bluuebunny/crossref_metadata_2025_split huggingface dataset:
Loss of Endothelial FTO Antagonizes Obesity-Induced Metabolic and Vascular Dysfunction
Authors: Krüger Nenja , Biwer Lauren A. , Good Miranda E. , Ruddiman Claire A. , Wolpe Abigail G. , DeLalio Leon J. , Murphy Sara , Macal Edgar H. , Ragolia Louis , Serbulea Vlad , Best Angela K. , Leitinger Norbert , Harris Thurl E. , Sonkusare Swapnil K. , Gödecke Axel , Isakson Brant E. 
Published: December 2019

Rationale:
Increasing prevalence of obesity and its associated risk with cardiovascular diseases demands a better understanding of the contribution of different cell types within this complex disease for developing new treatment options. Previous studies could prove a fundamental role of FTO (fat mass and obesity-associated protein) within obesity; however, its functional role within different cell types is less understood.

Objectives:
We identify endothelial FTO as a previously unknown central regulator of both obesity-induced metabolic and vascular alterations.

Methods and Results:

We generated endothelial
Fto
-deficient mice and analyzed the impact of obesity on those mice. While the loss of endothelial FTO did not influence the development of obesity and dyslipidemia, it protected mice from high-fat diet–induced glucose intolerance and insulin resistance by increasing AKT (protein kinase B) phosphorylation in endothelial cells and skeletal muscle. Furthermore, loss of endothelial FTO prevented the development of obesity-induced hypertension by preserving myogenic tone in resistance arteries. In
Fto
-deficient arteries, microarray analysis identified upregulation of
L-Pgds
with significant increases in prostaglandin D
2
levels. Blockade of prostaglandin D
2
synthesis inhibited the myogenic tone protection in resistance arteries of endothelial
Fto
-deficient mice on high-fat diet; conversely, direct addition of prostaglandin D
2
rescued myogenic tone in high-fat diet–fed control mice. Myogenic tone was increased in obese human arteries with FTO inhibitors or prostaglandin D
2
application.

Conclusions:
These data identify endothelial FTO as a previously unknown regulator in the development of obesity-induced metabolic and vascular changes, which is independent of its known function in regulation of obesity.
Atmospheric Radiative Processes Accelerate Ground Surface Warming over the Southeastern Tibetan Plateau during 1998–2013
Authors: Ji Peng , Yuan Xing , Li Dan 
Published: December 2019

AbstractThe Tibetan Plateau (TP), known as the world’s “Third Pole,” plays a vital role in regulating the regional and global climate and provides freshwater for about 1.5 billion people. Observations show an accelerated ground surface warming trend over the southeastern TP during the global warming slowdown period of 1998–2013, especially in the summer and winter seasons. The processes responsible for such acceleration are under debate as contributions from different radiative processes are still unknown. Here we estimate for the first time the contributions of each radiative component to the ground surface warming trend before and after 1998 by analyzing multisource datasets under an energy balance framework. Results show that declining cloud cover caused by the weakening of both the South Asian summer monsoon and local-scale atmospheric upward motion mainly led to the accelerated ground surface warming during the summers of 1998–2013, whereas the decreased surface albedo caused by the snow melting was the major warming factor in winter. Moreover, increased clear-sky longwave radiation induced by the warming middle and upper troposphere was the second largest factor, contributing to about 21%–48% of the ground surface warming trend in both the summer and winter seasons. Our results unravel the key processes driving the ground surface warming over the southeastern TP and have implications for the development of climate and Earth system models in simulating ground surface temperature change and other related complex cryosphere–hydrosphere–atmosphere interactions over high-altitude land areas.
Individual-, Community-, and Health System–Level Barriers to Optimal Type 2 Diabetes Care for Inner-City African Americans: An Integrative Review and Model Development
Authors: Campbell Jennifer A. , Egede Leonard E. 
Published: December 2019

Purpose The purpose of this integrative review is (1) to elucidate the unique barriers faced by inner-city African Americans for type 2 diabetes (T2DM) care; (2) to identify effective interventions/programs for optimal T2DM care at the individual, community, and health systems levels; and (3) to integrate 2 behavioral models and 1 social ecological model for framing interventions for inner-city African American to optimize T2DM care. Methods PRISMA guidelines were followed to systematically search PubMed, PsychInfo, and CINAHL. Integration of models was based on underlying principles of social ecological models. Results The search returned 1183 articles. Forty-six articles were synthesized after applying inclusion criteria. Multiple barriers for the individual level, community level, and health system level were identified. Major barriers include lack of knowledge, lack of social support, and self-management support. Interventions identified in this review show that among inner-city African Americans with T2DM, the focus is placed at the health systems level, with very limited focus toward addressing individual- and community-level barriers. Final synthesis includes development of a new integrated model that explains barriers to care across multiple levels. Conclusions These findings highlight the fragmentation that may be occurring between policy, research, and practice for achieving health equity and addressing health disparities for T2DM care among inner-city African Americans. The new model is an important step in the pursuit of equity in T2DM by specifying the complex barriers that occur across multiple levels. The application of this model using the 2017 National Standards for Diabetes–Self Management Education and Support are discussed.
Initial renal histology and early response predict outcomes of Brazilian lupus nephritis patients
Authors: Vajgel G , Oliveira C B L , Costa D M N , Cavalcante M A G M , Valente L M , Sesso R , Crovella S , Kirsztajn G M , Sandrin-Garcia P 
Published: December 2019

Objective We analyzed baseline and follow-up characteristics related to poorer renal outcomes in a Brazilian cohort of admixture race patients with lupus nephritis. Methods Overall, 280 outpatients with a diagnosis of systemic lupus erythematosus and previous kidney biopsy of lupus nephritis were recruited from August 2015 to December 2018 and had baseline laboratory and histologic data retrospectively analyzed; patients were then followed-up and data were recorded. The main outcome measure was the estimated glomerular filtration rate at last follow-up. Secondary analyses assessed the impact of initial kidney histology and treatment in long-term kidney survival. Results Median duration of lupus nephritis was 60 months (interquartile range: 27–120); 40 (14.3%) patients presented progressive chronic kidney disease (estimated glomerular filtration rate <30 and ≥10 ml/min/1.73 m2) or end-stage kidney disease at last visit. Adjusted logistic regression analysis showed that class IV lupus nephritis (odds ratio 14.91; 95% confidence interval 1.77–125.99; p = 0.01) and interstitial fibrosis ≥25% at initial biopsy (odds ratio 5.87; 95% confidence interval 1.32–26.16; p = 0.02), lack of complete or partial response at 12 months (odds ratio 16.3; 95% confidence interval 3.74–71.43; p < 0.001), and a second renal flare (odds ratio 4.49; 95% confidence interval 1.10–18.44; p = 0.04) were predictors of progressive chronic kidney disease. In a Kaplan-Meier survival curve we found that class IV lupus nephritis and interstitial fibrosis ≥25% were significantly associated with end-stage kidney disease throughout follow-up (hazard ratio 2.96; 95% confidence interval 1.3–7.0; p = 0.036 and hazard ratio 4.96; 95% confidence interval 1.9–12.9; p < 0.0001, respectively). Conclusion In this large cohort of admixture race patients, class IV lupus nephritis and chronic interstitial damage at initial renal biopsy together with non-response after 1 year of therapy and relapse were associated with worse long-term renal outcomes.
Optic nerve sheath diameter measurement for predicting raised intracranial pressure in pediatric patients: A systematic review and meta‐analysis
Authors: Lee Sun Hwa , Yun Seong Jong , Kim Dong Hyeon 
Published: December 2019

Background and objectives:No previous studies have investigated the relationship between the optic nerve sheath diameter and raised intracranial pressure in pediatric patients or have evaluated the usefulness of optic nerve sheath diameter in ocular ultrasound and brain computed tomography/magnetic resonance imaging. This study aimed to meta‐analyze the diagnostic performance of optic nerve sheath diameter for the diagnosis of raised intracranial pressure in pediatric patients.Methods:A database search of PubMed and EMBASE was performed to identify relevant studies. Bivariate modeling and hierarchical summary receiver operating characteristics modeling were performed to evaluate diagnostic performance. A pooled diagnostic odds ratio with a 95% confidence interval, not including 1, was considered informative. Subgroup analysis was performed according to the modality (ocular ultrasound vs brain computed tomography/magnetic resonance imaging). We performed meta‐regression analyses for heterogeneity exploration.Results:Eleven studies involving 546 patients were included. According to pooled diagnostic odds ratios, optic nerve sheath diameter was informative for the evaluation of raised intracranial pressure (diagnostic odds ratio, 47; 95% confidence interval, 11–206). Optic nerve sheath diameter showed a pooled sensitivity of 0.88 (95% confidence interval, 0.79–0.94), a pooled specificity of 0.86 (95% confidence interval, 0.70–0.95), and an area under the hierarchical summary receiver operating characteristics curve of 0.93 (95% confidence interval, 0.91–0.95) for the diagnosis of raised intracranial pressure. According to the subgroup analysis, ocular ultrasound (sensitivity, 0.91 (95% confidence interval, 0.81–0.96); specificity, 0.86 (95% confidence interval, 0.65–0.96)) showed higher sensitivity and comparable specificity than optic nerve sheath diameter measured on brain computed tomography/magnetic resonance imaging (sensitivity, 0.75 (95% confidence interval, 0.51–0.99); specificity, 0.91 (95% confidence interval, 0.74–1.00)). On meta‐regression analysis, the study design, number of patients, and reference standard were the sources of heterogeneity.Conclusion:Optic nerve sheath diameter may be a useful method for predicting raised intracranial pressure in pediatric patients. We recommend that the measurement of optic nerve sheath diameter should be performed using ocular ultrasound for a more accurate diagnosis of raised intracranial pressure in pediatric patients.
Correlation of happiness and professional autonomy in Iranian nurses
Authors: Mousavi Seyyedeh Roya , Amini Kourosh , Ramezani-badr Farhad , Roohani Mahin 
Published: December 2019

Background Happiness and professional autonomy in nurses increase job satisfaction, reduce turnover and improve the quality of healthcare services. Aims The present study aimed to examine the correlation between happiness and professional autonomy in Iranian nurses. Methods This descriptive-correlational study was conducted on 371 nurses in 2017. The participants were selected via two-step random sampling. Data were collected using the Oxford Happiness Inventory and Dempster Practice Behaviors Scale within the score ranges of 0–87 and 30–150, respectively. Data analysis was performed in SPSS version 16. Results Mean score of happiness among nurses was 43.1 ± 13.3 and the mean score of professional autonomy was 96.4 ± 13.5. According to Pearson's correlation coefficient, professional autonomy had a positive, significant correlation with happiness ( r = 0.481; p < 0.001). In addition, the results of regression analysis indicated that professional autonomy could predict 23% of the happiness variance in the nurses ( p < 0.001). Conclusions According to the results, the level of happiness in Iranian nurses was favourable, whereas the level of professional autonomy was moderate. Considering the significant correlation between happiness and professional autonomy, attention should be paid to the simultaneous enhancement of these variables to improve the efficiency of nursing care.
Delivering direct patient care in the haemodialysis unit: a focused ethnographic study of care delivery
Authors: Wood Alison F , Tocher Jennifer , Rodgers Sheila 
Published: December 2019

Background Direct patient care is a term used within nursing and healthcare to help quantify and qualify care delivery. Direct patient care time is considered as a valuable measure by healthcare providers to indicate efficiency and to quantify nursing work, however little is understood of the patient experience and care delivery in haemodialysis settings. Aim The aim of this study was to gain an understanding of patients’ and nursing staff perceptions and experiences of ‘direct patient care’ within one haemodialysis unit. Methods A focused ethnographic approach utilised participant observations, informal questioning, photographs and 27 semi-structured interviews of registered nurses, clinical support workers and patients. Observation notes and interviews were transcribed and thematically analysed. Results The key finding was the construction and reconceptualisation of care delivery in this setting. Care was identified to be delivered in two distinct ways, both of which allowed patients to feel cared for. ‘Active care’ where patients feel cared for when they are being dealt with directly by staff and ‘Passive care’ where patients feel cared for through staff availability and visibility. Conclusion Developing this understanding of patient care delivery in this specialism has highlighted some important aspects to the way care can be delivered which challenges current traditional understandings of direct patient care. Time spent with a patient is not the only important consideration to patient experience in haemodialysis. This understanding of passive care could improve care experiences in this setting.
Blood pressure assessments of pregnant women in a Day Assessment Unit – A prospective observational study
Authors: Krishnan Vidhu , Makris Angela , Hennessy AnneMarie , Hollis Brian , Lee Gaksoo 
Published: December 2019

Aim We investigated the optimum time and number of observations for assessing women in the Day Assessment Unit. Methods A single centre prospective observational study was undertaken. Women referred for blood pressure assessment in the Day Assessment Unit were recruited. Results The blood pressure of women who subsequently developed preeclampsia was noted to change differently over the time of observation compared to women with other hypertensive disorders, most notably in the first and third hour (p = 0.042), although the averages at each hour did not differ between these two groups. Conclusions Mean blood pressure measured over four hours did not significantly differ compared to blood pressure measured over one hour. Women who subsequently developed preeclampsia had a different pattern of blood pressure change whilst in the Day Assessment Unit.
Health State Utilities in Children and Adolescents With Osteochondritis Dissecans of the Knee
Authors: Adjei Joshua , Nwachukwu Benedict U. , Zhang Yi , Do Huong T. , Green Daniel W. , Dodwell Emily R. , Fabricant Peter D. 
Published: December 2019

Background: The impact of osteochondritis dissecans (OCD) lesions of the knee on a child’s health-related quality of life has not previously been quantified. Preference-based health utility assessment allows patients to assign quality-of-life valuations (utilities) to different health states and conditions. Purpose: To determine (1) patient-reported utility scores for health states associated with pediatric OCD lesions of the knee and (2) whether these scores are associated with patient demographics or disease severity. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Children, adolescents, and young adults being treated for OCD of the knee were interviewed to assess utilities for each of the 6 health states commonly encountered in the treatment of OCD: (1) symptomatic lesion, (2) nonoperative rehabilitation, (3) postoperative rehabilitation, (4) intermediate treatment success, (5) early degenerative knee changes, and (6) successful treatment (asymptomatic). Patients were asked to assign health utilities to each state using a standardized feeling thermometer (scale, 0-100), which were converted to a health state utility (scale, 0-1 [1 = perfect health]). Utilities were reported with descriptive statistics, and comparative analyses were performed to test whether assignments were associated with patient age, sex, or whether the OCD lesion required surgical intervention. Results: A total of 100 participants treated or undergoing treatment for OCD were prospectively enrolled; 74% were male (n = 74). The median age at the time of survey was 15 years (interquartile range, 13-16.5 years). Utility scores were as follows: symptomatic OCD lesion, 0.15; nonoperative rehabilitation, 0.30; postoperative rehabilitation, 0.30; early degenerative changes, 0.58; intermediate treatment success, 0.65; and successful treatment, 1.0. Utility scores were not associated with age, sex, or whether the participant underwent surgical treatment for the OCD lesion. Conclusion: The current study quantified patient-reported utilities for 6 OCD lesion health states, which may be used for future health-related quality of life, decision analysis, and quality/safety/value studies. These utility scores were stable and not affected by patient age, sex, or treatment strategy.
Does Curriculum Analysis in Clinical Residency Training Need to be Different?
Authors: Taha Mohamed Hassan , Abdalla Mohamed El Hassan , Ahmed Yasar 
Published: December 2019

Objectives: Curriculum analysis is an essential process in exploring the validity of assumptions behind the curriculum and judging its perspectives, goals, and objectives. This study analysed the curriculum of the Internal Medicine Residency Programme at the Sudan Medical Specialisation Board, exploring the programme’s strengths, weaknesses, and areas for improvement. Materials and Methods: A qualitative descriptive analysis method using Harden Ten Questions framework was used, implemented through document analysis. Thematic analysis was used to categorise the findings following the Harden Ten Questions framework. Results: The analysis of this curriculum using Harden Ten Questions framework revealed that it is built on needs assessment, with clear objectives and contents, good organisation of the contents and a precise management process. However, there is a need to improve the areas related to training strategies, training methods, assessment methods and the learning environment. Conclusions: This study showed that the curriculum is built to meet the needs of the Sudanese community. The contents fit for internal medicine clinical residency and the methods of training are likely to foster long-life learning. The curriculum needs some improvement particularly in the following areas such as clinical teaching, trainee assessments, and learning environments. Harden Ten Questions framework for curricula was practical to some degree in analysing the postgraduate curriculum. However, some suggestions have been made regarding the original framework to make it more adaptable to curriculum analysis at postgraduate level. The systematic analysis is transferable to the analysis of other undergraduate or postgraduate medical curricula in Sudan.
Early life exposure to air pollution and incidence of childhood asthma, allergic rhinitis and eczema
Authors: To Teresa , Zhu Jingqin , Stieb Dave , Gray Natasha , Fong Ivy , Pinault Lauren , Jerrett Michael , Robichaud Alain , Ménard Richard , van Donkelaar Aaron , Martin Randall V. , Hystad Perry , Brook Jeffrey R. , Dell Sharon 
Published: December 2019

RationaleThere is growing evidence that air pollution may contribute to the development of childhood asthma and other allergic diseases. In this follow-up of the Toronto Child Health Evaluation Questionnaire (T-CHEQ) study, we examined associations between early life exposures to air pollution and incidence of asthma, allergic rhinitis and eczema from birth through adolescence.Methods1286 T-CHEQ participants were followed from birth until outcome (March 31, 2016) or loss to follow-up, with a mean of 17 years of follow-up. Concentrations of nitrogen dioxide (NO2), ozone (O3) and particulate matter with a 50% cut-off aerodynamic diameter of 2.5 µm (PM2.5) from January 1, 1999 to December 31, 2012 were assigned to participants based on their postal codes at birth using ground observations, chemical/meteorological models, remote sensing and land-use regression models. Study outcomes included incidence of physician-diagnosed asthma, allergic rhinitis and eczema. Cox proportional hazard regression models were used to estimate hazard ratios per interquartile range of exposures and outcomes, adjusting for potential confounders.ResultsHazard ratios of 1.17 (95% CI 1.05–1.31) for asthma and 1.07 (95% CI 0.99–1.15) for eczema were observed for total oxidants (O3and NO2) at birth. No significant increase in risk was found for PM2.5.ConclusionsExposures to oxidant air pollutants (O3and NO2) but not PM2.5were associated with an increased risk of incident asthma and eczema in children. This suggests that improving air quality may contribute to the prevention of asthma and other allergic disease in childhood and adolescence.
Genetic landscape of adult Langerhans cell histiocytosis with lung involvement
Authors: Jouenne Fanélie , Chevret Sylvie , Bugnet Emmanuelle , Clappier Emmanuelle , Lorillon Gwenaël , Meignin Véronique , Sadoux Aurélie , Cohen Shannon , Haziot Alain , How-Kit Alexandre , Kannengiesser Caroline , Lebbé Céleste , Gossot Dominique , Mourah Samia , Tazi Abdellatif 
Published: December 2019

The clinical significance of theBRAFV600Emutation in adult Langerhans cell histiocytosis (LCH), including pulmonary Langerhans cell histiocytosis (PLCH), is not well understood. Similarly, the spectrum of molecular alterations involved in adult LCH has not been fully delineated. To address these issues, we genotyped a large number of adult LCH biopsies and searched for an association of identified molecular alterations with clinical presentation and disease outcome.Biopsies from 117 adult LCH patients, 83 with PLCH (median age 36.4 years, 56 females, 38 multisystem disease, 79 single system disease, 65 current smokers) were genotyped for theBRAFV600Emutation. In 69 cases, LCH lesions were also genotyped by whole-exome sequencing (WES) or targeted gene panel next-generation sequencing (NGS). Cox models were used to estimate the association of baseline characteristics with the hazard of LCH progression.MAPK pathway alterations were detected in 59 out of 69 cases (86%) (BRAFV600Emutation: 36%,BRAFN486_P490deletion: 28%,MAP2K1mutations: 15%, isolatedNRASQ61mutations: 4%), whileKRASmutations were virtually absent in PLCH lesions. TheBRAFV600Emutation was not associated with LCH presentation at diagnosis, including smoking status and lung function, in PLCH patients.BRAFV600Estatus did not influence the risk of LCH progression over time.Thus, MAPK alterations are present in most lesions from adult LCH patients, particularly in PLCH. Unlike reports in paediatric LCH,BRAFV600Egenotyping did not provide additional information on disease outcome. The search for alterations involved in the MAPK pathway, includingBRAFdeletions, is useful for guiding targeted treatment in selected patients with refractory progressive LCH.