bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of self‐reported symptoms or diagnosis of active tuberculosis in relationship to low body mass index, diabetes and their co‐occurrence
Authors: Prince L. , Andrews J. R. , Basu S. , Goldhaber‐Fiebert J. D. 
Published: August 2016

AbstractObjectiveGlobally, tuberculosis prevalence has declined, but its risk factors have varied across place and time – low body mass index (BMI) has persisted while diabetes has increased. Using India's National Family Health Survey (NFHS), wave 3 and World Health Survey (WHS) data, we examined their relationships to support projection of future trends and targeted control efforts.MethodsMultivariate logistic regressions at the individual level with and without diabetes/BMI interactions assessed the relationship between tuberculosis, diabetes and low BMI and the importance of risk factor co‐occurrence. Population‐level analyses examined how tuberculosis incidence and prevalence varied with diabetes/low BMI co‐occurrence.ResultsIn NFHS, diabetic individuals had higher predicted tuberculosis risks (diabetic vs. non‐diabetic: 2.50% vs. 0.63% at low BMI; 0.81% vs. 0.20% at normal BMI; 0.37% vs. 0.09% at high BMI), which were not significantly different when modelled independently or allowing for risk modification with diabetes/low BMI co‐occurrence. WHS findings were generally consistent. Population‐level analysis found that diabetes/low BMI co‐occurrence may be associated with elevated tuberculosis risk, although its predicted effect on tuberculosis incidence/prevalence was generally ≤0.2 percentage points and not robustly statistically significant.ConclusionsConcerns about the additional elevation of tuberculosis risk from diabetes/low BMI co‐occurrence and hence the need to coordinate tuberculosis control efforts around the nexus of co‐occurring diabetes and low BMI may be premature. However, study findings robustly support the importance of individually targeting low BMI and diabetes as part of ongoing tuberculosis control efforts.
SSVEP Recognition by Using Higher Harmonics Based on Music
Authors: Chen Kun , Xu Fei , Liu Quan , Liu Haojie , Zhang Yang , Ma Li , Ai Qingsong 
Published: August 2016

Abstract
Among different brain–computer interfaces (BCIs), the steady-state visual evoked potential (SSVEP)-based BCI has been widely used because of its higher signal to noise ratio (SNR) and greater information transfer rate (ITR). In this paper, a method based on multiple signal classification (MUSIC) was proposed for multidimensional SSVEP signal processing. Both fundamental and second harmonics of SSVEPs were employed for the final target recognition. The experimental results proved it has the advantage of reducing recognition time. Also, the relation between the duty-cycle of the stimulus signals and the amplitude of the second harmonics of SSVEPs was discussed via experiments. In order to verify the feasibility of proposed methods, a two-layer spelling system was designed. Different subjects including those who have never used BCIs before used the system fluently in an unshielded environment.
Epidemiological Investigation of Legionella pneumophila Serogroup 2 to 14 Isolates from Water Samples by Amplified Fragment Length Polymorphism and Sequence-Based Typing and Detection of Virulence Traits
Authors: Katsiaflaka Anna , Pournaras Spyros , Kristo Ioulia , Mouchtouri Varvara A. , Kyritsi Maria , Velonakis Emmanuel , Vatopoulos Alkiviadis C. , Hadjichristodoulou Christos 
Published: August 2016

ABSTRACT

The aim of this study is to explore the dispersion, clonality, and virulence of
Legionella pneumophila
serogroups 2 to 14 in the Greek environment. Eighty
L. pneumophila
serogroup 2 to 14 strains isolated from water distribution systems of hotels, hospitals, athletic venues, and ferries in Greece were tested by monoclonal antibodies (MAbs) for serogroup discrimination and molecularly by amplified fragment length polymorphism (AFLP) for genetic diversity. Fifty-six of 80 strains were also typed by the sequence-based typing (SBT) method. Αll strains were further analyzed for detection of two pathogenicity loci:
Legionella
vir
homologue (
lvh
) and repeats in structural toxin (
rtxA
). Thirty-seven strains (46.2%) belonged to serogroup 6, 26 strains (32.5%) to serogroup 3, and 7 (8.8%) to other serogroups (4, 5, 8, and 10). Ten strains (12.5%) were nontypeable (NT) into the known serogroups. Thirty-nine different AFLP types were found among the 80
L. pneumophila
serogroup 2 to 14 strains, and 24 different SBT types were found among the 56 strains tested. Among the 80 strains, the
lvh
locus was present in 75 (93.8%), the
rtxA
locus was found in 76 (95%), and both loci were found in 73 (91.3%) strains. This study showed that there is genetic variability of
L. pneumophila
serogroups 2 to 14 in the Greek environment as well as a high percentage of the pathogenicity loci. Ιntroducing an effective diagnostic test for
L. pneumophila
serogroups 2 to 14 in urine and promoting the examination of respiratory specimens from patients hospitalized for pneumonia in Greek hospitals are essential.

IMPORTANCE
In this study, the dispersion, clonality, and virulence of environmental isolates of
Legionella pneumophila
serogroups 2 to 14 (Lp2–14) in Greece were investigated. Genetic variability of Lp2–14 in the Greek environment was identified together with the presence of the pathogenicity loci in a high percentage of the isolates. Despite the high prevalence of Lp2–14 in the Greek environment, no clinical cases were reported, which may be due to underdiagnosis of the disease. Almost all the legionellosis cases are diagnosed in Greece by using the urine antigen test, which is specific for Lp1. There is an urgent need to improve the clinical diagnosis of legionellosis by introducing an effective diagnostic test for Lp2–14 in urine and by promoting the PCR examination of respiratory specimens from patients with compatible clinical symptoms.
Extending CRISPR-Cas9 Technology from Genome Editing to Transcriptional Engineering in the Genus Clostridium
Authors: Bruder Mark R. , Pyne Michael E. , Moo-Young Murray , Chung Duane A. , Chou C. Perry 
Published: August 2016

ABSTRACT

The discovery and exploitation of the prokaryotic adaptive immunity system based on clustered regularly interspaced short palindromic repeats (CRISPRs) and CRISPR-associated (Cas) proteins have revolutionized genetic engineering. CRISPR-Cas tools have enabled extensive genome editing as well as efficient modulation of the transcriptional program in a multitude of organisms. Progress in the development of genetic engineering tools for the genus
Clostridium
has lagged behind that of many other prokaryotes, presenting the CRISPR-Cas technology an opportunity to resolve a long-existing issue. Here, we applied the
Streptococcus pyogenes
type II CRISPR-Cas9 (SpCRISPR-Cas9) system for genome editing in
Clostridium acetobutylicum
DSM792. We further explored the utility of the SpCRISPR-Cas9 machinery for gene-specific transcriptional repression. For proof-of-concept demonstration, a plasmid-encoded fluorescent protein gene was used for transcriptional repression in
C. acetobutylicum
. Subsequently, we targeted the carbon catabolite repression (CCR) system of
C. acetobutylicum
through transcriptional repression of the
hprK
gene encoding HPr kinase/phosphorylase, leading to the coutilization of glucose and xylose, which are two abundant carbon sources from lignocellulosic feedstocks. Similar approaches based on SpCRISPR-Cas9 for genome editing and transcriptional repression were also demonstrated in
Clostridium pasteurianum
ATCC 6013. As such, this work lays a foundation for the derivation of clostridial strains for industrial purposes.

IMPORTANCE
After recognizing the industrial potential of
Clostridium
for decades, methods for the genetic manipulation of these anaerobic bacteria are still underdeveloped. This study reports the implementation of CRISPR-Cas technology for genome editing and transcriptional regulation in
Clostridium acetobutylicum
, which is arguably the most common industrial clostridial strain. The developed genetic tools enable simpler, more reliable, and more extensive derivation of
C. acetobutylicum
mutant strains for industrial purposes. Similar approaches were also demonstrated in
Clostridium pasteurianum
, another clostridial strain that is capable of utilizing glycerol as the carbon source for butanol fermentation, and therefore can be arguably applied in other clostridial strains.
Disparity in maternal, newborn and child health services in high focus states in India: a district-level cross-sectional analysis
Authors: Awasthi Ashish , Pandey C M , Chauhan Rajesh K , Singh Uttam 
Published: August 2016

ObjectivesTo examine the level and trend in the coverage gap of a set of interventions of maternal and child health services using a summary index and to assess the disparity in usage of maternal and child health services in the districts of high focus states of India.DesignData for the present study are taken from the Annual Health Survey (AHS), 2010–2013 and Census of India, 2011.SettingsThis study used secondary data from states having higher mortality and fertility rates, termed as high focus states in India.ParticipantsDistrict-level information regarding children aged 12–23 months and ever married women aged 15–49 years has been extracted from the AHS (2010–2013), and household amenities, female literacy and main workforce information has been obtained from the Census of India 2011.Measures2 summary indexes were calculated first for maternal and child health services and another for socioeconomic and development status, using data from AHS and Census. Cronbach's α was used to assess the internal consistency of the items used in the index.ResultsThe result shows that the coverage gap is highest in Uttar Pradesh (37%) and lowest in Madhya Pradesh (21%). Converge gap and socioeconomic development are negatively correlated (r=−0.49, p=0.01). The average coverage gap was highest in the lowest quintile of socioeconomic development. There was an absolute change of 1.5% per year in coverage gap during 2009–2013. In regression analysis, the coefficient of determination was 0.24, β=−30.05, p=0.01 for a negative relationship between socioeconomic development and coverage gap.ConclusionsThere is a significant disparity in the usage of maternal and child healthcare services in the districts of India. Resource-rich people (urban residents and richest quintile) are way ahead of marginalised people (rural residents and poorest quintile) in the usage of healthcare services.
Systematic review of validated case definitions for diabetes in ICD-9-coded and ICD-10-coded data in adult populations
Authors: Khokhar Bushra , Jette Nathalie , Metcalfe Amy , Cunningham Ceara Tess , Quan Hude , Kaplan Gilaad G , Butalia Sonia , Rabi Doreen 
Published: August 2016

ObjectivesWith steady increases in ‘big data’ and data analytics over the past two decades, administrative health databases have become more accessible and are now used regularly for diabetes surveillance. The objective of this study is to systematically review validated International Classification of Diseases (ICD)-based case definitions for diabetes in the adult population.Setting, participants and outcome measuresElectronic databases, MEDLINE and Embase, were searched for validation studies where an administrative case definition (using ICD codes) for diabetes in adults was validated against a reference and statistical measures of the performance reported.ResultsThe search yielded 2895 abstracts, and of the 193 potentially relevant studies, 16 met criteria. Diabetes definition for adults varied by data source, including physician claims (sensitivity ranged from 26.9% to 97%, specificity ranged from 94.3% to 99.4%, positive predictive value (PPV) ranged from 71.4% to 96.2%, negative predictive value (NPV) ranged from 95% to 99.6% and κ ranged from 0.8 to 0.9), hospital discharge data (sensitivity ranged from 59.1% to 92.6%, specificity ranged from 95.5% to 99%, PPV ranged from 62.5% to 96%, NPV ranged from 90.8% to 99% and κ ranged from 0.6 to 0.9) and a combination of both (sensitivity ranged from 57% to 95.6%, specificity ranged from 88% to 98.5%, PPV ranged from 54% to 80%, NPV ranged from 98% to 99.6% and κ ranged from 0.7 to 0.8).ConclusionsOverall, administrative health databases are useful for undertaking diabetes surveillance, but an awareness of the variation in performance being affected by case definition is essential. The performance characteristics of these case definitions depend on the variations in the definition of primary diagnosis in ICD-coded discharge data and/or the methodology adopted by the healthcare facility to extract information from patient records.
Usage, adherence and attrition: how new mothers engage with a nurse-moderated web-based intervention to support maternal and infant health. A 9-month observational study
Authors: Sawyer Michael G , Reece Christy E , Bowering Kerrie , Jeffs Debra , Sawyer Alyssa C P , Peters Jacqueline D , Mpundu-Kaambwa Christine , Clark Jennifer J , McDonald Denise , Mittinty Murthy N , Lynch John W 
Published: August 2016

ObjectivesTo identify factors predicting use, adherence and attrition with a nurse-moderated web-based group intervention designed to support mothers of infants aged 0–6 months.Design9-Month observational study.SettingCommunity maternal and child health service.Participants240 mothers attending initial postnatal health checks at community clinics who were randomly assigned to the intervention arm of a pragmatic preference randomised trial (total randomised controlled trial, n=819; response rate=45%).InterventionIn the first week (phase I), mothers were assisted with their first website login by a research assistant. In weeks 2–7 (phase II), mothers participated in the web-based intervention with an expectation of weekly logins. The web-based intervention was comparable to traditional face-to-face new mothers’ groups. During weeks 8–26 (phase III), mothers participated in an extended programme at a frequency of their choosing.Primary outcome measuresNumber of logins and posted messages. Standard self-report measures assessed maternal demographic and psychosocial characteristics.ResultsIn phase II, the median number of logins was 9 logins (IQR=1–25), and in phase III, it was 10 logins (IQR=0–39). Incident risk ratios from multivariable analyses indicated that compared to mothers with the lowest third of logins in phase I, those with the highest third had 6.43 times as many logins in phase II and 7.14 times in phase III. Fifty per cent of mothers logged-in at least once every 30 days for 147 days after phase I and 44% logged-in at least once in the last 30 days of the intervention. Frequency of logins during phase I was a stronger predictor of mothers’ level of engagement with the intervention than their demographic and psychosocial characteristics.ConclusionsMothers’ early use of web-based interventions could be employed to customise engagement protocols to the circumstances of individual mothers with the aim of improving adherence and reducing attrition with web-based interventions.Trial registration numberACTRN12613000204741; Results.
Exploring unintended consequences of policy initiatives in mental health: the example of Child and Adolescent Mental Health Services (CAMHS) in England
Authors: Foreman David M 
Published: August 2016

ObjectivesThe impact of policy and funding on Child and Adolescent Mental Health Service (CAMHS) activity and capacity, from 2003 to 2012, was assessed. The focus was on preschool children (aged 0–4 years), as current and 2003 policy initiatives stressed the importance of ‘early intervention’.SettingsNational service capacity from English CAMHS mapping was obtained from 2003 to 2008 inclusive. English Hospital Episode Statistics (HES) for English CAMHS was obtained from 2003 to 2012. The Child and Adolescent Faculty of the Royal College of Psychiatrists surveyed its members about comparative 0–4-year service activity and attitudes in 2012.ParticipantsCAMHS services in England provided HES and CAMHS mapping data. The Child and Adolescent Faculty of the Royal College of Psychiatrists are child psychiatrists, including trainees.Outcome measuresCAMHS mapping data provided national estimates of total numbers of CAMHS patients, whereas HES data counted appointments or episodes of inpatient care. The survey reported on Child Psychiatrists' informal estimates of service activity and attitudes towards children aged 0–4 years.ResultsThe association between service capacity and service activity was moderated by an interaction between specified funding and age, the youngest children benefiting least from specified funding and suffering most when it was withdrawn (Pr=0.005). Policy review and significant differences between age-specific HES trends (Pr<0.001) suggested this reflected prioritisation of older children. Clinicians were unaware of this effect at local level, though it significantly influenced their attitudes to prioritising this group (Pr=0.02).ConclusionsIf the new policy initiative for CAMHS is to succeed, it will need to have time-limited priorities attached to sustained, specified funding, with planning for limits as well as expansion. Data collection for policy evaluation should include measures of capacity and activity.
Semi-individualised Chinese medicine treatment as an adjuvant management for diabetic nephropathy: a pilot add-on, randomised, controlled, multicentre, open-label pragmatic clinical trial
Authors: Chan Kam Wa , Ip Tai Pang , Kwong Alfred Siu Kei , Lui Sing Leung , Chan Gary Chi Wang , Cowling Benjamin John , Yiu Wai Han , Wong Dickson Wai Leong , Liu Yang , Feng Yibin , Tan Kathryn Choon Beng , Chan Loretta Yuk Yee , Leung Joseph Chi Kam , Lai Kar Neng , Tang Sydney Chi Wai 
Published: August 2016

IntroductionDiabetes mellitus and diabetic nephropathy (DN) are prevalent and costly to manage. DN is the leading cause of end-stage kidney disease. Conventional therapy blocking the renin–angiotensin system has only achieved limited effect in preserving renal function. Recent observational data show that the use of Chinese medicine (CM), a major form of traditional medicine used extensively in Asia, could reduce the risk of end-stage kidney disease. However, existing clinical practice guidelines are weakly evidence-based and the effect of CM remains unclear. This trial explores the effect of an existing integrative Chinese–Western medicine protocol for the management of DN.ObjectiveTo optimise parameters and assess the feasibility for a subsequent phase III randomised controlled trial through preliminary evaluation on the effect of an adjuvant semi-individualised CM treatment protocol on patients with type 2 diabetes with stages 2–3 chronic kidney disease and macroalbuminuria.Methods and analysisThis is an assessor-blind, add-on, randomised, controlled, parallel, multicentre, open-label pilot pragmatic clinical trial. 148 patients diagnosed with DN will be recruited and randomised 1:1 to a 48-week additional semi-individualised CM treatment programme or standard medical care. Primary end points are the changes in estimated glomerular filtration rate and spot urine albumin-to-creatinine ratio between baseline and treatment end point. Secondary end points include fasting blood glucose, glycated haemoglobin, brain natriuretic peptide, fasting insulin, C peptide, fibroblast growth factor 23, urinary monocyte chemotactic protein-1, cystatin C, nephrin, transforming growth factor-β1 and vascular endothelial growth factor. Adverse events are monitored through self-completed questionnaire and clinical visits. Outcomes will be analysed by regression models. Enrolment started in July 2015.Ethics and registrationThis protocol is approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (reference number UW 14-301).Trial registration numberNCT02488252.
Hypertensive disorders of pregnancy and risk of diabetes in Indian women: a cross-sectional study
Authors: Agrawal Sutapa , Fledderjohann Jasmine 
Published: August 2016

BackgroundEpidemiological data from high-income countries suggest that women with hypertensive disorders of pregnancy (HDP) are more likely to develop diabetes later in life.ObjectiveWe investigated the association between pre-eclampsia and eclampsia (PE&E) during pregnancy and the risk of diabetes in Indian women.DesignCross-sectional study.SettingIndia.MethodsData from India's third National Family Health Survey (NFHS-3, 2005–2006), a cross-sectional survey of women aged 15–49 years, are used. Self-reported symptoms suggestive of PE&E were obtained from 39 657 women who had a live birth in the 5 years preceding the survey. The association between PE&E and self-reported diabetes status was assessed using multivariable logistic regression models adjusting for dietary intake, body mass index (BMI), tobacco smoking, alcohol drinking, frequency of TV watching, sociodemographic characteristics and geographic region.ResultsThe prevalence of symptoms suggestive of PE&E in women with diabetes was 1.8% (n=207; 95% CI 1.5 to 2.0; p<0.0001) and 2.1% (n=85; 95% CI 1.8 to 2.3; p<0.0001), respectively, compared with 1.1% (n=304; 95% CI 1.0 to 1.4) and 1.2% (n=426; 95% CI 1.1 to 1.5) in women who did not report any PE&E symptoms. In the multivariable analysis, PE&E was associated with 1.6 times (OR=1.59; 95% CI 1.31 to 1.94; p<0.0001) and 1.4 times (OR=1.36; 95% CI 1.05 to 1.77; p=0.001) higher risk for self-reported diabetes even after controlling for dietary intake, BMI and sociodemographic characteristics.ConclusionsHDP is strongly associated with the risk of diabetes in a large nationally representative sample of Indian women. These findings are important for a country which is already tackling the burden of young onset of diabetes in the population. However, longitudinal medical histories and a clinical measurement of diabetes are needed in this low-resource setting.
Patient safety priorities in mental healthcare in Switzerland: a modified Delphi study
Authors: Mascherek Anna C , Schwappach David L B 
Published: August 2016

ObjectiveIdentifying patient safety priorities in mental healthcare is an emerging issue. A variety of aspects of patient safety in medical care apply for patient safety in mental care as well. However, specific aspects may be different as a consequence of special characteristics of patients, setting and treatment. The aim of the present study was to combine knowledge from the field and research and bundle existing initiatives and projects to define patient safety priorities in mental healthcare in Switzerland. The present study draws on national expert panels, namely, round-table discussion and modified Delphi consensus method.DesignAs preparation for the modified Delphi questionnaire, two round-table discussions and one semistructured questionnaire were conducted. Preparative work was conducted between May 2015 and October 2015. The modified Delphi was conducted to gauge experts' opinion on priorities in patient safety in mental healthcare in Switzerland. In two independent rating rounds, experts made private ratings. The modified Delphi was conducted in winter 2015.ResultsNine topics were defined along the treatment pathway: diagnostic errors, non-drug treatment errors, medication errors, errors related to coercive measures, errors related to aggression management against self and others, errors in treatment of suicidal patients, communication errors, errors at interfaces of care and structural errors.ConclusionsPatient safety is considered as an important topic of quality in mental healthcare among experts, but it has been seriously neglected up until now. Activities in research and in practice are needed. Structural errors and diagnostics were given highest priority. From the topics identified, some are overlapping with important aspects of patient safety in medical care; however, some core aspects are unique.