bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can a midwife-led continuity model improve maternal services in a low-resource setting? A non-randomised cluster intervention study in Palestine
Authors: Mortensen Berit , Lukasse Mirjam , Diep Lien My , Lieng Marit , Abu-Awad Amal , Suleiman Munjid , Fosse Erik 
Published: March 2018

ObjectivesTo improve maternal health services in rural areas, the Palestinian Ministry of Health launched a midwife-led continuity model in the West Bank in 2013. Midwives were deployed weekly from governmental hospitals to provide antenatal and postnatal care in rural clinics. We studied the intervention’s impact on use and quality indicators of maternal services after 2 years’ experience.DesignA non-randomised intervention design was chosen. The study was based on registry data only available at cluster level, 2 years before (2011and2012) and 2 years after (2014and2015) the intervention.SettingAll 53 primary healthcare clinics in Nablus and Jericho regions were stratified for inclusion.Primary and secondary outcomesPrimary outcome was number of antenatal visits. Important secondary outcomes were number of referrals to specialist care and number of postnatal home visits. Differences in changes within the two groups before and after the intervention were compared by using mixed effect models.Results14 intervention clinics and 25 control clinics were included. Number of antenatal visits increased by 1.16 per woman in the intervention clinics, while declined by 0.39 in the control clinics, giving a statistically significant difference in change of 1.55 visits (95% CI 0.90 to 2.21). A statistically significant difference in number of referrals was observed between the groups, giving a ratio of rate ratios of 3.65 (2.78–4.78) as number of referrals increased by a rate ratio of 3.87 in the intervention group, while in the control the rate ratio was only 1.06.Home visits increased substantially in the intervention group but decreased in the control group, giving a ratio of RR 97.65 (45.20 - 210.96)ConclusionThe Palestinian midwife-led continuity model improved use and some quality indicators of maternal services. More research should be done to investigate if the model influenced individual health outcomes and satisfaction with care.Trial registration numberNCT03145571; Results.
Self-management interventions for adults with chronic kidney disease: a scoping review
Authors: Donald Maoliosa , Kahlon Bhavneet Kaur , Beanlands Heather , Straus Sharon , Ronksley Paul , Herrington Gwen , Tong Allison , Grill Allan , Waldvogel Blair , Large Chantel A , Large Claire L , Harwood Lori , Novak Marta , James Matthew T , Elliott Meghan , Fernandez Nicolas , Brimble Scott , Samuel Susan , Hemmelgarn Brenda R 
Published: March 2018

ObjectiveTo systematically identify and describe self-management interventions for adult patients with chronic kidney disease (CKD).SettingCommunity-based.ParticipantsAdults with CKD stages 1–5 (not requiring kidney replacement therapy).InterventionsSelf-management strategies for adults with CKD.Primary and secondary outcome measuresUsing a scoping review, electronic databases and grey literature were searched in October 2016 to identify self-management interventions for adults with CKD stages 1–5 (not requiring kidney replacement therapy). Randomised controlled trials (RCTs), non-RCTs, qualitative and mixed method studies were included and study selection and data extraction were independently performed by two reviewers. Outcomes included behaviours, cognitions, physiological measures, symptoms, health status and healthcare.ResultsFifty studies (19 RCTs, 7 quasi-experimental, 5 observational, 13 pre-post intervention, 1 mixed method and 5 qualitative) reporting 45 interventions were included. The most common intervention topic was diet/nutrition and interventions were regularly delivered face to face. Interventions were administered by a variety of providers, with nursing professionals the most common health professional group. Cognitions (ie, changes in general CKD knowledge, perceived self-management and motivation) were the most frequently reported outcome domain that showed improvement. Less than 1% of the interventions were co-developed with patients and 20% were based on a theory or framework.ConclusionsThere was a wide range of self-management interventions with considerable variability in outcomes for adults with CKD. Major gaps in the literature include lack of patient engagement in the design of the interventions, with the majority of interventions not applying a behavioural change theory to inform their development. This work highlights the need to involve patients to co-developed and evaluate a self-management intervention based on sound theories and clinical evidence.
Role of CHA2DS2-VASc score in predicting new-onset atrial fibrillation in patients with type 2 diabetes mellitus with and without hyperosmolar hyperglycaemic state: real-world data from a nationwide cohort
Authors: Hu Wei-Syun , Lin Cheng-Li 
Published: March 2018

PurposeThe objective of the current study was to explore the role of CHA2DS2-VASc score in predicting incidence of atrial fibrillation (AF) in patients with type 2 diabetes mellitus (DM). Furthermore, the use of the CHA2DS2-VASc score for stratifying new-onset AF risk in patients with DM and with/without hyperosmolar hyperglycaemic state (HHS) was also compared.MethodsThe study subjects were identified from Longitudinal Health Insurance Database provided by the National Health Research Institutes. The patients with DM were divided into two groups based on a history of HHS or not. The predictive ability of CHA2DS2-VASc score for stratifying new-onset AF risk in the two groups was calculated using the area under the curve of receiver-operating characteristic (AUROC).ResultsThe present study involved a total of 69 530 patients with type 2 DM. Among them, 1558 patients had a history of HHS, whereas 67 972 patients did not. The AUROC of the CHA2DS2-VASc score as a predictor of incident AF in patients with DM and with/without HHS was 0.67 (95% CI 0.59 to 0.75) and 0.71 (95% CI 0.70 to 0.72), respectively.ConclusionsTo conclude, we reported for the first time on the assessment of CHA2DS2-VASc score for incident AF risk discrimination in patients with type 2 DM. We further found that the predictive ability of the CHA2DS2-VASc score was attenuated in patients with type 2 DM and with HHS in comparison with those without HHS.
Factor VIIa administration in traumatic brain injury: an AAST-MITC propensity score analysis
Authors: Lombardo Sarah , Millar D , Jurkovich Gregory J , Coimbra Raul , Nirula Ram 
Published: March 2018

BackgroundRecombinant factor VIIa (rFVIIa) has been used off-label as an adjunct in the reversal of warfarin therapy and management of hemorrhage after trauma. Only a handful of these reports are rigorous studies, from which results regarding safety and effectiveness have been mixed. There remains no clear consensus as to the role of rFVIIa in traumatic brain injury (TBI).MethodsEleven level 1 trauma centers provided clinical data and head CT scans of patients with a Glasgow Coma Scale (GCS) score of ≤13 and radiographic evidence of TBI. A propensity score (PS) to receive rFVIIa in those surviving ≥2 days was calculated for each patient based on patient demographics, comorbidities, physiology, Injury Severity Score, admission GCS score, and treatment center. Patients receiving rFVIIa within 24 hours of admission were matched to patients who did not receive rFVIIa for outcomes assessment. Subgroup analysis evaluated patients with primary head injury with PS matching.ResultsThere were 4284 patient observations; 129 received rFVIIa. Groups were comparable after matching. No differences in mortality or morbidity were found. Improvement in GCS score from admission to discharge was less among those receiving rFVIIa (5.5 vs. 2.4; P value 0.001); however, there was no difference in average GCS score at discharge. No significant differences in outcomes were identified in patients with isolated TBI receiving rFVIIa.DiscussionrFVIIa in early management of TBI is not associated with a decreased risk of mortality or morbidity, and may negatively impact recovery and functional status at discharge in the severely injured patient with polytrauma.Level of evidenceLevel III.Study typeTherapeutic/care management.
Two epochs of eclogite metamorphism link ‘cold’ oceanic subduction and ‘hot’ continental subduction, the North Qaidam UHP belt, NW China
Authors: Song Shuguang , Niu Yaoling , Zhang Guibin , Zhang Lifei 
Published: March 2018

Abstract

Eclogites in the high-pressure (HP) and ultrahigh-pressure (UHP) belts record subduction-zone processes; exhumed eclogites of seafloor protoliths record low-temperature (mostly <600°C), high-pressure and ‘wet’ environments: that is, relatively ‘cold’ subduction with highly hydrous minerals such as lawsonite. In contrast, eclogites formed by the continental subduction record relatively ‘hot’ (
T
> 650°C) and ‘dry’ ultrahigh-pressure metamorphic (UHPM) conditions with syncollisional magmatism. Here, we investigate some eclogites from two ophiolite sequences that intercalated in the North Qaidam UHPM belt, which is genetically associated with continental subduction/collision. The observations of lawsonite pseudomorphs in garnets, garnet compositional zoning, mineral and fluid inclusions in zircons, and zircons with distinct trace-element patterns and U–Pb ages all suggest that these eclogites represent two exhumation episodes of subduction-zone metamorphic rocks: the early ‘cold’ and ‘wet’ lawsonite eclogite and the late ‘hot’ and ‘dry’ UHP kyanite eclogite. The early lawsonite-bearing eclogite gives metamorphic ages of 470–445 Ma and the later kysnite-bearing eclogite gives metamorphic ages of 438–420 Ma, with a time gap of
c.
7–10 myr. This gap may represent the timescale for transition from oceanic subduction and continental subduction to depths greater than 100 km. We conclude that evolution from oceanic subduction to continental collision and subduction was a continuous process.

In addition, we find that titanium contents in zircons have a positive correlation with U contents. Ti-in-zircon thermometry is likely to be invalid or limited for low-temperature eclogites.
The metamorphic evolution and tectonic significance of the Sumdo HP–UHP metamorphic terrane, central-south Lhasa Block, Tibet
Authors: Zhang Cong , Bader Thomas , van Roermund Herman , Yang Jingsui , Shen Tingting , Qiu Tian , Li Peng 
Published: March 2018

Abstract

The Lhasa terrane, forming one of the main tectonic components of the Himalayan–Tibetan orogen, has received a lot of attention as it records multiple episodes of plate spreading, subduction and collision within the realm of the Paleo-Tethys Ocean. A review of the mineralogical, petrological, geochemical and geochronological data of eclogites, associated blueschists and garnet-bearing mica schists from the Sumdo high- and ultrahigh-pressure metamorphic (HP/UHP) complex in the central/southern part of the Lhasa terrane, is present here so that the origin and tectono-metamorphic evolution of this important suture can be deduced. By re-evaluating the original published
P
–
T
conditions for the metamorphic rocks of the Sumdo Complex, we consider that the Sumdo Complex has experienced low temperature HP/UHP metamorphic conditions, characteristic of fast subduction (and exhumation) in a typical oceanic subduction zone setting. The original wide spread in the maximal peak
P
–
T
conditions could be reduced in size due to thus far unknown inconsistencies in the usage of applied geothermobarometric techniques. The remaining spread in the maximal
P
–
T
conditions (
c.
200°C/10 kbar) of the HP/UHP regions can be explained by a mechanism that the rocks from individual tectonic slices were subducted to different depths and followed by juxtaposition on their way back to the surface. A re-consideration of the isotopic ages of eclogites from the Sumdo Complex demonstrates that the opening of the Paleo-Tethys Ocean, located in between the two major components of the Lhasa terrane, was initiated prior to
c.
280 Ma and the eclogite facies metamorphism is likely to be of late Permian (
c.
260 Ma) to early Triassic age (245–225 Ma), recording different ages of subduction from individual slices of the oceanic crust. The closure of the Paleo-Tethys Ocean resulted, no earlier than 210 Ma, in the final collision between the northern and southern Lhasa blocks. This final collision event may have been triggered by the initial subduction of the Bangong–Nujiang Tethys Ocean in the north.
Sigmoid colon mucosal gene expression supports alterations of neuronal signaling in irritable bowel syndrome with constipation
Authors: Videlock Elizabeth J. , Mahurkar-Joshi Swapna , Hoffman Jill M. , Iliopoulos Dimitrios , Pothoulakis Charalabos , Mayer Emeran A. , Chang Lin 
Published: March 2018

Peripheral factors likely play a role in at least a subset of irritable bowel syndrome (IBS) patients. Few studies have investigated mucosal gene expression using an unbiased approach. Here, we performed mucosal gene profiling in a sex-balanced sample to identify relevant signaling pathways and gene networks and compare with publicly available profiling data from additional cohorts. Twenty Rome III+ IBS patients [10 IBS with constipation (IBS-C), 10 IBS with diarrhea (IBS-D), 5 men/women each), and 10 age-/sex-matched healthy controls (HCs)] underwent sigmoidoscopy with biopsy for gene microarray analysis, including differential expression, weighted gene coexpression network analysis (WGCNA), gene set enrichment analysis, and comparison with publicly available data. Expression levels of 67 genes were validated in an expanded cohort, including the above samples and 18 additional participants (6 each of IBS-C, IBS-D, HCs) using NanoString nCounter technology. There were 1,270 differentially expressed genes (FDR < 0.05) in IBS-C vs. HCs but none in IBS or IBS-D vs. HCs. WGNCA analysis identified activation of the cAMP/protein kinase A signaling pathway. Nine of 67 genes were validated by the NanoString nCounter technology (FDR < 0.05) in the expanded sample. Comparison with publicly available microarray data from the Mayo Clinic and University of Nottingham supports the reproducibility of 17 genes from the microarray analysis and three of nine genes validated by nCounter in IBS-C vs. HCs. This study supports the involvement of peripheral mechanisms in IBS-C, particularly pathways mediating neuronal signaling. NEW & NOTEWORTHY Peripheral factors play a role in the pathophysiology of irritable bowel syndrome (IBS), which, to date, has been mostly evident in IBS with diarrhea. Here, we show that sigmoid colon mucosal gene expression profiles differentiate IBS with constipation from healthy controls. These profiling data and analysis of additional cohorts also support the concept that peripheral neuronal pathways contribute to IBS pathophysiology.
IL-1 receptor activation undermines respiratory motor plasticity after systemic inflammation
Authors: Hocker Austin D. , Huxtable Adrianne G. 
Published: March 2018

Inflammation undermines respiratory motor plasticity, yet we are just beginning to understand the inflammatory signaling involved. Because interleukin-1 (IL-1) signaling promotes or inhibits plasticity in other central nervous system regions, we tested the following hypotheses: 1) IL-1 receptor (IL-1R) activation after systemic inflammation is necessary to undermine phrenic long-term facilitation (pLTF), a model of respiratory motor plasticity induced by acute intermittent hypoxia (AIH), and 2) spinal IL-1β is sufficient to undermine pLTF. pLTF is significantly reduced 24 h after lipopolysaccharide (LPS; 100 μg/kg ip, 12 ± 18%, n = 5) compared with control (57 ± 25%, n = 6) and restored by peripheral IL-1R antagonism (63 ± 13%, n = 5, AF-12198, 0.5 mg/kg ip, 24 h). Furthermore, acute, spinal IL-1R antagonism (1 mM AF-12198, 15 μl it) restored pLTF (53 ± 15%, n = 4) compared with LPS-treated rats (11 ± 10%; n = 5), demonstrating IL-1R activation is necessary to undermine pLTF after systemic inflammation. However, in healthy animals, pLTF persisted after spinal, exogenous recombinant rat IL-1β (rIL-1β) (1 ng ± AIH; 66 ± 26%, n = 3, 10 ng ± AIH; 102 ± 49%, n = 4, 100 ng + AIH; 93 ± 51%, n = 3, 300 ng ± AIH; 37 ± 40%, n = 3; P < 0.05 from baseline). In the absence of AIH, spinal rIL-1β induced progressive, dose-dependent phrenic amplitude facilitation (1 ng; −3 ± 5%, n = 3, 10 ng; 8 ± 22%, n = 3, 100 ng; 31 ± 12%, P < 0.05, n = 4, 300 ng; 51 ± 17%, P < 0.01 from baseline, n = 4). In sum, IL-1R activation, both systemically and spinally, undermines pLTF after LPS-induced systemic inflammation, but IL-1R activation is not sufficient to abolish plasticity. Understanding the inflammatory signaling inhibiting respiratory plasticity is crucial to developing treatment strategies utilizing respiratory plasticity to promote breathing during ventilatory control disorders.NEW & NOTEWORTHY This study gives novel insights concerning mechanisms by which systemic inflammation undermines respiratory motor plasticity. We demonstrate that interleukin-1 signaling, both peripherally and centrally, undermines respiratory motor plasticity. However, acute, exogenous interleukin-1 signaling is not sufficient to undermine respiratory motor plasticity.
Visualization of Monocytic Cells in Regressing Atherosclerotic Plaques by Intravital 2-Photon and Positron Emission Tomography–Based Imaging—Brief Report
Authors: Li Wenjun , Luehmann Hannah P. , Hsiao Hsi-Min , Tanaka Satona , Higashikubo Ryuji , Gauthier Jason M. , Sultan Deborah , Lavine Kory J. , Brody Steven L. , Gelman Andrew E. , Gropler Robert J. , Liu Yongjian , Kreisel Daniel 
Published: March 2018

Objective—
Aortic arch transplants have advanced our understanding of processes that contribute to progression and regression of atherosclerotic plaques. To characterize the dynamic behavior of monocytes and macrophages in atherosclerotic plaques over time, we developed a new model of cervical aortic arch transplantation in mice that is amenable to intravital imaging.

Approach and Results—

Vascularized aortic arch grafts were transplanted heterotropically to the right carotid arteries of recipient mice using microsurgical suture techniques. To image immune cells in atherosclerotic lesions during regression, plaque-bearing aortic arch grafts from B6 ApoE-deficient donors were transplanted into syngeneic CX
3
CR1 GFP reporter mice. Grafts were evaluated histologically, and monocytic cells in atherosclerotic plaques in ApoE-deficient grafts were imaged intravitally by 2-photon microscopy in serial fashion. In complementary experiments, CCR2
+
cells in plaques were serially imaged by positron emission tomography using specific molecular probes. Plaques in ApoE-deficient grafts underwent regression after transplantation into normolipidemic hosts. Intravital imaging revealed clusters of largely immotile CX
3
CR1
+
monocytes/macrophages in regressing plaques that had been recruited from the periphery. We observed a progressive decrease in CX
3
CR1
+
monocytic cells in regressing plaques and a decrease in CCR2
+
positron emission tomography signal during 4 months.

Conclusions—
Cervical transplantation of atherosclerotic mouse aortic arches represents a novel experimental tool to investigate cellular mechanisms that contribute to the remodeling of atherosclerotic plaques.
Moderate‐to‐Vigorous Physical Activity and All‐Cause Mortality: Do Bouts Matter?
Authors: Saint‐Maurice Pedro F. , Troiano Richard P. , Matthews Charles E. , Kraus William E. 
Published: March 2018

Background

The 2008 Physical Activity Guidelines for Americans recommends that adults accumulate moderate‐to‐vigorous physical activity (
MVPA
) in bouts of ≥10 minutes for substantial health benefits. To what extent the same amount of
MVPA
accumulated in bouts versus sporadically reduces mortality risk remains unclear.

Methods and Results

We analyzed data from the National Health and Nutrition Examination Survey 2003–2006 and death records available through 2011 (follow‐up period of ≈6.6 years; 700 deaths) to examine the associations between objectively measured physical activity accumulated with and without a bout criteria and all‐cause mortality in a representative sample of
US
adults 40 years and older (n=4840). Physical activity data were processed to generate minutes per day of total and bouted
MVPA
. Bouted
MVPA
was defined as
MVPA
accumulated in bouts of a minimum duration of either 5 or 10 minutes allowing for 1‐ to 2‐minute interruptions. Hazard ratios for all‐cause mortality associated with total and bouted
MVPA
were similar and ranged from 0.24 for the third quartile of total to 0.44 for the second quartile of 10‐minute bouts. The examination of jointly classified quartiles of total
MVPA
and tertiles of proportion of bouted activity revealed that greater amounts of bouted
MVPA
did not result in additional risk reductions for mortality.

Conclusions

These results provide evidence that mortality risk reductions associated with
MVPA
are independent of how activity is accumulated and can impact the development of physical activity guidelines and inform clinical practice.
SCIL-STROKE (Subcutaneous Interleukin-1 Receptor Antagonist in Ischemic Stroke)
Authors: Smith Craig J. , Hulme Sharon , Vail Andy , Heal Calvin , Parry-Jones Adrian R. , Scarth Sylvia , Hopkins Karen , Hoadley Margaret , Allan Stuart M. , Rothwell Nancy J. , Hopkins Stephen J. , Tyrrell Pippa J. 
Published: March 2018

Background and Purpose—
The proinflammatory cytokine IL-1 (interleukin-1) has a deleterious role in cerebral ischemia, which is attenuated by IL-1 receptor antagonist (IL-1Ra). IL-1 induces peripheral inflammatory mediators, such as interleukin-6, which are associated with worse prognosis after ischemic stroke. We investigated whether subcutaneous IL-1Ra reduces the peripheral inflammatory response in acute ischemic stroke.

Methods—
SCIL-STROKE (Subcutaneous Interleukin-1 Receptor Antagonist in Ischemic Stroke) was a single-center, double-blind, randomized, placebo-controlled phase 2 trial of subcutaneous IL-1Ra (100 mg administered twice daily for 3 days) in patients presenting within 5 hours of ischemic stroke onset. Randomization was stratified for baseline National Institutes of Health Stroke Scale score and thrombolysis. Measurement of plasma interleukin-6 and other peripheral inflammatory markers was undertaken at 5 time points. The primary outcome was difference in concentration of log(interleukin-6) as area under the curve to day 3. Secondary outcomes included exploratory effect of IL-1Ra on 3-month outcome with the modified Rankin Scale.

Results—

We recruited 80 patients (mean age, 72 years; median National Institutes of Health Stroke Scale, 12) of whom 73% received intravenous thrombolysis with alteplase. IL-1Ra significantly reduced plasma interleukin-6 (
P
<0.001) and plasma C-reactive protein (
P
<0.001). IL-1Ra was well tolerated with no safety concerns. Allocation to IL-1Ra was not associated with a favorable outcome on modified Rankin Scale: odds ratio (95% confidence interval)=0.67 (0.29–1.52),
P
=0.34. Exploratory mediation analysis suggested that IL-1Ra improved clinical outcome by reducing inflammation, but there was a statistically significant, alternative mechanism countering this benefit.

Conclusions—
IL-1Ra reduced plasma inflammatory markers which are known to be associated with worse clinical outcome in ischemic stroke. Subcutaneous IL-1Ra is safe and well tolerated. Further experimental studies are required to investigate efficacy and possible interactions of IL-1Ra with thrombolysis.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: ISRCTN74236229