bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening of non-invasive miRNA biomarker candidates for metastasis of gastric cancer by small RNA sequencing of plasma exosomes
Authors: Zhang Yingyi , Han Ting , Feng Dan , Li Jie , Wu Meihong , Peng Xiaobo , Wang Bin , Zhan Xianbao , Fu Peng 
Published: November 2019

Abstract
Gastric cancer remains one of the most lethal and prevalent malignancies, particularly in China. The majority of patients are diagnosed with gastric cancer at the late stages of the disease. Besides, the high relapse rate also contributes to the high mortality. Therefore, there exists an imperative need for the development of gastric cancer diagnostic techniques as well as novel indicators for gastric cancer metastasis. Exosomes, secreted by a variety of cell types, play critical roles in intercellular communication, which emerge as promising diagnostic biomarkers for gastric cancer. In this study, we present for the first time, at least to the best of our knowledge, the small RNA sequencing spectra of exosomes derived from the gastric cancer patient plasma using next-generation sequencing, focusing on the exploration of metastasis-related biomarkers. The exosomes enriched from patient plasma samples were well characterized by western blotting, transmission electron microscopy and nanoparticle-tracking analysis. In the following bioinformatic analysis of exosomal miRNAs, three candidates were proposed as the biomarkers for metastasis of gastric cancer, namely miR-10b-5p, miR-101-3p and miR-143-5p, for gastric cancer with lymph node metastasis, gastric cancer with ovarian metastasis and gastric cancer with liver metastasis, respectively. RT–qPCR was performed to test the accuracy of these candidates for validation. In conclusion, we successfully isolated and purified exosomes from plasma of patients with gastric cancer and identified several potential exosomal miRNA markers to distinguish gastric cancer patients with various kinds of metastasis.
Modern Clinician-initiated Clinical Trials to Determine Optimal Therapy for Multidrug-resistant Gram-negative Infections
Authors: Stewart Adam G , Harris Patrick N A , Chatfield Mark , Evans Scott R , van Duin David , Paterson David L 
Published: November 2019

Abstract
Treatment options for multidrug-resistant (MDR) gram-negative infection are growing. However, postregistration, pragmatic, and clinician-led clinical trials in this field are few, recruit small sample sizes, and experience deficiencies in design and operations. MDR gram-negative therapeutic trials are often inefficient, only evaluating a single antibiotic or strategy at a time. Novel clinical trial designs offer potential solutions by attempting to obtain clinically meaningful conclusions at the end or during a trial, for many treatment strategies, simultaneously. An integrated, consensus approach to MDR gram-negative infection trial design is crucial.
Tuberculosis in Hospitalized Patients With Human Immunodeficiency Virus: Clinical Characteristics, Mortality, and Implications From the Rapid Urine-based Screening for Tuberculosis to Reduce AIDS Related Mortality in Hospitalized Patients in Africa
Authors: Gupta-Wright Ankur , Fielding Katherine , Wilson Douglas , van Oosterhout Joep J , Grint Daniel , Mwandumba Henry C , Alufandika-Moyo Melanie , Peters Jurgens A , Chiume Lingstone , Lawn Stephen D , Corbett Elizabeth L 
Published: November 2019

Abstract

Background
Tuberculosis (TB) is the major killer of people living with human immunodeficiency virus (HIV) globally, with suboptimal diagnostics and management contributing to high case-fatality rates.

Methods
A prospective cohort of patients with confirmed TB (Xpert MTB/RIF and/or Determine TB-LAM Ag positive) identified through screening HIV-positive inpatients with sputum and urine diagnostics in Malawi and South Africa (Rapid urine-based Screening for Tuberculosis to reduce AIDS Related Mortality in hospitalized Patients in Africa [STAMP] trial). Urine was tested prospectively (intervention) or retrospectively (standard of care arm). We defined baseline clinical phenotypes using hierarchical cluster analysis, and also used Cox regression analysis to identify associations with early mortality (≤56 days).

Results
Of 322 patients with TB confirmed between October 2015 and September 2018, 78.0% had ≥1 positive urine test. Antiretroviral therapy (ART) coverage was 80.2% among those not newly diagnosed, but with median CD4 count 75 cells/µL and high HIV viral loads. Early mortality was 30.7% (99/322), despite near-universal prompt TB treatment. Older age, male sex, ART before admission, poor nutritional status, lower hemoglobin, and positive urine tests (TB-LAM and/or Xpert MTB/RIF) were associated with increased mortality in multivariate analyses. Cluster analysis (on baseline variables) defined 4 patient subgroups with early mortality ranging from 9.8% to 52.5%. Although unadjusted mortality was 9.3% lower in South Africa than Malawi, in adjusted models mortality was similar in both countries (hazard ratio, 0.9; P = .729).

Conclusions
Mortality following prompt inpatient diagnosis of HIV-associated TB remained unacceptably high, even in South Africa. Intensified management strategies are urgently needed, for which prognostic indicators could potentially guide both development and subsequent use.
Validity of a tool designed to assess the preventability of potentially preventable hospitalizations for chronic conditions
Authors: Johnston Jennifer J , Longman Jo M , Ewald Dan P , Rolfe Margaret I , Diez Alvarez Sergio , Gilliland Adrian H B , Chung Steven C , Das Sumon K , King Jonathan M , Passey Megan E 
Published: November 2019

Abstract

Background
Potentially preventable hospitalizations (PPH) are defined as unplanned hospital admissions which could potentially have been prevented with the provision of effective, timely outpatient care. To better understand and ultimately reduce rates of PPH, a means of identifying those which are actually preventable is required. The Preventability Assessment Tool (PAT) was designed for use by hospital clinicians to assess the preventability of unplanned admissions for chronic conditions.

Objective
The present study examined the ability of the PAT to distinguish between those unplanned admissions which are preventable and those which are not, compared to the assessments of an Expert Panel.

Methods
Data were collected between November 2014 and June 2017 at three hospitals in NSW, Australia. Participants were community-dwelling patients with unplanned hospital admissions for congestive heart failure, chronic obstructive pulmonary disease, diabetes complications or angina pectoris. A nurse and a doctor caring for the patient made assessments of the preventability of the admission using the PAT. Expert Panels made assessments of the preventability of each admission based on a comprehensive case report and consensus process.

Results
There was little concordance between the hospital doctors and nurses regarding the preventability of admissions, nor between the assessments of the Expert Panel and the hospital nurse or the Expert Panel and the hospital doctor.

Conclusions
The PAT demonstrated poor concurrent validity and is not a valid tool for assessing the preventability of unplanned hospital admissions. The use of Expert Panels provides a more rigorous approach to assessing the preventability of such admissions.
Development and psychometric study of a simple instrument to assess patient communication and comprehension skills: the AsCkS
Authors: González-De Paz Luis , Gálvez-Henández Pablo , Navarro-Rubio María Dolores 
Published: November 2019

Abstract

Background
Instruments to examine patients’ communication skills are impractical for daily clinical practice in primary health care, and it is assumed that health care professionals are always aware of the communication and comprehension status of patients.

Objective
To design and examine the psychometric properties of a new questionnaire (AsCkS) to screen patients’ risk of low communication and comprehension skills.

Methods
Designing the new questionnaire involved: (i) a content validity study to generate a set of items, (ii) administration of a questionnaire in a sample of patients and (iii) study of the psychometric properties using a Rasch probabilistic model. The test probability function was used to detect patients at risk of having low communication and comprehension skills, and the associated factors were studied using multivariate logistic regression.

Results
Five items were generated and 369 patients screened. In the Rasch analysis, one item was removed due to a lack of goodness-of-fit (Outfit = 3.64). The final set of four items showed good reliability (person separation index = 0.90). Convergent validity was moderate for the health literacy construct (r = 0.53) and low for the patient activation (r = 0.38): 77 patients (20.86%) were at risk of having low communication and comprehension skills. After adjustment, the associated factors were age (p &lt; 0.001) and lower educational level (p &lt; 0.001).

Conclusion
The AsCkS is a reliable and valid instrument and may be used to detect patients requiring a greater effort by the physician to communicate health care messages.
Early growth of different tree species on agricultural land along a latitudinal transect in Sweden
Authors: Rytter Lars , Lutter Reimo 
Published: November 2019

Abstract
Fast-growing tree species will be an important tool in the future production of renewables and in substituting non-renewable fossil energy sources. Sweden, like other countries around the Baltic Sea, has large areas of abandoned farmland usable for biomass production, but knowledge of growth performance of tree species candidates is insufficient. An experiment was initiated where six potentially high-producing tree species were compared. The best available plant material for each species was used on five sites over latitudes 56–64°N in Sweden. Results from the first 8–9 years are reported. Short rotation coppice willow (Salix schwerinii Wolf × S. viminalis L., clone ‘Tora’) had the fastest initial growth and production in southern Sweden. Hybrid aspen (Populus tremula L. × P. tremuloides Michx.) and poplar (Populus spp., section Tacamahaca), grown as short rotation forest, grew well over all sites and showed the highest productivity at the two northern sites. Hybrid larch (Larix ×eurolepis Henry) displayed a high potential at the two most southerly sites, whilst silver birch (Betula pendula Roth) was a medium-producing species at all sites. Norway spruce (Picea abies (L.) Karst.) started slowly, and Siberian larch (L. sukaczewii Dylis) produced poorly at the two northern sites in the initial stage. All tree species followed existing height development curves for the respective species on a high site quality level. Currently, well-growing clones of Populus spp. indicated that a wider selection of tree species can be used at high latitudes under climate change. The study showed a high growth potential for most species on former agricultural lands. However, measures to reduce climate and biological damage must be included in future efforts.
Age at natural menopause and development of chronic conditions and multimorbidity: results from an Australian prospective cohort
Authors: Xu Xiaolin , Jones Mark , Mishra Gita D 
Published: November 2019

Abstract

STUDY QUESTION
Is age at natural menopause (ANM) associated with the development of multiple chronic conditions (multimorbidity) in postmenopausal life?

SUMMARY ANSWER
Women with premature menopause experience increased odds of developing individual chronic conditions and multimorbidity.

WHAT IS KNOWN ALREADY
ANM is considered as a marker of age-related morbidity and mortality in postmenopausal life. Multimorbidity affects more than 60% of older women and has been recognized as the most common ‘chronic condition’. Few studies have examined the association between ANM and the development of multimorbidity.

STUDY DESIGN, SIZE, DURATION
A prospective national cohort study of 11 258 Australian women, aged 45–50 years in 1996. Women were followed from 1996 to 2016.

PARTICIPANTS/MATERIALS, SETTING, METHODS
Information about ANM and 11 chronic conditions (diabetes, hypertension, heart disease, stroke, arthritis, osteoporosis, asthma, chronic obstructive pulmonary disease, depression, anxiety and breast cancer) were estimated approximately every 3 years. Multimorbidity is defined as 2 or more of these 11 conditions. Generalized estimating equations were used to link the categorical ANM with individual chronic conditions and multimorbidity.

MAIN RESULTS AND THE ROLE OF CHANCE
Among 5107 women reporting ANM, 2.3% experienced premature menopause (≤40 years) and 55.1% developed multimorbidity. Compared with women who experienced menopause at age 50–51 years, women with premature menopause had twice the odds of experiencing multimorbidity by age 60 (OR = 1.98, 95% CI 1.31 to 2.98) and three times the odds of developing multimorbidity in their 60s (OR = 3.03, 95% CI 1.62 to 5.64). Women with premature menopause also experienced higher incidence of most individual chronic conditions.

LIMITATIONS, REASONS FOR CAUTION
The main limitation of this study was the use of self-reported data, but with repeated assessments from prospective study design and the validity of most of the chronic conditions from hospital data, the potential for non-differential misclassification is minimized.

WIDE IMPLICATIONS OF THE FINDINGS
To our knowledge, this is the first study to assess the association of premature menopause and development of multimorbidity in a larger national cohort of mid-aged women. Health professionals should consider comprehensive screening and assessment of risk factors for multimorbidity when treating women who experienced premature menopause.

STUDY FUNDING/COMPETING INTEREST(S)
The Australian Longitudinal Study on Women’s Health was supported by the Australian Government Department of Health. X.X. is funded by an International Postgraduate Research Scholarship from the Australian government and a UQ Centennial Scholarship from The University of Queensland. G.D.M. is supported by the National Health and Medical Research Council Principal Research Fellowship (APP1121844). None of the authors has any conflicts of interest to declare.
Cost-effectiveness and Clinical Outcomes of Early Anti–Tumor Necrosis Factor–α Intervention in Pediatric Crohn’s Disease
Authors: Bashir Naazish S , Walters Thomas D , Griffiths Anne M , Ito Shinya , Ungar Wendy J 
Published: November 2019

AbstractBackgroundAnti–tumor necrosis factor–α (anti-TNF-α) treatments are increasingly used to treat pediatric Crohn’s disease, even without a prior trial of immunomodulators, but the cost-effectiveness of such treatment algorithms has not been formally examined. Drug plan decision-makers require evidence of cost-effectiveness to inform funding decisions. The objective was to assess the incremental cost-effectiveness of early intervention with anti-TNF-α treatment vs a conventional step-up strategy per steroid-free remission-week gained from public health care and societal payer perspectives over 3 years.MethodsA probabilistic microsimulation model was constructed for children with newly diagnosed moderate to severe Crohn’s disease receiving anti-TNF-α treatment and concomitant treatments within the first 3 months of diagnosis compared with children receiving standard care consisting of steroids and/or immunomodulators with the possibility of anti-TNF-α treatment after 3 months of diagnosis. A North American multicenter observational study with 360 patients provided input into clinical outcomes and health care resource use.ResultsEarly intervention with anti-TNF-α treatment was more costly, with an incremental cost of CAD$31,112 (95% confidence interval [CI], $2939–$91,715), and more effective, with 11.3 more weeks in steroid-free remission (95% CI, 10.6–11.6) compared with standard care, resulting in an incremental cost per steroid-free remission-week gained of CAD$2756 from an Ontario public health care perspective and CAD$2968 from a societal perspective. The incremental cost-effectiveness ratio was sensitive to the price of infliximab.ConclusionsThe results suggest that although early anti-TNF-α was not cost-effective, it was clinically beneficial. These findings, along with other randomized controlled trial evidence, may inform formulary decision-making.
Is online case-based learning effective in helping undergraduate medical students choose the appropriate antibiotics to treat important infections?
Authors: Stevens Niall T , Bruen Catherine , Boland Fiona , Pawlikowska Teresa , Fitzpatrick Fidelma , Humphreys Hilary 
Published: November 2019

Abstract

Background
Medical students are frequently confused about indication for and choice of antibiotic. We developed an online learning resource that focused on antibiotic stewardship and important infections where medical students could practise their antibiotic decision-making skills safely.

Methods
The resource was made available to third-year undergraduate medical students via their virtual learning environment. It covered the theory and fundamentals of antibiotic stewardship and five clinical cases covering important infections. We assessed the number of attempts taken to achieve the required level of understanding to pass each activity and surveyed a selection of students for their feedback.

Results
Of 310 students, over 80% engaged with the theory-based components, with an average score exceeding 90% (range 93.4%–99.7%). Eighty-three percent (258/310) engaged with the first two cases (Clostridioides difficile infection and pyelonephritis) but only 61% (189/310) of students completed the fifth case on bacterial meningitis. Only 49.4% (153/310) of students completed all five cases, with 48% (73/153) of these achieving ≥90% on their first attempt of the associated quizzes. Fifty-nine percent (23/39) agreed or strongly agreed that the quality of the learning resource was excellent. Seventy-two percent (28/39) agreed or strongly agreed that the objectives of the resource were relevant to their needs as undergraduate medical students. Only 33% (13/39) reported the resource would change their practice.

Conclusions
Student feedback was positive but engagement with the cases needs improvement. Highlighting the utility of case-based technology-enhanced learning as a safe place to practise antibiotic decision-making skills among students may improve this.
Conflict Related Hunger, ‘Starvation Crimes’ and UN Security Council Resolution 2417 (2018)
Authors: Zappalà Salvatore 
Published: November 2019

Abstract
There is no doubt that Security Council Resolution 2417 (2018) is a first of its kind. More than its content, however, it is its adoption (by unanimity) that represents a success. For the first time, the Security Council engaged in a thematic manner with the issue of hunger (or food insecurity) in armed conflict, highlighting the vicious circle between food insecurity and armed conflicts and the duties of parties to conflicts to protect civilian populations and allow passage for humanitarian assistance and relief measures, as well as reiterating the prohibition of starvation as a method of combat, and its potential prosecution as war crime. On the basis of this resolution (which, inter alia, requests the Secretary-General to report on the matter more robustly, including through a form of early-warning mechanism that is per se an important new contribution) there is room for strengthened commitment to act more decisively on the part of the United Nations system as well as the Member States and other international actors. Moreover, the resolution paves the way for creative solutions which could entail, for example, the adoption of measures at the domestic level leading to more stringent regulation (and potential prosecution) of ‘starvation crimes’ and of any forms of deliberate obstruction to the delivery of humanitarian assistance. The resolution could also provide arguments for interpreting existing rules more in line with the objective, clearly promoted by the resolution itself, to strengthen the protection of civilians in armed conflicts.
Demographic consequences and characteristics of recent population mixing and colonization in Steller sea lions, Eumetopias jubatus
Authors: Hastings Kelly K , Rehberg Michael J , O’corry-Crowe Gregory M , Pendleton Grey W , Jemison Lauri A , Gelatt Thomas S 
Published: November 2019

AbstractSteller sea lions (Eumetopias jubatus) are composed of two genetically distinct metapopulations (an increasing “eastern” and a reduced and endangered “western” population, or stock for management purposes in U.S. waters) that are only recently mixing at new rookeries in northern Southeast Alaska, east of the current stock boundary. We used mark-recapture models and 18 years of resighting data of over 3,500 individuals marked at the new rookeries and at neighboring long-established rookeries in both populations to examine morphology, survival, and movement patterns of pups born at new rookeries based on whether they had mitochondrial DNA haplotypes from the western or eastern population (mtW or mtE); examine survival effects of dispersal to the Eastern Stock region for animals born in the Western Stock region; and estimate minimum proportions of animals with western genetic material in regions within Southeast Alaska. Pups born at new rookeries with mtW had similar mass, but reduced body condition and first-year survival (approximately −10%) compared to pups with mtE. mtE pups ranged more widely than mtW pups, including more to the sheltered waters of Southeast Alaska’s Inside Passage. Fitness benefits for western-born females that dispersed to Southeast Alaska were observed as higher female survival (+0.127, +0.099, and +0.032 at ages 1, 2, and 3+) and higher survival of their female offspring to breeding age (+0.15) compared to females that remained west of the boundary. We estimated that a minimum of 38% and 13% of animals in the North Outer Coast–Glacier Bay and Lynn Canal–Frederick Sound regions in Southeast Alaska, respectively, carry genetic information unique to the western population. Despite fitness benefits to western females that dispersed east, asymmetric dispersal costs or other genetic or maternal effects may limit the growth of the western genetic lineage at the new rookeries, and these factors require further study.
Mass and star formation rate of the host galaxies of compact binary mergers across cosmic time
Authors: Artale M Celeste , Mapelli Michela , Bouffanais Yann , Giacobbo Nicola , Pasquato Mario , Spera Mario 
Published: November 2019

ABSTRACT
We investigate the properties of the host galaxies of compact binary mergers across cosmic time, by means of population-synthesis simulations combined with galaxy catalogues from the eagle suite. We analyse the merger rate per galaxy of binary neutron stars (BNSs), black hole–neutron star binaries (BHNSs), and binary black holes (BBHs) from redshift zero up to six. The binary merger rate per galaxy strongly correlates with the stellar mass of the host galaxy at any redshift considered here. This correlation is significantly steeper for BNSs than for both BHNSs and BBHs. Moreover, we find that the merger rate per galaxy depends also on host galaxy’s star formation rate (SFR) and metallicity. We derive a robust fitting formula that relates the merger rate per galaxy with galaxy’s SFR, stellar mass, and metallicity at different redshifts. The typical masses of the host galaxies increase significantly as redshift decreases, as a consequence of the interplay between delay time distribution of compact binaries and cosmic assembly of galaxies. Finally, we study the evolution of the merger rate density with redshift. At low redshift (z ≤ 0.1) early-type galaxies give a larger contribution to the merger rate density than late-type galaxies. This trend reverts at z ≥ 1.