bluuebunny/crossref_metadata_2025_split huggingface dataset:
Generalised anxiety disorder and hospital admissions: findings from a large, population cohort study
Authors: Remes Olivia , Wainwright Nicholas , Surtees Paul , Lafortune Louise , Khaw Kay-Tee , Brayne Carol 
Published: October 2018

ObjectiveGeneralised anxiety disorder (GAD) is the most common anxiety disorder in the general population and has been associated with high economic and human burden. However, it has been neglected in the health services literature. The objective of this study is to assess whether GAD leads to hospital admissions using data from the European Prospective Investigation of Cancer-Norfolk. Other aims include determining whether early-onset or late-onset forms of the disorder, episode chronicity and frequency, and comorbidity with major depressive disorder (MDD) contribute to hospital admissions.DesignLarge, population study.SettingUK population-based cohort.Participants30 445 British participants were recruited through general practice registers in England. Of these, 20 919 completed a structured psychosocial questionnaire used to identify presence of GAD. Anxiety was assessed in 1996–2000, and health service use was captured between 1999/2000 and 2009 through record linkage with large, administrative health databases. 17 939 participants had complete data on covariates.Main outcome measurePast-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.ResultsIn this study, there were 2.2% (393/17 939) of respondents with GAD. Anxiety was not independently associated with hospital admissions (incidence rate ratio (IRR)=1.04, 95% CI 0.90 to 1.20) over 9 years. However, those whose anxiety was comorbid with depression showed a statistically significantly increased risk for hospital admissions (IRR=1.23, 95% CI 1.02 to 1.49).ConclusionPeople with GAD and MDD comorbidity were at an increased risk for hospital admissions. Clinicians should consider that meeting criteria for a pure or individual disorder at one point in time, such as past-year GAD, does not necessarily predict deleterious health outcomes; rather different forms of the disorder, such as comorbid cases, might be of greater importance.
Psychometric properties of gross motor assessment tools for children: a systematic review
Authors: Griffiths Alison , Toovey Rachel , Morgan Prue E , Spittle Alicia J 
Published: October 2018

ObjectiveGross motor assessment tools have a critical role in identifying, diagnosing and evaluating motor difficulties in childhood. The objective of this review was to systematically evaluate the psychometric properties and clinical utility of gross motor assessment tools for children aged 2–12 years.MethodA systematic search of MEDLINE, Embase, CINAHL and AMED was performed between May and July 2017. Methodological quality was assessed with the COnsensus-based Standards for the selection of health status Measurement INstruments checklist and an outcome measures rating form was used to evaluate reliability, validity and clinical utility of assessment tools.ResultsSeven assessment tools from 37 studies/manuals met the inclusion criteria: Bayley Scale of Infant and Toddler Development-III (Bayley-III), Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2), Movement Assessment Battery for Children-2 (MABC-2), McCarron Assessment of Neuromuscular Development (MAND), Neurological Sensory Motor Developmental Assessment (NSMDA), Peabody Developmental Motor Scales-2 (PDMS-2) and Test of Gross Motor Development-2 (TGMD-2). Methodological quality varied from poor to excellent. Validity and internal consistency varied from fair to excellent (α=0.5–0.99). The Bayley-III, NSMDA and MABC-2 have evidence of predictive validity. Test–retest reliability is excellent in the BOT-2 (intraclass correlation coefficient (ICC)=0.80–0.99), PDMS-2 (ICC=0.97), MABC-2 (ICC=0.83–0.96) and TGMD-2 (ICC=0.81–0.92). TGMD-2 has the highest inter-rater (ICC=0.88–0.93) and intrarater reliability (ICC=0.92–0.99).ConclusionsThe majority of gross motor assessments for children have good-excellent validity. Test–retest reliability is highest in the BOT-2, MABC-2, PDMS-2 and TGMD-2. The Bayley-III has the best predictive validity at 2 years of age for later motor outcome. None of the assessment tools demonstrate good evaluative validity. Further research on evaluative gross motor assessment tools are urgently needed.
Assessing C reactive protein/albumin ratio as a new biomarker for polycystic ovary syndrome: a case–control study of women from Bahraini medical clinics
Authors: Kalyan Shirin , Goshtesabi Azita , Sarray Sameh , Joannou Angela , Almawi Wassim Y 
Published: October 2018

ObjectivePolycystic ovary syndrome (PCOS) is an endocrine disorder affecting approximately one in seven women who experience androgen excess, menstrual cycle irregularities, frequent anovulation and a tendency for central obesity and insulin resistance. Chronic subclinical inflammation is now recognised as being common in the context of PCOS, which led to the postulation that PCOS may fundamentally be an inflammatory process. This study aimed to: (1) evaluate serum C reactive protein (CRP)/albumin ratio as a potential predictive biomarker for PCOS; (2) compare the relationship between CRP/albumin and PCOS to variables classically associated with the syndrome.DesignCase–control study.SettingAdult obstetrics/gynaecology, endocrinology and outpatient clinics; university hospital in Bahrain.Participants200 premenopausal women with a diagnosis of PCOS, and 119 ethnically matched eumenorrheic premenopausal women.Main outcome measuresCRP/albumin ratio, anthropometric measures, insulin resistance, androgen excess.ResultsIndependent of body mass index (BMI), receiver operating characteristic curve for CRP/albumin ratio as a selective biomarker for PCOS was 0.865 (95% CI 0.824 to 0.905), which was more sensitive than CRP alone. Binary regression analysis showed that CRP/albumin ratio outperformed classical correlates, Free Androgen Index and insulin resistance, in predicting PCOS for every BMI category.ConclusionCRP/albumin ratio, a marker for inflammation related to metabolic dysfunction, was found to have a stronger association with PCOS than either androgen excess or insulin resistance. Inflammation is known to be influenced by adiposity, but relative to controls, women with PCOS have higher levels of CRP/albumin irrespective of BMI. These findings support the view that inflammation plays a central role in the pathophysiology of PCOS.
Real-world effectiveness evaluation of budesonide/formoterol Spiromax for the management of asthma and chronic obstructive pulmonary disease in the UK
Authors: Voorham Jaco , Roche Nicolas , Benhaddi Hicham , van der Tol Marianka , Carter Victoria , van Boven Job F.M. , Bjermer Leif , Miravitlles Marc , Price David B 
Published: October 2018

ObjectivesBudesonide/formoterol (BF) Spiromax®is an inhaled corticosteroid/long-acting β2-agonist fixed-dose combination (FDC) inhaler, designed to minimise common inhaler errors and provide reliable and consistent dose delivery in asthma and chronic obstructive pulmonary disease (COPD). We evaluated non-inferiority of BF Spiromax after changing from another FDC inhaler, compared with continuing the original inhaler.MethodsPatients with asthma and/or COPD who switched to BF Spiromax were matched (1:3) with non-switchers. Data were obtained from the Optimum Patient Care Research Database and Clinical Practice Research Datalink in the UK. The primary end point was the proportion of patients achieving disease control (using the risk domain control (RDC) algorithm); secondary end points were: exacerbation rate, short-acting β2-agonist (SABA) use and treatment stability (achieved RDC; no maintenance treatment change). Non-inferiority was defined as having 95% CI lower bound above −10%, using conditional logistic regression and adjusted for relevant confounders.ResultsComparing 385 matched patients (asthma 253; COPD 132) who switched to BF Spiromax with 1091 (asthma 743; COPD 348) non-switchers, non-inferiority of BF Spiromax in RDC was demonstrated (adjusted difference: +6.6%; 95% CI –0.3 to 13.5). Among patients with asthma, switchers to BF Spiromax versus BF Turbuhaler®reported fewer exacerbations (adjusted rate ratio (RR) 0.76;95% CI 0.60 to 0.99; p=0.044); were less likely to use high daily doses of SABA (adjusted OR 0.71;95% CI 0.52 to 0.98; p=0.034); used fewer SABA inhalers (adjusted RR 0.92;95% CI 0.86 to 0.99; p=0.019); and were more likely to achieve treatment stability (adjusted OR 1.44;95% CI 1.02 to 2.04; p=0.037). No significant differences in these end points were seen among patients with COPD.ConclusionsAmong UK patients with asthma and COPD, real-world use of BF Spiromax was non-inferior to BF Turbuhaler in terms of disease control. Among patients with asthma, switching to BF Spiromax was associated with reduced exacerbations, reduced SABA use and improved treatment stability versus continuing on BF Turbuhaler.
Using the National Early Warning Score (NEWS) outside acute hospital settings: a qualitative study of staff experiences in the West of England
Authors: Brangan Emer , Banks Jonathan , Brant Heather , Pullyblank Anne , Le Roux Hein , Redwood Sabi 
Published: October 2018

ObjectivesEarly warning scores were developed to improve recognition of clinical deterioration in acute hospital settings. In England, the National Early Warning Score (NEWS) is increasingly being recommended at a national level for use outside such settings. In 2015, the West of England Academic Health Science Network supported the roll-out of NEWS across a range of non-acute-hospital healthcare sectors. Research on the use of NEWS outside acute hospitals is limited. The objective of this study was to explore staff experiences of using NEWS in these new settings.DesignThematic analysis of qualitative semi-structured interviews with purposefully sampled healthcare staff.SettingWest of England healthcare settings where NEWS was being used outside acute hospitals—primary care, ambulance, referral management, community and mental health services.ParticipantsTwenty-five healthcare staff interviewed from primary care (9), ambulance (3), referral management/acute interface (5), community (4) and mental health services (3), and service commissioning (1).ResultsParticipants reported that NEWS could support clinical decision-making around escalation of care, and provide a clear means of communicating clinical acuity between clinicians and across different healthcare organisations. Challenges with implementing NEWS varied—in primary care, clinicians had to select patients for NEWS and adopt different methods of clinical assessment, whereas for paramedics it fitted well with usual clinical practice and was used for all patients. In community services and mental health, modifications were ‘needed’ to make the tool relevant to some patient populations.ConclusionsThis study demonstrated that while NEWS can work for staff outside acute hospital settings, the potential for routine clinical practice to accommodate NEWS in such settings varied. A tailored approach to implementation in different settings, incorporating guidance supported by further research on the use of NEWS with specific patient groups in community settings, may be beneficial, and enhance staff confidence in the tool.
Age, health and other factors associated with return to work for those engaging with a welfare-to-work initiative: a cohort study of administrative data from the UK’s Work Programme
Authors: Brown Judith , Katikireddi Srinivasa Vittal , Leyland Alastair H , McQuaid Ronald W , Frank John , Macdonald Ewan B 
Published: October 2018

ObjectivesTo investigate the role of individual factors (including age, health and personal circumstances) and external factors associated with clients having a job start while engaging with the Work Programme and variations by benefit type.SettingThe UK Government’s main return to work initiative (The Work Programme) in Scotland.DesignPiecewise Poisson regression to calculate incident rate ratios using administrative data from 2013 to 2016 to identify factors associated with job start.Participants4322 Employment and Support Allowance (ESA) clients not in work due to poor health and 8996 Jobseeker’s Allowance (JSA) clients, aged 18–64 years, referred to the Work Programme between April 2013 and July 2014.Main outcome measuresStarting a job and the time to first job start after entering the Work Programme.ResultsJSA clients (62%) were more likely to return to work (RTW) than ESA clients (20%). There is a strong negative relationship between age and the predicted probability of having a job start during the 2-year engagement with the programme for both JSA and ESA clients. JSA clients were most likely to RTW in the first 3 months, while for ESA clients the predicted probability of having a first job start was fairly constant over the 2 years. Health, including the number of health conditions, length of unemployment, client perception of job start and other individual factors were associated with job starts for both groups.ConclusionsAge plays an important role in influencing RTW; however, important potentially modifiable factors include the length of unemployment, the management of multimorbidity and the individual’s perception of the likelihood of job start. Future welfare-to-work programmes may be improved by providing age-specific interventions which focus on health and biopsychosocial factors to enable more people to realise the potential health benefits of RTW.
Premature dissolution of the Agile patency device: implications for capsule endoscopy
Authors: Wray Nicholas , Healy Ailish , Thurston Vicky , Hale Melissa Fay , Sidhu Reena , Blakeborough Tony , McAlindon Mark 
Published: October 2018

BackgroundThe main risk of capsule endoscopy is retention of the capsule behind a stricture. Passage of an intact Agile patency device (Medtronic, Dublin, Ireland) through the small bowel is widely used to ensure luminal patency, although capsule retention has occurred in patients who have had a reassuring patency study. The device is designed to remain intact for at least 30 hours postingestion, such that loss of signal from the radiofrequency identification tag contained within, or absence of the device on radiological imaging, implies unimpeded intestinal transit.AimTo identify the rate of premature dissolution (<30 hours postingestion) of the Agile patency device.MethodsOutcomes of all consecutive patients having an Agile patency device were analysed.ResultsPremature dissolution of the patency device occurred in 5 of 307 patients, an incidence of 1.3%. This was recognised by the detection of a persistent radiofrequency signal after radiological imaging had failed to identify the patency device, prompting a careful search for the radiofrequency tag on the CT scout film. The tag was difficult to detect because of an oblique lie making it appear smaller than its 13×3 mm size and confusion with intra-abdominal or other metallic fragments.ConclusionsIn the absence of radiological evidence of an intact Agile patency device, premature dissolution should be suspected in patients registering a persistent radiofrequency signal and confirmed by identifying the radiofrequency identification tag. Failure to do so might result in false reassurance that capsule endoscopy could be performed without risk of retention.
Aortic dilatation and outcome in women with Turner syndrome
Authors: Duijnhouwer Anthonie L , Bons Lidia R , Timmers Henri J L M , van Kimmenade Roland R L , Snoeren Miranda , Timmermans Janneke , van den Hoven Allard T , Kempers Marlies , van Dijk Arie P J , Fleischer Kathrin , Roos-Hesselink Jolien W 
Published: October 2018

BackgroundWomen with Turner syndrome (TS) are at increased risk of aortic dissection, which is related to ascending aortic diameter. However, the relation between aortic diameter and outcome is not well determined. This study evaluates the prevalence of aortic dilatation, the growth rate of the aorta and the risk of aortic complications in adults with TS.MethodsSingle centre, retrospective study of all women with TS followed with a strict protocol in an outpatient TS clinic. Aortic diameters were analysed using advanced imaging. The primary outcome was a combined endpoint of aortic-related mortality, aortic dissection and preventive aortic surgery. The secondary endpoint was aortic growth and prevalence of aortic dilatation, defined as an aortic size index >20 mm/m2at baseline.ResultsAt least one cardiac MR/CT was available in 268 women with TS, having median age of 28.7 (IQR: 21.3–39.7) years. Aortic dilatation was present in 22%. Linear regression identified independent factors associated with larger aortic diameters: age (coefficient=0.23; p<0.001), hypertension (coefficient=2.7; p<0.001), bicuspid aortic valve (coefficient=3.3; p<0.001), 45XO karyotype (coefficient=1.7; p=0.002), weight (coefficient=0.075; p<0.001) and growth hormone treatment (coefficient=1.4; p=0.044). During follow-up (6.8±3.2 years), five women (2%) reached the primary endpoint (two dissections, three aortic surgery). Women withmore than one scan (n=171; 1015 patient-years follow-up), the median aortic growth was 0.20 (IQR: 0.00–0.44) mm/year. In multivariate analysis, aortic growth was not associated with baseline aortic diameter or other variables.ConclusionsAortic dilatation is common and known associations were confirmed in large adult TS cohort However, aortic dissection, related mortality and preventive aortic surgery are rare. Growth hormone treatment in childhood was associated with aortic dimensions.
Coronary anatomy in Turner syndrome versus patients with isolated bicuspid aortic valves
Authors: Koenraadt Wilke M C , Siebelink Hans-Marc J , Bartelings Margot M , Schalij Martin J , van der Vlugt Maureen J , van den Bosch Annemien E , Budde Ricardo P J , Roos-Hesselink Jolien W , Duijnhouwer Anthonie L , van den Hoven Allard T , DeRuiter Marco C , Jongbloed Monique R M 
Published: October 2018

ObjectiveVariations in coronary anatomy, like absent left main stem and left dominant coronary system, have been described in patients with Turner syndrome (TS) and in patients with bicuspid aortic valves (BAV). It is unknown whether coronary variations in TS are related to BAV and to specific BAV subtypes.AimTo compare coronary anatomy in patients with TS with/without BAV versus isolated BAV and to study BAV morphology subtypes in these groups.MethodsCoronary anatomy and BAV morphology were studied in 86 patients with TS (20 TS-BAV, 66 TS-tricuspid aortic valve) and 86 patients with isolated BAV (37±13 years vs 42±15 years, respectively) by CT.ResultsThere was no significant difference in coronary dominance between patients with TS with and without BAV (25% vs 21%, p=0.933). BAVs with fusion of right and left coronary leaflets (RL BAV) without raphe showed a high prevalence of left coronary dominance in both TS-BAV and isolated BAV (both 38%). Absent left main stem was more often seen in TS-BAV as compared with isolated BAV (10% vs 0%). All patients with TS-BAV with absent left main stem had RL BAV without raphe.ConclusionThe equal distribution of left dominance in RL BAV without raphe in TS-BAV and isolated BAV suggests that presence of left dominance is a feature of BAVs without raphe, independent of TS. Both TS and RL BAV without raphe seem independently associated with absent left main stems. Awareness of the higher incidence of particularly absent left main stems is important to avoid complications during hypothermic perfusion.
Risk factors for hyperperfusion-induced intracranial hemorrhage after carotid artery stenting in patients with symptomatic severe carotid stenosis evaluation
Authors: Zhang Lei , Dai Dongwei , Li Zifu , Duan Guoli , Zhang Yong-wei , Yang Pengfei , Huang Qinghai , Xu Yi , Hong Bo , Liu Jianmin 
Published: October 2018

BackgroundAnalyzing risk factors for hyperperfusion-induced intracranial hemorrhage (HICH) after carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis.MethodsThis study retrospectively analyzed clinical data of 210 patients, who had symptomatic severe carotid stenosis (70–99%) and received CAS treatment between June 2009 and June 2015, and evaluated the relationship of HICH with patients’ clinical baseline data, imaging features, and treatment strategies.ResultsSeven patients (3.3%) developed HICH after CAS. The incidence of HICH among patients with near total occlusion was significantly higher than among those without (10.1% vs 0%, P<0.001). Out of the seven, five had no development of either anterior or posterior circulations, and two had no development of anterior circulation and poor development of posterior circulation. Results showed that patients with poor compensation of Willis’ Circle were more likely to develop HICH compared with other patients (P<0.001). All patients received preoperative CT perfusion. TTP index was defined as the TTP ratio between the affected and contralateral side. The results showed that the TTP index was significantly different between the HICH group and non-HICH group (1.15±0.10 vs 1.30±0.15, P<0.001). An analysis of the ROC curve indicated that patients with TTP index >1.22 were more likely to develop HICH compared with other patients (sensitivity 100%, specificity 75.9%).ConclusionsPatients with severe unilateral carotid stenosis, the presence of near total occlusion, poor compensation of Willis’ Circle, and preoperative TTP index>1.22, have a higher risk of developing HICH after CAS.
Economic Sanctions and North Korea
Authors: Carbaugh Bob , Ghosh Koushik 
Published: October 2018

The United States has enacted economic sanctions against North Korea since the early 1950s when North Korea attacked South Korea. Can North Korea be pressured into giving up its nuclear weapons? This article discusses the role of economic sanctions as a tool of international diplomacy with North Korea. Using concepts and tools taught in undergraduate economics classes, the article discusses the operation of sanctions and then it applies this analysis to the case of North Korea. The article examines the success that sanctions have achieved in bringing Kim Jong Un to the bargaining table and the difficulties that sanctions encounter in promoting a lasting resolution of the conflict between North Korea and the United States. The article is written for a broad audience of economics students. JEL Classifications: F0, F1
RETRACTED ARTICLE: Injectable hydrogel
encapsulating Cu2MnS2 nanoplates for
photothermal therapy against breast cancer
Authors: Fu Ji-jun , Chen Ming-yue , Li Jie-xia , Zhou Jun-hua , Xie Sheng-nan , Yuan Ping , Tang Bo , Liu Cheng-cheng 
Published: October 2018

Abstract
Background
In order to explore the possibility of treating breast cancer by
local photo-therapy, a photothermal agents loaded in situ hydrogel was
established. In detail, The
Cu2MnS2 nanoplates were
prepared by one-pot synthesis and, the thermosensitive Pluronic F127 was used as
the hydrogel matrix. The Cu2MnS2
nanoplates and the hydrogel were characterized by morphous, particle size, serum
stability, photothermal performance upon repeated 808 nm laser irradiation as
well as the rheology features. The therapeutic effects of the
Cu2MnS2 nanoplates and the
hydrogel were evaluated qualitatively and quantitatively in 4T1 mouse breast
cancer cells. The retention, photothermal efficacy, therapeutic effects and
systemic toxicity of the hydrogel were assessed in tumor bearing mouse
model.

Results
The Cu2MnS2 nanoplates
with a diameter of about 35 nm exhibited satisfying serum stability, photo-heat
conversion ability and repeated laser exposure stability. The hydrogel
encapsulation did not negatively influence the above features of the
photothermal agent. The nanoplates loaded in situ hydrogel shows a phase
transition at body temperature and, as a result, a long retention in
vivo.

Conclusions
The photothermal agent embedded hydrogel played a promising
photothermal therapeutic effects in tumor bearing mouse model with low systemic
toxicity after peritumoral administration.