bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethnic differences in atrial fibrillation in patients with heart failure from Asia-Pacific
Authors: Tan Eugene S J , Tay Wan Ting , Teng Tiew-Hwa Katherine , Sim David , Leong Kui Toh Gerard , Yeo Poh Shuan Daniel , Ong Hean Yee , Jaufeerally Fazlur , Ng Tze Pin , Poppe Katrina , Lund Mayanna , Devlin Gerard , Troughton Richard W , Ling Lieng Hsi , Richards Arthur Mark , Doughty Robert N , Lam Carolyn S P 
Published: January 2019

ObjectiveEthnic differences in the prevalence of atrial fibrillation (AF) in heart failure (HF) remain unclear. We compared the prevalence and clinical correlates of AF among different ethnicities in an Asian-Pacific population with HF.MethodsPatients with validated HF were prospectively studied across Singapore and New Zealand (NZ).ResultsAmong 1746 patients with HF (62% Asian, 26% women, mean age 66 (SD 13) years, mean ejection fraction (EF) 37 (SD 16%), 39% had AF. The prevalence of AF was markedly lower in Singapore-Asians than NZ-Europeans (24% vs 63%; p<0.001), even after adjusting for age, clinical and echocardiographic covariates, regardless of EF group (pinteractionfor EF=0.39). Patients with AF were older, had higher body mass index and were more likely to have a history of hypertension, stroke, peripheral vascular disease, renal disease, chronic respiratory disease and increased alcohol intake, but less likely to have diabetes. Clinical correlates were similar for Asians and NZ-Europeans, except diabetes: Asian diabetic patients with HF had less AF compared with Asian patients without diabetes (OR 0.66, 95% CI 0.50 to 0.88), whereas among NZ-Europeans there was no significant association between diabetes and AF (OR 1.22, 95% CI 0.85 to 1.75) (pinteractionfor ethnicity=0.01). AF was associated with a higher crude composite outcome of mortality and HF hospitalisations at 2 years (HR 1.19, 95% CI 1.02 to 1.38).ConclusionThere is a strikingly lower prevalence of AF among Asian compared with NZ-European patients with HF. The underlying mechanisms for the lower prevalence of AF among Asians, particularly in the presence of diabetes, deserve further study.Trial registration numberACTRN12610000374066.
Characteristics of the built environment and spatial patterning of type 2 diabetes in the urban core of Durham, North Carolina
Authors: Bravo Mercedes A , Anthopolos Rebecca , Miranda Marie Lynn 
Published: January 2019

BackgroundFew studies examine relationships between built environment (BE) and type 2 diabetes mellitus (T2DM) using spatial models, investigate BE domains apart from food environment or physical activity resources or conduct sensitivity analysis of methodological choices made in measuring BE. We examine geographic heterogeneity of T2DM, describe how heterogeneity in T2DM relates to BE and estimate associations of T2DM with BE.MethodsIndividual-level electronic health records (n=41 203) from the Duke Medicine Enterprise Data Warehouse (2007–2011) were linked to BE based on census block. Data on housing damage, property disorder, territoriality, vacancy and public nuisances were used to estimate BE based on four different construction methods (CMs). We used race-stratified aspatial and spatial Bayesian models to assess geographic heterogeneity in T2DM and associations of T2DM with BE.ResultsAmong whites, a 1 SD increase in poor quality BE was associated with a 1.03 (95% credible interval 1.01 to 1.06) and 1.06 (95 % credible interval 1.02 to 1.11) increased risk of T2DM for poor quality BE CM1 and CM2, respectively. Among blacks/African Americans, associations between T2DM and BE overlapped with the null for all CMs. The addition of BE to white models reduced residual geographic heterogeneity in T2DM by 4%–15%, depending on CM. In black/African–American models, BE did not affect residual heterogeneity.ConclusionAssociations of T2DM with BE were sensitive to CM and geographic heterogeneity in T2DM differed by race/ethnicity. Findings underscore the need to consider multiple methods of estimating BE and consider differences in relationships by race/ethnicity.
Differential vulnerability to neighbourhood disorder: a gene×environment interaction study
Authors: Robinette Jennifer Williams , Boardman Jason D , Crimmins Eileen M 
Published: January 2019

BackgroundType 2 diabetes (T2D) is preventable, it is increasing in prevalence and it is a major risk factor for morbidity and mortality. Importantly, residents of neighbourhoods with high levels of disorder are more likely to develop T2D than those living in less disordered neighbourhoods and neighbourhood disorder may exacerbate genetic risk for T2D.MethodWe use genetic, self-reported neighbourhood, and health data from the Health and Retirement Study. We conducted weighted logistic regression analyses in which neighbourhood disorder, polygenic scores for T2D and their interaction predicted T2D.ResultsGreater perceptions of neighbourhood disorder (OR=1.11, p<0.001) and higher polygenic scores for T2D (OR=1.42, p<0.001) were each significantly and independently associated with an increased risk of T2D. Furthermore, living in a neighbourhood perceived as having high levels of disorder exacerbated genetic risk for T2D (OR=1.10, p=0.001). This significant gene×environment interaction was observed after adjusting for years of schooling, age, gender, levels of physical activity and obesity.ConclusionFindings in the present study suggested that minimising people’s exposure to vandalism, vacant buildings, trash and circumstances viewed by residents as unsafe may reduce the burden of this prevalent chronic health condition, particularly for subgroups of the population who carry genetic liability for T2D.
SMAD3pathogenic variants: risk for thoracic aortic disease and associated complications from the Montalcino Aortic Consortium
Authors: Hostetler Ellen M , Regalado Ellen S , Guo Dong-Chuan , Hanna Nadine , Arnaud Pauline , Muiño-Mosquera Laura , Callewaert Bert Louis , Lee Kwanghyuk , Leal Suzanne M , Wallace Stephanie E , Rideout Andrea L , Dyack Sarah , Aatre Rajani D , Boileau Catherine , De Backer Julie , Jondeau Guillaume , Milewicz Dianna M 
Published: January 2019

BackgroundPathogenic variants inSMAD3cause thoracic aortic aneurysms and dissections, along with aneurysms and rupture of other arteries. Here, we examined differences in clinical presentation of aortic events (dissection or surgical repair of an aneurysm) with respect to age and variant type in an international cohort of individuals withSMAD3variants.MethodsAortic status and events, vital status and clinical features were abstracted through retrospective review of medical records of 212 individuals with 51 uniqueSMAD3variants, including haploinsufficiency (HI) and missense substitutions in the MH2 domain, as well as novel in-frame deletions and missense variants in the MH1 domain.ResultsAortic events were documented in 37% of cases, with dissections accounting for 70% of events. The median age at first aortic event was significantly lower in individuals withSMAD3MH2 missense variants than those with HI variants (42years vs 49 years; p=0.003), but there was no difference in frequency of aortic events by variant type. The cumulative risk of an aortic event was 50% at 54 years of age. No aortic events in childhood were observed.ConclusionsSMAD3pathogenic variants cause thoracic aortic aneurysms and dissections in the majority of individuals with variable age of onset and reduced penetrance. Of the covariates examined, the type of underlyingSMAD3variant was responsible for some of this variation. Later onset of aortic events and the absence of aortic events in children associated withSMAD3variants support gene-specific management of this disorder.
Night work and sick leave during pregnancy: a national register-based within-worker cohort study
Authors: Hammer Paula Edeusa Cristina , Garde Anne Helene , Begtrup Luise Moelenberg , Flachs Esben Meulengracht , Hansen Johnni , Hansen Åse Marie , Hougaard Karin Sørig , Kolstad Henrik A , Larsen Ann Dyreborg , Pinborg Anja Bisgaard , Specht Ina Olmer , Bonde Jens Peter 
Published: January 2019

ObjectiveThe aim of our study was to investigate the acute effect of night work during pregnancy on the risk of calling in sick the following day using register-based information and the workers as their own controls.MethodsUsing the payroll-based national Danish Working Hour Database, including all public hospital employees in Denmark, we identified 9799 pregnant women with ≥1 day shift and ≥1 night shift and ≥1 day of sick leave during the first 32 pregnancy weeks from January 2007 to December 2013. We performed fixed effects logistic regression, that is, within-worker comparisons, of the risk of sick leave of any duration starting within 24 hours after night shifts of different length versus day shifts.ResultsMost of the participants were nurses (64%) or physicians (16%). We found an increased relative risk of sick leave following night shifts compared with day shifts during all pregnancy trimesters. The risk was highest for night shifts lasting >12 hours (OR 1.37, 95% CI 1.15 to 1.63 for nurses; OR 1.87, 95% CI 1.69 to 2.08 for physicians) and among women aged >35 years (OR 1.42, 95% CI 1.24 to 1.63).ConclusionAmong Danish public hospital employees night shifts during pregnancy, especially shifts longer than 12 hours, increased the risk of calling in sick the following day independent of personal factors and time-invariant confounders in all pregnancy trimesters.
ECG conduction disturbances and ryanodine receptor expression levels in occupational lead exposure workers
Authors: Xie Jie , Du Guihua , Zhang Yuanyuan , Zhou Fankun , Wu Junfang , Jiao Huan , Li Yanshu , Chen Ying , Ouyang Lu , Bo Dandan , Feng Chang , Yang Wei , Fan Guangqin 
Published: January 2019

ObjectivesA significant number of researches have evidenced that occupational lead (Pb) exposure increased risks of cardiovascular disease. However, evidences about the potential effects of Pb on the cardiac conduction system are sparse and inconclusive. Besides, ryanodine receptors (RyRs) induced dysfunction of cardiac excitation contraction coupling which is considered to be one of the mechanisms in cardiovascular diseases. Therefore, we examined the association between occupational Pb exposure and ECG conduction abnormalities, as well as RyRs in Pb-induced ECG abnormalities.MethodsWe investigated 529 Pb smelter workers, and measured blood lead (BPb), zinc protoporphyrin (ZPP), ECG outcomes and RyR expression levels. Based on BPb levels, the workers were divided into three groups: the BPb not elevated group, the BPb elevated group and the Pb poisoning group. Descriptive and multivariable analyses were performed.ResultsCompared with the BPb not elevated group, the Pb poisoning group had a higher incidence of high QRS voltage, and a lower level of RyR1 gene expression (p<0.05). Further unconditional multivariable logistic regression analyses showed that high QRS voltage was positively related to BPb (OR=1.045, 95% CI 1.014 to 1.078) and inversely associated with RyR1 expression (OR=0.042, 95% CI 0.002 to 0.980) after adjusting for potential confounders. In addition, multiple linear regression analyses showed that the QTc interval was positively associated with ZPP (β=0.299, 95% CI 0.130 to 0.468) after adjusting for potential confounders.ConclusionsOur study provided evidences that occupational exposure to Pb may be associated with worse ECG outcomes (high QRS voltage), which might be related to decreased levels of RyR1.
Secondhand smoke alters arachidonic acid metabolism and inflammation in infants and children with cystic fibrosis
Authors: Kopp Benjamin T , Thompson Rohan , Kim Jeeho , Konstan Robert , Diaz Alejandro , Smith Bennett , Shrestha Chandra , Rogers Lynette K , Hayes Don , Tumin Dmitry , Woodley Frederick W , Ramilo Octavio , Sanders Don B , Groner Judith A , Mejias Asuncion 
Published: January 2019

BackgroundMechanisms that facilitate early infection and inflammation in cystic fibrosis (CF) are unclear. We previously demonstrated that children with CF and parental-reported secondhand smoke exposure (SHSe) have increased susceptibility to bacterial infections. SHSe hinders arachidonic acid (AA) metabolites that mediate immune function in patients without CF, and may influence CF immune dysfunction. We aimed to define SHSe’s impact on inflammation mediators and infection in children with CF.MethodsSeventy-seven children with CF <10 years of age (35 infants <1 year; 42 children 1–10 years) were enrolled and hair nicotine concentrations measured as an objective surrogate of SHSe. AA signalling by serum and macrophage lipidomics, inflammation using blood transcriptional profiles and in vitro macrophage responses to bacterial infection after SHSe were assessed.ResultsHair nicotine concentrations were elevated in 63% of patients. Of the AA metabolites measured by plasma lipidomics, prostaglandin D2 (PGD2) concentrations were decreased in children with CF exposed to SHSe, and associated with more frequent hospitalisations (p=0.007) and worsened weight z scores (p=0.008). Children with CF exposed to SHSe demonstrated decreased expression of the prostaglandin genes PTGES3 and PTGR2 and overexpression of inflammatory pathways. These findings were confirmed using an in vitro model, where SHSe was associated with a dose-dependent decrease in PGD2 and increased methicillin-resistant Staphylococcus aureus survival in human CF macrophages.ConclusionsInfants and young children with CF and SHSe have altered AA metabolism and dysregulated inflammatory gene expression resulting in impaired bacterial clearance. Our findings identified potential therapeutic targets to halt early disease progression associated with SHSe in the young population with CF.
Impact of organisation and specialist service delivery on lung cancer outcomes
Authors: Adizie Jana Bhavani , Khakwani Aamir , Beckett Paul , Hubbard Richard , Navani Neal , Harden Susan V , Woolhouse Ian 
Published: January 2019

IntroductionData from the National Lung Cancer Audit (NLCA) often show variation in outcomes between lung cancer units which are not entirely explained by case mix. We explore the association between the organisation of services and patient outcome.MethodsDetails of service provision were collected via an electronic survey in June 2017. An overall organisational score derived from eleven key service factors from national lung cancer commissioning guidance was calculated for each organisation. The results for each hospital were linked to their patient outcome results from the 2015 NLCA cases. Multivariate logistic regression analysis was used to link the organisational score to patient outcomes.ResultsLung cancer unit organisational audit scores varied from 0 to 11. Thirty-eight (29%) units had a score of 0–4, 64 (50%) had a score of 5–7 and 27 (21%) had a score of 8–11. Multivariate regression analysis revealed that, compared with an organisational score of 0–4, patients seen at units with a score of 8–11 had higher 1-year survival (adjusted OR (95% CI)=2.30 (1.04 to 5.08), p<0.001), higher curative-intent treatment rate (adjusted OR (95% CI)=1.62 (1.26 to 2.09), p<0.001) and greater likelihood of receiving treatment within 62 days (adjusted OR (95% CI)=1.49 (1.20 to 1.86), p<0.001).ConclusionNational variation in the provision of services and workforce remain. We provide evidence that adherence to the national lung commissioning guidance has the potential to improve patient outcomes within the current service structure.
Emergency Consent: Patients’ and Surrogates’ Perspectives on Consent for Clinical Trials in Acute Stroke and Myocardial Infarction
Authors: Dickert Neal W. , Scicluna Victoria M. , Adeoye Opeolu , Angiolillo Dominick J. , Blankenship James C. , Devireddy Chandan M. , Frankel Michael R. , Goldkind Sara F. , Kumar Gautam , Ko Yi‐An , Mitchell Andrea R. , Nogueria Raul G. , Parker Ruth M. , Patel Manesh R. , Riedford Michele , Silbergleit Robert , Speight Candace D. , Spokoyny Ilana , Weinfurt Kevin P. , Pentz Rebecca D. 
Published: January 2019

Background
Emergent informed consent for clinical trials in acute myocardial infarction (AMI) and stroke is challenging. The role and value of consent are controversial, and insufficient data exist regarding patients’ and surrogates’ experiences.

Methods and Results
We conducted structured interviews with patients (or surrogates) enrolled in AMI or acute stroke trials at 6 sites between 2011 and 2016. Primary domains included trial recall, consent experiences, and preferences regarding involvement. Descriptive and test statistics were used to characterize responses and explore relationships between key domains and characteristics. Multivariable logistic regression was used to examine associations between key covariates and consent preferences. There were 176 (84 stroke, 92 AMI) completed interviews. Most stroke respondents (82%) were surrogates; all AMI respondents were patients. Average time from trial enrollment to interview was 1.9 years (stroke) and 2.8 years (AMI); 89% of stroke and 62% of AMI respondents remembered being in the trial, and among these respondents, 80% (stroke) and 44% (AMI) remembered reading some of the consent form. Over 90% reported not feeling pressure to enroll, being treated in a caring way, and being treated with dignity. A minority (16% stroke and 26% AMI) reported they would have preferred not to be asked for consent. Just over half (61% stroke and 53% AMI) recalled a postenrollment conversation about the study.

Conclusions
Most respondents felt they were treated respectfully and were glad they had been asked for consent. Trial recall was relatively low, and many respondents recalled little postenrollment discussion. Further development of context‐sensitive approaches to consent is important.
Economic evaluation of stepped care for the management of childhood anxiety disorders: Results from a randomised trial
Authors: Chatterton Mary Lou , Rapee Ronald M , Catchpool Max , Lyneham Heidi J , Wuthrich Viviana , Hudson Jennifer L , Kangas Maria , Mihalopoulos Cathrine 
Published: January 2019

Background: Stepped care has been promoted for the management of mental disorders; however, there is no empirical evidence to support the cost-effectiveness of this approach for the treatment of anxiety disorders in youth. Method: This economic evaluation was conducted within a randomised controlled trial comparing stepped care to a validated, manualised treatment in 281 young people, aged 7–17, with a diagnosed anxiety disorder. Intervention costs were determined from therapist records. Administrative data on medication and medical service use were used to determine additional health care costs during the study period. Parents also completed a resource use questionnaire to collect medications, services not captured in administrative data and parental lost productivity. Outcomes included participant-completed quality of life, Child Health Utility – nine-dimension and parent-completed Assessment of Quality of Life – eight-dimension to calculate quality-adjusted life years. Mean costs and quality-adjusted life years were compared between groups at 12-month follow-up. Results: Intervention delivery costs were significantly less for stepped care from the societal perspective (mean difference −$198, 95% confidence interval −$353 to −$19). Total combined costs were less for stepped care from both societal (−$1334, 95% confidence interval −$2386 to $510) and health sector (−$563, 95% confidence interval −$1353 to $643) perspectives but did not differ significantly from the manualised treatment. Youth and parental quality-adjusted life years were not significantly different between groups. Sensitivity analysis indicated that the results were robust. Conclusion: For youth with anxiety, this three-step model provided comparable outcomes and total health sector costs to a validated face-to-face programme. However, it was less costly to deliver from a societal perspective, making it an attractive option for some parents. Future economic evaluations comparing various models of stepped care to treatment as usual are recommended.
Approach to pneumothorax surgery: a national survey of current UK practice
Authors: Asghar Nawaz Muhammad , Apparau Denish , Zacharias Joseph , Shackcloth Michael 
Published: January 2019

Background Pneumothorax is a common condition with various management options. We aimed to determine the current surgical practice in the United Kingdom. Method An online questionnaire regarding surgical strategy was sent to all consultants who were members of the Society for Cardiothoracic Surgery (80 thoracic). Results Fifty-six consultants, mainly thoracic, responded to the survey. Video-assisted thoracoscopic surgery was unanimously the preferred approach, the majority (59%) using 3 ports. Regarding the timing of surgery, 53 (95%) surgeons would intervene at first presentation with persistent air leak and/or lung collapse, 41 (73%) for a first bilateral pneumothorax, 22 (39%) only for recurrent pneumothorax, and 18 (32%) for the first computed tomography evidence of bullae. Apical bullectomy + pleurectomy was the preferred technique for 26 (46%) surgeons, and apical bullectomy + apical pleurectomy + pleural abrasion was the choice for 13 (23%). Some surgeons were concerned about talc and avoid it. The majority (70%) used a single apical drain with or without 24–48 h suction. Regarding chest radiography, the response was variable but 48% performed immediate postoperative and/or daily chest radiographs. Currently, most surgeons (59%) use digital drains and feel it monitors air leaks better. The perceived chronic pain (1%–3%) and recurrence rates (0%–3%) were stated by 59% and 86%, respectively. Conclusion There is variability in the surgical management of pneumothorax among surgeons across the UK, but they all use video-assisted thoracoscopic surgery as the intervention of choice for pneumothorax surgery, and there is a shift towards early surgical intervention.
Surgical outcomes of early-stage small-cell lung cancer: single-center experience
Authors: Sayan Muhammet , Satir Turk Merve , Celik Ali , Cuneyt Kurul Ismail , Irfan Tastepe Abdullah 
Published: January 2019

Background Small-cell lung cancer is a highly aggressive and metastatic epithelial lung malignancy. A small percentage of these tumors can be detected at an early stage and may be appropriate for surgical treatment. We analyzed the data of patients with early-stage small-cell lung cancer who underwent lobectomy and mediastinal lymph node dissection. Methods Between January 2011 and December 2016, 26 patients with early-stage small-cell lung cancer underwent lobectomy and mediastinal lymph node dissection and were included the study. The mean age was 60.9 years and 18 (69.2%) were male. Patients with increased uptake of 18 F-fludeoxyglucose in mediastinal or distant organs on positron-emission tomography computed tomography, or lung resections other than lobectomy, were not included in the study. Results The most common tumor location was the right upper lobe. The diagnoses were achieved by intraoperative frozen section study in almost all patients (92.3%). Mean overall survival was 58.5 ± 6.7 months (range 45–71 months) and the 5-year survival rate was 53%. We found that a statistically significant correlation between lymph node metastasis in N1 or N2 stations and survival. There was also a significant relationship between N2 nodal metastasis and recurrence. Conclusion As stated in the current guidelines, lung lobectomy and mediastinal lymph node resection should be considered in early-stage small-cell lung cancers. Survival outcomes of surgery for early-stage small-cell lung cancer are similar to the results in non-small-cell lung cancer.