bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exercise referral schemes enhanced by self-management strategies to reduce sedentary behaviour and increase physical activity among community-dwelling older adults from four European countries: protocol for the process evaluation of the SITLESS randomised controlled trial
Authors: Coll-Planas Laura , Blancafort Alias Sergi , Tully Mark , Caserotti Paolo , Giné-Garriga Maria , Blackburn Nicole , Skjødt Mathias , Wirth Katharina , Deidda Manuela , McIntosh Emma , Rothenbacher Dietrich , Gallardo Rodríguez Rodrigo , Jerez-Roig Javier , Sansano-Nadal Oriol , Santiago Marta , Wilson Jason , Guerra-Balic Míriam , Martín-Borràs Carme , Gonzalez Denise , Lefebvre Guillaume , Denkinger Michael , Kee Frank , Salvà Casanovas Antoni , Roqué i Figuls Marta 
Published: June 2019

IntroductionSITLESS is a randomised controlled trial determining whether exercise referral schemes can be enhanced by self-management strategies to reduce sedentary behaviour and increase physical activity in the long term, in community-dwelling older citizens. The intervention is complex and requires a process evaluation to understand how implementation, causal mechanisms and context shape outcomes. The specific aims are to assess fidelity and reach of the implementation, understand the contextual aspects of each intervention site, evaluate the mechanisms of impact, and explore perceived effects.Methods and analysisFollowing the Medical Research Council guidance on complex interventions, a combination of qualitative and quantitative procedures is applied, including observational checklists and attendance registries, standardised scales (ie, Marcus’s Self-Efficacy Questionnaire, Physical Activity Self-Regulation Scale and the Lubben Social Network Scale) at baseline, postintervention and follow-up assessments, semistructured questionnaires gathering contextual characteristics, and participant observations of the sessions. Semistructured interviews and focus groups with the participants and trainers are conducted at postintervention and during the follow-up to explore their experiences. Outcomes from the standardised scales are analysed as moderators within the impact evaluation. Descriptive results on context and perceived effects complement results on impact. The qualitative and quantitative findings will help to refine the logic model to finally support the interpretation of the results on the effectiveness of the intervention.Ethics and disseminationThe study design was approved by the respective Ethical Committee of Ramon Llull University, Southern Denmark, Northern Ireland and Ulm University. Participation is voluntary, and all participants are asked to sign informed consent before starting the study. A dissemination plan operationalises how to achieve a social impact by reaching academic and non-academic stakeholders. A data management plan describes the specific data sets and regulates its deposition and curation. All publications will be open access.Trial registration numberNCT02629666; Pre-results.
Health behaviours and mental and physical health status in older adults with a history of homelessness: a cross-sectional population-based study in England
Authors: Smith Lee , Veronese Nicola , López-Sánchez Guillermo Felipe , Moller Eloise , Johnstone James , Firth Joseph , Grabovac Igor , Yang Lin , Soysal Pinar , Jackson Sarah E 
Published: June 2019

ObjectivesThis study compared (1) levels of engagement in lifestyle risk behaviours and (2) mental and physical health status in individuals who have previously been homeless to those of individuals who have not.DesignCross-sectional.ParticipantsData were from participants (n=6931) of the English Longitudinal Study of Ageing.MeasuresParticipants reported whether they had ever been homeless. We used regression models to analyse associations between homelessness and (1) cigarette smoking, daily alcohol consumption and physical inactivity, adjusting for sociodemographic covariates (age, sex, ethnicity, highest level of education, marital status and household non-pension wealth) and (2) self-rated health, limiting long-standing illness, depressive symptoms, life satisfaction, quality of life and loneliness, adjusting for sociodemographics and health behaviours.Results104 participants (1.5%) reported having been homeless. Individuals who had been homeless were significantly more likely to be physically inactive (OR 1.62, 95% CI 1.44 to 2.52), report fair/bad/very bad self-rated health (OR 1.75, 95% CI 1.07 to 2.86), have a limiting long-standing illness (OR 2.66, 95% CI 1.65 to 4.30) and be depressed (OR 3.06, 95% CI 1.85 to 5.05) and scored lower on measures of life satisfaction (17.34 vs 19.96, p<0.001) and quality of life (39.02 vs 41.21, p=0.013). Rates of smoking (20.2% vs 15.4%, p=0.436), daily drinking (27.6% vs 22.8%, p=0.385) and loneliness (27.1% vs 21.0%, p=0.080) were also elevated.ConclusionsThose who were once homeless have poorer mental and physical health outcomes and are more likely to be physically inactive. Interventions to improve their health and quality of life are required.
Endoscopic ultrasound versus endoscopic retrograde cholangiopancreatography-guided biliary drainage for primary decompression of malignant biliary obstruction: protocol for a systematic review and meta-analysis of randomised controlled trials
Authors: Jin Zheng , Wei Yaping , Lin Huapeng , Huang Haitao , Lv Wen , Zhang Xiaofeng 
Published: June 2019

IntroductionCurrent evidence supporting the utility of endoscopic ultrasound-guided biliary drainage (EUS-BD) as a first-line treatment option for malignant biliary obstruction (MBO) is limited. We plan to provide a systematic review and meta-analysis to compare the performance of EUS-BD and endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD) as primary palliation of MBO.Methods and analysisRandomised controlled trials evaluating EUS-BD versus ERCP-BD in primary drainage of MBO will be searched in MEDLINE, EMBASE, Web of Science, the Cochrane Library, ClinicalTrials.gov and Google Scholar, from database inception to 31 October 2018. Data on study design, participant characteristics, intervention details and outcomes will be extracted. Primary outcomes to be assessed are technical and clinical success. Secondary outcomes include adverse events, stent patency, stent dysfunction, reinterventions, procedure duration and overall survival. Study quality will be assessed using the Cochrane Risk of Bias Tool. Meta-analysis will be performed using RevMan V.5.3 statistical software. Data will be combined with a random effect model. The results will be presented as a risk ratio for dichotomous data, weighted mean difference for continuous data and HR for time-to-event data. Publication bias will be visualised using funnel plots.Ethics and disseminationThis study will not use primary data, and therefore, formal ethical approval is not required. The findings will be disseminated through peer-reviewed journals and committee conferences.PROSPERO registration numberCRD42018117040
Factors supporting and constraining the implementation of robot-assisted surgery: a realist interview study
Authors: Randell Rebecca , Honey Stephanie , Alvarado Natasha , Greenhalgh Joanne , Hindmarsh Jon , Pearman Alan , Jayne David , Gardner Peter , Gill Arron , Kotze Alwyn , Dowding Dawn 
Published: June 2019

ObjectiveTo capture stakeholders’ theories concerning how and in what contexts robot-assisted surgery becomes integrated into routine practice.DesignA literature review provided tentative theories that were revised through a realist interview study. Literature-based theories were presented to the interviewees, who were asked to describe to what extent and in what ways those theories reflected their experience. Analysis focused on identifying mechanisms through which robot-assisted surgery becomes integrated into practice and contexts in which those mechanisms are triggered.SettingNine hospitals in England where robot-assisted surgery is used for colorectal operations.ParticipantsForty-four theatre staff with experience of robot-assisted colorectal surgery, including surgeons, surgical trainees, theatre nurses, operating department practitioners and anaesthetists.ResultsInterviewees emphasised the importance of support from hospital management, team leaders and surgical colleagues. Training together as a team was seen as beneficial, increasing trust in each other’s knowledge and supporting team bonding, in turn leading to improved teamwork. When first introducing robot-assisted surgery, it is beneficial to have a handpicked dedicated robotic team who are able to quickly gain experience and confidence. A suitably sized operating theatre can reduce operation duration and the risk of de-sterilisation. Motivation among team members to persist with robot-assisted surgery can be achieved without involvement in the initial decision to purchase a robot, but training that enables team members to feel confident as they take on the new tasks is essential.ConclusionsWe captured accounts of how robot-assisted surgery has been introduced into a range of hospitals. Using a realist approach, we were also able to capture perceptions of the factors that support and constrain the integration of robot-assisted surgery into routine practice. We have translated these into recommendations that can inform future implementations of robot-assisted surgery.
Can we validate a clinical score to predict the risk of severe infection in patients with systemic lupus erythematosus? A longitudinal retrospective study in a British Cohort
Authors: Tejera Segura Beatriz , Rua-Figueroa Iñigo , Pego-Reigosa Jose Maria , del Campo Victor , Wincup Chris , Isenberg David , Rahman Anisur 
Published: June 2019

ObjectiveSevere infections are a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Our primary objective was to use data from a large Spanish cohort to develop a risk score for severe infection in SLE, the SLE Severe Infection Score (SLESIS) and to validate SLESIS in a separate cohort of 699 British patients.Design and settingRetrospective longitudinal study in a specialist tertiary care clinic in London, UK.ParticipantsPatients fulfilling international classification criteria for SLE (n=209). This included 98 patients who had suffered severe infections (defined as infection leading to hospitalisation and/or death) and 111 randomly selected patients who had never suffered severe infections.OutcomesWe retrospectively calculated SLESIS at diagnosis for all 209 patients. For the infection cases we also calculated SLESIS just prior to infection and compared it to SLESIS in 98 controls matched for disease duration. We carried out receiver operator characteristic (ROC) analysis to quantify predictive value of SLESIS for severe infection.ResultsMedian SLESIS (IQR) at diagnosis was higher in the infection group than in the control group (4.27 (3.18) vs 2.55 (3.79), p=0.0008). Median SLESIS prior to infection was higher than at diagnosis (6.64 vs 4.27, p<0.001). In ROC analysis, predictive value of SLESIS just before the infection (area under the curve (AUC)=0.79) was higher than that of SLESIS at diagnosis (AUC=0.63).ConclusionsWe validated the association of SLESIS with severe infection in an independent cohort. Calculation of SLESIS at each clinic visit may help in management of infection risk in patients with SLE. Prospective studies are needed to confirm these findings.
Factors other than medical acuity that influence hospitalisation: a scoping review protocol
Authors: Giday Mellena , Hawes Meghaan , Madhavan Ann , Bann Maralyssa 
Published: June 2019

IntroductionThere is evidence that patients are admitted to the hospital with low-acuity medical issues, though delineation of the underlying factors has not been comprehensively explored. This scoping review will provide an overview of the existing literature regarding factors outside of acute medical illness that influence hospitalisation of adults. The review will also seek to provide a review of common language and definitions used in the research on this phenomenon.Methods and analysisThe scoping review framework, outlined by Arksey and O’Malley and expanded on by Levacet al, will be used as the basis for this study. A systematic search of seven databases (PubMed, CINAHL, PsycINFO, EMBASE, Web of Science, Sociological Abstracts and Social Science Abstracts) will be conducted to identify existing literature followed by a standardised two-phase, two-reviewer process to select relevant papers for inclusion. Relevant studies will investigate adult non-psychiatric hospital admission plus at least one additional factor unrelated to medical acuity. Details of the work will be extracted, including the terminology used and perspectives included. An assessment of methodological quality will be performed using a tool designed for mixed-methods systematic review.Ethics and disseminationThe scoping review protocol delineates a transparent and rigorous review process, the results of which will be disseminated through peer-reviewed publication and presentation at relevant local or national meetings. The study does not require ethics approval as the data will be accumulated through the review of published, peer-reviewed literature and grey literature.
Oral anticoagulants in atrial fibrillation with valvular heart disease and bioprosthetic heart valves
Authors: Malik Aaqib H , Yandrapalli Srikanth , Aronow Wilbert S , Panza Julio A , Cooper Howard A 
Published: June 2019

ObjectiveCurrent guidelines endorse the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF). However, little is known about their safety and efficacy in valvular heart disease (VHD). Similarly, there is a paucity of data regarding NOACs use in patients with a bioprosthetic heart valve (BPHV). We, therefore, performed a network meta-analysis in the subgroups of VHD and meta-analysis in patients with a BPHV.MethodsPubMed, Cochrane and Embase were searched for randomised controlled trials. Summary effects were estimated by the random-effects model. The outcomes of interest were a stroke or systemic embolisation (SSE), myocardial infarction (MI), all-cause mortality, major adverse cardiac events, major bleeding and intracranial haemorrhage (ICH).ResultsIn patients with VHD, rivaroxaban was associated with more ICH and major bleeding than other NOACs, while edoxaban 30 mg was associated with least major bleeding. Data combining all NOACs showed a significant reduction in SSE, MI and ICH (0.70, [0.57 to 0.85; p<0.001]; 0.70 [0.50 to 0.99; p<0.002]; and 0.46 [0.24 to 0.86; p<0.01], respectively). Analysis of 280 patients with AF and a BPHV showed similar outcomes with NOACs and warfarin.ConclusionsNOACs performed better than warfarin for a reduction in SSE, MI and ICH in patients with VHD. Individually NOACs performed similarly to each other except for an increased risk of ICH and major bleeding with rivaroxaban and a reduced risk of major bleeding with edoxaban 30 mg. In patients with a BPHV, results with NOACs seem similar to those with warfarin and this needs to be further explored in larger studies.
Comparison of three commonly used CT perfusion software packages in patients with acute ischemic stroke
Authors: Koopman Miou S , Berkhemer Olvert A , Geuskens Ralph R E G , Emmer Bart J , van Walderveen Marianne A A , Jenniskens Sjoerd F M , van Zwam Wim H , van Oostenbrugge Robert J , van der Lugt Aad , Dippel Diederik W J , Beenen Ludo F , Roos Yvo B W E M , Marquering Henk A , Majoie Charles B L M 
Published: June 2019

Background and purposeCT perfusion (CTP) might support decision making in patients with acute ischemic stroke by providing perfusion maps of ischemic tissue. Currently, the reliability of CTP is hampered by varying results between different post-processing software packages. The purpose of this study is to compare ischemic core volumes estimated by IntelliSpace Portal (ISP) and syngo.via with core volumes as estimated by RAPID.MethodsThirty-five CTP datasets from patients in the MR CLEAN trial were post-processed. Core volumes were estimated with ISP using default settings and with syngo.via using three different settings: default settings (method A); additional smoothing filter (method B); and adjusted settings (method C). The results were compared with RAPID. Agreement between methods was assessed using Bland–Altman analysis and intraclass correlation coefficient (ICC). Accuracy for detecting volumes up to 25 mL, 50 mL, and 70 mL was assessed. Final infarct volumes were determined on follow-up non-contrast CT.ResultsMedian core volume was 50 mL with ISP, 41 mL with syngo.via method A, 20 mL with method B, 36 mL with method C, and 11 mL with RAPID. Agreement ranged from poor (ISP: ICC 0.41; method A: ICC 0.23) to good (method B: ICC 0.83; method C: ICC 0.85). The bias (1.8 mL) and limits of agreement (−27, 31 mL) were the smallest with syngo.via with additional smoothing (method B). Agreement for detecting core volumes ≤25 mL with ISP was 54% and 57%, 85% and 74% for syngo.via methods A, B, and C, respectively.ConclusionBest agreement with RAPID software is provided by syngo.via default settings with additional smoothing. Moreover, this method has the highest agreement in categorizing patients with small core volumes.
Pseudomonas aeruginosaeradication therapy and risk of acquiringAspergillusin young children with cystic fibrosis
Authors: Harun Sabariah Noor , Holford Nicholas H G , Grimwood Keith , Wainwright Claire E , Hennig Stefanie 
Published: June 2019

BackgroundWhileAspergillusdetection rates in adults, adolescents and older children with cystic fibrosis (CF) have increased, the risk of acquiring this fungal pathogen in young children is unknown.AimTo determine the risk and explanatory factors of acquiringAspergillusin children with CF by age 5 years.MethodsCross-sectional analysis of clinical, bronchoalveolar lavage and treatment data from the Australasian Cystic Fibrosis Bronchoalveolar Lavage study was used to identify predictive factors for detectingAspergillusat age 5 years. A parametric repeated time-to-event model quantitatively described the risk and factors associated with acquiringAspergillusandPseudomonas aeruginosafrom birth until age 5 years.ResultsCross-sectional analysis found that the number ofP. aeruginosaeradication courses increased the odds of detectingAspergillusat age 5 years (OR 1.61, 95% CI 1.23 to 2.12). The median (IQR) age for the firstP. aeruginosapositive culture was 2.38 (1.32–3.79) years and 3.69 (1.68–4.74) years for the firstAspergilluspositive culture. The risk ofP. aeruginosaandAspergillusevents changes with time after the first year of study entry. It also decreases forP. aeruginosaafter completingP. aeruginosaeradication (HR 0.15, 95% CI 0.00 to 0.79), but increases forAspergillusevents (HR 2.75, 95% CI 1.45 to 5.41). The risk of acquiring both types of events increases after having had a previous event.ConclusionIn young children with CF, completingP. aeruginosaeradication therapy and previousAspergillusevents are associated with increased risk of acquiringAspergillus.
Individual Characteristics of Resilience are Associated With Lower‐Than‐Expected Neighborhood Rates of Cardiovascular Disease in Blacks: Results From the Morehouse‐Emory Cardiovascular (MECA) Center for Health Equity Study
Authors: Topel Matthew L. , Kim Jeong Hwan , Mujahid Mahasin S. , Ko Yi‐An , Vaccarino Viola , Mubasher Mohamed , Liu Chang , Dunbar Sandra , Sims Mario , Taylor Herman A. , Quyyumi Arshed A. , Baltrus Peter , Lewis Tené T. 
Published: June 2019

Background
Factors promoting cardiovascular health in the face of high risk, ie, resilience, are unknown and may identify novel areas of intervention for reducing racial health disparities. We examined neighborhood perceptions and psychological attributes of blacks living in high and low cardiovascular–risk neighborhoods, as potential characteristics of resilience promoting cardiovascular health.

Methods and Results

We identified 1433 blacks residing in census tracts of Atlanta,
GA
, with higher‐than‐expected (“high” risk) or lower‐than‐expected (“low” risk) rates of cardiovascular mortality, hospitalizations, and emergency department visits during 2010–2014. Domains of psychosocial well‐being and neighborhood quality were assessed via telephone survey between August 2016 and October 2016. Using multilevel logistic regression, odds of reporting better resilient characteristics were compared between individuals living in low‐ versus high‐risk neighborhoods. Those from low‐risk (versus high‐risk) neighborhoods reported better neighborhood aesthetic quality (odds ratio [
OR
], 1.84), healthy food access (
OR
, 1.69), and absence of violence (
OR
, 0.67). Individuals from low‐risk neighborhoods reported greater optimism (
OR
, 1.38), purpose in life (
OR
, 1.42), and fewer depressive symptoms (
OR
, 0.69). After full adjustment, these associations remained significant for neighborhood factors (aesthetic quality, healthy food access, violence) and psychosocial well‐being (purpose in life). We found no evidence of differences in self‐reported cardiovascular risk factors or disease history between low‐ versus high‐risk neighborhoods.

Conclusions
Positive neighborhood environments and psychological characteristics are associated with low cardiovascular–risk neighborhoods, despite similar prevalence of cardiovascular risk factors, in the census tracts studied. These factors may confer cardiovascular resilience among blacks.
Granuloma formation following cyanoacrylate glue injection in peripheral veins and arteriovenous malformation
Authors: Parsi Kurosh , Kang Mina , Yang Anes , Kossard Steven 
Published: June 2019

Background Cyanoacrylate adhesive closure is a technically simple alternative to endothermal ablation of peripheral veins. N-butyl cyanoacrylate is delivered via catheters or by percutaneous injection resulting in occlusion of target veins. The local tissue reaction or the systemic immune response that may follow have not been characterised. Aim To characterise the late local tissue reaction to N-butyl cyanoacrylate glue injected in peripheral vessels. Methods Biopsies were obtained from two patients. In patient one, distal tributaries of the great saphenous vein were injected with VenaBlock™ glue under ultrasound guidance. Ultrasound-guided incisional biopsies were performed at one week, six weeks and 12 months. In patient two, a peripheral arterio-venous malformation was injected with Venablock™ and biopsy was performed 12 months later. Histological analysis was performed using haematoxylin and eosin and immunofixation with CD-4, CD-31, CD-34, CD-68 and D2-40. Results Echogenic material with a strong shadow artefact consistent with the injected N-butyl cyanoacrylate was observed on ultrasound on all follow-up occasions. Biopsies taken at one week showed intravascular glue without histiocytes. Biopsies at six weeks showed isolated foreign body histiocytes coating intravascular fibrillary glue spicules but no granuloma formation. The one-year biopsies showed extravascular changes including fibrosis, lymphoid aggregates and multiple extravascular foreign body cavitated granulomas. Some vessel lumens contained residual spicules of glue but no intravascular granulomas. The extravascular granulomas were deeply located, asymptomatic and not complicated by clinical ulceration. Histologically, there was no evidence of transepidermal elimination. Conclusion Extravascular foreign body cavitated granulomas containing spicules of glue with fibrosis and lymphoid aggregates occur as a delayed finding following the use of N-butyl cyanoacrylate.