bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of the nurse-led Activate intervention in patients at risk of cardiovascular disease in primary care: a cluster-randomised controlled trial
Authors: Westland Heleen , Schuurmans Marieke J , Bos-Touwen Irene D , de Bruin-van Leersum Marjolein A , Monninkhof Evelyn M , Schröder Carin D , de Vette Daphne A , Trappenburg Jaap CA 
Published: May 2020

BackgroundTo understand better the success of self-management interventions and to enable tailoring of such interventions at specific subgroups of patients, the nurse-led Activate intervention is developed targeting one component of self-management (physical activity) in a heterogeneous subgroup (patients at risk of cardiovascular disease) in Dutch primary care.AimThe aim of this study was to evaluate the effectiveness of the Activate intervention and identifying which patient-related characteristics modify the effect.MethodsA two-armed cluster-randomised controlled trial was conducted comparing the intervention with care as usual. The intervention consisted of four nurse-led behaviour change consultations within a 3-month period. Data were collected at baseline, 3 months and 6 months. Primary outcome was the daily amount of moderate to vigorous physical activity at 6 months. Secondary outcomes included sedentary behaviour, self-efficacy for physical activity, patient activation for self-management and health status. Prespecified effect modifiers were age, body mass index, level of education, social support, depression, patient provider relationship and baseline physical activity.ResultsThirty-one general practices (n = 195 patients) were included (intervention group n = 93; control group n = 102). No significant between-group difference was found for physical activity (mean difference 2.49 minutes; 95% confidence interval -2.1; 7.1; P = 0.28) and secondary outcomes. Patients with low perceived social support (P = 0.01) and patients with a low baseline activity level (P = 0.02) benefitted more from the intervention.ConclusionThe Activate intervention did not improve patients’ physical activity and secondary outcomes in primary care patients at risk of cardiovascular disease. To understand the results, the intervention fidelity and active components for effective self-management require further investigation.Trial registration: ClinicalTrials.gov NCT02725203.
Less Invasive Approach to Left Ventricular Assist Device Implantation May Improve Survival in High-Risk Patients
Authors: Pasrija Chetan , Sawan Mariem A. , Sorensen Erik , Voorhees Hannah Joy , Shah Aakash , Wang Libin , Ton Van-Khue , DiChiacchio Laura , Kaczorowski David J. , Griffith Bartley P. , Pham Si M. , Kon Zachary N. 
Published: May 2020

Objective Despite improvement in outcomes after left ventricular assist device (LVAD) implantation over the past 2 decades, high-risk recipients continue to have a prohibitive rate of morbidity and mortality. We hypothesized that a less invasive approach to LVAD implantation would be associated with improved survival compared to a conventional approach in this high-risk cohort. Methods All consecutive LVAD recipients (2013 to 2017) that underwent centrifugal LVAD implantation were retrospectively reviewed. Patients were classified as high-risk if INTERMACS 1 or required temporary VAD/venoarterial extracorporeal membrane oxygenation prior to durable VAD implantation. Patients were stratified into 3 groups: left thoracotomy with hemi-sternotomy (LTHS) high-risk, conventional sternotomy (CS) high-risk, and non-high-risk. The primary outcome was 1-year survival. Results A total of 57 patients (LTHS high-risk: 11, CS high-risk: 12, non-high-risk: 34) were identified. Preoperative right ventricular failure scores, HeartMate-II mortality scores, and end-organ dysfunction were similar between the 2 high-risk groups. While operative time was similar between the 3 groups, cardiopulmonary bypass time was significantly shorter in the LTHS high-risk group compared to other groups. There was a trend toward decreased intensive care unit length of stay and ventilator time in LTHS high-risk compared to CS high-risk patients. Moreover, between these 2 groups, there was a significant decrease in temporary right VAD support (50% vs 0%, P = 0.014), and 1-year survival was significantly higher in the LTHS group (42% vs 91%, P = 0.025). Conclusions Less invasive LVAD implantation appears to be associated with improved survival compared to conventional LVAD implantation in high-risk patients.
The economic burden of inpatient diabetic foot ulcers in Toronto, Canada
Authors: Syed Muzammil H , Salata Konrad , Hussain Mohamad A , Zamzam Abdelrahman , de Mestral Charles , Wheatcroft Mark , Harlock John , Awartani Deana , Aljabri Badr , Verma Amol , Razak Fahad , Verma Subodh , Al-Omran Mohammed 
Published: May 2020

Objective Diabetic foot ulcer, which often leads to lower limb amputation, is a devastating complication of diabetes that is a major burden on patients and the healthcare system. The main objective of this study is to determine the economic burden of diabetic foot ulcer-related care. Methods We conducted a multicenter study of all diabetic foot ulcer patients admitted to general internal medicine wards at seven hospitals in the Greater Toronto Area, Canada from 2010 to 2015, using the GEMINI database. We compared the mean costs of care per patient for diabetic foot ulcer-related admissions, admissions for other diabetes-related complications, and admissions for the top five most costly general internal medicine conditions, using the Ontario Case Costing Initiative. Regression models were used to determine adjusted estimates of cost per patient. Propensity-score matched analyses were performed as sensitivity analyses. Results Our study cohort comprised of 557 diabetic foot ulcer patients; 2939 non-diabetic foot ulcer diabetes patients; and 23,656 patients with the top 5 most costly general internal medicine conditions. Diabetic foot ulcer admissions incurred the highest mean cost per patient ($22,754) when compared to admissions with non-diabetic foot ulcer diabetes ($8,350) and the top five most costly conditions ($10,169). Using adjusted linear regression, diabetic foot ulcer admissions demonstrated a 49.6% greater mean cost of care than non-diabetic foot ulcer-related diabetes admissions (95% CI 1.14–1.58), and a 25.6% greater mean cost than the top five most costly conditions (95% CI 1.17–1.34). Propensity-scored matched analyses confirmed these results. Conclusion Diabetic foot ulcer patients incur significantly higher costs of care when compared to admissions with non-diabetic foot ulcer-related diabetes patients, and the top five most costly general internal medicine conditions.
Workload-indexed blood pressure response to a maximum exercise test among professional indoor athletes
Authors: Bauer Pascal , Kraushaar Lutz , Dörr Oliver , Nef Holger , Hamm Christian W , Most Astrid 
Published: May 2020

Abstract

Background
Exercise testing is performed regularly in professional athletes. However, the blood pressure response (BPR) to exercise is rarely investigated in this cohort, and normative upper thresholds are lacking. Recently, a workload-indexed BPR (increase in systolic blood pressure per increase in metabolic equivalent of task (SBP/MET slope)) was evaluated in a general population and was compared with mortality. We sought to evaluate the SBP/MET slope in professional athletes and compare it with performance.

Design
This was a cross-sectional study.

Methods
A total of 142 male professional indoor athletes (age 26 ± 5 years) were examined. Blood pressure was measured at rest and during a standardized, graded cycle ergometer test. We assessed the BPR during exercise, the workload, and the metabolic equivalent of task (MET). Athletes were divided into groups according to their SBP/MET slope quartiles (I &lt;4.3; II 4.3–6.2; III &gt;6.2–9; IV &gt;9 mmHg/MET) and compared regarding systolic BP (sBP) and workload achieved.

Results
Athletes in group I (n = 42) had the lowest maximum sBP (180 ± 13 mmHg) but achieved the highest relative workload (4.2 ± 1 W/kg). With increasing SBP/MET slope, the maximum sBP increased (II (n = 56): 195 ± 15 mmHg; III (n = 44): 216 ± 16 mmHg) and the workload achieved decreased (II: 3.9 ± 0.7 W/kg; III: 3.3 ± 0.5 W/kg). The differences in sBP between these groups were significant (p &lt; 0.001). None of the athletes were assigned to group IV (&gt;9 mmHg/MET).

Conclusion
Athletes in the lowest SBP/MET slope quartile displayed the lowest maximum sBP but achieved a higher workload than athletes classified into the other SBP/MET slope groups. This simple, novel metric might help to distinguish a normal from an exaggerated BPR to exercise, to identify athletes at risk of developing hypertension.
Childhood hearing impairment and its associated factors in sub-Saharan Africa in the 21st century: A systematic review and meta-analysis
Authors: Desalew Assefa , Feto Gelano Tilayie , Semahegn Agumasie , Geda Biftu , Ali Tilahun 
Published: May 2020

Background: Childhood hearing impairment is still a significant cause of disability in the 21st century in developing countries. Particularly, the burden is more severe in sub-Saharan Africa, where the majority of children with hearing problems is living. Thre are great variations and inconsistencies of available findings conducted in sub-Saharan Africa. Hence, the aim of this review was to determine the pooled prevalence of childhood hearing impairment and its associated factors in sub-Saharan Africa. Methods: Studies were searched from main databases (PubMed, CINAHL, and African Journals Online), Google Scholar, and other relevant sources using electronic and manual techniques. All observational studies, written in English and conducted among participants (aged less than 18 years) from 2000 to 2018, were eligible. Heterogeneity between included studies was assessed using I2, and publication bias was explored using visual inspection of the funnel plot. Statistical analysis was carried out to determine pooled prevalence using Stata version 14. In addition, subgroup analysis was carried out for the normality criteria of hearing thresholds and characteristics of the study populations. Results: The pooled prevalence of hearing impairment was 10% (95% confidence interval (CI): 9%–11%). The magnitude of hearing impairment varies with the normality criterion used. The most commonly used threshold was 25 and 30 dB hearing level. The prevalence of hearing impairment based on normality criterion (>20 dB, >25 dB, >30 dB, and >35 dB) were 17%, 19%, 2%, and 1%, respectively. While in the questionnaire-based evaluation, the prevalence was 6% (95% CI: 3%–9%). In addition, based on population characteristics, the prevalence of hearing impairment for school or community-based children was 6% (95% CI: 5%–7%) while the prevalence for children with comorbidities was 23% (95% CI: 15%–31%). Chronic suppurative otitis media, impacted cerumen, advanced stage of human immunodeficiency virus, tuberculosis infection, and age of the children were associated with hearing impairment in sub-Saharan Africa. Conclusion: Hearing impairment in children and adolescents in sub-Saharan Africa was high, and associated with preventable and treatable risk factors.
Optimising patients with long-term spinal cord injury for nephrectomy: A review of pre-, peri- and post-operative factors to safeguard outcomes
Authors: Donati-Bourne J , Kasmani Z , Mohamed WGE , Pillai P , O’Dair J , Bhatt RI 
Published: May 2020

Objectives: To review the potential challenges a urologist may encounter when embarking on simple/partial/radical nephrectomy in patients with long-term spinal cord injury and propose strategies to pre-empt and manage these. Materials and methods: Comprehensive literature review via PubMed, MEDLINE® and Google™ Scholar searching for relevant scientific articles published to date in English. Recommendations for strategies to safeguard surgical outcomes discussed with a panel of experienced upper-tract urologists. Results: Pre-operative considerations:  - urethral assessment via flexible cystoscopy due to higher incidence of urethral pathology in spinal cord injury;  - assessing for chronic constipation and distended bowel; and  - considering glomerular filtration rate assessment by radio-isotope techniques, such as 51chromium-EDTA Peri-operative considerations:  - adequate theatre staffing for safe patient transfer; and  - planned choice of incision, due to higher incidence of previous abdominal surgery, stoma bags and/or foreign body devices. Post-operative considerations:  - ensuring attending medical staff are trained to recognise autonomic dysreflexia;  - early re-mobilisation with physiotherapists experienced in treating spinal cord injury; and  - attentive antibiotic stewardship due to higher risk of hospital-acquired or urinary infections Conclusions: Patients with long-term spinal cord injury pose significant potential challenges in the pre-, peri- and post-operative stages of nephrectomy. Familiarisation and optimisation of such factors is recommended to safeguard outcomes. Level of evidence: Not applicable for this multicentre audit.
An evaluation of the impact of attachment and trauma training for pupil referral unit staff
Authors: Greenhalgh Rebecca , Fflur Siana , Donnelly Katherine , Kirkaldie Helen , McDonnell Lynn 
Published: May 2020

Background: The Gwent Attachment Service trained four pupil referral units (PRUs) staff in attachment- and trauma-informed work. Education staff received 2 days of training and then attended six skills development sessions (SDSs) on a monthly basis to embed the training concepts into their work. This model takes a “whole systems approach” to intervention, drawing on evidence suggesting that having a supportive and consistent system around a child that takes into account their attachment needs leads to better outcomes. Methods: Self-reported knowledge of attachment- and trauma-informed work, confidence in carrying out this work, and worries about implementing this work were collected from 64 education staff members across the four PRUs. Measures were repeated at three time points: pre-training, post-training, and post-SDS. Results: Knowledge and confidence increased from pre- to post-training. Knowledge did not significantly differ between post-training and post-SDS. Confidence was lower at post-SDS than post-training but remained above pre-training ratings. Worries decreased from pre- to post-training and decreased again post-SDS. Conclusion: Training and SDSs can improve teaching staffs’ perception of their knowledge and confidence, while reducing worries about working in an attachment- and trauma-informed way. SDSs decreased worries about working in an attachment- and trauma-informed way over and above training alone, indicating that the SDSs contribute added value. This study presents a promising starting point for improving the lives of children and young people who have experienced trauma and have attachment difficulties.
A Didactic Lecture Is Effective in Teaching Sonographers the TI-RADS System for Stratifying Thyroid Nodules
Authors: Patel Vishal , Roberts Jeffrey , Cohen Bruce , Frank Susan , Fine Rona Orentlicher , Rosenblum Jessica , Koenigsberg Mordecai , Stein Marjorie 
Published: May 2020

Objective: The aim of this study is to determine whether a one-hour image-rich didactic lecture given to sonographers can successfully teach them the TI-RADS (Thyroid Imaging, Reporting and Data System) lexicon, to improve their recognition of malignant thyroid nodules. Methods: A one-hour image-rich didactic lecture on TI-RADS was designed that encompassed the diagnostic criteria for thyroid malignancy and technical tips to better demonstrate thyroid nodules. A lecture was presented to 34 sonographers across multiple sites. The study examined the effects of the lecture by comparing the results of a pretest, an immediate posttest, and a two-week delayed posttest. Results: All 34 sonographers participated in the lecture intervention and each assessment. The prelecture assessment scores ranged from 13% to 73% with an average of 46%. Immediately after the lecture, the assessment scores ranged from 27% to 100%, with an average of 77%. Two weeks after the lectures, scores ranged from 27% to 93%, with an average of 70%. Compared to the pretest, there was a statistically significant increase in average scores immediately after and two weeks after the lecture. Conclusion: It is critically importance to have a reliable, noninvasive method to identify thyroid nodules that have a greater chance of malignancy. A didactic lecture could successfully teach, result in knowledge retention, and increase sonographers’ confidence in the TI-RADS lexicon.
Results from the European Union MAPEC_LIFE cohort study on air pollution and chromosomal damage in children: are public health policies sufficiently protective?
Authors:   MAPEC_LIFE Study Group, Ceretti Elisabetta , Donato Francesco , Zani Claudia , Villarini Milena , Verani Marco , De Donno Antonella , Bonetta Sara , Feretti Donatella , Carducci Annalaura , Idolo Adele , Carraro Elisabetta , Covolo Loredana , Moretti Massimo , Palomba Giacomo , Grassi Tiziana , Bonetti Alberto , Bonizzoni Silvia , Biggeri Annibale , Gelatti Umberto 
Published: May 2020

Abstract
Background
Children are at high risk of suffering health consequences of air pollution and childhood exposure can increase the risk of developing chronic diseases in adulthood. This study, part of the MAPEC_LIFE project (LIFE12 ENV/IT/000614), aimed to investigate the associations between exposure to urban air pollutants and micronucleus (MN) frequency, as a biomarker of chromosomal damage, in buccal cells of children for supporting implementation and updating of environmental policy and legislation.

Methods
This prospective epidemiological cohort study was carried out on 6- to 8-year-old children living in five Italian towns with different levels and features of air pollution. Exfoliated buccal cells of the children were sampled twice, in winter and spring, obtaining 2139 biological samples for genotoxicological investigation. Micronucleus (MN) frequency was investigated in buccal cells of children and its association with air pollution exposure was assessed applying multiple Poisson regression mixed models, including socio-demographic and lifestyle factors as confounders. We also dichotomize air pollutants’ concentration according to the EU Ambient Air Quality Directives and WHO Air Quality Guidelines in all Poisson regression models to assess their risk predictive capacity.

Results
Positive and statistically significant associations were found between MN frequency and PM10, PM2.5, benzene, SO2 and ozone. The increment of the risk of having MN in buccal cells for each μg/m3 increase of pollutant concentration was maximum for benzene (18.9%, 95% CIs 2.2–38.4%) and modest for the other pollutants (between 0.2 and 1.4%). An increased risk (between 17.9% and 59.8%) was found also for exposure to PM10, benzene and benzo(a)pyrene levels higher than the threshold limits.

Conclusions
Some air pollutants are able to induce chromosomal damage in buccal cells of children even at concentrations below present EU/WHO limits. This type of biological effects may be indicative of the environmental pressure which populations are exposed to in urban areas.
Comparative genomics of whole-cell pertussis vaccine strains from India
Authors: Alai Shweta , Ghattargi Vikas C. , Gautam Manish , Patel Krunal , Pawar Shrikant P. , Dhotre Dhiraj P. , Shaligram Umesh , Gairola Sunil 
Published: May 2020

Abstract
Background
Despite high vaccination coverage using acellular (ACV) and whole-cell pertussis (WCV) vaccines, the resurgence of pertussis is observed globally. Genetic divergence in circulating strains of Bordetella pertussis has been reported as one of the contributing factors for the resurgence of the disease. Our current knowledge of B. pertussis genetic evolution in circulating strains is mostly based on studies conducted in countries using ACVs targeting only a few antigens used in the production of ACVs. To better understand the adaptation to vaccine-induced selection pressure, it will be essential to study B. pertussis populations in developing countries which are using WCVs. India is a significant user and global supplier of WCVs. We report here comparative genome analyses of vaccine and clinical isolates reported from India. Whole-genome sequences obtained from vaccine strains: WCV (J445, J446, J447 and J448), ACV (BP165) were compared with Tohama-I reference strain and recently reported clinical isolates from India (BPD1, BPD2). Core genome-based phylogenetic analysis was also performed using 166 isolates reported from countries using ACV.

Results
Whole-genome analysis of vaccine and clinical isolates reported from India revealed high genetic similarity and conserved genome among strains. Phylogenetic analysis showed that clinical and vaccine strains share genetic closeness with reference strain Tohama-I. The allelic profile of vaccine strains (J445:ptxP1/ptxA2/prn1/fim2–1/fim3–1; J446: ptxP2/ptxA4/prn7/fim2–2/fim3–1; J447 and J448: ptxP1/ptxA1/ prn1/fim2–1/fim3–1), which matched entirely with clinical isolates (BPD1:ptxP1/ptxA1/prn1/fim2–1 and BPD2: ptxP1/ptxA1/prn1/fim2–1) reported from India. Multi-locus sequence typing (MLST) demonstrated the presence of dominant sequence types ST2 and primitive ST1 in vaccine strains which will allow better coverage against circulating strains of B. pertussis.

Conclusions
The study provides a detailed characterization of vaccine and clinical strains reported from India, which will further facilitate epidemiological studies on genetic shifts in countries which are using WCVs in their immunization programs.
In-depth analysis of T2Bacteria positive results in patients with concurrent negative blood culture: a case series
Authors: Kalligeros Markos , Zacharioudakis Ioannis M. , Tansarli Giannoula S. , Tori Katerina , Shehadeh Fadi , Mylonakis Eleftherios 
Published: May 2020

Abstract
Background
T2Bacteria assay uses T2 magnetic resonance (T2MR) technology for the rapid diagnosis of bacterial bloodstream infections (BSIs). This FDA cleared technology can detect 5 of the most prevalent pathogens causing bacteremia (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecium). Because the significance of discordant results between the T2Bacteria assay and blood culture (BC) remains a challenge, in this case series we reviewed the medical records of patients who had a positive T2Bacteria test and a concurrent negative BC.

Methods
Among 233 participants, we identified 20 patients with 21 (9%) discordant T2Bacteria-positive/BC-negative (T2+/BC-) results. We classified these results based on clinical cultures and clinical evidence.

Results
When we analyzed these 21 discordant results in-depth, 11 (52.5%) fulfilled criteria for probable BSI, 4 (19%) for possible BSI, and 6 (28.5%) were presumptive false positives. Among the probable/possible BSIs, discordant results were often associated with patients diagnosed with closed space and localized infections [pyelonephritis (n = 7), abscess (n = 4), pneumonia (n = 1), infected hematoma (n = 1), and osteomyelitis (n = 1)]. Also, within the preceding 2 days of the T2+/BC- blood sample, 80% (16/20) of the patients had received at least one dose of an antimicrobial agent which was active against the T2Bacteria-detected pathogen.

Conclusions
In the majority of discrepant results, the T2Bacteria assay detected a plausible pathogen that was supported by clinical and/or microbiologic data. Discrepancies appear to be associated with closed space and localized infections and the recent use of effective antibacterial agents. The clinical significance and potential implications of such discordant results should be further investigated.