bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using electronic health record data to establish a chronic kidney disease surveillance system in China: protocol for the China Kidney Disease Network (CK-NET)-Yinzhou Study
Authors: Wang Jinwei , Bao Beiyan , Shen Peng , Kong Guilan , Yang Yu , Sun Xiaoyu , Ding Guohui , Gao Bixia , Yang Chao , Zhao Minghui , Lin Hongbo , Zhang Luxia 
Published: August 2019

IntroductionChronic kidney disease (CKD) is an important public health problem worldwide. However, there are few active disease surveillance systems for it. The China Kidney Disease Network (CK-NET) was established as a comprehensive surveillance system for CKD using various data sources. As part of this, the proposed CK-NET-Yinzhou study aims to build a regional surveillance system in a developed coastal area in China to obtain detailed dynamic information about kidney disease and to improve the ability to manage the disease effectively.Methods and analysisYinzhou is a district of Ningbo city, Zhejiang province. The district has a population of more than 1 million. By 2016, 98% were registered in a regional health information system that started in 2009. This system includes administrative databases containing general demographic characteristics, health check information, inpatient and outpatient electronic medical records, health insurance information, disease surveillance and management information, and death certificates. We will use longitudinal individual electronic health record data to identify people with CKD by repeated laboratory measurements and diagnostic codes. We will also evaluate the associated risk factors, prognosis and disease management. An intelligent clinical decision support system (CDSS) will be developed based on clinical guidelines, domain expert knowledge and real-world data, and will be integrated into the hospital information system.Ethics and disseminationThe CK-NET-Yinzhou study has been reviewed and approved by the Peking University First Hospital Ethics Committee. Privacy of local residents registered with the health information system will be tightly protected through the study process. The findings of the study will be disseminated through peer-reviewed journal articles, posters and presentations in national and international scientific conferences, as well as among local practitioners through the CDSS.
Modern contraceptive use among sexually active women aged 15–19 years in North-Western Tanzania: results from the Adolescent 360 (A360) baseline survey
Authors: Nsanya Mussa Kelvin , Atchison Christina J , Bottomley Christian , Doyle Aoife Margaret , Kapiga Saidi H 
Published: August 2019

ObjectivesTo describe differences in modern contraceptive use among adolescent women aged 15–19 years according to their marital status and to determine factors associated with modern contraceptive use among sexually active women in this population.DesignCross-sectional analysis of Adolescent 360 evaluation baseline survey.SettingThe 15 urban and semiurban wards of Ilemela district, Mwanza region, North-Western Tanzania.ParticipantsAdolescent women aged 15–19 years who were living in the study site from August 2017 to February 2018 and who provided informed consent. Women were classified as married if they had a husband or were living as married. Unmarried women were classified as sexually active if they reported having sexual intercourse in the last 12 months.Outcome measurePrevalence of modern contraceptive among adolescent women aged 15–19 years.ResultsData were available for 3511 women aged 15–19 years, of which 201 (5.7%) were married and 744 (22.5%) were unmarried-sexually active. We found strong evidence of differences in use of modern contraceptive methods according to marital status of adolescent women. Determinants of modern contraception use among unmarried-sexually active women were increasing age, increasing level of education, being in education, hearing of modern contraception from interpersonal sources or in the media in the last 12 months, perceiving partner and/or friends support for contraceptive use, as well as higher knowledge and self efficacy for contraception.ConclusionsSexual and reproductive health programmes aiming to increase uptake of modern contraceptives in this population of adolescent women should consider the importance of girl’s education and social support for contraceptive use particularly among unmarried-sexually active women.
Semistructured interviews regarding patients’ perceptions of Choosing Wisely and shared decision-making: an Australian study
Authors: Allen Jacqueline , King Richard , Goergen Stacy K , Melder Angela , Neeman Naama , Hadley Annemarie , Hutchinson Alison M 
Published: August 2019

ObjectivesThis study aimed to examine how patients perceive shared decision-making regarding CT scan referral and use of the five Choosing Wisely questions with their general practitioner (GP).DesignThis is a qualitative exploratory study using semistructured interviews.SettingThis study was conducted in a large metropolitan public healthcare organisation in urban Australia.ParticipantsFollowing purposive sampling, 20 patients and 2 carers participated. Patient participants aged 18 years or older were eligible if they were attending the healthcare organisation for a CT scan and referred by their GP. Carers/family were eligible to participate when they were in the role of an unpaid carer and were aged 18 years or older. Participants were required to speak English sufficiently to provide informed consent. Participants with cognitive impairment were excluded.FindingsEighteen interviews were conducted with the patient only. Two interviews were conducted with the patient and the patient’s carer. Fourteen participants were female. Five themes resulted from the thematic analysis: (1) needing to know, (2) questioning doctors is not necessary, (3) discussing scans is not required, (4) uncertainty about questioning and (5) valuing the Choosing Wisely questions. Participants reported that they presented to their GP with a health problem that they needed to understand and address. Participants accepted their GPs decision to prescribe a CT scan to identify the nature of their problem. They reported ambivalence about engaging in shared decision-making with their doctor, although many participants reported valuing the Choosing Wisely questions.ConclusionsShared decision-making is an important principle underpinning Choosing Wisely. Practice implementation requires understanding patients’ motivations to engage in shared decision-making with a focus on attitudes, beliefs, knowledge and emotions. Systems-level support and education for healthcare practitioners in effective communication is important. However, this needs to emphasise communication with patients who have varying degrees of motivation to engage in shared decision-making and Choosing Wisely.
General practice physicians’ and nurses’ self-reported multidisciplinary end-of-life care: a systematic review
Authors: Senior Hugh , Grant Matthew , Rhee Joel J , Aubin Michèle , McVey Peta , Johnson Claire , Monterosso Leanne , Nwachukwu Harriet , Fallon-Ferguson Julia , Yates Patsy , Williams Briony , Mitchell Geoffrey 
Published: August 2019

BackgroundGeneral practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide end-of-life care (EoLC) as the population ages. To enhance primary palliative care (PC), the care they provide needs to be understood to inform best practice models of care.ObjectiveTo provide a comprehensive description of the self-reported role and performance of GPs and GPNs in (1) specific medical/nursing roles, (2) communication, (3) care co-ordination, (4) access and out-of-hours care, and (5) multidisciplinary care.MethodSystematic literature review. Data included papers (2000 to 2017) sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases.ResultsFrom 6209 journal articles, 29 reviewed papers reported the GPs’ and GPNs’ role in EoLC or PC practice. GPs report a central role in symptom management, treatment withdrawal, non-malignant disease management and terminal sedation. Information provision included breaking bad news, prognosis and place of death. Psychosocial concerns were often addressed. Quality of communication depended on GP–patient relationships and GP skills. Challenges were unrealistic patient and family expectations, family conflict and lack of advance care planning. GPs often delayed end-of-life discussions until 3 months before death. Home visits were common, but less so for urban, female and part-time GPs. GPs co-ordinated care with secondary care, but in some cases parallel care occurred. Trust in, and availability of, the GP was critical for shared care. There was minimal reference to GPNs’ roles.ConclusionsGPs play a critical role in palliative care. More work is required on the role of GPNs, case finding and models to promote shared care, home visits and out-of-hours services.
Sex differences in left ventricular remodelling, myocardial fibrosis and mortality after aortic valve replacement
Authors: Singh Anvesha , Musa Tarique Al , Treibel Thomas A , Vassiliou Vassiliou S , Captur Gabriella , Chin Calvin , Dobson Laura E , Pica Silvia , Loudon Margaret , Malley Tamir , Rigolli Marzia , Foley James Robert John , Bijsterveld Petra , Law Graham R , Dweck Marc Richard , Myerson Saul G , Prasad Sanjay K , Moon James C , Greenwood John P , McCann Gerry P 
Published: August 2019

ObjectivesTo investigate sex differences in left ventricular remodelling and outcome in patients undergoing surgical or transcatheter aortic valve replacement (SAVR/TAVR).MethodsIn this multicentre, observational, outcome study with imaging core-lab analysis, patients with severe aortic stenosis (AS) listed for intervention at one of six UK centres were prospectively recruited and underwent cardiovascular magnetic resonance imaging. The primary endpoint was all-cause mortality and secondary endpoint was cardiovascular mortality.Results674 patients (425 men, 249 women, age 75±14 years) were included: 399 SAVR, 275 TAVR. Women were older, had higher surgical risk scores and underwent TAVR more frequently (53% vs 33.6%, p<0.001). More men had bicuspid aortic valves (BAVs) (26.7% vs 14.9%, p<0.001) and demonstrated more advanced remodelling than women. During a median follow-up of 3.6 years, 145 (21.5%) patients died, with no significant sex difference in all-cause mortality (23.3% vs 20.5%, p=0.114), but higher cardiovascular mortality in women (13.7% vs 8.5%, p=0.012). There were no significant sex-related differences in outcome in the SAVR or TAVR subgroups, or after excluding those with BAV. Factors independently associated with all-cause mortality were age, left ventricular ejection fraction (LVEF), BAV (better) and myocardial fibrosis detected with late gadolinium enhancement (LGE) in men, and age, LVEF and LGE in women. Age and LGE were independently associated with cardiovascular mortality in both sexes.ConclusionsMen demonstrate more advanced remodelling in response to a similar severity of AS. The higher cardiovascular mortality observed in women following AVR is accounted for by women having less BAV and higher risk scores resulting in more TAVR. LGE is associated with a worse prognosis in both sexes.
A cohort study comparing rate of repeat testing for sexually transmitted and blood-borne infections between clients of an internet-based testing programme and of sexually transmitted infection clinics in Vancouver, Canada
Authors: Gilbert Mark , Salway Travis , Haag Devon , Elliot Elizabeth , Fairley Christopher , Krajden Mel , Grennan Troy , Shoveller Jean , Ogilvie Gina Suzanne 
Published: August 2019

ObjectivesInternet-based sexually transmitted and blood-borne infection (STBBI) testing services reduce testing barriers through bypassing face-to-face clinical encounters, potentially enabling clients at ongoing sexual risk to test more frequently. To our knowledge, this hypothesis has not been previously tested. We compared the frequency of repeat testing between Vancouver-based clients ofGetCheckedOnline(GCO)—an internet-based STBBI testing service in British Columbia, Canada—and clients of three sexually transmitted infection (STI) clinics in Vancouver for 29 months after GCO launched.MethodsAn administrative data cohort (n=19 497) was assembled using GCO, clinical and laboratory databases. We included all individuals who tested for HIV, gonorrhoea/chlamydia, syphilis or hepatitis C at three STI clinics or using GCO, between September 2014 and February 2017. The rate of repeat testing (>30 days after first episode) was compared between clients who used GCO at least once and those who tested only in STI clinics. Poisson regression was used to generate relative rate (RR) for repeat testing, with adjustment for age, gender/sexual orientation, risk factors (eg, history of STI diagnosis) and rate of testing before GCO launched.Results1093 GCO clients were identified, of whom 434 (40%) had repeat test episodes; 8200/18 404 (45%) of clinic clients tested more than once. During the 29-month analysis period, GCO clients repeat tested 1.87 times per person-year, whereas clinic clients repeat tested 1.53 times per person-year, resulting in a crude RR of 1.22 (95% CI: 1.14 to 1.31). Adjustment for covariates increased the RR to 1.26 (95% CI: 1.15 to 1.37).ConclusionsIn this cohort, individuals using internet-based STBBI testing had a rate of repeat testing 22% greater than clinic-based clients. This effect was increased after adjusting for characteristics associated with higher test frequency. The online interface of GCO may facilitate more frequent testing and may therefore contribute to earlier STBBI diagnosis.
TAS6417/CLN-081 Is a Pan-Mutation–Selective EGFR Tyrosine Kinase Inhibitor with a Broad Spectrum of Preclinical Activity against Clinically Relevant EGFR Mutations
Authors: Udagawa Hibiki , Hasako Shinichi , Ohashi Akihiro , Fujioka Rumi , Hakozaki Yumi , Shibuya Mikiko , Abe Naomi , Komori Toshiharu , Haruma Tomonori , Terasaka Miki , Fujita Ryoto , Hashimoto Akihiro , Funabashi Kaoru , Yasuda Hiroyuki , Miyadera Kazutaka , Goto Koichi , Costa Daniel B. , Kobayashi Susumu S. 
Published: August 2019

Abstract

Despite the worldwide approval of three generations of EGFR tyrosine kinase inhibitors (TKI) for advanced non–small cell lung cancers with EGFR mutations, no TKI with a broad spectrum of activity against all clinically relevant mutations is currently available. In this study, we sought to evaluate a covalent mutation-specific EGFR TKI, TAS6417 (also named CLN-081), with the broadest level of activity against EGFR mutations with a prevalence of ≥1%. Lung cancer and genetically engineered cell lines, as well as murine xenograft models were used to evaluate the efficacy of TAS6417 and other approved/in-development EGFR TKIs (erlotinib, afatinib, osimertinib, and poziotinib). We demonstrate that TAS6417 is a robust inhibitor against the most common EGFR mutations (exon 19 deletions and L858R) and the most potent against cells harboring EGFR-T790M (first/second-generation TKI resistance mutation). In addition, TAS6417 has activity in cells driven by less common EGFR-G719X, L861Q, and S768I mutations. For recalcitrant EGFR exon 20 insertion mutations, selectivity indexes (wild-type EGFR/mutant EGFR ratio of inhibition) favored TAS6417 in comparison with poziotinib and osimertinib, indicating a wider therapeutic window. Taken together, we demonstrate that TAS6417 is a potent EGFR TKI with a broad spectrum of activity and a wider therapeutic window than most approved/in-development generations of EGFR inhibitors.

Implications:
TAS6417/CLN-081 is a potent EGFR TKI with a wide therapeutic window and may be effective in lung cancer patients with clinically relevant EGFR mutations.
A new species of Gnomidolon Thomson, 1864 and taxonomic and geographical notes on Hexoplonini (Coleoptera, Cerambycidae) from Colombia
Authors: García Kimberly 
Published: August 2019

A new species of Gnomidolon from Colombia is described and illustrated: Gnomidolon franciscoi sp. nov.; and the previous key for the genus is modified to include the new species. The male of Gnomidolon hamatum Linsley, 1935 is described and illustrated for the first time. Additionally, a chromatic variation in some species of Hexoplonini from Colombia is reported and the geographical distribution of four species is expanded.
Simultaneous Determination of Biliary and Intestinal Cholesterol Secretion Reveals That CETP (Cholesteryl Ester Transfer Protein) Alters Elimination Route in Mice
Authors: Li Jianing , Pijut Sonja S. , Wang Yuhuan , Ji Ailing , Kaur Rupinder , Temel Ryan E. , van der Westhuyzen Deneys R. , Graf Gregory A. 
Published: August 2019

Objective:
Determine the impact of CETP (cholesteryl ester transfer protein) on the route of cholesterol elimination in mice.

Approach and Results:
We adapted our protocol for biliary cholesterol secretion with published methods for measuring transintestinal cholesterol elimination. Bile was diverted and biliary lipid secretion maintained by infusion of bile acid. The proximal small bowel was perfused with bile acid micelles. In high-fat, high-cholesterol–fed mice, the presence of a CETP transgene increased biliary cholesterol secretion at the expense of transintestinal cholesterol elimination. The increase in biliary cholesterol secretion was not associated with increases in hepatic SR-BI (scavenger receptor BI) or ABCG5 (ATP-binding cassette G5) ABCG8. The decline in intestinal cholesterol secretion was associated with an increase in intestinal Niemann-Pick disease, type C1, gene-like 1 mRNA. Finally, we followed the delivery of HDL (high-density lipoprotein) or LDL (low-density lipoprotein) cholesteryl esters (CE) from plasma to bile and intestinal perfusates. HDL-CE favored the biliary pathway. Following high-fat feeding, the presence of CETP directed HDL-CE away from the bile and towards the intestine. The presence of CETP increased LDL-CE delivery to bile, whereas the appearance of LDL-CE in intestinal perfusate was near the lower limit of detection.

Conclusions:
Biliary and intestinal cholesterol secretion can be simultaneously measured in mice and used as a model to examine factors that alter cholesterol elimination. Plasma factors, such as CETP, alter the route of cholesterol elimination from the body. Intestinal and biliary cholesterol secretion rates are independent of transhepatic or transintestinal delivery of HDL-CE, whereas LDL-CE was eliminated almost exclusively in the hepatobiliary pathway.
Association of Cognitive Impairment With Treatment and Outcomes in Older Myocardial Infarction Patients: A Report From the NCDR Chest Pain–MI Registry
Authors: Bagai Akshay , Chen Anita Y. , Udell Jacob A. , Dodson John A. , McManus David D. , Maurer Mathew S. , Enriquez Jonathan R. , Hochman Judith , Goyal Abhinav , Henry Timothy D. , Gulati Martha , Garratt Kirk N. , Roe Matthew T. , Alexander Karen P. 
Published: August 2019

Background

Little is known regarding use of cardiac therapies and clinical outcomes among older myocardial infarction (
MI
) patients with cognitive impairment.

Methods and Results

Patients ≥65 years old with MI in the
NCDR
(National Cardiovascular Data Registry) Chest Pain–
MI
Registry between January 2015 and December 2016 were categorized by presence and degree of chart‐documented cognitive impairment. We evaluated whether cognitive impairment was associated with all‐cause in‐hospital mortality after adjusting for known prognosticators. Among 43 812 ST‐segment–elevation myocardial infarction (STEMI) patients, 3.9% had mild and 2.0% had moderate/severe cognitive impairment; among 90 904 non–ST‐segment–elevation myocardial infarction (NSTEMI patients, 5.7% had mild and 2.6% had moderate/severe cognitive impairment. A statistically significant but numerically small difference in the use of primary percutaneous coronary intervention was observed between patients with STEMI with and without cognitive impairment (none, 92.1% versus mild, 92.8% versus moderate/severe, 90.4%;
P
=0.03); use of fibrinolysis was lower among patients with cognitive impairment (none, 40.9% versus mild, 27.4% versus moderate/severe, 24.2%;
P
<0.001). Compared with
NSTEMI
patients without cognitive impairment, rates of angiography, percutaneous coronary intervention, and coronary artery bypass grafting were significantly lower among patients with NSTEMI with mild (41%, 45%, and 70% lower, respectively) and moderate/severe cognitive impairment (71%, 74%, and 93% lower, respectively). After adjustment, compared with no cognitive impairment, presence of moderate/severe (
STEMI
: odds ratio, 2.2, 95%
CI
, 1.8–2.7;
NSTEMI
: odds ratio, 1.7, 95%
CI
, 1.4–2.0) and mild cognitive impairment (
STEMI
:
OR
, 1.3, 95%
CI
, 1.1–1.5;
NSTEMI
: odds ratio, 1.3, 95%
CI
, 1.2–1.5) was associated with higher in‐hospital mortality.

Conclusions
Patients with NSTEMI with cognitive impairment are substantially less likely to receive invasive cardiac care, while patients with STEMI with cognitive impairment receive similar primary percutaneous coronary intervention but less fibrinolysis. Presence and degree of cognitive impairment was independently associated with increased in‐hospital mortality. Approaching clinical decision making for older patients with MI with cognitive impairment requires further study.
Blood Pressure Drop and Penumbral Tissue Loss in Nonrecanalized Emergent Large Vessel Occlusion
Authors: Jeong Han-Gil , Kim Beom Joon , Kim Hyeran , Jung Cheolkyu , Han Moon-Ku , Liebeskind David S. , Bae Hee-Joon 
Published: August 2019

Background and Purpose—
For patients with emergent large vessel occlusion who may not benefit from timely recanalization treatment, maintaining adequate cerebral perfusion to prevent penumbral tissue loss is a key therapeutic strategy. Cerebral perfusion should be proportional to systemic blood pressure (BP) due to the loss of autoregulation properties in ischemic brain tissue. We hypothesized that acute fluctuations in BP would lead to aggravated penumbral tissue loss in persistent large vessel occlusion.

Methods—

A total of 80 patients with persistent large vessel occlusion of internal carotid artery or middle cerebral artery admitted within 24 hours after onset, and with a baseline, National Institutes of Health Stroke Scale score ≥4-point were included. Baseline and follow-up (median 88 hours) magnetic resonance images were analyzed, and penumbra was defined as the T
max
>6 s region excluding baseline infarction. The hypoperfusion intensity ratio (T
max
>10 s/T
max
>6 s) was calculated within the penumbra. Penumbral tissue loss (%) was defined as the proportion of follow-up infarct in the penumbra. With serial BP measurements in the first 24 hours (median 29, interquartile range 26–35), BP and BP variability parameters, including BP
dropmax
(change from local maxima to minima), were calculated and compared. Generalized linear models were applied to examine the association between BP parameters and the penumbral tissue loss.

Results—

The median penumbral volume was 79.3 mL (interquartile range, 38.2–129.6) and median penumbral tissue loss was 36.7% (interquartile range, 12.0–56.1). In a multivariable analysis, systolic BP (SBP) SBP
dropmax
(β±SE of fourth quartile, 17.82±6.58;
P
value, 0.01) and diastolic BP (DBP) DBP
dropmax
(β±SE of fourth quartile, 14.04±6.38;
P
value, 0.01) were associated with increasing penumbral tissue loss, independently of age, baseline infarction and hypoperfusion intensity ratio. DBP
incmax
, SBP
max
, DBP
max
, SBP
max-min
, DBP
max-min
, and most of the DBP variability indices were associated with penumbral tissue loss.

Conclusions—
BP fluctuations, even a brief and drastic BP drop in the first 24 hours, significantly contributed to penumbral tissue loss irrespective of baseline hypoperfusion.