bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are gluten-free food staples accessible to all patients with coeliac disease?
Authors: Hanci Ozan , Jeanes Yvonne M 
Published: October 2018

IntroductionWithin England the removal of prescribed gluten-free (GF) foods from many Clinical Commissioning Groups has resulted in a greater reliance on commercially available GF food by adults and children with coeliac disease (CD). High cost and limited availability of GF foods are associated with poorer dietary adherence in people with CD.AimTo assess if the rise in popularity of GF diets globally has improved the cost or availability of cereal-based GF foods over the past 6 years.DesignObservational study where data were collected on cereal-based GF foods from 50 stores and 10 internet retailers. The number of GF foods within each food category and the cost per 100 g of GF and gluten-containing (GC) foods were compared by store type.ResultsGF food availability has increased in premium stores and online. The majority (82%) of GF food categories were significantly more expensive online compared with regular supermarkets. On average, GF breads were 400% more expensive compared with GC breads (p<0.001); no narrowing in cost difference over time observed. Convenience stores did not stock any GF bread nor GF pasta and only one of the budget supermarkets stocked them, similar to data reported 6 years ago.ConclusionsGF food availability has increased, predominately in premium markets. The GF food desert within convenience and budget stores will continue to disproportionately impact poor socioeconomic cohorts, the elderly and physically disabled. A lack of accessibility to GF foods impacts GF dietary adherence, increasing related comorbidities and healthcare costs.
Consumer credit, chronic disease and risk behaviours
Authors: Dean Lorraine T , Knapp Emily A , Snguon Sevly , Ransome Yusuf , Qato Dima M , Visvanathan Kala 
Published: October 2018

BackgroundCredit scores have been identified as a marker of disease burden. This study investigated credit scores’ association with chronic diseases and health behaviours that are associated with chronic diseases.MethodsThis cross-sectional analysis included data on 2083 residents of Philadelphia, Pennsylvania, USA in 2015. Nine-digit ZIP code level FICO credit scores were appended to individual self-reported chronic diseases (obesity, diabetes, hypertension) and related health behaviours (smoking, exercise, and salt intake and medication adherence among those with hypertension). Models adjusted for individual-level and area-level demographics and retail pharmacy accessibility.ResultsMedian ZIP code credit score was 665 (SD=58). In adjusted models, each 50-point increase in ZIP code credit score was significantly associated with: 8% lower chronic disease risk; 6% lower overweight/obesity risk, 19% lower diabetes risk; 9% lower hypertension risk and 14% lower smoking risk. Other health behaviours were not significantly associated. Compared with high prime credit, subprime credit score was significantly associated with a 15%–70% increased risk of chronic disease, following a dose–response pattern with a prime rating.ConclusionLower area level credit scores may be associated with greater chronic disease prevalence but not necessarily with related health behaviours. Area-level consumer credit may make a novel contribution to identifying chronic disease patterns.
Trust and all-cause mortality: a multilevel study of US General Social Survey data (1978–2010)
Authors: Giordano Giuseppe Nicola , Mewes Jan , Miething Alexander 
Published: October 2018

BackgroundWithin public health research, generalised trust has been considered an independent predictor of morbidity and mortality for over two decades. However, there are no population-based studies that have scrutinised both contextual-level and individual-level effects of generalised trust on all-cause mortality. We, therefore, aim to investigate such associations by using pooled nationally representative US General Social Survey (GSS) data linked to the National Death Register (NDI).MethodsThe combined GSS–NDI data from the USA have 90 contextual units. Our sample consisted of 25 270 respondents from 1972 to 2010, with 6424 recorded deaths by 2014. We used multilevel parametric Weibull survival models reporting HRs and 95% CI (credible intervals for Bayesian analysis). Individual-level and contextual-level generalised trust were the exposures of interest; covariates included age, race, gender, marital status, education and household income.ResultsWe found a robust, significant impact of individual-level and contextual-level trust on mortality (HR=0.92, 95% CI 0.88 to 0.97; and HR=0.96, 95% CI 0.93 to 0.98, respectively). There were no discernible gender differences. Neither did we observe any significant cross-level interactions.ConclusionHigh levels of individual and contextual generalised trust protect against mortality, even after considering numerous individual and aggregated socioeconomic conditions. Its robustness at both levels hints at the importance of psychosocial mechanisms, as well as a trustworthy environment. Declining trust levels across the USA should be of concern; decision makers should consider direct and indirect effects of policy on trust with the view to halting this decline.
Learning ability correlates with brain atrophy and disability progression in RRMS
Authors: Sormani Maria Pia , De Stefano Nicola , Giovannoni Gavin , Langdon Dawn , Piani-Meier Daniela , Haering Dieter A , Kappos Ludwig , Tomic Davorka 
Published: October 2018

ObjectiveTo assess the prognostic value of practice effect on Paced Auditory Serial Addition Test (PASAT) in multiple sclerosis.MethodsWe compared screening (day −14) and baseline (day 0) PASAT scores of 1009 patients from the FTY720 Research Evaluating Effects of Daily Oral therapy in Multiple Sclerosis (FREEDOMS) trial. We grouped patients into high and low learners if their PASAT score change was above or below the median change in their screening PASAT quartile group. We used Wilcoxon test to compare baseline disease characteristics between high and low learners, and multiple regression models to assess the respective impact of learning ability, baseline normalised brain volume and treatment on brain volume loss and 6-month confirmed disability progression over 2 years.ResultsThe mean PASAT score at screening was 45.38, increasing on average by 3.18 from day −14 to day 0. High learners were younger (p=0.003), had lower Expanded Disability Status Scale score (p=0.031), higher brain volume (p<0.001) and lower T2 lesion volume (p=0.009) at baseline. Learning status was not significantly associated with disability progression (HR=0.953, p=0.779), when adjusting for baseline normalised brain volume, screening PASAT score and treatment arm. However, the effect of fingolimod on disability progression was more pronounced in high learners (HR=0.396, p<0.001) than in low learners (HR=0.798, p=0.351; p for interaction=0.05). Brain volume loss at month 24 tended to be higher in low learners (0.17%, p=0.058), after adjusting for the same covariates.ConclusionsShort-term practice effects on PASAT are related to brain volume, disease severity and age and have clinically meaningful prognostic implications. High learners benefited more from fingolimod treatment.
Global Heritage Stone: Belgian black ‘marbles’
Authors: Tourneur Francis 
Published: October 2018

Abstract

The appellation ‘Belgian black “marbles”’ usually designates dark fine-grained limestones present in the Paleozoic substrate of south Belgium. They have been extracted mostly in Frasnian (Upper Devonian) and Viséan (Lower Carboniferous) strata, in various different localities (Namur, Dinant, Theux, Basècles, Mazy-Golzinne among others). Nearly devoid of fossils and veins, they take a mirror-like polished finish, with a pure black colour. These limestones were already known during Antiquity but were only intensively exploited from the Middle Ages. Many different uses were made of these stones, for architecture, decoration or sculpture, in religious or civil contexts, following all the successive styles, Romanesque, Gothic, Renaissance, baroque and so on. All these products, architectural, decorative and sculptural, were probably manufactured close to the quarries and were first exported to neighbouring countries (France and the Netherlands), then to all of Europe (Italy, Germany, Denmark, Poland, Baltic states, etc.) and, by the beginning of the nineteenth century, worldwide. They were always considered as high value-added objects, which allowed them to travel great distances from their origin. Thousands of references document the widespread use of these exceptional natural stones. They were employed, among other famous applications, as the black background of the
Pietre dure
marquetry of Florence. Some other lesser uses were either for musical instruments or lithographic stones. Today only one underground quarry exploits the black ‘marble’, at Golzinne (close to Namur). This prestigious material, with its dark aura, is suitable for recognition as a Global Heritage Stone Resource.
Complex Congenital Heart Disease Associated With Disordered Myocardial Architecture in a Midtrimester Human Fetus
Authors: Garcia-Canadilla Patricia , Dejea Hector , Bonnin Anne , Balicevic Vedrana , Loncaric Sven , Zhang Chong , Butakoff Constantine , Aguado-Sierra Jazmin , Vázquez Mariano , Jackson Laurence H. , Stuckey Daniel J. , Rau Cristoph , Stampanoni Marco , Bijnens Bart , Cook Andrew C. 
Published: October 2018

Background:
In the era of increasingly successful corrective interventions in patients with congenital heart disease (CHD), global and regional myocardial remodeling are emerging as important sources of long-term morbidity/mortality. Changes in organization of the myocardium in CHD, and in its mechanical properties, conduction, and blood supply, result in altered myocardial function both before and after surgery. To gain a better understanding and develop appropriate and individualized treatment strategies, the microscopic organization of cardiomyocytes, and their integration at a macroscopic level, needs to be completely understood. The aim of this study is to describe, for the first time, in 3 dimensions and nondestructively the detailed remodeling of cardiac microstructure present in a human fetal heart with complex CHD.

Methods and Results:
Synchrotron X-ray phase-contrast imaging was used to image an archival midgestation formalin-fixed fetal heart with right isomerism and complex CHD and compare with a control fetal heart. Analysis of myocyte aggregates, at detail not accessible with other techniques, was performed. Macroanatomic and conduction system changes specific to the disease were clearly observable, together with disordered myocyte organization in the morphologically right ventricle myocardium. Electrical activation simulations suggested altered synchronicity of the morphologically right ventricle.

Conclusions:
We have shown the potential of X-ray phase-contrast imaging for studying cardiac microstructure in the developing human fetal heart at high resolution providing novel insight while preserving valuable archival material for future study. This is the first study to show myocardial alterations occur in complex CHD as early as midgestation.
Fully Automated Echocardiogram Interpretation in Clinical Practice
Authors: Zhang Jeffrey , Gajjala Sravani , Agrawal Pulkit , Tison Geoffrey H. , Hallock Laura A. , Beussink-Nelson Lauren , Lassen Mats H. , Fan Eugene , Aras Mandar A. , Jordan ChaRandle , Fleischmann Kirsten E. , Melisko Michelle , Qasim Atif , Shah Sanjiv J. , Bajcsy Ruzena , Deo Rahul C. 
Published: October 2018

Background:
Automated cardiac image interpretation has the potential to transform clinical practice in multiple ways, including enabling serial assessment of cardiac function by nonexperts in primary care and rural settings. We hypothesized that advances in computer vision could enable building a fully automated, scalable analysis pipeline for echocardiogram interpretation, including (1) view identification, (2) image segmentation, (3) quantification of structure and function, and (4) disease detection.

Methods:
Using 14 035 echocardiograms spanning a 10-year period, we trained and evaluated convolutional neural network models for multiple tasks, including automated identification of 23 viewpoints and segmentation of cardiac chambers across 5 common views. The segmentation output was used to quantify chamber volumes and left ventricular mass, determine ejection fraction, and facilitate automated determination of longitudinal strain through speckle tracking. Results were evaluated through comparison to manual segmentation and measurements from 8666 echocardiograms obtained during the routine clinical workflow. Finally, we developed models to detect 3 diseases: hypertrophic cardiomyopathy, cardiac amyloid, and pulmonary arterial hypertension.

Results:
Convolutional neural networks accurately identified views (eg, 96% for parasternal long axis), including flagging partially obscured cardiac chambers, and enabled the segmentation of individual cardiac chambers. The resulting cardiac structure measurements agreed with study report values (eg, median absolute deviations of 15% to 17% of observed values for left ventricular mass, left ventricular diastolic volume, and left atrial volume). In terms of function, we computed automated ejection fraction and longitudinal strain measurements (within 2 cohorts), which agreed with commercial software-derived values (for ejection fraction, median absolute deviation=9.7% of observed, N=6407 studies; for strain, median absolute deviation=7.5%, n=419, and 9.0%, n=110) and demonstrated applicability to serial monitoring of patients with breast cancer for trastuzumab cardiotoxicity. Overall, we found automated measurements to be comparable or superior to manual measurements across 11 internal consistency metrics (eg, the correlation of left atrial and ventricular volumes). Finally, we trained convolutional neural networks to detect hypertrophic cardiomyopathy, cardiac amyloidosis, and pulmonary arterial hypertension with C statistics of 0.93, 0.87, and 0.85, respectively.

Conclusions:
Our pipeline lays the groundwork for using automated interpretation to support serial patient tracking and scalable analysis of millions of echocardiograms archived within healthcare systems.
High-Sensitivity Cardiac Troponin I and Clinical Risk Scores in Patients With Suspected Acute Coronary Syndrome
Authors: Chapman Andrew R. , Hesse Kerrick , Andrews Jack , Ken Lee Kuan , Anand Atul , Shah Anoop S. V. , Sandeman Dennis , Ferry Amy V. , Jameson Jack , Piya Simran , Stewart Stacey , Marshall Lucy , Strachan Fiona E. , Gray Alasdair , Newby David E. , Mills Nicholas L. 
Published: October 2018

Background:
High-sensitivity cardiac troponin assays can help to identify patients who are at low risk of myocardial infarction in the emergency department. We aimed to determine whether the addition of clinical risk scores would improve the safety of early rule-out pathways for myocardial infarction.

Methods:
In 1935 patients with suspected acute coronary syndrome, we evaluated the safety and efficacy of 2 rule-out pathways alone or in conjunction with low-risk TIMI (Thrombolysis In Myocardial Infarction) (0 or 1), GRACE (Global Registry of Acute Coronary Events) (≤108), EDACS (Emergency Department Assessment of Chest Pain Score) (<16), or HEART (History, ECG, Age, Risk factors, Troponin) (≤3) scores. The European Society of Cardiology 3-hour pathway uses a single diagnostic threshold (99th percentile), whereas the High-STEACS (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome) pathway applies different thresholds to rule out (<5 ng/L) and rule in (>99th percentile) myocardial infarction.

Results:

Myocardial infarction or cardiac death during the index presentation or at 30 days occurred in 14.3% of patients (276/1935). The European Society of Cardiology pathway ruled out 70%, with 27 missed events giving a negative predictive value of 97.9% (95% CI, 97.1–98.6). The addition of a HEART score ≤3 reduced the proportion ruled out by the European Society of Cardiology pathway to 25% but improved the negative predictive value to 99.7% (95% CI, 99.0–100;
P
<0.001). The High-STEACS pathway ruled out 65%, with 3 missed events for a negative predictive value of 99.7% (95% CI, 99.4–99.9). No risk score improved the negative predictive value of the High-STEACS pathways, but all reduced the proportion ruled out (24% to 47%;
P
<0.001 for all).

Conclusions:
Clinical risk scores significantly improved the safety of the European Society of Cardiology 3-hour pathway, which relies on a single cardiac troponin threshold at the 99th percentile to rule in and rule out myocardial infarction. Where lower thresholds are used to rule out myocardial infarction, as applied in the High-STEACS pathway, risk scores halve the proportion of patients ruled out without improving safety.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01852123.
Minimally Invasive Surgery for Intracerebral Hemorrhage
Authors: Scaggiante Jacopo , Zhang Xiangnan , Mocco J , Kellner Christopher P. 
Published: October 2018

Background and Purpose—
Minimally invasive surgery (MIS) for intracerebral hemorrhage (ICH) has been evaluated in numerous clinical trials. Although meta-analyses for this strategy have been performed in the past, recent trials add important information to results of the comparison and permit strategy-specific analyses, including evaluation of endoscopic evacuation and stereotactic thrombolysis.

Methods—
Major scientific databases including but not limited to Pubmed, the CENTRAL (Cochrane Central Register of Controlled Trials), Embase, Web of Science, Scopus, the ICTRP (International Clinical Trials Registry Platform), the Internet Stroke Center, and the CNKI (Chinese National Knowledge Infrastructure) were searched in October of 2017 for randomized controlled trials of MIS treatment of supratentorial spontaneous ICH. The primary outcome was defined as death or dependence at the end of follow-up, and the secondary outcome was defined as death.

Results—
The initial search yielded 958 reports, which were reduced to 15 high-quality randomized controlled trials involving 2152 patients. We analyzed odds ratios for MIS overall, endoscopic surgery, and stereotactic thrombolysis compared with conventional treatment, including medical treatment and conventional craniotomy. The odds ratio and CIs of the primary and secondary outcomes were 0.46 (0.36–0.57) and 0.59 (0.45–0.76) for MIS versus conventional treatment; 0.40 (0.25–0.66) and 0.37 (0.20–0.67) for endoscopic surgery versus conventional treatment; 0.47 (0.34–0.65) and 0.76 (0.56–1.04) for stereotactic thrombolysis versus conventional treatment; and 0.44 (0.29–0.67) and 0.56 (0.37–0.84) for MIS versus craniotomy. We also conducted subgroup analyses focusing on time to evacuation for MIS versus conventional treatment and found 0.36 (0.22–0.59) and 0.59 (0.34–1.00) for evacuations performed within 24 hours and 0.49 (0.38–0.63) and 0.57 (0.43–0.76) for evacuations performed within 72 hours.

Conclusions—
This meta-analysis demonstrates that select patients with supratentorial ICH benefit from MIS over other treatments. This beneficial effect remains true when analyzing specific techniques and evacuation timing subgroups.
Decline in the Severity of Carotid Atherosclerosis and Associated Risk Factors From 2002 to 2014
Authors: Hackam Daniel G. , Spence J. David 
Published: October 2018

Background and Purpose—
Several recent studies suggest declining rates of carotid revascularization for patients with carotid stenosis. We investigated whether carotid atherosclerosis severity has declined in recent years.

Methods—
We used carotid ultrasound to evaluate stenosis and plaque area in 6039 patients presenting to vascular medicine clinics in 3 eras: 2002 to 2005, 2006 to 2009, and 2010 to 2014.

Results—
The total plaque area at the time of referral to the clinics declined by 24% between 2002 and 2014; the percentage of patients presenting with carotid stenosis >60% declined by 29.9%, and the number presenting with >80% stenosis declined by 36.4%. There were significant reductions in plasma lipids and blood pressure during the same interval.

Conclusions—
Atherosclerosis severity seems to be declining over time. Better treatment of risk factors in the community may be responsible.
Neuroimaging Determinants of Poststroke Cognitive Performance
Authors: Puy Laurent , Barbay Mélanie , Roussel Martine , Canaple Sandrine , Lamy Chantal , Arnoux Audrey , Leclercq Claire , Mas Jean-Louis , Tasseel-Ponche Sophie , Constans Jean-Marc , Godefroy Olivier ,   GRECogVASC Study Group
Published: October 2018

Background and Purpose—
We aimed to define the neuroimaging determinants of poststroke cognitive performance and their relative contributions among a spectrum of magnetic resonance imaging markers, including lesion burden and strategic locations.

Methods—
We prospectively included patients with stroke from the GRECogVASC study (Groupe de Réflexion pour l’Évaluation Cognitive Vasculaire) who underwent 3-T magnetic resonance imaging and a comprehensive standardized battery of neuropsychological tests 6 months after the index event. An optimized global cognitive score and neuroimaging markers, including stroke characteristics, cerebral atrophy markers, and small vessel diseases markers, were assessed. Location of strategic strokes was determined using a specifically designed method taking into account stroke size and cerebral atrophy. A stepwise multivariable linear regression model was used to identify magnetic resonance imaging determinants of cognitive performance.

Results—

Data were available for 356 patients (mean age: 63.67±10.6 years; 326 [91.6%] of the patients had experienced an ischemic stroke). Six months poststroke, 50.8% of patients presented with a neurocognitive disorder. Strategic strokes (right corticospinal tract, left antero-middle thalamus, left arcuate fasciculus, left middle frontal gyrus, and left postero-inferior cerebellum;
R
2
=0.225;
P
=0.0001), medial temporal lobe atrophy (
R
2
=0.077;
P
=0.0001), total brain tissue volume (
R
2
=0.028;
P
=0.004), and stroke volume (
R
2
=0.013;
P
=0.005) were independent determinants of cognitive performance. Strategic strokes accounted for the largest proportion of the variance in the cognitive score (22.5%). The white matter hyperintensity burden, brain microbleeds, and dilated perivascular spaces were not independent determinants.

Conclusions—
Optimized global cognitive score and combined approach of both quantitative measures related to structure loss and qualitative measures related to the presence of strategic lesion are required to improve the determination of structure-function relationship of cognitive performance after stroke.