bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘Shouting from the roof tops’: a qualitative study of how children with leukaemia are diagnosed in primary care
Authors: Clarke Rachel T , Jones Caroline HD , Mitchell Christopher D , Thompson Matthew J 
Published: February 2014

ObjectivesTo investigate the prehospital presentation of paediatric leukaemia and identify the disease and non-disease related factors which facilitate or impede diagnosis.DesignThematic analysis of qualitative semistructured interviews.SettingOne tertiary referral centre in Southern England.Participants21 parents and 9 general practitioners (GPs) of 18 children (<18-year-old) with a new diagnosis of acute leukaemia.ResultsThe majority of children were first seen by GPs before the characteristic signs and symptoms of leukaemia had developed. In their absence, behavioural cues such as the child becoming apathetic or ‘not themselves’ often triggered parents to seek medical help. Most GPs were unclear about the nature and severity of the child's presentation: then, safety netting, thorough history-taking and examination, and reliance on contextual information about the parents or from prior hospital paediatrics experience were used to manage diagnostic uncertainty. The nature of the doctor–parent relationship helped and hindered the diagnostic pathway. GPs’ prior perceptions of parents as being ‘sensible’ or ‘worriers’ influenced how gravely they treated parental concerns, with ‘worriers’ being taken less seriously. Some parents believed GPs failed to listen to their anxieties and discounted their expert knowledge of their child. Specific delay factors included lack of continuity of GP; some GPs’ reluctance to take blood from children; and some parents feeling unable to voice effectively their concerns.ConclusionsThe presentation of paediatric leukaemia in primary care differs from that described in many hospital studies, with greater diversity and intermittency of symptoms, and the frequent absence of ‘red flags’ of serious illness. A wide range of non-disease related factors potentially delay the diagnosis of paediatric leukaemia, including tensions in the doctor–patient relationship and the doctors’ cognitive biases. The identification and attempted modification of these factors may minimise diagnostic delay more successfully than raising awareness of ‘red flags’ of disease.
CRIB—the use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer: a pilot randomised controlled trial (RCT) with embedded feasibility study
Authors: Munro Julie , Adams Richard , Campbell Anna , Campbell Sandra , Donaldson Cam , Godwin Jon , Haw Sally , Kidd Lisa , Lane Chrissie , Leslie Stephen J , Mason Helen , Mutrie Nanette , O'Carroll Ronan , Taylor Cara , Treweek Shaun , Watson Angus , Hubbard Gill 
Published: February 2014

IntroductionPatients with colorectal cancer report ongoing physical and psychological impairments and a high proportion of these patients are overweight, insufficiently active and high-risk drinkers, putting them at risk of poor recovery and risk of recurrence and comorbidities. A challenge is implementing sustainable and effective rehabilitation as part of routine care for this group.Methods and analysisA two-arm pilot randomised controlled trial (RCT) with embedded feasibility study undertaken as a phased programme of work. The intervention involves an existing cardiac rehabilitation programme for cardiac patients accepting colorectal cancer patient referrals. The intervention consists of supervised exercise sessions run by a cardiac physiotherapist and information sessions. Phase 1 will involve one research site enrolling 12 patients to assess intervention and study design processes. Semistructured interviews with patients with colorectal cancer and cardiac patients and clinicians will be used to gather data on acceptability of the intervention and study procedures. Phase 2 will involve three sites enrolling 66 patients with colorectal cancer randomised to control or intervention groups. Outcome measures will be taken preintervention and postintervention, for phases 1 and 2. The primary outcome is accelerometer measured physical activity; secondary outcomes are self-report physical activity, quality of life, anxiety, depression, symptoms including fatigue. The following variables will also be examined to determine if these factors influence adherence and outcomes: self-efficacy, risk perception and treatments.Ethics and disseminationFull ethical approval was granted by NRES Committees—North of Scotland (13/NS/0004; IRAS project ID: 121757) on 22 February 2013. The proposed work is novel in that it aims to test the feasibility and acceptability of using an evidence-based and theory driven existing cardiac rehabilitation service with patients with colorectal cancer. Should this model of rehabilitation prove to be clinically and cost effective we aim to conduct a randomised controlled trial of this intervention to measure effectiveness.Trial registration referenceISRCTN63510637; UKCRN id 14092.
Does a geographical context of deprivation affect differences in injury mortality? A multilevel analysis in South Korean adults residing in metropolitan cities
Authors: Lee JeSuk , Lee Weon-Young , Noh MaengSeok , Khang Young-Ho 
Published: February 2014

BackgroundThis study aimed to examine whether the socioeconomic context of urban areas affects differences in adult mortality from injuries in the districts of all seven South Korean metropolitan cities, after adjusting for individual demographic and socioeconomic indicators.MethodsTwo different sets of data were used in this study: (1) the National Death Registration data from 2003 to 2008; and (2) the National Census in 2005. Variables for individual characteristics were gender, age, residential area and educational level. A geographic deprivation index was calculated based on the Carstairs Index. Multilevel Poisson regression models were used to analyse the relationship between area deprivation levels and injury mortality.ResultsGreater mortality risks of traffic accidents, falls, suicide and all injuries were found in the elderly, the less educated and men, compared with their counterparts. The most deprived districts were at greater risks of death due to traffic accidents (risk ratio (RR)=1.34; 95% CI 1.05 to 1.73), falls (RR=1.63; 95% CI 1.20 to 2.20), suicide (RR=1.09; 95% CI 1.01 to 1.17) and all injuries (RR=1.14; 95% CI 1.07 to 1.22) compared with the least deprived districts, even after individual level socioeconomic variables were controlled for. However, area level deprivation did not show cross level interactions with the individual level education in estimating fatal injury risks.ConclusionsBoth contextual and compositional effects of socioeconomic status on injury mortality among urban areas in South Korea should be considered in allocating resources for injury prevention.
Feminisation of UK General Practice: a challenge for the Defence Medical Services?
Authors: Withnall Richard D J , Graham D J M , Morris L E , Wallace M 
Published: February 2014

BackgroundThe Defence Medical Services (DMS) primarily recruits its trained General Practitioners (GPs) from the NHS and since 1970, the number of men entering medicine has doubled whereas the number of women has increased 10-fold; female GPs will outnumber their male counterparts by 2017. This study performs a quantitative assessment of the potential impact of feminisation of UK General Practice upon the DMS recruitment and workforce planning.MethodsGeneral Medial Council General Practice Certificate of Completion of Training (GMC GP CCT) data were analysed to identify any change in the percentage of male and female GP Specialty Training Registrars successfully completing GP vocational training between 2007 and 2012, thus becoming potentially recruitable into the DMS as independent GPs.ResultsA 3% increase was seen in the number of women achieving GMC GP CCT between 2007 and 2012 (p=0.015). The percentage of DMS GP Specialty Training Registrars (GPStRs) gaining their GMC GP CCT in 2012 who were women (25%) was about half that seen nationally (59%). A lack of 2007 by-sex GMC GP CCT data for DMS GPStRs prevented a comparison with 2012.ConclusionsThe national increase of only 3% infers feminisation of UK General Practice is not an immediate challenge for the DMS. Nevertheless, as feminisation of the UK GP workforce is expected to continue, the future cohort from whom the DMS will recruit its GPs is likely to contain increasing numbers of women. With the return to contingency, the DMS may wish to consider the implications of increasing numbers of female GPs upon service delivery in the UK and overseas, and explore more flexible medical employment models.
Vitamin D levels and left ventricular diastolic function
Authors: Pandit Anil , Mookadam Farouk , Boddu Sailaja , Aryal Pandit Aashrayata , Tandar Anwar , Chaliki Hari , Cha Stephen , Lee Howard R 
Published: February 2014

ObjectiveTo determine the association between serum vitamin D level and left ventricular (LV) diastolic dysfunction.BackgroundVitamin D deficiency has been shown in observational and prospective studies to be associated with cardiovascular diseases including coronary artery disease, LV hypertrophy and systolic heart failure. Even though diastolic LV dysfunction is an early manifestation of cardiac disease, there is no study that examines whether a deficiency of vitamin D is associated with LV diastolic dysfunction.MethodA retrospective observational review of 1011 patients (679 women) was conducted to examine if low 25-OH-vitamin D levels were associated with LV diastolic dysfunction.ResultsAll the LV diastolic dysfunction parameters: left atrial volume index, E/e', e' velocity, LV mass index and deceleration time were not significantly different between patients with 25-OH vitamin D level ≤20 ng/mL vs 25-OH vitamin D level >20 ng/mL.ConclusionsDespite growing medical literature suggesting vitamin D deficiency is associated with cardiovascular disease, in this present study there is no significant association of vitamin D levels and LV diastolic performance, including left atrial volume index.
Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and meta-analysis
Authors: Pandit Anil , Aryal Madan Raj , Aryal Pandit Aashrayata , Hakim Fayaz Ahmad , Giri Smith , Mainali Naba Raj , Sharma Prashant , Lee Howard R , Fortuin F David , Mookadam Farouk 
Published: February 2014

AimThe benefit of preventive percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) has been shown in randomised trials. However, all the randomised trials are underpowered to detect benefit in cardiac death. We aim to systematically review evidence on the cardiac mortality benefit of preventive PCI in patients presenting with acute STEMI in randomised patient populations.MethodsPubMed, Scopus, Cochrane and clinicaltrials.gov databases were searched for studies published until 30 September 2013. The studies were limited to randomised clinical trials. Independent observers abstracted the data on outcomes, characteristics and qualities of studies included. Fixed effect model was employed for meta-analysis. Heterogeneity of studies included was analysed using I2statistics.ResultsIn three randomised clinical trials published, involving 748 patients with acute STEMI and multivessel disease, 416 patients were randomised to preventive PCI and 332 to culprit-only PCI. Patients undergoing preventive PCI had significant lower risk of cardiovascular deaths (pooled OR 0.39, 95% CI 0.18 to 0.83, p=0.01, I2=0%), repeat revascularisation (pooled OR 0.28, 95% CI 0.18 to 0.44, p=0.00001, I2=0%) and non-fatal myocardial infarction (pooled OR 0.38, 95% CI 0.20 to 0.75, p=0.005, I2=0%) compared with culprit-only revascularisation.ConclusionsIn patients presenting with acute STEMI and significant multivessel coronary artery disease, based on our data, preventive PCI is associated with lower risk of cardiovascular mortality compared with primary PCI of only the culprit artery. This finding needs to be confirmed in larger adequately powered randomised clinical trials.
The importance of partnership factors and individual factors associated with absent or inconsistent condom use in heterosexuals: a cross-sectional study
Authors: Matser Amy , Heiligenberg Marlies , Geskus Ronald , Heijman Titia , Low Nicola , Kretzschmar Mirjam , Schim van der Loeff Maarten 
Published: February 2014

ObjectivesDecisions to use condoms are made within partnerships. We examined the associations between inconsistent or no condom use and individual and partnership characteristics. We also examined the relative importance of individual versus partnership factors.MethodsCross-sectional study of heterosexual individuals enrolled from the sexually transmitted infections (STI) outpatient clinic in Amsterdam, the Netherlands, from May to August 2010. Participants completed a questionnaire about sexual behaviour with the last four partners in the preceding year. Participant and partnership factors associated with inconsistent or no condom use in steady and casual partnerships were identified.Results2144 individuals were included, reporting 6401 partnerships; 54.7% were female, the median age was 25 (IQR 22–30) years and 79.9% were Dutch. Inconsistent or no condom use occurred in 86.1% of 2387 steady partnerships and in 66.5% of 4014 casual partnerships. There was statistical evidence of associations between inconsistent condom use in steady partnerships and ethnic concordance, longer duration, higher number of sex acts, practising anal sex, and sex-related drug use. In casual partnerships, associations were found with having an older partner, ethnic concordance, longer duration, higher number of sex acts, anal sex, sex-related drug use, ongoing partnerships and concurrency. In multivariable models, partnership factors explained 50.9% of the variance in steady partnerships and 70.1% in casual partnerships compared with 10.5% and 15.4% respectively for individual factors.ConclusionsAmong heterosexual STI clinic attendees in Amsterdam, partnership factors are more important factors related with inconsistent condom use than characteristics of the individual.
Curcumin Suppresses Proliferation of Colon Cancer Cells by Targeting CDK2
Authors: Lim Tae-Gyu , Lee Sung-Young , Huang Zunnan , Lim Do Young , Chen Hanyong , Jung Sung Keun , Bode Ann M. , Lee Ki Won , Dong Zigang 
Published: February 2014

Abstract
Curcumin, the yellow pigment of turmeric found in Southeast Indian food, is one of the most popular phytochemicals for cancer prevention. Numerous reports have demonstrated modulation of multiple cellular signaling pathways by curcumin and its molecular targets in various cancer cell lines. To identify a new molecular target of curcumin, we used shape screening and reverse docking to screen the Protein Data Bank against curcumin. Cyclin-dependent kinase 2 (CDK2), a major cell-cycle protein, was identified as a potential molecular target of curcumin. Indeed, in vitro and ex vivo kinase assay data revealed a dramatic suppressive effect of curcumin on CDK2 kinase activity. Furthermore, curcumin induced G1 cell-cycle arrest, which is regulated by CDK2 in HCT116 cells. Although the expression levels of CDK2 and its regulatory subunit, cyclin E, were not changed, the phosphorylation of retinoblastoma (Rb), a well-known CDK2 substrate, was reduced by curcumin. Because curcumin induced cell-cycle arrest, we investigated the antiproliferative effect of curcumin on HCT116 colon cancer cells. In this experiment, curcumin suppressed HCT116 cell proliferation effectively. To determine whether CDK2 is a direct target of curcumin, CDK2 expression was knocked down in HCT116 cells. As expected, HCT116 sh-CDK2 cells exhibited G1 arrest and reduced proliferation. Because of the low levels of CDK2 in HCT116 sh-CDK2 cells, the effects of curcumin on G1 arrest and cell proliferation were not substantially relative to HCT116 sh-control cells. From these results, we identified CDK2 as a direct target of curcumin in colon cancer cells. Cancer Prev Res; 7(4); 466–74. ©2014 AACR.
Interstitial Fibrosis, Left Ventricular Remodeling, and Myocardial Mechanical Behavior in a Population-Based Multiethnic Cohort
Authors: Donekal Sirisha , Venkatesh Bharath A. , Liu Yuan Chang , Liu Chia-Ying , Yoneyama Kihei , Wu Colin O. , Nacif Marcelo , Gomes Antoinette S. , Hundley W. Gregory , Bluemke David A. , Lima Joao A.C. 
Published: February 2014

Background—
Tagged cardiac magnetic resonance provides detailed information on regional myocardial function and mechanical behavior. T1 mapping by cardiac magnetic resonance allows noninvasive quantification of myocardial extracellular expansion (ECE), which has been related to interstitial fibrosis in previous clinical and subclinical studies. We assessed sex-associated differences in the relation of ECE to left ventricular (LV) remodeling and myocardial systolic and diastolic deformation in a large community-based multiethnic population.

Methods and Results—

Midventricular midwall peak circumferential shortening and early diastolic strain rate and LV torsion and torsional recoil rate were determined using cardiac magnetic resonance tagging. Midventricular short-axis T1 maps were acquired in the same examination pre- and postcontrast injection using Modified Look-Locker Inversion-Recovery sequence. Multivariable linear regression (estimated regression coefficient,
B
) was used to adjust for risk factors and subclinical disease measures. Of 1230 participants, 114 had a visible myocardial scar by late gadolinium enhancement. Participants without a visible myocardial scar (n=1116) had no history of previous clinical events. In the latter group, multivariable linear regression demonstrated that lower postcontrast T1 times, reflecting greater ECE, were associated with lower circumferential shortening (
B
=−0.1;
P
=0.0001), lower LV end-diastolic volume index (
B
=0.6;
P
=0.0001), and lower LV end-diastolic mass index (
B
=0.4;
P
=0.0001). In addition, lower postcontrast T1 times were associated with lower early diastolic strain rate (
B
=0.01;
P
=0.03) in women only and lower LV torsion (
B
=0.005;
P
=0.03) and lower LV ejection fraction (B=0.2,
P
=0.01) in men only.

Conclusions—
Greater ECE is associated with reduced LV end-diastolic volume index and LV end-diastolic mass index in a large multiethnic population without history of previous cardiovascular events. In addition, greater ECE is associated with reduced circumferential shortening, lower early diastolic strain rate, and a preserved ejection fraction in women, whereas in men, greater ECE is associated with greater LV dysfunction manifested as reduced circumferential shortening, reduced LV torsion, and reduced ejection fraction.
Effects of Noninvasive Facial Nerve Stimulation in the Dog Middle Cerebral Artery Occlusion Model of Ischemic Stroke
Authors: Borsody Mark K. , Yamada Chisa , Bielawski Dawn , Heaton Tamara , Castro Prado Fernando , Garcia Andrea , Azpiroz Joaquín , Sacristan Emilio 
Published: February 2014

Background and Purpose—
Facial nerve stimulation has been proposed as a new treatment of ischemic stroke because autonomic components of the nerve dilate cerebral arteries and increase cerebral blood flow when activated. A noninvasive facial nerve stimulator device based on pulsed magnetic stimulation was tested in a dog middle cerebral artery occlusion model.

Methods—

We used an ischemic stroke dog model involving injection of autologous blood clot into the internal carotid artery that reliably embolizes to the middle cerebral artery. Thirty minutes after middle cerebral artery occlusion, the geniculate ganglion region of the facial nerve was stimulated for 5 minutes. Brain perfusion was measured using gadolinium-enhanced contrast MRI, and ATP and total phosphate levels were measured using
31
P spectroscopy. Separately, a dog model of brain hemorrhage involving puncture of the intracranial internal carotid artery served as an initial examination of facial nerve stimulation safety.

Results—
Facial nerve stimulation caused a significant improvement in perfusion in the hemisphere affected by ischemic stroke and a reduction in ischemic core volume in comparison to sham stimulation control. The ATP/total phosphate ratio showed a large decrease poststroke in the control group versus a normal level in the stimulation group. The same stimulation administered to dogs with brain hemorrhage did not cause hematoma enlargement.

Conclusions—
These results support the development and evaluation of a noninvasive facial nerve stimulator device as a treatment of ischemic stroke.
Serum Albumin Levels Are Associated With Cardioembolic and Cryptogenic Ischemic Strokes
Authors: Xu Wei-Hai , Dong Chuanhui , Rundek Tatjana , Elkind Mitchell S.V. , Sacco Ralph L. 
Published: February 2014

Background and Purpose—
Low serum albumin concentrations have been associated with increased stroke risk, but the underlying mechanisms are less well studied. We aimed to investigate the association between serum albumin levels and ischemic stroke etiologies in a large, population-based, multiethnic, prospective, cohort study.

Methods—
Participants from the Northern Manhattan Study (NOMAS; n=2986; mean age, 69±10 years) free of stroke at baseline were followed for incident stroke (a median follow-up of 12 years). Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for baseline serum albumin levels and risk of ischemic stroke and ischemic stroke subtypes after adjusting for vascular risk factors.

Results—
The mean baseline serum albumin level was 4.42±0.33 g/dL. There were 271 ischemic strokes during follow-up. Participants with serum albumin levels of 2.7 to 4.2 g/dL (the lowest tertile) had increased risk of all stroke (HR, 1.76; 95% CI, 1.32–2.35), ischemic stroke (HR, 1.67; 95% CI, 1.21–2.29), cardioembolic stroke (HR, 1.92; 95% CI, 1.10–3.34), and cryptogenic stroke (HR, 2.59; 95% CI, 1.21–5.53), compared with those with levels of 4.6 to 5.5 g/dL (the top tertile; reference). Low albumin levels (2.7–4.2 g/dL) were not associated with large vessel or lacunar stroke.

Conclusions—
Our study shows an association between low serum albumin levels and ischemic stroke, particularly cardioembolic and cryptogenic subtypes. These results suggest the potential shared pathophysiological relationship between low serum albumin levels, cardiac embolism, and cryptogenic infarction, which warrants further investigation.
Armenian Involvement in the Latin-Mongol Crusade: Uses of the Magi and Prester John in Constable Smbat’s Letter and Hayton of Corycus’s “Flos historiarum terre orientis,” 1248-1307
Authors: Osipian Alexandr 
Published: February 2014

Abstract
This paper examines the issue of how Armenians and Nestorians in the Mongol service used the Western legends about the Orient to influence the crusading plans of the Latin Christians between 1248 and 1307. In particular, it considers the role of the ruling elite of Cilician Armenia as mediators between Mongols and Franks in Outremer, first discussing the Letter of Cilician Constable Smbat (1248), and then examining the treatise “Flos historiarum terre orientis” by Hayton of Corycus (Het’um/Haitonus, 1307) with the crusading proposal contained in it. This article examines the narrative techniques used by Smbat and Het’um to produce a positive image of the Mongols/Tatars for Western readers in a wider cultural context of contemporary European perception of the Orient. In particular, it researches how Smbat incorporated the stories about the Magi and Prester John into the description of the Mongol Empire and the spread of Christianity within it. Special attention is given to a comparison of Armenian sources written for internal (Armenian) and external (Frankish) readers. This article also develops a hypothesis that Armenian diplomacy used Louis IX of France’s letter and his envoy William of Rubruck to enforce the position of the Cilician king Het’um I at the Mongol court in 1254.