bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of perinatal mortality in the first year of midwifery practice in New Zealand: analysis of a retrospective national cohort
Authors: Sadler Lynn C , McAra-Couper Judith , Pittam Deborah , Wise Michelle R , Thompson John M D 
Published: April 2018

ObjectivesTo determine whether there was an increased risk of perinatal mortality among mothers booked for care with community lead maternity carer (LMC) midwives in their first compared with later years of practice.DesignRetrospective cohort study using linked national maternity, mortality and workforce data; adjusted analysis using logistic regression.SettingNew Zealand.ParticipantsWomen under community LMC midwifery care birthing 2008–2014.Main outcome measuresPerinatal mortality (stillbirths and neonatal deaths of babies born from 20 weeks’ gestation to the 27th day of postnatal life), excluding terminations and deaths associated with congenital abnormalities.ResultsThere were 2045 deaths among 344 910 births booked with midwives.First year of practice midwives cared for women with higher risk of perinatal mortality, including Māori, Pacific, Indian, <20-year-old mothers, nullipara, smokers, women living in socioeconomic deprivation and with high body mass index, than midwives beyond first year of practice.There was a significant reduction in unadjusted odds of perinatal mortality among women under the care of midwives beyond the first year compared with those within the first year (OR 0.79, 95% CI 0.67 to 0.93) but no significant reduction in risk remained after adjusting for known risk factors, (OR 0.89, 95% CI 0.74 to 1.07).There was a significant increase in the adjusted odds of perinatal mortality among midwives booking a caseload of 15 or fewer mothers per year (1.34, 1.01 to 1.78) and 16 to 30 (1.25, 1.04 to 1.50) compared with midwives booking 51 to 80.ConclusionsFindings suggest that the first year of midwifery practice is not associated with an increased risk of perinatal mortality but there is evidence that early career midwives are caring for higher-risk women. These findings suggest inequity of access for higher-risk women to experienced midwives and highlight an opportunity to improve support for vulnerable women and new midwives.
Antithrombotic therapy in patients receiving saphenous vein coronary artery bypass grafts: a protocol for a systematic review and network meta-analysis
Authors: Solo Karla , Martin Janet , Lavi Shahar , Kabali Conrad , John-Baptiste Ava , Nevis Immaculate F , Choudhury Tawfiq , Mamas Mamas A , Bagur Rodrigo 
Published: April 2018

IntroductionThe current evidence for the prevention of saphenous vein graft failure (SVGF) after coronary artery bypass graft (CABG) surgery consists of direct head-to-head comparison of treatments (including placebo) in randomised-controlled trials (RCTs) and observational studies. However, summarising the evidence using traditional pairwise meta-analyses does not allow the inclusion of data from treatments that have not been compared head to head. Exclusion of such comparisons could impact the precision of pooled estimates in a meta-analysis. Hence, to address the challenge of whether aspirin alone or in addition to another antithrombotic agent is a more effective regimen to improve SVG patency, a network meta-analysis (NMA) is necessary. The objectives of this study are to synthesise the available evidence on antithrombotic agents (or their combination) and estimate the treatment effects among direct and indirect treatment comparisons on SVGF and major adverse cardiovascular events, and to generate a treatment ranking according to their efficacy and safety outcomes.MethodsWe will perform a systematic review of RCTs evaluating antithrombotic agents in patients undergoing CABG. A comprehensive English literature search will be conducted using electronic databases and grey literature resources to identify published and unpublished articles. Two individuals will independently and in duplicate screen potential studies, assess the eligibility of potential studies and extract data. Risk of bias and quality of evidence will also be evaluated independently and in duplicate. We will investigate the data to ensure its suitability for NMA, including adequacy of the outcome data and transitivity of treatment effects. We plan to estimate the pooled direct, indirect and the mixed effects for all antithrombotic agents using a NMA.Ethics and disseminationDue to the nature of the study, there are no ethical concerns nor informed consent required. We anticipate that this NMA will be the first to simultaneously assess the relative effects of multiple antithrombotic agents in patients undergoing CABG. The results of this NMA will inform clinicians, patients and guideline developers the best available evidence on comparative effects benefits of antithrombotic agents after CABG while considering the side effect profile to support future clinical decision-making. We will disseminate the results of our systematic review and NMA through a peer-reviewed journal.PROSPERO registration numberCRD42017065678.
Pathways of association between maternal haemoglobin and stillbirth: path-analysis of maternity data from two hospitals in England
Authors: Nair Manisha , Knight Marian , Robinson Susan , Nelson-Piercy Catherine , Stanworth Simon J , Churchill David 
Published: April 2018

ObjectiveTo investigate the mechanisms that link maternal haemoglobin concentration with stillbirth.DesignA retrospective cohort analysis using anonymised maternity data from two hospitals in England.SettingThe Royal Wolverhampton NHS Trust and Guy’s and St Thomas’ NHS Foundation Trust.Study population12 636 women with singleton pregnancies ≥24 weeks of gestation giving birth in the two hospitals during 2013–2015.MethodA conceptual framework of hypothesised pathways through birth weight-for-gestational age and maternal infection including potential confounders and other risk factors was developed and examined using path-analysis. Path-analysis was performed by fitting a set of regression equations using weighted least squares adjusted for mean and variance. Goodness-of-fit indices were estimated.Main outcome measuresCoefficient of association (β) for relationship between each parameter, and direct, indirect and total effects via the postulated pathways.ResultsThe path-model showed a significant adjusted indirect negative effect of maternal haemoglobin on stillbirth mediated via birth weight-for-gestational age (standardised estimate (SE)=−0.01; 95% CI=−0.01 to −0.001; P=0.028). The effect through maternal infection was not significant at P<0.05 (SE=0.001; 95% CI=−0.004 to 0.01; P=0.610). There was a residual direct negative effect of maternal haemoglobin on stillbirth (SE=−0.12; 95% CI −0.23 to −0.02; P=0.020) after accounting for the two pathways. Total indirect SE=−0.004; 95% CI −0.01 to 0.003; P=0.267; total direct and indirect SE=−0.13; 95% CI −0.23 to −0.02; P=0.016. The goodness-of-fit indices showed a good fit between the model and the data.ConclusionWhile some of the influence on risk of stillbirth acts through low birth weight-for-gestational age, the majority does not. Several new mechanisms have been suggested for how haemoglobin may be exerting its influence on the risk of stillbirth possibly involving genetic, epigenetic and/or alternative obstetric and nutritional pathologies, but much more research is needed.
A systematic review of interventions by healthcare professionals to improve management of non-communicable diseases and communicable diseases requiring long-term care in adults who are homeless
Authors: Hanlon Peter , Yeoman Lynsey , Gibson Lauren , Esiovwa Regina , Williamson Andrea E , Mair Frances S , Lowrie Richard 
Published: April 2018

ObjectiveIdentify, describe and appraise trials of interventions delivered by healthcare professionals to manage non-communicable diseases (NCDs) and communicable diseases that require long-term care or treatment (LT-CDs), excluding mental health and substance use disorders, in homeless adults.DesignSystematic review of randomised controlled trials (RCTs), non-RCTs and controlled before–after studies. Interventions characterised using Effective Practice and Organisation of Care (EPOC) taxonomy. Quality assessed using EPOC risk of bias criteria.Data sourcesDatabase searches (MEDLINE, Embase, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Cochrane Central Register of Controlled Trials), hand searching reference lists, citation searches, grey literature and contact with study authors.SettingCommunity.ParticipantsAdults (≥18 years) fulfilling European Typology of Homelessness criteria.InterventionDelivered by healthcare professionals managing NCD and LT-CDs.OutcomesPrimary outcome: unscheduled healthcare utilisation. Secondary outcomes: mortality, biological markers of disease control, adherence to treatment, engagement in care, patient satisfaction, knowledge, self-efficacy, quality of life and cost-effectiveness.Results11 studies were included (8 RCTs, 2 quasi-experimental and 1 feasibility) involving 9–520 participants (67%–94% male, median age 37–49 years). Ten from USA and one from UK. Studies included various NCDs (n=3); or focused on latent tuberculosis (n=4); HIV (n=2); hepatitis C (n=1) or type 2 diabetes (n=1). All interventions were complex with multiple components. Four described theories underpinning intervention. Three assessed unscheduled healthcare utilisation: none showed consistent reduction in hospitalisation or emergency department attendance. Six assessed adherence to specific treatments, of which four showed improved adherence to latent tuberculosis therapy. Three concerned education case management, all of which improved disease-specific knowledge. No improvements in biological markers of disease (two studies) and none assessed mortality.ConclusionsEvidence for management of NCD and LT-CDs in homeless adults is sparse. Educational case-management interventions may improve knowledge and medication adherence. Large trials of theory-based interventions are needed, assessing healthcare utilisation and outcomes as well as assessment of biological outcomes and cost-effectiveness.
Transdisciplinary research for impact: protocol for a realist evaluation of the relationship between transdisciplinary research collaboration and knowledge translation
Authors: Archibald Mandy M , Lawless Michael , Harvey Gillian , Kitson Alison L 
Published: April 2018

IntroductionTransdisciplinary teams are increasingly regarded as integral to conducting effective research. Similarly, knowledge translation is often seen as a solution to improving the relevance and benefits of health research. Yet, whether, how, for whom and under which circumstances transdisciplinary research influences knowledge translation is undertheorised, which limits its potential impact. The proposed research aims to identify the contexts and mechanisms by which transdisciplinary research contributes to developing shared understandings and behaviours of knowledge translation between team members.Methods and analysisUsing a longitudinal case-study design approach to realist evaluation, we outline a study protocol examining whether, how, if and for whom transdisciplinary collaboration can impact knowledge translation understandings and behaviours within a 5-year transdisciplinary Centre of Research Excellence. Data are being collected between February 2017 and December 2020 over four rounds of theory development, refinement and testing using interviews, observation, document review and visual elicitation as data sources.Ethics and disseminationThe Health Research Ethics Committee of the University of Adelaide approved this study. Findings will be communicated with team members at scheduled intervals throughout the study verbally and by means of creative reflective approaches (eg, arts elicitation, journalling). This research will be used to help support optimal team functioning by identifying strategies to support knowledge sharing and communication within and beyond the team to facilitate attainment of research objectives. Academic dissemination will occur through publication and presentations.
Rehabilitation following meniscal repair: a systematic review
Authors: Spang III Robert C , Nasr Michael C , Mohamadi Amin , DeAngelis Joseph P , Nazarian Ara , Ramappa Arun J 
Published: April 2018

ObjectiveTo review existing biomechanical and clinical evidence regarding postoperative weight-bearing and range of motion restrictions for patients following meniscal repair surgery.Methods and data sourcesFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we searched MEDLINE using following search strategy: ((((“Weight-Bearing/physiology”[Mesh]) OR “Range of Motion, Articular”[Mesh]) OR “Rehabilitation”[Mesh])) AND (“Menisci, Tibial”[Mesh]). Additional articles were derived from previous reviews. Eligible studies were published in English and reported a rehabilitation protocol following meniscal repair on human. We summarised rehabilitation protocols and patients’ outcome among original studies.ResultsSeventeen clinical studies were included in this systematic review. There was wide variation in rehabilitation protocols among clinical studies. Biomechanical evidence from small cadaveric studies suggests that higher degrees of knee flexion and weight-bearing may be safe following meniscal repair and may not compromise the repair. An accelerated protocol with immediate weight-bearing at tolerance and early motion to non-weight-bearing with immobilising up to 6 weeks postoperatively is reported. Accelerated rehabilitation protocols are not associated with higher failure rates following meniscal repair.ConclusionsThere is a lack of consensus regarding the optimal postoperative protocol following meniscal repair. Small clinical studies support rehabilitation protocols that allow early motion. Additional studies are needed to better clarify the interplay between tear type, repair method and optimal rehabilitation protocol.
Clinical outcome of Guillain-Barré syndrome after prolonged mechanical ventilation
Authors: van den Berg Bianca , Storm Eline F , Garssen Marcel J P , Blomkwist-Markens Patricia H , Jacobs Bart C 
Published: April 2018

BackgroundPatients with Guillain-Barré syndrome (GBS) may suffer from respiratory failure for months or longer. The aim of this study was to determine the frequency, clinical course and outcome of patients with GBS requiring prolonged mechanical ventilation (MV).MethodsProspectively collected data from 526 patients with GBS participating in previous trials were analysed to determine the frequency and duration of prolonged MV (longer than 2 months). In addition, a cross-sectional study was conducted in patients with GBS requiring MV to determine the clinical course and long-term outcome with the ability to walk unaided as primary endpoint.ResultsIn the cohort study, 145 of 526 patients with GBS (28%) required MV, including 33 (6%) patients with prolonged MV. Patients requiring prolonged MV had a lower Medical Research Council sum score and more frequent bulbar involvement and inexcitable nerves compared with shorter ventilated patients. At 6 months, 18% of patients with prolonged MV were able to walk unaided compared with 76% of patients requiring shorter MV (P<0.001). In the cross-sectional study, 63 patients requiring MV were included with a median follow-up of 11 years (range 2–44 years). Twenty-six (41%) of these patients needed prolonged MV (median 93 days, range 62–261). Fifteen (58%) of these patients were able to walk unaided at maximum follow-up and eight (31%) reached this endpoint more than 1 year after diagnosis.ConclusionsProlonged ventilation in GBS is associated with poor prognosis, yet patients requiring prolonged ventilation may show slow but persistent recovery for years and even reach the ability to walk and live independently.
Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials
Authors: Boers Anna M M , Jansen Ivo G H , Beenen Ludo F M , Devlin Thomas G , San Roman Luis , Heo Ji Hoe , Ribó Marc , Brown Scott , Almekhlafi Mohammed A , Liebeskind David S , Teitelbaum Jeanne , Lingsma Hester F , van Zwam Wim H , Cuadras Patricia , du Mesnil de Rochemont Richard , Beaumont Marine , Brown Martin M , Yoo Albert J , van Oostenbrugge Robert J , Menon Bijoy K , Donnan Geoffrey A , Mas Jean Louis , Roos Yvo B W E M , Oppenheim Catherine , van der Lugt Aad , Dowling Richard J , Hill Michael D , Davalos Antoni , Moulin Thierry , Agrinier Nelly , Demchuk Andrew M , Lopes Demetrius K , Aja Rodríguez Lucia , Dippel Diederik W J , Campbell Bruce C V , Mitchell Peter J , Al-Ajlan Fahad S , Jovin Tudor G , Madigan Jeremy , Albers Gregory W , Soize Sebastien , Guillemin Francis , Reddy Vivek K , Bracard Serge , Blasco Jordi , Muir Keith W , Nogueira Raul G , White Phil M , Goyal Mayank , Davis Stephen M , Marquering Henk A , Majoie Charles B L M 
Published: April 2018

BackgroundFollow-up infarct volume (FIV) has been recommended as an early indicator of treatment efficacy in patients with acute ischemic stroke. Questions remain about the optimal imaging approach for FIV measurement.ObjectiveTo examine the association of FIV with 90-day modified Rankin Scale (mRS) score and investigate its dependency on acquisition time and modality.MethodsData of seven trials were pooled. FIV was assessed on follow-up (12 hours to 2 weeks) CT or MRI. Infarct location was defined as laterality and involvement of the Alberta Stroke Program Early CT Score regions. Relative quality and strength of multivariable regression models of the association between FIV and functional outcome were assessed. Dependency of imaging modality and acquisition time (≤48 hours vs >48 hours) was evaluated.ResultsOf 1665 included patients, 83% were imaged with CT. Median FIV was 41 mL (IQR 14–120). A large FIV was associated with worse functional outcome (OR=0.88(95% CI 0.87 to 0.89) per 10 mL) in adjusted analysis. A model including FIV, location, and hemorrhage type best predicted mRS score. FIV of ≥133 mL was highly specific for unfavorable outcome. FIV was equally strongly associated with mRS score for assessment on CT and MRI, even though large differences in volume were present (48 mL (IQR 15–131) vs 22 mL (IQR 8–71), respectively). Associations of both early and late FIV assessments with outcome were similar in strength (ρ=0.60(95% CI 0.56 to 0.64) and ρ=0.55(95% CI 0.50 to 0.60), respectively).ConclusionsIn patients with an acute ischemic stroke due to a proximal intracranial occlusion of the anterior circulation, FIV is a strong independent predictor of functional outcome and can be assessed before 48 hours, oneither CT or MRI.
Taking the pressure off the spring: the case of rebounding smoking rates when antitobacco campaigns ceased
Authors: Dono Joanne , Bowden Jacqueline , Kim Susan , Miller Caroline 
Published: April 2018

Objective
Smoking rates have been compared with a spring, requiring continuous downward pressure against protobacco forces, rather than a screw, which once driven down stays down. Quality antitobacco mass media campaigns put downward pressure on smoking rates. The suspension of a major Australian state campaign provided a natural experiment to assess effects on smoking. Furthermore, we document the positive influence of robust monitoring and mature advocacy on the political decision to reinstate funding. We also document the misuse by industry of South Australian smoking data from the period between Australia’s implementation and subsequent evaluation of plain packaging.

Methods
A time series analysis was used to examine monthly smoking prevalence trends at each of four intervention points: (A) commencement of high-intensity mass media campaign (August 2010); (B) introduction of plain packaging (December 2012), (C) defunding of campaign (July 2013); and (D) reinstatement of moderate-intensity campaign (July 2014).

Findings
The suspension of the antitobacco campaign was disruptive to achieving smoking prevalence targets. There was an absence of a downward monthly smoking prevalence trajectory during the non-campaign period. Moreover, there was a significant decline in smoking prevalence during the period of high-intensity advertising, which continued after the introduction of plain packaging laws, and at the recommencement of campaign activity.

Conclusions
While the observed declines in smoking prevalence are likely due to a combination of interventions and cannot be attributed exclusively to antitobacco advertising, the results reinforce the political decision to reinstate the campaign and demonstrate the need for maintained investment to keep downward pressure on smoking rates.
Mitochondrial Ca
2+
Influx Contributes to Arrhythmic Risk in Nonischemic Cardiomyopathy
Authors: Xie An , Song Zhen , Liu Hong , Zhou Anyu , Shi Guangbin , Wang Qiongying , Gu Lianzhi , Liu Man , Xie Lai‐Hua , Qu Zhilin , Dudley Samuel C. 
Published: April 2018

Background

Heart failure (HF) is associated with increased arrhythmia risk and triggered activity. Abnormal Ca
2+
handling is thought to underlie triggered activity, and mitochondria participate in Ca
2+
homeostasis.

Methods and Results

A model of nonischemic HF was induced in C57BL/6 mice by hypertension. Computer simulations were performed using a mouse ventricular myocyte model of HF. Isoproterenol‐induced premature ventricular contractions and ventricular fibrillation were more prevalent in nonischemic HF mice than sham controls. Isolated myopathic myocytes showed decreased cytoplasmic Ca
2+
transients, increased mitochondrial Ca
2+
transients, and increased action potential duration at 90% repolarization. The alteration of action potential duration at 90% repolarization was consistent with in vivo corrected QT prolongation and could be explained by augmented L‐type Ca
2+
currents, increased Na
+
‐Ca
2+
exchange currents, and decreased total K
+
currents. Of myopathic ventricular myocytes, 66% showed early afterdepolarizations (EADs) compared with 17% of sham myocytes (
P
<0.05). Intracellular application of 1 μmol/L Ru360, a mitochondrial Ca
2+
uniporter–specific antagonist, could reduce mitochondrial Ca
2+
transients, decrease action potential duration at 90% repolarization, and ameliorate EADs. Furthermore, genetic knockdown of mitochondrial Ca
2+
uniporters inhibited mitochondrial Ca
2+
uptake, reduced Na
+
‐Ca
2+
exchange currents, decreased action potential duration at 90% repolarization, suppressed EADs, and reduced ventricular fibrillation in nonischemic HF mice. Computer simulations showed that EADs promoted by HF remodeling could be abolished by blocking either the mitochondrial Ca
2+
uniporter or the L‐type Ca
2+
current, consistent with the experimental observations.

Conclusions

Mitochondrial Ca
2+
handling plays an important role in EADs seen with nonischemic cardiomyopathy and may represent a therapeutic target to reduce arrhythmic risk in this condition.