bluuebunny/crossref_metadata_2025_split huggingface dataset:
Visual benefit versus visual gain: what is the effect of baseline covariants in the treatment arm relative to the control arm? A pooled analysis of ANCHOR and MARINA
Authors: Tufail Adnan , Margaron Philippe , Guerin Tadhg , Larsen Michael 
Published: September 2019

BackgroundThis study aimed to elucidate visual benefits of ranibizumab in patients with neovascular age-related macular degeneration (nAMD) compared with control arms and identify factors affecting response.MethodsThis is a post-hoc pooled analysis of two phase III studies, ANCHOR and MARINA, of ranibizumab for the treatment of nAMD. ANCHOR included 83 international sites. MARINA included 96 sites in the USA. Analysis included patients (control, n=323; ranibizumab, n=332) with nAMD and a baseline best-corrected visual acuity (BCVA) of ≥35–<85 letters.ResultsPatients receiving ranibizumab achieved an adjusted mean BCVA superiority of 18.9 and 21.2 letters over 12 and 24 months, respectively, compared with control. Ranibizumab treatment, higher baseline BCVA, lower age and smaller lesion size were positively associated with the ability to achieve BCVA >69 letters. Patients with the highest baseline BCVA had lowest BCVA gains. Ranibizumab treatment, lower baseline BCVA, lower age and smaller lesion size were identified as significant predictors of BCVA gain from baseline at month 24 (all p<0.0001). However, the difference in mean BCVA gains at month 24 between treatment and control groups was similar for all baseline BCVA subgroups (≥35–<55 letters, 21.9 letters; ≥55–<70 letters, 25.2 letters; ≥70–<85 letters, 19.3 letters).ConclusionsHigher baseline BCVA is associated with lower BCVA gains but a greater likelihood of achieving good final BCVA >69 letters due to smaller gains needed to achieve response. Visual benefits, including maintenance of visual acuity (VA), final VA achieved and relative gain compared with natural disease progression, should be considered when assessing treatment response in nAMD.
Impact of a pharmacist intervention at an intensive care rehabilitation clinic
Authors: MacTavish Pamela , Quasim Tara , Shaw Martin , Devine Helen , Daniel Malcolm , Kinsella John , Fenelon Carl , Kishore Rakesh , Iwashyna Theodore J , McPeake Joanne 
Published: September 2019

ObjectiveWhile disruptions in medications are common among patients who survive critical illness, there is limited information about specific medication-related problems among survivors of critical care. This study sought to determine the prevalence of specific medication-related problems detected in patients, seen after critical care discharge.DesignConsecutive patients attending an intensive care unit (ICU) follow-up programme were included in this single-centre service evaluation.SettingTertiary care regional centre in Scotland (UK).Participants47 patients reviewed after critical care discharge at an ICU follow-up programme.InterventionsPharmacists conducted a full medication review, including: medicines reconciliation, assessing the appropriateness of each prescribed medication, identification of any medication-related problems and checking adherence.MeasurementsMedication-related problems in patients following critical care discharge. Interventions and medication-related problems were systematically graded and risk factors were identified using an adapted version of the National Patient Safety Agency Risk Matrix.Main results69 medication-related problems were identified in 38 (81%) of the 47 patients. The most common documented problem was drug omission (29%). 64% of the medication-related problems identified were classified as either moderate or major. The number of pain medications prescribed at discharge from intensive care was predictive of medication-related problems (OR 2.02, 95% CI 1.14 to 4.26, p=0.03).ConclusionsMedication problems are common following critical care. Better communication of medication changes both to patients and their ongoing care providers may be beneficial following a critical care admission. In the absence of highly effective communication, a pharmacy intervention may contribute substantially to an intensive care rehabilitation or recovery programme.
Developing the role of midwives as ‘contraceptive champions’ to support early access to effective postnatal contraception for women
Authors: Gallimore Annette , Craig Alison , Cameron Sharon , Milne Dona , Lakha Fatim 
Published: September 2019

ObjectiveTo evaluate the acceptability of the new contraceptive champion role to the first hospital and community midwives in NHS Lothian trained in this role.DesignHealth service evaluation.PopulationHospital and community midwives trained as contraceptive champions, NHS Lothian, Scotland, UK.MethodsQualitative research: 1:1 semi-structured interviews (baseline and follow-up) with five contraceptive champions.Main outcome measureQualitative data on views of the new contraceptive champions on the first 6 months of the role.ResultsAll contraceptive champions stated increased confidence in their knowledge of postnatal contraception. They reported that women had not questioned the role of midwives in inserting contraceptive implants postnatally in hospital and at home. Midwife colleagues and hospital doctors had been supportive.ConclusionThe new role of contraceptive champion is reported by midwives to have been well received in its first year by women, the midwives themselves and their healthcare colleagues.
Value of monitoring negative emotional bias in primary care in England for personalised antidepressant treatment: a modelling study
Authors: Simon Judit , Harmer Catherine J , Kingslake Jonathan , Dawson Gerard R , Dourish Colin T , Goodwin Guy M 
Published: September 2019

BackgroundDepressed patients often focus on negative life events. Effective antidepressant therapy reverses this negative emotional bias (NEB) within 1 week. Clinical therapeutic effect usually requires 4–6 weeks. The value of implementing NEB monitoring for the personalisation of antidepressant therapy is unknown.ObjectiveTo estimate the likely outcome and cost consequences of adopting the P1vital Oxford Emotional Test Battery (ETB) for this purpose in routine primary care in England.MethodsA hybrid decision analytic model (decision tree plus Markov model) was developed to estimate the cost-effectiveness of ETB monitoring versus no ETB over 52 weeks using quality-adjusted life years (QALYs). Differences in depression severity, episode type and analytical perspectives were considered. Input data were derived from relevant guidelines, literature, national databases, expert opinion and the developers for the year 2013. Multiple sensitivity analyses addressed uncertainty.FindingsThe mean number of ETB tests is 2.162 per newly diagnosed patient and 2.166 per patient with recurrent depression. The incremental cost-effectiveness of ETB versus ‘no ETB’ is £4355/QALY from the healthcare perspective. From the broader societal perspective, ETB is more effective and cost saving.ConclusionsMonitoring negative emotional bias in primary care in England for personalised antidepressant treatment using ETB seems as an effective and cost-effective option under all considered scenarios (including worst case). Its main economic value seems to lie in reduced productivity loss as opposed to healthcare savings.Clinical implicationsThe test supports accelerated application of evidence-based depression care. Further optimisation and implementation in the ongoing European PReDicT trial is ongoing.
Quantifying and monitoring fibrosis in non-alcoholic fatty liver disease using dual-photon microscopy
Authors: Wang Yan , Wong Grace Lai-Hung , He Fang-Ping , Sun Jian , Chan Anthony Wing-Hung , Yang Jinlian , Shu Sally She-Ting , Liang Xieer , Tse Yee Kit , Fan Xiao-Tang , Hou Jinlin , Chan Henry Lik-Yuen , Wong Vincent Wai-Sun 
Published: September 2019

ObjectiveFibrosis stage is strongly associated with liver-related outcomes and is a key surrogate endpoint in drug trials for non-alcoholic steatohepatitis. Dual-photon microscopy allows automated quantification of fibrosis-related parameters (q-FPs) and may facilitate large-scale histological studies. We aim to validate the performance of q-FPs in a large histological cohort.Design344 patients with non-alcoholic fatty liver disease (NAFLD) underwent 428 liver biopsies (240 had paired transient elastography examination). Fibrosis stage was scored using the NASH Clinical Research Network system, and q-FPs were measured by dual-photon microscopy using unstained slides. Patients were randomly assigned to the training and validation cohorts to test the performance of individual q-FPs and derive optimal cut-offs.ResultsOver 25 q-FPs had area under the receiver-operating characteristics curves >0.90 for different fibrosis stages. Among them, the perimeter of collagen fibres and number of long collagen fibres had the highest accuracy. At the best cut-offs, the two q-FPs had 88.3%–96.2% sensitivity and 78.1%–91.1% specificity for different fibrosis stages in the validation cohort. q-FPs and histological scoring had nearly identical correlations with liver stiffness measurement, suggesting that the accuracy of q-FPs approached that of histological assessment. Among patients with paired liver biopsies, changes in the same q-FPs were associated with changes in fibrosis stage. At a median follow-up of 5.6 years, baseline q-FPs predicted liver-related events.Conclusionq-FP is highly accurate in the assessment of fibrosis in NAFLD patients. This automated platform can be used in future studies as objective and reliable evaluation of histological fibrosis.
International consensus conference on stool banking for faecal microbiota transplantation in clinical practice
Authors: Cammarota Giovanni , Ianiro Gianluca , Kelly Colleen R , Mullish Benjamin H , Allegretti Jessica R , Kassam Zain , Putignani Lorenza , Fischer Monika , Keller Josbert J , Costello Samuel Paul , Sokol Harry , Kump Patrizia , Satokari Reetta , Kahn Stacy A , Kao Dina , Arkkila Perttu , Kuijper Ed J , Vehreschild Maria J GT , Pintus Cristina , Lopetuso Loris , Masucci Luca , Scaldaferri Franco , Terveer E M , Nieuwdorp Max , López-Sanromán Antonio , Kupcinskas Juozas , Hart Ailsa , Tilg Herbert , Gasbarrini Antonio 
Published: September 2019

Although faecal microbiota transplantation (FMT) has a well-established role in the treatment of recurrentClostridioides difficileinfection (CDI), its widespread dissemination is limited by several obstacles, including lack of dedicated centres, difficulties with donor recruitment and complexities related to regulation and safety monitoring. Given the considerable burden of CDI on global healthcare systems, FMT should be widely available to most centres.Stool banks may guarantee reliable, timely and equitable access to FMT for patients and a traceable workflow that ensures safety and quality of procedures. In this consensus project, FMT experts from Europe, North America and Australia gathered and released statements on the following issues related to the stool banking: general principles, objectives and organisation of the stool bank; selection and screening of donors; collection, preparation and storage of faeces; services and clients; registries, monitoring of outcomes and ethical issues; and the evolving role of FMT in clinical practice,Consensus on each statement was achieved through a Delphi process and then in a plenary face-to-face meeting. For each key issue, the best available evidence was assessed, with the aim of providing guidance for the development of stool banks in order to promote accessibility to FMT in clinical practice.
Trends in school-age pedestrian and pedalcyclist crashes in the USA: 26 states, 2000–2014
Authors: Wheeler-Martin Katherine C , Curry Allison E , Metzger Kristina B , DiMaggio Charles J 
Published: September 2019

BackgroundDespite substantial progress, motor vehicle crashes remain a leading killer of US children. Previously, we documented significant positive impacts of Safe Routes to School interventions on school-age pedestrian and pedalcyclist crashes.ObjectiveTo expand our analysis of US trends in motor vehicle crashes involving school-age pedestrians and pedalcyclists, exploring heterogeneity by age and geography.MethodsWe obtained recent police-reported crash data from 26 states, calculating population rates of pedestrian and pedalcyclist crashes, crash fatality rates and pedestrian commuter-adjusted crash rates (‘pedestrian danger index’) for school-age children as compared with other age groups. We estimated national and statewide trends by age, injury status, day and travel hour using hierarchical linear modeling.ResultsSchool-age children accounted for nearly one in three pedestrians and one in two pedalcyclists struck in motor vehicle crashes from 2000 to 2014. Yet, the rates of these crashes declined 40% and 53%, respectively, over that time, on average, even as adult rates rose. Average crash rates varied geographically from 24.4 to 100.8 pedestrians and 15.6 to 56.7 pedalcyclists struck per 100 000 youth. Crash rates and fatality rates were inversely correlated.ConclusionsDespite recent increases in adult pedestrian crashes, school-age and younger pedestrians experienced ongoing declines in motor vehicle crashes through 2014 across the USA. There was no evidence of displacement in crash severity; declines were observed in all outcomes. The growing body of state crash data resources can present analytic challenges but also provides unique insights into national and local pedestrian crash trends for all crash outcomes.
Characteristics, behaviour and role of biomarkers in metastatic triple-negative breast cancer
Authors: Goto Yutaro , Thike Aye Aye , Ong Clara Chong Hui , Lim Johnathan Xiande , Md Nasir Nur Diyana , Li Huihua , Koh Valerie Cui Yun , Chen Xiao-Yang , Yeong Joe Poh Sheng , Sasano Hironobu , Tan Puay Hoon 
Published: September 2019

AimsCharacterising the factors responsible for metastatic triple-negative breast cancer (TNBC) is of significant importance, considering its high mortality rate and scant data. In this study, we evaluated the characteristics, clinical behaviour and role of biomarkers (androgen receptor (AR), oestrogen receptor beta (ERβ) and p53) in metastatic TNBC.MethodsImmunohistochemistry was performed for AR, ERβ and p53 on 125 primary TNBCs with known metastasis and correlated with clinicopathological parameters and outcome.ARandp53mRNA profiling was also carried out on 34 tumours from the same series and correlated with outcomes.ResultsIn this cohort, grade 3 and pT2 tumours predominated. The most common site for metastasis was the lung and pleura (41, 32.8%), and 15 (12.0%) cases demonstrated metastasis in multiple sites. Among these, 92% of tumours metastasised without preceding local recurrences. Five- and ten-year overall survival (OS) rates were 27% and 7.2%, while 5- and 10- year survival rates after metastasis were 9.6% and 3.2% respectively. AR, ERβ and p53 protein expressions were observed in 16%, 96.8% and 58.1% of tumours, respectively. A combinational phenotype of AR-ERβ+p53+ tumours was associated with poorer OS (HR 1.543, 95%CI 1.030 to 2.310, p=0.035). HigherARmRNA levels were significantly associated with favourable OS (p=0.015) and survival after metastasis (p=0.027).ConclusionsMetastatic TNBC harboured aggressive behaviour and displayed predominantly visceral metastasis with most metastatic events occurring without intervening local recurrences. A combinational phenotype of AR-ERβ+p53+ was significantly associated with poorer OS.
Cigarette smoking and oral microbiota in low-income and African-American populations
Authors: Yang Yaohua , Zheng Wei , Cai Qiu-Yin , Shrubsole Martha J , Pei Zhiheng , Brucker Robert , Steinwandel Mark D , Bordenstein Seth R , Li Zhigang , Blot William J , Shu Xiao-Ou , Long Jirong 
Published: September 2019

BackgroundCigarette smoking is a common risk factor for diseases and cancers. Oral microbiota is also associated with diseases and cancers. However, little is known about the impact of cigarette smoking on the oral microbiota, especially among ethnic minority populations.MethodsWe investigated cigarette smoking in relationship with the oral microbiota in a large population of predominately low-income and African-American participants. Mouth rinse samples were collected from 1616 participants within the Southern Community Cohort Study, including 592 current-smokers, 477 former-smokers and 547 never-smokers. Oral microbiota was profiled by 16S ribosomal RNA gene deep sequencing.ResultsCurrent-smokers showed a different overall microbial composition from former-smokers (p=6.62×10−7) and never-smokers (p=6.00×10−8). The two probiotic genera,BifidobacteriumandLactobacillus, were enriched among current-smokers when compared with never-smokers, with Bonferroni-corrected p values (PBonferroni) of 1.28×10−4 and 5.89×10−7, respectively. The phylumActinobacteriawas also enriched in current-smokers when compared with never-smokers, with a median relative abundance of 12.35% versus 9.36%, respectively, and with aPBonferroni=9.11×10−11. In contrast, the phylumProteobacteriawas depleted in current smokers (PBonferroni=5.57×10−13), with the relative abundance being almost three times that of never-smokers (7.22%) when compared with that of current-smokers (2.47%). Multiple taxa within these two phyla showed differences in abundance/prevalence between current-smokers and never-smokers atPBonferroni<0.05. The differences in the overall microbial composition and abundance/prevalence of most taxa were observed among both African-Americans and European-Americans. Meanwhile, such differences were not observed between former-smokers and never-smokers.ConclusionSmoking has strong impacts on oral microbial community, which was recovered after smoking cessation.
Relationship between childhood socioeconomic position and adverse childhood experiences (ACEs): a systematic review
Authors: Walsh David , McCartney Gerry , Smith Michael , Armour Gillian 
Published: September 2019

Background‘Adverse childhood experiences’ (ACEs) are associated with increased risk of negative outcomes in later life: ACEs have consequently become a policy priority in many countries. Despite ACEs being highly socially patterned, there has been very little discussion in the political discourse regarding the role of childhood socioeconomic position (SEP) in understanding and addressing them. The aim here was to undertake a systematic review of the literature on the relationship between childhood SEP and ACEs.MethodsMEDLINE, PsycINFO, ProQuest and Cochrane Library databases were searched. Inclusion criteria were: (1) measurement of SEP in childhood; (2) measurement of multiple ACEs; (3) ACEs were the outcome; and (4) statistical quantification of the relationship between childhood SEP and ACEs. Search terms included ACEs, SEP and synonyms; a second search additionally included ‘maltreatment’. Overall study quality/risk of bias was calculated using a modified version of the Hamilton Tool.ResultsIn the ACEs-based search, only 6 out of 2825 screened papers were eligible for qualitative synthesis. The second search (including maltreatment) increased numbers to: 4562 papers screened and 35 included for synthesis. Eighteen papers were deemed ‘high’ quality, five ‘medium’ and the rest ‘low’. Meaningful statistical associations were observed between childhood SEP and ACEs/maltreatment in the vast majority of studies, including all except one of those deemed to be high quality.ConclusionLower childhood SEP is associated with a greater risk of ACEs/maltreatment. With UK child poverty levels predicted to increase markedly, any policy approach that ignores the socioeconomic context to ACEs is therefore flawed.PROSPERO registration numberCRD42017064781.
Effect of mode of anesthesia on radiation exposure in patients undergoing endovascular recanalization of anterior circulation embolic stroke
Authors: Hemmerich Felix , Weyland Charlotte S , Schönenberger Silvia , Ringleb Peter A , Möhlenbruch Markus A , Bendszus Martin , Pfaff Johannes AR 
Published: September 2019

PurposeTo determine the effect of general anesthesia (GA) versus conscious sedation (CS) on radiation exposure (RE), procedure time (PT), and fluoroscopy time (FT) in patients receiving endovascular stroke treatment (EST) for large vessel occlusions (LVOs) in the anterior circulation.MethodsRetrospective analysis of an institutional review board−approved prospective stroke database of a comprehensive stroke center focusing on RE (as dose area product (DAP) in Gy.cm², median (IQR)), PT, and FT (in minutes, median (IQR)) in patients receiving EST for LVOs of the anterior circulation according to the mode of anesthesia during the intervention.ResultsOverall 544 patients were included in this analysis (GA: n=143, CS: n=401). For all included LVOs in the anterior circulation PTs (GA: 69 (44–100); CS: 59 (37–99); p=0.235), FTs (GA: 33 (20–56); CS: 29 (16–51); p=0.286), and RE (DAP, GA: 116.23 (73.47–173.41); CS: 110.5 (68.35–184.65); p=0.929) were comparable. In a subgroup analysis of occlusions of the middle cerebral artery (M1-segment; GA: n=80/544, 14.7%; CS: n=211/544, 38.8%), PTs (GA: 69 (37–101); CS: 54 (35 – 89); p=0.223), FTs (GA: 33 (19–55); CS: 25 (14–48); p=0.264), and RE (DAP, GA: 110.91 (66.8–169.12); CS: 103.8 (63.17–181); p=0.893) were similar.ConclusionIn this retrospective analysis, no effect of the mode of anesthesia on the radiation exposure during EST was detected as GA and CS showed comparable PT, FT, and DAPs.
Functional, inflammatory and interstitial impairment due to artificial stone dust ultrafine particles exposure
Authors: Ophir Noa , Bar Shai Amir , Korenstein Rafi , Kramer Mordechai R , Fireman Elizabeth 
Published: September 2019

ObjectiveArtificial stone dust (ASD) contains high levels of ultrafine particles (UFP <1 µm) which penetrate deeply into the lungs. This study aimed to demonstrate the direct effect of UFP in the lungs of ASD-exposed workers on functional inflammatory and imaging parameters.Methods68 workers with up to 20 years of ASD exposure at the workplace were recruited from small enterprises throughout the country and compared with 48 non-exposed individuals. Pulmonary function test (PFT), CT, induced sputum (IS) and cytokine analyses were performed by conventional methods. The CT scans were evaluated for features indicative of silicosis in three zones of each lung. UFP were quantitated by the NanoSight LM20 system (NanoSight, Salisbury) using the Nanoparticle Tracking Analysis. Interleukin (IL)-6, IL-8 and tumour necrosis factor alpha (TNF-α) levels were measured by Luminex (R&D Systems).ResultsThirty-four patients had CT scores between 0 and 42, and 29 of them were diagnosed with silicosis. Content of the UFP retrieved from IS supernatants correlated negatively with the PFT results (total lung capacity r=−0.347, p=0.011; forced expiratory volume in 1 s r=−0.299, p=0.046; diffusion lung carbon monoxide in a single breath r=−0.425, p=0.004) and with the CT score (r=0.378, p=0.023), and with the inflammatory cytokines IL-8 (r=0.336, p=0.024), IL-6 (r=0.294, p=0.065) and TNF-α (r=0.409, p=0.007). Raw material of ASD was left to sedimentate in water for <15 min, and 50% of the floating particles were UFP. A cut-off of 8×106 UFP/mL in IS samples had a sensitivity of 77% to predict pulmonary disease.ConclusionsThis is the first demonstration of an association between UFP-related decreased PFT results, worsening of CT findings and elevation of inflammatory cytokines, which may be attributed to high-dose inhalation of UFP of ASD at the workplace.