bluuebunny/crossref_metadata_2025_split huggingface dataset:
General practitioners’ and out-of-hours doctors’ role as gatekeeper in emergency admissions to somatic hospitals in Norway: registry-based observational study
Authors: Blinkenberg Jesper , Pahlavanyali Sahar , Hetlevik Øystein , Sandvik Hogne , Hunskaar Steinar 
Published: August 2019

Abstract

Background
Primary care doctors have a gatekeeper function in many healthcare systems, and strategies to reduce emergency hospital admissions often focus on general practitioners’ (GPs’) and out-of-hours (OOH) doctors’ role. The aim of the present study was to investigate these doctors’ role in emergency admissions to somatic hospitals in the Norwegian public healthcare system, where GPs and OOH doctors have a distinct gatekeeper function.

Methods
A cross-sectional analysis was performed by linking data from the Norwegian Patient Registry (NPR) and the physicians’ claims database. The referring doctor was defined as the physician who had sent a claim for a consultation with the patient within 24 h prior to an emergency admission. If there was no claim registered prior to hospital arrival, the admission was defined as direct, representing admissions from ambulance services, referrals from nursing home doctors, and admissions initiated by in-hospital doctors.

Results
In 2014 there were 497,587 emergency admissions to somatic hospitals in Norway after excluding birth related conditions. Direct admissions were most frequent (43%), 31% were referred by OOH doctors, 25% were referred by GPs, whereas only 2% were referred from outpatient clinics or private specialists with public contract. Direct admissions were more common in central areas (52%), here GPs’ referrals constituted only 16%. The prehospital paths varied with the hospital discharge diagnosis. For anaemias, 46–49% were referred by GPs, for acute appendicitis and mental/alcohol related disorders 52 and 49% were referred by OOH doctors, respectively. For both malignant neoplasms and cardiac arrest 63% were direct admissions.

Conclusions
GPs or OOH doctors referred many emergencies to somatic hospitals, and for some clinical conditions GPs’ and OOH doctors’ gatekeeping role was substantial. However, a significant proportion of the emergency admissions was direct, and this reduces the impact of the GPs’ and OOH doctors’ gatekeeper roles, even in a strict gatekeeping system.
Analyzing ancient Chinese handmade Lajian paper exhibiting an orange-red color
Authors: Luo Yanbing , Chen Jiali , Yang Cheng , Huang Yifan 
Published: August 2019

Abstract
The ancient technique employed to produce Lajian paper—a very famous Chinese traditional handmade paper—has been lost. However, widespread restoration of the traditional skills used in the paper’s production is emerging in China. A small piece of orange-red Lajian paper dating from the Qing dynasty and decorated with flecked Ag and Au was chosen as the subject of this study to investigate the paper’s composition and structure using optical microscopy (OM), SEM–EDS, X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, and FTIR spectroscopy. The results revealed that the raw materials constituting the Lajian paper were bast and bamboo fibers. Each of the two paper layers was treated differently. First, the upper orange-red layer was treated with kaolinite and organic turmeric. Next, inorganic minium nt was used to obtain an orange-red color. Animal glue was used as a binding medium. Finally, the dyed surface was waxed with Chinese insect wax and then polished with small stones to form a smooth coating. The same treatment, except for the intentional use of inorganic pigment, was applied to the backing layer. Turmeric dye, minium, and wax coating protected Lajian paper from humidity and mold growth while maintaining the stability of the paper.
Extending the role of headquarters beyond the firm boundary: entrepreneurial alliance innovation
Authors: Kim Jaeho , Wu Andy 
Published: August 2019

AbstractPrior research on corporate headquarters (CHQ) characteristics identifies the impact of CHQ location and composition on the innovation outcomes of internal subsidiaries. However, given that external strategic alliances with high-tech entrepreneurial firms represent a key source of innovation for the corporation, corporations must also consider how their choices of CHQ location and composition affect the innovation outcomes of these partners. In a study of 36 incumbent pharmaceutical corporations in 377 strategic alliances with 143 VC-backed biotechnology startups, we leverage detailed hand-collected data on CHQ locations and functions to estimate the effect of the CHQ on the innovation performance of the corporations’ entrepreneurial alliance partners. We find that a 1000-km decrease in CHQ–partner distance leads to an increase of 28 forward citations for the alliance partner, i.e., a 1% decrease in the distance is associated with a 1.7% increase in innovation performance. We find that the co-located presence of the corporation’s R&D function at the CHQ attenuates the benefit of CHQ–partner proximity, particularly for alliances structured for horizontal collaboration at the same part of the value chain. This study contributes to the literatures on both CHQ design and technology alliances.
21-Gene Recurrence Score Adds Significant Value for Grade 3 Breast Cancers: Results From a National Cohort
Authors: Iorgulescu J. Bryan , Freedman Rachel A. , Lester Susan C. , Mittendorf Elizabeth A. , Brock Jane E. 
Published: August 2019

PURPOSEThe 21-gene recurrence score (RS) is used to identify patients with hormone receptor–positive early-stage breast cancer who may benefit from the addition of chemotherapy to endocrine therapy. We hypothesized that many women with poor prognostic histopathologic grade 3 disease may be offered chemotherapy irrespective of RS results, of whom a subset may not benefit from adjuvant chemotherapy.PATIENTS AND METHODSA total of 30,864 women in the National Cancer Database were diagnosed with pT1c to pT2, pN0 to pN1, grade 3 estrogen receptor–positive, human epidermal growth factor receptor 2–negative invasive breast carcinoma from 2010 to 2015. RS was stratified as low (less than 18), intermediate (18 to 30), and high (31 or more). Overall survival by RS was evaluated by Kaplan-Meier, log-rank, and multivariable proportional hazards, with adjustment for relevant clinical and demographic variables.RESULTSRS testing in grade 3 cancers increased between 2010 and 2015 (pN0, 53% to 72%; pN1, 16% to 36%). Among the 13,558 women with pN0 and the 2,840 with pN1 disease with RS testing, 27.1% and 30.0%, respectively, had low scores (less than 18). The 5-year overall survival rate for patients with a high RS, but not low RS, was significantly higher with chemotherapy ( v no chemotherapy; absolute differences: high RS pN0 = 12.2% and pN1 = 25.5%, both P < .001; low RS pN0 = 2.5%, P = .07; and pN1 = 1.0%, P = .27), findings that were reinforced in multivariable analyses risk adjusted by clinicopathologic characteristics.CONCLUSIONIncreased use of RS may help to better tailor treatment recommendations by stratifying patients with grade 3 disease into those who will and will not derive survival benefit and should be considered in all patients with estrogen receptor–positive/human epidermal growth factor receptor 2–negative T1c to T2, N0 to N1 disease.
The auxiliary ESCRT complexes provide robustness to cold in poikilothermic organisms
Authors: Bäumers Miriam , Klose Sven , Brüser Christian , Haag Carl , Hänsch Sebastian , Pannen Hendrik , Weidtkamp-Peters Stefanie , Feldbrügge Michael , Klein Thomas 
Published: August 2019

The ESCRT pathway, comprising the in sequence acting ESCRT-0, -I, -II, -III and Vps4 complexes, conducts the abscission of membranes away from the cytosol. Whereas the components of the central ESCRT-III core complex have been thoroughly investigated, the function of the components of the associated two auxiliary ESCRT sub-complexes are not well-understood in metazoans, especially at the organismal level.
We here present the developmental analysis of the Drosophila orthologs of the auxiliary ESCRTs Chmp5 and Ist1, DChmp5 and DIst1, which belong to the two auxiliary sub-complexes. While each single null mutant displayed mild defects in development, the Dist1 Dchmp5 double mutant display a severe defect, indicating that the two genes act synergistically, but in separate pathway. Moreover, the presented results indicate that the auxiliary ESCRTs provide robustness against cold during development of diverse poikilothermic organisms, probably by preventing the accumulation of the ESCRT-III core component Shrub on the endosomal membrane.
Fibroblast growth factor-6 enhances CDK2 and MATK expression in microvesicles derived from human stem cells extracted from exfoliated deciduous teeth
Authors: Othman Ahmed , Mubarak Rabab , Sabry Dina 
Published: August 2019

Background: Stem cells from human exfoliated deciduous teeth (SHEDs) are considered one of the most convenient sources of adult stem cells. This study aimed to examine the effect of fibroblast growth factor 6 (FGF-6) on SHEDs and evaluate CDK2 and MATK gene expression in SHED-derived microvesicles (MVs). SHEDs were cultured from deciduous teeth pulp. Methods: SHEDs were divided into two groups: the control group and test groups, with and without FGF-6 supplementation, respectively. After the third passage, SHED proliferation was assessed by MTT assay. MVs were purified and CDK2 and MATK gene expression was assessed by real-time polymerase chain reaction. SHEDs were identified by their positivity for CD90 and CD73, and negativity for CD45 and CD34. Results: SHEDs proliferation in the test group was significantly higher than in the control group (P<0.001). mRNA from SHED-derived MVs from the test group exhibited a markedly elevated expression of CDK2 and MATK, (P<0.002 and P<0.005, respectively) in comparison with those of the control group. FGF-6 enhanced the proliferation of SHEDs. Proliferation enhancement is favorable for the production of a large number of stem cells, which will then be beneficial for cell-based therapies. Conclusions: CDK2 and MATK genes in SHED-derived MVs can be used as molecular biomarkers for SHED proliferation.
Anti-hypercholesterolemic effect of Zingiber montanum extract
Authors: Paramita Swandari , Aminyoto Meiliati , Ismail Sjarif , Arung Enos Tangke 
Published: August 2019

Background: High cholesterol levels (hypercholesterolemia) has been recognized to cause various disease, most notably the cardiovascular disease. Unfortunately, most anti-hypercholesterolemic drugs deliver several side effects for patients, by which medicinal plants have begun to attract attention for treating hypercholesterolemia. Among others, Zingiber montanum (J.König) Link ex A.Dietr. has traditionally been taken for treating health problems caused by high cholesterol levels. Hence, this work aimed at investigating anti-hypercholesterolemic effects offered by the plant. Methods: This study was conducted on 30 male Wistar rats. During experiments, the subjects were divided into 6 groups (n=5), i.e. no treatment (Group 1, control); high-fat diet (Group 2, control); high-fat diet with simvastatin (Group 3); high-fat diet with plant extracts (Group 4-6 with 100, 200, and 400 mg/kg BW, respectively). After 4 weeks of treatments, blood samples were collected from each group. Then, plasma concentrations of triglycerides, total cholesterol, high density lipoproteins (HDL), and low density lipoproteins (LDL) were measured. Results: There were significant differences in total cholesterol (p=0.000), LDL (p=0.000) and triglycerides (p=0.001) for Groups 4-6 (high-fat diet treated with different plant extract doses) in comparison with Group 2 (high-fat diet, control). Meanwhile, there were no significant differences in HDL levels (p=0.830) between Group 2 (high-fat diet, control) and other groups. The results also showed significant differences in total cholesterol and LDL for subjects treated with plant extracts (Group 4, 100 mg/kg BW, p=0.000; Group 5, 200 mg/kg BW, p=0.000; Group 6, 400 mg/kg BW, p=0.000) compared to Group 2 (high-fat diet, control). Then, treatments with 400 mg/kg BW (Group 6) discovered significant reductions in total cholesterol, LDL, and triglycerides (p=0.030). Conclusion: Therefore, Z. montanum has been discovered to deliver anti-hypercholesterolemic effects to experimental subjects, making it potential to act as a natural source of anti-hypercholesterolemic agents.
Association of thrombocytopenia with splenomegaly in malaria patients in East Kalimantan: A cross-sectional, retrospective study
Authors: Siagian Loly R.D. , Lumbantoruan Vera M. , Hasanah Nurul , Sihotang Fransiska A. , Gunawan Carta 
Published: August 2019

Background: Malaria still presents as a major health problem in Indonesia and specifically in East Kalimantan. One common sign found in malaria patient is thrombocytopenia, the mechanism of which is still unclear. Several studies have suggested some mechanisms, one of which is splenomegaly. This study aimed to discover the association between thrombocytopenia and splenomegaly of malaria patients in East Kalimantan. Methods: This study was a descriptive retrospective study with clinical and laboratory data obtained from the medical records of malaria patients in four major public hospitals from January 2015 to July 2018. The association between thrombocytopenia with splenomegaly was analysed using Chi-Square test. Results: A total of 215 patients were included; 189 male (87.9%) and 26 female (12.1%). The etiologic agents found in these patients were Plasmodium vivax (43.2%), Plasmodium falciparum (42.8%), and mixed infection (Plasmodium falciparum and Plasmodium vivax) (4.6%). The thrombocyte count was normal in 28 patients (13%) and decreased in 187 patients (87%). Among patients with thrombocytopenia, the percentage of mild, moderate and severe thrombocytopenia was 18.2%, 43.8% and 33%, respectively. Splenomegaly was found in only 11 patients (5.1%). We found no association between thrombocytopenia with splenomegaly (p=0.61). Conclusions: We conclude that thrombocytopenia is not associated with splenomegaly in these malaria patients.
Development of an informatics system for accelerating biomedical research.
Authors: Navale Vivek , Ji Michele , Vovk Olga , Misquitta Leonie , Gebremichael Tsega , Garcia Alison , Fann Yang , McAuliffe Matthew 
Published: August 2019

Biomedical translational research can benefit from informatics system that support the confidentiality, integrity and accessibility of data. Such systems require functional capabilities for researchers to securely submit data to designated biomedical repositories. Reusability of data is enhanced by the availability functional capabilities that ensure confidentiality, integrity and access of data. A biomedical research system was developed by combining common data element methodology with a service-oriented architecture to support multiple disease focused research programs. Seven service modules are integrated together to provide a collaborative and extensible web-based environment. The modules - Data Dictionary, Account Management, Query Tool, Protocol and Form Research Management System, Meta Study, Repository Manager and globally unique identifier (GUID) facilitate the management of research protocols, submitting and curating data (clinical, imaging, and derived genomics) within the associated data repositories. No personally identifiable information is stored within the repositories. Data is made findable by use of digital object identifiers that are associated with the research studies. Reuse of data is possible by searching through volumes of aggregated research data across multiple studies. The application of common data element(s) methodology for development of content-based repositories leads to increase in data interoperability that can further hypothesis-based biomedical research.
Diversity and distribution of fish fauna of upstream and downstream areas at Koto Panjang Reservoir, Riau Province, Indonesia
Authors: Aryani Netti , Suharman Indra , Azrita Azrita , Syandri Hafrijal , Mardiah Ainul 
Published: August 2019

Background: The capture fishery sectors in the river and reservoir play an important role in the Indonesian economy through increased income and diversification of livelihoods. The present study was conducted to ascertain fish diversity and their distribution pattern in the upstream and downstream areas of Koto Panjang Reservoir, Riau Province-Indonesia. Methods: Fish samples were collected for a period of 12 months using a variety of fish nets at four sites; Koto Mesjid (KM) and Batu Bersurat (BB), located in the upstream area of Koto Panjang Reservoir and Rantau Berangin (RB) and Kuok (KK), located in the downstream area of Koto Panjang Reservoir. Data obtained were analyzed using standard taxonomic keys based on morphometric characters. Results: A total of 44 species belonging 19 families and 33 genera were recorded in the study area. Alpha diversity indices showed that fish diversity in this area was quite high (Shannon’s index = 2.10 and Simpson-D = 0.21) and evenness was low (evenness H/S =0.19). The ﬁsh in KM and BB sites (upstream) were from eight and 11 families, respectively. In RB and KK sites (downstream), fish were from 16 and 15 families, respectively. In KM, BB, RB and KK sites, the dominant family was Cyprinidae, comprising 33.45%, 50.95%, 43.04% and 39.35% of all fish caught at each site, respectively. Exotic species, especially Nile tilapia, were 20.15%, 14.11%, 5.62%, and 5.34%, respectively. Some differences were also noted between the upstream and downstream reservoirs, with a slight increase in exotic species in the upstream reservoir over the study period (from 11.39% vs. 34.66%), corresponding to decrease of native species (from 88.61% vs. 65.34%). Conclusions: The diversity and distribution of fish fauna were varied in upstream and downstream areas of Koto Panjang Reservoir. The exotic species were found to be dominant in the upstream reservoir areas.
Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: A living systematic review
Authors: Counotte Michel Jacques , Meili Kaspar Walter , Taghavi Katayoun , Calvet Guilherme , Sejvar James , Low Nicola 
Published: August 2019

Background:The Zika virus (ZIKV) caused a large outbreak in the Americas leading to the declaration of a Public Health Emergency of International Concern in February 2016. A causal relation between infection and adverse congenital outcomes such as microcephaly was declared by the World Health Organization (WHO) informed by a systematic review structured according to a framework of ten dimensions of causality, based on the work of Bradford Hill. Subsequently, the evidence has continued to accumulate, which we incorporate in regular updates of the original work, rendering it a living systematic review.Methods:We present an update of our living systematic review on the causal relation between ZIKV infection and adverse congenital outcomes and between ZIKV and GBS for four dimensions of causality: strength of association, dose-response, specificity, and consistency. We assess the evidence published between January 18, 2017 and July 1, 2019.Results:We found that the strength of association between ZIKV infection and adverse outcomes from case-control studies differs according to whether exposure to ZIKV is assessed in the mother (OR 3.8, 95% CI: 1.7-8.7, I2=19.8%) or the foetus/infant (OR 37.4, 95% CI: 11.0-127.1, I2=0%). In cohort studies, the risk of congenital abnormalities was 3.5 times higher after ZIKV infection (95% CI: 0.9-13.5, I2=0%). The strength of association between ZIKV infection and GBS was higher in studies that enrolled controls from hospital (OR: 55.8, 95% CI: 17.2-181.7, I2=0%) than in studies that enrolled controls at random from the same community or household (OR: 2.0, 95% CI: 0.8-5.4, I2=74.6%). In case-control studies, selection of controls from hospitals could have biased results.Conclusions:The conclusions that ZIKV infection causes adverse congenital outcomes and GBS are reinforced with the evidence published between January 18, 2017 and July 1, 2019.
Impact of cigarette price increase on health and financing outcomes in Vietnam
Authors: Wu Daphne C. , Jha Prabhat , Dutta Sheila , Marquez Patricio 
Published: August 2019

Background: Vietnam had about 15 million male smokers in 2015. To reduce adult tobacco use in Vietnam through an increase in the excise tax of cigarettes, we conducted an extended cost-effectiveness analysis to examine the impact of two scenarios of cigarette price increases. Methods: We estimated, across income quintiles, the life-years gained, treatment cost averted, number of men avoiding catastrophic health expenditure and extreme poverty, and additional tax revenue under a 32% and a 62% increase in cigarette price through increased excise tax. We considered only male smokers as they constitute majority of the smokers. We used the average price elasticity of demand for cigarettes in Vietnam of -0.53. Results: Under both scenarios of price increase, men in the poorest quintile would gain about 2.8 times the life-years and avert 2.5 times the treatment cost averted by the richest quintile. With a 32% price increase, about 285,000 men would avoid catastrophic health expenditure; as a result, about 95,000 men, more than half of whom in the poorest quintile, would avoid falling into extreme poverty. In contrast to the distribution of health benefits, the extra revenue generated from men in the richest quintile would be 1.2 times that from the poorest quintile. With a 62% price increase, about 553,000 men would avoid catastrophic health expenditure, and about 183,000 men, more than half of whom in the poorest quintile, would avoid falling into extreme poverty. The extra revenue generated from men in the richest quintile would be 3.8 times that from the poorest quintile. Conclusions: Higher cigarette prices would particularly benefit the poorest income quintile of Vietnamese, in terms of health and financial outcomes. Thus, tobacco taxes are an effective way to improve health and reduce poverty in Vietnam.
Evaluation of wettability characteristics and adhesion of resin composite to photo-polymerized pulp-capping materials with and without bioactive glass
Authors: Tulumbaci Fatih , Korkut Emre , Ozer Hazal , Özcan Mutlu 
Published: August 2019

Objective: The purpose of this study was to evaluate mechanical and physical properties of three different light-curable resin-based materials (TheraCal LC, Biner LC, and CalciPlus LC) with or without BAG. Material and Methods: 15 cylindrically shaped specimens (n=5) were prepared for contact angle test. The test values (?) were determined with the sessile drop method using three test liquids. 30 acrylic cylindrical blocks were prepared, and holes of (6mmx1mm) were made in the center of the cylinders for shear bond strength test. An adhesive system and a restorative composite material were applied via cylindrically shaped plastic tubes of (2mmx2mm) at the center of the light-curable resin-based material surfaces. The specimens were mounted in a universal testing machine. A crosshead speed of 1 mm/min was applied to each specimen using a knife-edge blade. Results: The highest (74.77°±13.56) and the lowest (35.35°±12.89) contact angle values were recorded for the MB Biner LC group and the CalciPlus LC, respectively. Statistically significant differences observed in contact angle values between the test groups (p<0.05). The surface free energy of Biner LC (?S 36.22) was lower than that of TheraCal LC (?S 44.70) and CalciPlus LC (?S 46.20) (p<0.05). There was no significant difference in shear bond strength values between TheraCal LC and CalciPlus LC (p>0.05). Conclusions: Hydrophilic property of Theracal LC and Calciplus LC resulted in better bonding strength in these materials. The BAG used in Calciplus LC did not adversely affect mechanical and surface properties of the material.