bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adult psychosocial outcomes of men and women who were looked-after or adopted as children: prospective observational study
Authors: Teyhan Alison , Wijedasa Dinithi , Macleod John 
Published: February 2018

ObjectiveTo investigate whether men and women who were looked-after (in public care) or adopted as children are at increased risk of adverse psychological and social outcomes in adulthood.Design, settingProspective observational study using the Avon Longitudinal Study of Parents and Children, which recruited pregnant women and their male partners in and around Bristol, UK in the early 1990s.Participants8775 women and 3654 men who completed questionnaires at recruitment (mean age: women 29; men 32) and 5 years later.ExposureChildhood public care status: looked-after; adopted; not looked-after or adopted (reference group).OutcomesSubstance use (alcohol, cannabis, tobacco) prepregnancy and 5 years later; if ever had addiction; anxiety and depression during pregnancy and 5 years later; if ever had mental health problem; social support during pregnancy; criminal conviction.ResultsFor women, 2.7% were adopted and 1.8% had been looked-after; for men, 2.4% and 1.4%, respectively. The looked-after group reported the poorest outcomes overall, but this was not a universal pattern, and there were gender differences. Smoking rates were high for both the looked-after (men 47%, women 58%) and adopted (men 44%, women 40%) groups relative to the reference group (both 28%). The looked-after group were at increased risk of a high depression score (men: 26% vs 11%, OR 2.9 (95% CI 1.5 to 5.6); women: 24% vs 9%, 3.4 (2.2 to 5.0)). A high anxiety score was reported by 10% of the reference women, compared with 26% of those looked-after (3.0 (2.0 to 4.5)) and 17% of those adopted (1.8 (1.2 to 2.6)). Looked-after men and women reported the lowest social support, while criminal convictions and addiction were highest for looked-after men. Adjustment for adult socioeconomic position generally attenuated associations for the looked-after group.ConclusionsThe needs of those who experience public care as children persist into adulthood. Health and social care providers should recognise this.
Cohort profile: ‘Centenari a Trieste’ (CaT), a study of the health status of centenarians in a small defined area of Italy
Authors: Tettamanti Mauro , Marcon Gabriella 
Published: February 2018

PurposeCentenarians, a segment of the population which some 50 years ago comprised only a few individuals, now count thousands in many countries, and demographic projections forecast that this growth will continue. The study of this new population will give us new information on extreme longevity and help prepare for their health and social needs. The aim of the Centenari a Trieste study is to describe the health and health service use by centenarians, with specific focus on cognitive status.ParticipantsThis is a population-based study of centenarians living in the province of Trieste (Italy), a small area with a high prevalence of centenarians and a close network of health and social services, which makes it possible to conduct a study. Consenting individuals were visited by a clinician, tested by neuropsychologists and also gave a sample of their blood. Administrative data were retrieved as well.Findings to dateOf the 163 centenarians, 70 could be contacted and participated in the study. The main reasons for non-participation were impossibility to contact the subject (70) and death (20). Centenarians were mostly women (90%), tended to live in a nursing home (60%) and were generally severely functionally impaired (Barthel Index <50: 61%). Data from the administrative database showed that about one out of five needed hospitalisation in the preceding year and more than three out of four had at least one drug prescription.Future plansIn 2017, we started a new wave of the study enrolling people who had just become centenarian and reassessing subjects already seen; we hope to extend this recruitment in the next years. Subjects are now examined also by cardiologists and dental specialists. We are collecting further different biological specimens to investigate new hypotheses on the cognitive function of the centenarians.
New mechanism to identify cost savings in English NHS prescribing: minimising ‘price per unit’, a cross-sectional study
Authors: Croker Richard , Walker Alex J , Bacon Seb , Curtis Helen J , French Lisa , Goldacre Ben 
Published: February 2018

BackgroundMinimising prescription costs while maintaining quality is a core element of delivering high-value healthcare. There are various strategies to achieve savings, but almost no research to date on determining the most effective approach. We describe a new method of identifying potential savings due to large national variations in drug cost, including variation in generic drug cost, and compare these with potential savings from an established method (generic prescribing).MethodsWe used English National Health Service (NHS) Digital prescribing data, from October 2015 to September 2016. Potential cost savings were calculated by determining the price per unit (eg, pill, millilitre) for each drug and dose within each general practice. This was compared against the same cost for the practice at the lowest cost decile to determine achievable savings. We compared these price-per-unit savings to the savings possible from generic switching and determined the chemicals with the highest savings nationally. A senior pharmacist manually assessed whether a random sample of savings were practically achievable.ResultsWe identified a theoretical maximum of £410 million of savings over 12 months. £273 million of these savings were for individual prescribing changes worth over £50 per practice per month (mean annual saving £33 433 per practice); this compares favourably with generic switching, where only £35 million of achievable savings were identified. The biggest savings nationally were on glucose blood testing reagents (£12 million), fluticasone propionate (£9 million) and venlafaxine (£8 million). Approximately half of all savings were deemed practically achievable.DiscussionWe have developed a new method to identify and enable large potential cost savings within NHS community prescribing. Given the current pressures on the NHS, it is vital that these potential savings are realised. Our tool enabling doctors to achieve these savings is now launched in pilot form at OpenPrescribing.net. However, savings could potentially be achieved more simply through national policy change.
Risk factors for difficult peripheral venous cannulation in hospitalised patients. Protocol for a multicentre case–control study in 48 units of eight public hospitals in Spain
Authors: Rodriguez-Calero Miguel Angel , Fernandez-Fernandez Ismael , Molero-Ballester Luis Javier , Matamalas-Massanet Catalina , Moreno-Mejias Luis , de Pedro-Gomez Joan Ernest , Blanco-Mavillard Ian , Morales-Asencio Jose Miguel 
Published: February 2018

IntroductionPatients with difficult venous access experience undesirable effects during healthcare, such as delayed diagnosis and initiation of treatment, stress and pain related to the technique and reduced satisfaction. This study aims to identify risk factors with which to model the appearance of difficulty in achieving peripheral venous puncture in hospital treatment.Methods and analysisCase–control study. We will include adult patients requiring peripheral venous cannulation in eight public hospitals, excluding those in emergency situations and women in childbirth or during puerperium. The nurse who performs the technique will record in an anonymised register variables related to the intervention. Subsequently, a researcher will extract the health variables from the patient’s medical history. Patients who present one of the following conditions will be assigned to the case group: two or more failed punctures, need for puncture support, need for central access after failure to achieve peripheral access, or decision to reject the technique. The control group will be obtained from records of patients who do not meet the above conditions. It has been stated a minimum sample size of 2070 patients, 207 cases and 1863 controls.A descriptive analysis will be made of the distribution of the phenomenon. The variables hypothesised to be risk factors for the appearance of difficult venous cannulation will be studied using a logistic regression model.Ethics and disseminationThe study was funded in January 2017 and obtained ethical approval from the Research Ethics Committee of the Balearic Islands. Informed consent will be obtained prior to data collection. Results will be published in a peer-reviewed scientific journal.
Long-term trends of liver cancer mortality by gender in urban and rural areas in China: an age-period-cohort analysis
Authors: Sun Yuanyuan , Wang Yanhong , Li Mengmeng , Cheng Kailiang , Zhao Xinyu , Zheng Yuan , Liu Yan , Lei Shaoyuan , Wang Li 
Published: February 2018

ObjectivesTo provide an up-to-date overview of long-term trends of liver cancer mortality and evaluate the effects attributable to age, period and cohort in Chinese population stratified by gender and urban/rural areas.MethodsPopulation and liver cancer mortality data were obtained based on the Disease Surveillance Points in China from 1991 to 2014. To examine the time trends of liver cancer mortality by gender in urban and rural areas in China, Joinpoint analysis was used to estimate the annual per cent change. The intrinsic estimator, a method of age-period-cohort analysis to estimate age, period and cohort effects simultaneously, was used to analyse the underlying mechanisms for liver cancer mortality trends in the aforementioned four groups.ResultsWe observed a significant decline in liver cancer mortality for urban men (average annual per cent change (AAPC)=−1.1%, P<0.05) and urban women (AAPC=−1.4%, P<0.05), while the liver cancer mortality remained stable for rural men (AAPC=−0.1%, P>0.05) and rural women (AAPC=−0.9%, P>0.05). Compared with the 15–19 age group, the liver cancer mortality risk of the 85 and above age group increased 65 and 42 times for urban and rural men, and 102 and 70 times for urban and rural women. From the 1990–1994 period to the 2005–2009 period, the risk increased 56% and 92% for urban and rural men, and 30% and 74% for urban and rural women. Compared with period and cohort effects, age effects were the most influential factor in liver cancer mortality.ConclusionsAs the status of ageing population in China gets worse, the burden caused by liver cancer mortality could still be a great challenge for China in the future. The disparity of liver cancer mortality trends between urban and rural residents can be attributed to period effects, referring to the unequal medical levels and resources between urban and rural areas.
Telephone or integrated contraception counselling before abortion: impact on method choice and receipt
Authors: Lohr Patricia A , Aiken Abigail R A , Forsyth Tracey , Trussell James 
Published: February 2018

BackgroundIncorporating thorough contraception counselling into an abortion consultation is challenging. We compared contraceptive choices and methods received between two counselling models: (1) telephone counselling separate from the abortion consultation and (2) face-to-face counselling integrated into the consultation.MethodsWe obtained de-identified data on demographic characteristics and contraceptive methods that had been chosen and received by women who had an abortion at British Pregnancy Advisory Service between 2011 and 2014 and had a choice of counselling models. We compared the characteristics of women who chose each model of counselling and the contraceptive methods they chose and received using Fisher’s exact test, and used logistic regression to explore associations between counselling model and choice and receipt of Tier 1 contraceptive methods (intrauterine contraception, implant, sterilisation), controlling for covariates.ResultsThe sample included 18 573 women. Women choosing telephone counselling were more likely to be non-White (34% vs 22%, P<0.001), to report prior difficulty obtaining contraception (40% vs 3%, P<0.001), and to have not used contraception at conception (37.1% vs 33.8%, P<0.001). Overall, 93% of women chose a contraceptive method after counselling. Telephone counselling was significantly associated with both choosing and receiving a Tier 1 method (OR 1.80, 95% CI 1.66 to 1.96 and OR 1.60, 95% CI 1.42 to 1.71, respectively). Fewer women who had telephone counselling received a less effective method (eg, condom, diaphragm) compared with those who chose integrated counselling (6.0% vs 19.2%, P<0.001).DiscussionTelephone-based contraception counselling separate from the abortion consultation may serve some women better than integrated counselling, particularly those reporting past difficulty obtaining contraception.
PD-1 and PD-L1 expression in thymic epithelial tumours and non-neoplastic thymus
Authors: Bagir Emine Kilic , Acikalin Arbil , Avci Alper , Gumurdulu Derya , Paydas Semra 
Published: February 2018

AimsWe explored the relationships between programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) expression and the pathological and clinical features of thymic epithelial tumours and thymic hyperplasia.MethodsWe evaluated PD-1 and PDL-1 expressions within epithelial and microenvironmental components in thymic epithelial tumours (n=44) and thymic hyperplasias (n=8), immunohistochemically. We compared the results with demographic, clinical and histopathological features of the cases.ResultsWe found 48% epithelial expression and 82.7% microenvironment expression for PD-1 and 11.5% epithelial expression and 34.6% microenvironment expression for PD-L1. There was no PD-1 expression, in either the epithelial or microenvironment, in the thymic hyperplasia group. PD-1 and PD-L1 positivity was more significant in thymic epithelial tumours than thymic hyperplasia. Patients with PD-1-positive microenvironments exhibited significantly shorter mean estimated survival time than their negative counterparts.ConclusionThese findings suggest that anti-PD-1 and anti-PD-L1 therapies may benefit patients due to high release of PD-1 and PD-L1 in thymic epithelial tumours.
CC chemokine receptor 2 promotes recruitment of myeloid cells associated with insulin resistance in nonalcoholic fatty liver disease
Authors: Parker Richard , Weston Christopher J. , Miao Zhenhua , Corbett Christopher , Armstrong Matthew J. , Ertl Linda , Ebsworth Karen , Walters Matthew J. , Baumart Trageen , Newland Dale , McMahon Jeff , Zhang Penglie , Singh Rajinder , Campbell James , Newsome Philip N. , Charo Israel , Schall Thomas J. , Adams David H. 
Published: February 2018

Nonalcoholic fatty liver disease (NAFLD) is a common disease, closely associated with obesity and insulin resistance. We investigated the presence of a subset of myeloid cells associated with metabolic disturbance in the liver of patients with NAFLD and a murine model of obesity-induced liver disease. Gene and protein expression in liver and serum was investigated with RT-PCR or ELISA and correlated to clinical disease. Liver-infiltrating immune cells were isolated from normal or diseased human liver for flow cytometric analysis. In animal experiments, mice were fed a high-fat diet (60% of calories from fat) for 16 wk, or high-fat diet with 30% fructose for 32 wk to induce steatohepatitis and fibrosis. A small molecule inhibitor of CC chemokine receptor 2 (CCR2), CCX872, was administered to some mice. A subset of CD11c+CD206+ immune cells was enriched in human liver tissue, and greater infiltration was observed in NAFLD. The presence of CD11c+CD206+ myeloid cells correlated with systemic insulin resistance. CD11c+CD206+ cells expressed high levels of CCR2, and liver CC chemokine ligand 2 (CCL2) expression was increased in nonalcoholic steatohepatitis and correlated with disease activity. In mice, CCR2 inhibition reduced infiltration of liver CD11b+CD11c+F4/80+ monocytes, which are functional homologs of human CD11c+CD206+ cells, and improved liver injury and glycemic control. A role for CCR2/CCL2 in human NAFLD has long been postulated. These data confirm a role for this chemokine/receptor axis, through mediating adipose and hepatic infiltration of myeloid cells. Inhibition of CCR2 improved hepatic inflammation and fibrosis in murine models of NAFLD. These data confirm the rationale for targeting CCR2 to treat NAFLD. NEW & NOTEWORTHY These data show for the first time that CD11c+CD206+ myeloid cells, previously associated with human adipose tissue inflammation, infiltrate into liver tissue in nonalcoholic fatty liver disease. These cells express CCR2. Inhibition of CCR2 in mice inhibits hepatic inflammation caused by a murine homolog of these myeloid cells and improves experimental liver disease.
Individualized estimation of human core body temperature using noninvasive measurements
Authors: Laxminarayan Srinivas , Rakesh Vineet , Oyama Tatsuya , Kazman Josh B. , Yanovich Ran , Ketko Itay , Epstein Yoram , Morrison Shawnda , Reifman Jaques 
Published: February 2018

A rising core body temperature (Tc) during strenuous physical activity is a leading indicator of heat-injury risk. Hence, a system that can estimate Tcin real time and provide early warning of an impending temperature rise may enable proactive interventions to reduce the risk of heat injuries. However, real-time field assessment of Tcrequires impractical invasive technologies. To address this problem, we developed a mathematical model that describes the relationships between Tcand noninvasive measurements of an individual’s physical activity, heart rate, and skin temperature, and two environmental variables (ambient temperature and relative humidity). A Kalman filter adapts the model parameters to each individual and provides real-time personalized Tcestimates. Using data from three distinct studies, comprising 166 subjects who performed treadmill and cycle ergometer tasks under different experimental conditions, we assessed model performance via the root mean squared error (RMSE). The individualized model yielded an overall average RMSE of 0.33 (SD = 0.18)°C, allowing us to reach the same conclusions in each study as those obtained using the Tcmeasurements. Furthermore, for 22 unique subjects whose Tcexceeded 38.5°C, a potential lower Tclimit of clinical relevance, the average RMSE decreased to 0.25 (SD = 0.20)°C. Importantly, these results remained robust in the presence of simulated real-world operational conditions, yielding no more than 16% worse RMSEs when measurements were missing (40%) or laden with added noise. Hence, the individualized model provides a practical means to develop an early warning system for reducing heat-injury risk.NEW & NOTEWORTHY A model that uses an individual’s noninvasive measurements and environmental variables can continually “learn” the individual’s heat-stress response by automatically adapting the model parameters on the fly to provide real-time individualized core body temperature estimates. This individualized model can replace impractical invasive sensors, serving as a practical and effective surrogate for core temperature monitoring.
Body map of regional vs. whole body sweating rate and sweat electrolyte concentrations in men and women during moderate exercise-heat stress
Authors: Baker Lindsay B. , Ungaro Corey T. , Sopeña Bridget C. , Nuccio Ryan P. , Reimel Adam J. , Carter James M. , Stofan John R. , Barnes Kelly A. 
Published: February 2018

This study determined the relations between regional (REG) and whole body (WB) sweating rate (RSR and WBSR, respectively) as well as REG and WB sweat Na+concentration ([Na+]) during exercise. Twenty-six recreational athletes (17 men, 9 women) cycled for 90 min while WB sweat [Na+] was measured using the washdown technique. RSR and REG sweat [Na+] were measured from nine regions using absorbent patches. RSR and REG sweat [Na+] from all regions were significantly ( P < 0.05) correlated with WBSR ( r = 0.58–0.83) and WB sweat [Na+] ( r = 0.74–0.88), respectively. However, the slope and y-intercept of the regression lines for most models were significantly different than 1 and 0, respectively. The coefficients of determination ( r2) were 0.44–0.69 for RSR predicting WBSR [best predictors: dorsal forearm ( r2 = 0.62) and triceps ( r2 = 0.69)] and 0.55–0.77 for REG predicting WB sweat [Na+] [best predictors: ventral forearm ( r2 = 0.73) and thigh ( r2 = 0.77)]. There was a significant ( P < 0.05) effect of day-to-day variability on the regression model predicting WBSR from RSR at most regions but no effect on predictions of WB sweat [Na+] from REG. Results suggest that REG cannot be used as a direct surrogate for WB sweating responses. Nonetheless, the use of regression equations to predict WB sweat [Na+] from REG can provide an estimation of WB sweat [Na+] with an acceptable level of accuracy, especially using the forearm or thigh. However, the best practice for measuring WBSR remains conventional WB mass balance calculations since prediction of WBSR from RSR using absorbent patches does not meet the accuracy or reliability required to inform fluid intake recommendations.NEW & NOTEWORTHY This study developed a body map of regional sweating rate and regional (REG) sweat electrolyte concentrations and determined the effect of within-subject (bilateral and day-to-day) and between-subject (sex) factors on the relations between REG and the whole body (WB). Regression equations can be used to predict WB sweat Na+concentration from REG, especially using the forearm or thigh. However, prediction of WB sweating rate from REG sweating rate using absorbent patches does not reach the accuracy or reliability required to inform fluid intake recommendations.