bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016
Authors: Tammes Peter , Payne Rupert A , Salisbury Chris , Chalder Melanie , Purdy Sarah , Morris Richard W 
Published: September 2019

ObjectiveTo investigate whether the introduction of a named general practitioner (GP, family physician) improved patients’ healthcare for patients aged 75 and over in England.SettingRandom sample of 27 500 patients aged 65 to 84 in 2012 within 139 English practices from the Clinical Practice Research Datalink linked with Hospital Episode Statistics.DesignProspective cohort approach, measuring patients’ GP consultations and emergency hospital admissions 2 years before/after the intervention. Patients were grouped in (i) aged over 74 and (ii) younger than 75 in both periods in order to compare who were or were not subject to the intervention. Adjusted associations between the named GP scheme, continuity of care and emergency hospital admission were examined using multilevel modelling.InterventionNational Health Service policy to introduce a named accountable GP for patients aged over 74 in April 2014.Main outcome measures(A) Continuity of care index-score, (B) risk of emergency hospital admissions, (C) number of emergency hospital admissions.ResultsThe intervention was associated with a decrease in continuity index-scores of −0.024 (95% CI −0.030 to −0.018, p<0.001); there were no differences in the decrease between the two age groups (−0.005, 95% CI −0.014 to 0.005). In the pre-intervention and post-intervention periods, respectively, 15.4% and 19.4% patients had an emergency admission. The probability of an emergency hospital admission increased after the intervention (OR 1.156, 95% CI 1.064 to 1.257, p=0.001); this increase was bigger for patients over 74 (relative OR 1.191, 95% CI 1.066 to 1.330, p=0.002). The average number of emergency hospital admissions increased after the intervention (rate ratio (RR) 1.178, 95% CI 1.103 to 1.259, p<0.001); this increase was greater for patients over 74 (relative RR 1.143, 95% CI 1.052 to 1.242, p=0.001).ConclusionThe introduction of the named GP scheme was not associated with improvements in either continuity of care or rates of unplanned hospitalisation.
Critical appraisal of clinical practice guidelines for the diagnosis and treatment of stress urinary incontinence using AGREE II instrument: a systematic review protocol
Authors: Yang Xiaowei , Zhang AiXia , Tan Yanquan , Zhang Zhengbao , Zhang Jie 
Published: September 2019

IntroductionStress urinary incontinence is a major health problem, and several clinical guidelines have been formulated and released regarding this in different countries. However, the recommendations in these guidelines formulated by different organisations and countries are inconsistent. This review aims to conduct a critical appraisal of clinical practice guidelines for the diagnosis and treatment of stress urinary incontinence.Methods and analysisWe will conduct a comprehensive search in the following databases: PubMed, Embase, Medline, Cochrane Library, three Chinese databases and six guideline databases. The databases will be searched from January 2003, and the comprehensive search will be done again to include all the qualified guidelines before making conclusions. The quality of clinical practice guidelines will be assessed by three appraisers using the Appraisal of Guidelines Research and Evaluation II instrument, and this will be scored. The recommendation available in the guidance will also be summarised in different domains including the diagnosis standard, recommended examination and questionnaire for assessment, conservative treatment and surgical treatment.Ethics and disseminationThis review will be disseminated through peer-reviewed publications. The results will help inform the health practitioners about the recommendations in clinical practice guidelines.PROSPERO registration numberCRD42018115743.
Clinicopathological risk factors for gastric cancer: a retrospective cohort study in China
Authors: Hu Kongwang , Wang Shuaili , Wang Zikun , Li Longlong , Huang Zhiguo , Yu Weiqiang , Chen Zhongxue , Wu Qing-Fa 
Published: September 2019

ObjectiveTo examine the potential clinicopathological factors affecting the prognosis of patients with gastric cancer after surgical treatment in China.MethodsBetween 1 January 2001 and 31 December 2012, a total of 716 patients aged 22–84 years with gastric cancer were enrolled in the study. Survival analysis techniques including log rank test and Cox proportional hazard regression model were applied to evaluate the prognostic significance of clinicopathological characteristics in terms of survival time.ResultsOf the 24 demographic and pathological variables collected in the data, 16 prognostic factors of gastric cancer were found to have statistically significant influences on survival time from the unadjusted analyses. The adjusted analysis furtherly revealed that age, age square, lymph node metastasis rate group, tumour size group, surgical type II, number of cancer nodules, invasion depth group and the interaction between surgical type II and tumour size group were important prognosis and clinicopathological factors for gastric cancer in Chinese.ConclusionOur study with relatively large sample size and many potential risk factors enable us to identify independent risk factors associated with the prognosis of gastric cancer. Findings from the current study can be used to assist clinical decision-making, and serve as a benchmark for the planning of future prognosis and therapy for patients with gastric carcinoma.
Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK
Authors: García Rodríguez Luis Alberto , Martín-Pérez Mar , Vora Pareen , Roberts Luke , Balabanova Yanina , Brobert Gunnar , Fatoba Samuel , Suzart-Woischnik Kiliana , Schaefer Bernhard , Ruigomez Ana 
Published: September 2019

ObjectiveTo evaluate the appropriateness of the initial prescribed daily dose of non-vitamin K antagonist oral anticoagulants (NOACs) according to label in patients with non-valvular atrial fibrillation (NVAF) in the UK.DesignPopulation-based cross-sectional study.SettingUK primary care.Population30 467 patients with NVAF and a first prescription for apixaban, dabigatran or rivaroxaban between January 2011 and December 2016.Main outcome measuresPercentage of patients prescribed a NOAC dose according to the European Union (EU) labels (appropriately dosed), and not according to the EU labels (inappropriately dosed—including both underdosed and overdosed patients); percentage of patients prescribed an initial NOAC dose according to renal function status.ResultsA total of 15 252 (50.1%) patients started NOAC therapy on rivaroxaban, 10 834 (35.6%) on apixaban and 4381 (14.4%) on dabigatran. Among patients starting NOAC therapy on rivaroxaban, 17.3% were eligible to receive a reduced dose compared with 12.8% of patients starting on apixaban and 53.8% of patients starting on dabigatran. The majority of patients were prescribed an appropriate dose according to the EU labels: apixaban 74.9 %, dabigatran, 74.4%; rivaroxaban, 84.2%. Underdosing occurred in 21.6% (apixaban), 8.7% (dabigatran), 9.1% (rivaroxaban). Overdosing was more frequent for dabigatran (16.9%) than for rivaroxaban (6.6%) or apixaban (3.5%). There was a trend towards dose reduction with increasing renal impairment. Among patients with severe renal impairment, the majority received a reduced dose NOAC: apixaban, 91.1%, dabigatran, 80.0%, rivaroxaban, 83.0%.ConclusionBetween 2011 and 2016, the majority of patients starting NOAC therapy in UK primary care were prescribed a daily dose in line with the approved EU drug label. Underdosing was more than twice as common among patients starting on apixaban than those starting on dabigatran or rivaroxaban. Research into the patient characteristics that may influence inappropriate underdosing of NOACs in UK primary care is warranted.
Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan
Authors: Huang Yi-Chia , Sun Hsin-Yun , Chuang Yu-Chung , Huang Yu-Shan , Lin Kuan-Yin , Huang Sung-Hsi , Chen Guan-Jhou , Luo Yu-Zheng , Wu Pei-Ying , Liu Wen-Chun , Hung Chien-Ching , Chang Shan-Chwen 
Published: September 2019

ObjectivesRapid initiation of antiretroviral therapy (ART) engenders faster viral suppression but with suboptimal rates of durable viral suppression and engagement in care, as reported by clinical trials in resource-limited settings. Real-world experience with rapid ART initiation remains limited in resource-rich settings.DesignRetrospective cohort study.SettingA tertiary hospital in metropolitan Taipei, Taiwan.ParticipantsWe included 631 patients newly diagnosed as having HIV infection between March 2014 and July 2018.Main outcome measuresRapid ART initiation was defined as starting ART within 7 days after HIV diagnosis confirmation. HIV diagnosis, ART initiation and viral suppression dates and clinical outcome data were collected by reviewing medical records. The rates of loss to follow-up (LTFU), engagement in care and virological rebound at 12 months were compared between patients with rapid ART initiation and those with standard initiation.ResultsRapid ART initiation increased from 33.8% in 2014 to 68.3% in 2017, and the median interval between HIV diagnosis and viral suppression (HIV RNA load <200 copies/mL) decreased from 138 to 47 days. Patients with rapid ART initiation had a significantly higher rate of engagement in care at 12 months than did those with standard initiation (88.3% vs 79.0%; p=0.002). Patients aged <30 years had a higher risk of LTFU (HR: 2.19; 95% CI 1.20 to 3.98); and rapid ART initiation was associated with a lower risk of LTFU (HR: 0.41; 95% CI 0.24 to 0.83). Patients aged <30 years were more likely to acquire incident sexually transmitted infections (STIs) before achieving viral suppression.ConclusionsRapid ART initiation was associated with a higher rate of engagement in care at 12 months and shortened interval from diagnosis to HIV suppression. Delayed ART initiation may increase onwards HIV transmission considering the high rates of STIs.Ethics approvalThe study was approved by the Research Ethics Committee of National Taiwan University Hospital (Registration No. 201003112R).
Flavour types used by youth and adult tobacco users in wave 2 of the Population Assessment of Tobacco and Health (PATH) Study 2014–2015
Authors: Rose Shyanika W , Johnson Amanda L , Glasser Allison M , Villanti Andrea C , Ambrose Bridget K , Conway Kevin , Cummings K. Michael , Stanton Cassandra A. , Delnevo Cristine , Wackowski Olivia A , Edwards Kathryn C , Feirman Shari P , Bansal-Travers Maansi , Bernat Jennifer , Holder-Hayes Enver , Green Victoria , Silveira Marushka L , Zhou Yitong , Abudayyeh Haneen , Hyland Andrew 
Published: September 2019

BackgroundMost youth and young adult (YA) tobacco users use flavoured products; however, little is known about specific flavours used.MethodsWe report flavour types among US tobacco users from the Population Assessment of Tobacco and Health Study, wave 2, 2014–2015. At wave 2, we examined (1) flavour use and type at past 30-day use; (2) new flavoured tobacco product use and type; (3) product-specific flavour patterns across youth (ages 12–17) (n=920), YA (18–24) (n=3726) and adult (25+) (n=10 346) past 30-day and new tobacco users and (4) concordance between self-coded and expert-coded brand flavour type among all adults (18+).ResultsPrevalence of flavoured tobacco product use was highest among youth, followed by YA and adult 25+ any tobacco users. Within each age group, flavoured use was greatest among hookah, e-cigarette and snus users. Overall, menthol/mint, fruit and candy/sweet were the most prevalent flavour types at first and past 30-day use across age groups. For past 30-day use, all flavour types except menthol/mint exhibited an inverse age gradient, with more prevalent use among youth and YAs, followed by adults 25+. Prevalence of menthol/mint use was high (over 50% youth, YAs; 76% adults 25+) and exhibited a positive age gradient overall, though the reverse for cigarettes. Brand-categorised and self-reported flavour use measures among adults 18+ were moderately to substantially concordant across most products.ConclusionsCommon flavours like menthol/mint, fruit and candy/sweet enhance appeal to young tobacco users. Information on flavour types used by product and age can inform tobacco flavour regulations to addess flavour appeal especially among youth.
Plasma 25-Hydroxyvitamin D Levels and Survival in Patients with Advanced or Metastatic Colorectal Cancer: Findings from CALGB/SWOG 80405 (Alliance)
Authors: Yuan Chen , Sato Kaori , Hollis Bruce W. , Zhang Sui , Niedzwiecki Donna , Ou Fang-Shu , Chang I-Wen , O'Neil Bert H. , Innocenti Federico , Lenz Heinz-Josef , Blanke Charles D. , Goldberg Richard M. , Venook Alan P. , Mayer Robert J. , Fuchs Charles S. , Meyerhardt Jeffrey A. , Ng Kimmie 
Published: September 2019

Abstract

Purpose:
Previous studies have suggested that higher circulating 25-hydroxyvitamin D [25(OH)D] levels are associated with decreased colorectal cancer risk and improved survival. However, the influence of vitamin D status on disease progression and patient survival remains largely unknown for patients with advanced or metastatic colorectal cancer.

Experimental Design:
We prospectively collected blood samples in 1,041 patients with previously untreated advanced or metastatic colorectal cancer participating in a randomized phase III clinical trial of first-line chemotherapy plus biologic therapy. We examined the association of baseline plasma 25(OH)D levels with overall survival (OS) and progression-free survival (PFS). Cox proportional hazards models were used to calculate hazard ratios (HRs) and confidence intervals (CIs), adjusted for prognostic factors and confounders.

Results:
At study entry, 63% of patients were vitamin D deficient (&lt;20 ng/mL) and 31% were vitamin D insufficient (20–&lt;30 ng/mL). Higher 25(OH)D levels were associated with an improvement in OS and PFS (Ptrend = 0.0009 and 0.03, respectively). Compared with patients in the bottom quintile of 25(OH)D (≤10.8 ng/mL), those in the top quintile (≥24.1 ng/mL) had a multivariable-adjusted HR of 0.66 (95% CI, 0.53–0.83) for OS and 0.81 (95% CI, 0.66–1.00) for PFS. The improved survival associated with higher 25(OH)D levels was consistent across patient subgroups of prognostic patient and tumor characteristics.

Conclusions:
In this large cohort of patients with advanced or metastatic colorectal cancer, higher plasma 25(OH)D levels were associated with improved OS and PFS. Clinical trials assessing the benefit of vitamin D supplementation in patients with colorectal cancer are warranted.
Phosphoinositide 3-Kinase Signaling Can Modulate MHC Class I and II Expression
Authors: Chandrasekaran Sanjay , Sasaki Maiko , Scharer Christopher D. , Kissick Haydn T. , Patterson Dillon G. , Magliocca Kelly R. , Seykora John T. , Sapkota Bishu , Gutman David A. , Cooper Lee A. , Lesinski Gregory B. , Waller Edmund K. , Thomas Susan N. , Kotenko Sergei V. , Boss Jeremy M. , Moreno Carlos S. , Swerlick Robert A. , Pollack Brian P. 
Published: September 2019

AbstractMolecular events activating the PI3K pathway are frequently detected in human tumors and the activation of PI3K signaling alters numerous cellular processes including tumor cell proliferation, survival, and motility. More recent studies have highlighted the impact of PI3K signaling on the cellular response to interferons and other immunologic processes relevant to antitumor immunity. Given the ability of IFNγ to regulate antigen processing and presentation and the pivotal role of MHC class I (MHCI) and II (MHCII) expression in T-cell–mediated antitumor immunity, we sought to determine the impact of PI3K signaling on MHCI and MHCII induction by IFNγ. We found that the induction of cell surface MHCI and MHCII molecules by IFNγ is enhanced by the clinical grade PI3K inhibitors dactolisib and pictilisib. We also found that PI3K inhibition increases STAT1 protein levels following IFNγ treatment and increases accessibility at genomic STAT1-binding motifs. Conversely, we found that pharmacologic activation of PI3K signaling can repress the induction of MHCI and MHCII molecules by IFNγ, and likewise, the loss of PTEN attenuates the induction of MHCI, MHCII, and STAT1 by IFNγ. Consistent with these in vitro studies, we found that within human head and neck squamous cell carcinomas, intratumoral regions with high phospho-AKT IHC staining had reduced MHCI IHC staining.Implications:Collectively, these findings demonstrate that MHC expression can be modulated by PI3K signaling and suggest that activation of PI3K signaling may promote immune escape via effects on antigen presentation.
Joint Association of Serum Homocysteine and High-Sensitivity C-Reactive Protein with Arterial Stiffness in Chinese Population: A 12-Year Longitudinal Study
Authors: Wang Keke , Wang Yang , Chu Chao , Hu Jiawen , Zheng Wenling , Yan Yu , Ma Qiong , Gao Ke , Yuan Yue , Mu Jianjun 
Published: September 2019

<b><i>Background:</i></b> Elevated plasma homocysteine (Hcy) and high-sensitivity C-reactive protein (hsCRP) levels are independent risk factors for cardiovascular diseases. However, it is unclear whether the coexistence of these conditions accelerates the risk of arterial stiffness. Our study aimed to evaluate the association of combined Hcy and hsCRP with arterial stiffness in Chinese middle-aged adults. <b><i>Material/Methods:</i></b> We conducted a 12-year longitudinal study in 220 individuals in Hanzhong, China, from 2005 to 2017. The average age at follow-up was 41.83 ± 3.10 years. Demographic information, medical history, anthropometric measurements, and blood pressure as well as urine and fasting blood samples, including Hcy, hsCRP, and brachial-ankle pulse wave velocity (baPWV) were measured and analyzed. <b><i>Results:</i></b> BaPWV levels showed a linear growth trend with the increasing of hsCRP (<i>p</i> for trend &#x3c;0.01). The ORs in the highest quartile compared to the lowest quartile were 1.985 (95% CI 0.776–5.077; <i>p</i> = 0.152) and 3.960 (95% CI 1.468–10.684; <i>p</i>= 0.007) for Hcy and hsCRP, respectively. When Hcy and hsCRP were combined, subjects in both the highest quartile of Hcy and hsCRP (Hcy ≥15.50 μmol/L and hsCRP ≥0.82 μmol/L) had a 12.68-fold increased risk of developing arterial stiffness at the 12-year follow-up compared to those in the lowest quartile of Hcy and hsCRP (Hcy ≤9.91 μmol/L and hsCRP ≤0.19 μmol/L) after adjusting for potential confounders. <b><i>Conclusions:</i></b> The present study demonstrated that the combination of elevated serum Hcy and hsCRP may contribute to an increased risk of arterial stiffness.
Ethnic Diversity in the Recruitment of Diplomats: Why MFAs Take the Issue Seriously
Authors: Lequesne Christian , Castillo Gabriel , Holm Minda , Abdullah Walid Jumblatt , Leira Halvard , Tiwary Kamna , Wong Reuben 
Published: September 2019

Summary
Diversity and its management have become an issue in all organisations. Ministries of foreign affairs (MFAs) do not escape the issue. In the 2000s, states decided to consider more ethnic diversity in the recruitment of their diplomats. In some countries, this new goal requires affirmative action programs. This article is based on three case studies. The first case study analyses two Western countries — France and Norway — where MFAs have to reflect the diversity of immigration in their societies. The second case study analyses the case of Brazil, a country where the legacy of slavery still causes discrimination in the recruitment of diplomats. The third case study analyses ethnic diversity in the MFAs of India and Singapore, which recognise multiculturalism or multiracialism. The study draws five comparative conclusions to generalise on why MFAs in the world cannot escape the challenge of ethnic diversity in their recruitment policy.
Paul, the Gift and Philippians
Authors: Willis Wendell L. 
Published: September 2019

Abstract
This paper employs a basic insight from John M. G. Barclay’s book, Paul and the Gift, that the word χάρις in first-century Greek very often referred to a gift, especially his “perfection” of the word as “conditional.” In Paul’s lifetime the common cultural expectation was that the recipient of a gift accepted that a return gift was normative and expected—whether physical or not. This understanding is thoroughly discussed in Seneca, De Beneficiis which describes how the obligation to reciprocity in giving and receiving is expected of all civil persons, apart from civic position and status. This is because the function of a gift is the building or maintaining of relationships. This purpose is shown to be the case also in Philippians with reference to the passage employing the lexeme (Phil 1:7, 29; 2:6-11) and in 4:10-20 where Paul discusses the gift he received from the Philippian church.
Observed and Simulated Precipitation over Northeastern North America: How Do Daily and Subdaily Extremes Scale in Space and Time?
Authors: Innocenti Silvia , Mailhot Alain , Frigon Anne , Cannon Alex J. , Leduc Martin 
Published: September 2019

AbstractThe characterization of extreme precipitation at fine spatiotemporal scale represents a paramount challenge in hydroclimate sciences due to large uncertainties affecting the precipitation estimation from existing datasets. Comparing the spatiotemporal structure of precipitation extremes estimated from different datasets thus represents an essential step for climate model evaluation, as it provides insight into a model’s ability to simulate atmospheric processes occurring at different scales. This study compares the probability distributions and the annual and diurnal cycles of occurrence of daily and subdaily precipitation annual maxima (AM) estimated over northeastern North America from five observed and simulated datasets: meteorological station series, the bias-corrected (CRT) satellite CMORPH, version 1.0, and the Multi-Source Weighted-Ensemble Precipitation (MSWEP), version 2, gridded datasets, various Canadian RCM, version 5 (CRCM5), simulations, and a 13-yr convection-permitting WRF, version 3.4.1, simulation. ERA-Interim-driven CRCM5 and WRF simulations well reproduced subdaily extreme quantiles and the AM annual and diurnal cycles observed at stations, while CMORPH and MSWEP displayed good performance only for daily and longer extreme statistics. The spatiotemporal statistical structure of precipitation extremes is then assessed considering the variation of AM quantiles across various spatial scales and durations. The results suggest that a two-parameter analytical relationship well describes the AM spatiotemporal structure at the regional scale, allowing us to approximate some crucial properties of point precipitation extremes from gridded datasets. Averaging the estimates from various members of the initial-condition CRCM5 Large Ensemble (CRCM5-LE) also made it possible to reduce the sampling errors and robustly estimate the AM spatiotemporal structure at the local scale of each model grid box.