bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Making of Democratic Citizens: How Regime‐Specific Socialization Shapes Europeans’ Expectations of Democracy
Authors: Heyne Lea 
Published: December 2018

AbstractWhen analysing support for democracy, researchers tend to assume that ‘democracy’ is a concept that travels across countries. This paper argues that democracy is not the same thing for every citizen, because collective and individual socialization experiences strongly shape the criteria citizens expect a democracy to fulfil. Based on the literature on varieties of democracy, I suppose that individual expectations of democracy are influenced by regime‐specific socialization, and depend on the democratic history, authoritarian legacies, and the prevalent democratic model. Due to socialization and democratic learning, individuals acquire democratic preferences and value those dimensions more which they experience in their own democracy. Using data from the European Social Survey (ESS) and the Democracy Barometer, I test how the national democratic context in 26 European democracies influences these individual democratic ideals. I find evidence for both socialization and participation effects of the democratic context on citizens’ democratic expectations.
Exclusion criteria and adverse events in perioperative trials of tranexamic acid: a systematic review and meta‐analysis
Authors: Yates Jeffrey , Perelman Iris , Khair Simonne , Taylor Joshua , Lampron Jacinthe , Tinmouth Alan , Saidenberg Elianna 
Published: December 2018

BACKGROUNDTranexamic acid (TXA) is an inexpensive therapy effective at minimizing perioperative blood loss and transfusion. However, it remains underutilized due to safety concerns. To date, no evidence‐based guidelines exist identifying which patients should not receive TXA therapy. This study determined patient groups for whom safety information regarding TXA is lacking due to common exclusion from perioperative TXA trials.STUDY DESIGN AND METHODSA systematic review searching the databases Medline, EMBASE, CENTRAL, and Clinicaltrials.gov was performed. Randomized controlled trials (RCTs) administering systemic TXA perioperatively to elective or emergent surgery patients were eligible. Our primary outcome was to describe exclusion criteria of RCTs, and the secondary outcome was TXA safety. A descriptive synthesis of exclusion criteria was performed, and TXA safety was assessed by meta‐analysis.RESULTSA total of 268 eligible RCTs were included. Meta‐analysis showed that systemic TXA did not increase risk of adverse events compared to placebo or no intervention (relative risk, 1.05; 95% confidence interval, 0.99‐1.12). Patient groups commonly excluded from perioperative TXA trials, and thus potentially lacking TXA safety data, were those with major comorbidities, a history of thromboembolism, medication use affecting coagulation, TXA allergy, and coagulopathy. Exclusion of patients with major comorbidities may not be necessary; we showed that the risk of adverse events was similar in studies that excluded patients with major comorbidities and those that did not.CONCLUSIONSufficient evidence exists to develop perioperative guidelines for TXA use in many populations. Further studies evaluating perioperative TXA use in patients with a history of thromboembolism are warranted.
Outcome in dogs with presumptive idiopathic pericardial effusion after thoracoscopic pericardectomy and pericardioscopy
Authors: Carvajal Jose L. , Case J. Brad , Mayhew Philipp D. , Runge Jeffrey , Singh Ameet , Townsend Sarah , Monnet Eric 
Published: December 2018

AbstractObjectiveTo report the outcome of dogs with presumptive echocardiographic idiopathic pericardial effusion treated with thoracoscopic pericardectomy and pericardioscopy.Study designMulti‐institutional retrospective study (2011‐2017).AnimalsEighteen dogs.MethodsRecords were searched for dogs with pericardial effusion and no identified cause by preoperative echocardiography and subsequent thoracoscopic pericardectomy and pericardioscopy. Collected data included presenting complaint, physical examination, laboratory results, imaging, and operative findings. Follow‐up was obtained via telephone interview and/or recheck examination.ResultsNo evidence of mass lesions or cause for the effusion was identified in any of the dogs by preoperative echocardiography. Nine dogs had unremarkable pericardioscopic examination results. Nine dogs had pericardioscopic abnormalities consistent with masses, nodules, or adhesions. Median survival time (MST) for the 9 dogs with abnormalities identified by pericardioscopy was 66 days, whereas MST for the 9 dogs with unremarkable pericardioscopic examination results was not reached (P = .0067). Median survival time for dogs based on histopathologic diagnosis alone was not different between dogs with a diagnosis of neoplasia and dogs with a diagnosis of pericarditis (P = .1056). Among dogs with lesions identified during pericardioscopy, MST did not differ between those with a diagnosis of malignancy and those with a diagnosis of pericarditis (P = .78).ConclusionDogs with presumptive idiopathic pericardial effusion without evidence of masses, nodules, and/or adhesions during thoracoscopic pericardectomy and pericardioscopy lived longer than dogs in which abnormalities were identified during pericardioscopy.Clinical significanceThoracoscopic pericardectomy/pericardioscopy and targeted biopsy of the pericardium and pleura are recommended in dogs with echocardiographic idiopathic pericardial effusion.
Removal of tetracycline antibiotic by Lemna gibba L. from aqueous solutions
Authors: Topal Murat , Öbek Erdal , Uslu Şenel Gülşad , Arslan Topal E. Işıl 
Published: December 2018

AbstractIn this study, the efficiency of Lemna gibba L. on tetracycline (TC) removal from the solutions prepared at various initial TC concentrations (50, 100 and 300 µg/L) was investigated. The study was conducted in the reactors planted with Lemna gibba L. plants. Lemna gibba L. plants in the reactors were harvested at various hydraulic retention times. Then, the concentrations of TC were determined by using LC/‐MS‐MS. The maximum removal efficiencies for the TC50, TC100 and TC300 in the planted reactors were 99.8 ± 4.1; 99.9 ± 4.9 and 99 ± 4.9%, respectively. The harvesting times for Lemna gibba L. at TC50, TC100 and TC300 concentrations were determined to be 12, 8 and 12 hours, respectively. First‐, second‐ and pseudo‐first‐order kinetics are determined in the planted reactors (with Lemna gibba L.). According to the study results, second‐order kinetics were obtained at TC50, TC100, TC300 concentrations. As a result, the Lemna gibba L. plant can be used as an alternative treatment method to other advanced treatment methods and it can be done with a cheap method by adapting to existing treatment plants. Lemna gibba L. plants can be used to remove pollutants by applying them to polluted lakes and water bodies.
Histone demethylase UTX is a therapeutic target for diabetic kidney disease
Authors: Chen Hong , Huang Yixue , Zhu Xiuqin , Liu Chong , Yuan Yangmian , Su Hua , Zhang Chun , Liu Chengyu , Xiong Mingrui , Qu Yannan , Yun Peng , Zheng Ling , Huang Kun 
Published: December 2018

Key points
Diabetic kidney disease (DKD) is a major complication of diabetes. We found that UTX (ubiquitously transcribed tetratricopeptide repeat on chromosome X, also known as KDM6A), a histone demethylase, was upregulated in the renal mesangial and tubular cells of diabetic mice and DKD patients.
In cultured renal mesangial and tubular cells, UTX overexpression promoted palmitic acid‐induced elevation of inflammation and DNA damage, whereas UTX knockdown or GSK‐J4 treatment showed the opposite effects.
We found that UTX demethylase activity‐dependently regulated the transcription of inflammatory genes and apoptosis; moreover, UTX bound with p53 and p53‐dependently exacerbated DNA damage.
Administration of GSK‐J4, an H3K27 demethylase inhibitor, ameliorated the diabetes‐induced renal abnormalities in db/db mice, an animal model of type 2 diabetes.
These results revealed the possible mechanisms underlying the regulation of histone methylation in DKD and suggest UTX as a potential therapeutic target for DKD.
AbstractDiabetic kidney disease (DKD) is a microvascular complication of diabetes and the leading cause of end‐stage kidney disease worldwide without effective therapy available. UTX (ubiquitously transcribed tetratricopeptide repeat on chromosome X, also known as KDM6A), a histone demethylase that removes the di‐ and tri‐methyl groups from histone H3K27, plays important biological roles in gene activation, cell fate control and life span regulation in Caenorhabditis elegans. In the present study, we report upregulated UTX in the kidneys of diabetic mice and DKD patients. Administration of GSK‐J4, an H3K27 demethylase inhibitor, ameliorated the diabetes‐induced renal dysfunction, abnormal morphology, inflammation, apoptosis and DNA damage in db/db mice, comprising an animal model of type 2 diabetes. In cultured renal mesanglial and tubular cells, UTX overexpression promoted palmitic acid induced elevation of inflammation and DNA damage, whereas UTX knockdown or GSK‐J4 treatment showed the opposite effects. Mechanistically, we found that UTX demethylase activity‐dependently regulated the transcription of inflammatory genes; moreover, UTX bound with p53 and p53‐dependently exacerbated DNA damage. Collectively, our results suggest UTX as a potential therapeutic target for DKD.
Scaling up quality improvement intervention for perinatal care in Nepal (NePeriQIP); study protocol of a cluster randomised trial
Authors: KC Ashish , Bergström Anna , Chaulagain Dipak , Brunell Olivia , Ewald Uwe , Gurung Abhishek , Eriksson Leif , Litorp Helena , Wrammert Johan , Grönqvist Erik , Edin Per-Anders , Le Grange Claire , Lamichhane Bikash , Shrestha Parashuram , Pokharel Amrit , Pun Asha , Singh Chahana , Målqvist Mats 
Published: December 2018

IntroductionNepal Perinatal Quality Improvement Project (NePeriQIP) intends to scale up a quality improvement (QI) intervention for perinatal care according to WHO/National guidelines in hospitals of Nepal using the existing health system structures. The intervention builds on previous research on the implementation of Helping Babies Breathe-quality improvement cycle in a tertiary healthcare setting in Nepal. The objective of this study is to evaluate the effect of this scaled-up intervention on perinatal health outcomes.Methods/designCluster-randomised controlled trial using a stepped wedged design with 3 months delay between wedges will be conducted in 12 public hospitals with a total annual delivery rate of 60 000. Each wedge will consist of 3 hospitals. Impact will be evaluated on intrapartum-related mortality (primary outcome), overall neonatal mortality and morbidity and health worker’s performance on neonatal care (secondary outcomes). A process evaluation and a cost-effectiveness analysis will be performed to understand the functionality of the intervention and to further guide health system investments will also be performed.DiscussionIn contexts where resources are limited, there is a need to find scalable and sustainable implementation strategies for improved care delivery. The proposed study will add to the scarce evidence base on how to scale up interventions within existing health systems. If successful, the NePeriQIP model can provide a replicable solution in similar settings where support and investment from the health system is poor, and national governments have made a global pledge to reduce perinatal mortality.Trial registration numberISRCTN30829654.
Measuring ability to assess claims about treatment effects: the development of the ‘Claim Evaluation Tools’
Authors: Austvoll-Dahlgren Astrid , Semakula Daniel , Nsangi Allen , Oxman Andrew David , Chalmers Iain , Rosenbaum Sarah , Guttersrud Øystein 
Published: December 2018

ObjectivesTo describe the development of the Claim Evaluation Tools, a set of flexible items to measure people's ability to assess claims about treatment effects.SettingMethodologists and members of the community (including children) in Uganda, Rwanda, Kenya, Norway, the UK and Australia.ParticipantsIn the iterative development of the items, we used purposeful sampling of people with training in research methodology, such as teachers of evidence-based medicine, as well as patients and members of the public from low-income and high-income countries. Development consisted of 4 processes: (1) determining the scope of the Claim Evaluation Tools and development of items; (2) expert item review and feedback (n=63); (3) cognitive interviews with children and adult end-users (n=109); and (4) piloting and administrative tests (n=956).ResultsThe Claim Evaluation Tools database currently includes a battery of multiple-choice items. Each item begins with a scenario which is intended to be relevant across contexts, and which can be used for children (from age 10  and above), adult members of the public and health professionals. People with expertise in research methods judged the items to have face validity, and end-users judged them relevant and acceptable in their settings. In response to feedback from methodologists and end-users, we simplified some text, explained terms where needed, and redesigned formats and instructions.ConclusionsThe Claim Evaluation Tools database is a flexible resource from which researchers, teachers and others can design measurement instruments to meet their own requirements. These evaluation tools are being managed and made freely available for non-commercial use (on request) through Testing Treatmentsinteractive(testingtreatments.org).Trial registration numbersPACTR201606001679337andPACTR201606001676150; Pre-results.
Trends and population-attributable risk estimates for predictors of early neonatal mortality in Nigeria, 2003–2013: a cross-sectional analysis
Authors: Ezeh Osita Kingsley 
Published: December 2018

ObjectivesTo assess trends in early neonatal mortality (ENM) and population-attributable risk (PAR) estimates for predictors of ENM in Nigeria.Design, setting and participantsA cross-sectional data on 63 844 singleton live births within the preceding 5 years from the 2003, 2008 and 2013 Nigeria Demographic and Health Surveys were used. Adjusted PARs were used to estimate the number of early neonatal deaths attributable to each predictor in the final multivariable Cox regression model.Main outcome measuresENM, defined as the death of a live-born singleton between birth and 6 days of life.ResultsThe ENM rate slightly declined from 30.5 (95% CI 26.1 to 34.9) to 26.1 (CI 24.3 to 27.9) during the study period. Approximately 36 746 (CI 14 656 to 56 920) and 37 752 (CI 23 433 to 51 126) early neonatal deaths were attributable to rural residence and male sex, respectively. Other significant predictors of ENM included small neonates (attributable number: 25 884, CI 19 172 to 31 953), maternal age <20 years (11 708, CI 8521 to 17 042), caesarean section (6312, CI 4260 to 8521) and birth order ≥4 with a short birth interval (≤2 years) (18 929, CI 12 781 to 25 563)).ConclusionsTo improve early neonatal survival in Nigeria, community-based interventions are needed for small neonates, and to promote delayed first pregnancy, child spacing and timely referral for sick male neonates and caesarean delivery.
Understanding determinants of unequal distribution of stillbirth in Tehran, Iran: a concentration index decomposition approach
Authors: Almasi-Hashiani Amir , Sepidarkish Mahdi , Safiri Saeid , Khedmati Morasae Esmaeil , Shadi Yahya , Omani-Samani Reza 
Published: December 2018

ObjectiveThe present inquiry set to determine the economic inequality in history of stillbirth and understanding determinants of unequal distribution of stillbirth in Tehran, Iran.MethodsA population-based cross-sectional study was conducted on 5170 pregnancies in Tehran, Iran, since 2015. Principal component analysis (PCA) was applied to measure the asset-based economic status. Concentration index was used to measure socioeconomic inequality in stillbirth and then decomposed into its determinants.ResultsThe concentration index and its 95% CI for stillbirth was −0.121 (−0.235 to −0.002). Decomposition of the concentration index showed that mother’s education (50%), mother’s occupation (30%), economic status (26%) and father’s age (12%) had the highest positive contributions to measured inequality in stillbirth history in Tehran. Mother’s age (17%) had the highest negative contribution to inequality.ConclusionsStillbirth is unequally distributed among Iranian women and is mostly concentrated among low economic status people. Mother-related factors had the highest positive and negative contributions to inequality, highlighting specific interventions for mothers to redress inequality.
Cost-effectiveness of telehealthcare to patients with chronic obstructive pulmonary disease: results from the Danish ‘TeleCare North’ cluster-randomised trial
Authors: Witt Udsen Flemming , Lilholt Pernille Heyckendorff , Hejlesen Ole , Ehlers Lars 
Published: December 2018

ObjectivesTo investigate the cost-effectiveness of a telehealthcare solution in addition to usual care compared with usual care.DesignA 12-month cost-utility analysis conducted alongside a cluster-randomised trial.SettingCommunity-based setting in the geographical area of North Denmark Region in Denmark.Participants26 municipality districts define randomisation clusters with 13 districts in each arm. 1225 patients with chronic obstructive pulmonary disease were enrolled, of which 578 patients were randomised to telehealthcare and 647 to usual care.InterventionsIn addition to usual care, patients in the intervention group received a set of telehealthcare equipment and were monitored by a municipality-based healthcare team. Patients in the control group received usual care.Main outcome measureIncremental costs per quality-adjusted life-years gained from baseline up to 12 months follow-up.ResultsFrom a healthcare and social sector perspective, the adjusted mean difference in total costs between telehealthcare and usual care was €728 (95% CI −754 to 2211) and the adjusted mean difference in quality-adjusted life-years gained was 0.0132 (95% CI −0.0083 to 0.0346). The incremental cost-effectiveness ratio was €55 327 per quality-adjusted life-year gained. Decision-makers should be willing to pay more than €55 000 to achieve a probability of cost-effectiveness >50%. This conclusion is robust to changes in the definition of hospital contacts and reduced intervention costs. Only in the most optimistic scenario combining the effects of all sensitivity analyses, does the incremental cost-effectiveness ratio fall below the UK thresholds values (€21 068 per quality-adjusted life-year).ConclusionsTelehealthcare is unlikely to be a cost-effective addition to usual care, if it is offered to all patients with chronic obstructive pulmonary disease and if the willingness-to-pay threshold values from the National Institute for Health and Care Excellence are applied.Trial registrationClinicaltrials.gov,NCT01984840, 14 November 2013.
Cost-effectiveness of a randomised trial of physical activity in Alzheimer’s disease: a secondary analysis exploring patient and proxy-reported health-related quality of life measures in Denmark
Authors: Sopina Elizaveta , Sørensen Jan , Beyer Nina , Hasselbalch Steen Gregers , Waldemar Gunhild 
Published: December 2018

ObjectivesTo explore the cost-effectiveness of a supervised moderate-to-high intensity aerobic exercise programme in people diagnosed with Alzheimer’s disease (AD) and estimate incremental cost-effectiveness ratios (ICER) using participant-reported and proxy-reported measures of health-related quality of life (HRQoL)DesignA cost-effectiveness analysis of economic and HRQoL data from a randomised trial delivered over 16 weeks.SettingMemory clinics in Denmark.Participants200 individuals with mild AD aged 50–90 years gave informed consent to participate in the study. Participants were randomised to control or intervention group.InterventionsControl group received treatment as usual. The intervention group performed 1 hour of supervised moderate-to-high intensity aerobic exercise three times weekly for 16 weeks.Primary and secondary outcomes measuresDifferent physical, functional and health measures were obtained at inclusion (baseline) and 4 and 16 weeks after. HRQoL (EuroQol-5 Dimensions-5 Levels/EQ-Visual Analogue Scale) was reported by the participants and the primary caregivers as proxy respondents. Differences in HRQOL as reported by the participant and caregiver were explored as were different values of caregiver time with respite from care tasks.ResultsThe intervention cost was estimated at €608 and €496 per participant, with and without transport cost, respectively. Participants and caregivers in the intervention group reported a small, positive non-significant improvement in EQ-5D-5L and EQ-VAS after 16 weeks. The ICER was estimated at €72 000/quality-adjusted life year using participant-reported outcomes and €87000 using caregiver-reported outcomes.ConclusionsThe findings suggest that the exercise intervention is unlikely to be cost-effective within the commonly applied threshold values. The cost of the intervention might be offset by potential savings from reduction in use of health and social care.Trial registration numberhttps://clinicaltrials.gov/ct2/show/NCT01681602.
Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission
Authors: Zhang Zhongheng , Bokhari Faran , Guo Yizhan , Goyal Hemant 
Published: December 2018

Background and objectivesDelayed patient admission to the intensive care unit (ICU) from the ED is common in China. Patients with severe sepsis or septic shock requiring ICU admission are in need of specialised monitoring and tailored treatment. Delayed admission to the ICU might be associated with adverse clinical outcomes for patients with sepsis.MethodsPatients with sepsis admitted to the ICU from the ED from January 2010 to April 2018 were retrospectively identified from a clinical data warehouse. The primary endpoint was in-hospital mortality. Length of stay in ED (EDLOS) was compared between survivors and non-survivors. A multivariable regression model was employed to adjust for potential confounding due to patient clinical condition.ResultsA total of 1997 patients, including 473 non-survivors and 1524 survivors, were included. The crude mortality rate for patients with EDLOS <6 hours was 21.4%, which was significantly lower than patients with EDLOS of 12–24 hours (31.9%), and those with EDLOS >24 hours (31.8%). After adjusting for PaO2/FiO2, serum creatinine, age, Sequential Organ Failure Assessment, body mass index, lactate, comorbidities and infection site, EDLOS continued to be independently associated with increased risk of hospital mortality. Compared with the group with EDLOS <6 hours, those with EDLOS between 12and24 hours (OR 1.82, 95% CI 1.28 to 2.58) and EDLOS >24 hours (OR 1.79, 95% CI 1.27 to 2.52) showed a significantly increased risk of death.ConclusionsOur study shows that prolonged EDLOS is independently associated with increased risk of hospital mortality in patients with sepsis requiring ICU admission.