bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis
Authors: Huntley A L , Johnson R , King A , Morris R W , Purdy S 
Published: May 2016

ObjectivesThe aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (non-RCTs, NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS).SettingCM initiated either while as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community.ParticipantsAdults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries.InterventionCM based on nurse coordinated multicomponent care which is applicable to the primary care-based health systems.Primary and secondary outcomesPrimary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary healthcare resources.Results22 studies were included: 17 RCTs and 5 NRCTs. 17 studies described hospital-initiated CM (n=4794) and 5 described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 (95% CI 0.60 to 0.92), p=0.008) and LOS (mean difference −1.28 days (95% CI −2.04 to −0.52), p=0.001) in favour of CM compared with usual care. 9 trials described cost data of which 6 reported no difference between CM and usual care. There were 4 studies of community-initiated CM versus usual care (2 RCTs and 2 NRCTs) with only the 2 NRCTs showing a reduction in admissions.ConclusionsHospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. 9 trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission.
Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why?
Authors: Dinh Michael M , Berendsen Russell Saartje , Bein Kendall J , Chalkley Dane R , Muscatello David , Paoloni Richard , Ivers Rebecca 
Published: May 2016

ObjectiveThe present study aims to use a statewide population-based registry to assess the prevalence of low acuity emergency department (ED) presentations, describe the trend in presentation rates and to determine whether they were associated with various presentation characteristics such as the type of hospital as well as clinical and demographic variables.Design and settingThis was a retrospective analysis of a population-based registry of ED presentations in New South Wales (NSW). Generalised estimating equations with log links were used to determine factors associated with low acuity presentations to account for repeat presentations and the possibility of clustering of outcomes.ParticipantsPatients were included in this analysis if they presented to an ED between January 2010 and December 2014. The outcomes of interest were low acuity presentation, defined as those who self-presented (were not transported by ambulance), were assigned a triage category of 4 or 5 (semiurgent or non-urgent) and discharged back to usual residence from ED.ResultsThere were 10.7 million ED presentations analysed. Of these, 45% were classified as a low acuity presentation. There was no discernible increase in the rate of low acuity presentations across NSW between 2010 and 2014. The strongest predictors of low acuity ED presentation were age <40 years of age (OR 1.77); injury or musculoskeletal administrative and non-urgent procedures (OR 2.96); ear, nose and throat, eye or oral (OR 5.53); skin or allergy-type presenting problems (OR 2.84).ConclusionsLow acuity ED presentations comprise almost half of all ED presentations. Alternative emergency models of care may help meet the needs of these patients.
Irie Classroom Toolbox: a study protocol for a cluster-randomised trial of a universal violence prevention programme in Jamaican preschools
Authors: Baker-Henningham Helen , Vera-Hernández Marcos , Alderman Harold , Walker Susan 
Published: May 2016

IntroductionWe aim to determine the effectiveness of a school-based violence prevention programme implemented in Jamaican preschools, on reducing the levels of aggression among children at school, and violence against children by teachers.Methods and analysisThis is a 2-arm, single-blind, cluster-randomised controlled trial with parallel assignment. Clusters are 76 preschools in Kingston, and all teachers and classrooms in the selected schools are included in the study. In addition, a random sample of up to 12 children in the 4-year-old classes have been selected for evaluation of child-level outcomes. The intervention involves training teachers in classroom behaviour management and in strategies to promote children's social-emotional competence. Training is delivered through five full-day workshops, monthly in-class coaching over 2 school terms, and weekly text messages. The primary outcome measures are: (1) observed levels of child aggression and (2) observed violence against children by teachers. Secondary outcomes include observations of the levels of children's prosocial behaviour and the quality of the classroom environment, teachers’ reports of their mental health, teacher-reported child mental health, direct tests of children's self-regulation and child attendance.Ethics and disseminationIf this intervention were effective at improving the caregiving environment of young children in school, this would have significant implications for the prevention of child mental health problems, and prevention of violence against children in low and middle-income countries where services are often limited. The intervention is integrated into the school system and involves training existing staff, and thus, represents an appropriate strategy for large-scale implementation and benefits at the population level. Ethical consent for the study was given by the School of Psychology Ethics and Research Committee, Bangor University (ref: 2014-14167), and by the University of the West Indies Ethics Committee (ref: ECP 50,14/15).Trial registration numberISRCTN11968472; Pre-results.
A Quality Improvement Project to Assess Timing of Initial Investigations in Stroke Medicine
Authors: Thompson Sarah , Jones Rhian 
Published: May 2016

There are several investigations that can be completed in the acute phase of admission for patients with suspected stroke.These include receiving a CT Head scan and also blood tests specific for stroke. The national guidelines regarding CT Head scans detail they should be completed within 12 hours of admission1and the trust guidelines, local to where this quality improvement project was based, advise a CT Head should be completed within four hours of admission.2The current national guidelines do not specify exact stroke blood tests, however trust guidelines give a specific set of blood tests that would be appropriate to be taken when a patient presents to A&E with a suspected stroke. These included FBC, U&E, blood glucose, ESR, cholesterol, TFTs, and coagulation screen.2The aim of this quality improvement project was to assess the timing of CT Head scans and blood tests and to implement a tool to ensure these are done in a timely fashion, within the emergency care setting. The project was completed through three PSDA cycles. The first was undertaken in an A&E department, which was soon to be closed and moved to a different site. The second cycle was then completed at the new site, to assess if there had been any change in timings of these interventions. In the previous site it was found that 97% of patients audited received a CT Head scan within four hours. At the new site it was found 94% patients received a CT Head within four hours, therefore both meeting trust targets on the whole. A full set of stroke blood tests were completed at the old site in 53% of patients and this decreased to 22% of patients at the new site. At this point it was decided an intervention should be implemented to ensure this did not continue. The intervention used was updating a stroke panel on the trust computer system (an easy to use, one-click button entitled “Stroke/TIA”) with the correct blood tests and the use of this was promoted throughout the trust.A post-intervention audit was completed three months after the tool was promoted and patients receiving the correct blood tests whilst in the A&E department increased to 75%. The amount of patients receiving a CT Head scan within four hours was 100% therefore meeting both trust and national guidelines. In conclusion, the stroke blood panel appears to have improved the amount of patients receiving the correct blood tests when admitted with suspected stroke and will continue to stay in place at the trust.
The influence of refugee status and secondary migration on preterm birth
Authors: Wanigaratne Susitha , Cole Donald C , Bassil Kate , Hyman Ilene , Moineddin Rahim , Urquia Marcelo L 
Published: May 2016

BackgroundIt is unknown whether the risk of preterm birth (PTB) is elevated for forced (refugee) international migrants and whether prolonged displacement amplifies risk. While voluntary migrants who arrive from a country other than their country of birth (ie, secondary migrants) have favourable birth outcomes compared with those who migrated directly from their country of birth (ie, primary migrants), secondary migration may be detrimental for refugees who experience distinct challenges in transition countries. Our objectives were (1) to determine whether refugee status was associated with PTB and (2) whether the relation between refugee status and PTB differed between secondary and primary migrants.MethodsWe conducted a retrospective population-based cohort study. Ontario immigration (2002–2010) and hospitalisation data (2002–2010) were linked to estimate adjusted cumulative odds ratios (ACOR) of PTB (22–31, 32–36, 37–41 weeks of gestation), with 95% CIs (95% CI) comparing refugees with non-refugees. We further included a product term between refugee status and secondary migration.ResultsOverall, refugees (N=12 913) had 17% greater cumulative odds of short gestation (ACOR=1.17, 95% CI 1.07 to 1.28) compared with non-refugees (N=110 640). Secondary migration modified the association between refugee status and PTB (p=0.007). Secondary refugees had 58% greater cumulative odds of short gestation (ACOR=1.58, 95% CI 1.25 to 2.00) than secondary non-refugees, while primary refugees had 12% greater cumulative odds of short gestation (ACOR=1.12, 95% CI 1.02 to 1.23) than primary non-refugee immigrants.ConclusionsRefugee status, jointly with secondary migration, influences PTB among migrants.
Gout and diabetes: a common combination
Authors: Collier Andrew , Stirling Angus , Cameron Lyall , Hair Mario , Crosbie David 
Published: May 2016

AbstractThe aims of this cross-sectional study were to compare metabolic parameters in people with gout and diabetes with gout only and type 2 diabetes mellitus (T2DM) only. Fifty General Practices in NHS Ayrshire and Arran (population 340 377) contributed data. The sample was split into three groups, those with both gout and T2DM, those with gout only and those with T2DM only. The prevalence of gout in Ayrshire and Arran was 2.65%. The prevalence of gout in people with type 1 and 2 diabetes was 1.90% (p=0.30) and 10.12% (p&lt;10−5), respectively. Patients with both conditions were significantly more likely to be male (p&lt;10−5), older (p&lt;10−5), have a higher mean body mass index (p&lt;0.001), higher triglycerides (p&lt;10−4), lower mean total, high-density lipoprotein- and low-density lipoprotein cholesterol (p&lt;10−5), lower estimated glomerular filtration rate (p&lt;0.001), neuropathy (p=0.02), lower haemoglobin (p&lt;0.001), to be prescribed more medications (p&lt;10−5) and less likely to smoke (p&lt;0.01). There was an association between lower haemoglobin A1c and increased prevalence of gout (p&lt;0.001). 42.4% of patients with gout alone and 36.2% of those with both gout and diabetes had a urate measure. This study defines much more clearly the association between gout and T2DM. Of interest, in terms of lifestyle, both better glycaemic control and smoking are associated with a higher prevalence of gout.
Clinical presentation, diagnostic findings and long‐term survival in large breed dogs with meningoencephalitis of unknown aetiology
Authors: Cornelis I. , Volk H. A. , De Decker S. 
Published: May 2016

Although several studies indicate that meningoencephalitis of unknown aetiology (MUA) might affect every dog breed at every age, little is known about clinical presentation, diagnostic findings and long‐term survival in large breed dogs. The aim of this study was therefore to compare the clinical presentation, diagnostic findings and long‐term survival between large and small/medium breed dogs diagnosed with MUA. One hundred and eleven dogs met the inclusion criteria. 28 (25 per cent) dogs were considered large breed dogs compared with 83 (75 per cent) small/medium breed dogs. Large breed dogs presented significantly more often with a decreased mentation. Age, gender, duration of clinical signs prior to diagnosis, presence of seizures or cluster seizures, variables on complete blood count and cerebrospinal fluid analysis, and all variables on MRI were not significantly different between small/medium and large breed dogs. Median survival time was 281 and 106 days for the large and small/medium breed dogs, respectively, with no significant difference in survival curves for both groups. Although considered not typically affected by MUA, 25 per cent of dogs included in this study were considered large breed dogs. Therefore, MUA should be included in the differential diagnosis for large breed dogs presenting with intracranial neurological signs. If diagnosed with MUA, large breed dogs also carried a guarded prognosis.
Cancer Stem-like Properties in Colorectal Cancer Cells with Low Proteasome Activity
Authors: Munakata Koji , Uemura Mamoru , Tanaka Shinji , Kawai Kenji , Kitahara Tomohiro , Miyo Masaaki , Kano Yoshihiro , Nishikawa Shinpei , Fukusumi Takahito , Takahashi Yusuke , Hata Taishi , Nishimura Junichi , Takemasa Ichiro , Mizushima Tsunekazu , Ikenaga Masakazu , Kato Takeshi , Murata Kohei , Carethers John M. , Yamamoto Hirofumi , Doki Yuichiro , Mori Masaki 
Published: May 2016

Abstract
Purpose: One of the main reasons for cancer treatment resistance is the existence of cancer stem-like cells (CSCs). Here, we elucidated the relationship between low proteasome activity cells (LPACs) and CSCs.
Experimental Design: The human colorectal cancer cell lines HCT116, SW480, DLD1, and KM12SM were engineered to stably express a green fluorescent molecule fused to the degron of ornithine decarboxylase, resulting in an accumulation of the fluorescence in LPACs. LPACs were isolated by flow cytometry. Treatment resistance (radio- and chemotherapy) and the capacity of LPACs to act as CSCs were analyzed. Microarray analysis was performed to reveal genes related to treatment resistance. The prognostic impact of potent genes was examined in 190 patients with colorectal cancer.
Results: LPACs had a significantly increased capacity for radioresistance and chemoresistance (5-fluorouracil and oxaliplatin), significantly lower reactive oxygen species activity, and significantly increased sphere formation capacity compared with non-LPACs. The number of cells in the G0–G1 phase was significantly higher among LPACs. Subcutaneous injection of as few as 20 LPACs led to tumor formation in immunologically incompetent mice. Microarray analysis revealed that the expression of EP300-interacting inhibitor of differentiation 3 (EID3) was significantly increased in LPACs. In vitro assay revealed that EID3 positively controlled cell proliferation and treatment resistance. The high expression of EID3 was an adverse prognostic indicator in patients with colorectal cancer (P = 0.0400).
Conclusions: LPACs have characteristic treatment resistance and act as CSCs in colorectal cancer. In addition, EID3 is one of the potential regulators of treatment resistance in colorectal cancer and may be a potential therapeutic target. Clin Cancer Res; 22(21); 5277–86. ©2016 AACR.
Analytic Validation of RNA In Situ Hybridization (RISH) for AR and AR-V7 Expression in Human Prostate Cancer
Authors: Guedes Liana B. , Morais Carlos L. , Almutairi Fawaz , Haffner Michael C. , Zheng Qizhi , Isaacs John T. , Antonarakis Emmanuel S. , Lu Changxue , Tsai Harrison , Luo Jun , De Marzo Angelo M. , Lotan Tamara L. 
Published: May 2016

Abstract
Purpose: RNA expression of androgen receptor splice variants may be a biomarker of resistance to novel androgen deprivation therapies in castrate-resistant prostate cancer (CRPC). We analytically validated an RNA in situ hybridization (RISH) assay for total AR and AR-V7 for use in formalin-fixed paraffin-embedded (FFPE) prostate tumors.
Experimental Design: We used prostate cell lines and xenografts to validate chromogenic RISH to detect RNA containing AR exon 1 (AR-E1, surrogate for total AR RNA species) and cryptic exon 3 (AR-CE3, surrogate for AR-V7 expression). RISH signals were quantified in FFPE primary tumors and CRPC specimens, comparing to known AR and AR-V7 status by IHC and RT-PCR.
Results: The quantified RISH results correlated significantly with total AR and AR-V7 levels by RT-PCR in cell lines, xenografts, and autopsy metastases. Both AR-E1 and AR-CE3 RISH signals were localized in nuclear punctae in addition to the expected cytoplasmic speckles. Compared with admixed benign glands, AR-E1 expression was significantly higher in primary tumor cells with a median fold increase of 3.0 and 1.4 in two independent cohorts (P &lt; 0.0001 and P = 0.04, respectively). While AR-CE3 expression was detectable in primary prostatic tumors, levels were substantially higher in a subset of CRPC metastases and cell lines, and were correlated with AR-E1 expression.
Conclusions: RISH for AR-E1 and AR-CE3 is an analytically valid method to examine total AR and AR-V7 RNA levels in FFPE tissues. Future clinical validation studies are required to determine whether AR RISH is a prognostic or predictive biomarker in specific clinical contexts. Clin Cancer Res; 22(18); 4651–63. ©2016 AACR.
Testosterone in Androgen Receptor Signaling and DNA Repair: Enemy or Frenemy?
Authors: Chua Melvin Lee Kiang , Bristow Robert G. 
Published: May 2016

Abstract
Androgen suppression mediates transcriptional downregulation of DNA repair genes. Stimulation with supraphysiologic levels of dihydrotestosterone induces formation of lethal DNA breaks through recruitment of topoisomerase II enzymes to fragile DNA sites. Bipolar castration and stimulation that contributes to increasing DNA damage represents a novel strategy of sensitizing prostate cancer to cytotoxic therapies, including radiotherapy. Clin Cancer Res; 22(13); 3124–6. ©2016 AACR.
See related article by Hedayati et al., p. 3310
Watchful Waiting in Continuous-Flow Left Ventricular Assist Device Patients With Ongoing Hemolysis Is Associated With an Increased Risk for Cerebrovascular Accident or Death
Authors: Levin Allison P. , Saeed Omar , Willey Joshua Z. , Levin Charles J. , Fried Justin A. , Patel Snehal R. , Sims Daniel B. , Nguyen Jenni D. , Shin Julia J. , Topkara Veli K. , Colombo Paolo C. , Goldstein Daniel J. , Naka Yoshifumi , Takayama Hiroo , Uriel Nir , Jorde Ulrich P. 
Published: May 2016

Background—
Management of hemolysis in the setting of suspected device thrombosis in continuous-flow left ventricular assist device patients varies widely, ranging from watchful waiting with intensified antithrombotic therapy to early surgical device exchange. The aim of this study was to compare the outcomes of hemolysis events treated with surgical interventions versus medical management alone.

Methods and Results—

A retrospective review of Heartmate II continuous-flow left ventricular assist device patients at 2 centers from January 2009 to September 2014 was completed. Patients were categorized as surgical management if hemolysis refractory to intensification of standard antithrombotic therapy was treated surgically. The primary end point was the first occurrence of cerebrovascular accident (CVA) or death. Sixty-four hemolysis events occurred in 49/367 patients implanted with Heartmate II continuous-flow left ventricular assist devices. Of 49 primary hemolysis events, 24 were treated with surgical interventions. After surgical treatment, 1 patient died and 2 experienced CVAs, as compared with 3 deaths and 9 CVAs in the 25 patients who remained on intensified antithrombotic therapy alone. The 1-year freedom from CVA or death was 87.5% and 49.5% in the surgical and medical cohorts, respectively (
P
=0.027). Resolution of a primary hemolysis event without CVA or death occurred in 21/24 patients treated with surgical interventions and in 13/25 who remained on medical therapy alone. A similar association between treatment and outcome was noted in the 15 recurrent hemolysis events.

Conclusions—
Hemolysis refractory to intensification of antithrombotic therapy identifies continuous-flow left ventricular assist device patients at major risk for CVA and death. Early device exchange should be considered to minimize these risks.
White Matter Hyperintensities Are Under Strong Genetic Influence
Authors: Sachdev Perminder S. , Thalamuthu Anbupalam , Mather Karen A. , Ames David , Wright Margaret J. , Wen Wei , Bowden Jocelyn , Lee Teresa , Brodaty Henry , Crawford John , Duckworth Tanya , Kang Kristan , Garden Natalie , Martin Nick , Lemmon Christel 
Published: May 2016

Background and Purpose—
The genetic basis of white matter hyperintensities (WMH) is still unknown. This study examines the heritability of WMH in both sexes and in different brain regions, and the influence of age.

Methods—
Participants from the Older Australian Twins Study were recruited (n=320; 92 monozygotic and 68 dizygotic pairs) who volunteered for magnetic resonance imaging scans and medical assessments. Heritability, that is, the ratio of the additive genetic variance to the total phenotypic variance, was estimated using the twin design.

Results—
Heritability was high for total WMH volume (0.76), and for periventricular WMH (0.64) and deep WMH (0.77), and varied from 0.18 for the cerebellum to 0.76 for the occipital lobe. The genetic correlation between deep and periventricular WMH regions was 0.85, with one additive genetics factor accounting for most of the shared variance. Heritability was consistently higher in women in the cerebral regions. Heritability in deep but not periventricular WMH declined with age, in particular after the age of 75.

Conclusions—
WMH have a strong genetic influence but this is not uniform through the brain, being higher for deep than periventricular WMH and in the cerebral regions. The genetic influence is higher in women, and there is an age-related decline, most markedly for deep WMH. The data suggest some heterogeneity in the pathogenesis of WMH for different brain regions and for men and women.