Setting
Ambulatory care.

Patients
A cross-sectional survey of 15 772 patients with adult-onset newly diagnosed diabetes was conducted in China from April 2015 to October 2017.

Intervention
None.

Main Outcome Measures
Six parameters including glutamate decarboxylase antibodies (GADA), age of onset, body mass index (BMI), glycated hemoglobin A1c (HbA1c), homoeostatic model assessment 2 estimates of β-cell function (HOMA2-B) and insulin resistance (HOMA2-IR) were measured to calculate the patient subgroups.

Results
Our patients clustered into 5 subgroups: 6.2% were in the severe autoimmune diabetes (SAID) subgroup, 24.8% were in the severe insulin-deficient diabetes (SIDD) subgroup, 16.6% were in the severe insulin-resistance diabetes (SIRD) subgroup, 21.6% were in the mild obesity-related diabetes (MOD) subgroup and 30.9% were in the mild age-related diabetes (MARD) subgroup. When compared with the Swedish population, the proportion of SIDD subgroup was higher. In general, Chinese patients had younger age, lower BMI, higher HbA1c, lower HOMA2-B and HOMA2-IR, and higher insulin use but lower metformin usage than the Swedish patients.

Conclusion
The Swedish diabetes regrouping scheme is applicable to adult-onset diabetes in China, with a high proportion of patients with the severe insulin deficient diabetes. Further validations of long-term diabetes complications remain warranted in future studies.