bluuebunny/crossref_metadata_2025_split huggingface dataset:
Which interactions matter in economic evaluations? A simulation study
Authors: Dakin Helen A , Gray Alastair 
Published: August 2019

Abstract
Background

We aimed to assess the magnitude of interactions in costs, quality-adjusted life-years (QALYs) and net benefits within a sample of published economic evaluations of factorial randomised controlled trials (RCTs), evaluate the impact that different analytical methods would have had on the results and compare the performance of different criteria for identifying which interactions should be taken into account.

Methods

We conducted a systematic review of full economic evaluations conducted alongside factorial RCTs and reviewed the methods used in different studies, as well as the incidence, magnitude, statistical significance, and type of interactions observed within the trials. We developed the interaction-effect ratio as a measure of the magnitude of interactions relative to main effects. For those studies reporting sufficient data, we assessed whether changing the form of analysis to ignore or include interactions would have changed the conclusions. We evaluated how well different criteria for identifying which interactions should be taken into account in the analysis would perform in practice, using simulated data drawn from the studies identified in the review.

Results and conclusions

Large interactions for economic endpoints occurred frequently within the 40 studies identified in the review, although interactions rarely changed the conclusions. Simulation work demonstrated that in analyses of factorial RCTs, taking account of all interactions or including interactions above a certain size (regardless of statistical significance) minimised the opportunity cost from adopting treatments that do not in fact have the highest true net benefit.
Determining Some Factors Affecting the Longevity of Hemodialysis Patients. Using Survival Analysis
Authors: Rafati Shideh , Hassani Laleh , Tamaddondar Mohamad , Sabili Abdolnabi 
Published: August 2019

Abstract
Background

Dialysis is a method for removing excess fluid and uremic waste from the body of chronic renal-failure patients. In patients with CRF, blood dialysis stops death. Hemodialysis prevents the death of patients with chronic renal failure. Various factors can affect the survival of patients undergoing dialysis treatment. The current study aimed to determine such factors.Methods

This descriptive-analytic study examined 252 patients undergoing dialysis from 2010 to 2016 in all of hospitals in Bandar Abbas- Iran, whose data had been recorded in the dialysis unit or it was possible to get their files. The study used Lasso Regression in Cox's proportional hazards model in case with multi variables, background diseases, Body Mass Index,…… The collected data was analyzed using SPSS software and through installing glmnet and survival packages in R software.Results

In this study, 35 (13.9%) death events and 217 (86.1%) censored events were observed. The mean survival time of 252 patients was equal to 10.93 ± 7.82 years and the median survival time of these patients was calculated to be ten years. Based on the results of the Cox model under the penalized method of Lasso, The risk of mortality for patients with diploma degree was by 49% lower than that of the illiterate group (HR = 0.51). The risk of death for unemployed patients and farmers was equal to 0.66 (HR = 1.66) and 0.29 (HR = 1.29), respectively, higher than that of employees. Another significant factor in this study is the duration of each dialysis session. The risk of mortality has been reduced by 0.34 (HR = 0.66) for a single increase during dialysis.Conclusions

Apart from congenital and underlying diseases which early diagnosis will prevent kidney failure, the risk of mortality will be reduced by training behavioral issues in patients undergoing dialysis such as dialysis at predetermined hours and times and appropriate nutritional behaviors.
Inclusion of non-inferiority analysis in superiority-based clinical trials with single-arm, two-stage Simon’s design
Authors: Sampayo-Cordero Miguel , Miguel-Huguet Bernat , Pérez-García José , Páez David , Guerrero-Zotano Ángel , Noguera Javier Garde , Aguirre Elena , Holgado Esther , López-Miranda Elena , Huang Xin , Llombart-Cussac Antonio , Malfettone Andrea , Cortés Javier 
Published: August 2019

Abstract
Background The non-inferiority (NI) hypothesis is not usually considered in the early phases of clinical development. A proof-of-concept phase II study that allows for the analysis of NI, if superiority criteria cannot be met, may balance between multiple endpoints and additional parameters, which will result in more informed decisions in regard to the therapeutics’ potential value. Methods A total of 12,768 two-stage Simon’s design trials were constructed based on different assumptions of rejection response probability, minimum desired response probability, type I and II errors, and NI margins. P-value and type II error were calculated with stochastic ordering using Uniformly Minimum Variance Unbiased Estimator. Type I and II errors were simulated using the Monte Carlo method. Agreement between calculated and simulated values was analyzed with Bland-Altman plots. Results The level of agreement was equivalent between calculated and simulated values in two-stage superiority designs and ones in which switching to NI was allowed. Conclusion Switching to NI analysis, when superiority criteria are not achieved, may be useful for weighing additional factors such as clinical benefit duration, safety, cost, or biomarker strategy while assessing activity and early efficacy rate. Implementation of this strategy can be achieved through simple adaptations to existing designs for one-arm phase II clinical trials.
Identifying solutions to bottlenecks in hypertension service delivery: Insights for improving case detection in Tajikistan
Authors: Chukwuma Adanna , Gong Estelle , Latypova Mutriba , Fraser-Hurt Nicole 
Published: August 2019

Abstract
Background

Hypertension, a significant risk factor for ischemic heart disease and other chronic conditions, is the third-highest cause of death and disability in Tajikistan. Thus, ensuring the early detection and appropriate management of hypertension is a core element of strategies to improve population health in Tajikistan. For a strategy to be successful, it should be informed by the causes of gaps in service delivery and feasible solutions to these challenges. The objective of this study was to undertake a systematic assessment of bottlenecks in service delivery for hypertension within primary health care in Tajikistan and define appropriate solutions.Methods

Our study drew on the cascade of care framework to examine patient progression through the recommended stages of care. We triangulated data from household surveys and facility registries to describe the cascade. Focus group discussions with local stakeholders identified the determinants of discontinuities in care. Drawing on global empirical evidence on effective interventions and stakeholder judgments on the feasibility of implementation, we developed recommendations to improve hypertension service delivery.Results

We review the results for the case detection stage of the cascade of care, which had the most significant gaps. Of the half a million people with hypertension in either Oblast, about 10 percent have been diagnosed in Khatlon and only 5 percent in Sogd. Bottlenecks in case detection include misinformation about hypertension, ambiguous protocols, and limited delivery capacity. Solutions identified to these challenges were mobilizing faith-based organizations, scaling up screening through health caravans, job aids for providers, and task-shifting to increase provider supply.Conclusions

Translating findings on discontinuities in care for hypertension and other chronic diseases to actionable policy insights can be facilitated by collaboration with local stakeholders, triangulation of data sources, and identifying the intersection between the feasible and the effective in defining solutions to service delivery bottlenecks.
The need for home care physicians in Japan – 2020 to 2060
Authors: Iwata Hiroyoshi , Matsushima Masato , Watanabe Takamasa , Sugiyama Yoshifumi , Yokobayashi Kenichi , Son Daisuke , Satoi Yoshinao , Yoshida Eriko , Satake Sumiko , Hinata Yuki , Fujinuma Yasuki 
Published: August 2019

Abstract
Background Due to the fact that Japan faces the most elderly society in the world, the Japanese government has launched an unprecedented health plan to reinforce home care medicine and increase the number of home care physicians, which means that an understanding of future needs for geriatric home care is vital. However, little is known about the future need for home care physicians. We attempted to estimate the basic need for home care physicians from 2020 to 2060. Methods Our estimation is based on modification of major health work force analysis methods with previously reported official data. Two models were developed to estimate the necessary number of home care physicians: one based on home care patient mortality, the other using physician-patient ratio, working with estimated numbers of home and nursing home deaths from 2020 to 2060. Moreover, the final process considered and adjusted for future changes in the proportion of deaths occurring at home. Results Results were highly concordant between our two models. In every instance, the mortality method’s mid-range estimation was between the physician-patient ratio method’s high- and low-estimations. Furthermore, our estimation is in line with the current number of physicians which was calculated using a different method. Approximately 1.6 times the current 38,000 home care physicians will be needed in Japan in the mid 2030’s, peaking at just above 60,000. However, the need for home care physicians is anticipated to begin to decrease by 2040. Conclusion The results indicate that the importance of home care physicians will rise with the growing elderly population, and that improvements in home care could partially suppress the future need for physicians. After the mid 2030’s, the supply can be reduced gradually, accounting for the decreasing total number of deaths after 2040. In order to provide sufficient home care and terminal care at home, increasing the number of home care physicians is indispensable. However, the unregulated supply of home care physicians will require careful attention in the future.
Assessing health system challenges and opportunities for better noncommunicable disease outcomes: the case of Mauritius
Authors: Musango Laurent , TIMOL Maryam , BURHOO Premduth , SHAIKH Faisal , DONNEN Philippe , KIRIGIA Joses Muthuri 
Published: August 2019

Abstract
Background This study provides an overview of NCD mortality, morbidity and risk factors; rates coverage of core population NCD interventions and individual NCD services in Mauritius; assesses health systems challenges and opportunities for better NCD outcomes; and recommends priority action areas to accelerate gains in NCD outcomes in Mauritius. Methods The Mauritius country assessment applied the guidelines developed by the World Health Organization Regional Office for Europe for systematically assessing health system challenges and opportunities for improving NCD outcomes. The assessment used mixed approaches to provide a fuller picture of the health system. Results In 2016, Mauritius sustained a total of 10 022 deaths from all causes. About 8,893 (88.7%) were from NCDs. Of the deaths due to NCDS, 6,935 (78%) were caused by cardiovascular diseases (CVD), diabetes and malignant neoplasms (cancers). Majority of NCDs are attributed to alcohol abuse, tobacco use, physical inactivity, and unhealthy diet. Of the 24-core population-based interventions for addressing these risk factors, 16.7% were rated extensive, 37.5% moderate and 45.8% limited. Three (20%), 8 (53%) and 4 (27%) of the 15 individual/personal CVD, diabetes and cancer services were rated extensive, moderate and limited respectively. Some of the challenges hindering NCD intervention scale-up include: lack of a government-led coordination mechanism; limited community empowerment for behavioural change; inefficient primary health care; insufficiently integrated health management information system; lack of explicit processes for prioritizing public health expenditures; and weak health workforce management. Conclusion There is urgent need to establish a high-level multisectoral/multistakeholder committee to oversee implementation of multisectoral activities for strengthening national health systems and other systems that address NCD risk factors and social determinants of health.
Increased soil moisture aggravated the competitive effects of the invasive tree Rhus typhina on the native tree Cotinus coggygria
Authors: Guo Xiao , Xu Zhen-Wei , Li Ming-Yan , Ren Xiao-Huang , Liu Jian , Guo Weihua 
Published: August 2019

Abstract
Background: Invasive exotic species cause significant problems, and the effects of extreme precipitation and drought, which might occur more frequently under the global climate change scenarios, on interspecific relationship between invasive and native species remain unclear. Results: We conducted a greenhouse experiment with three soil water levels (30%–40%, 50%–60%, and 70%–80% of field capacity) and two cultivation treatments (monoculture pots, one seedling of either species and mixture pots, one seedling of each species) to investigate soil water content effects on the relationship between invasive Rhus typhina and native Cotinus coggygria. We found that in mixture pots, the leaf area index and total chlorophyll concentration of R. typhina were lower than those in monoculture pots; the biomass parameters were unaffected. The growth, biomass, and gas exchange parameters, and total chlorophyll concentration of C. coggygria in mixture pots were lower than those in monoculture pots. Drought decreased the growth parameters, total chlorophyll concentration, and leaf biomass, but did not change gas exchange and other biomass parameters in R. typhina. The growth parameters, leaf area index, biomass parameters, total chlorophyll concentration, and net photosynthetic rate of C. coggygria decreased under drought conditions. The log response ratio (lnRR), calculated as ln (total biomass of a target plant grown in monoculture / total biomass of a target plant grown in mixed culture), of R. typhina was lower than that of C. coggygria. The lnRR of R. typhina and C. coggygria decreased and increased with increase in soil water content, respectively. Conclusions: R. typhina has greater capacity to relatively stable growth in the drought condition than C. coggygria and has strong competition advantages in the mixture with C. coggygria, especially in the drought condition. Our study will help understand the causes of invasiveness and wide distribution of R. typhina under various moisture conditions and predict its expansion under climate change scenarios.
Trade-off strategy of leaf functional traits of desert halophyte Lycium ruthenicum in the lower reaches of Heihe River, Northwest China: response to soil moisture and salinity
Authors: Li Shanjia , Gou Wei , Wang Hui , Wu Guoqiang , Su Peixi 
Published: August 2019

Abstract
Abstract
Background: Understanding salinity resistance and water utilization on shrub species is a challenge to the management and conservation of desert halophytes. Lycium ruthenicum Murr.with a significant soil and water conservation capacity, is one of the dominant shrubs and halophytes in the lower reaches of the Heihe River, Northwest China. In this paper, the effects of two depths (0-40 and 40-80 cm) of soil salinities and water contents on the leaf functional traits of eight L. ruthenicum communities in different distances from the main channel were studied. Fourteen leaf water physiological and ecological stoichiometric traits were investigated, linking with soil factors to explain desert plant trade-off strategies.
Results: Specific leaf volume (SLV), specific leaf area (SLA), leaf thickness (LT), nitrogen (N), C:N, C:P could serve as good indicators of drought and saline resistance. Low N, specific leaf area (SLA) indicated that the plant was located at the slow investment-return axis of the species resource utilization. Low C:N, C:P showed that L. ruthenicum had a defensive life history strategy at drought and salinity areas. The RDA results showed that 0-40 and 40-80 cm soil properties respectively explained 93.45% and 99.96% leaf traits variation. Soil water contents, HCO3- had extremely positive correlation (P<0.01) with leaf functional traits. Shallow soil water contents significantly affects P, and deeper soil water contents significantly responds C and N; shallow soil salinity significantly affected LT, C and N contents, whereas deeper soil salinity significantly affected N and SLV.
Conclusions: L. ruthenicum had a foliar resource acquisition and resource conservation trade-off with a defensive life history strategy in the area of drought and salinity. This finding provides baseline information to facilitate the management and restoration of arid-saline desert ecosystem.
Myocardial Characterization in Pre-Dialysis Chronic Kidney Disease: A Study of Prevalence, Patterns and Outcomes
Authors: Price Anna M , Hayer Manvir K , Vijapurapu Ravi , Fyyaz Saad A , Moody William E , Ferro Charles J , Townend Jonathan N , Steeds Richard P , Edwards Nicola C 
Published: August 2019

Abstract
Background Late gadolinium enhancement (LGE) using cardiac magnetic resonance (CMR) characterizes myocardial disease and predicts an adverse cardiovascular (CV) prognosis. Myocardial abnormalities, are present in early chronic kidney disease (CKD). To date there are no data defining prevalence, pattern and clinical implications of LGE-CMR in CKD.Methods Patients with pre-dialysis CKD (stage 2-5) attending specialist renal clinics at University Hospital Birmingham (UK) who underwent gadolinium enhanced CMR (1.5T) between 2005 and 2017 were included. The patterns and presence (LGEpos) / absence (LGEneg) of LGE were assessed by two blinded observers. Association between LGE and CV outcomes were assessed.Results In total, 159 patients received gadolinium (male 61%, mean age 55 years, mean left ventricular ejection fraction 69%, left ventricular hypertrophy 5%) with a median follow up period of 3.8 years [1.04-11.59]. LGEpos was present in 55 (34%) subjects; the patterns were: right ventricular insertion point n=28 (51%), mid wall n=18 (33%), sub-endocardial n=5 (9%) and sub-epicardial n=4 (7%). There were no differences in left ventricular structural or functional parameters with LGEpos. There were 12 adverse CV outcomes over follow up; 7 of 55 with LGEpos and 5 of 104 LGEneg. LGEpos was not predicted by age, gender, glomerular filtration rate or electrocardiographic abnormalities.Conclusions In a selected cohort of subjects with moderate CKD but low CV risk, LGE was present in approximately a third of patients. LGE was not associated with adverse CV outcomes. Further studies in high risk CKD cohorts are required to assess the role of LGE with multiplicative risk factors.
Circulating Long Noncoding RNA GAS5 as a novel biomarker for patients with atrial fibrillation
Authors: Shi Jiaran , Chen Shi , Wu Bifeng , Yang Kun , Hu Xiaosheng 
Published: August 2019

Abstract
Background Long noncoding RNA (LncRNA) played a vital role in pathophysiology of cardiovascular diseases. However, its role in the diagnosis of atrial fibrillation (AF) remains unknown. The aim of this study is to identify the diagnostic value of lncRNA GAS5 for AF patients.Methods Four lncRNAs (NEAT1, GAS5, UCA1, and TUG1) were selected as potential biomarkers of AF. The circulating expression of lncRNAs were measured by qRT-PCR. Receiver operating characteristic curve (ROC) and area under the ROC curve (AUC) were applied to assess their diagnostic value for AF.Results In screening trial, LncRNA GAS5 was down-regulated in AF patients, with no significant differences in other three lncRNAs. Then a total of 128 participants were enrolled including 85 AF patients and 43 controls. Circulating levels of GAS5 in AF patients were remarkably reduced compared with controls ( P <0.001). The AUC was 0.858, with 81.2% sensitivity and 86.0% specificity. Further, the downregulation of GAS5 was more significant in persistent rather than paroxysmal AF. Correlation analysis showed that GAS5 was negatively correlated with CHA2DS2-VASc score and several echocardiography indexes.Conclusions Circulating lncRNA GAS5 is a potential biomarker for AF diagnosis and may prognose AF progression and stroke risk.
­­A convolutional neural network-based system to detect malignant findings in FDG PET/CT examinations
Authors: Kawauchi Keisuke , Furuya Sho , Hirata Kenji , Katoh Chietsugu , Manabe Osamu , Kobayashi Kentaro , Watanabe Shiro , Shiga Tohru 
Published: August 2019

Abstract
Background As the number of PET/CT scanners increases and FDG PET/CT becomes a common imaging modality for oncology, the demands for automated detection systems on artificial intelligence (AI) to prevent human oversight and misdiagnosis are rapidly growing. We aimed to develop a convolutional neural network (CNN)-based system that can classify whole-body FDG PET as 1) benign, 2) malignant, or 3) equivocal.Methods This retrospective study investigated 3,485 sequential patients with malignant or suspected malignant disease, who underwent whole-body FDG PET/CT at our institute. All the cases were classified into the 3 categories by a nuclear medicine physician. A residual network (ResNet)-based CNN architecture was built for classifying patients into the 3 categories. This network was trained with PET images. Five-fold cross-validations were carried out to estimate the classification performance. In addition, we examined whether the CNN could determine the location of the malignant uptake, be it in the head-and-neck region, chest, abdomen, or pelvic region.Results There were 1,280 (37%), 1,450 (42%) and 755 (22%) patients classified as benign, malignant and equivocal, respectively. In patient-based analysis, the CNN predicted benign and malignant images with 99.4% and 99.4% accuracy, respectively. Furthermore, in region-based analysis, the prediction was correct with the probability of 97.3% (head-and-neck), 96.6% (chest), 92.8% (abdomen) and 99.6% (pelvic region), respectively.Conclusion The CNN-based system reliably classified FDG PET images into 3 categories, indicating that it would be helpful for physicians as a double-checking system to prevent oversight and misdiagnosis.