bluuebunny/crossref_metadata_2025_split huggingface dataset:
Controlling Nutritional Status (CONUT) score as a predictor of all-cause mortality in elderly hypertensive patients: a prospective follow-up study
Authors: Sun Xiaonan , Luo Leiming , Zhao Xiaoqian , Ye Ping 
Published: September 2017

ObjectivesThe aim of this study was to elucidate the impact of nutritional status on survival per Controlling Nutritional Status (CONUT) score and Geriatric Nutritional Risk Index (GNRI) in patients with hypertension over 80 years of age.DesignProspective follow-up study.ParticipantsA total of 336 hypertensive patients over 80 years old were included in this study.Outcome measuresAll-cause deaths were recorded as Kaplan-Meier curves to evaluate the association between CONUT and all-cause mortality at follow-up. Cox regression models were used to investigate the prognostic value of CONUT and GNRI for all-cause mortality in the 90-day period after admission.ResultsHypertensive patients with higher CONUT scores exhibited higher mortality within 90 days after admission (1.49%, 6.74%, 15.38%, respectively, χ2=30.92, p=0.000). Surviving patients had higher body mass index (24.25±3.05 vs 24.25±3.05, p=0.012), haemoglobin (123.78±17.05 vs 115.07±20.42, p=0.040) and albumin levels, as well as lower fasting blood glucose (6.90±2.48 vs 8.24±3.51, p=0.010). Higher GRNI score (99.42±6.55 vs 95.69±7.77, p=0.002) and lower CONUT (3.13±1.98 vs 5.14±2.32) both indicated better nutritional status. Kaplan-Meier curves indicated that survival rates were significantly worse in the high-CONUT group compared with the low-CONUT group (χ1=13.372, p=0.001). Cox regression indicated an increase in HR with increasing CONUT risk (from normal to moderate to severe). HRs (95% CI) for 3-month mortality was 1.458 (95% CI 1.102 to 1.911). In both respiratory tract infection and ‘other reason’ groups, only CONUT was a sufficiently predictor for all-cause mortality (HR=1.284, 95% CI 1.013 to 1.740, p=0.020 and HR=1.841, 95% CI 1.117 to 4.518, p=0.011). Receiver operating characteristic showed that CONUT higher than 3.0 was found to predict all-cause mortality with a sensitivity of 77.8% and a specificity of 64.7% (area under the curve=0.778, p<0.001).ConclusionNutritional status assessed via CONUT is an accurate predictor of all-cause mortality 90 days postadmission. Evaluation of nutritional status may provide additional prognostic information in hypertensive patients.
Adherence and dosing interval of subcutaneous antitumour necrosis factor biologics among patients with inflammatory arthritis: analysis from a Canadian administrative database
Authors: Bhoi Peter , Bessette Louis , Bell Mary J , Tkaczyk Cathy , Nantel Francois , Maslova Karina 
Published: September 2017

ObjectivesSubcutaneous tumour necrosis factor alpha TNFαinhibitors (SC-TNFis) such as golimumab (GLM), adalimumab (ADA), etanercept (ETA) and certolizumab pegol (CZP) have been used for many years for the treatment of inflammatory arthritis. Non-adherence to therapy is an important modifiable factor that may compromise patient outcomes. The aim of this analysis was to compare adherence and dosing interval of SC-TNFis in the treatment of people with inflammatory arthritis.DesignWe used the IMS Brogan database combining both Canadian private and public drug plan databases of Ontario and Quebec. Target drugs included SC-TNFis for inflammatory arthritis. The index period was from 1 January 2010 to 30 June 2012 and patients were followed for 24 months through 30 June 2014. Inclusion criteria were adult patients newly prescribed a SC-TNFis with at least three prescriptions and retained on therapy at 24 months.Dosing regimens as per the product monographs were used to compare actual versus expected drug utilisation. The mean possession ratio was used as a marker for adherence. Patients who scored >80% were considered adherent. The average days between units was estimated by taking the total days on therapy and divided by the number of units the patient received.Results4035 patients were included: 683 (16.9%), 1400 (34.7%), 1765 (43.7%) and 187 (4.6%) were treated with GLM, ADA, ETA and CZP, respectively. The proportion of adherent patients in the GLM cohort (n=595/683, 87%, p<0.0001) was greater compared with ADA (n=1044/1400, 75%), ETA (n=1285/1765, 73%) and CZP-treated patients (132/187, 71%). In addition, the number of patients receiving biological drug at a shorter dosing interval was similar between cohorts, and was 5%, 6%, 12% and 4% in GLM (≤26 days), ADA (≤12 days), ETA (≤6 days) and CZP-treated patients (≤12 days), respectively.ConclusionsIn this real-life administrative database, GLM had better adherence compared with other SC-TNFis.
How novice, skilled and advanced clinical researchers include variables in a case report form for clinical research: a qualitative study
Authors: Chu Hongling , Zeng Lin , Fetters Micheal D , Li Nan , Tao Liyuan , Shi Yanyan , Zhang Hua , Wang Xiaoxiao , Li Fengwei , Zhao Yiming 
Published: September 2017

ObjectivesDespite varying degrees in research training, most academic clinicians are expected to conduct clinical research. The objective of this research was to understand how clinical researchers of different skill levels include variables in a case report form for their clinical research.SettingThe setting for this research was a major academic institution in Beijing, China.ParticipantsThe target population was clinical researchers with three levels of experience, namely, limited clinical research experience, clinicians with rich clinical research experience and clinical research experts.MethodsUsing a qualitative approach, we conducted 13 individual interviews (face to face) and one group interview (n=4) with clinical researchers from June to September 2016. Based on maximum variation sampling to identify researchers with three levels of research experience: eight clinicians with limited clinical research experience, five clinicians with rich clinical research experience and four clinical research experts. These 17 researchers had diverse hospital-based medical specialties and or specialisation in clinical research.ResultsOur analysis yields a typology of three processes developing a case report form that varies according to research experience level. Novice clinician researchers often have an incomplete protocol or none at all, and conduct data collection and publication based on a general framework. Experienced clinician researchers include variables in the case report form based on previous experience with attention to including domains or items at risk for omission and by eliminating unnecessary variables. Expert researchers consider comprehensively in advance data collection and implementation needs and plan accordingly.ConclusionThese results illustrate increasing levels of sophistication in research planning that increase sophistication in selection for variables in the case report form. These findings suggest that novice and intermediate-level researchers could benefit by emulating the comprehensive planning procedures such as those used by expert clinical researchers.
Comparative effectiveness of injectable penicillin versus a combination of penicillin and gentamicin in children with pneumonia characterised by indrawing in Kenya: protocol for an observational study
Authors: Malla Lucas , Perera-Salazar Rafael , McFadden Emily , English Mike 
Published: September 2017

IntroductionWHO treatment guidelines are widely recommended for guiding treatment for millions of children with pneumonia every year across multiple low-income and middle-income countries. Guidelines are based on synthesis of available evidence that provides moderate certainty in evidence of effects for forms of pneumonia that can result in hospitalisation. However, trials have included fewer children from Africa than other settings, and it is suggested that African children with pneumonia have higher mortality. Thus, despite improving access to recommended treatments and deployment with high coverage of childhood vaccines, pneumonia remains one of the top causes of mortality for children in Kenya. Establishing whether there are benefits of alternative treatment regimens to help reduce mortality would require pragmatic clinical trials. However, these remain relatively expensive and time consuming. This protocol describes an approach to using secondary analysis of a new, large observational dataset as a potentially cheaper and quicker way to examine the comparative effectiveness of penicillin versus penicillin plus gentamicin in treatment of indrawing pneumonia. Addressing this question is important, as although it is now recommended that this form of pneumonia is treated with oral medication as an outpatient, it remains associated with non-trivial mortality that may be higher outside trial populations.Methods and analysisWe will use a large observational dataset that captures data on all admissions to 13 Kenyan county hospitals. These data represent the findings of clinicians in practice and, because the system was developed for large observational research, pose challenges of non-random treatment allocation and missing data. To overcome these challenges, this analysis will use a rigorous approach to study design, propensity score methods and multiple imputation to minimise bias.Ethics and disseminationThe primary data are held by hospitals participating in the Kenyan Clinical Information Network project with de-identifed data shared with the Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme for agreed analyses. The use of data for the analysis described received ethical clearance from the KEMRI scientific and ethical review committee. The findings of this analysis will be published.
Measuring the preference towards patient-centred communication with the Chinese-revised Patient–Practitioner Orientation Scale: a cross-sectional study among physicians and patients in clinical settings in Shanghai, China
Authors: Wang Jie , Zou Runyu , Fu Hua , Qian Haihong , Yan Yueren , Wang Fan 
Published: September 2017

ObjectivesTo adapt the Patient–Practitioner Orientation Scale (PPOS), to a Chinese context, and explore the preference towards patient-centred communication among physicians and patients with the Chinese-revised Patient–Practitioner Orientation Scale (CR-PPOS).DesignA cross-sectional questionnaire-based study.SettingClinical settings from eight medical units, including four community hospitals and four general hospitals, in Shanghai, China.Participants1018 participants, including 187 physicians and 831 patients, completed this study in two successive stages.Outcome measurementsPsychometric properties of the CR-PPOS and participants’ score on the CR-PPOS.ResultsCompared with the original PPOS, the 11-item CR-PPOS obtained better psychometric indices. Physicians and patients scored differently on both the total CR-PPOS and its two subscales. Compared with physicians, the scores of patients were more influenced by their personal characteristics, such as age and education.ConclusionsThe CR-PPOS is a better instrument in a Chinese context than the original translated version. The divergence in the extent to which patient-centred communication is preferred among Chinese physicians and patients should be noted. Adapting physicians’ communication strategy to patients’ preferences based on their personal characteristics can be a viable approach towards improving clinical efficiency.
Development of the Huddle Observation Tool for structured case management discussions to improve situation awareness on inpatient clinical wards
Authors: Edbrooke-Childs Julian , Hayes Jacqueline , Sharples Evelyn , Gondek Dawid , Stapley Emily , Sevdalis Nick , Lachman Peter , Deighton Jessica 
Published: September 2017

Background‘Situation Awareness For Everyone’ (SAFE) was a 3-year project which aimed to improve situation awareness in clinical teams in order to detect potential deterioration and other potential risks to children on hospital wards. The key intervention was the ‘huddle’, a structured case management discussion which is central to facilitating situation awareness. This study aimed to develop an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle.MethodsA cross-sectional observational design was used to psychometrically develop the ‘Huddle Observation Tool’ (HOT) over three phases using standardised psychometric methodology. Huddles were observed across four NHS paediatric wards participating in SAFE by five researchers; two wards within specialist children hospitals and two within district general hospitals, with location, number of beds and length of stay considered to make the sample as heterogeneous as possible. Inter-rater reliability was calculated using the weighted kappa and intraclass correlation coefficient.ResultsInter-rater reliability was acceptable for the collaborative culture (weighted kappa=0.32, 95% CI 0.17 to 0.42), environment items (weighted kappa=0.78, 95% CI 0.52 to 1) and total score (intraclass correlation coefficient=0.87, 95% CI 0.68 to 0.95). It was lower for the structure and risk management items, suggesting that these were more variable in how observers rated them. However, agreement on the global score for huddles was acceptable.ConclusionWe developed an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle. Future research should examine whether observational evaluations of huddles are associated with other indicators of safety on clinical wards (eg, safety climate and incidents of patient harm), and whether scores on the HOT are associated with improved situation awareness and reductions in deterioration and adverse events in clinical settings, such as inpatient wards.
Chronic diseases as predictors of labour market attachment after participation in subsidised re-employment programme: a 6-year follow-up study
Authors: Nwaru Chioma A , Peutere Laura , Kivimäki Mika , Pentti Jaana , Vahtera Jussi , Virtanen Pekka J 
Published: September 2017

BackgroundLittle is known about the work patterns of re-employed people. We investigated the labour market attachment trajectories of re-employed people and assessed the influence of chronic diseases on these trajectories.MethodsThe study was based on register data of 18 944 people (aged 18–60 years) who participated in a subsidised re-employment programme in Finland. Latent class growth analysis with zero-inflated Poisson was used to model the labour market attachment trajectories over a 6-year follow-up time. Multinomial logistic regression was used to examine the associations between chronic diseases and labour market attachment trajectories, adjusting for age, gender, educational level, size of town and calendar year in subsidised re-employment programme.ResultsWe identified four distinct labour market attachment trajectories, namely: strengthening (a relatively stable attachment throughout the follow-up time; 77%), delayed (initial weak attachment increasing later; 6%), leavers (attachment declined with time; 10%) and none-attached (weak attachment throughout the study period; 7%). We found that severe mental problems strongly increased the likelihood of belonging in the leavers (OR 3.61; 95% CI 2.23 to 5.37) and none-attached (OR 3.41; 95% CI 1.91 to 6.10) trajectories, while chronic hypertension was associated with none-attached (OR 1.37; 95% CI 1.06 to 1.77) trajectory. The associations between other chronic diseases (diabetes, heart disease, asthma and arthritics) and labour market attachment trajectories were less evident.ConclusionsRe-employed people appear to follow distinct labour market attachment trajectories over time. Having chronic diseases, especially mental disorders appear to increase the risk for relatively poor labour market attachment.
Economic Development and Climate Protection: Coloring, Texturing and Shading of Response Measures in Sustainable Development
Authors: GOVINDASAMY Peter 
Published: September 2017

The Paris Agreement recognizes that countries may be affected not only by climate change, but also by impacts of measures taken in response to it. The Agreement also requires parties to address the adverse implications arising from the use of response measures, particularly on developing countries. Parties' tool-kit of response measures to meet their pre-2020 actions and post-2020 intended nationally determined contributions (INDCs) could include trade measures such as carbon taxes, cap-and-trade schemes and related offsets, carbon border tax adjustments, carbon standards and labelling, and subsidies for low carbon goods. Aside from parties, international organizations are also developing response measures such as the ISO's carbon footprint standards (CFPs). These measures could have economic and trade implications and may possibly modify the conditions of competition in various sectors. Depending on how these measures are designed and applied, they can also be incompatible with WTO law. The inter-linkages between trade and climate response measures will become more pronounced as parties implement their pre-2020 climate actions and post-2020 INDCs. Trade disputes are more likely in a world of uncoordinated and conflicting national responses to climate challenge. What should be done to foster coherence between the WTO and UNFCCC regimes, and prevent legal inconsistencies from arising? This calls for the governance of response measures — the need for pre-emptive cooperation at the national and international levels supplemented by ex-ante and ex-post transparency and guided by parameters to foster coherence between the trade and climate regimes. While this paper discusses response measures and their implications from the trade-climate lens, the approach adopted in the paper would also be applicable in the interaction of response measures with other policy areas such as economic diversification, just transition in the workforce and development issues. In sum, as the paper highlights, from the perspective of the Paris Agreement's mandate that climate protection should be enhanced in the context of sustainable development, and response measures must also colored, textured and shaded in sustainable development.
Phase-dependent deficits during reach-to-grasp after human spinal cord injury
Authors: Lei Yuming , Perez Monica A. 
Published: September 2017

Most cervical spinal cord injuries result in asymmetrical functional impairments in hand and arm function. However, the extent to which reach-to-grasp movements are affected in humans with incomplete cervical spinal cord injury (SCI) remains poorly understood. Using kinematics and electromyographic (EMG) recordings in hand and arm muscles we studied the different phases of unilateral self-paced reach-to-grasp movements (arm acceleration, hand opening and closing) to a small cylinder in the more and less affected arms of individuals with cervical SCI and in age-matched controls. We found that SCI subjects showed prolonged movement duration in both arms during arm acceleration, and hand opening and closing compared with controls. Notably, the more affected arm showed an additional increase in movement duration at the time to close the hand compared with the less affected arm. Also, the time at which the index finger and thumb contacted the object and the variability of finger movement trajectory were increased in the more compared with the less affected arm of SCI participants. Participants with prolonged movement duration during hand closing were those with more pronounced deficits in sensory function. The muscle activation ratio between the first dorsal interosseous and abductor pollicis brevis muscles decreased during hand closing in the more compared with the less affected arm of SCI participants. Our results suggest that deficits in movement kinematics during reach-to-grasp movements are more pronounced at the time to close the hand in the more affected arm of SCI participants, likely related to deficits in EMG muscle activation and sensory function. NEW & NOTEWORTHY Humans with cervical spinal cord injury usually present asymmetrical functional impairments in hand and arm function. Here, we demonstrate for the first time that deficits in movement kinematics during reaching and grasping movements are more pronounced at the time to close the hand in the more affected arm of spinal cord injury. We suggest that this is in part related to deficits in muscle activation ratios between hand muscles and a decrease in sensory function.
New Advances and Challenges of Targeting Cancer Stem Cells
Authors: Dashzeveg Nurmaa K. , Taftaf Rokana , Ramos Erika K. , Torre-Healy Luke , Chumakova Anastasia , Silver Daniel J. , Alban Tyler J. , Sinyuk Maksim , Thiagarajan Praveena S. , Jarrar Awad M. , Turaga Soumya M. , Saygin Caner , Mulkearns-Hubert Erin , Hitomi Masahiro , Rich Jeremy N. , Gerson Stanton L. , Lathia Justin D. , Liu Huiping 
Published: September 2017

Abstract
The second International Cancer Stem Cell Conference in Cleveland, Ohio, on September 20–23, 2016, convened 330 attendees from academic, industrial, and clinical organizations. It featured a debate on the concepts and challenges of the cancer stem cells (CSC) as well as CSC-centered scientific sessions on clinical trials, genetics and epigenetics, tumor microenvironment, immune suppression, metastasis, therapeutic resistance, and emerging novel concepts. The conference hosted 35 renowned speakers, 100 posters, 20 short talks, and a preconference workshop. The reported advances of CSC research and therapies fostered new collaborations across national and international borders, and inspired the next generation's young scientists. Cancer Res; 77(19); 5222–7. ©2017 AACR.
Roles for Innate Immunity in Combination Immunotherapies
Authors: Moynihan Kelly D. , Irvine Darrell J. 
Published: September 2017

Abstract
Immunity to infectious agents involves a coordinated response of innate and adaptive immune cells working in concert, with many feed-forward and regulatory interactions between both arms of the immune system. In contrast, many therapeutic strategies to augment immunity against tumors have focused predominantly on stimulation of adaptive immunity. However, a growing appreciation of the potential contributions of innate immune effectors to antitumor immunity, especially in the context of combination immunotherapy, is leading to novel strategies to elicit a more integrated immune response against cancer. Here we review antitumor activities of innate immune cells, mechanisms of their synergy with adaptive immune responses against tumors, and discuss recent studies highlighting the potential of combination therapies recruiting both innate and adaptive immune effectors to eradicate established tumors. Cancer Res; 77(19); 5215–21. ©2017 AACR.