bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing content validity and user perspectives on the Team Check-up Tool: expert survey and user focus groups
Authors: Marsteller Jill A , Hsu Yea-Jen , Chan Kitty S , Lubomski Lisa H 
Published: April 2016

ObjectiveThis study assesses content validity and user feedback on the Team Check-up Tool (TCT), an instrument used for measuring dynamic context of quality improvement (QI) teams and their implementation of QI activities.MethodsWe conducted two focus groups and one larger feedback session with TCT users to assess feasibility, importance of areas of inquiry and barriers to use. A panel of eight QI experts evaluated the item-by-item content (content validity) of TCT by rating the relevance of each item to implementation success. We calculated item-level and scale-level content validity using the content validity index (CVI).ResultsScale-level CVI was 0.872. Highly rated items included implementation of recommended interventions, educational activities, team review of performance data, team sharing of performance data with staff and specific barriers to progress. Four items were rated relatively low: presentation of performance data to the hospital/health system board; manner of provision of feedback of data to staff; to what other units the team attempted to spread and turnover of QI team members. Items identified in user focus groups as important included whether there were events distracting staff from the initiative, number of team meetings and turnover of QI team members. Focus groups also identified barriers to the completion of the tool, including lack of feedback and response fatigue during stable activity periods.ConclusionThe findings support the conclusion that the TCT measures meaningful areas of context and implementation in team-based QI initiatives, particularly intervention activity tracking, review and sharing of performance data and team progress barriers. We offer a modified instrument with a framework for real-time measurement of important elements of implementation and context of QI teams based on the findings.
Comparison of oxygen uptake during cycle ergometry with and without functional electrical stimulation in patients with COPD: protocol for a randomised, single-blind, placebo-controlled, cross-over trial
Authors: Medrinal Clément , Prieur Guillaume , Debeaumont David , Robledo Quesada Aurora , Combret Yann , Quieffin Jean , Contal Olivier , Lamia Bouchra 
Published: April 2016

IntroductionChronic obstructive pulmonary disease (COPD) has systemic repercussions that can lead to peripheral muscle dysfunction. Muscle atrophy reduces aerobic capacity, greatly limiting activities of daily living and quality of life. Pulmonary rehabilitation is the gold standard treatment for these patients, however, patients may not be able to reach sufficient training intensities for benefits to occur. Technologies such as functional electrical stimulation (FES) are currently being adapted and tested to enhance exercise training. We hypothesise that FES coupled with cycling (FES-cycling) will improve maximal uptake of oxygen (VO2) and aerobic capacity more than endurance training with placebo stimulation.MethodsA randomised, single-blind, placebo-controlled crossover trial will be carried out to evaluate the effects of FES-cycling on VO2during endurance exercise on a cycle ergometer in patients with COPD. 25 patients with COPD will carry out two 30 min sessions at a constant load; one session with active and one with placebo FES. The primary outcome is oxygen uptake recorded with a metabolic measurement system. Secondary outcomes include ventilation equivalent for oxygen, ventilation equivalent for carbon dioxide, cardiac output, lactate values, perceived dyspnoea and perceived muscle fatigue.Results and conclusionsApproval has been granted by our Institutional Review Board (Comité de Protection des Personnes Nord-Ouest 3). The results of the trial will be presented at national and international meetings and published in peer-reviewed journals.Trial registration numberNCT02594722.
Exercise therapy in primary biliary cirrhosis: the importance of moving while sitting on a surgical waiting list—a case study
Authors: Hallsworth Kate , Jopson Laura , Jones David E , Trenell Michael I 
Published: April 2016

BackgroundIt is being increasingly recognised that reduced cardiorespiratory fitness is associated with poorer outcomes after major surgery. Exercise limitation and reduced aerobic capacity are common in people with end-stage liver disease. There is limited evidence about the role of exercise therapy in the management of primary biliary cirrhosis (PBC) and no studies have looked at the effect of exercise in people with PBC who are awaiting liver transplantation. This case study is the first to report that personalised exercise therapy improves cardiorespiratory fitness in a patient with PBC without worsening symptoms of severe fatigue.MethodsCardiopulmonary exercise testing was used to assess cardiorespiratory fitness in a patient with end-stage PBC prior to listing for transplantation. A personalised exercise programme was designed to improve cardiorespiratory fitness while the patient was on the transplant waiting list.ResultsAnaerobic threshold, VO2PEAKand maximum workload all improved with regular exercise. Fatigue levels remained unaltered.ConclusionsThis patient tolerated and adhered to a personalised exercise programme for a prolonged period of time while awaiting surgery despite significant fatigue and disease burden. Liver transplantation was successfully completed and this woman remains well over 2 years post-surgery.
Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: a mid-term follow-up analysis
Authors: Crippa Stefano , Bassi Claudio , Salvia Roberto , Malleo Giuseppe , Marchegiani Giovanni , Rebours Vinciane , Levy Philippe , Partelli Stefano , Suleiman Shadeah L , Banks Peter A , Ahmed Nazir , Chari Suresh T , Fernández-del Castillo Carlos , Falconi Massimo 
Published: April 2016

ObjectiveTo evaluate mid-term outcomes and predictors of survival in non-operated patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) with worrisome features or high-risk stigmata as defined by International Consensus Guidelines for IPMN. Reasons for non-surgical options were physicians’ recommendation, patient personal choice or comorbidities precluding surgery.MethodsIn this retrospective, multicentre analysis, IPMNs were classified as branch duct (BD) and main duct (MD), the latter including mixed IPMNs. Univariate and multivariate analysis for overall survival (OS) and disease-specific survival (DSS) were obtained.ResultsOf 281 patients identified, 159 (57%) had BD-IPMNs and 122 (43%) had MD-IPMNs; 50 (18%) had high-risk stigmata and 231 (82%) had worrisome features. Median follow-up was 51 months. The 5-year OS and DSS for the entire cohort were 81% and 89.9%. An invasive pancreatic malignancy developed in 34 patients (12%); 31 had invasive IPMNs (11%) and 3 had IPMN-distinct pancreatic ductal adenocarcinoma (1%). Independent predictors of poor DSS in the entire cohort were age >70 years, atypical/malignant cyst fluid cytology, jaundice and MD >15 mm. Compared with MD-IPMNs, BD-IPMNs had significantly better 5-year OS (86% vs 74.1%, p=0.002) and DSS (97% vs 81.2%, p<0.0001). Patients with worrisome features had better 5-year DSS compared with those with high-risk stigmata (96.2% vs 60.2%, p<0.0001).ConclusionsIn elderly patients with IPMNs that have worrisome features, the 5-year DSS is 96%, suggesting that conservative management is appropriate. By contrast, presence of high-risk stigmata is associated with a 40% risk of IPMN-related death, reinforcing that surgical resection should be offered to fit patients.
Trends in violence in England and Wales 2010–2014
Authors: Sivarajasingam Vaseekaran , Page Nicholas , Wells John , Morgan Peter , Matthews Kent , Moore Simon , Shepherd Jonathan 
Published: April 2016

BackgroundThe National Violence Surveillance Network (NVSN) of emergency departments (ED), minor injuries units and walk-in-centres in England and Wales has brought clarity to contradictory violence trends derived from crime survey and police data. Gender, age-specific and regional trends in violence-related injury in England and Wales since 2010 have not been studied.MethodsData on violence-related injury were collected from a structured sample of 151 EDs in England and Wales. ED attendance date and age and gender of patients who reported injury in violence from 1 January 2010 to 31 December 2014 were identified from attendance codes, specified at the local level. Time series statistical methods were used to detect both regional and national trends.ResultsIn total, 247 016 (178 709 males: 72.3%) violence-related attendances were identified. Estimated annual injury rate across England and Wales was 4.4/1000 population (95% CI 3.9 to 4.9); males 6.5/1000 (95% CI 5.6 to 7.2) and females 2.4/1000 (95% CI 2.1 to 2.6). On average, overall attendances decreased by 13.8% per year over the 5 years (95% CI −14.8 to −12.1). Attendances decreased significantly for both genders and all age groups (0–10, 11–17, 18–30, 31–50, 51+ years); declines were greatest among children and adolescents. Significant decreases in violence-related injury were found in all but two regions. Violence peaked in May and July.ConclusionsFrom an ED perspective, violence in England and Wales decreased substantially between 2010 and 2014, especially among children and adolescents. Violence prevention efforts should focus on regions with the highest injury rates and during the period May–July.
High levels of cathepsin D and cystatin B are associated with increased risk of coronary events
Authors: Gonçalves Isabel , Hultman Karin , Dunér Pontus , Edsfeldt Andreas , Hedblad Bo , Fredrikson Gunilla Nordin , Björkbacka Harry , Nilsson Jan , Bengtsson Eva 
Published: April 2016

ObjectiveThe majority of acute coronary syndromes are caused by plaque ruptures. Proteases secreted by macrophages play an important role in plaque ruptures by degrading extracellular matrix proteins in the fibrous cap. Matrix metalloproteinases have been shown to be markers for cardiovascular disease whereas the members of the cathepsin protease family are less studied.MethodsCathepsin D, cathepsin L and cystatin B were measured in plasma at baseline from 384 individuals who developed coronary events (CEs), and from 409 age-matched and sex-matched controls from the Malmö Diet and Cancer cardiovascular cohort.ResultsCathepsin D (180 (142–238) vs 163 (128–210), p<0.001), cathepsin L (55 (44–73) vs 52 (43–67), p<0.05) and cystatin B levels (45 (36–57) vs 42 (33–52), p<0.001) were significantly increased in CE cases compared to controls. In addition, increased cathepsin D (220 (165–313) vs 167 (133–211), p<0.001), cathepsin L (61 (46–80) vs 53 (43–68), p<0.05) and cystatin B (46 (38–58) vs 43 (34–54), p<0.05) were associated with prevalent diabetes. Furthermore, cathepsin D and cystatin B were increased in smokers. The HRs for incident CE comparing the highest to the lowest tertile(s) of cathepsin D and cystatin B were 1.34 (95% CI 1.02 to 1.75) and 1.26 (95% CI 1.01 to 1.57), respectively, after adjusting for age, sex, low-density lipoprotein/high-density lipoprotein ratio, triglycerides, body mass index, hypertension and glucose, but these associations did not remain significant after further addition of smoking to the model. In addition, cathepsin D was increased in incident CE cases among smokers after adjusting for cardiovascular risk factors.ConclusionsThe associations of cathepsin D and cystatin B with future CE provide clinical support for a role of these factors in cardiovascular disease, which for cathepsin D may be of particular importance for smokers.
β-Glucan content, viscosity, and solubility of Canadian grown oat as influenced by cultivar and growing location
Authors: Herrera Mariana Perez , Gao Jun , Vasanthan Thava , Temelli Feral , Henderson Kelly 
Published: April 2016

The composition and physicochemical properties of oat flour with respect to β-glucan content and its solubility and viscosity were investigated. Eight oat cultivars grown in 20 prairie locations for three consecutive years were examined in this study to establish how cultivar, growing location, and their interaction influence the abovementioned attributes. It was found that the β-glucan content was primarily influenced by oat cultivar, while growing location and the interaction between cultivar and location had minimal effect. Among the eight cultivars, HiFi had the highest β-glucan content (5.82% w/w), while Derby had the lowest (4.37% w/w). Growing location, oat cultivar, and their interaction had a significant effect on β-glucan solubility and viscosity. The β-glucan solubility differed among oat cultivars, where 28.44–34.28% of the β-glucan present in the oat flour could be solubilized at 37°C. Viscosity was evaluated by consecutive fixed speed tests at shear rates of 1.29–129 s−1. Results showed that shear rate, growing location, and cultivar affected viscosity. The flow behavior index (n) for all β-glucan dispersions indicated shear-thinning behavior. HiFi had the highest β-glucan solubility and viscosity among all the cultivars analyzed. The findings provide insight into raw material selection and variations in raw material characteristics when targeting specific oat product applications.
Starch granule size distribution from twelve wheat cultivars in east China’s Huaibei region
Authors: Li Wenyang , Yan Suhui , Shi Xiaqing , Zhang Congyu , Shao Qingqin , Xu Feng , Wang Jianfei 
Published: April 2016

The granule size distribution of starch strongly influences its physicochemical properties and the functionality of wheat. Twelve wheat cultivars grown in east China’s Huanghuai region were used for investigating the granule size distribution, amylose content, and their interrelationship. The results showed that the volume distribution of starch granules show the typical bimodal with peak values in the ranges of 4.44–5.36 µm and 21.7–23.82 µm, respectively. Surface area distribution of granules was also bimodal with peak values in the ranges of 2.53–3.06 µm and 19.8–21.7 µm, respectively. The limits between the two populations both occurred at 10 µm. A typical population of number distribution of granules with peak values in the range of 0.52–0.67 µm. Proportions of granules <2.6 µm, 2.6–10 µm, and 10–40 µm were in the range of 10.06–13.63%, 28.54–41.6%, and 45.4–61.3% of total volume, respectively. Proportions of granules <10 µm were in the range of 99.9% of the total number. The amylose content was significant and negatively correlated to volume percentage of granule <10 µm, and significant and positively correlated to the volume percentage of granule 22–40 µm.
The Effect of Exercise Training on Mediators of Inflammation in Breast Cancer Survivors: A Systematic Review with Meta-analysis
Authors: Meneses-Echávez Jose F. , Correa-Bautista Jorge E. , González-Jiménez Emilio , Schmidt Río-Valle Jacqueline , Elkins Mark R. , Lobelo Felipe , Ramírez-Vélez Robinson 
Published: April 2016

Abstract
Several sources of evidence indicate that exercise during and after breast cancer could positively modulate the tumor microenvironment. This meta-analysis aimed to determine the effects of exercise training on mediators of inflammation in breast cancer survivors. We searched for randomized controlled trials published from January 1990 to March 2014. An inverse variance method of meta-analysis was performed using a random effects model in the presence of statistical heterogeneity. Eight high-quality trials (n = 478) were included. Exercise improved the serum concentrations of IL6 [weighted mean difference (WMD) = −0.55 pg/mL; 95% confidence interval (CI), −1.02 to −0.09], TNFα (WMD = −0.64 pg/mL; 95% CI, −1.21 to −0.06), IL8 (MD = −0.49 pg/mL; 95% CI, −0.89 to −0.09), and IL2 (WMD = 1.03 pg/mL; 95% CI, 0.40 to 1.67). No significant differences were found in the serum concentrations of C-reactive protein (WMD = −0.15; 95% CI, −0.56 to 0.25) or IL10 (WMD = 0.41; 95% CI, −0.18 to 1.02). Exercise training positively modulates chronic low-grade inflammation in women with breast cancer, which may impact upon carcinogenic mechanisms and the tumor microenvironment. These findings align with the other positive effects of exercise for breast cancer survivors, reinforcing the appropriateness of exercise prescription in this population. Cancer Epidemiol Biomarkers Prev; 25(7); 1009–17. ©2016 AACR.
Neutrophils Suppress Intraluminal NK Cell–Mediated Tumor Cell Clearance and Enhance Extravasation of Disseminated Carcinoma Cells
Authors: Spiegel Asaf , Brooks Mary W. , Houshyar Samin , Reinhardt Ferenc , Ardolino Michele , Fessler Evelyn , Chen Michelle B. , Krall Jordan A. , DeCock Jasmine , Zervantonakis Ioannis K. , Iannello Alexandre , Iwamoto Yoshiko , Cortez-Retamozo Virna , Kamm Roger D. , Pittet Mikael J. , Raulet David H. , Weinberg Robert A. 
Published: April 2016

AbstractImmune cells promote the initial metastatic dissemination of carcinoma cells from primary tumors. In contrast to their well-studied functions in the initial stages of metastasis, the specific roles of immunocytes in facilitating progression through the critical later steps of the invasion–metastasis cascade remain poorly understood. Here, we define novel functions of neutrophils in promoting intraluminal survival and extravasation at sites of metastatic dissemination. We show that CD11b+/Ly6G+ neutrophils enhance metastasis formation via two distinct mechanisms. First, neutrophils inhibit natural killer cell function, which leads to a significant increase in the intraluminal survival time of tumor cells. Thereafter, neutrophils operate to facilitate extravasation of tumor cells through the secretion of IL1β and matrix metalloproteinases. These results identify neutrophils as key regulators of intraluminal survival and extravasation through their cross-talk with host cells and disseminating carcinoma cells.Significance: This study provides important insights into the systemic contributions of neutrophils to cancer metastasis by identifying how neutrophils facilitate intermediate steps of the invasion–metastasis cascade. We demonstrate that neutrophils suppress natural killer cell activity and increase extravasation of tumor cells. Cancer Discov; 6(6); 630–49. ©2016 AACR.This article is highlighted in the In This Issue feature, p. 561
Myofiber Architecture of the Human Atria as Revealed by Submillimeter Diffusion Tensor Imaging
Authors: Pashakhanloo Farhad , Herzka Daniel A. , Ashikaga Hiroshi , Mori Susumu , Gai Neville , Bluemke David A. , Trayanova Natalia A. , McVeigh Elliot R. 
Published: April 2016

Background—
Accurate knowledge of the human atrial fibrous structure is paramount in understanding the mechanisms of atrial electric function in health and disease. Thus far, such knowledge has been acquired from destructive sectioning, and there is a paucity of data about atrial fiber architecture variability in the human population.

Methods and Results—
In this study, we have developed a customized 3-dimensional diffusion tensor magnetic resonance imaging sequence on a clinical scanner that makes it possible to image an entire intact human heart specimen ex vivo at submillimeter resolution. The data from 8 human atrial specimens obtained with this technique present complete maps of the fibrous organization of the human atria. The findings demonstrate that the main features of atrial anatomy are mostly preserved across subjects although the exact location and orientation of atrial bundles vary. Using the full tractography data, we were able to cluster, visualize, and characterize the distinct major bundles in the human atria. Furthermore, quantitative characterization of the fiber angles across the atrial wall revealed that the transmural fiber angle distribution is heterogeneous throughout different regions of the atria.

Conclusions—
The application of submillimeter diffusion tensor magnetic resonance imaging provides an unprecedented level of information on both human atrial structure, as well as its intersubject variability. The high resolution and fidelity of this data could enhance our understanding of structural contributions to atrial rhythm and pump disorders and lead to improvements in their targeted treatment.
Clinical Outcomes After Evaluation of Stable Chest Pain by Coronary Computed Tomographic Angiography Versus Usual Care
Authors: Bittencourt Márcio Sommer , Hulten Edward A. , Murthy Venkatesh L. , Cheezum Michael , Rochitte Carlos E. , Carli Marcelo F. Di , Blankstein Ron 
Published: April 2016

Background—
Limited data exist on how noninvasive testing options compare for evaluating patients with suspected stable coronary artery disease. In this study, we have performed a meta-analysis of randomized controlled trials comparing the use of coronary computed tomographic angiography (CTA) with usual care.

Methods and Results—

We systematically searched databases for randomized clinical trials comparing coronary CTA with usual care for the evaluation of stable chest pain with follow-up for cardiovascular outcomes. The primary outcomes were myocardial infarction and all-cause mortality. We identified 4 randomized clinical trials, including a total of 7403 patients undergoing coronary CTA and 7414 patients undergoing usual care with various functional testing approaches. When compared with usual care, the use of coronary CTA was associated with a significant reduction in the annual rate of myocardial infarction (rate ratio, 0.69; 95% confidence interval, 0.49–0.98;
P
=0.038), but no difference was found in all-cause mortality. There was a trend toward more invasive coronary angiographies among patients undergoing coronary CTA (odds ratio, 1.33; 95% confidence interval, 0.95–1.84;
P
=0.09) and higher use of coronary revascularizations (odds ratio, 1.77; 95% confidence interval, 1.14–2.75). Significant heterogeneity for invasive coronary angiography and revascularization was noted, which was attributable to the Scottish Computed Tomography of the HEART (SCOT-HEART) study. We found no difference in the rate of admission for cardiac chest pain (rate ratio, 1.21; 95% confidence interval, 0.95–1.54).

Conclusions—
In comparison to usual care, an initial investigation of suspected stable coronary artery disease using coronary CTA resulted in a significant reduction in myocardial infarction, an increased incidence of coronary revascularization, and no effect in all-cause mortality. Future studies should further define whether the potential reduction in myocardial infarction identified justifies the increased resource utilization associated with coronary CTA.