bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing income-related inequities in colorectal cancer screening: lessons learned from a retrospective analysis of organised programme and non-programme screening delivery in Winnipeg, Manitoba
Authors: Decker Kathleen M , Demers Alain A , Nugent Zoann , Biswanger Natalie , Singh Harminder 
Published: February 2016

ObjectiveWe examined organised colorectal cancer (CRC) screening programme and non-programme faecal occult blood test (FOBT) use from 2008 to 2012 for individuals living in Winnipeg, Manitoba, by area-level income.SettingWinnipeg, Manitoba, a region with universal healthcare and an organised CRC screening programme.ParticipantsIndividuals who had a non-programme FOBT were identified from the Provincial Medical Claims database. Individuals who had a programme FOBT were identified from the provincial screening registry. Census data were used to determine average household income based on area of residence.Statistical analysisTrends in age-standardised FOBT rates were examined using Joinpoint Regression. Logistic regression was performed to explore the association between programme and non-programme FOBT use and income quintile.ResultsFOBT use (non-programme and programme) increased from 32.2% in 2008 to 41.6% in 2012. Individuals living in the highest income areas (Q5) were more likely to have a non-programme FOBT compared with those living in other areas. Individuals living in areas with the lowest average income level (Q1) were less likely to have had programme FOBT than those living in areas with the highest average income level (OR 0.80, 95% CI 0.77 to 0.82). There was no difference in programme FOBT use for individuals living in areas with the second lowest income level (Q2) compared with those living in areas with the highest. Individuals living in areas with a moderate-income level (Q3 and Q4) were more likely to have had a programme FOBT compared with those living in an area with the highest income level (OR 1.12, 95% CI 1.09 to 1.15 for Q3 and OR 1.10, 95% CI 1.07 to 1.13 for Q4).ConclusionsInequities by income observed for non-programme FOBTs were largely eliminated when programme FOBTs were examined. Targeted interventions within organised screening programmes in very low-income areas are needed.
Identifying determinants of heterogeneous transmission dynamics of the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea, 2015: a retrospective epidemiological analysis
Authors: Nishiura Hiroshi , Endo Akira , Saitoh Masaya , Kinoshita Ryo , Ueno Ryo , Nakaoka Shinji , Miyamatsu Yuichiro , Dong Yueping , Chowell Gerardo , Mizumoto Kenji 
Published: February 2016

ObjectivesTo investigate the heterogeneous transmission patterns of Middle East respiratory syndrome (MERS) in the Republic of Korea, with a particular focus on epidemiological characteristics of superspreaders.DesignRetrospective epidemiological analysis.SettingMultiple healthcare facilities of secondary and tertiary care centres in an urban setting.ParticipantsA total of 185 laboratory-confirmed cases with partially known dates of illness onset and most likely sources of infection.Primary and secondary outcome measuresSuperspreaders were identified using the transmission tree. The reproduction number, that is, the average number of secondary cases produced by a single primary case, was estimated as a function of time and according to different types of hosts.ResultsA total of five superspreaders were identified. The reproduction number throughout the course of the outbreak was estimated at 1.0 due to reconstruction of the transmission tree, while the variance of secondary cases generated by a primary case was 52.1. All of the superspreaders involved in this outbreak appeared to have generated a substantial number of contacts in multiple healthcare facilities (association: p<0.01), generating on average 4.0 (0.0–8.6) and 28.6 (0.0–63.9) secondary cases among patients who visited multiple healthcare facilities and others. The time-dependent reproduction numbers declined substantially below the value of 1 on and after 13 June 2015.ConclusionsSuperspreaders who visited multiple facilities drove the epidemic by generating a disproportionate number of secondary cases. Our findings underscore the need to limit the contacts in healthcare settings. Contact tracing efforts could assist early laboratory testing and diagnosis of suspected cases.
The relationship between red blood cell distribution width and blood pressure abnormal dipping in patients with essential hypertension: a cross-sectional study
Authors: Su Dan , Guo Qi , Gao Ya , Han Jin , Yan Bin , Peng Liyuan , Song Anqi , Zhou Fuling , Wang Gang 
Published: February 2016

ObjectiveTo investigate whether red blood cell distribution width (RDW) is associated with the blood pressure (BP) reverse-dipper pattern in patients with hypertension.DesignCross-sectional study.SettingSingle centre.ParticipantsPatients with essential hypertension were included in our study (n=708). The exclusion criteria included age <18 or >90 years, incomplete clinical data, night workers, diagnosis of secondary hypertension, under antihypertensive treatment, intolerance for the 24 h ambulatory BP monitoring (ABPM) and BP reading success rate <70%.MeasurementPhysical examination and ABPM were performed for all patients in our study. The value of RDW was measured using an automated haematology analyser.Statistical methodsThe distribution of RDW in patients with hypertension among different circadian BP pattern groups was analyzed using analysis of variance (ANOVA). Multinomial logistic regression was applied to explore the associations of RDW and other relevant variables with ABPM results.ResultsThere was significantly increased RDW in reverse dippers (13.52±1.05) than dippers (13.25±0.85) of hypertension (p=0.012). Moreover, multinomial logistic regression analysis showed that RDW (OR 1.325, 95% CI 1.037 to 1.692, p=0.024) and diabetes mellitus (OR 2.286, 95% CI 1.380 to 3.788, p=0.001) were significantly different when comparing the reverse-dipper BP pattern with the dipper pattern. However, there was no difference of RDW between the non-dipper pattern and the reverse-dipper pattern (OR 1.036, 95% CI 0.867 to 1.238, p=0.693). In addition to this, RDW was negatively correlated with the decline rate of nocturnal systolic BP (r=−0.113; p=0.003) and diastolic BP (r=−0.101; p=0.007).ConclusionsOur results suggested that RDW might associate with the abnormal dipper BP patterns of either reverse dipping or non-dipping homogeneously examined with 24 h ABPM.
Cross-sectional study of the prehospital management of adult patients with a suspected seizure (EPIC1)
Authors: Dickson Jon M , Taylor Louise H , Shewan Jane , Baldwin Trevor , Grünewald Richard A , Reuber Markus 
Published: February 2016

ObjectivesSuspected seizures are a common reason for emergency calls to ambulance services. Prehospital management of these patients is an important element of good quality care. The aim of this study, conducted in a regional ambulance service in the UK, was to quantify the number of emergency telephone calls for suspected seizures in adults, the associated costs, and to describe the patients’ characteristics, their prehospital management and their immediate outcomes.DesignQuantitative cross-sectional study using routinely collected data and a detailed review of the clinical records of a consecutive series of adult patients (≥16 years).SettingA regional ambulance service within the National Health Service in England.ParticipantsCross-sectional data from all 605 481 adult emergency incidents managed by the ambulance service from 1 April 2012 to 31 March 2013. We selected a consecutive series of 178 individual incidents from May 2012 for more detailed analysis (132 after exclusions and removal of non-seizure cases).ResultsSuspected seizures made up 3.3% of all emergency incidents. True medical emergencies were uncommon but 3.3% had partially occluded airways, 6.8% had ongoing seizure activity and 59.1% had clinical problems in addition to the seizure (29.1% involving injury). Emergency vehicles were dispatched for 97.2% of suspected seizures, the seizure had terminated on arrival in 93.2% of incidents, 75% of these patients were transported to hospital. The estimated emergency management cost per annum of suspected seizures in the English ambulance services is £45.2 million (€64.0 million, $68.6 million).ConclusionsMany patients with suspected seizures could potentially be treated more effectively and at lower cost by modifying ambulance call handling protocols. The development of innovative care pathways could give call handlers and paramedics alternatives to hospital transportation. Increased adoption of care plans could reduce 999 calls and could increase the rates of successful home or community treatment.
Area Median Income and Metropolitan Versus Nonmetropolitan Location of Care for Acute Coronary Syndromes: A Complex Interaction of Social Determinants
Authors: Fabreau Gabriel E. , Leung Alexander A. , Southern Danielle A. , James Matthew T. , Knudtson Merrill L. , Ghali William A. , Ayanian John Z. 
Published: February 2016

Background
Metropolitan versus nonmetropolitan status and area median income may independently affect care for and outcomes of acute coronary syndromes. We sought to determine whether location of care modifies the association among area income, receipt of cardiac catheterization, and mortality following an acute coronary syndrome in a universal health care system.

Methods and Results

We studied a cohort of 14 012 acute coronary syndrome patients admitted to cardiology services between April 18, 2004, and December 31, 2011, in southern Alberta, Canada. We used multivariable logistic regression to determine the odds of cardiac catheterization within 1 day and 7 days of admission and the odds of 30‐day and 1‐year mortality according to area median household income quintile for patients presenting at metropolitan and nonmetropolitan hospitals. In models adjusting for area income, patients who presented at nonmetropolitan facilities had lower adjusted odds of receiving cardiac catheterization within 1 day of admission (odds ratio 0.22, 95%
CI
0.11–0.46,
P
<0.001). Among nonmetropolitan patients, when examined by socioeconomic status, each incremental decrease in income quintile was associated with 10% lower adjusted odds of receiving cardiac catheterization within 7 days (
P
<0.001) and 24% higher adjusted odds of 30‐day mortality (
P
=0.008) but no significant difference for 1‐year mortality (
P
=0.12). There were no differences in adjusted mortality among metropolitan patients.

Conclusion
Within a universal health care system, the association among area income and receipt of cardiac catheterization and 30‐day mortality differed depending on the location of initial medical care for acute coronary syndromes. Care protocols are required to improve access to care and outcomes in patients from low‐income nonmetropolitan communities.
Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial Fibrillation
Authors: Yao Xiaoxi , Abraham Neena S. , Alexander G. Caleb , Crown William , Montori Victor M. , Sangaralingham Lindsey R. , Gersh Bernard J. , Shah Nilay D. , Noseworthy Peter A. 
Published: February 2016

Background

In comparison to warfarin, non–vitamin K antagonist oral anticoagulants (
NOAC
s) have the advantages of ease of dosing, fewer drug interactions, and lack of need for ongoing monitoring. We sought to evaluate whether these advantages translate to improved adherence and whether adherence is associated with improved outcomes in patients with atrial fibrillation.

Methods and Results

We performed a retrospective cohort analysis by using a large
US
commercial insurance database to identify 64 661 patients with atrial fibrillation who initiated warfarin, dabigatran, rivaroxaban, or apixaban treatment between November 1, 2010, and December 31, 2014. During a median of 1.1 y of follow‐up, 47.5% of
NOAC
patients had a proportion of days covered of ≥80%, compared with 40.2% in warfarin patients (
P
<0.001). Patients with
CHA
2
DS
2
‐
VAS
c (risk based on the presence of congestive heart failure, hypertension age 65–74 y, age ≥75 y, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, sex category) score ≥4 were at increased risk of stroke when they were not taking anticoagulation ≥1 month versus <1 week (1–3 months: hazard ratio [
HR
] 1.96, 3–6 months:
HR
2.64, ≥6 months:
HR
3.66; all
P
<0.001). Patients with
CHA
2
DS
2
‐
VAS
c score 2 or 3 were at increased risk of stroke when they were not taking anticoagulation ≥6 months (
HR
2.73,
P
<0.001). In these patients with
CHA
2
DS
2
‐
VAS
c score ≥2, nonadherence was not associated with intracranial hemorrhage. Among patients with
CHA
2
DS
2
‐
VAS
c score 0 or 1, time not taking anticoagulation was not associated with stroke, but not taking anticoagulation ≥3 months was associated with a significant reduction of bleeding.

Conclusions

Adherence to anticoagulation is poor in practice and may be modestly improved with
NOAC
s. Adherence to therapy appears to be most important in patients with
CHA
2
DS
2
‐
VAS
c score ≥2, whereas the benefits of anticoagulation may not outweigh the harms in patients with
CHA
2
DS
2
‐
VAS
c score 0 or 1.
Patient- and Aneurysm-Specific Risk Factors for Intracranial Aneurysm Growth
Authors: Backes Daan , Rinkel Gabriel J.E. , Laban Kamil G. , Algra Ale , Vergouwen Mervyn D.I. 
Published: February 2016

Background and Purpose—
Follow-up imaging is often performed in intracranial aneurysms that are not treated. We performed a systematic review and meta-analysis on patient- and aneurysm-specific risk factors for aneurysm growth.

Methods—

We searched EMBASE and MEDLINE for cohort studies describing risk factors for aneurysm growth. Two authors independently assessed study eligibility and rated quality with the Newcastle Ottawa Scale. With univariable Poisson regression analysis, we calculated risk ratios (RRs) with corresponding 95% confidence intervals (95% CI) of risk factors for aneurysm growth. Heterogeneity was assessed with
I
2
.

Results—

Eighteen studies on 15 patient-populations described 3990 patients with 4972 unruptured aneurysms. A total of 437 aneurysms (9%) enlarged during 13 987 aneurysm-years of follow-up. Compared with aneurysms ≤4 mm, RRs were 2.56 (95% CI, 1.93–3.39;
I
2
=98%) for ≥5 mm, 2.80 (95% CI, 2.01–3.90;
I
2
=96%) for ≥7 mm, and 5.38 (95% CI, 3.76–7.70;
I
2
=97%) for ≥10 mm. Compared with aneurysms on the middle cerebral artery, the RR for basilar artery was 1.94 (95% CI, 1.32–2.83;
I
2
=57%). RRs were 2.03 (95% CI, 1.52–2.71;
I
2
=59%) for smoking at baseline, 2.04 (95% CI, 1.56–2.66;
I
2
=90%) for multiple unruptured aneurysms, 1.26 (95% CI, 0.97–1.62;
I
2
=59%) for women, 1.24 (95% CI, 0.98–1.58;
I
2
=40%) for hypertension, and 2.32 (95% CI, 1.46–3.68;
I
2
=91%) for irregular aneurysm shape. Compared with other regions, RR was 0.75 (95% CI, 0.58–0.96) for Japan and 0.64 (95% CI, 0.45–0.90) for Finland.

Conclusions—
Most risk factors for aneurysm growth are consistent with risk factors for rupture. In contrast with rupture, the risk of growth was smaller in Japanese and Finnish cohorts compared with other regions. Pooling of individual patient data from low- and high-risk geographical regions is needed to assess independent predictors of aneurysm growth.
Seasonal Variability of the Gulf Stream Kinetic Energy
Authors: Kang Dujuan , Curchitser Enrique N. , Rosati Anthony 
Published: February 2016

AbstractThe seasonal variability of the mean kinetic energy (MKE) and eddy kinetic energy (EKE) of the Gulf Stream (GS) is examined using high-resolution regional ocean model simulations. A set of three numerical experiments with different surface wind and buoyancy forcing is analyzed to investigate the mechanisms governing the seasonal cycle of upper ocean energetics. In the GS along-coast region, MKE has a significant seasonal cycle that peaks in summer, while EKE has two comparable peaks in May and September near the surface; the May peak decays rapidly with depth. In the off-coast region, MKE has a weak seasonal cycle that peaks in summer, while EKE has a dominant peak in May and a secondary peak in September near the surface. The May peak also decays with depth leaving the September peak as the only seasonal signal below 100 m. An analysis of the three numerical experiments suggests that the seasonal variability in the local wind forcing significantly impacts the September peak of the along-coast EKE through a local-flow barotropic instability process. Alternatively, the seasonal buoyancy forcing primarily impacts the flow baroclinic instability and is consequently related to the May peak of the upper ocean EKE in both regions. The analysis results indicate that the seasonal cycle of the along-coast MKE is influenced by both local energy generation by wind and the advection of energy from upstream regions. Finally, the MKE cycle and the September peak of EKE in the off-coast region are mainly affected by advection of energy from remote regions, giving rise to correlations with the seasonal cycle of remote winds.
Biomaterials in Rhinology
Authors: Massey Conner J. , Suh Jeffrey D. , Tessema Belachew , Gray Stacey T. , Singh Ameet 
Published: February 2016

IntroductionMany different kinds of rhinologic biomaterials, both nonabsorbable and absorbable, have been developed over the years to improve outcomes following endoscopic sinus surgery (ESS) for patients with chronic rhinosinusitis. In particular, these products have been designed to prevent postoperative bleeding, optimize the wound healing process, and reduce inflammation. This review evaluates the most recent evidence on biomaterials used in rhinology, focusing on these outcomes after ESS.Data SourcesMEDLINE, Scopus, Google Scholar, and Clinicaltrials.gov.Review MethodsA primary literature search based on the listed databases was performed with combinatorial search terms. Studies were considered for review if they met a set of inclusion and exclusion criteria.ConclusionsSome products have performed better than others in clinical trials, although significant heterogeneity among studies does not allow for selection of a clearly superior biomaterial. While nonabsorbable biomaterials are still effective in achieving certain outcomes, newer, absorbable substances may be just as effective and avoid the morbidity associated with nasal packing removal. Steroid‐eluting biomaterials have shown promising early results in reducing inflammation and promoting wound healing.Implications for PracticeCertain absorbable biomaterials, such as chitosan gel and fibrin glue, have performed well with respect to postoperative hemostasis and wound healing, although they do not address mucosal inflammation. Steroid delivery systems may play an increasingly important role in reducing disease recurrence after ESS, although more studies are needed to assess long‐term outcomes.
Variation in Delivery of Sinus Surgery in the Medicaid Population across Ethnicities
Authors: Woodard Troy , Sindwani Raj , Halderman Ashleigh A. , Holy Chantal E. , Gurrola Jose 
Published: February 2016

ObjectiveTo evaluate differences in sinus surgery rates in the US Medicaid population by ethnicities.Study DesignRetrospective administrative database analysis.SettingUS‐based outpatient settings.MethodsAll patients from the MarketScan Medicaid database with endoscopic sinus surgery from 2009 to 2013 were stratified by ethnicity, age (5‐year increments, as per US Census), and sex. Crude rates of endoscopic sinus surgery per age group and sex were compiled for all patients and each ethnic group (African American, Caucasian, Hispanics, and others). Age and sex standardization was done with the MarketScan Medicaid overall population as standard. The coefficient of variation, extremal ratio, and chi‐square statistics were calculated to determine variation across ethnicities.ResultsOverall sinus surgery rates per 1000 people in the Medicaid population ranged from 0.36 to 0.40 from 2009 to 2013 (African Americans: 0.24‐0.26; Hispanics: 0.21‐0.37; Caucasians: 0.47‐0.56; rate of surgery statistically lower for African American vs Hispanics for 4 of 5 years). The coefficient of variation and extremal ratio ranged from 29.3% to 45.6% and 1.98 to 2.6, respectively. Differences among groups were significant for all years (P <. 0001). Comparison of sex‐adjusted ratios by age group demonstrated greater rates of surgery in the Caucasian group versus other groups for all age categories.ConclusionThe Medicaid database was selected for this analysis to eliminate payer and wealth as potential confounders in access to health care. Despite this approach, significant differences in surgery rates among ethnic groups were observed. Further research is critical to understand those differences and provide actionable and effective recommendations for change.
Sino‐Nasal Outcome Test–22
Authors: Shapira Galitz Yael , Halperin Doron , Bavnik Yosef , Warman Meir 
Published: February 2016

ObjectiveTo perform the translation, cross‐cultural adaptation, and validation of the Sino‐Nasal Outcome Test–22 (SNOT‐22) questionnaire to the Hebrew language.Study Design and SettingA single‐center prospective cross‐sectional study.Subjects and MethodsSeventy‐three chronic rhinosinusitis (CRS) patients and 73 patients without sinonasal disease filled the Hebrew version of the SNOT‐22 questionnaire. Fifty‐one CRS patients underwent endoscopic sinus surgery, out of which 28 filled a postoperative questionnaire. Seventy‐three healthy volunteers without sinonasal disease also answered the questionnaire. Internal consistency, test‐retest reproducibility, validity, and responsiveness of the questionnaire were evaluated.ResultsQuestionnaire reliability was excellent, with a high internal consistency (Cronbach’s alpha coefficient, 0.91‐0.936) and test‐retest reproducibility (Spearman’s coefficient, 0.962). Mean scores for the preoperative, postoperative, and control groups were 50.44, 29.64, and 13.15, respectively (P <. 0001 for CRS vs controls, P <. 001 for preoperative vs postoperative), showing validity and responsiveness of the questionnaire.ConclusionThe Hebrew version of SNOT‐22 questionnaire is a valid outcome measure for patients with CRS with or without nasal polyps.