bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effectiveness of providing peer benchmarked feedback to hip replacement surgeons based on patient-reported outcome measures—results from the PROFILE (Patient-Reported Outcomes: Feedback Interpretation and Learning Experiment) trial: a cluster randomised controlled study
Authors: Boyce Maria B , Browne John P 
Published: August 2015

ObjectiveTo test whether providing surgeons with peer benchmarked feedback about patient-reported outcomes is effective in improving patient outcomes.DesignCluster randomised controlled trial.SettingSecondary care—Ireland.ParticipantsSurgeons were recruited through the Irish Institute of Trauma and Orthopaedic Surgery, and patients were recruited in hospitals prior to surgery. We randomly allocated 21 surgeons and 550 patients.InterventionSurgeons in the intervention group received peer benchmarked patient-reported outcome measures (PROMs) feedback and education.Main outcome variablePostoperative Oxford Hip Score (OHS).ResultsPrimary outcome data were available for 11 intervention surgeons with responsibility for 230 patients and 10 control surgeons with responsibility for 228 patients. The mean postoperative OHS for the intervention group was 40.8 (95% CI 39.8 to 41.7) and for the control group was 41.9 (95% CI 41.1 to 42.7). The adjusted effect estimate was −1.1 (95% CI −2.4 to 0.2, p=0.09). Secondary outcomes were the Hip Osteoarthritis Outcome Score (HOOS), EQ-5D and the proportion of patients reporting a problem after surgery. The mean postoperative HOOS for the intervention group was 36.2 and for the control group was 37.1. The adjusted effect estimate was −1.1 (95% CI −2.4 to 0.3, p=0.1). The mean postoperative EQ-5D for the intervention group was 0.85 and for the control group was 0.87. The adjusted effect estimate was −0.02 (95% CI −0.05 to 0.008, p=0.2). 27% of intervention patients and 24% of control patients reported at least one complication after surgery (adjusted OR=1.2, 95% CI 0.6 to 2.3, p=0.6).ConclusionsOutcomes for patients operated on by surgeons who had received peer benchmarked PROMs data were not statistically different from the outcomes of patients operated on by surgeons who did not receive feedback. PROMs information alone seems to be insufficient to identify opportunities for quality improvement.Trial registration numberISRCTN 69032522.
Environmental factors and their association with emergency department hand hygiene compliance: an observational study
Authors: Carter Eileen J , Wyer Peter , Giglio James , Jia Haomiao , Nelson Germaine , Kauari Vepuka E , Larson Elaine L 
Published: August 2015

ObjectivesHand hygiene is effective in preventing healthcare-associated infections. Environmental conditions in the emergency department (ED), including crowding and the use of non-traditional patient care areas (ie, hallways), may pose barriers to hand hygiene compliance. We examined the relationship between these environmental conditions and proper hand hygiene.MethodsThis was a single-site, observational study. From October 2013 to January 2014, trained observers recorded hand hygiene compliance among staff in the ED according to the World Health Organization ‘My 5 Moments for Hand Hygiene’. Multivariable logistic regression was used to analyse the relationship between environmental conditions and hand hygiene compliance, while controlling for important covariates (eg, hand hygiene indication, glove use, shift, etc).ResultsA total of 1673 hand hygiene opportunities were observed. In multivariable analyses, hand hygiene compliance was significantly lower when the ED was at its highest level of crowding than when the ED was not crowded and lower among hallway care areas than semiprivate care areas (OR=0.39, 95% CI 0.28 to 0.55; OR=0.73, 95% CI 0.55 to 0.97).ConclusionsUnique environmental conditions pose barriers to hand hygiene compliance in the ED setting and should be considered by ED hand hygiene improvement efforts. Further study is needed to evaluate the impact of these environmental conditions on actual rates of infection transmission.
Adolescent Exercise in Association with Mortality from All Causes, Cardiovascular Disease, and Cancer among Middle-Aged and Older Chinese Women
Authors: Nechuta Sarah J. , Shu Xiao Ou , Yang Gong , Cai Hui , Gao Yu-Tang , Li Hong-Lan , Xiang Yong-Bing , Zheng Wei 
Published: August 2015

Abstract
Background: Little is known regarding the role of early-life exercise, a potentially modifiable factor, in long-term adult morbidity and mortality. We utilized the Shanghai Women's Health Study (SWHS) to investigate adolescent exercise in association with cancer, cardiovascular disease (CVD), and all-cause mortality among middle-aged and older women.
Methods: The SWHS is a prospective cohort of 74,941 Chinese women ages 40 to 70 years recruited from 1996 to 2000. In-person interviews at enrollment assessed adolescent and adult exercise history, medical and reproductive history, and other lifestyle and socioeconomic (SES) factors. Mortality follow-up occurs via annual linkage to the Shanghai Vital Statistics Registry. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) were derived from Cox regression models.
Results: Adjusting for birth year and other adolescent factors, adolescent exercise was associated with reduced risk of cancer, CVD, and total mortality [HRs (95% CI), 0.83 (0.72–0.95), 0.83 (0.70–0.98), and 0.78 (0.71–0.85), respectively for ≤1.33 hours (h)/week, and 0.83 (0.74–0.93), 0.62 (0.53–0.72), and 0.71 (0.66–0.77), respectively for &gt;1.33 h/week (reference = none)]. Results were attenuated after adjustment for adult SES and lifestyle factors. Participation in sports teams was inversely associated with cancer mortality [HR (95% CI), 0.86 (0.76–0.97)]. Joint adolescent and adult exercise was associated with reduced risk of all-cause, CVD, and cancer mortality [HRs (95% CIs), 0.80 (0.72–0.89), 0.83 (0.69–1.00), and 0.87 (0.74–1.01), respectively], adjusting for adult/adolescent factors, and adolescence exercise only was inversely associated with cancer mortality [HR (95% CI), 0.84 (0.71–0.98)].
Conclusions: Adolescent exercise participation, independent of adult exercise, was associated with reduced risk of cancer, CVD, and all-cause mortality.
Impact: Results support promotion of exercise in adolescence to reduce mortality in later life. Cancer Epidemiol Biomarkers Prev; 24(8); 1270–6. ©2015 AACR.
Can the Lung Cancer Pie Be Divided into Angiogenic Slices?
Authors: Cascone Tina , Heymach John V. 
Published: August 2015

Abstract
There are no validated markers for predicting benefit from angiogenesis inhibitors or classifying tumors with distinct angiogenic phenotypes. In patients with non–small cell lung cancer treated with bevacizumab and erlotinib, Franzini and colleagues find that angiogenesis- and hypoxia-associated gene expression signatures predict tumor response and/or clinical outcome, and may define distinct angiogenic patterns. Clin Cancer Res; 21(23); 5188–90. ©2015 AACR.
See related article by Franzini et al., p. 5253
Metabolic Imaging as a Biomarker of Early Radiation Response in Tumors
Authors: Lai Stephen Y. , Fuller C. David , Bhattacharya Pratip K. , Frank Steven J. 
Published: August 2015

Abstract
13C-pyruvate hyperpolarized magnetic resonance imaging (HP-MRI) is emerging as a viable quantitative biomarker for solid tumor response and normal tissue toxicity after radiotherapy. This technology effectively predicts response related to metabolic agents or alterations in the tumor microenvironment, but challenges remain to be addressed to ensure successful translational implementation. Clin Cancer Res; 21(22); 4996–8. ©2015 AACR.
See related article by Saito et al., p. 5073
USP44+ Cancer Stem Cell Subclones Contribute to Breast Cancer Aggressiveness by Promoting Vasculogenic Mimicry
Authors: Liu Tieju , Sun Baocun , Zhao Xiulan , Li Yanlei , Zhao Xueming , Liu Ying , Yao Zhi , Gu Qiang , Dong Xueyi , Shao Bing , Lin Xian , Liu Fang , An Jindan 
Published: August 2015

Abstract
Vasculogenic mimicry (VM), a newly defined pattern of tumor blood supply, describes the functional plasticity of aggressive cancer cells that form vascular networks. In our previous study, breast cancer stem cells (CSC) were shown to potentially participate in VM formation. In this study, breast CSCs presented centrosome amplification (CA) phenotype and ubiquitin-specific protease 44 (USP44) upregulation. USP44 expression contributed to the establishment of bipolar spindles in breast CSCs with supernumerary centrosomes by localizing at pole-associated centrosomes. The bipolar spindle patterns of breast CSCs with CA, including planar-like and apico-basal–like, functioned differently during the VM process of CSCs. Moreover, the ability of transendothelial migration in VM-forming cells was increased. In vivo experiment results showed that CSC xenografts presented linearly patterned programmed cell necrosis, which provided a spatial foundation for VM formation as well as angiogenesis. Breast CSCs further showed increased levels of IL6 and IL8. However, USP44 silencing induced spindle multipolarity, abated VM, reduced transendothelial migration, and consequently decreased IL6 and IL8 levels in breast CSCs. Finally, USP44+ CSC subclones (ALDH1+/USP44+/IL6+/IL8+) were identified in breast cancer specimens through consecutive sections scanning. The subclones were related not only to CA, but also to VM. Statistical analysis suggested that USP44+ CSC subclones could be used as an independent prognostic biomarker of poor clinical outcomes in patients with breast cancer. Collectively, the identification of USP44+ CSC subclones may contribute to the prediction of VM formation and aggressive behavior. This study provides novel insights into the therapy for advanced breast cancer. Mol Cancer Ther; 14(9); 2121–31. ©2015 AACR.
Superoxide Dismutase 1 In Vivo Ameliorates Maternal Diabetes Mellitus–Induced Apoptosis and Heart Defects Through Restoration of Impaired Wnt Signaling
Authors: Wang Fang , Fisher Steven A. , Zhong Jianxiang , Wu Yanqing , Yang Peixin 
Published: August 2015

Background—
Oxidative stress is manifested in embryos exposed to maternal diabetes mellitus, yet specific mechanisms for diabetes mellitus–induced heart defects are not defined. Gene deletion of intermediates of Wingless-related integration (Wnt) signaling causes heart defects similar to those observed in embryos from diabetic pregnancies. We tested the hypothesis that diabetes mellitus–induced oxidative stress impairs Wnt signaling, thereby causing heart defects, and that these defects can be rescued by transgenic overexpression of the reactive oxygen species scavenger superoxide dismutase 1 (SOD1).

Methods and Results—
Wild-type (WT) and SOD1-overexpressing embryos from nondiabetic WT control dams and nondiabetic/diabetic WT female mice mated with SOD1 transgenic male mice were analyzed. No heart defects were observed in WT and SOD1 embryos under nondiabetic conditions. WT embryos of diabetic dams had a 26% incidence of cardiac outlet defects that were suppressed by SOD1 overexpression. Insulin treatment reduced blood glucose levels and heart defects. Diabetes mellitus increased superoxide production, canonical Wnt antagonist expression, caspase activation, and apoptosis and suppressed cell proliferation. Diabetes mellitus suppressed Wnt signaling intermediates and Wnt target gene expression in the embryonic heart, each of which were reversed by SOD1 overexpression. Hydrogen peroxide and peroxynitrite mimicked the inhibitory effect of high glucose on Wnt signaling, which was abolished by the SOD1 mimetic, tempol.

Conclusions—
The oxidative stress of diabetes mellitus impairs Wnt signaling and causes cardiac outlet defects that are rescued by SOD1 overexpression. This suggests that targeting of components of the Wnt5a signaling pathway may be a viable strategy for suppression of congenital heart defects in fetuses of diabetic pregnancies.
Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function
Authors: Aleong Ryan G. , Mulvahill Matthew J. , Halder Indrani , Carlson Nichole E. , Singh Madhurmeet , Bloom Heather L. , Dudley Samuel C. , Ellinor Patrick T. , Shalaby Alaa , Weiss Raul , Gutmann Rebecca , Sauer William H. , Narayanan Kumar , Chugh Sumeet S. , Saba Samir , London Barry 
Published: August 2015

Background

Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however,
LV
ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk‐stratify for ventricular arrhythmias.

Methods and Results

Patients from the Genetic Risk of Assessment of Defibrillator Events (
GRADE
) study (N=930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter‐defibrillator shock and death, heart transplant, or ventricular assist device placement by
LV
diameter and mass.
LV
mass was divided into normal, mild, moderate, and severe classifications. Severe
LV
end‐diastolic diameter had worse shock‐free survival than normal and mild
LV
end‐diastolic diameter (
P
=0.0002 and 0.0063, respectively; 2‐year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4‐year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end‐diastolic diameter (
P
<0.0001 and 0.0441, respectively; 2‐year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4‐year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe
LV
mass had worse shock‐free survival than normal and mild LV mass (
P
=0.0370 and 0.0280, respectively; 2‐year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4‐year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (
P
=0.1319). In a multivariable Cox proportional hazards analysis adjusted for
LV
ejection fraction,
LV
end‐diastolic diameter was associated with appropriate implantable cardioverter‐defibrillator shocks (hazard ratio 1.22,
P
=0.020).
LV
end‐diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29,
P
=0.0009).

Conclusions
LV dilatation may complement ejection fraction to predict ventricular arrhythmias.

Clinical Trial Registration

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02045043.
Increased Heme Levels in the Heart Lead to Exacerbated Ischemic Injury
Authors: Sawicki Konrad Teodor , Shang Meng , Wu Rongxue , Chang Hsiang‐Chun , Khechaduri Arineh , Sato Tatsuya , Kamide Christine , Liu Ting , Naga Prasad Sathyamangla V. , Ardehali Hossein 
Published: August 2015

Background

Heme is an essential iron‐containing molecule for cardiovascular physiology, but in excess it may increase oxidative stress. Failing human hearts have increased heme levels, with upregulation of the rate‐limiting enzyme in heme synthesis, δ‐aminolevulinic acid synthase 2 (
ALAS
2), which is normally not expressed in cardiomyocytes. We hypothesized that increased heme accumulation (through cardiac overexpression of
ALAS
2) leads to increased oxidative stress and cell death in the heart.

Methods and Results

We first showed that
ALAS
2 and heme levels are increased in the hearts of mice subjected to coronary ligation. To determine the causative role of increased heme in the development of heart failure, we generated transgenic mice with cardiac‐specific overexpression of
ALAS
2. While
ALAS
2 transgenic mice have normal cardiac function at baseline, their hearts display increased heme content, higher oxidative stress, exacerbated cell death, and worsened cardiac function after coronary ligation compared to nontransgenic littermates. We confirmed in cultured cardiomyoblasts that the increased oxidative stress and cell death observed with
ALAS
2 overexpression is mediated by increased heme accumulation. Furthermore, knockdown of
ALAS
2 in cultured cardiomyoblasts exposed to hypoxia reversed the increases in heme content and cell death. Administration of the mitochondrial antioxidant MitoTempo to
ALAS
2‐overexpressing cardiomyoblasts normalized the elevated oxidative stress and cell death levels to baseline, indicating that the effects of increased
ALAS
2 and heme are through elevated mitochondrial oxidative stress. The clinical relevance of these findings was supported by the finding of increased
ALAS
2 induction and heme accumulation in failing human hearts from patients with ischemic cardiomyopathy compared to nonischemic cardiomyopathy.

Conclusions
Heme accumulation is detrimental to cardiac function under ischemic conditions, and reducing heme in the heart may be a novel approach for protection against the development of heart failure.
China’s Relations with the Latin American and Caribbean Countries
Authors: Harris Richard L. 
Published: August 2015

The Western academic literature and media coverage of the increasing economic and political relations between the People’s Republic of China (PRC or China) and the Latin American and Caribbean countries contains biases, fears, and misinformation about those relations. Closer examination reveals that Chinese trade, investment and loans have supported the left-leaning governments in the region that are attempting to develop alternative postcapitalist societies. China’s leaders seek allies among the developing countries to join with them in creating a new multipolar and more equitable global order. The PRC has launched a new economic strategy that makes consumer demand the main engine of China’s economic development. It seeks to boost productivity, reduce the country’s growing income disparities, and pursue an environmentally sustainable path of economic development based on advanced high-value and clean manufacturing technologies and renewable sources of clean energy. The PRC’s goal of developing a new ecological civilization will provide opportunities for the Latin American and Caribbean economies to export a more diversified basket of goods to China and attract Chinese investments and loans into new areas such as renewable energy. La literatura académica occidental y la cobertura mediática de las crecientes relaciones económicas y políticas entre la República Popular China (RPC o China) y los países de América Latina y el Caribe incluyen prejuicios, miedos, y desinformación respecto a esas relaciones. Un examen más detenido revela que el comercio, la inversión, y los préstamos chinos han apoyado los gobiernos de izquierda en la región que intentan establecer sociedades alternativas post-capitalistas. Los líderes chinos buscan aliados entre los países en vías de desarrollo para aunar esfuerzos en la creación de un nuevo orden global multipolar y más equitativo. La RPC ha lanzado una nueva estrategia económica colocando la demanda consumidora como motor principal del desarrollo económico chino. Busca impulsar la productividad, reducir las crecientes disparidades de ingresos en el país, y emprender un camino sostenible de desarrollo económico en base a tecnologías avanzadas de alto valor y de manufactura limpia junto con fuentes renovables de energía limpia. El objetivo de la RPC de promover una nueva civilización ecológica brindará oportunidades para la exportación de parte de las economías latinoamericanas y caribeñas de una canasta más diversificada de bienes a la China y de atraer inversiones y préstamos chinos en nuevas áreas como la energía renovable.
Methicillin-resistant Staphylococcus aureus: Prevalence, incidence, risk factors, and effects on survival of patients in a specialist palliative care unit: A prospective observational study
Authors: Gleeson Aoife , Larkin Philip , Walsh Cathal , O’Sullivan Niamh 
Published: August 2015

Background: Little is known about the impact of methicillin-resistant Staphylococcus aureus in palliative care settings. To date, the clinical impact of methicillin-resistant Staphylococcus aureus in palliative care is unknown. Aim: To determine prevalence and incidence of methicillin-resistant Staphylococcus aureus colonisation in a specialist palliative care setting, to identify risk factors for methicillin-resistant Staphylococcus aureus colonisation, to determine the eradication success rate and to determine the impact of methicillin-resistant Staphylococcus aureus on survival. Design: Prospective cohort study. Setting/participants: Data were collected for consecutive admissions to an inpatient palliative care service. Patients were screened for methicillin-resistant Staphylococcus aureus colonisation on admission and 1 week post admission. Methicillin-resistant Staphylococcus aureus eradication was attempted in methicillin-resistant Staphylococcus aureus positive patients. Results: Data were collected from 609 admissions for 466 individual patients. Admission screening data were available in 95.5%. Prevalence of methicillin-resistant Staphylococcus aureus colonisation was 11.59% (54 patients). One week incidence of methicillin-resistant Staphylococcus aureus colonisation was 1.2%. Risk factors for methicillin-resistant Staphylococcus aureus colonisation were determined using Chi-Squared test and included high Waterlow score ( p < 0.01), high palliative performance scale score ( p < 0.01), methicillin-resistant Staphylococcus aureus status prior to admission ( p < 0.01), admission from hospital ( p < 0.05), presence of urinary catheter or percutaneous endoscopic gastrostomy tube ( p < 0.05) and poor dietary intake ( p < 0.05). Regression analysis did not identify independent risk factors. Methicillin-resistant Staphylococcus aureus was eradicated in 8.1% of admissions, while 46 patients commenced on the protocol (62.2%) died before completing it. Methicillin-resistant Staphylococcus aureus did not significantly impact survival but was significantly associated with having infection episodes and longer length of stay. Conclusion: This study identified risk factors for methicillin-resistant Staphylococcus aureus colonisation in palliative care patients. Methicillin-resistant Staphylococcus aureus was eradicated in 8.1% of patients. Hence, restricting methicillin-resistant Staphylococcus aureus screening to high-risk palliative care patients may be prudent.