bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of self-perceived cardiovascular disease risk among smokers with Framingham and PROCAM scores: a cross-sectional analysis of baseline data from a randomised controlled trial
Authors: Desgraz Benoît , Collet Tinh-Hai , Rodondi Nicolas , Cornuz Jacques , Clair Carole 
Published: January 2017

ObjectivesPrevious studies suggest that smokers have a misperception of their 10-year cardiovascular risk. We aimed to compare 10-year cardiovascular risk self-perception and calculated risk among smokers willing to quit and assess the determinants of a possible misperception.DesignCross-sectional secondary analysis of baseline data from a randomised controlled trial of smoking cessation.Participants514 participants, mean age 51.1 years, 46% women, 98% Caucasian. Eligible participants were regular smokers, aged between 40 and 70 years, with a consumption of at least 10 cigarettes per day for at least a year. None of them had experienced cardiovascular disease before. Exclusion criteria comprised a history of myocardial infarction, coronary heart disease, stroke, heart failure, peripheral vascular disease, carotid atherosclerosis or cardiac arrhythmia. Participants with renal or liver failure, psychiatric disorders, substance and alcohol abuse and with smoking cessation therapies were excluded.InterventionsParticipants were asked to estimate their 10-year cardiovascular risk using a 3-item scale corresponding to high-risk, moderate-risk and low-risk categories. We compared their risk perception with Framingham and Prospective Cardiovascular Munster Study (PROCAM) scores. We used multivariable-adjusted logistic regression models to determine characteristics of participants who underestimate their risk versus those who correctly estimate or overestimate it.ResultsBetween 38% and 42% of smokers correctly perceived their 10-year cardiovascular risk, and 39–50% overestimated their 10-year cardiovascular risk while 12–19% underestimated it compared with their calculated 10-year cardiovascular risk depending on the score used. Underestimation of 10-year cardiovascular risk was associated with male gender (OR 8.16; CI 3.83 to 17.36), older age (OR 1.06; CI 1.02 to 1.09), and the presence of hyperlipidaemia (OR 2.71; CI 1.47 to 5.01) and diabetes mellitus (OR 13.93; CI 3.83 to 50.66).ConclusionsAmong smokers, misperception of their 10-year cardiovascular risk is common, with one-fifth underestimating it. These findings may help physicians target patients with such characteristics to help them change their health behaviour and adherence to risk-reduction therapy.Trial registration numberNCT00548665; Post-results.
Development and validation of brief scales to measure emotional and behavioural problems among Chinese adolescents
Authors: Shen Minxue , Hu Ming , Sun Zhenqiu 
Published: January 2017

ObjectivesTo develop and validate brief scales to measure common emotional and behavioural problems among adolescents in the examination-oriented education system and collectivistic culture of China.SettingMiddle schools in Hunan province.Participants5442 middle school students aged 11–19 years were sampled. 4727 valid questionnaires were collected and used for validation of the scales. The final sample included 2408 boys and 2319 girls.Primary and secondary outcome measuresThe tools were assessed by the item response theory, classical test theory (reliability and construct validity) and differential item functioning.ResultsFour scales to measure anxiety, depression, study problem and sociality problem were established. Exploratory factor analysis showed that each scale had two solutions. Confirmatory factor analysis showed acceptable to good model fit for each scale. Internal consistency and test–retest reliability of all scales were above 0.7. Item response theory showed that all items had acceptable discrimination parameters and most items had appropriate difficulty parameters. 10 items demonstrated differential item functioning with respect to gender.ConclusionsFour brief scales were developed and validated among adolescents in middle schools of China. The scales have good psychometric properties with minor differential item functioning. They can be used in middle school settings, and will help school officials to assess the students’ emotional/behavioural problems.
Is having a family member with chronic health concerns bad for young people's health? Cross-sectional evidence from a national survey of young Australians
Authors: Moffat Anna K , Redmond Gerry 
Published: January 2017

ObjectivesYoung people's perspectives on the association between having a family member with a chronic health concern (FHC) and their own health are under-researched. This study used young people's reports to assess the prevalence of FHCs and their association with negative health outcomes, with an aim of identifying potential inequalities between marginalised and non-marginalised young people. Family cohesion was examined as a moderating factor.DesignCross-sectional data from the Australian Child Wellbeing Project survey were used. Respondents were asked whether someone in their family experienced one or more FHCs (disability, mental illness or drug/alcohol addiction). In addition, their experience of different psychosomatic symptoms (headache, sleeplessness, irritability, etc), aspects of family relationships and social and economic characteristics (disability, materially disadvantaged and Indigenous) were documented.SettingNationally representative Australian sample.Participants1531 students in school years 4 and 6 and 3846 students in year 8.ResultsA quarter of students reported having an FHC (years 4 and 6: 23.96% (95% CI 19.30% to 28.62%); year 8: 25.35% (95% CI 22.77% to 27.94%)). Significantly, more students with FHCs than those without reported experiencing 2 or more negative health symptoms at least weekly (OR=1.78; 95% CI 1.19 to 2.65; p<0.01). However, an independent relationship between FHCs and symptom load was only found in the case of FHC-drug/alcohol addiction. Marginalised students and students reporting low family cohesion had an increased prevalence of FHCs and notably higher symptom loads where FHCs were present. Level of family cohesion did not impact the relationship between FHCs and symptom load.ConclusionsThe burden of FHCs is inequitably distributed between marginalised and non-marginalised groups, and between young people experiencing different levels of family cohesion. More work is required regarding appropriate targets for community and family-level interventions to support young people in the context of FHCs.
Treatment targeted at underlying disease versus palliative care in terminally ill patients: a systematic review
Authors: Reljic Tea , Kumar Ambuj , Klocksieben Farina A , Djulbegovic Benjamin 
Published: January 2017

ObjectiveTo assess the efficacy of active treatment targeted at underlying disease (TTD)/potentially curative treatments versus palliative care (PC) in improving overall survival (OS) in terminally ill patients.DesignWe performed a systematic review and meta-analysis of randomised controlled trials (RCT). Methodological quality of included RCTs was assessed using the Cochrane risk of bias tool.Data sourcesMedline and Cochrane databases were searched, with no language restriction, from inception to 19 October 2016.Eligibility criteria for selecting studiesAny RCT assessing the efficacy of any active TTD versus PC in adult patients with terminal illness with a prognosis of <6-month survival were eligible for inclusion.ResultsInitial search identified 8252 citations of which 10 RCTs (15 comparisons, 1549 patients) met inclusion criteria. All RCTs included patients with cancer. OS was reported in 7 RCTs (8 comparisons, 1158 patients). The pooled results showed no statistically significant difference in OS between TTD and PC (HR (95% CI) 0.85 (0.71 to 1.02)). The heterogeneity between pooled studies was high (I2=62.1%). Overall rates of adverse events were higher in the TTD arm.ConclusionsOur systematic review of available RCTs in patients with terminal illness due to cancer shows that TTD compared with PC did not demonstrably impact OS and is associated with increased toxicity. The results provide assurance to physicians, patients and family that the patients' survival will not be compromised by referral to hospice with focus on PC.
Combining qualitative and quantitative operational research methods to inform quality improvement in pathways that span multiple settings
Authors: Crowe Sonya , Brown Katherine , Tregay Jenifer , Wray Jo , Knowles Rachel , Ridout Deborah A , Bull Catherine , Utley Martin 
Published: January 2017

BackgroundImproving integration and continuity of care across sectors within resource constraints is a priority in many health systems. Qualitative operational research methods of problem structuring have been used to address quality improvement in services involving multiple sectors but not in combination with quantitative operational research methods that enable targeting of interventions according to patient risk. We aimed to combine these methods to augment and inform an improvement initiative concerning infants with congenital heart disease (CHD) whose complex care pathway spans multiple sectors.MethodsSoft systems methodology was used to consider systematically changes to services from the perspectives of community, primary, secondary and tertiary care professionals and a patient group, incorporating relevant evidence. Classification and regression tree (CART) analysis of national audit datasets was conducted along with data visualisation designed to inform service improvement within the context of limited resources.ResultsA ‘Rich Picture’ was developed capturing the main features of services for infants with CHD pertinent to service improvement. This was used, along with a graphical summary of the CART analysis, to guide discussions about targeting interventions at specific patient risk groups. Agreement was reached across representatives of relevant health professions and patients on a coherent set of targeted recommendations for quality improvement. These fed into national decisions about service provision and commissioning.ConclusionsWhen tackling complex problems in service provision across multiple settings, it is important to acknowledge and work with multiple perspectives systematically and to consider targeting service improvements in response to confined resources. Our research demonstrates that applying a combination of qualitative and quantitative operational research methods is one approach to doing so that warrants further consideration.
A quasi-experimental evaluation of dried blood spot testing through community pharmacies in the Tayside region of Scotland
Authors: Radley Andrew , Melville Karen , Tait Jan , Stephens Brian , Evans Josie M M , Dillon John F 
Published: January 2017

ObjectiveComparison of uptake of dried blood spot testing (DBST) for hepatitis C virus (HCV) infection between community pharmacies and established services.DesignQuantitative evaluation of a service development with qualitative process evaluation undertaken in parallel.SettingSix pharmacies from 36 community pharmacies within Dundee City, a large urban settlement with high levels of socioeconomic deprivation.ParticipantsPatients in receipt of opioid substitution therapy (OST) not tested for HCV within 12 months. The 6 pharmacies provided OST for approximately 363 patients from a cohort of 1385 patients within Dundee City.InterventionProvision of DBST by pharmacists.Main outcome measureReceipt of DBST between January and December 2014.Results43 of 143 service users with no record of testing from the 6 community pharmacies accepted DBST. Of 561 from the remaining 1022 service users with no record of testing, 75 were tested for HCV (30% vs 13%). The OR for increased uptake of testing within the 6 pharmacies was 2.25 (95% CI 1.48 to 3.41, Z statistic=3.81, p=<0.0001) compared with other services. The DBST taken by the pharmacies provided 12 patients with a reactive test. The process evaluation identified key themes important to staff and recipients of the service. A logic model was constructed.LimitationsNon-experimental service evaluation performed in community pharmacies records service activity in one location across a single time period.InterpretationSome evidence that DBST from community pharmacies may be feasible. Service users received the service positively. Staff reported that DBST was straightforward and achievable.
Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes
Authors: Rai Ansaar T , Boo SoHyun , Buseman Chelsea , Adcock Amelia K , Tarabishy Abdul R , Miller Maurice M , Roberts Thomas D , Domico Jennifer R , Carpenter Jeffrey S 
Published: January 2017

BackgroundLimited efficacy of IV recombinant tissue plasminogen activator (rt-PA) for large vessel occlusions (LVO) raises doubts about its utility prior to endovascular therapy.PurposeTo compare outcomes and hospital costs for anterior circulation LVOs (middle cerebral artery, internal carotid artery terminus (ICA-T)) treated with either primary endovascular therapy alone (EV-Only) or bridging therapy (IV+EV)).MethodsA single-center retrospective analysis was performed. Clinical and demographic data were collected prospectively and relevant cost data were obtained for each patient in the study.Results90 consecutive patients were divided into EV-Only (n=52) and IV+EV (n=38) groups. There was no difference in demographics, stroke severity, or clot distribution. The mean (SD) time to presentation was 5:19 (4:30) hours in the EV-Only group and 1:46 (0:52) hours in the IV+EV group (p<0.0001). Recanalization: EV-Only 35 (67%) versus IV+EV 31 (81.6%) (p=0.12). Favorable outcome: EV-Only 26 (50%) versus IV+EV 22 (58%) (p=0.45). For patients presenting within 4.5 hours (n=64): Recanalization: EV-Only 21/26 (81%) versus IV+EV 31/38 (81.6%) (p=0.93). Favorable outcome: EV-Only 14/26 (54%) versus IV+EV 22/38 (58%) (p=0.75). There was no significant difference in rates of hemorrhage, mortality, home discharge, or length of stay. A stent retriever was used in 67 cases (74.4%), with similar recanalization, outcomes, and number of passes in the EV-Only and IV+EV groups. The mean (SD) total hospital cost was $33 810 (13 505) for the EV-Only group and $40 743 (17 177) for the IV+EV group (p=0.02). The direct cost was $23 034 (8786) for the EV-Only group and $28 711 (11 406) for the IV+EV group (p=0.007). These significantly higher costs persisted for the subgroup presenting in <4.5 hours and the stent retriever subgroup. IV rt-PA administration independently predicted higher hospital costs.ConclusionsIV rt-PA did not improve recanalization, thrombectomy efficacy, functional outcomes, or length of stay. Combined therapy was associated with significantly higher total and direct hospital costs than endovascular therapy alone.
Wire escalation in emergent revascularization procedures of internal carotid artery occlusions: the use of high tip stiffness microguidewires
Authors: Cohen José E , Leker Ronen R , Gomori John M , Itshayek Eyal 
Published: January 2017

ObjectiveWe examined the usefulness and safety of high tip stiffness cardiac microguidewires in the endovascular revascularization of selected cases of internal carotid artery (ICA) occlusion.MethodsFiles of patients with acute ischemic symptoms due to ICA occlusions managed from August 2010 to August 2016 by urgent endovascular revascularization were retrospectively reviewed with a waiver of informed consent. Cases where there was escalation to stiff tipped cardiovascular microguidewires after at least two failed attempts to cross the carotid occlusion with standard neuro-microguidewires were included. Radiological and interventional data were recorded.Results63 patients with acute carotid occlusions underwent emergent endovascular revascularization in the study period; 5/63 patients met the inclusion criteria. In 4/5 patients, there was no angiographic evidence of the remnant origin of the ICA; in 1/5 there was a wide round shaped proximal calcified cap that precluded soft guidewire entry. In all cases, antegrade wiring was achieved only after switching to stiffer guidewires designed for the management of chronic cardiac occlusions. The use of these stiffer tip wires was considered of critical importance in achieving the successful performance of the ICA revascularization procedure. In all patients, revascularization was achieved, and 90 day modified Rankin Scale score ranged from 0 to 2.ConclusionsWhen regular neuro-guidewires do not allow antegrade wiring in cases of ICA occlusion, wire escalation to high tip stiffness guidewires may improve success. These wires, designed to deal with chronic total coronary occlusions, can serve as a platform for new neuro-guidewires to be used in the challenging field of resistant supra-aortic occlusions.
Posterior circulation perforator aneurysms: a proposed management algorithm
Authors: Buell Thomas J , Ding Dale , Raper Daniel M S , Chen Ching-Jen , Hixson Harry R , Crowley R Webster , Evans Avery J , Jensen Mary E , Liu Kenneth C 
Published: January 2017

IntroductionSubarachnoid hemorrhage (SAH) from posterior circulation perforator aneurysms (PCPAs) is rare and its natural history is unknown. Diagnosis may be difficult, acute management is poorly defined, and long-term recurrent SAH rates and clinical outcome data are lacking.MethodsWe searched our institution's records for cases of PCPA rupture and analyzed patient demographics, Hunt and Hess (HH) grades, diagnostic imaging, management, and clinical outcomes. We conducted telephone interviews to calculate modified Rankin Scale (mRS) scores.ResultsWe identified 9 patients (6 male, 3 female) with a ruptured PCPA who presented to the University of Virginia Health System (Charlottesville, VA, USA) between 2010 and 2016. Median and mean ages were 62 and 63 years, respectively. Median HH grade was 3. Seven of nine (78%) PCPAs were angiographically occult on initial imaging and median time to diagnosis was 5 days. Three conservatively managed patients had a mean mRS score of 0.67 (range 0–1) at mean follow-up of 35.3 months. Antifibrinolytic therapy was administered to all conservatively managed patients without thrombotic complication. Six patients receiving endovascular treatment had a mean mRS score of 2.67 (range 0–6) at mean follow-up of 49.2 months. No cases of recurrent SAH were seen in the study.ConclusionsThe rarity of PCPA has precluded long-term clinical follow-up until now. Our experience suggests low recurrent SAH rates. Until further studies are performed, conservative management, possibly combined with antifibrinolytic therapy, may be a viable treatment with acceptable long-term outcome.
The performance of the Alere HIV combo point-of-care test on stored serum samples; useful for detection of early HIV-1 infections?
Authors: van Tienen Carla , Rugebregt Sharona , Scherbeijn Sandra , Götz Hannelore , Geurts van Kessel Corine 
Published: January 2017

IntroductionThe Alere HIV-1/2 Antigen/Antibody Combo point-of-care test is a commercially available 4th-generation rapid test for the diagnosis of HIV infection, including acute infection. We evaluated the sensitivity of this test in samples from patients with acute, recent or chronic HIV-1 infection.MethodsA validation of the test was performed using 89 HIV-positive serum samples collected in 2008–2016, that were stored at −20°C. Twenty-three samples were only p24-positive (acute infection); 49 samples were antibody-positive and p24-positive (recent infection); 17 samples were only antibody-positive (chronic infection). HIV infection was confirmed by standard-of-care assays and PCR. Samples came from patients attending an outpatient clinic for STDs at the Public Health Department and from patients within the Erasmus Medical Center, Rotterdam, the Netherlands.ResultsThe overall sensitivity of the test for diagnosing HIV infection based on detection of p24 antigen and/or antibodies was 92% (95% CI 86% to 98%) (82/89). In acute sera with only p24 antigen positivity, the sensitivity of the test decreased to 65% (95% CI 46% to 85%) (15/23). When both antibody and antigen testing were positive, the p24 sensitivity was only 24% (95% CI 12% to 36%) (12/49), but in these sera the final test result was positive in all sera (49/49) due to the positive antibody component.ConclusionsIn a laboratory setting, this test has an overall sensitivity of 92% to detect any stage of HIV-1 infection using sera specimens. It performs relatively well in detecting early HIV and may be beneficial as an initial screening in patients with a recent exposure to HIV. Additional testing in a laboratory setting remains mandatory as a proportion of acute HIV-1 infections are missed with this test.
The RAS–Effector Interaction as a Drug Target
Authors: Keeton Adam B. , Salter E. Alan , Piazza Gary A. 
Published: January 2017

Abstract
About a third of all human cancers harbor mutations in one of the K-, N-, or HRAS genes that encode an abnormal RAS protein locked in a constitutively activated state to drive malignant transformation and tumor growth. Despite more than three decades of intensive research aimed at the discovery of RAS-directed therapeutics, there are no FDA-approved drugs that are broadly effective against RAS-driven cancers. Although RAS proteins are often said to be “undruggable,” there is mounting evidence suggesting it may be feasible to develop direct inhibitors of RAS proteins. Here, we review this evidence with a focus on compounds capable of inhibiting the interaction of RAS proteins with their effectors that transduce the signals of RAS and that drive and sustain malignant transformation and tumor growth. These reports of direct-acting RAS inhibitors provide valuable insight for further discovery and development of clinical candidates for RAS-driven cancers involving mutations in RAS genes or otherwise activated RAS proteins. Cancer Res; 77(2); 221–6. ©2017 AACR.
A Conference of New Ideas in Cancer—Challenging Dogmas
Authors: Gandhi Varsha , Jalali Rakesh 
Published: January 2017

Abstract
In 2016, Tata Memorial Center in Mumbai, India, reached its platinum jubilee milestone (75 years), which was celebrated with conferences. The first of these was entitled, "A Conference of New Ideas in Cancer – Challenging Dogmas.” The aim of the conference was to take an honest appraisal about the state of cancer research today, to debate “currently entrenched versus contrarian viewpoints” and to reflect upon whether the current research and therapeutic strategies are appropriate and whether resources are being optimally utilized in meaningful ways. Below, we describe major highlights of this meeting. Cancer Res; 77(2); 234–7. ©2017 AACR.
Mutated Chromatin Regulatory Factors as Tumor Drivers in Cancer
Authors: Koschmann Carl , Nunez Felipe J. , Mendez Flor , Brosnan-Cashman Jacqueline A. , Meeker Alan K. , Lowenstein Pedro R. , Castro Maria G. 
Published: January 2017

Abstract
Genes encoding proteins that regulate chromatin structure and DNA modifications [i.e., chromatin regulatory factors (CRF)] and genes encoding histone proteins harbor recurrent mutations in most human cancers. These mutations lead to modifications in tumor chromatin and DNA structure and an altered epigenetic state that contribute to tumorigenesis. Mutated CRFs have now been identified in most types of cancer and are increasingly regarded as novel therapeutic targets. In this review, we discuss DNA alterations in CRFs and how these influence tumor chromatin structure and function, which in turn leads to tumorigenesis. We also discuss the clinical implications and review concepts of targeted treatments for these mutations. Continued research on CRF mutations will be critical for our future understanding of cancer biology and the development and implementation of novel cancer therapies. Cancer Res; 77(2); 227–33. ©2017 AACR.