bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics of carotid atherosclerosis in elderly patients with type 2 diabetes at different disease course, and the intervention by statins in very elderly patients
Authors: Chen Wenjun , Tian Tao , Wang Shiming , Xue Yan , Sun Zongqin , Wang Shuli 
Published: July 2017

AbstractIntroductionChronic complications of diabetes have become the leading cause of death in elderly patients with diabetes. Carotid atherosclerosis, one of the major complications, was evaluated and the effects of atorvastatin on carotid atherosclerosis in very elderly patients with type 2 diabetes were observed.Materials and MethodsPatients were divided into three groups: (i) disease course <5 years; (ii) disease course 5–10 years; (iii) disease course >10 years, and carotid atherosclerosis was evaluated. The very elderly patients were treated with statins, and the effect was observed.ResultsCarotid intima‐media thickness values, plaque instability and levels of homocysteine, cystatin, and C‐reactive protein in diabetes patients were significantly higher than those in the healthy control group, whereas levels of C‐peptide and estimated glomerular filtration rate in the patients were significantly lower. In patients with type 2 diabetes for >10 years, intima‐media thickness values and plaque instability were obviously higher than those in patients with type 2 diabetes for <5 years, while levels of fasting C‐peptide and estimated glomerular filtration rate were lower than those in patients with type 2 diabetes for <5 years. In the very elderly patients, after statins treatment, intima‐media thickness values, levels of homocysteine and C‐reactive protein were significantly reduced, as well as the number of unstable plaques.ConclusionsIn the elderly patients with type 2 diabetes, carotid atherosclerosis‐related factors increased obviously, and renal function declined obviously, which were closely related to the disease course. Atorvastatin significantly reduced homocysteine and C‐reactive protein, and delayed and reversed the progress of carotid atherosclerosis in very elderly patients with type 2 diabetes.
Characteristics of frequent emergency department users with type 2 diabetes mellitus in Korea
Authors: Ustulin Morena , Woo Junghoon , Woo Jeong‐taek , Rhee Sang Youl 
Published: July 2017

AbstractAims/IntroductionFrequent emergency department (ED) visitors are medically vulnerable individuals. We identified the characteristics of “frequent ED users” among Korean patients with type 2 diabetes mellitus.Materials and methodsWe used the Health Insurance Review and Assessment Service National Patient Sample, which is a nationally representative sample. Patients (n = 109,412) with type 2 diabetes mellitus as a primary or secondary diagnosis at one of their visits were included. Individuals were classified into three groups according to the number of ED visits: frequent (≥4 visits), occasional (<4 visits) and non‐users of the ED. The characteristics of the patients that distinguished frequent users from the other groups were investigated.ResultsFrequent ED users were mainly men (P < 0.001), with longer treatment duration (P < 0.001), more frequent comorbidities (cardiovascular and chronic kidney disease) and primary diagnosis made by surgery (P = 0.0028). They had higher mortality (P = 0.0085), longer hospitalization duration (P < 0.001), higher costs per visit (P < 0.001) and more often required medical protection (P < 0.001). These patients were treated more frequently with sulfonylurea, insulin, meglitinide and alpha‐glucosidase inhibitors (P < 0.05).ConclusionsThe present findings suggest that frequent users of the ED with type 2 diabetes mellitus have serious health conditions, a poor socioeconomic situation and tend to take some medicines (sulfonylurea, etc.), which often are associated with hypoglycemia. Attention should be given to therapy, and to patients with renal and cardiovascular diseases to decrease the dependency of these patients on the ED.
Varying occurrence of extended‐spectrum beta‐lactamase bacteria among three produce types
Authors: Toh Benjamin E. W. , Bokhari Osama , Kutbi Abdullah , Haroon Mohamed Fauzi , Mantilla‐Calderon David , Zowawi Hosam , Hong Pei‐Ying 
Published: July 2017

AbstractA monitoring effort that spanned across 1.5 years was conducted to examine three types of produce‐associated microbiota. The average amount of antibiotic‐resistant bacteria recovered from lettuce, tomato, and cucumber was 1.02 × 1010, 2.05 × 107, and 4.78 × 109 cells per 50 g of each produce, respectively. A total of 480 bacterial isolates were obtained and identified from their 16S rRNA genes, revealing isolates that were ubiquitously recovered from all three types of produce. However, sporadic presence of Klebsiella pneumoniae and Acinetobacter baumannii was detected on lettuce and cucumbers but not tomatoes. End‐point PCR revealed that the K. pneumoniae and A. baumannii isolates were positive for genes encoding extended spectrum beta‐lactamase. Whole genome sequencing of two of the K. pneumoniae isolates further suggested the presence of the blaCTX‐M‐15 gene in a conjugative plasmid, as well as other antibiotic resistance genes and virulence‐associated traits in either conjugative plasmids or the chromosomal genome. Quantitative microbial risk assessment indicated varying levels of ingestion risk associated with different types of produce. In particular, the risk arising from ESBL‐positive K. pneumoniae in lettuce, but not in cucumbers or tomatoes, was higher than the acceptable annual risk of 10−4.Practical applicationsThree types of vegetables were sampled and evaluated over 1.5 years to determine differences in their associated bacterial isolates. Particular emphasis was placed on identifying pathogenic strains that were positive for extended spectrum beta‐lactamase (ESBL). Quantitative estimates of the microbial risk associated with the ESBL‐positive pathogens showed that different produce types may incur varying levels of ingestion risk. Most of the currently reported ESBL‐positive bacterial isolates have been identified in nosocomial environments. However, the carriage of such drug‐resistant bacteria in vegetables suggests a possible connection between our daily diet and human health.
A profile of foodservices in Curitiba and a critical analysis of the results of sanitary inspections at these establishments
Authors: Olmedo Patrícia Vitório , Stangarlin‐Fiori Lize , Opolski Medeiros Caroline , Tondo Eduardo César , Ferreira Sila Mary Rodrigues 
Published: July 2017

AbstractThe purpose of this study was to evaluate the profile of foodservices' in Curitiba, in southern Brazil and the results of health inspections performed at these establishments, with the goal of contributing to improvements in sanitary inspection processes and to the sanitary conditions in foodservices. The study was based on data from sanitary inspections conducted at foodservice establishments from January 2005 to July 2015 found in the Municipal Sanitary Inspection and Environmental Information System. Most of the establishments inspected were restaurants and similar establishments: snack bars, cafes; as well as grocery store, supermarkets and hypermarkets, and most irregularities were found in these sectors. Health inspections in the city are carried out in emergency criteria, and most performed at the request of foodservices that are quest a license or because of a customer complaint. Inspections led to more educational than punitive measures. Even 10 years after passage of a national law governing food handling procedures, when 70% of the foodservices presented improper sanitary conditions. The main irregularities found were related to work procedures and processes, sanitary conditions, and physical structure. These result reinforces the importance that legislators and inspection teams reevaluate their goals, strategies and work processes to prioritize food safety.Practical applicationsThis study is important because it offers a diagnosis and a discussion of foodservices and evaluates actions of Sanitary Inspection Agency, to assist in the development of tools and strategies to strengthen the work of sanitary inspectors so that they can be recognized as agents of transformation in public health.
3‐D microstructure of olivine in complex geological materials reconstructed by correlative X‐ray ‐CT and EBSD analyses
Authors: KAHL W.‐A. , DILISSEN N. , HIDAS K. , GARRIDO C.J. , LÓPEZ‐SÁNCHEZ‐VIZCAÍNO V. , ROMÁN‐ALPISTE M.J. 
Published: July 2017

SummaryWe reconstruct the 3‐D microstructure of centimetre‐sized olivine crystals in rocks from the Almirez ultramafic massif (SE Spain) using combined X‐ray micro computed tomography (‐CT) and electron backscatter diffraction (EBSD). The semidestructive sample treatment involves geographically oriented drill pressing of rocks and preparation of oriented thin sections for EBSD from the ‐CT scanned cores. The ‐CT results show that the mean intercept length (MIL) analyses provide reliable information on the shape preferred orientation (SPO) of texturally different olivine groups. We show that statistical interpretation of crystal preferred orientation (CPO) and SPO of olivine becomes feasible because the highest densities of the distribution of main olivine crystal axes from EBSD are aligned with the three axes of the 3‐D ellipsoid calculated from the MIL analyses from ‐CT. From EBSD data we distinguish multiple CPO groups and by locating the thin sections within the ‐CT volume, we assign SPO to the corresponding olivine crystal aggregates, which confirm the results of statistical comparison. We demonstrate that the limitations of both methods (i.e. no crystal orientation data in ‐CT and no spatial information in EBSD) can be overcome, and the 3‐D orientation of the crystallographic axes of olivines from different orientation groups can be successfully correlated with the crystal shapes of representative olivine grains. Through this approach one can establish the link among geological structures, macrostructure, fabric and 3‐D SPO‐CPO relationship at the hand specimen scale even in complex, coarse‐grained geomaterials.
A reliable approach to prepare brittle semiconducting materials for cross‐sectional transmission electron microscopy
Authors: DYCUS J.H. , LEBEAU J.M. 
Published: July 2017

SummaryHere, we present a sample preparation approach that simplifies the thinning of very brittle wide bandgap semiconducting materials in cross‐section geometry for (scanning) transmission electron microscopy. Using AlN thin films grown on sapphire and AlN substrates as case studies, we demonstrate that high‐quality samples can be routinely prepared while greatly reducing the preparation time and consumables cost. The approach removes the sample preparation barrier to studying a wide variety of materials by electron microscopy.
The impact of a Web‐based educational program on the recognition and management of deteriorating patients
Authors: Liaw Sok Ying , Chng Devon Yun Jia , Wong Lai Fun , Ho Jasmine Tze Yin , Mordiffi Siti Zubaidah , Cooper Simon , Chua Wei Ling , Ang Emily Neo Kim 
Published: July 2017

Aims and objectivesTo evaluate the effectiveness of a Web‐based educational program to enhance enrolled nurses’ knowledge and skills in the recognition and management of deteriorating patients.BackgroundWard nurses of different skill levels play a pivotal role in detecting and responding to deteriorating patients. A skill mix of registered nurses, enrolled nurses, licensed practical nurses or healthcare assistants is often employed for the provision of nursing care in acute settings. Non‐registered nurses frequently perform bedside care and are in the best position to detect deteriorating patients and initiate immediate actions, including commanding the attention of registered nurses. Education is needed to improve the knowledge and skills of these nurses.DesignA randomised controlled trial with a pretest–post‐test design.MethodsThe sample included enrolled nurses from an acute care tertiary hospital. Following a baseline evaluation, the experimental group received a Web‐based educational intervention. Pre–post assessment of skills and knowledge was performed with a simulated scenario and a knowledge questionnaire. Sixty‐four nurses completed the entire study.ResultsFollowing the intervention, participants from the experimental group were significantly more likely than those in the control group to monitor the patient's respiratory and pulse rates. In addition, they had significantly higher post‐test mean scores for knowledge and skills in assessing and managing clinical deterioration and reporting deterioration.ConclusionThe Web‐based educational intervention significantly improved enrolled nurses’ knowledge and skills in the recognition and management of a deteriorating patient in a simulated setting.Relevance to clinical practiceEase of access to the Web‐based platform contributed to the feasibility and acceptability of this study, which has the potential to positively impact patient safety.
Disparities in the Use of Diabetes Screening in Appalachia
Authors: Lobo Jennifer M. , Anderson Roger , Stukenborg George J. , McCall Anthony , Kang Hyojung , Camacho Fabian , Sohn Min‐Woong 
Published: July 2017

AbstractPurposeThe Appalachian region presents disproportionately high rates of chronic disease compared to the rest of the United States. Early diagnosis of diabetes through screening is an important step in reducing diabetes complications. This study examines disparities in the use of diabetes screening in Appalachia.MethodsWe analyzed 2009 and 2010 Behavioral Risk Factor Surveillance System data for 96,111 adults aged ≥45 years from 11 Appalachian states. Based on economic status, Appalachian counties were grouped into distressed (least affluent), at‐risk, transitional, and competitive (most affluent). Logistic regression analyses were used to estimate the statistical significance and effect size of factors associated with diabetes screening.ResultsCompetitive counties had the highest rate of diabetes screening (65.4%). At‐risk counties had the lowest rate (60.3%), about 7.8% lower compared to competitive counties (P < .001). After adjusting for socioeconomic factors, differences in screening rates between county economic levels in Appalachia were not statistically significant. Among respondents ≥65 years, at‐risk counties had an 8.1% lower screening rate compared to competitive counties; this difference was not adequately explained by differences in socioeconomic factors. Screening rates in distressed and transitional counties were not significantly different from competitive counties in unadjusted or adjusted models.ConclusionsAt‐risk counties had significantly lower screening rates than competitive counties. They should receive more policy attention similar to that received by distressed counties. Social policies that improve socioeconomic status and educational attainment, and health policies that reduce barriers to access to care may reduce disparities in diabetes screening rates in the less affluent Appalachian counties.
The gamma‐glutamyl transpeptidase‐to‐albumin ratio predicts significant fibrosis and cirrhosis in chronic hepatitis B patients
Authors: Li Q. , Lu C. , Li W. , Huang Y. , Chen L. 
Published: July 2017

SummaryBackground/Aim Simple, inexpensive and clinically available noninvasive liver fibrosis tests are highly needed. We aimed to develop a novel noninvasive index for predicting significant fibrosis and cirrhosis in chronic hepatitis B (CHB) patients. Methods Using liver histology as gold standard, we developed a novel index to predict significant fibrosis and cirrhosis in CHB patients and then compared the diagnostic accuracy of the novel index, aspartate transaminase‐to‐platelet ratio index (APRI), and fibrosis index based on four factors (FIB‐4) in a training set (606 patients) and a validation set (216 patients) from the same patient catchment area. Results Of 606 CHB patients in the training set, 33.2% had significant fibrosis and 11.4% had cirrhosis. In multivariable analysis, gamma‐glutamyl transpeptidase (GGT) (OR=1.032, p<0.001) and albumin (OR=0.953, p=0.048) were independent predictors of significant fibrosis. Consequently, a GGT‐to‐albumin ratio (GAR) was developed. In the training set, the area under the receiver operating characteristic curve (AUROC) of GAR was significantly higher than that of APRI and FIB‐4 to predict ≥F2 (0.82, 0.70, and 0.68, respectively), ≥F3 (0.86, 0.76, and 0.75, respectively), and F4 (0.88, 0.75, and 0.73, respectively), respectively. In the validation set, the AUROC of GAR was also better than APRI and FIB‐4 for predicting ≥F2 (0.81, 0.63 and 0.61, respectively), ≥F3 (0.88, 0.78, and 0.76, respectively) and F4 (0.92, 0.85, and 0.78, respectively), respectively. Conclusions GAR is a more accurate noninvasive index than APRI and FIB‐4 to stage significant fibrosis and cirrhosis in CHB patients and represents a novel noninvasive alternative to liver biopsy.
On the potential of a short‐term intensive intervention to interrupt HCV transmission in HIV‐positive men who have sex with men: A mathematical modelling study
Authors: Salazar‐Vizcaya L. , Kouyos R. D. , Fehr J. , Braun D. , Estill J. , Bernasconi E. , Delaloye J. , Stöckle M. , Schmid P. , Rougemont M. , Wandeler G. , Günthard H. F. , Keiser O. , Rauch A. ,   The Swiss HIV Cohort Study
Published: July 2017

SummaryIncreasing access to direct‐acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection and decelerating the rise in high‐risk behaviour over the next decade could curb the HCV epidemic among HIV‐positive men who have sex with men (MSM). We investigated if similar outcomes would be achieved by short‐term intensive interventions like the Swiss‐HCVree‐trial. We used a HCV transmission model emulating two 12‐months intensive interventions combining risk counselling with (i) universal DAA treatment (pangenotypic intervention) and (ii) DAA treatment for HCV genotypes 1 and 4 (replicating the Swiss‐HCVree‐trial). To capture potential changes outside intensive interventions, we varied time from HCV infection to treatment in clinical routine and overall high‐risk behaviour among HIV‐positive MSM. Simulated prevalence dropped from 5.5% in 2016 to ≤2.0% over the intervention period (June/2016‐May/2017) with the pangenotypic intervention, and to ≤3.6% with the Swiss‐HCVree‐trial. Assuming time to treatment in clinical routine reflected reimbursement restrictions (METAVIR ≥F2, 16.9 years) and stable high‐risk behaviour in the overall MSM population, prevalence in 2025 reached 13.1% without intensive intervention, 11.1% with the pangenotypic intervention and 11.8% with the Swiss‐HCVree‐trial. If time to treatment in clinical routine was 2 years, prevalence in 2025 declined to 4.8% without intensive intervention, to 2.8% with the pangenotypic intervention, and to 3.5% with the Swiss‐HCVree‐trial. In this scenario, the pangenotypic intervention and the Swiss‐HCVree‐trial reduced cumulative (2016‐2025) treatment episodes by 36% and 24%, respectively. Therefore, intensive interventions could reduce future HCV treatment costs and boost the benefits of long‐term efforts to prevent high‐risk behaviour and to reduce treatment delay. But if after intensive interventions treatment is deferred until F2, short‐term benefits of intensive interventions would dissipate in the long term.
Combining albumin‐bilirubin score with future liver remnant predicts post‐hepatectomy liver failure in HBV‐associated HCC patients
Authors: Zou Heng , Wen Yu , Yuan Kun , Miao Xiong‐Ying , Xiong Li , Liu Kui‐Jie 
Published: July 2017

AbstractBackground and AimsAccurate assessment of liver functional reserve pre‐operatively is vital for safe hepatic resection. The ALBI score is a new model for assessing liver function. This study aimed to evaluate the value of combining ALBI score with sFLR in predicting post‐operative morbidity and PHLF in HCC patients who underwent hepatectomy.MethodsPatients undergoing three‐dimensional CT reconstruction prior to hepatectomy for HCC between January 2015 and January 2017 were enrolled. The values of the CP score, ALBI score and sFLR in predicting post‐operative outcomes were evaluated.ResultsA total of 229 HCC patients were enrolled; 24 (10.5%) experienced major complications and 21 (9.2%) developed PHLF. The incidence of major complications and PHLF increased with increasing ALBI grade. The ALBI grade classified patients with CP grade A into two subgroups with different incidences of PHLF (P=.029). sFLR and ALBI scores were identified as independent predictors of PHLF. The AUC values for the CP score, ALBI score, sFLR and sFLR×ALBI for predicting major complications were 0.600, 0.756, 0.660 and 0.790 respectively. The AUC values of the CP score, ALBI score, sFLR and sFLR×ALBI for predicting PHLF were 0.646, 0.738, 0.758 and 0.884 respectively.ConclusionsThe ALBI score showed superior predictive value of post‐operative outcomes over CP score, and the combination of sFLR and ALBI score was identified as a stronger predictor of post‐operative outcomes than the sFLR or ALBI score alone.
Availability of breastfeeding peer support in the United Kingdom: A cross‐sectional study
Authors: Grant Aimee , McEwan Kirsten , Tedstone Sally , Greene Giles , Copeland Lauren , Hunter Billie , Sanders Julia , Phillips Rhiannon , Brown Amy , Robling Mike , Paranjothy Shantini 
Published: July 2017

AbstractPeer support is recommended by the World Health Organization for the initiation and continuation of breastfeeding, and this recommendation is included in United Kingdom (U.K.) guidance. There is a lack of information about how, when, and where breastfeeding peer support was provided in the U.K. We aimed to generate an overview of how peer support is delivered in the U.K. and to gain an understanding of challenges for implementation. We surveyed all U.K. infant feeding coordinators (n = 696) who were part of U.K.‐based National Infant Feeding Networks, covering 177 National Health Service (NHS) organisations. We received 136 responses (individual response rate 19.5%), covering 102 U.K. NHS organisations (organisational response rate 58%). We also searched NHS organisation websites to obtain data on the presence of breastfeeding peer support. Breastfeeding peer support was available in 56% of areas. However, coverage within areas was variable. The provision of training and ongoing supervision, and peer‐supporter roles, varied significantly between services. Around one third of respondents felt that breastfeeding peer‐support services were not well integrated with NHS health services. Financial issues were commonly reported to have a negative impact on service provision. One quarter of respondents stated that breastfeeding peer support was not accessed by mothers from poorer social backgrounds. Overall, there was marked variation in the provision of peer‐support services for breastfeeding in the U.K. A more robust evidence base is urgently needed to inform guidance on the structure and provision of breastfeeding peer‐support services.