bluuebunny/crossref_metadata_2025_split huggingface dataset:
Approaches for combining primary care electronic health record data from multiple sources: a systematic review of observational studies
Authors: Dedman Daniel , Cabecinha Melissa , Williams Rachael , Evans Stephen J W , Bhaskaran Krishnan , Douglas Ian J 
Published: October 2020

ObjectiveTo identify observational studies which used data from more than one primary care electronic health record (EHR) database, and summarise key characteristics including: objective and rationale for using multiple data sources; methods used to manage, analyse and (where applicable) combine data; and approaches used to assess and report heterogeneity between data sources.DesignA systematic review of published studies.Data sourcesPubmed and Embase databases were searched using list of named primary care EHR databases; supplementary hand searches of reference list of studies were retained after initial screening.Study selectionObservational studies published between January 2000 and May 2018 were selected, which included at least two different primary care EHR databases.Results6054 studies were identified from database and hand searches, and 109 were included in the final review, the majority published between 2014 and 2018. Included studies used 38 different primary care EHR data sources. Forty-seven studies (44%) were descriptive or methodological. Of 62 analytical studies, 22 (36%) presented separate results from each database, with no attempt to combine them; 29 (48%) combined individual patient data in a one-stage meta-analysis and 21 (34%) combined estimates from each database using two-stage meta-analysis. Discussion and exploration of heterogeneity was inconsistent across studies.ConclusionsComparing patterns and trends in different populations, or in different primary care EHR databases from the same populations, is important and a common objective for multi-database studies. When combining results from several databases using meta-analysis, provision of separate results from each database is helpful for interpretation. We found that these were often missing, particularly for studies using one-stage approaches, which also often lacked details of any statistical adjustment for heterogeneity and/or clustering. For two-stage meta-analysis, a clear rationale should be provided for choice of fixed effect and/or random effects or other models.
Association between hyperemesis gravidarum and psychological symptoms, psychosocial outcomes and infant bonding: a two-point prospective case–control multicentre survey study in an inner city setting
Authors: Mitchell-Jones Nicola , Lawson Kim , Bobdiwala Shabnam , Farren Jessica Alice , Tobias Aurelio , Bourne Tom , Bottomley Cecilia 
Published: October 2020

ObjectivesTo assess if there is any association between hyperemesis gravidarum (HG), psychological morbidity and infant bonding and to quantify any psychosocial consequences of HG.DesignTwo-point prospective case–control, multicentre survey study with antenatal and postnatal data collection.SettingThree London hospitals.ParticipantsPregnant women at ≤12 completed weeks gestation recruited consecutively over 2 years. Women with HG were recruited at the time of admission; controls recruited from a low risk antenatal clinic. 106 women were recruited to the case group and 108 to the control. Response rates at antenatal data collection were 87% and 85% in the case and control groups, respectively. Postnatally, the response rate was 90% in both groups.Primary and secondary outcome measuresPrimary outcomes were psychological morbidity in the antenatal and postnatal periods, infant bonding in the postnatal period and psychosocial implications of HG. Secondary outcomes were the effects of severity and longevity of HG and assessment of correlation between Edinburgh Postnatal Depression Scale scores and maternal-to-infant bonding scores.ResultsAntenatally, 49% of cases had probable depression compared with 6% of controls (OR 14.4 (5.29 to 39.44)). Postnatally, 29% of cases had probable depression versus 7% of controls (OR 5.2 (1.65 to 17.21)). There was no direct association between HG and infant bonding. 53% of women in the HG group reported needing four or more weeks of sick leave compared with 2% in the control group (OR 60.5 (95% CI 8.4 to 2535.6)).ConclusionsLong-lasting psychological morbidity associated with HG was evident. Significantly more women in the case group sought help for mental health symptoms in the antenatal period, however very few were diagnosed with or treated for depression in pregnancy or referred to specialist perinatal mental health services. HG did not directly affect infant bonding. Women in the case group required long periods off work, highlighting the socioeconomic impact of HG.
Effects of social vulnerability and heat index on emergency medical service incidents in San Antonio, Texas, in 2018
Authors: Zottarelli Lisa K , Sharif Hatim O , Xu Xiaohe , Sunil Thankam S 
Published: October 2020

BackgroundExcessive heat is a leading weather-related cause of fatalities in the USA. Vulnerable populations can face greater exposure to health risks during extreme heat events. The aim of this study is to examine the effects of excessive heat and community-level social vulnerability on morbidity in San Antonio, Texas, in 2018.MethodsHeat Index (HI) data are from the National Oceanic and Atmospheric Administration. Social vulnerability is measured using the Centres for Disease Control and Prevention’s Social Vulnerability Index (SVI). Morbidity is measured as the number of emergency medical service (EMS) incidents. Sixty-one zip codes were analysed for the 153 constrained calendar days from 1 May to 30 September 2018. Negative binomial regression analysis with the time-stratified case-crossover design was conducted to predict the effects of HI and SVI on the rate of EMS incidents.ResultsHI is significantly and positively associated with the rate of EMS incidents. Social vulnerability has a statistically significant association with EMS incidents, with higher levels of community-level social vulnerability associated with higher rates of EMS incidents. The effect of the HI on the rate of EMS incidents is significantly and positively moderated by the SVI.ConclusionsSocial vulnerability and excessive heat increase the rate of EMS incidents. As the number of excessive heat days increases and San Antonio continues to have extreme disparities by location, there will be an effect on health systems, including EMSs.
Age-related and socioeconomic inequalities in timeliness of referral and start of treatment in colorectal cancer: a population-based analysis
Authors: Hayes Louise , Adams Jean , McCallum Iain , Forrest Lynne , Hidajat Mira , White Martin , Sharp Linda 
Published: October 2020

BackgroundPoorer colorectal cancer survival in the UK than in similar countries may be partly due to delays in the care pathway. To address this, cancer waiting time targets were established. We investigated if socio-demographic inequalities exist in meeting cancer waiting times for colorectal cancer.MethodsWe identified primary colorectal cancers (International Classification of Diseases, Tenth Revision C18–C20; n=35 142) diagnosed in the period 2001–2010 in the Northern and Yorkshire Cancer Registry area. Using multivariable logistic regression, we calculated likelihood of referral and treatment within target by age group and deprivation quintile.Results48% of the patients were referred to hospital within target (≤14 days from general practitioner (GP) referral to first hospital appointment); 52% started treatment within 31 days of diagnosis; and 44% started treatment within 62 days of GP referral. Individuals aged 60–69, 70–79 and 80+ years were significantly more likely to attend a first hospital appointment within 14 days than those aged <60 years (adjusted OR=1.23, 95% CI 1.12 to 1.34; adjusted OR=1.19, 95% CI 1.09 to 1.29; adjusted OR=1.30, 95% CI 1.18 to 1.42, respectively). Older age was significantly associated with lower likelihood of starting treatment within 31 days of diagnosis and 62 days of referral. Deprivation was not related to referral within target but was associated with lower likelihood of starting treatment within 31 days of diagnosis or 62 days of referral (most vs least: adjusted OR=0.82, 95% CI 0.74 to 0.91).ConclusionsOlder patients with colorectal cancer were less likely to experience referral delays but more likely to experience treatment delays. More deprived patients were more likely to experience treatment delays. Investigation of patient pathways, treatment decision-making and treatment planning would improve understanding of these inequalities.
Brain imaging abnormalities and outcome after acute ischaemic stroke: the ENCHANTED trial
Authors: Delcourt Candice , Wang Xia , Zhou Zien , Wardlaw Joanna M , Mair Grant , Robinson Thompson G , Chen Xiaoying , Yoshimura Sohei , Torii-Yoshimura Takako , Carcel Cheryl , Calic Zeljka , Tan Wee Yong , Malavera Alejandra , Anderson Craig S , Lindley Richard I 
Published: October 2020

Objective
To test the hypothesis that imaging signs of ‘brain frailty’ and acute ischaemia predict clinical outcomes and symptomatic intracranial haemorrhage (sICH) after thrombolysis for acute ischaemic stroke (AIS) in the alteplase dose arm of ENhanced Control of Hypertension ANd Thrombolysis strokE stuDy (ENCHANTED).

Methods
Blinded assessors coded baseline images for acute ischaemic signs (presence, extent, swelling and attenuation of acute lesions; and hyperattenuated arteries) and pre-existing changes (atrophy, leucoaraiosis and old ischaemic lesions). Logistic regression models assessed associations between imaging features and death at 7 and 90 days; good recovery (modified Rankin Scale scores 0–2 at 90 days) and sICH. Data are reported with adjusted ORs and 95% CIs.

Results
2916 patients (67±13 years, National Institutes of Health Stroke Scale 8 (5–14)) were included. Visible ischaemic lesions, severe hypoattenuation, large ischaemic lesion, swelling and hyperattenuated arteries were associated with 7-day death (OR (95% CI): 1.52 (1.06 to 2.18); 1.51 (1.01 to 2.18); 2.67 (1.52 to 4.71); 1.49 (1.03 to 2.14) and 2.17 (1.48 to 3.18)) and inversely with good outcome. Severe atrophy was inversely associated with 7-day death (0.52 (0.29 to 0.96)). Atrophy (1.52 (1.08 to 2.15)) and severe leucoaraiosis (1.74 (1.20 to 2.54)) were associated with 90-day death. Hyperattenuated arteries were associated with sICH (1.71 (1.01 to 2.89)). No imaging features modified the effect of alteplase dose.

Conclusions
Non-expert-defined brain imaging signs of brain frailty and acute ischaemia contribute to the prognosis of thrombolysis-treated AIS patients for sICH and mortality. However, these imaging features showed no interaction with alteplase dose.
Cognition and behaviour in frontotemporal dementia with and without amyotrophic lateral sclerosis
Authors: Saxon Jennifer A , Thompson Jennifer C , Harris Jennifer M , Richardson Anna M , Langheinrich Tobias , Rollinson Sara , Pickering-Brown Stuart , Chaouch Amina , Ealing John , Hamdalla Hisham , Young Carolyn A , Blackburn Dan , Majeed Tahir , Gall Claire , Jones Matthew , Snowden Julie S 
Published: October 2020

Objective
The precise relationship between frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) is incompletely understood. The association has been described as a continuum, yet data suggest that this may be an oversimplification. Direct comparisons between patients who have behavioural variant FTD (bvFTD) with and without ALS are rare. This prospective comparative study aimed to determine whether there are phenotypic differences in cognition and behaviour between patients with FTD-ALS and bvFTD alone.

Methods
Patients with bvFTD or FTD-ALS and healthy controls underwent neuropsychological testing, focusing on language, executive functions and social cognition. Behavioural change was measured through caregiver interview. Blood samples were screened for known FTD genes.

Results

23 bvFTD, 20 FTD-ALS and 30 controls participated. On cognitive tests, highly significant differences were elicited between patients and controls, confirming the tests’ sensitivities to FTD. bvFTD and FTD-ALS groups performed similarly, although with slightly greater difficulty in patients with ALS-FTD on category fluency and a sentence-ordering task that assesses grammar production. Patients with bvFTD demonstrated more widespread behavioural change, with more frequent disinhibition, impulsivity, loss of empathy and repetitive behaviours. Behaviour in FTD-ALS was dominated by apathy. The
C9ORF72
repeat expansion was associated with poorer performance on language-related tasks.

Conclusions

Differences were elicited in cognition and behaviour between bvFTD and FTD-ALS, and patients carrying the
C9ORF72
repeat expansion. The findings, which raise the possibility of phenotypic variation between bvFTD and FTD-ALS, have clinical implications for early detection of FTD-ALS and theoretical implications for the nature of the relationship between FTD and ALS.
In-thrombus thrombin secretion: a new diagnostic marker of atrial fibrillation in cryptogenic stroke
Authors: Itsekson Hayosh Ze'ev , Abu Bandora Eiman , Shelestovich Natalia , Nulman Maya , Bakon Mati , Yaniv Gal , Khaitovitch Boris , Balan Shmuel , Gerasimova Alexandra , Drori Tali , Mausbach Stefan , Schwammenthal Yvonne , Afek Arnon , Chapman Joab , Shavit Stein Efrat , Orion David 
Published: October 2020

BackgroundEndovascularly retrieved clots are a potential resource for diagnosing stroke etiology, which may influence secondary prevention treatment. In this study we measured thrombin activity eluted by serially washing clots.MethodsClots were retrieved from 68 patients with acute ischemic stroke, freshly frozen and classified by standard criteria into proven atrial fibrillation (AF, 18 patients), atherosclerotic origin (AS, 15 patients), cryptogenic stroke (Cr, 17 patients) and other known causes (18 patients). Thawed clot samples were washed by transferring them into 1 mL buffer in seven hourly cycles and a fluorescent substrate assay was used to measure secreted thrombin activity. The clots were also examined histologically. Artificial fibrin and red blood cell-rich clots were similarly assayed for wash-eluted thrombin activity as an external control.ResultsThrombin activity eluted from clots of AF origin decreased significantly with time in contrast to steady levels eluted from AS origin thrombi (P<0.0001 by repeated measures ANOVA). The Cr stroke group was indistinguishable from the AF group and differed statistically from the AS group (P=0.017 by repeated measures ANOVA). In artificial clots we found a biphasic activity pattern, with initially decreasing levels of eluted thrombin (AF pattern) and then, with continuing washes, steady eluted thrombin levels (AS pattern).ConclusionsAn assay measuring the change in thrombin in clots retrieved during acute stroke endovascular thrombectomy procedures may serve as a diagnostic marker of the origin of the clot. The suggested mechanism for these differences may be the clot location before its retrieval, with high blood flow causing thrombin washout in atherosclerotic clots, in contrast to atrium appendage low blood flow retaining high thrombin levels.
Point-of-care ultrasound augments physical examination learning by undergraduate medical students
Authors: Wong Chun Ka , Hai JoJo , Chan Kwong Yue Eric , Un Ka Chun , Zhou Mi , Huang Duo , Cheng Yang Yang , Li Wen Hua , Yin Li Xue , Yue Wen Sheng , Tse Hung Fat , Yeung Pauline , Yip Pok Siu , Li Vivian Kam Sheung , Chan Arren , Cheung Michelle , Cheung Chi Wai , Lau Chu Pak , Siu Chung Wah 
Published: October 2020

ABSTRACTBackgroundLittle is known about the impact of the provision of handheld point-of-care ultrasound (POCUS) devices on physical examination skills of medical students.MethodsWe describe an educational initiative that comprised a POCUS workshop followed by allocation of a POCUS device to medical students for use over the subsequent 8 weeks. They were encouraged to scan patients and correlate their physical examination findings. A mobile instant messaging group discussion platform was set to provide feedback from instructors. Physical examination skills were assessed by means of clinical examination.Results210 final-year medical students from the University of Hong Kong participated in the programme. 46.3% completed the end of programme electronic survey: 74.6% enjoyed using the POCUS device, 50.0% found POCUS useful to validate physical examination findings and 47.7% agreed that POCUS increased their confidence with physical examination. 93.9% agreed that the programme should be incorporated into the medical curriculum and 81.9% would prefer keeping the device for longer time from 16 weeks (45.6%) to over 49 weeks (35.3%). Medical students who participated in the POCUS programme had a higher mean score for abdominal examination compared with those from the previous academic year with no POCUS programme (3.65±0.52 vs 3.21±0.80, p=0.014), but there was no statistically significant difference in their mean score for cardiovascular examination (3.62±0.64 vs 3.36±0.93, p=0.203).ConclusionThe POCUS programme that included provision of a personal handheld POCUS device improved students’ attitude, confidence and ability to perform a physical examination.
A description of blend electrolysis for treatment of canine distichiasis: 78 cases (2012–2017)
Authors: Ioannides Joy , Everson Richard , Matas Riera Marian , Dawson Charlotte 
Published: October 2020

ObjectiveTo describe a population of dogs treated with blend electrolysis for distichiasis at The Royal Veterinary College and report the complications seen.MethodsIn part 1, records were reviewed from 2012 to 2017 and a population of 78 dogs with distichiasis treated using blend electrolysis (Sterex SX‐B blend epilator) analysed. In part 2, 18 dogs treated with blend electrolysis were re‐examined prospectively by a diplomate of the European College of Veterinary Ophthalmologists (ECVO).ResultsIn part 1, brachycephalic breeds accounted for 62 per cent. English bulldog was the most common breed (42 per cent). In this population, 88 per cent of dogs were successfully treated with one treatment of electrolysis (successful treatment defined as resolution of clinical signs). Forty‐five dogs had recurrent distichia on follow‐up, mostly fine distichia without clinical discomfort. Twelve per cent required repeat electrolysis. Complications were infrequent: five dogs had scarring or hypopigmentation of the eyelid margin. In part 2, 18 dogs were re‐examined. Ten had distichia recurrence, six had eyelid scarring and five had depigmentation associated with electrolysis. Two dogs had occasional clinical signs thought to be related to distichiasis. All owners perceived their dogs’ ocular comfort to be improved following blend electrolysis.ConclusionsBrachycephalic breeds, most notably English bulldogs, are over‐represented in this population. Blend electrolysis appears an effective treatment for resolution of clinical signs.
Farmers’ and veterinary surgeons’ knowledge, perceptions and attitudes towards cattle abortion investigations in the UK
Authors: Clothier Georgiana , Wapenaar Wendela , Kenny Eva , Windham Emily 
Published: October 2020

BackgroundCattle abortion can significantly affect farm productivity and be an important cause of economic loss on beef and dairy farms.MethodA questionnaire‐based survey, completed by 379 farmers and 134 veterinary surgeons from the UK and Ireland, investigated motivators and barriers towards abortion investigations and perceptions of cattle abortion. Participants were recruited using convenience sampling.ResultsVeterinary surgeons underestimated farmers' willingness to pay for an abortion investigation; 54 per cent of veterinary surgeons expected farmers to pay under 100£/€, compared with 46 per cent of farmers. Most farmers (27 per cent) were willing to pay 101–250£/€ and 12 per cent above 500£/€. The incidence threshold warranting abortion investigation was 4 per cent for veterinary surgeons and lower for farmers at 2 per cent, especially beef farmers, where 48 per cent indicated a 1 per cent incidence required attention. Seventy‐five per cent of dairy farmers used more than 2 per cent as their threshold. Eighty‐four per cent of veterinary surgeons and 95 per cent of farmers agreed on the same abortion definition.ConclusionVeterinary surgeons and farmers agree on the definition of abortion; however, veterinary surgeons underestimate the willingness of farmers to engage with and pay for abortion investigations. A more proactive approach from veterinary surgeons, including improved communication and transparency around costs, expectations and clients’ goals can improve abortion investigation outcomes.
Bottomonium spectroscopy in the quark–gluon plasma
Authors: Wolschin Georg 
Published: October 2020

The spectroscopic properties of heavy quarkonia are substantially different in the quark–gluon plasma (QGP) that is created in relativistic heavy-ion collisions as compared to the vacuum situation that can be tested in [Formula: see text] collisions at the same center-of-mass energy. In this paper, a series of recent works about the dissociation of the [Formula: see text] and [Formula: see text] states in the hot QGP are summarized. Quarkonia dissociation occurs due to (1) screening of the real quark-antiquark potential, (2) collisional damping through the imaginary part of the potential, and (3) gluon-induced dissociation. In addition, reduced feed-down plays a decisive role for the spin-triplet ground state. Transverse-momentum and centrality-dependent data are well reproduced in Pb–Pb collisions at LHC energies. In the asymmetric [Formula: see text]-Pb system, alterations of the parton density functions in the lead nucleus account for the leading fraction of the modifications in cold nuclear matter (CNM), but the hot-medium effects turn out to be relevant in spite of the small initial spatial extent of the fireball, providing additional evidence for the generation of a quark–gluon droplet.
Association of HIVEP3 Gene and Lnc RNA with Femoral Neck Bone Mineral Content and Hip Geometry by Genome-Wide Association Analysis in Chinese People
Authors: Hu Weiwei , He Jinwei , Qi Luyue , Wang Chun , Yue Hua , Gu Jiemei , Zhang Hao , Wang Yi , Zhang Zhenlin 
Published: October 2020

Purpose. GWAS has successfully located and analyzed the pathogenic genes of osteoporosis. Genetic studies have found that heritability of BMD is 50%–85% while the other half is caused by hip geometric parameters and tissue horizontal characteristics. This study was designed to study the GWAS of osteoporosis in Shanghai Han population. Methods. We collected 1224 unrelated healthy young men (20–40 years old), young women (20–40 years old), and postmenopausal women (over 50 years old) who lived in Shanghai. BMD and hip geometric parameters were measured by dual-energy X-ray absorptiometry. The genomic DNA of peripheral blood was extracted and analyzed by using Illumina Human Asian Screening Array-24 +

v
1.0

(ASA) gene chip. Statistical analysis was carried out to evaluate the relationship between these SNPs and BMD and hip geometric parameters. Results. A total of 1155 subjects were included. We found that one SNP rs35282355 located in the human immunodeficiency virus type 1 enhancer-binding protein 3 gene (HIVEP3) and another 25 SNPs located in LINC RNA were significantly correlated with bone mineral content (BMC) in the femoral neck (

P

= 2.30 × 10−9,

P

< 5 × 10−8). We also found that the correlation between SNP rs35282355 and cross-sectional area (CSA) of hip geometry was a significant marginal statistical difference (

P

= 5.95 × 10−8). Conclusions. Through this study, we found that HIVEP3 gene and LINC RNA are potentially correlated with femoral neck BMC. These results provide important information for us to further understand the etiology and genetic pathogenesis of osteoporosis. In the future, we will expand the sample size to verify these loci and carry out molecular research.