bluuebunny/crossref_metadata_2025_split huggingface dataset:
Substance-related and addictive disorders among adults with intellectual and developmental disabilities (IDD): an Ontario population cohort study
Authors: Lin Elizabeth , Balogh Robert , McGarry Caitlin , Selick Avra , Dobranowski Kristin , Wilton Andrew S , Lunsky Yona 
Published: September 2016

ObjectivesDescribe the prevalence of substance-related and addictive disorders (SRAD) in adults with intellectual and developmental disabilities (IDD) and compare the sociodemographic and clinical characteristics of adults with IDD and SRAD to those with IDD or SRAD only.DesignPopulation-based cohort study (the Health Care Access Research and Development Disabilities (H-CARDD) cohort).SettingAll legal residents of Ontario, Canada.Participants66 484 adults, aged 18–64, with IDD identified through linked provincial health and disability income benefits administrative data from fiscal year 2009. 96 589 adults, aged 18–64, with SRAD but without IDD drawn from the provincial health administrative data.Main outcome measuresSociodemographic (age group, sex, neighbourhood income quintile, rurality) and clinical (psychiatric and chronic disease diagnoses, morbidity) characteristics.ResultsThe prevalence of SRAD among adults with IDD was 6.4%, considerably higher than many previous reports and also higher than found for adults without IDD in Ontario (3.5%). Among those with both IDD and SRAD, the rate of psychiatric comorbidity was 78.8%, and the proportion with high or very high overall morbidity was 59.5%. The most common psychiatric comorbidities were anxiety disorders (67.6%), followed by affective (44.6%), psychotic (35.8%) and personality disorders (23.5%). These adults also tended to be younger and more likely to live in the poorest neighbourhoods compared with adults with IDD but no SRAD and adults with SRAD but no IDD.ConclusionsSRAD is a significant concern for adults with IDD. It is associated with high rates of psychiatric and other comorbidities, indicating that care coordination and system navigation may be important concerns. Attention should be paid to increasing the recognition of SRAD among individuals with IDD by both healthcare and social service providers and to improving staff skills in successfully engaging those with both IDD and SRAD.
Exploring experiences of cancer care in Wales: a thematic analysis of free-text responses to the 2013 Wales Cancer Patient Experience Survey (WCPES)
Authors: Bracher Michael , Corner Dame Jessica , Wagland Richard 
Published: September 2016

ObjectivesTo provide the first systematic analysis of a national (Wales) sample of free-text comments from patients with cancer, to determine emerging themes and insights regarding experiences of cancer care in Wales.DesignThematic analysis of free-text data from a population-based survey.Setting and participantsAdult patients with a confirmed cancer diagnosis treated within a 3-month period during 2012 in the 7 health boards and 1 trust providing cancer care in Wales.Main outcome measuresFree-text categorised by theme, coded as positive or negative, with ratios. Overarching themes are identified incorporating comment categories.Methods4672 respondents (of n=7352 survey respondents) provided free-text comments. Data were coded using a multistage approach: (1) coding of comments into general categories (eg, nursing, surgery, etc), (2) coding of subcategories within main categories (eg, nursing care, nursing communication, etc), (3) cross-sectional analysis to identify themes cutting across categories, (4) mapping of categories/subcategories to corresponding closed questions in the Wales Cancer Patient Experience Survey (WCPES) data for comparison.ResultsMost free-text respondents (82%, n 3818) provided positive comments about their cancer care, with 49% (n=2313) giving a negative comment (ratio 0.6:1, negative-to-positive). 3172 respondents (67.9% of free-text respondents) provided a comment mapping to 1 of 4 overarching themes: communication (n=1673, 35.8% free-text respondents, a ratio of 1.0:1); waiting during the treatment and/or post-treatment phase (n=923, 19.8%, ratio 1.5:1); staffing and resource levels (n=671, 14.4% ratio 5.3:1); speed and quality of diagnostic care (n=374, 8.0%, ratio 1.5:1). Within these areas, constituent subthemes are discussed.ConclusionsThis study presents specific areas of concern for patients with cancer, and reveals a number of themes present across the cancer journey. While the majority of comments were positive, analysis reveals concerns shared by significant numbers of respondents. Timely communication can help to manage these anxieties, even where delays or difficulties in treatment may be encountered.
Noise-induced hearing loss in a longitudinal study of Norwegian railway workers
Authors: Lie Arve , Skogstad Marit , Johnsen Torstein Seip , Engdahl Bo , Tambs Kristian 
Published: September 2016

ObjectiveThe aim of this study was to analyse longitudinal data to assess the risk of noise-induced hearing loss (NIHL) in Norwegian railway workers.DesignLongitudinal.SettingA major Norwegian railway company.MethodsWe examined data from the first and last audiograms for the period 1991–2014, from 9640 railway workers with varying occupational noise exposure and with an average observation period of 10 years. The course of hearing acuity in seven groups of railway workers (train drivers, conductors, bus drivers, traffic controllers, train maintenance workers, track maintenance workers and others) were compared with each other and with ISO standards (ISO 1999).ResultsThe change in hearing threshold during the observation period was 2–3 dB in the 0.5–4 kHz range and 6–7 dB in the 3–6 kHz range adjusted for age and sex, for all occupational groups, which is slightly less than expected (8 dB) according to ISO 1999.ConclusionsThe risk of NIHL in Norwegian railway workers during the period 1991–2014 has been negligible.
Optimising case detection within UK electronic health records: use of multiple linked databases for detecting liver injury
Authors: Wing Kevin , Bhaskaran Krishnan , Smeeth Liam , van Staa Tjeerd P , Klungel Olaf H , Reynolds Robert F , Douglas Ian 
Published: September 2016

ObjectivesWe aimed to create a ‘multidatabase’ algorithm for identification of cholestatic liver injury using multiple linked UK databases, before (1) assessing the improvement in case ascertainment compared to using a single database and (2) developing a new single-database case-definition algorithm, validated against the multidatabase algorithm.DesignMethod development for case ascertainment.SettingThree UK population-based electronic health record databases: the UK Clinical Practice Research Datalink (CPRD), the UK Hospital Episodes Statistics (HES) database and the UK Office of National Statistics (ONS) mortality database.Participants16 040 people over the age of 18 years with linked CPRD–HES records indicating potential cholestatic liver injury between 1 January 2000 and 1 January 2013.Primary outcome measures(1) The number of cases of cholestatic liver injury detected by the multidatabase algorithm. (2) The relative contribution of each data source to multidatabase case status. (3) The ability of the new single-database algorithm to discriminate multidatabase algorithm case status.ResultsWithin the multidatabase case identification algorithm, 4033 of 16 040 potential cases (25%) were identified as definite cases based on CPRD data. HES data allowed possible cases to be discriminated from unlikely cases (947 of 16 040, 6%), but only facilitated identification of 1 definite case. ONS data did not contribute to case definition. The new single-database (CPRD-only) algorithm had a very good ability to discriminate multidatabase case status (area under the receiver operator characteristic curve 0.95).ConclusionsCPRD–HES–ONS linkage confers minimal improvement in cholestatic liver injury case ascertainment compared to using CPRD data alone, and a multidatabase algorithm provides little additional information for validation of a CPRD-only algorithm. The availability of laboratory test results within CPRD but not HES means that algorithms based on CPRD–HES-linked data may not always be merited for studies of liver injury, or for other outcomes relying primarily on laboratory test results.
Cohort profile: cerebral palsy in the Norwegian and Danish birth cohorts (MOBAND-CP)
Authors: Tollånes Mette C , Strandberg-Larsen Katrine , Forthun Ingeborg , Petersen Tanja Gram , Moster Dag , Andersen Anne-Marie Nybo , Stoltenberg Camilla , Olsen Jørn , Wilcox Allen J 
Published: September 2016

PurposeThe purpose ofMOthers andBAbies inNorway andDenmark cerebral palsy (MOBAND-CP) was to study CP aetiology in a prospective design.ParticipantsMOBAND-CP is a cohort of more than 210 000 children, created as a collaboration between the world's two largest pregnancy cohorts—the Norwegian Mother and Child Cohort study (MoBa) and the Danish National Birth Cohort. MOBAND-CP includes maternal interview/questionnaire data collected during pregnancy and follow-up, plus linked information from national health registries.Findings to dateInitial harmonisation of data from the 2 cohorts has created 140 variables for children and their mothers. In the MOBAND-CP cohort, 438 children with CP have been identified through record linkage with validated national registries, providing by far the largest such sample with prospectively collected detailed pregnancy data. Several studies investigating various hypotheses regarding CP aetiology are currently on-going.Future plansAdditional data can be harmonised as necessary to meet requirements of new projects. Biological specimens collected during pregnancy and at delivery are potentially available for assay, as are results from assays conducted on these specimens for other projects. The study size allows consideration of CP subtypes, which is rare in aetiological studies of CP. In addition, MOBAND-CP provides a platform within the context of a merged birth cohort of exceptional size that could, after appropriate permissions have been sought, be used for cohort and case-cohort studies of other relatively rare health conditions of infants and children.
Improving communication between phlebotomists and doctors: a quality improvement project
Authors: Saunsbury Emma , Howarth Gabrielle 
Published: September 2016

Blood tests are a seemingly basic investigation, but are often a vital part of directing patient management. Despite the importance of this everyday process, we indentified the potential for improvement of the current phlebotomy service in our hospital, as both junior doctors and phlebotomists reported a lack of communication and standardised practice across the wards. Resulting delays in obtaining blood test results can impact detrimentally on patient safety and management.We designed a survey which highlighted inefficient handovers and discrepancies between wards as driving factors behind this. We therefore aimed to improve communication between phlebotomists and doctors, as well as the overall organisation of the service. This took the form of the “Phlebotomy Box,” a box file system offering a set location for blood stickers to be situated. The box concept was optimised on a series of medical and surgical wards, incorporating multidisciplinary feedback from relevant teams. We measured how many untaken bloods were handed over to medical staff continuously, both pre- and post implementation of the phlebotomy box.Our baseline ward demonstrated poor handover rates of untaken bloods, ranging from 0% to 40%. This increased to a consistent 100% following introduction of the Phlebotomy Box and ongoing staff education. Once optimised, the box was trialled on a further two medical wards and one surgical ward, achieving 100% handover from an initial 0% to 67%. Quantitative improvement was also reflected qualitatively in widespread staff surveys, with overwhelmingly positive support and acceptance.In summary, the Phlebotomy Box innovation has led to 100% of untaken bloods being effectively handed over. We have demonstrated a significant improvement in communication and efficiency within the phlebotomy service, with tangible benefits to patient care, as minimising time lags can prevent delays in clinical decisions. The phlebotomy box represents a simplistic, sustainable intervention that could be easily replicated in other Trusts.
Soluble urokinase plasminogen activator receptor (suPAR) in acute care: a strong marker of disease presence and severity, readmission and mortality. A retrospective cohort study
Authors: Rasmussen Line Jee Hartmann , Ladelund Steen , Haupt Thomas Huneck , Ellekilde Gertrude , Poulsen Jørgen Hjelm , Iversen Kasper , Eugen-Olsen Jesper , Andersen Ove 
Published: September 2016

ObjectiveSoluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker associated with presence and progression of disease and with increased risk of mortality. We aimed to evaluate the unspecific biomarker suPAR as a prognostic marker in patients admitted to acute care.MethodsThis registry-based retrospective cohort study included 4343 consecutively admitted patients from the Acute Medical Unit at a large Danish university hospital. Time to readmission and death were analysed by multiple Cox regression. Results were reported as HRs for 30-day and 90-day follow-up.ResultsDuring 30-day follow-up, 782 patients (18.0%) were readmitted and 224 patients (5.2%) died. Comparing 30-day readmission and mortality between patients in the highest and lowest suPAR quartiles yielded HRs of 2.11 (95% CI 1.70 to 2.62) and 4.11 (95% CI 2.46 to 6.85), respectively, when adjusting for age, sex, Charlson score and C reactive protein. Area under the curve for receiver operating characteristics curve analysis of suPAR for 30-day mortality was 0.84 (95% CI 0.81 to 0.86). Furthermore, in the entire cohort, women had slightly higher suPAR compared with men, and suPAR was associated with age, admission time, admission to intensive care unit and Charlson score.ConclusionsIn this large unselected population of acute medical patients, suPAR is strongly associated with disease severity, readmission and mortality after adjusting for all other risk factors, indicating that suPAR adds information to established prognostic indicators. While patients with low suPAR levels have low risk of readmission and mortality, patients with high suPAR levels have a high risk of adverse events.
Stress activates pronociceptive endogenous opioid signalling in DRG neurons during chronic colitis
Authors: Guerrero-Alba Raquel , Valdez-Morales Eduardo E , Jimenez-Vargas Nestor N , Lopez-Lopez Cintya , Jaramillo-Polanco Josue , Okamoto Takanobu , Nasser Yasmin , Bunnett Nigel W , Lomax Alan E , Vanner Stephen J 
Published: September 2016

Aims and backgroundPsychological stress accompanies chronic inflammatory diseases such as IBD, and stress hormones can exacerbate pain signalling. In contrast, the endogenous opioid system has an important analgesic action during chronic inflammation. This study examined the interaction of these pathways.MethodsMouse nociceptive dorsal root ganglia (DRG) neurons were incubated with supernatants from segments of inflamed colon collected from patients with chronic UC and mice with dextran sodium sulfate (cDSS)-induced chronic colitis. Stress effects were studied by adding stress hormones (epinephrine and corticosterone) to dissociated neurons or by exposing cDSS mice to water avoidance stress. Changes in excitability of colonic DRG nociceptors were measured using patch clamp and Ca2+imaging techniques.ResultsSupernatants from patients with chronic UC and from colons of mice with chronic colitis caused a naloxone-sensitive inhibition of neuronal excitability and capsaicin-evoked Ca2+responses. Stress hormones decreased signalling induced by human and mouse supernatants. This effect resulted from stress hormones signalling directly to DRG neurons and indirectly through signalling to the immune system, leading to decreased opioid levels and increased acute inflammation. The net effect of stress was a change endogenous opioid signalling in DRG neurons from an inhibitory to an excitatory effect. This switch was associated with a change in G protein-coupled receptor excitatory signalling to a pathway sensitive to inhibitors of protein kinase A-protein, phospholipase C-protein and G protein βϒ subunits.ConclusionsStress hormones block the inhibitory actions of endogenous opioids and can change the effect of opioid signalling in DRG neurons to excitation. Targeting these pathways may prevent heavy opioid use in IBD.
Too good to intervene? Thrombectomy for large vessel occlusion strokes with minimal symptoms: an intention-to-treat analysis
Authors: Haussen Diogo C , Bouslama Mehdi , Grossberg Jonathan A , Anderson Aaron , Belagage Samir , Frankel Michael , Bianchi Nicolas , Rebello Leticia C , Nogueira Raul G 
Published: September 2016

IntroductionThe minimal stroke severity justifying endovascular intervention remains elusive; however, a significant proportion of patients presenting with large vessel occlusion (LVO) and mild symptoms subsequently decline and face poor outcomes.ObjectiveTo evaluate our experience with these patients by comparing best medical therapy with thrombectomy in an intention-to-treat analysis.MethodsAnalysis of prospectively collected data of all consecutive patients with National Institutes of Health Stroke Scale (NIHSS) score ≤5, LVO on CT angiography, and baseline modified Rankin Scale (mRS) score 0–2 from November 2014 to May 2016. After careful discussion with patients/family, a decision to pursue medical or interventional therapy was made. Deterioration (development of aphasia, neglect, and/or significant weakness) triggered reconsideration of thrombectomy. The primary outcome measure was NIHSS shift (discharge NIHSS score minus admission NIHSS score).ResultsOf the 32 patients qualifying for the study, 22 (69%) were primarily treated with medical therapy and 10 (31%) intervention. Baseline characteristics were comparable. Nine (41%) medically treated patients had subsequent deterioration requiring thrombectomy. Median time from arrival to deterioration was 5.2 hours (2.0–25.0). Successful reperfusion (modified Treatment in Cerebral Infarction 2b−3) was achieved in all 19 thrombectomy patients. The NIHSS shift significantly favored thrombectomy (−2.5 vs 0; p<0.01). The median NIHSS score at discharge was low with both thrombectomy (1 (0–3)) and medical therapy (2 (0.5–4.5)). 90-Day mRS 0–2 rates were 100% and 77%, respectively (p=0.15). Multivariable linear regression indicated that thrombectomy was independently associated with a beneficial NIHSS shift (unstandardized β −4.2 (95% CI −8.2 to −0.1); p=0.04).ConclusionsThrombectomy led to a shift towards a lower NIHSS in patients with LVO presenting with minimal stroke symptoms. Despite the overall perception that this condition is benign, nearly a quarter of patients primarily treated with medical therapy did not achieve independence at 90 days.
Application of visually based, computerised diagnostic decision support system in dermatological medical education: a pilot study
Authors: Chou Wan-Yi , Tien Peng-Tai , Lin Fang-Yu , Chiu Pin-Chi 
Published: September 2016

ABSTRACTBackgroundMedical education has shifted from memory-based practice to evidence-based decisions. The question arises: how can we ensure that all students get correct and systematic information? Visually based, computerised diagnostic decision support system (VCDDSS, VisualDx) may just fit our needs. A pilot study was conducted to investigate its role in medical education and clinical practice.MethodsThis was a prospective study, including one consultant dermatologist, 51 medical students and 13 dermatology residents, conducted in the dermatology teaching clinic at China Medical University Hospital from 30 December 2014 to 21 April 2015. Clinical diagnoses of 13 patients were made before and after using VCDDSS. Questionnaires were filled out at the end. The consultant dermatologist’s diagnosis was defined as the standard answer; the Sign test was used to analyse diagnostic accuracy and the Fisher exact test to analyse questionnaires.ResultsThere was an 18.75% increase in diagnostic accuracy after use of VCDDSS (62.5–81.25%; p value &lt;0.01). Significant associations were found in diagnostic assistance in terms of user factors such as accessibility, interface satisfaction, quality of imaging, textual description, and a Chinese language interface option (p value&lt;0.01).ConclusionsThis study demonstrated that VCDDSS increases diagnostic accuracy by 18.75%, which means we can avoid possible misdiagnosis, provide better treatment, and avoid waste of medical resources. The user satisfaction is high. We expect wider application of this kind of decision support system in clinical practice, medical education, residency training, and patient education in the future. Further large-scale studies should be planned to confirm its application.
Hafnium isotope constraints on the origin of Mesoarchaean andesites in southern West Greenland, North Atlantic Craton
Authors: Szilas Kristoffer , Tusch Jonas , Hoffmann J. Elis , Garde Adam A. , Münker Carsten 
Published: September 2016

Abstract

Numerous supracrustal belts in southern West Greenland host leucoamphibolites, which commonly preserve volcaniclastic textures, and are interpreted as meta-andesites. Such rocks are associated with mesocratic amphibolites of tholeiitic basaltic compositions, which display pillow-lava structures and, thus, support eruption in an oceanic environment. Here we present bulk-rock Lu–Hf isotope data for meta-andesites from the approximately 3071 Ma Qussuk supracrustal belt. Surprisingly, we find evidence for the involvement of a source with near-chondritic Hf-isotope composition in the meta-andesites, whereas the metabasalts display more depleted compositions, with

ε

Hf

3071

Ma

around +4. Trace element modelling indicates that fractional crystallization in combination with crustal assimilation (AFC) is not capable of producing the geochemical compositions of the meta-andesitic rocks from a basaltic melt. Instead, these meta-andesites point to large degrees (
c.
50%) of magma mixing, involving mafic and felsic end members. This may either represent: (1) a magma chamber process; (2) mantle-wedge overprinting by a silicic component; or (3) large degrees of melting of primitive mafic crust. Given that there is abundant independent structural and metamorphic evidence for horizontal tectonics in the Archaean crust of southern West Greenland, it is likely that these calc-alkaline meta-andesites and tholeiitic metabasalts were produced by Mesoarchaean subduction zone volcanism.