bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence, Characteristics and Outcomes of Delirium in Patients With Noninvasive Ventilation: A Prospective Observational Study
Authors: Zhang Rui , Bai Linfu , Han Xiaoli , Huang Shicong , Zhou Lintong , Duan Jun 
Published: August 2020

Abstract
Background: Knowledge of delirium in noninvasive ventilation (NIV) is lacking. We aimed to report the incidence, characteristics and outcomes of delirium in NIV patients. Methods: A prospective observational study was performed in an intensive care unit (ICU) of a teaching hospital. Patients who used NIV as a fist-line intervention were enrolled. During NIV intervention, delirium was screened using Confusion Assessment Method for the ICU every day. Results: We enrolled 1083 patients. Of them, 196 patients (18.1%) experienced delirium during NIV intervention. Patients with delirium had higher NIV failure rates (37.8% vs. 21.0%, p ＜0.01), higher ICU mortality (33.2% vs. 14.3%, p ＜0.01) and higher hospital mortality (37.2% vs. 17.0%, p ＜0.01) than the subjects without delirium. They also spent longer time on NIV (median 6.3 vs. 3.7 days, p ＜0.01), and stayed longer in ICU (median 9.0 vs. 6.0 days, p ＜0.01) and hospital (median 14.5 vs. 11.0 days, p ＜0.01). Furthermore, delirium was independently associated with NIV failure, ICU mortality and hospital mortality (OR =1.97, 2.58 and 2.55, respectively; all p values ＜0.01). These results were confirmed in COPD and non-COPD cohorts. Compared with hyperactive delirium patients, the NIV days was longer in hypoactive delirium patients and much longer in mixed delirium patients (median 3.4 vs. 6.5 vs. 10.1 days, p ＜0.01). Similar outcomes were found in the length of stay in ICU and hospital. However, the NIV failure, ICU mortality and hospital mortality did not differ between three subtypes of delirium.Conclusions: Delirium increases the NIV failure rates, elevates the ICU and hospital mortality, prolongs the NIV days, and lengthens the ICU and hospital stay. Mixed delirium patients use more ICU resources than hypoactive delirium patients and much more than hyperactive delirium patients.
Evaluation of Malaria Preventive Measures Among Adult Patients Attending the Bamendjou and Foumbot District Hospitals of the West Region of Cameroon
Authors: Nlinwe Nfor Omarine , Singong Yengong Clinton , Florentine Tenkam Makamdoum Ruth 
Published: August 2020

Abstract
Background: Although significant decrease in entomological and epidemiological indicators was reported in Cameroon since the introduction of insecticide treated bed nets, malaria prevalence remains high also in some parts of the West Region of Cameroon. Therefore this study was designed to evaluate malaria preventive measures among patients attending the Bamendjou and Foumbot District hospitals of the West Region of Cameroon. Methods: This was a cross sectional study carried out within a period of three months, from January to March 2020. Data was obtained using a structured questionnaire and laboratory analysis. The CareStart ™ Malaria HRP2 (Pf) qualitative rapid diagnostic test was used for malaria diagnosis. The questionnaire was designed to collect information on respondent’s socio demographic characteristics, and use of malaria preventive measures. Data was analyzed using descriptive statistics, regression analysis and Chi-square (and Fisher’s exact) test. Results: A total of 170 study participants were recruited in Foumbot and 197 in Bamendjou. Malaria was significantly (P < 0.0001) more prevalent in Foumbot (47.06%) than in Bamendjou (19.8%). In Foumbot, nonuse of insect repellent spray (P = 0.0214), insect repellent body cream (P = 0.0009), mosquito spray (P = 0.0001) and not draining stagnant water (P = 0.0004) predisposed to higher risk of malaria. But in Bamendjou, nonuse of insect repellent spray (P = 0.0012), long lasting insecticidal bed nets (P = 0.0001), window and door nets (P = 0.0286), predisposed to higher risk of malaria. Conclusions: Malaria prevalence was high among the study participants especially in Foumbot. Adequate follow-up to ensure effective execution of the recently launched third phase of LLINs distribution campaign in Cameroon is recommended. Additionally, Intergrated Vector Management is required to ensure effective control of malaria transmission in Foumbot and Bamendjou.
The Novel Fibrosis Index at Diagnosis May Predict All-cause Mortality in Patients With Antineutrophil Cytoplasmic Antibody-associated Vasculitis Without Substantial Liver Diseases.&nbsp;
Authors: Pyo Jung Yoon , Ahn Sung Soo , Lee Lucy Eunju , Choi Gwang-mu , Song Jason Jungsik , Park Yong-Beom , Lee Sang-Won 
Published: August 2020

Abstract
Objectives: Antineutrophil cytoplasmic antibody associated vasculitis (AAV) is a fatal disease. Currently, predictors of mortality of AAV are based on distribution of organ involvement. Novel fibrosis index (NFI) is an index, which is composed of laboratory results, that reflects the degree of liver fibrosis. The aim of this study is to evaluate whether NFI can predict poor outcomes among patients with AAV without substantial liver diseases. Methods: 210 immunosuppressive drug-naïve AAV patients were retrospectively reviewed. NFI was calculated as follows: NFI= [serum bilirubin x (alkaline phosphatase)2] / [platelet count x (serum albumin)2]. Cut-off of NFI was set at 1.24, and patients were divided into two groups. Poor outcomes were defined as all-cause mortality, relapse, and end-stage renal disease (ESRD). Results: During the median 34.5 months of follow up, twenty-one patients (10%) died, 72 patients (34.3%) relapsed, and 38 patients (18.1%) reached ESRD due to AAV progression. The median calculated NFI was 0.61, and it was higher in AAV patients with all-cause mortality than those without mortality, but it didn’t reach the statistical significance (1.26 vs. 0.59). AAV patients with NFI at diagnosis ≥ 1.24 exhibited a significantly lower cumulative patients’ survival rate than those with NFI at diagnosis < 1.24 (P = 0.002). Multivariate Cox hazard model analysis showed that NFI at diagnosis ≥ 1.24 was an independent predictor of all-cause mortality in AAV (HR 2.850, 95% CI 1.026, 7.910).Conclusions: NFI at diagnosis ≥1.24 may be an independent predictive marker for all-cause mortality in AAV patients without substantial liver diseases.
Exploring the Heterogeneity of Factors that may Influence Implementation of PrEP in Family Planning Clinics: A Latent Profile Analysis
Authors: Piper Kaitlin N , Haardörfer Regine , Escoffery Cam , Sheth Anandi N , Sales Jessica 
Published: August 2020

Abstract
Background: Title X-funded family planning clinics have been identified as optimal sites for delivery of pre-exposure prophylaxis (PrEP) for HIV prevention. However, PrEP has not been widely integrated into family planning services, especially in the Southern U.S., and data suggest there may be significant implementation challenges in this setting. Because Title X clinics vary greatly in provider-, organizational-, and systems-level characteristics, there is likely variation in capacity to implement PrEP across clinics. Methods: We conducted a survey from February-June 2018 among providers and administrators of non-PrEP providing Title X-funded clinics across 18 southern states. Survey items were designed using the Consolidated Framework for Implementation Research (CFIR) to assess constructs relevant to PrEP implementation. To explore the heterogeneity of CFIR-related determinants and identify distinct sub-groups of Title X clinics, a latent profile analysis was conducted using nine CFIR constructs: complexity, relative advantage, cost, attitudes, implementation climate, compatibility, leadership engagement, available resources, and cosmopolitanism. We then conducted a multi-level analysis (accounting for nesting of participants within clinics) to test whether group membership was associated with readiness for implementation of PrEP, controlling for key sociodemographic characteristics. Results: 414 healthcare providers/administrators from 227 non-PrEP providing Title X clinics participated in the study. We identified six sub-groups of clinics that each had distinct patterns of perceptions across the CFIR-related determinants. Clinic sub-groups included: “High Capacity”, “Optimistic”, “Advantageous”, “Moderate”, “Incompatible”, and “Resource Constrained”. Group membership was related to numerous provider-level (i.e., ability to prescribe medication), clinic-level (i.e., provision of primary care), and community-level characteristics (i.e., county-level HIV prevalence). In comparison to the “Moderate” group (which held neutral perceptions across the CFIR constructs), the “High Capacity” and “Optimistic” groups had significantly higher levels of implementation readiness; and the “Resource Constrained group had a significantly lower level of implementation readiness.Conclusions: Latent profile analyses can help researchers understand how context-specific implementation determinants vary across individuals and settings (such as clinics), allowing implementation planning to be tailored to the specific needs of each segment of the population.
Landslide Susceptibility Assessment Based on Geological Data and Remote Sensing Processed Data Using Bi-Variate Statistical Model and GIS: A Case Study on Rangamati District, Bangladesh
Authors: Hafsa Bibi , Chowdhury Md. Sharafat , Rahman Md. Naimur 
Published: August 2020

Abstract
Landslide is a major hazard all over the world and a very frequent phenomenon in Southeast Asian mountainous terrain. It has become a frequent phenomenon in the hilly regions of Bangladesh and the Rangamati district is the worst victims. This study aims to identify the landslide susceptible area of Rangamati district according to geological and satellite image processed data of the previously occurred landslide. Geological map of Rangamati District, Landsat 8 OLI images of October-2019 and SRTM images were used for landslide factor data mining. In present study Surface geology, Distance from fault line, Slope Angle, Slope Aspect, NDVI, BSI and NDCI are considered as the major factors related to landslide occurrence. Effects of the selected factors were calculated by using bivariate statistical approach (frequency ratio method) to examine the correlation between landslide occurrence and the influencing factors. Results of the landslide susceptibility show that surface geology and fault line has a strong correlation with landslide occurrence in Rangamati district. Analysis also shows that medium to high clay content availability with bare soil surface (no or low vegetation) that have a low slope angle (3 to 16 degree) are closely correlated to landslide occurrence. In the rainy season clay content saturated by heavy rainfall produce mud that flows according to very low slope cause landslide in this region. Due to geological characteristics this landslide can be defined as mud flow. Landslide susceptible map shows that the area near water bodies and lower part of hill slope are more susceptible to landslide occurrence.
Transcriptional Profiling of Leukocytes in Critically Ill COVID19 Patients: Implications for Interferon Response and Coagulation
Authors: Gill Sean , Santos Claudia C. dos , O’Gorman David B. , Carter David E. , Patterson Eric K. , Slessarev Marat , Martin Claudio , Daley Mark , Miller Michael R. , Cepinskas Gediminas , Fraser Douglas D. 
Published: August 2020

Abstract
Background: COVID19 is caused by the SARS-CoV-2 virus and has been associated with severe inflammation leading to organ dysfunction and mortality. Our aim was to profile the transcriptome in leukocytes from critically ill patients positive for COVID19 compared to those negative for COVID19 to better understand the COVID19 associated host response. For these studies, all patients admitted to our tertiary care intensive care unit (ICU) suspected of being infected with SARS-CoV-2, using standardized hospital screening methodologies, had blood samples collected at the time of admission to the ICU. Transcriptome profiling of leukocytes via ribonucleic acid sequencing (RNAseq) was then performed and differentially expressed genes as well as significantly enriched gene sets were identified.Results: We enrolled seven COVID19+ (PCR positive, 2 SARS-CoV-2 genes) and seven age- and sex-matched COVID19- (PCR negative) control ICU patients. Cohorts were well-balanced with the exception that COVID19- patients had significantly higher total white blood cell counts and circulating neutrophils and COVID19+ patients were more likely to suffer bilateral pneumonia. The mortality rate for this cohort of COVID19+ ICU patients was 29%. Transcriptional analysis revealed that when compared to COVID19- patients, the altered transcriptional responses of leukocytes in critically ill COVID19+ ICU patients appeared to be associated with multiple interrelated outcomes, including but not limited to robust interferon (IFN)-associated transcriptional responses, a marked decrease in the transcriptional activity of genes contributing to protein synthesis and the dysregulated expression of genes that contribute to coagulation, platelet activation, Toll-like receptor activation, neurotrophin signalling, and protein SUMOylation/ubiquitination. Conclusions: Our findings demonstrate that critically ill COVID19+ patients on day 1 of admission to the ICU display a unique leukocyte transcriptional profile that distinguishes them from COVID19- patients, providing guidance for future targeted studies exploring novel prognostic and therapeutic aspects of COVID19.
10 Years Follow up of Chondroblastoma Treated with Intralesional Curettage: A Retrospective Study
Authors: Yang Lei , Yang Panyi , Wang Daoxi , Yang Xiaodong , Li Lang , tang xueyang 
Published: August 2020

Abstract
Introduction: Chondroblastoma is a rare benign tumor mainly occurred in epiphyses and apophyses of long bones, and usually affects the young people. The primary treatment for chondroblastoma is intralesional curettage. The aim of this study was to evaluate the clinical and radiologic results of patients suffering chondroblastoma treated with intralesional curettage, electrocauterization of the cavity and bone grafting. Patients and Methods: From January 2000 to January 2010, 15 patients with chondroblastoma were treated with intralesional curettage and electrocauterization of the cavity, among which14 patients received bone grafting. After operation, patients were immobilized with splint for 4 weeks and followed up for at least 10 years. The recurrence was examined by clinical manifestation and X ray. The clinical outcome included complications and the Musculoskeletal Tumor Society Score (MSTS).Results: Totally, 15 patients with chondroblastoma were enrolled in our study, including 9 males and 6 females, with a mean age of 13 years old (range from 8 to 21 years). The most common chief compliant were pain and limited joint motion, others including local swelling and increased skin temperature. The mean duration of symptom was 5 months (range from 2-14 months). Tumors mostly affected the proximal humerus (7/15), distal femur (4/15), proximal femur (1/15), proximal tibia (2/15) and femoral head (1/15). Eight patients were undiagnosed or misdiagnosed before operation, only 7 patients with a consideration of chondroblastoma. With a mean follow up of 12years (range from 10-16 years) , two patients had complications of upper limb shortening and1 patient suffered re-operation due to tumor recurrence. The mean postoperative MSTS score was 28.1 (range, 24 to 30) points, which was significantly higher than the preoperative score of 17.6 (range, 12 to 21) points.Conclusion: Thorough curettage with electrocauterization and bone grafting has a good functional outcome in the treatment of chondroblastoma, but still has a low risk of recurrence and complications.Level of Evidence: Level IV, retrospective case series.
Sustained Acoustic Medicine as a Non-surgical and Non-opioid Knee Osteoarthritis Treatment Option: A Health Economic Cost-effectiveness Analysis for Symptom Management&nbsp;
Authors: Best Thomas M , Petterson Stephanie , Plancher Kevin 
Published: August 2020

Abstract
Background: Patients diagnosed with osteoarthritis (OA) and presenting with symptoms are seeking conservative treatment options to reduce pain, improve function, and avoid surgery. Sustained acoustic medicine (SAM), a multi-hour treatment has demonstrated improved clinical outcomes for patients with knee OA. The purpose of this analysis was to compare the costs and effectiveness of multi-hour SAM treatment versus the standard of care (SOC) over a 6-month timeframe for OA symptom management.Methods: A decision tree analysis was used to compare the costs and effectiveness of SAM treatment versus SOC in patients with OA. Probabilities of success for OA treatment and effectiveness were derived from the literature using systematic reviews and meta-analyses. Costs were derived from Medicare payment rates and manufacturer prices. Functional effectiveness was measured as the effect size of a therapy and treatment pathways compared to a SOC treatment pathway. A sensitivity analysis was performed to determine which cost variables had the greatest effect on deciding which option was the least costly. An incremental cost effectiveness plot comparing SAM treatment vs. SOC was also generated using 1,000 iterations of the model. Lastly, the incremental cost effectiveness ratio (ICER) was calculated as the (cost of SAM minus cost of SOC) divided by (functional effectiveness of SAM minus functional effectiveness of SOC). Results: Base case demonstrated that over 6 months, the cost and functional effectiveness of SAM was $8,641 and 0.52 versus SOC at: $6,281 and 0.39, respectively. Sensitivity analysis demonstrated that in order for SAM to be the less expensive option, the cost per 15-minute session of PT would need to be greater than $88, or SAM would need to be priced at less than or equal to $2,276. Incremental cost effectiveness demonstrated that most of the time (84%), SAM treatment resulted in improved functional effectiveness but at a higher cost than SOC.Conclusion: In patients with osteoarthritis, SAM treatment demonstrated improved pain and functional gains compared to SOC but at an increased cost. Based on the SAM treatment ICER score being ≤$50,000, it appears that SAM is a cost-effective treatment for knee OA.
Clinical Utility of Procalcitonin in Febrile Infants Younger Than 3 Months of Age Visiting a Pediatric Emergency Room: A Retrospective Single Center Study.
Authors: park Jun Sung , Byun Young-Hoon , Lee Jeong-Yong , Lee Jong Seung , Ryu Jeong-Min , Choi Seung Jun 
Published: August 2020

Abstract
BackgroundFever in infants under 90 days of age is highly likely to be caused by a severe bacterial infection (SBI) and it accounts for a large number of patients visiting the pediatric emergency room. In order to predict the presence of a bacterial infection and reduce unnecessary inpatient treatment, the classic classification system is based on crude white blood cell (WBC) count, urinalysis, and x-ray, and it is modified and applied at each center including recently appeared biomarkers such as c-reactive protein (CRP) or procalcitonin (PCT). This study analyzed the usefulness of PCT in predicting SBI when applied along with the existing classification system, including CRP, among infants less than 90 days old who visited the hospital with a fever in a single institution pediatric emergency center.MethodsWe retrospectively reviewed the medical records of patients younger than 3 months of age who presented with fever at the Seoul Asan Medical Center pediatric emergency room between July 2017 and October 2018. ResultsA total of 317 patients were analyzed, and 61 were diagnosed with SBI, of which urinary tract infection (UTI) accounted for the largest proportion (55/61, 90.2%). There were differences in WBC, neutrophil proportion, CRP, and PCT between the SBI group and the non-SBI group, and the AUC values of WBC, CRP, and PCT were 0.651, 0.804, and 0.746, respectively. When using cutoff values of CRP and PCTs as 2.0 mg/dL and 0.3 ng/mL, respectively, sensitivity and specificity for SBI were 49.2/89.5, and 54.1/87.5, respectively. WBC, CRP, and PCT were statistically significant for predicting SBI in multivariate analysis (odds ratios 1.066, 1.377, 1.291 respectively). When the subjects were classified using the existing classification criteria, WBC and CRP, the positive predictive value (PPV) and negative predictive value (NPV) were 29.3% and 88.7%, respectively, and when PCT was added, PPV and NPV were 30.7% and 92%, respectively, both increased.ConclusionPCT is useful for predicting SBI in children aged 3 months or less who visit the emergency room with a fever, and it is helpful for improving the diagnostic accuracy even when combined with WBC and CRP.
Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial
Authors: Delvaux Nicolas , Piessens Veerle , De Burghgraeve Tine , Mamouris Pavlos , Vaes Bert , Stichele Robert Vander , Cloetens Hanne , Thomas Josse , Ramaekers Dirk , De Sutter An , Aertgeerts Bert 
Published: August 2020

Abstract
BackgroundInappropriate laboratory test ordering poses an important burden for healthcare. Clinical decision support systems (CDSS) have been cited as promising tools to improve laboratory test ordering behavior. The objectives of this study were to evaluate the effects of an intervention that integrated a clinical decision support service into a computerized physician order entry (CPOE) on the appropriateness and volume of laboratory test ordering, and on diagnostic error in primary care.MethodsThis study was a pragmatic, cluster randomized, open label, controlled clinical trial.Setting280 general practitioners (GPs) from 72 primary care practices in Belgium.PatientsPatients aged 18 years with a laboratory test order for at least one of 17 indications; cardiovascular disease management, hypertension, check-up, chronic kidney disease (CKD), thyroid disease, type 2 diabetes mellitus, fatigue, anemia, liver disease, gout, suspicion of acute coronary syndrome (ACS), suspicion of lung embolism, rheumatoid arthritis, sexually transmitted infections (STI), acute diarrhea, chronic diarrhea, and follow-up of medication.InterventionsThe CDSS was integrated into a computerized physician order entry (CPOE) in the form of evidence-based order sets that suggested appropriate tests based on the indication provided by the general physician.MeasurementsThe primary outcome of the ELMO study was the proportion of appropriate tests over the total number of ordered tests and inappropriately not-requested tests. Secondary outcomes of the ELMO study included diagnostic error, test volume and cascade activities.ResultsCDSS increased the proportion of appropriate tests by 0.21 (95% CI 0.16 - 0.26, p<.0001) for all tests included in the study. GPs in the CDSS arm ordered 7 (7.15 (95% CI 3.37 - 10.93, p=.0002)) tests fewer per panel. CDSS did not increase diagnostic error. The absolute difference in proportions was a decrease of 0.66% (95% CI 1.4% decrease - 0.05% increase) in possible diagnostic error.ConclusionsA CDSS in the form of order sets, integrated within the CPOE improved appropriateness and decreased volume of laboratory test ordering without increasing diagnostic error. Trial RegistrationClinicaltrials.gov Identifier: NCT02950142