bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the impact of the NICE head injury guidelines on inpatient mortality from traumatic brain injury: an interrupted time series analysis
Authors: Marincowitz Carl , Lecky Fiona , Allgar Victoria , Sheldon Trevor 
Published: June 2019

ObjectiveTo evaluate the impact of National Institute for Health and Care Excellence (NICE) head injury guidelines on deaths and hospital admissions caused by traumatic brain injury (TBI).SettingAll hospitals in England between 1998 and 2017.ParticipantsPatients admitted to hospital or who died up to 30 days following hospital admission with International Classification of Diseases (ICD) coding indicating the reason for admission or death was TBI.InterventionAn interrupted time series analysis was conducted with intervention points when each of the three guidelines was introduced. Analysis was stratified by guideline recommendation specific age groups (0–15, 16–64 and 65+).Outcome measuresThe monthly population mortality and admission rates for TBI.Study designAn interrupted time series analysis using complete Office of National Statistics cause of death data linked to hospital episode statistics for inpatient admissions in England.ResultsThe monthly TBI mortality and admission rates in the 65+ age group increased from 0.5 to 1.5 and 10 to 30 per 100 000 population, respectively. The increasing mortality rate was unaffected by the introduction of any of the guidelines.The introduction of the second NICE head injury guideline was associated with a significant reduction in the monthly TBI mortality rate in the 16–64 age group (-0.005; 95% CI: −0.002 to −0.007).In the 0–15 age group the TBI mortality rate fell from around 0.05 to 0.01 per 100 000 population and this trend was unaffected by any guideline.ConclusionThe introduction of NICE head injury guidelines was associated with a reduced admitted TBI mortality rate after specialist care was recommended for severe TBI. The improvement was solely observed in patients aged 16–64 years.The cause of the observed increased admission and mortality rates in those 65+ and potential treatments for TBI in this age group require further investigation.
Improving the effectiveness of cancer multidisciplinary team meetings: analysis of a national survey of MDT members’ opinions about streamlining patient discussions
Authors: Hoinville Linda , Taylor Cath , Zasada Magda , Warner Ross , Pottle Emma , Green James 
Published: June 2019

BackgroundCancer is diagnosed and managed by multidisciplinary teams (MDTs) in the UK and worldwide, these teams meet regularly in MDT meetings (MDMs) to discuss individual patient treatment options. Rising cancer incidence and increasing case complexity have increased pressure on MDMs. Streamlining discussions has been suggested as a way to enhance efficiency and to ensure high-quality discussion of complex cases.MethodsSecondary analysis of quantitative and qualitative data from a national survey of 1220 MDT members regarding their views about streamlining MDM discussions.ResultsThe majority of participants agreed that streamlining discussions may be beneficial although variable interpretations of ‘streamlining’ were apparent. Agreement levels varied significantly by tumour type and occupational group. The main reason for opposing streamlining were concerns about the possible impact on the quality and safety of patient care. Participants suggested a range of alternative approaches for improving efficiency in MDMs in addition to the use of treatment protocols and pre-MDT meetings.ConclusionsThis work complements previous analyses in supporting the development of tumour-specific guidance for streamlining MDM discussions considering a range of approaches. The information provided about the variation in opinions between MDT for different tumour types will inform the development of these guidelines. The evidence for variation in opinions between those in different occupational groups and the reasons underlying these opinions will facilitate their implementation. The impact of any changes in MDM practices on the quality and safety of patient care requires evaluation.
Population-level diagnosis and care cascade for chlamydia in Australia
Authors: Gray Richard T , Callander Denton , Hocking Jane S , McGregor Skye , McManus Hamish , Dyda Amalie , Moreira Clarissa , Braat Sabine , Hengel Belinda , Ward James , Wilson David P , Donovan Basil , Kaldor John M , Guy Rebecca J 
Published: June 2019

ObjectivesKey strategies to control chlamydia include testing, treatment, partner management and re-testing. We developed a diagnosis and care cascade for chlamydia to highlight gaps in control strategies nationally and to inform efforts to optimise control programmes.MethodsThe Australian Chlamydia Cascade was organised into four steps: (1) annual number of new chlamydia infections (including re-infections); (2) annual number of chlamydia diagnoses; (3) annual number of diagnoses treated; (4) annual number of diagnoses followed by a re-test for chlamydia within 42–180 days of diagnosis. For 2016, we estimated the number of infections among young men and women aged 15–29 years in each of these steps using a combination of mathematical modelling, national notification data, sentinel surveillance data and previous research studies.ResultsAmong young people in Australia, there were an estimated 248 580 (range, 240 690–256 470) new chlamydia infections in 2016 (96 470 in women; 152 100 in men) of which 70 164 were diagnosed (28.2% overall: women 43.4%, men 18.6%). Of the chlamydia infections diagnosed, 65 490 (range, 59 640–70 160) were treated (93.3% across all populations), but only 11 330 (range, 7660–16 285) diagnoses were followed by a re-test within 42–180 days (17.3% overall: women 20.6%, men 12.5%) of diagnosis.ConclusionsThe greatest gaps in the Australian Chlamydia Cascade for young people were in the diagnosis and re-testing steps, with 72% of infections undiagnosed and 83% of those diagnosed not re-tested: both were especially low among men. Treatment rates were also lower than recommended by guidelines. Our cascade highlights the need for enhanced strategies to improve treatment and re-testing coverage such as short message service reminders, point-of-care and postal test kits.
US young adults’ perceived effectiveness of draft pictorial e-cigarette warning labels
Authors: Sontag Jennah , Manderski Michelle T Bover , Hammond David , Wackowski Olivia A 
Published: June 2019

SignificanceResearch shows that pictorial warning labels for cigarettes are more effective than text-only warnings, and preliminary work suggests that pictorial warnings could also be considered for electronic cigarettes (e-cigarettes). Pictorial warnings may be important for maximising their effectiveness among young people and enhancing the salience of the single nicotine addiction warning required for e-cigarettes to date in the USA. This study collected pilot data about the perceived effectiveness of draft e-cigarette pictorial warnings.MethodsParticipants were 876 young adults (ages 18–29) recruited through Amazon Mechanical Turk who completed an online e-cigarette survey in 2018. Participants viewed and ranked five versions of the same e-cigarette nicotine addiction warning message—four pictorial and one text-only–on their perceived noticeability, likelihood of capturing young people’s attention, memorability, relevance to the addiction warning text and overall effectiveness in warning people about e-cigarette risks. For each outcome, presentation of the five warning versions was randomised. Pictorials included symbolic images of risk and addiction, and of priority audiences for the warning (ie, young people).ResultsFor all outcomes, pictorial warnings were ranked higher than the text-only warning, and the warning using a yellow triangle caution icon was ranked highest for all outcomes. The text-only warning was ranked as the least likely to be effective for all four outcomes in which it was assessed. Trends were similar for current e-cigarette users and non-users.ConclusionsFuture research should assess perceptions and the appropriateness of pictorial imagery for e-cigarette warnings and test their efficacy against text-only warnings experimentally.
Comparison of geophysical and botanical results in simulated clandestine graves in rural and tropical environments in Colombia, South America
Authors: Molina Carlos Martin , Pringle Jamie K. 
Published: June 2019

Abstract

In most Latin American countries there are significant numbers of both missing people and forced disappearances,
c.
84 000 alone in Colombia. Successful detection of buried human remains by forensic search teams can be difficult in varying terrain and climates. This paper reports on the geophysical and botanical monitoring of simulated clandestine graves in two different environments over 24 months to establish optimal detection methods and equipment configurations. Twelve clandestine burials were simulated at three different burial depths (0.5, 0.8 and 1.2 m) commonly encountered in Latin America. The simulated targets were three pig carcasses, three human skeletons, three graves with burnt human beheaded skeletons and finally three empty graves to act as control. Geophysical detection methods included ground-penetrating radar, magnetic susceptibility, bulk ground conductivity and electrical resistivity. Geophysical results showed that apparent electrical resistivity was optimal to detect targets (85% success) in semi-rural areas and ground-penetrating radar was optimal to detect targets (92%) in tropical rainforest areas, followed by magnetic susceptibility and bulk ground conductivity. Botanical results evidenced variations in both study sites, which should be noted by forensic search investigators, with rapid growth of
Raphanus
in the tropical rainforest graves and
Malvaceae
and
Petiveria
in the rural study site. This paper shows the importance of conducting long-term controlled studies to assist forensic search teams with expected results and optimum equipment configuration(s).
Acquisition of a simple motor skill: task-dependent adaptation and long-term changes in the human soleus stretch reflex
Authors: Mrachacz-Kersting N. , Kersting U. G. , de Brito Silva P. , Makihara Y. , Arendt-Nielsen L. , Sinkjær T. , Thompson A. K. 
Published: June 2019

Changing the H reflex through operant conditioning leads to CNS multisite plasticity and can affect previously learned skills. To further understand the mechanisms of this plasticity, we operantly conditioned the initial component (M1) of the soleus stretch reflex. Unlike the H reflex, the stretch reflex is affected by fusimotor control, comprises several bursts of activity resulting from temporally dispersed afferent inputs, and may activate spinal motoneurons via several different spinal and supraspinal pathways. Neurologically normal participants completed 6 baseline sessions and 24 operant conditioning sessions in which they were encouraged to increase (M1up) or decrease (M1down) M1 size. Five of eight M1up participants significantly increased M1; the final M1 size of those five participants was 143 ± 15% (mean ± SE) of the baseline value. All eight M1down participants significantly decreased M1; their final M1 size was 62 ± 6% of baseline. Similar to the previous H-reflex conditioning studies, conditioned reflex change consisted of within-session task-dependent adaptation and across-session long-term change. Task-dependent adaptation was evident in conditioning session 1 with M1up and by session 4 with M1down. Long-term change was evident by session 10 with M1up and by session 16 with M1down. Task-dependent adaptation was greater with M1up than with the previous H-reflex upconditioning. This may reflect adaptive changes in muscle spindle sensitivity, which affects the stretch reflex but not the H reflex. Because the stretch reflex is related to motor function more directly than the H reflex, M1 conditioning may provide a valuable tool for exploring the functional impact of reflex conditioning and its potential therapeutic applications. NEW & NOTEWORTHY Since the activity of stretch reflex pathways contributes to locomotion, changing it through training may improve locomotor rehabilitation in people with CNS disorders. Here we show for the first time that people can change the size of the soleus spinal stretch reflex through operant conditioning. Conditioned stretch reflex change is the sum of task-dependent adaptation and long-term change, consistent with H-reflex conditioning yet different from it in the composition and amount of the two components.
Prospective Association of Serum and Dietary Magnesium with Colorectal Cancer Incidence
Authors: Polter Elizabeth J. , Onyeaghala Guillaume , Lutsey Pamela L. , Folsom Aaron R. , Joshu Corinne E. , Platz Elizabeth A. , Prizment Anna E. 
Published: June 2019

Abstract

Background:
Laboratory and epidemiologic research suggests a protective role of magnesium in colorectal cancer development. We estimated the associations of serum and dietary magnesium with colorectal cancer incidence in the Atherosclerosis Risk in Communities (ARIC) study.

Methods:
Serum magnesium concentration was measured in blood collected twice (1987–1989 and 1990–1992) and averaged. Dietary magnesium was assessed by food-frequency questionnaire administered twice (1987–1989 and 1993–1995) and averaged. For both dietary and serum magnesium, the averaged measures were categorized into quintiles for analysis. Analyses included 315 colorectal cancer cases among 13,009 participants for serum magnesium (followed for a median of 20.4 years), and 256 cases among 10,971 participants for dietary magnesium (followed for a median of 17.5 years). Cox proportional hazards regression was used to calculate multivariable-adjusted HRs and 95% confidence intervals (CI).

Results:
Multivariable-adjusted HRs (95% CI) of colorectal cancer for the highest four quintiles compared with the first quintile of serum magnesium were as follows: Q2: 0.70 (0.49–0.99); Q3: 0.68 (0.47–1.00); Q4: 0.87 (0.62–1.21); and Q5: 0.79 (0.57–1.11; Ptrend = 0.04). An inverse association was present in females (HR for Q5 vs. Q1: 0.59, 95% CI: 0.36–0.98, Ptrend = 0.01), but not males (HR for Q5 vs. Q1: 1.10, 95% CI: 0.67–1.79, Ptrend = 0.92; Pinteraction = 0.34). Dietary magnesium was not statistically significantly associated with colorectal cancer risk.

Conclusions:
Our study found a higher risk of colorectal cancer with lower serum magnesium among females, but not males.

Impact:
If our findings are confirmed, maintaining adequate serum magnesium levels may be important for colorectal cancer prevention.
Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes
Authors: Gregg L. Parker , Jain Nishank , Carmody Thomas , Minhajuddin Abu T. , Rush A. John , Trivedi Madhukar H. , Hedayati S. Susan 
Published: June 2019

<b><i>Background:</i></b> Fatigue, although common and associated with outcomes in dialysis-dependent chronic kidney disease (CKD), has not been studied in nondialysis chronic kidney disease (CKD-ND) patients. <b><i>Methods:</i></b> In this longitudinal cohort of 266 outpatients with CKD-ND stages 2–5, we measured self-reported fatigue on 3 scales-Quick Inventory of Depression Symptomatology-Self Report (QIDS-SR<sub>16</sub>), Beck Depression Inventory-I (BDI-I), and short form 12 health survey (SF-12) questionnaires and evaluated the prespecified composite of progression to dialysis initiation, death, or hospitalization after 12 months. Logistic and linear regression assessed characteristics associated with fatigue. Survival analysis measured associations of fatigue with outcomes. <b><i>Results:</i></b> Mean age was 64.4 ± 12.0 years, and mean estimated glomerular filtration rate (eGFR) was 31.6 ± 16.7 mL/min/1.73 m<sup>2</sup>. Fatigue was common, with 69.2% reporting fatigue on QIDS-SR<sub>16</sub> and 77.7% on BDI-I. Unemployment, comorbidities, use of antidepressant medications, and lower hemoglobin correlated with fatigue. There were 126 outcome events. Participants that reported any versus no fatigue on QIDS-SR<sub>16</sub> were more likely to reach the composite, hazard ratio (HR) 1.70 (95% CI 1.11–2.59), which persisted after adjusting for demographics, comorbidities, substance abuse, hemoglobin, albumin, eGFR, and calcium-phosphorus product, HR 1.63 (1.05–2.55). Fatigue severity by the SF-12 was also associated with outcomes independent of demographics, comorbidities, and substance abuse, HR per unit increase 1.18 (1.03–1.35). No association was observed with fatigue on the BDI-I. <b><i>Conclusion:</i></b> Fatigue affected about 2/3 of CKD-ND patients and associated with unemployment, comorbidities, antidepressant medication use, and anemia. Fatigue measured by the QIDS-SR<sub>16</sub> and SF-12 independently predicted outcomes in CKD patients. Eliciting the presence of fatigue may be a clinically significant prognostic assessment in CKD patients.
Caracterização e prospecção de grafita do Complexo Jequitinhonha
Authors: Brito Hermando , Piumbini Bruno Salaroli , Luz José Aurélio Medeiros da , Nascimento Eduardo Morato Dias 
Published: June 2019

O advento da tecnologia do grafeno vem destacando ainda mais a importância da grafita no panorama industrial moderno, tornando esse mineral estratégico. Os novos campos de sua utilização tornaram a explotação de grafita cristalina (flake) economicamente atrativa. Os gnaisses kinzigíticos do Complexo Jequitinhonha contêm mineralizações de grafita e têm sido objeto de estudos recentes. A compreensão do comportamento da mineralização por meio da caracterização permite o avanço nas técnicas para sua prospecção e exploração. Estabelecer a influência dos contaminantes do meio geológico e as características que esses conferem à mineralização é importante para a padronização dos procedimentos de prospecção e beneficiamento. Este estudo permitiu determinar o padrão resistivo/condutivo da mineralização em função de seus contaminantes, estabelecendo as características inerentes à mineralização de grafita que permitem padronizar critérios de prospecção e posterior utilização industrial do minério.
Empagliflozin Improves Kidney Outcomes in Patients With or Without Heart Failure
Authors: Butler Javed , Zannad Faiez , Fitchett David , Zinman Bernard , Koitka-Weber Audrey , von Eynatten Maximilian , Zwiener Isabella , George Jyothis , Brueckmann Martina , Cheung Alfred K. , Wanner Christoph 
Published: June 2019

Background:
In EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) empagliflozin significantly reduced the risk of cardiovascular and kidney outcomes in patients with type 2 diabetes mellitus and established cardiovascular disease. Post hoc, we evaluated empagliflozin on kidney outcomes in patients with or without heart failure (HF).

Methods and Results:

Individuals were randomized to empagliflozin 10 mg, 25 mg, or placebo. Prespecified analyses by baseline HF status included risk of incident or worsening nephropathy and estimated glomerular filtration rate slope analyses. Cox proportional hazards models assessed consistency of treatment effect across subgroups. Safety evaluations included kidney-related adverse events. At baseline, 244 (10.5%) and 462 (9.9%) patients had HF in the placebo and empagliflozin groups, respectively. Overall, the incidence of kidney outcome events was numerically higher in patients with than without HF. In the HF group, empagliflozin reduced risk of incident or worsening nephropathy or cardiovascular death by 43% (hazard ratio, 0.57 [95% CI, 0.42–0.77]) and progression to macroalbuminuria by 50% (hazard ratio, 0.50 [0.33–0.75]). After an initial transient decrease, estimated glomerular filtration rate stabilized over time with empagliflozin but gradually declined with placebo. Kidney effects in patients with HF were consistent with those in the overall study population (all
P
values for interaction >0.05). Across groups, the incidence rate of kidney-related adverse events/100 patient-years was higher in patients with than without HF; however, overall rates were comparable between groups.

Conclusions:
These findings from EMPA-REG OUTCOME support the hypothesis that empagliflozin could reduce the risk of clinically relevant kidney events and may slow progression of chronic kidney disease in individuals with type 2 diabetes mellitus regardless of HF status.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01131676.
Rivaroxaban With or Without Aspirin in Patients With Heart Failure and Chronic Coronary or Peripheral Artery Disease
Authors: Branch Kelley R. , Probstfield Jeffrey L. , Eikelboom John W. , Bosch Jackie , Maggioni Aldo P. , Cheng Richard K. , Bhatt Deepak L. , Avezum Alvaro , Fox Keith A.A. , Connolly Stuart J. , Shestakovska Olga , Yusuf Salim 
Published: June 2019

Background:
Patients with chronic coronary artery disease or peripheral artery disease and history of heart failure (HF) are at high risk for major adverse cardiovascular events. We explored the effects of rivaroxaban with or without aspirin in these patients.

Methods:
The COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies) randomized 27 395 participants with chronic coronary artery disease or peripheral artery disease to rivaroxaban 2.5 mg twice daily plus aspirin 100 mg daily, rivaroxaban 5 mg twice daily alone, or aspirin 100 mg alone. Patients with New York Heart Association functional class III or IV HF or left ventricular ejection fraction (EF) <30% were excluded. The primary major adverse cardiovascular events outcome comprised cardiovascular death, stroke, or myocardial infarction, and the primary safety outcome was major bleeding using modified International Society of Thrombosis and Haemostasis criteria. Investigators recorded a history of HF and EF at baseline, if available. We examined the effects of rivaroxaban on major adverse cardiovascular events and major bleeding in patients with or without a history of HF and an EF <40% or ≥40% at baseline.

Results:

Of the 5902 participants (22%) with a history of HF, 4971 (84%) had EF recorded at baseline, and 12% had EF <40%. Rivaroxaban and aspirin had similar relative reduction in major adverse cardiovascular events compared with aspirin in participants with HF (5.5% versus 7.9%; hazard ratio [HR], 0.68; 95% CI, 0.53–0.86) and those without HF (3.8% versus 4.7%; HR, 0.79; 95% CI, 0.68–0.93;
P
for interaction 0.28) but larger absolute risk reduction in those with HF (HF absolute risk reduction 2.4%, number needed to treat=42; no HF absolute risk reduction 1.0%, number needed to treat=103). The primary major adverse cardiovascular events outcome was not statistically different between those with EF <40% (HR, 0.88; 95% CI, 0.55–1.42) and ≥40% (HR, 0.81; 95% CI, 0.67–0.98;
P
for interaction 0.36). The excess hazard for major bleeding was not different in participants with HF (2.5% versus 1.8%; HR, 1.36; 95% CI, 0.88–2.09) than in those without HF (3.3% versus 1.9%; HR, 1.79; 95% CI, 1.45–2.21;
P
for interaction 0.26). There were no significant differences in the primary outcomes with rivaroxaban alone.

Conclusions:
In patients with chronic coronary artery disease or peripheral artery disease and a history of mild or moderate HF, combination rivaroxaban and aspirin compared with aspirin alone produces similar relative but larger absolute benefits than in those without HF.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01776424.