bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective ‘mystery shopper’ study in UK primary care
Authors: Stevens Sarah L , McManus Richard J , Stevens Richard John 
Published: April 2018

ObjectivesHypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form part of research databases. We aimed to determine the current practice of BP measurement during routine general practice appointments.Design(1) An online cross-sectional survey and (2) a prospective ‘mystery shopper’ study where patients agreed to report how BP was measured during their next appointment.SettingPrimary care.ParticipantsPatient charity/involvement group members completing an online survey between July 2015 and January 2016. 334 participants completed the prospective study (51.5% male, mean age=59.3 years) of which 279 (83.5%) had diabetes.Primary outcomeProportion of patients having BP measured according to guidelines.Results217 participants with (183) and without diabetes (34) had their BP measured at their last appointment. BP was measured in line with UK guidance in 63.7% and 60.0% of participants with and without diabetes, respectively. Initial pressures were significantly higher in those who had their BP measured more than once compared with only once (p=0.016/0.089 systolic and p<0.001/p=0.022 diastolic, in patients with/without diabetes, respectively).ConclusionsCurrent practice of routine BP measurement in UK primary care is often concordant with guidelines for repeat measurement. Further studies are required to confirm findings in broader populations, to confirm when a third repeat reading is obtained routinely and to assess adherence to other aspects of BP measurement guidance.
‘Re-engage’ pilot study protocol: a nurse-led eHealth intervention to re-engage, educate and empower childhood cancer survivors
Authors: Signorelli Christina , Wakefield Claire E , Johnston Karen A , Fardell Joanna E , Brierley Mary-Ellen E , Thornton-Benko Elysia , Foreman Tali , Webber Kate , Wallace W Hamish , Cohn Richard J 
Published: April 2018

IntroductionMany childhood cancer survivors are disengaged from cancer-related follow-up care despite being at high risk of treatment-related late effects. Innovative models of long-term follow-up (LTFU) care to manage ongoing treatment-related complications are needed. ‘Re-engage’ is a nurse-led eHealth intervention designed to improve survivors’ health-related self-efficacy, targeted at survivors disengaged from follow-up. Re-engage aims to overcome survivor- and parent-reported barriers to care and ensure survivors receive the care most appropriate to their risk level.Methods and analysisThis study will recruit 30 Australian childhood cancer survivors who are not receiving any cancer-related care. Participation involves two online/telephone consultations with a survivorship nurse for medical assessment, a case review, risk stratification and creation of a care plan by a multidisciplinary team of specialists. We will assess the feasibility of implementing ‘Re-engage’ and its acceptability to participants and health professionals involved. The primary outcome will be survivors’ health-related self-efficacy, measured at baseline and 1 and 6 months postintervention. Secondary outcomes will include the effect of ‘Re-engage’ on survivors’ health behaviours and beliefs, engagement in healthcare, information needs and emotional well-being. We will also document the cost per patient to deliver ‘Re-engage’. If Re-engage is acceptable, feasible and demonstrates early efficacy, it may have the potential to empower survivors in coordinating their complex care, improving survivors’ long-term engagement and satisfaction with care. Ideally, it will be implemented into clinical practice to recall survivors lost to follow-up and reduce the ongoing burden of treatment for childhood cancer.Ethics and disseminationThe study protocol has been approved by the South Eastern Sydney Local Health District Human Research Ethics Committee (reference number: 16/366). The results will be disseminated in peer-reviewed journals and at scientific conferences. A lay summary will be published on the Behavioural Sciences Unit website.Trial registration numberACTRN12618000194268.
Cardiac rehabilitation and physical activity: systematic review and meta-analysis
Authors: Dibben Grace Olivia , Dalal Hasnain M , Taylor Rod S , Doherty Patrick , Tang Lars Hermann , Hillsdon Melvyn 
Published: April 2018

ObjectiveTo undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies.MethodsDatabases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis.ResultsForty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor.ConclusionOverall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA.
Exercise testing in patients with asymptomatic moderate or severe aortic stenosis
Authors: Saeed Sahrai , Rajani Ronak , Seifert Reinhard , Parkin Denise , Chambers John Boyd 
Published: April 2018

ObjectiveTo assess the safety and tolerability of treadmill exercise testing and the association of revealed symptoms with outcome in apparently asymptomatic patients with moderate to severe aortic stenosis (AS).MethodsA retrospective cohort study of 316 patients (age 65±12 years, 67% men) with moderate and severe AS who underwent echocardiography and modified Bruce exercise treadmill tests (ETTs) at a specialist valve clinic. The outcome measures were aortic valve replacement (AVR), all-cause mortality or a composite of AVR and all-cause mortality.ResultsAt baseline, there were 210 (66%) patients with moderate and 106 (34%) with severe AS. There were 264 (83%) events. 234 (74%) patients reached an indication for AVR, 145 (69%) with moderate and 88 (83%) with severe AS (p<0.05). Of the 30 (9%) deaths recoded during follow-up, 20 (67%) were cardiovascular related. In total, 797 exercise tests (mean 2.5±2.1 per patient) were performed. No serious adverse events were observed. The prevalence of revealed symptoms at baseline ETT was 29% (n=91) and was significantly higher in severe AS compared with moderate AS (38%vs23%, p=0.008). Symptoms were revealed in 18%–59% of patients during serial ETT conducted over a follow-up period of 34.9 (SD 35.1) months. The event-free survival at 24 months with revealed symptoms was 46%±4% and without revealed symptoms was 70%±4%.ConclusionsETT in patients with moderate or severe AS is safe and tolerable. Serial exercise testing is useful to reveal symptoms not volunteered on the history and adds incremental prognostic information to baseline testing.
German petroleum geologists and World War II
Authors: Kölbl-Ebert Martina 
Published: April 2018

Abstract
In the 1930s, Alfred Bentz, August Moos and Karl Krejci-Graf were among the most noteworthy petroleum geologists in Germany. Being scientific modernists, they systematized the search for oil, introducing modern exploration methods. All three, at some stage, worked for the German state on providing the petroleum needed by the German military during World War II. The three colleagues seem to have had an amicable relationship. They were, however, very different. Bentz was not a member of the National Socialist party but obviously lent his expertise to the regime; as did Krejci-Graf, who, although also was not a party member, was a member of the SS, whereas Moos, due to his Jewish background, was murdered in January 1945 in the concentration camp of Buchenwald. This paper endeavours to sketch the lives of the three colleagues, highlighting their relationship and the interconnectedness of contemporary moral issues with professional and scientific demands.
The Plausibility of Obesity Paradox in Cancer—Point
Authors: Park Yikyung , Peterson Lindsay L. , Colditz Graham A. 
Published: April 2018

Abstract
In contrast to the convincing evidence that obesity (measured by body mass index, BMI) increases the risk of many different types of cancer, there is an ambiguity in the role of obesity in survival among cancer patients. Some studies suggested that higher BMI decreased mortality risk in cancer patients, a phenomenon called the obesity paradox. The spurious positive association between BMI and cancer survival is likely to be explained by several methodologic limitations including confounding, reverse causation, and collider stratification bias. Also, the inadequacy of BMI as a measure of body fatness in cancer patients commonly experiencing changes in body weight and body composition may have resulted in the paradox. Other factors contributing to the divergent results in literature are significant heterogeneity in study design and method (e.g., study population, follow-up length); time of BMI assessment (pre-, peri-, or post-diagnosis); and lack of consideration for variability in the strength and directions of associations by age, sex, race/ethnicity, and cancer subtype. Robust but practical methods to accurately assess body fatness and body compositions and weight trajectories in cancer survivors are needed to advance this emerging field and to develop weight guidelines to improve both the length and the quality of cancer survival. Cancer Res; 78(8); 1898–903. ©2018 AACR.
Antibody-Dependent Cellular Phagocytosis by Macrophages is a Novel Mechanism of Action of Elotuzumab
Authors: Kurdi Ahmed T. , Glavey Siobhan V. , Bezman Natalie A. , Jhatakia Amy , Guerriero Jennifer L. , Manier Salomon , Moschetta Michele , Mishima Yuji , Roccaro Aldo , Detappe Alexandre , Liu Chia-Jen , Sacco Antonio , Huynh Daisy , Tai Yu-Tzu , Robbins Michael D. , Azzi Jamil , Ghobrial Irene M. 
Published: April 2018

AbstractElotuzumab, a recently approved antibody for the treatment of multiple myeloma, has been shown to stimulate Fcγ receptor (FcγR)-mediated antibody-dependent cellular cytotoxicity by natural killer (NK) cells toward myeloma cells. The modulatory effects of elotuzumab on other effector cells in the tumor microenvironment, however, has not been fully explored. Antibody-dependent cellular phagocytosis (ADCP) is a mechanism by which macrophages contribute to antitumor potency of monoclonal antibodies. Herein, we studied the NK cell independent effect of elotuzumab on tumor-associated macrophages using a xenograft tumor model deficient in NK and adaptive immune cells. We demonstrate significant antitumor efficacy of single-agent elotuzumab in immunocompromised xenograft models of multiple myeloma, which is in part mediated by Fc–FcγR interaction of elotuzumab with macrophages. Elotuzumab is shown in this study to induce phenotypic activation of macrophages in vivo and mediates ADCP of myeloma cells though a FcγR-dependent manner in vitro. Together, these findings propose a novel immune-mediated mechanism by which elotuzumab exerts anti-myeloma activity and helps to provide rationale for combination therapies that can enhance macrophage activity. Mol Cancer Ther; 17(7); 1454–63. ©2018 AACR.
Mechanistic Investigations of Diarrhea Toxicity Induced by Anti-HER2/3 Combination Therapy
Authors: Moisan Annie , Michielin Francesca , Jacob Wolfgang , Kronenberg Sven , Wilson Sabine , Avignon Blandine , Gérard Régine , Benmansour Fethallah , McIntyre Christine , Meneses-Lorente Georgina , Hasmann Max , Schneeweiss Andreas , Weisser Martin , Adessi Céline 
Published: April 2018

Abstract
Combination of targeted therapies is expected to provide superior efficacy in the treatment of cancer either by enhanced antitumor activity or by preventing or delaying the development of resistance. Common challenges in developing combination therapies include the potential of additive and aggravated toxicities associated with pharmacologically related adverse effects. We have recently reported that combination of anti-HER2 and anti-HER3 antibodies, pertuzumab and lumretuzumab, along with paclitaxel chemotherapy in metastatic breast cancer, resulted in a high incidence of diarrhea that ultimately limited further clinical development of this combination. Here, we further dissected the diarrhea profile of the various patient dose cohorts and carried out in vitro investigations in human colon cell lines and explants to decipher the contribution and the mechanism of anti-HER2/3 therapeutic antibodies to intestinal epithelium malfunction. Our clinical investigations in patients revealed that while dose reduction of lumretuzumab, omission of pertuzumab loading dose, and introduction of a prophylactic antidiarrheal treatment reduced most severe adverse events, patients still suffered from persistent diarrhea during the treatment. Our in vitro investigations showed that pertuzumab and lumretuzumab combination treatment resulted in upregulation of chloride channel activity without indication of intestinal barrier disruption. Overall, our findings provide a mechanistic rationale to explore alternative of conventional antigut motility using medication targeting chloride channel activity to mitigate diarrhea of HER combination therapies. Mol Cancer Ther; 17(7); 1464–74. ©2018 AACR.
Materiais pictóricos da cerâmica Guarani do alto Uruguai a partir de medidas de fluorescência de raios X
Authors: Carbonera Mirian , Appoloni Carlos R. , Santos Gustavo H. dos 
Published: April 2018

Os Guarani pré-coloniais estavam distribuídos por grandes áreas da América do Sul, especialmente em regiões da Bacia do Rio da Prata e zonas litorâneas do Sul do Brasil. A grande característica em termos de cultura material é sua produção cerâmica, com destaque para os vasilhames pintados tanto na superfície externa como na interna. Apresentamos, a partir de medidas de fluorescência de raios X, a análise dos dados de proveniência dos pigmentos utilizados na produção das tintas aplicadas no acabamento de cerâmicas da unidade Guarani de três sítios arqueológicos localizados na Volta do Uvá, alto rio Uruguai. Esta análise indicou que os pigmentos vermelho e branco provêm de materiais inorgânicos derivados de minerais terrosos.
Association Between Early Outpatient Visits and Readmissions After Ischemic Stroke
Authors: Terman Samuel W. , Reeves Mathew J. , Skolarus Lesli E. , Burke James F. 
Published: April 2018

Background:
Reducing hospital readmission is an important goal to optimize poststroke care and reduce costs. Early outpatient follow-up may represent one important strategy to reduce readmissions. We examined the association between time to first outpatient contact and readmission to inform postdischarge transitions.

Methods and Results:

We performed a retrospective cohort study of all Medicare fee-for-service patients discharged home after an acute ischemic stroke in 2012 identified by the
InternationalClassification of Diseases, Ninth Revision, Clinical Modification
codes. Our primary predictor variable was whether patients had a primary care or neurology visit within 30 days of discharge. Our primary outcome variable was all-cause 30-day hospital readmission. We used separate multivariable Cox models with primary care and neurology visits specified as time-dependent covariates, adjusted for numerous patient- and systems-level factors. The cohort included 78 345 patients. Sixty-one percent and 16% of patients, respectively, had a primary care and neurology visit within 30 days of discharge. Visits occurred a median (interquartile range) 7 (4–13) and 15 (5–22) days after discharge for primary care and neurology, respectively. Thirty-day readmission occurred in 9.4% of patients. Readmissions occurred a median 14 (interquartile range, 7–21) days after discharge. Patients who had a primary care visit within 30 days of discharge had a slightly lower adjusted hazard of readmission than those who did not (hazard ratio, 0.98; 95% confidence interval, 0.97–0.98). The association was nearly identical for 30-day neurology visits (hazard ratio, 0.98; 95% confidence interval, 0.97–0.98).

Conclusions:
Thirty-day outpatient follow-up was associated with a small reduction in hospital readmission among elderly patients with stroke discharged home. Further work should assess how outpatient care may be improved to further reduce readmissions.
Value-Based ST-Segment–Elevation Myocardial Infarction Care Using Risk-Guided Triage and Early Discharge
Authors: Ebinger Joseph E. , Strauss Craig E. , Garberich Ross R. , Bradley Steven M. , Rush Pam , Chavez Ivan J. , Poulose Anil K. , Porten Brandon R. , Henry Timothy D. 
Published: April 2018

Background:
Prior studies suggest that low-risk ST-segment–elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention can be considered for early discharge. We describe the implementation of an STEMI risk score to decrease cost while maintaining optimal patient outcomes.

Methods and Results:

We determined the impact of risk-guided STEMI care on healthcare value through the retrospective application of the Zwolle Risk Score to 967 patients receiving primary percutaneous coronary intervention between 2009 and 2011. Of these patients, 540 (56%) were categorized as low risk, indicating they may be safely triaged directly to a telemetry unit rather than the intensive care unit and targeted for early discharge. We subsequently developed and implemented a modified Zwolle Risk Calculator into the electronic medical record to support application of the fast-track protocol for low-risk STEMI patients. Among 549 prospective patients with STEMI, 62% were low risk, and the fast-track protocol was followed in 75% of cases. Prospective results confirmed lower rates of complications (low risk 8.3% versus high risk 38.7%;
P
<0.001) and in-hospital mortality (low risk 0.4% versus High risk 12.5%;
P
<0.001) in the low-risk cohort. Low-risk patients had a shorter median length of stay (median and [25th, 75th percentiles]: low risk 2 [2, 3] versus high risk: 3 [2, 6];
P
<0.001) and lower overall costs (low risk $6720 [$5280–$9030] versus high risk $11 783 [$7953–$25 359];
P
<0.001). Low-risk patients treated on-protocol had shorter median length of stay (on-protocol 2 [1, 2] versus off-protocol 2 [2, 3];
P
<0.001) and hospital costs (on-protocol $6090 [$4730, $7356] versus off-protocol $11 783 [$7953, $25 359];
P
<0.001) than those treated off-protocol. On-protocol low-risk patients in the prospective cohort also had lower costs and shorter length of stay than low-risk patients in the retrospective cohort (
P
<0.001 for both).

Conclusions:
In our study, risk-guided triage and discharge after primary percutaneous coronary intervention for STEMI improved healthcare value by reducing costs of care without compromising quality of care or patient outcomes.
Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry
Authors: Fudim Marat , Liu Peter R. , Shrader Peter , Blanco Rosalia G. , Allen Larry A. , Fonarow Gregg C. , Gersh Bernard J. , Kowey Peter R. , Mahaffey Kenneth W. , Hylek Elaine , Go Alan S. , Thomas Laine , Peterson Eric D. , Piccini Jonathan P. 
Published: April 2018

Background

Mineralocorticoid receptor antagonist (
MRA
) therapy may be beneficial to patients with atrial fibrillation (
AF
), but little is known about their use in patients with
AF
and subsequent outcomes.

Methods and Results

In order to better understand
MRA
use and subsequent outcomes, we performed a retrospective cohort study of the contemporary
ORBIT
‐
AF
(Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
AF
progression and cardiovascular outcomes were compared using propensity‐matched Cox proportional hazards modeling according to
MRA
use at baseline and new
MRA
use at follow‐up versus patients with no
MRA
use. Among 7012 patients with nonpermanent
AF
, 320 patients were taking
MRA
at enrollment, and 416 patients initiated
MRA
use during follow‐up. The mean patient age was 72.5 years, 56.3% were men, and 70.4% had paroxysmal
AF
. Among all patients taking
MRAs,
434 (59.0%) had heart failure, 655 (89.0%) had hypertension, and 380 (51.6%) had both. After adjustment, new
MRA
use was not associated with reduced
AF
progression (hazard ratio, 1.18; 95% confidence interval, 0.88–1.58;
P
=0.27) but showed a trend towards lower risk of stroke, transient ischemic attack, or systemic embolism (hazard ratio, 0.17; 95% confidence interval, 0.02–1.23;
P
=0.08). Results were similar for a comparison of new
MRA
users and baseline
MRA
users compared with nonusers.

Conclusions

In community‐based outpatients with
AF
, the majority of
MRA
use was for
heart failure
and hypertension.
MRA
use also trended towards lower adjusted stroke risk. Future studies should test the hypothesis that
MRA
use may decrease the risk of stroke in patients with
AF
.