bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optical coherence tomography angiography of perilimbal vasculature: validation of a standardised imaging algorithm
Authors: Patel Chaitali N , Antony Anjaly K , Kommula Hasna , Shah Sahil , Singh Vivek , Basu Sayan 
Published: May 2019

PurposeTo test the reliability and accuracy of a standardised non-invasive imaging algorithm using optical coherence tomography angiography (OCTA) in detecting and quantifying pharmacologically induced changes in the perilimbal vasculature.MethodsIn this prospective observational imaging study, 370 angiograms of 15 normal eyes and 10 eyes with nasal pterygiums were obtained using a commercially available OCTA system with split-spectrum amplitude-decorrelation angiography technology. Postprocessing of the images to quantify the area occupied by the blood vessels was performed using the Fiji software. The main outcome measures were reliability (intraobserver and interobserver agreement) and accuracy of the standardised algorithm in detecting and quantifying relative change (vasoconstriction and vasodilatation) in the area occupied by the blood vessels after instillation of topical vasoconstrictors.ResultsThe intraclass correlation coefficients for intraobserver and interobserver agreement were 0.91 and 0.88 (good to excellent), respectively. In normal eyes, significant vasoconstriction was noted at 5 min (35%–47%) after application of eye-drops, which peaked at 10 min (43%–63%) and was sustained until 20 min (35%–51%), followed by gradual recovery. Greatest effect was noted with a combination of 5% phenylephrine and 0.15% brimonidine tartrate (BT) eye-drops as compared with either one or two drops of BT alone, both at the 10 min (p=0.0058) and 20 min (p=0.0375) time points. This dose-dependent temporal trend was replicated in eyes with primary nasal pterygium (p=0.31).ConclusionsThe findings suggest that OCTA can reliably and accurately detect and quantify relative changes in the perilimbal vasculature in both normal eyes and in eyes with pterygium.
Effect of dose of behavioral weight loss treatment on glycemic control in adults with prediabetes
Authors: Bauman Viviana , Ariel-Donges Aviva H , Gordon Eliza L , Daniels Michael J , Xu Dandan , Ross Kathryn M , Limacher Marian C , Perri Michael G 
Published: May 2019

ObjectiveThis study examined the effects of three doses of behavioral weight loss treatment, compared with a nutrition education control group, on changes in glycemic control in individuals with obesity and prediabetes.Research design and methodsThe study included 287 adults (77% female, 81% White; mean (SD) age=54.1 (10.5) years, body mass index=36.3 (3.9) kg/m2, and hemoglobin A1c (HbA1c)=5.9 (0.2%)). Participants were randomized to one of three behavioral treatment doses (high=24 sessions, moderate=16 sessions, or low=8 sessions) or to an education group (control=8 sessions). Changes in HbA1c, fasting glucose, and body weight were assessed from baseline to 6 months.ResultsMean (99.2% credible interval (CI)) reductions in HbA1c were 0.11% (0.07% to 0.16%), 0.08% (0.03% to 0.13%), 0.03% (–0.01% to 0.07%), and 0.02% (–0.02% to 0.07%), for the high, moderate, low, and control conditions, respectively. Mean (CI) reductions in fasting blood glucose were 0.26 mmol/L (0.14 to 0.39), 0.09 mmol/L (0 to 0.19), 0.01 mmol/L (–0.07 to 0.09), and 0.04 mmol/L (–0.03 to 0.12) for the high, moderate, low, and control conditions, respectively. The high-dose treatment produced significantly greater reductions in HbA1c and fasting blood glucose than the low-dose and control conditions (posterior probabilities (pp)<0.001); no other significant between-group differences were observed. Mean (CI) reductions in body weight were 10.91 kg (9.30 to 12.64), 10.08 kg (8.38 to 11.72), 6.35 kg (5.19 to 7.69), and 3.82 kg (3.04 to 4.54) for the high, moderate, low, and control conditions, respectively. All between-group differences in 6-month weight change were significant (pps<0.001) except for the high-dose versus moderate-dose comparison.ConclusionFor adults with obesity and prediabetes a high dose of behavioral treatment involving 24 sessions over 6 months may be needed to optimize improvements in glycemic control.Trial registration numberNCT00912652.
Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis
Authors: Pham Ba' , Thomas Sonia M , Lillie Erin , Lee Taehoon , Hamid Jemila , Richter Trevor , Janoudi Ghayath , Agarwal Arnav , Sharpe Jane P , Scott Alistair , Warren Rachel , Brahmbhatt Ronak , Macdonald Erin , Straus Sharon E , Tricco Andrea C 
Published: May 2019

ObjectivesTo evaluate the comparative effectiveness and safety of intravitreal bevacizumab, ranibizumab and aflibercept for patients with choroidal neovascular age-related macular degeneration (cn-AMD), diabetic macular oedema (DMO), macular oedema due to retinal vein occlusion (RVO-MO) and myopic choroidal neovascularisation (m-CNV).DesignSystematic review and random-effects meta-analysis.MethodsMultiple databases were searched from inception to 17 August 2017. Eligible head-to-head randomised controlled trials (RCTs) comparing the (anti-VEGF) drugs in adult patients aged ≥18 years with the retinal conditions of interest. Two reviewers independently screened studies, extracted data and assessed risk of bias.Results19 RCTs involving 7459 patients with cn-AMD (n=12), DMO (n=3), RVO-MO (n=2) and m-CNV (n=2) were included. Vision gain was not significantly different in patients with cn-AMD, DMO, RVO-MO and m-CNV treated with bevacizumab versus ranibizumab. Similarly, vision gain was not significantly different between cn-AMD patients treated with aflibercept versus ranibizumab. Patients with DMO treated with aflibercept experienced significantly higher vision gain at 12 months than patients receiving ranibizumab or bevacizumab; however, this difference was not significant at 24 months. Rates of systemic serious harms were similar across anti-VEGF agents. Posthoc analyses revealed that an as-needed treatment regimen (6–9 injections per year) was associated with a mortality increase of 1.8% (risk ratio: 2.0 [1.2 to 3.5], 2 RCTs, 1795 patients) compared with monthly treatment in cn-AMD patients.ConclusionsIntravitreal bevacizumab was a reasonable alternative to ranibizumab and aflibercept in patients with cn-AMD, DMO, RVO-MO and m-CNV. The only exception was for patients with DME and low visual acuity (<69 early treatment diabetic retinopathy study [ETDRS] letters), where treatment with aflibercept was associated with significantly higher vision gain (≥15 ETDRS letters) than bevacizumab or ranibizumab at 12 months; but the significant effects were not maintained at 24 months. The choice of anti-VEGF drugs may depend on the specific retinal condition, baseline visual acuity and treatment regimen.PROSPERO registration numberCRD42015022041.
To what extent does sex, age and BMI impact medical and pharmacy costs? A retrospective cohort study involving employees in a large school district in the USA
Authors: Merrill Ray M , Fowers Rylan 
Published: May 2019

ObjectiveTo identify the extent that sex, age and body mass index (BMI) is associated with medical and pharmacy costs.DesignRetrospective cohort.SettingA school district in the Western USA involving 2531 workers continuously employed during 2011–2014.Main outcome measuresMedical and pharmacy costs and BMI.ResultsApproximately 84% of employees participated in wellness screening. Participants were 1.03 (95% CI 1.01 to 1.06) times more likely to be women and younger (M=47.8 vs 49.8, p<0.001). Median medical and pharmacy costs were higher for women than men, increased with age, and were greater in morbidly obese individuals (p<0.001). Annual pharmacy claims were 18% more likely to be filed by women than men, 23% more likely filed by those aged ≥60 versus <40 years, and 6% more likely filed by morbidly obese individuals than of normal weight (p<0.001) individuals. Greater medical and pharmacy costs in older age were most pronounced in underweight and morbidly obese groups. Higher use of medication among women than men was primarily because of drugs involving birth control, osteoporosis, thyroid disease and urinary tract infection. Higher medication use in older age was primarily related to medications used to treat gastrointestinal problems. Medication use was positively associated with BMI weight classifications for most of the 33 drug types considered, with exceptions involving birth control, herpes and osteoporosis. A J-shape relationship was observed between BMI and medication use for acne, antibiotic, cold/influenza/allergy, eye infection, oedema, muscle spasms, pain and ulcers.ConclusionsMedications associated with higher medical and pharmacy costs among women, older age and underweight or obese individuals are identified. Lowering medical and pharmacy costs requires weight management in older ages, particularly for underweight and obese. Higher pharmacy costs for certain drugs among underweight individuals may be associated with poorer nutrition.
Five-year prognosis and impact of adolescent knee pain: a prospective population-based cohort study of 504 adolescents in Denmark
Authors: Rathleff Michael Skovdal , Holden Sinead , Straszek Christian Lund , Olesen Jens Lykkegaard , Jensen Martin Bach , Roos Ewa M 
Published: May 2019

ObjectivesInvestigate the prognosis of adolescent knee pain, and evaluate its impact on health, care-seeking and career choices 5 years later.DesignPre-registered, prospective cohort study.SettingPopulation-based cohort initiated in school setting.ParticipantsFrom a cohort of 2200 adolescents aged 15–19 years in 2011, 504 reported knee pain on at least a monthly basis, and were followed prospectively in this cohort study, together with 252 controls who did not have knee pain in 2011.Main outcome measuresOutcomes included the Pain and Symptoms subscales from the Knee injury and Osteoarthritis Outcome Score (KOOS), pain intensity measured with a Numeric Rating Scale, pain frequency, knee-related and health-related quality of life, sports participation, physical activity level, KOOS subscales: Function and Sport/recreation, quality of sleep, healthcare consultations, treatments received for their knee pain, the use of painkillers and impact on choice of job or career.ResultsAt follow-up, 358 (71.0%) from the knee pain group and 182 (72.2%) from the control group responded. Of note, 40.5% (95% CI: 35.4% to 45.6%) from the knee pain group reported knee pain 5 years later which was frequent and intense compared with 13.2% (95% CI: 8.2 to 18.1) of the control group. Those from the knee pain group still suffering from knee pain reported poorer physical health (13 points worse on KOOS Function and 30 points worse on KOOS Sport/recreation), stopped or reduced their sports participation because of knee pain (60%), reported worse sleep quality and worse knee-related and general quality of life. In terms of health behaviours, those still with knee pain reported more healthcare consultations. One-third used pain killers regularly, and 15% (95% CI: 12% to 20%) reported that knee pain influenced their choice of job or career.ConclusionFour out of every 10 adolescents with knee pain still experienced frequent and intense knee pain 5 years later, severe enough to impact health, health behaviours and career choices.Trail registration numberNCT02873143.
Time-driven activity-based costing of total knee replacements in Karachi, Pakistan
Authors: Khan Rabia Mansoor , Albutt Katherine , Qureshi Muhammad Abdullah , Ansari Zara , Drevin Gustaf , Mukhopadhyay Swagoto , Khan Mansoor Ali , Chinoy Muhammad Amin , Meara John , Hussain Hamidah 
Published: May 2019

IntroductionOsteoarthritis of the knee has been identified as the most common disability in Pakistan. Total knee replacement (TKR) surgery is the curative treatment for advanced osteoarthritis of the knee; however, cost remains one of the barriers to effective and timely service delivery.ObjectiveWe conducted a time-driven activity-based costing (TDABC) analysis of TKR to identify major cost drivers and areas for process improvement.Methods and analysisWe performed a prospective TDABC analysis of patients who underwent bilateral TKR at The Indus Hospital (TIH) during a 14-month period from October 2015 to December 2016. Detailed process maps were developed for each phase of the care cycle. Time durations and costs were allocated to each resource utilised and aggregated across the care cycle, including personnel, direct and indirect costs.ResultsWe identified seven care phases for a complete TKR care cycle and created their detailed process maps. Major time contributors were ward stay and discharge (20 160 min), TKR surgery (563 min) and surgical admission (333 min). Overall, 92.10% of time is spent during the ward stay and discharge phase of care. Patients remain hospitalised for an average of 14 days postoperatively. Overall institutional cost of a TKR at TIH was US$4360.51 (Pakistani rupees 456 981.17) per bilateral TKR surgery. The overall primary cost drivers for the full bundle of care were consumables used during TKR surgery itself, consumables utilised in the wards and personnel costs contributing 57.64%, 27.45% and 12.03% of total costs, respectively.ConclusionUtilising TDABC allowed us to obtain a granular analysis of time and cost that was subsequently used to inform quality process improvement initiatives. In low-resource settings, such as Pakistan, TDABC has the potential to be a useful tool to guide resource allocation and process improvement.
Measuring financial risk protection in health benefits packages: scoping review protocol to inform allocative efficiency studies
Authors: Abou Jaoude Gerard Joseph , Skordis-Worrall Jolene , Haghparast-Bidgoli Hassan 
Published: May 2019

IntroductionTo progress towards Universal Health Coverage (UHC), countries will need to define a health benefits package of services free at the point of use. Financial risk protection is a core component of UHC and should therefore be considered a key dimension of health benefits packages. Allocative efficiency modelling tools can support national analytical capacity to inform an evidence-based selection of services, but none are currently able to estimate financial risk protection. A review of existing methods used to measure financial risk protection can facilitate their inclusion in modelling tools so that the latter can become more relevant to national decision making in light of UHC.Methods and analysisThis protocol proposes to conduct a scoping review of existing methods used to measure financial risk protection and assess their potential to inform the selection of services in a health benefits package. The proposed review will follow the methodological framework developed by Arksey and O’Malley and the subsequent recommendations made by Levacet al. Several databases will be systematically searched including: (1) PubMed; (2) Scopus; (3) Web of Science and (4) Google Scholar. Grey literature will also be scanned, and the bibliography of all selected studies will be hand searched. Following the selection of studies according to defined inclusion and exclusion criteria, key characteristics will be collected from the studies using a data extraction tool. Key characteristics will include the type of method used, geographical region of focus and application to specific services or packages. The extracted data will then be charted, collated, reported and summarised using descriptive statistics, a thematic analysis and graphical presentations.Ethics and disseminationThe scoping review proposed in this protocol does not require ethical approval. The final results will be disseminated via publication in a peer-reviewed journal, conference presentations and shared with key stakeholders.
General practitioner use of D-dimer in suspected venous thromboembolism: historical cohort study in one geographical region in the Netherlands
Authors: Schols Angel M R , Meijs Eline , Dinant Geert-Jan , Stoffers Henri E J H , Krekels Mariëlle M E , Cals Jochen W L 
Published: May 2019

ObjectivesTo investigate how many general practitioner (GP)-referred venous thromboembolic events (VTEs) are diagnosed during 1 year in one geographical region and to investigate the (urgent) referral pathway of VTE diagnoses, including the role of laboratory D-dimer testing.DesignHistorical cohort study.SettingGP patients of 47 general practices in a demarcated geographical region of 161 503 inhabitants in the Netherlands.ParticipantsWe analysed all 895 primary care patients in whom either the GP determined a D-dimer value or who had a diagnostic work-up for suspected VTE in a non-academic hospital during 2015.Primary and secondary outcome measuresThe primary outcomes of this study were the total number of VTEs per year and the diagnostic pathways—including the role of GP determined D-dimer testing—of patients urgently referred to secondary care for suspected VTE. Additionally, we explored the use of an age-adjusted D-dimer cut-off.ResultsThe annual VTE incidence was 0.9 per 1000 inhabitants. GPs annually ordered 5.1 D-dimer tests per 1000 inhabitants. Of 470 urgently GP-referred patients, 31.3% had a VTE. Of those urgently referred based on clinical assessment only (without D-dimer testing), 73.8% (96/130) had a VTE; based on clinical assessment and laboratory D-dimer testing yielded 15.0% (51/340) VTE. Applying age-adjusted D-dimer cut-offs to all patients aged 50 years or older resulted in a reduction of positive D-dimer results from 97.9% to 79.4%, without missing any VTE.ConclusionsAlthough D-dimer testing contributes to the diagnostic work-up of VTE, GPs have a high detection rate for VTE in patients who they urgently refer to secondary care based on clinical assessment only.
Identification of Plasmodium falciparum and host factors associated with cerebral malaria: description of the protocol for a prospective, case-control study in Benin (NeuroCM)
Authors: Joste Valentin , Maurice Laurine , Bertin Gwladys I , Aubouy Agnès , Boumédiène Farid , Houzé Sandrine , Ajzenberg Daniel , Argy Nicolas , Massougbodji Achille , Dossou-Dagba Ida , Alao Maroufou Jules , Cot Michel , Deloron Philippe , Faucher Jean-François 
Published: May 2019

IntroductionIn 2016, an estimated 216 million cases and 445 000 deaths of malaria occurred worldwide, in 91 countries. In Benin, malaria causes 26.8% of consultation and hospitalisation motif in the general population and 20.9% in children under 5 years old.The goal of the NeuroCM project is to identify the causative factors of neuroinflammation in the context of cerebral malaria. There are currently very few systematic data from West Africa on the aetiologies and management of non-malarial non-traumatic coma in small children, and NeuroCM will help to fill this gap. We postulate that an accurate understanding of molecular and cellular mechanisms involved in neuroinflammation may help to define efficient strategies to prevent and manage cerebral malaria.Methods and analysisThis is a prospective, case-control study comparing cerebral malaria to uncomplicated malaria and non-malarial non-traumatic coma. This study takes place in Benin, precisely in Cotonou for children with coma and in Sô-Ava district for children with uncomplicated malaria. We aim to include 300 children aged between 24 and 71 months and divided in three different clinical groups during 12 months (from December 2017 to November 2018) with a 21 to 28 days follow-up for coma. Study data, including clinical, biological and research results will be collected and managed using CSOnline-Ennov Clinical.Ethics and disseminationEthics approval for the NeuroCM study has been obtained fromComité National d’Ethique pour la Recherche en santéof Benin (n°67/MS/DC/SGM/DRFMT/CNERS/SA; 10/17/2017). NeuroCM study has also been approved byComité consultatif de déontologie et d’éthiqueof Institut de Recherche pour le Développement (IRD; 10/24/2017). The study results will be disseminated through the direct consultations with the WHO’s Multilateral Initiative on Malaria (TDR-MIM) and Roll Back Malaria programme, through scientific meetings and peer-reviewed publications in scientific or medical journals, and through guidelines and booklets.
Protective effects of blue light-blocking shades on phototoxicity in human ocular surface cells
Authors: Niwano Yoshimi , Iwasawa Atsuo , Tsubota Kazuo , Ayaki Masahiko , Negishi Kazuno 
Published: May 2019

ObjectiveBlue light hazards for retina and ocular surface have been repeatedly described and many protective methods are introduced for retina; however, no study has been conducted on ocular surface protection. The purpose of this in vitro study was to examine phototoxicity and shade protection after blue light irradiation in primary human cells of corneal surface origin.Methods and analysisPrimary human cells of corneal surface origin were obtained from eye bank eyes. After blue light irradiation (405 nm) of these cells for 3 min, and a further 24 hours’ incubation, surviving viable cells were assessed by the methyl thiazolyl tetrazolium assay. Simultaneously, cell viability was determined in wells covered by ultraviolet and blue light shades.ResultsUnder subconfluent conditions, viable cells decreased by around 50% after blue light irradiation, compared with control cells without irradiation. The blue light phototoxicity was not blocked by the control shade, but the ultraviolet-blocking and blue light-blocking shades protected the cells from phototoxicity, producing a 30%–40% reduction (ultraviolet) and 15%–30% reduction (blue light) in viable cells.ConclusionThese results indicate that blue light injures ocular surface cells and the cells are protected from damage by a shade. We recommend blue light protection to maintain ocular health, especially in high-risk populations, such as people with dry eye, contact lens users, the malnourished and the elderly.
Cornell product is an ECG marker of heart failure with preserved ejection fraction
Authors: Tan Eugene SJ , Chan Siew Pang , Xu Chang Fen , Yap Jonathan , Richards Arthur Mark , Ling Lieng Hsi , Sim David , Jaufeerally Fazlur , Yeo Daniel , Loh Seet Yoong , Ong Hean Yee , Leong Kui Toh Gerard , Ng Tze Pin , Nyunt Shwe Zin , Feng Liang , Okin Peter , Lam Carolyn SP , Lim Toon Wei 
Published: May 2019

ObjectiveECG markers of heart failure (HF) with preserved ejection fraction (HFpEF) are lacking. We hypothesised that the Cornell product (CP) is a risk marker of HFpEF and has prognostic utility in HFpEF.MethodsCP =[(amplitude of R wave in aVL+depth of S wave in V3)×QRS] was measured on baseline 12-lead ECG in a prospective Asian population-based study of 606 healthy controls (aged 55±10 years, 45% men), 221 hypertensive controls (62±9 years, 58% men) and 242 HFpEF (68±12 years, 49% men); all with EF ≥50% and followed for 2 years for all-cause mortality and HF hospitalisations.ResultsCP increased across groups from healthy controls to hypertensive controls to HFpEF, and distinguished between HFpEF and hypertension with an optimal cut-off of ≥1800 mm*ms (sensitivity 40%, specificity 85%). Age, male sex, systolic blood pressure (SBP) and heart rate were independent predictors of CP ≥1800 mm*ms, and CP was associated with echocardiographic E/e′ (r=0.27, p<0.01) and left ventricular mass index (r=0.46, p<0.01). Adjusting for clinical and echocardiographic variables and log N-terminal pro B-type natriuretic peptide (NT-proBNP), CP ≥1800 mm*ms was significantly associated with HFpEF (adjusted OR 2.7, 95% CI 1.0 to 7.0). At 2-year follow-up, there were 29 deaths and 61 HF hospitalisations, all within the HFpEF group. Even after adjusting for log NT-proBNP, clinical and echocardiographic variables, CP ≥1800 mm*ms remained strongly associated with a higher composite endpoint of all-cause mortality and HF hospitalisations (adjusted HR 2.1, 95% CI 1.2 to 3.5).ConclusionThe Cornell product is an easily applicable ECG marker of HFpEF and predicts poor prognosis by reflecting the severity of diastolic dysfunction and LV hypertrophy.