bluuebunny/crossref_metadata_2025_split huggingface dataset:
Responses to concerns about child maltreatment: a qualitative study of GPs in England
Authors: Woodman Jenny , Gilbert Ruth , Allister Janice , Glaser Danya , Brandon Marian 
Published: December 2013

ObjectivesTo provide a rich description of current responses to concerns related to child maltreatment among a sample of English general practitioners (GPs).DesignIn-depth, face-to-face interviews (November 2010 to September 2011). Participants selected and discussed families who had prompted ‘maltreatment-related concerns’. Thematic analysis of data.Setting4 general practices in England.Participants14 GPs, 2 practice nurses and 2 health visitors from practices with at least 1 ‘expert’ GP (expertise in child safeguarding/protection).ResultsThe concerns about neglect and emotional abuse dominated the interviews. GPs described intense and long-term involvement with families with multiple social and medical problems. Narratives were distilled into seven possible actions that GPs took in response to maltreatment-related concerns. These were orientated towards whole families (monitoring and advocating), the parents (coaching) and children (opportune healthcare), and included referral to or working with other services and recording concerns. Facilitators of the seven actions were: trusting relationships between GPs and parents, good working relationships with health visitors and framing the problem/response as ‘medical’. Narratives indicated significant time and energy spent building facilitating relationships with parents with the aim of improving the child's well-being.ConclusionsThese GPs used core general practice skills for on-going management of families who prompted concerns about neglect and emotional abuse. Policy and research focus should be broadened to include strategies for direct intervention and on-going involvement by GPs, such as using their core skills during consultations and practice systems for monitoring families and encouraging presentation to general practice. Exemplars of current practice, such as those identified in our study, should be evaluated for feasibility and acceptability in representative general practice settings as well as tested for efficacy, safety and cost. The seven actions could form the basis for the ‘lead professional’ role in general practice as proposed in the 2013 version of ‘Working Together ’guidance.
‘Looking for the needle in the haystack’: a qualitative study of the pathway to diagnosis of type 1 diabetes in children
Authors: Usher-Smith Juliet A , Thompson Matthew J , Walter Fiona M 
Published: December 2013

ObjectiveTo explore the pathway to diagnosis of type 1 diabetes (T1D) in children from the perspective of the child, family and general practitioner (GP).DesignQualitative interview study.ParticipantsParents of children aged 1 month to 16 years diagnosed with new onset T1D within the previous 3 months, children over 6 years diagnosed with new onset T1D within the previous 3 months and GPs who saw those children prior to diagnosis.SettingChildren and parents were identified and recruited from two hospitals within the East of England.ResultsThe parents of 16 children (2–16 years) were interviewed. The total interval from onset of symptoms to diagnosis ranged from 6 to 127 days. The appraisal interval was the longest for almost all children and the diagnostic interval the shortest. Even with some knowledge of T1D, it took many parents several weeks of a complex cyclical and iterative decision-making process and often a physical trigger, such as weight loss, to decide to consult a healthcare professional. By that stage, many had already made or suspected the diagnosis of T1D themselves. Five GPs were interviewed. They felt that the main challenges to diagnosing T1D in children were the rarity of the condition coupled with how well most of the children appeared, and the difficulty in obtaining urine or blood samples from children.ConclusionsThis study highlights the difficulties for parents and GPs in recognising the early symptoms of T1D. It suggests that future interventions should be targeted at parents in the appraisal interval and include the importance of timely presentation to a healthcare professional and the differences between types 1 and 2 diabetes. Primary care physicians should also take parental concerns seriously and do urine dipstick tests during the consultation for children with symptoms of T1D.
The impact of the coronary collateral circulation on outcomes in patients with acute coronary syndromes: results from the ACUITY trial
Authors: Meier Pascal , Lansky Alexandra J , Fahy Martin , Xu Ke , White Harvey D , Bertrand Michel E , Mehran Roxana , Stone Gregg W 
Published: December 2013

ObjectiveWe sought to assess the prognostic role of collaterals in a large population of patients presenting with an acute coronary syndrome (ACS).MethodsThe coronary collateral circulation was assessed by an independent angiographic core laboratory using the Rentrop Score in patients enrolled in the randomised Acute Catheterization and Urgent Intervention Triage Strategy trial.ResultsThe cohort comprised 5412 patients with moderate to high risk ACS. A total of 858 patients (16.0%) had visible collaterals while 4554 patients (84.0%) had no collaterals. After multivariable adjustment, there were no differences in clinical outcomes at 1 year between the groups, including major adverse cardiac events (MACE) (HR 0.94 (95% CI 0.76 to 1.16), p=0.55), mortality (HR 1.03 (0.65 to 1.62), p=0.91), myocardial infarction (MI) (HR 1.07 (0.83 to 1.38), p=0.60) and unplanned target vessel revascularisation (TVR) (HR 0.95 (0.71 to 1.28), p=0.75). Similarly, in the subgroup of patients undergoing percutaneous coronary intervention (PCI), the adjusted HR for major adverse cardiac events was 1.1 (0.76 to 1.61), p=0.595; 0.81 (0.10 to 6.44), p=0.999 for mortality; and 0.86 (0.54 to 1.35), p=0.564 for MI. The risk of unplanned TVR was increased (HR 2.74 (1.48 to 5.10), p=0.004).ConclusionsIn contrast to other studies, this large core laboratory-based analysis does not confirm a beneficial role of visible coronary collateral vessels on clinical outcomes in patients with ACS; the presence of collaterals was even associated with increased mortality in the unadjusted analysis. Collaterals were associated with a higher risk of TVR in patients undergoing PCI, a finding that may not have been fully corrected given confounders and clinical differences between the groups.Trial registrationClinicalTrials.gov Identifier: NCT00093158.
Rates of intentionally caused and road crash deaths of US citizens abroad
Authors: Sherry Melissa K , Mossallam Mahmoud , Mulligan Matthew , Hyder Adnan A , Bishai David 
Published: December 2013

ContextCurrently, little is known about rates of death by cause and country among US travellers. Understanding the risk by cause and country is imperative to risk communication and the development of risk reduction strategies.MethodsPublicly available data on non-natural deaths of US citizens abroad were gathered from January 2003 to December 2009 from the US Department of State's Department Bureau of Consular Affairs. Traveller information was gathered from the US Department of Commerce Office of Travel and Tourism for the same time period. Rates of death were calculated by dividing the number of non-natural deaths of US citizens abroad by the number of US outbound visits for each country.ResultsA total of 5417 non-natural death events were retrieved between 2003 and 2009 from the US State Department. Intentionally caused death rates ranged from 21.44 per 1 000 000 visits in the Philippines to 0 per 1 000 000 visits in several countries; the majority of countries had fewer than five intentionally caused deaths per 1 000 000 visits. Rates of road traffic crashes were higher than rates of intentionally caused deaths in almost every instance. Thailand had the highest rate of deaths due to road traffic crashes (16.49 per 1 000 000), followed by Vietnam, Morocco and South Africa (15.12 per 1 000 000, 11.96 per 1 000 000 and 10.90 per 1 000 000, respectively). Motorcycle deaths account for most of the heightened risk observed in Thailand and Vietnam.ConclusionsThe leading cause of non-natural deaths in US travellers abroad was road crashes, which exceeds intentional injury as the leading cause of non-natural deaths in almost every country where US citizens travel. Southeast Asia had the highest unintentional injury death rates for US citizens abroad due to the high rates of deaths from motorcycle crashes.
Local existence of polynomial decay solutions to the Boltzmann equation for soft potentials
Authors: Morimoto Yoshinori , Yang Tong 
Published: December 2013

The existence of classical solutions to the Cauchy problem for the Boltzmann equation without angular cutoff has been extensively studied in the framework when the solution has Maxwellian decay in the velocity variable, cf. [6, 8] and the references therein. In this paper, we prove local existence of solutions with polynomial decay in the velocity variable for the Boltzmann equation with soft potential. In the proof, the singular change of variables between post- and pre-collision velocities plays an important role, as well as the regular one introduced in the celebrated cancelation lemma by Alexandre–Desvillettes–Villani–Wennberg [Entropy dissipation and long-range interactions, Arch. Ration. Mech. Anal. 152 (2000) 327–355].
Concedamos a liberdade de traçar: brincando de escrever um Dicionário de perfeições inventadas na oficina de escrita
Authors: Lange Mariana de Bastiani 
Published: December 2013

Este artigo visa desenvolver questões acerca da escrita, da infância e da educação, narrando a história da criação de um “dicionário de palavras inventadas”. Este dicionário foi criado por crianças que participavam de oficinas de escrita. Fundamentadas nas relações entre literatura e psicanálise, as oficinas de escrita foram desenvolvidas com diferentes grupos de crianças. A história do Dicionário de Perfeições Inventadas dialoga com os escritos de Manoel de Barros e Roland Barthes.
A Novel Mouse Model of Aortic Valve Stenosis Induced by Direct Wire Injury
Authors: Honda Shintaro , Miyamoto Takuya , Watanabe Tetsu , Narumi Taro , Kadowaki Shinpei , Honda Yuki , Otaki Yoichiro , Hasegawa Hiromasa , Netsu Shunsuke , Funayama Akira , Ishino Mitsunori , Nishiyama Satoshi , Takahashi Hiroki , Arimoto Takanori , Shishido Tetsuro , Miyashita Takehiko , Kubota Isao 
Published: December 2013

Objective—
The response-to-tissue-injury theory is currently the favorite paradigm to investigate valve pathology. To the best of our knowledge, there are currently no in vivo valve injury models. There are few calcific aortic valve stenosis (AVS) models that develop hemodynamically significant stenosis. Here, we investigated the effect of direct mechanical injury on aortic valves in vivo and developed a novel mouse model of calcific AVS.

Approach and Results—
Aortic valve injury was created by inserting and moving a spring guidewire under echocardiographic guidance into the left ventricle of male C57/BL6 mice via right common carotid artery. Serial echocardiographic measurements revealed that aortic velocity was increased 1 week after injury and persistently increased until 16 weeks after injury. AVS mice showed a higher heart weight/body weight ratio and decreased left ventricular fractioning shortening 4 weeks after injury, compared with sham mice. We found remarkable proliferation of valve leaflets 4 weeks after injury. Proliferative valves showed increased production of reactive oxygen species and expression of inflammatory cytokines and osteochondrogenic factors. Alizarin red staining showed valvular calcification 12 weeks after injury.

Conclusions—
We report a novel calcific AVS model to support the response-to-tissue-injury theory. This model may be a valuable tool for analyzing the mechanism of AVS and assessing therapeutic options.
Activation of Liver X Receptor Decreases Atherosclerosis in
Ldlr

−/−

Mice in the Absence of ATP-Binding Cassette Transporters A1 and G1 in Myeloid Cells
Authors: Kappus Mojdeh S. , Murphy Andrew J. , Abramowicz Sandra , Ntonga Vusisizwe , Welch Carrie L. , Tall Alan R. , Westerterp Marit 
Published: December 2013

Objective—
Liver X receptor (LXR) activators decrease atherosclerosis in mice. LXR activators (1) directly upregulate genes involved in reverse cholesterol transport and (2) exert anti-inflammatory effects mediated by transrepression of nuclear factor-κB target genes. We investigated whether myeloid cell deficiency of ATP-binding cassette transporters A1 and G1 (ABCA1/G1), principal targets of LXR that promote macrophage cholesterol efflux and initiate reverse cholesterol transport, would abolish the beneficial effects of LXR activation on atherosclerosis.

Approach and Results—

LXR activator T0901317 substantially reduced inflammatory gene expression in macrophages lacking ABCA1/G1.
Ldlr

−/−

mice were transplanted with
Abca1

−/−

Abcg1

−/−

or wild-type bone marrow (BM) and fed a Western-type diet for 6 weeks with or without T0901317 supplementation.
Abca1/g1
BM deficiency increased atherosclerotic lesion complexity and inflammatory cell infiltration into the adventitia and myocardium. T0901317 markedly decreased lesion area, complexity, and inflammatory cell infiltration in the
Abca1

−/−

Abcg1

−/−

BM–transplanted mice. To investigate whether this was because of macrophage
Abca1/g1
deficiency,
Ldlr

−/−

mice were transplanted with
LysmCreAbca1

fl/fl

Abcg1

fl/fl

or
Abca1

fl/fl

Abcg1

fl/fl

BM and fed Western-type diet with or without the more specific LXR agonist GW3965 for 12 weeks. GW3965 decreased lesion size in both groups, and the decrease was more prominent in the
LysmCreAbca1

fl/fl

Abcg1

fl/fl

group.

Conclusions—
The results suggest that anti-inflammatory effects of LXR activators are of key importance to their antiatherosclerotic effects in vivo independent of cholesterol efflux pathways mediated by macrophage ABCA1/G1. This has implications for the development of LXR activators that lack adverse effects on lipogenic genes while maintaining the ability to transrepress inflammatory genes.
Interleukin-23 Deficiency Leads to Impaired Wound Healing and Adverse Prognosis After Myocardial Infarction
Authors: Savvatis Konstantinos , Pappritz Kathleen , Becher Peter Moritz , Lindner Diana , Zietsch Christin , Volk Hans-Dieter , Westermann Dirk , Schultheiss Heinz-Peter , Tschöpe Carsten 
Published: December 2013

Background—
CD4+ cells are implicated in the healing process after myocardial infarction (MI). We sought to investigate the role of interleukin-23 (IL-23) deficiency, a cytokine important in differentiation of CD4+ cells, in scar formation of the ischemic heart.

Methods and Results—
MI was performed in wild-type and IL23p19−/− mice. Thirty-day mortality, hemodynamic function 4 days after MI and myocardial inflammation, and remodeling 4 and 30 days after MI were examined. Differentiation of fibroblasts from infarcted and noninfarcted hearts into myofibroblasts was examined under basal conditions and after stimulation with interferon-γ, IL-17α and IL-23. Interleukin-23p19−/− mice showed higher expression of proinflammatory cytokines and immune cell infiltration in the scar early after MI compared with wild-type mice. A stronger interferon-γ/Th1 reaction seemed to be responsible for the increased inflammation under IL-23 deficiency. Expression of α-smooth muscle actin (α-SMA), collagen I and III was significantly higher in the heart tissue and isolated cardiac fibroblasts 4 days after MI in the wild-type mice. Interleukin-23p19−/− mice showed impaired healing compared with wild-type mice, as seen by significantly higher mortality because of ventricular rupture (40% higher after 30 days) and stronger left ventricular dilation early after MI. Stimulation of cardiac fibroblasts with interferon-γ, the main Th1 cytokine, but not with IL-23 or IL-17α, led to a significant downregulation of α-smooth muscle actin, collagen I and III and decreased migration and differentiation to myofibroblasts.

Conclusions—
IL-23 deficiency leads to increased myocardial inflammation and decreased cardiac fibroblast activation, associated with impaired scar formation and adverse remodeling after MI.
Mechanical Dyssynchrony Precedes QRS Widening in ATP‐Sensitive K
+
Channel–Deficient Dilated Cardiomyopathy
Authors: Yamada Satsuki , Arrell D. Kent , Kane Garvan C. , Nelson Timothy J. , Perez‐Terzic Carmen M. , Behfar Atta , Purushothaman Saranya , Prinzen Frits W. , Auricchio Angelo , Terzic Andre 
Published: December 2013

Background
Contractile discordance exacerbates cardiac dysfunction, aggravating heart failure outcome. Dissecting the genesis of mechanical dyssynchrony would enable an early diagnosis before advanced disease.

Methods and Results

High‐resolution speckle‐tracking echocardiography was applied in a knockout murine surrogate of adult‐onset human cardiomyopathy caused by mutations in cardioprotective ATP‐sensitive K
+
(K
ATP
) channels. Preceding the established criteria of cardiac dyssynchrony, multiparametric speckle‐based strain resolved nascent erosion of dysfunctional regions within cardiomyopathic ventricles of the K
ATP
channel–null mutant exposed to hemodynamic stress. Not observed in wild‐type counterparts, intraventricular disparity in wall motion, validated by the degree, direction, and delay of myocardial speckle patterns, unmasked the disease substrate from asymptomatic to overt heart failure. Mechanical dyssynchrony preceded widening of the
QRS
complex and exercise intolerance and progressed into global myocardial discoordination and decompensated cardiac pump function, precipitating a low output syndrome.

Conclusions

The present study, with the use of high‐resolution imaging, prospectively resolved the origin and extent of intraventricular motion disparity in a K
ATP
channel–knockout model of dilated cardiomyopathy. Mechanical dyssynchrony established as an early marker of cardiomyopathic disease offers novel insight into the pathodynamics of dyssynchronous heart failure.
Clinical and Magnetic Resonance Imaging Predictors of Very Early Neurological Response to Intravenous Thrombolysis in Patients With Middle Cerebral Artery Occlusion
Authors: Apoil Marion , Turc Guillaume , Tisserand Marie , Calvet David , Naggara Olivier , Domigo Valérie , Baron Jean‐Claude , Oppenheim Catherine , Touzé Emmanuel 
Published: December 2013

Background

The early identification of patients who are unlikely to respond to intravenous recombinant tissue plasminogen activator (
IV
‐
tPA
) could help select candidates for additional intra‐arterial therapy or add‐on antithrombotic drugs during the acute stage of stroke. Given that very early neurological improvement (
VENI
) is a reliable surrogate of early recanalization, we assessed the clinical and magnetic resonance imaging predictors of lack of
VENI
.

Methods and Results

We reviewed consecutive ischemic stroke patients with middle cerebral artery occlusion and treated within 4.5 hours by
IV
‐
tPA
between 2003 and 2012 in our center, where magnetic resonance imaging is systematically implemented as first‐line diagnostic workup. Lack of
VENI
was defined as a <40% decrease in baseline National Institutes of Health Stroke Scale (
NIHSS
) score 1 hour after start of
IV
‐
tPA
. Poor outcome was defined as a 3‐month modified
R
ankin scale ≥2. Associations between lack of
VENI
and potential determinants were assessed in logistic regression models. In all, 186 patients were included (median baseline
NIHSS
score, 16; median onset to treatment time, 155 minutes). One hundred forty‐three patients (77%) had no
VENI
. The variables significantly associated with lack of
VENI
in multivariable analysis were baseline
NIHSS
(
OR
, 1.08; 95%
CI
, 1.01 to 1.16 per 1‐point increase;
P
=0.03), onset to treatment time >120 minutes (
OR
, 2.94; 95% CI, 1.31 to 6.63;
P
=0.009) and diffusion weighted imaging—Alberta Stroke Programme Early CT Score ≤5 (
OR
, 3.60; 95%
CI
, 1.14 to 11.35;
P
=0.03). Patients without
VENI
were more likely to have a modified Rankin Scale ≥2 than those without
VENI
(68% versus 24%;
OR
, 5.01; 95%
CI
, 2.12 to 11.82) and less likely to have recanalization after 24 hours (
OR
, 0.41; 95%
CI
, 0.19 to 0.88).

Conclusions

Lack of
VENI
provides an early estimate of 3‐month outcome and recanalization after
IV
‐
tPA
. Baseline
NIHSS
, onset to treatment time, and diffusion weighted imaging—Alberta Stroke Programme Early CT Score could help to predict lack of
VENI
and, in turn, might help early selection of candidates for complementary reperfusion strategies.
A Plasma Long‐Chain Acylcarnitine Predicts Cardiovascular Mortality in Incident Dialysis Patients
Authors: Kalim Sahir , Clish Clary B. , Wenger Julia , Elmariah Sammy , Yeh Robert W. , Deferio Joseph J. , Pierce Kerry , Deik Amy , Gerszten Robert E. , Thadhani Ravi , Rhee Eugene P. 
Published: December 2013

Background
The marked excess in cardiovascular mortality that results from uremia remains poorly understood.

Methods and Results

In 2 independent, nested case‐control studies, we applied liquid chromatography‐mass spectrometry‐based metabolite profiling to plasma obtained from participants of a large cohort of incident hemodialysis patients. First, 100 individuals who died of a cardiovascular cause within 1 year of initiating hemodialysis (cases) were randomly selected along with 100 individuals who survived for at least 1 year (controls), matched for age, sex, and race. Four highly intercorrelated long‐chain acylcarnitines achieved the significance threshold adjusted for multiple testing (
P
<0.0003). Oleoylcarnitine, the long‐chain acylcarnitine with the strongest association with cardiovascular mortality in unadjusted analysis, remained associated with 1‐year cardiovascular death after multivariable adjustment (odds ratio per
SD
2.3 [95% confidence interval, 1.4 to 3.8];
P
=0.001). The association between oleoylcarnitine and 1‐year cardiovascular death was then replicated in an independent sample (n=300, odds ratio per
SD
1.4 [95% confidence interval, 1.1 to 1.9];
P
=0.008). Addition of oleoylcarnitine to clinical variables improved cardiovascular risk prediction using net reclassification (
NRI
, 0.38 [95% confidence interval, 0.20 to 0.56];
P
<0.0001). In physiologic profiling studies, we demonstrate that the fold change in plasma acylcarnitine levels from the aorta to renal vein and from pre‐ to post hemodialysis samples exclude renal or dialytic clearance of long‐chain acylcarnitines as confounders in our analysis.

Conclusions
Our data highlight clinically meaningful alterations in acylcarnitine homeostasis at the time of dialysis initiation, which may represent an early marker, effector, or both of uremic cardiovascular risk.