bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology and trends in non-fatal self-harm in three centres in England, 2000–2012: findings from the Multicentre Study of Self-harm in England
Authors: Geulayov Galit , Kapur Navneet , Turnbull Pauline , Clements Caroline , Waters Keith , Ness Jennifer , Townsend Ellen , Hawton Keith 
Published: April 2016

ObjectivesSelf-harm is a major health problem in many countries, with potential adverse outcomes including suicide and other causes of premature death. It is important to monitor national trends in this behaviour. We examined trends in non-fatal self-harm and its management in England during the 13-year period, 2000–2012.Design and settingThis observational study was undertaken in the three centres of the Multicentre Study of Self-harm in England. Information on all episodes of self-harm by individuals aged 15 years and over presenting to five general hospitals in three cities (Oxford, Manchester and Derby) was collected through face-to-face assessment or scrutiny of emergency department electronic databases. We used negative binomial regression models to assess trends in rates of self-harm and logistic regression models for binary outcomes (eg, assessed vs non-assessed patients).ParticipantsDuring 2000–2012, there were 84 378 self-harm episodes (58.6% by females), involving 47 048 persons.ResultsRates of self-harm declined in females (incidence rate ratio (IRR) 0.98; 95% CI 0.97 to 0.99, p<0.0001). In males, rates of self-harm declined until 2008 (IRR 0.96; 95% CI 0.95 to 0.98, p<0.0001) and then increased (IRR 1.05; 95% CI 1.02 to 1.09, p=0.002). Rates of self-harm were strongly correlated with suicide rates in England in males (r=0.82, p=0.0006) and females (r=0.74, p=0.004). Over 75% of self-harm episodes were due to self-poisoning, mainly with analgesics (45.7%), antidepressants (24.7%) and benzodiazepines (13.8%). A substantial increase in self-injury occurred in the latter part of the study period. This was especially marked for self-cutting/stabbing and hanging/asphyxiation. Psychosocial assessment by specialist mental health staff occurred in 53.2% of episodes.ConclusionsTrends in rates of self-harm and suicide may be closely related; therefore, self-harm can be a useful mental health indicator. Despite national guidance, many patients still do not receive psychosocial assessment, especially those who self-injure.
Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study
Authors: Inacio Maria C S , Hansen Craig , Pratt Nicole L , Graves Stephen E , Roughead Elizabeth E 
Published: April 2016

ObjectivesTo determine chronic opioid use pre-THA (total hip arthroplasty) and post-THA, and risk factors for persistent or new chronic opioid use post-THA.DesignRetrospective cohort study.SettingAustralian Government Department of Veterans' Affairs health claims database.Participants9525 patients who had an elective unilateral THA between 1/01/2001 and 12/31/2012.Primary outcome measureChronic opioid use. Defined as 90 days of continuous opioid use or 120 days of non-continuous use.ResultsPre-THA, 6.2% (n=593) of patients were chronic users, while 5.2% (n=492) were post-THA. Among the 492 postoperative chronic users, 302 (61%) were chronic users pre-THA and post-THA and 190 (39%) became new chronic users after surgery. Risk factors for persistent chronic use were younger age (OR=0.96, 95% CI 0.93 to 0.99/1-year increment), back pain (OR=1.99, 95% CI 1.20 to 3.23), diabetes (OR=3.52, 95% CI 1.05 to 11.8), hypnotics use (OR=2.52, 95% CI 1.48 to 4.30) and higher pre-THA opioid exposure (compared with opioid use for 94–157 days, 157–224 days (OR=3.75, 95% CI 2.28 to 6.18), 225+ days (OR=5.18, 95% CI 2.92 to 9.19). Risk factors for new chronic opioid use post-THA were being a woman (OR=1.40, 95% CI 1.00 to 1.96), back pain (OR=3.90, 95% CI 2.85 to 5.33), depression (OR=1.70, 95% CI 1.20 to 2.41), gastric acid disease (OR=1.62, 95% CI 1.16 to 2.25), migraine (OR=5.11, 95% CI 1.08 to 24.18), liver disease (OR=4.33, 95% CI 1.08 to 17.35), weight loss (OR=2.60, 95% CI 1.06 to 6.39), dementia (OR=2.19, 95% CI 1.04 to 4.61), hyperlipidaemia (OR=1.38, 95% CI 1.00 to 1.91), hypnotics (OR=1.56, 95% CI 1.13 to 2.16) and antineuropathic pain medication use (OR=3.11, 95% CI 2.05 to 4.72).ConclusionsPatients undergoing THA are exposed to opioids for long periods of time, putting them at high risk of harm related to opioid use. We identified groups at risk of chronic opioid use, including younger patients and women, as well as modifiable risk factors of chronic opioid use, including level of opioid exposure presurgery and hypnotic use. These indicators of chronic opioid use can be used by clinicians to target patient groups for suitable pain management interventions.
Examining the social determinants of children's developmental health: protocol for building a pan-Canadian population-based monitoring system for early childhood development
Authors: Guhn Martin , Janus Magdalena , Enns Jennifer , Brownell Marni , Forer Barry , Duku Eric , Muhajarine Nazeem , Raos Rob 
Published: April 2016

IntroductionEarly childhood is a key period to establish policies and practices that optimise children's health and development, but Canada lacks nationally representative data on social indicators of children's well-being. To address this gap, the Early Development Instrument (EDI), a teacher-administered questionnaire completed for kindergarten-age children, has been implemented across most Canadian provinces over the past 10 years. The purpose of this protocol is to describe the Canadian Neighbourhoods and Early Child Development (CanNECD) Study, the aims of which are to create a pan-Canadian EDI database to monitor trends over time in children's developmental health and to advance research examining the social determinants of health.Methods and analysisCanada-wide EDI records from 2004 to 2014 (representing over 700 000 children) will be linked to Canada Census and Income Taxfiler data. Variables of socioeconomic status derived from these databases will be used to predict neighbourhood-level EDI vulnerability rates by conducting a series of regression analyses and latent variable models at provincial/territorial and national levels. Where data are available, we will measure the neighbourhood-level change in developmental vulnerability rates over time and model the socioeconomic factors associated with those trends.Ethics and disseminationEthics approval for this study was granted by the Behavioural Research Ethics Board at the University of British Columbia. Study findings will be disseminated to key partners, including provincial and federal ministries, schools and school districts, collaborative community groups and the early childhood development research community. The database created as part of this longitudinal population-level monitoring system will allow researchers to associate practices, programmes and policies at school and community levels with trends in developmental health outcomes. The CanNECD Study will guide future early childhood development action and policies, using the database as a tool for formative programme and policy evaluation.
Workarounds to hospital electronic prescribing systems: a qualitative study in English hospitals
Authors: Cresswell Kathrin M , Mozaffar Hajar , Lee Lisa , Williams Robin , Sheikh Aziz 
Published: April 2016

BackgroundConcerns with the usability of electronic prescribing (ePrescribing) systems can lead to the development of workarounds by users.ObjectivesTo investigate the types of workarounds users employed, the underlying reasons offered and implications for care provision and patient safety.MethodsWe collected a large qualitative data set, comprising interviews, observations and project documents, as part of an evaluation of ePrescribing systems in five English hospitals, which we conceptualised as case studies. Data were collected at up to three different time points throughout implementation and adoption. Thematic analysis involving deductive and inductive approaches was facilitated by NVivo 10.ResultsOur data set consisted of 173 interviews, 24 rounds of observation and 17 documents. Participating hospitals were at various stages of implementing a range of systems with differing functionalities. We identified two types of workarounds: informal and formal. The former were informal practices employed by users not approved by management, which were introduced because of perceived changes to professional roles, issues with system usability and performance and challenges relating to the inaccessibility of hardware. The latter were formalised practices that were promoted by management and occurred when systems posed threats to patient safety and organisational functioning. Both types of workarounds involved using paper and other software systems as intermediaries, which often created new risks relating to a lack of efficient transfer of real-time information between different users.ConclusionsAssessing formal and informal workarounds employed by users should be part of routine organisational implementation strategies of major health information technology initiatives. Workarounds can create new risks and present new opportunities for improvement in system design and integration.
Approaches to managing uncertainty in people with life-limiting conditions: role of communication and palliative care
Authors: Etkind S N , Koffman J 
Published: April 2016

AbstractPatients with any major illness can expect to experience uncertainty about the nature of their illness, its treatment and their prognosis. Prognostic uncertainty is a particular source of patient distress among those living with life-limiting disease. Uncertainty also affects professionals and it has been argued that the level of professional tolerance of uncertainty can affect levels of investigation as well as healthcare resource use. We know that the way in which uncertainty is recognised, managed and communicated can have important impacts on patients' treatment and quality of life. Current approaches to uncertainty in life-limiting illness include the use of care bundles and approaches that focus on communication and education. The experience in communicating in difficult situations that specialist palliative care professionals can provide may also be of benefit for patients with life-limiting illness in the context of uncertainty. While there are a number of promising approaches to uncertainty, as yet few interventions targeted at recognising and addressing uncertainty have been fully evaluated and further research is needed in this area.
The Cretaceous of the South Kyzylkum and Nuratau Region, Western Tien Shan, Central Uzbekistan
Authors: McCann Tom 
Published: April 2016

Abstract
The Kyzylkum and south Nuratau areas of Central Uzbekistan form the westernmost parts of the Tien Shan and contain rare outcrops of Cretaceous rocks that were deposited along the northern margin of the Amu Darya Basin. The succession can be subdivided into 18 clastic and carbonate facies, and these were deposited in a series of contrasting depositional environments from Aptian through to Maastrichtian times. Broadly, the region comprised a coastal–marine transitional zone, with the coastline advancing and retreating over time, these changes being related to major marine incursions to the east (as far as the Tarim Basin). Tectonic activity along the basin margin, with subsequent uplift of parts of the mosaic of boundary blocks, most probably influenced the development of coeval clastic/carbonate successions in the late Cretaceous.
Heads Up! Predictive Gene Signatures in Head and Neck Cancer May Be Coming Soon
Authors: Chau Nicole G. , Hammerman Peter S. 
Published: April 2016

Abstract
Cetuximab–platinum chemotherapy is used for recurrent/metastatic head and neck squamous cell carcinoma (HNSCC); however, a minority of patients benefit. Gene expression profiling (GEP) of HNSCCs with prolonged responses to cetuximab-chemotherapy demonstrate basal subtype traits including signatures of EGFR signaling and hypoxic differentiation. GEP of short-response patients show RAS activation. Clin Cancer Res; 22(15); 3710–2. ©2016 AACR.
See related article by Bossi et al., p. 3961
Role for the Aryl Hydrocarbon Receptor and Diverse Ligands in Oral Squamous Cell Carcinoma Migration and Tumorigenesis
Authors: Stanford Elizabeth A. , Ramirez-Cardenas Alejandra , Wang Zhongyan , Novikov Olga , Alamoud Khalid , Koutrakis Petros , Mizgerd Joseph P. , Genco Caroline A. , Kukuruzinska Maria , Monti Stefano , Bais Manish V. , Sherr David H. 
Published: April 2016

Abstract
Over 45,000 new cases of oral and pharyngeal cancers are diagnosed and account for over 8,000 deaths a year in the United States. An environmental chemical receptor, the aryl hydrocarbon receptor (AhR), has previously been implicated in oral squamous cell carcinoma (OSCC) initiation as well as in normal tissue-specific stem cell self-renewal. These previous studies inspired the hypothesis that the AhR plays a role in both the acquisition and progression of OSCC, as well as in the formation and maintenance of cancer stem-like cells. To test this hypothesis, AhR activity in two oral squamous cell lines was modulated with AhR prototypic, environmental and bacterial AhR ligands, AhR-specific inhibitors, and phenotypic, genomic and functional characteristics were evaluated. The data demonstrate that: (i) primary OSCC tissue expresses elevated levels of nuclear AhR as compared with normal tissue, (ii) AhR mRNA expression is upregulated in 320 primary OSCCs, (iii) AhR hyperactivation with several ligands, including environmental and bacterial ligands, significantly increases AhR activity, ALDH1 activity, and accelerates cell migration, (iv) AhR inhibition blocks the rapid migration of OSCC cells and reduces cell chemoresistance, (v) AhR knockdown inhibits tumorsphere formation in low adherence conditions, and (vi) AhR knockdown inhibits tumor growth and increases overall survival in vivo. These data demonstrate that the AhR plays an important role in development and progression of OSCC, and specifically cancer stem-like cells. Prototypic, environmental, and bacterial AhR ligands may exacerbate OSCC by enhancing expression of these properties.
Implications: This study, for the first time, demonstrates the ability of diverse AhR ligands to regulate AhR activity in oral squamous cell carcinoma cells, as well as regulate several important characteristics of oral cancer stem cells, in vivo and in vitro. Mol Cancer Res; 14(8); 696–706. ©2016 AACR.
HIV and Hepatitis C–Coinfected Patients Have Lower Low‐Density Lipoprotein Cholesterol Despite Higher Proprotein Convertase Subtilisin Kexin 9 (PCSK9): An Apparent “PCSK9–Lipid Paradox”
Authors: Kohli Payal , Ganz Peter , Ma Yifei , Scherzer Rebecca , Hur Sophia , Weigel Bernard , Grunfeld Carl , Deeks Steven , Wasserman Scott , Scott Rob , Hsue Priscilla Y. 
Published: April 2016

Background

Proprotein convertase subtilisin kexin 9 (
PCSK
9) inhibitors reduce low‐density lipoprotein cholesterol (
LDL
‐C) and improve outcomes in the general population.
HIV
‐infected individuals are at increased risk for cardiovascular events and have high rates of dyslipidemia and hepatitis C virus (
HCV
) coinfection, making
PCSK
9 inhibition a potentially attractive therapy.

Methods and Results

We studied 567 participants from a clinic‐based cohort to compare
PCSK
9 levels in patients with
HIV
/
HCV
coinfection (n=110) with those with
HIV
infection alone (n=385) and with uninfected controls (n=72). The mean age was 49 years, and the median
LDL
‐C level was 100 mg/dL (
IQR
77–124 mg/dL); 21% were taking statins. The 3 groups had similar rates of traditional risk factors. Total cholesterol,
LDL
‐C, and high‐density lipoprotein cholesterol levels were lower in coinfected patients compared with controls (
P
<0.001).
PCSK
9 was 21% higher in
HIV
/
HCV
‐coinfected patients versus controls (95%
CI
9–34%,
P
<0.001) and 11% higher in coinfected individuals versus those with
HIV
infection alone (95%
CI
3–20%,
P
=0.008). After adjustment for cardiovascular risk factors,
HIV
/
HCV
coinfection remained significantly associated with 20% higher
PCSK
9 levels versus controls (95%
CI
8–33%,
P
=0.001). Interleukin‐6 levels increased in a stepwise fashion from controls (lowest) to
HIV
‐infected to
HIV
/
HCV
‐coinfected individuals (highest) and correlated with
PCSK
9 (
r
=0.11,
P
=0.018).

Conclusions

Despite having
lower
LDL
‐C, circulating
PCSK
9 levels were
increased
in patients coinfected with
HIV
and
HCV
in parallel with elevations in the inflammatory, proatherogenic cytokine interleukin‐6. Clinical trials should be conducted to determine the efficacy of targeted
PCSK
9 inhibition in the setting of
HIV
/
HCV
coinfection.
Remnant Lipoprotein Cholesterol and Incident Coronary Heart Disease: The Jackson Heart and Framingham Offspring Cohort Studies
Authors: Joshi Parag H. , Khokhar Arif A. , Massaro Joseph M. , Lirette Seth T. , Griswold Michael E. , Martin Seth S. , Blaha Michael J. , Kulkarni Krishnaji R. , Correa Adolfo , D'Agostino Ralph B. , Jones Steven R. , Toth Peter P. ,   the Lipoprotein Investigators Collaborative (LIC) Study Group
Published: April 2016

Background

Remnant lipoproteins (RLPs), the triglyceride‐enriched precursors to low‐density lipoprotein, are an emerging risk factor for coronary heart disease (
CHD
). We sought to determine the association of RLP cholesterol (
RLP
‐C) levels with incident
CHD
in 2 diverse, prospective, longitudinal observational US cohorts.

Methods and Results

We analyzed cholesterol levels from serum lipoprotein samples separated via density gradient ultracentrifugation in 4114 US black participants (mean age 53.8 years, 64% women) from the Jackson Heart Study and a random sample of 818 predominantly white participants (mean age 57.3 years, 52% women) from the Framingham Offspring Cohort Study. Multivariable‐adjusted hazard ratios (
HRs
) for
RLP
‐C (the sum of very low‐density lipoprotein
3
cholesterol and intermediate‐density lipoprotein cholesterol) were derived to estimate associations with incident
CHD
events consisting of myocardial infarction,
CHD
death, and revascularizations for each cohort separately and as a combined population. There were 146
CHD
events in the combined population. After adjustments for age, sex, body mass index, smoking, blood pressure, diabetes, and lipid‐lowering therapy for the combined population,
RLP
‐C (
HR
1.23 per 1‐
SD
increase, 95%
CI
1.06–1.42,
P
<0.01) and intermediate‐density lipoprotein cholesterol (
HR
1.26 per 1‐
SD
increase, 95%
CI
1.08–1.47,
P
<0.01) predicted
CHD
during an 8‐year follow‐up. Associations were attenuated by high‐density lipoprotein cholesterol and ultimately lost significance with inclusion of real low‐density lipoprotein cholesterol, which excludes Lp(a) and IDL cholesterol fractions. Similar associations were seen in multivariable analyses within each cohort.

Conclusion

RLP
‐C levels are predictive of incident
CHD
in this diverse group of primary prevention subjects. Interventions aimed at reducing
RLP
‐C to prevent
CHD
warrant further intensive investigation.

Clinical Trial Registration

URL
:
http://www.ClinicalTrials.gov
. Unique identifier:
NCT
00415415.
Thromboelastogram reduces blood use by inspecting coagulation in heart surgery
Authors: Yildirim Funda , Tuncer Barıs , Ozbakkaloglu Alper , Kurdal Adnan Taner , Ozturk Tulun , Iskesen Ihsan 
Published: April 2016

Objective Blood transfusion after coronary artery bypass surgery is carried out according to general coagulation tests and blood counts. Our aim was to determine the effects of rotational thromboelastography results on the amount of blood products used in the intraoperative and postoperative periods in coronary artery bypass patients. Methods Our study included 164 patients who underwent coronary artery bypass. A control group was formed from 82 patients picked from hospital records, who had elective coronary artery bypass before the introduction of rotational thromboelastography in our clinic. Blood transfusion was performed in this group according to conventional laboratory data. The study group comprised 82 patients who had elective coronary artery bypass after the introduction of rotational thromboelastography. Blood transfusion was performed in the study group according to rotational thromboelastogram results. The amounts of blood products used in the 2 groups were compared. Results There were statistically significant decreases in the intraoperative and postoperative amounts of packed red blood cells ( p = 0.012 and p = 0.006) and postoperative whole blood ( p = 0.013) used in the study group compared to the control group. Postoperative bleeding was also significantly reduced ( p = 0.001) in the study group. Conclusion Blood transfusion is an important issue after coronary artery bypass, and because of the decreased amount of blood products used, a rotational thromboelastography-based blood transfusion algorithm should be applied in patients undergoing coronary artery bypass.
Factors Influencing Child Feeding Practices Related to Home Fortification With Micronutrient Powder Among Caregivers of Under-5 Children in Bangladesh
Authors: Sarma Haribondhu , Uddin Md. Fakhar , Harbour Catherine , Ahmed Tahmeed 
Published: April 2016

Background: Anemia is a major public health concern in Bangladesh, affecting about 51% of under-5 children. There are a number of strategies to overcome this micronutrient-deficiency burden, and home fortification (HF) with micronutrient powder (MNP) is one of them. Objective: As part of an evaluation of an HF with MNP intervention program, we conducted a qualitative study to understand the factors influencing demand, purchase, and utilization of MNP by caregivers of under-5 children. Methods: We purposively selected study participants from 5 subdistricts and 1 urban slum in Bangladesh where HF with Pushtikona (a brand name of MNP) program is available. Data were collected through household observations and conducting in-depth interviews and focus group discussions with caregivers, grandmothers, and fathers of under-5 children. Results: Our study showed that caregivers were initially cautious, using Pushtikona on a trial basis, and afterward they employed various strategies to get their children to eat food fortified with Pushtikona. Barriers to acceptance and use of Pushtikona included inappropriate initiation of complementary feeding, discouragement from influential family members as well as miscommunication, conflicting information, and irregular visits by the health workers who sell Pushtikona to caregivers. Based on these findings, we characterized the users of Pushtikona as regular, ever, irregular, and never. Conclusion: The evidence suggests that focusing on counseling caregivers and other family members on the importance of MNP and on age-appropriate feeding practices will be critical to the success of this intervention program as will regular visits by health workers and improved service delivery.
Burden associated with smoking as a suicidal risk factor in an Australian sample of patients with psychosis
Authors: Sankaranarayanan Anoop , Castle David 
Published: April 2016

Objective: We aim to describe the burden associated with smoking as a risk factor for suicidal behaviors among patients with psychosis. Method: We calculated the Population Attributable Risk (PAR) associated with smoking and other known modifiable risk factors for suicidal behaviors for participants ( N=1812) who took part in the Australian Survey of High Impact Psychosis (SHIP). A combined PAR for the seven identified modifiable risk factors was calculated. Results: Smoking contributed to 21% of the suicidal behaviors in this sample; together, the seven factors contributed to 86% of all attempted suicide in this cohort. Conclusions: Smoking may exert a role either directly or indirectly. Evidence indicates that smoking is associated with psychological, biochemical and neurobiological changes that are in turn implicated in smoking. Suicidal behaviors are nevertheless complex behaviors needing multi-faceted approach.