bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk assessment and antibiotic prescribing decisions in children presenting to UK primary care with cough: a vignette study
Authors: Nurek Martine , Delaney Brendan C , Kostopoulou Olga 
Published: July 2020

ObjectivesThe validated ‘STARWAVe’ (Short illness duration, Temperature, Age, Recession, Wheeze, Asthma, Vomiting) clinical prediction rule (CPR) uses seven variables to guide risk assessment and antimicrobial stewardship in children presenting with cough. We aimed to compare general practitioners’ (GPs) risk assessments and prescribing decisions to those of STARWAVe and assess the influence of the CPR’s clinical variables.SettingPrimary care.Participants252 GPs, currently practising in the UK.DesignGPs were randomly assigned to view four (of a possible eight) clinical vignettes online. Each vignette depicted a child presenting with cough, who was described in terms of the seven STARWAVe variables. Systematically, we manipulated patient age (20 months vs 5 years), illness duration (3 vs 6 days), vomiting (present vs absent) and wheeze (present vs absent), holding the remaining STARWAVe variables constant.Outcome measuresPer vignette, GPs assessed risk of hospitalisation and indicated whether they would prescribe antibiotics or not.ResultsGPs overestimated risk of hospitalisation in 9% of vignette presentations (88/1008) and underestimated it in 46% (459/1008). Despite underestimating risk, they overprescribed: 78% of prescriptions were unnecessary relative to GPs’ own risk assessments (121/156), while 83% were unnecessary relative to STARWAVe risk assessments (130/156). All four of the manipulated variables influenced risk assessments, but only three influenced prescribing decisions: a shorter illness duration reduced prescribing odds (OR 0.14, 95% CI 0.08 to 0.27, p<0.001), while vomiting and wheeze increased them (ORvomit 2.17, 95% CI 1.32 to 3.57, p=0.002; ORwheeze 8.98, 95% CI 4.99 to 16.15, p<0.001).ConclusionsRelative to STARWAVe, GPs underestimated risk of hospitalisation, overprescribed and appeared to misinterpret illness duration (prescribing for longer rather than shorter illnesses). It is important to ascertain discrepancies between CPRs and current clinical practice. This has implications for the integration of CPRs into the electronic health record and the provision of intelligible explanations to decision-makers.
Mapping of modifiable barriers and facilitators with interdisciplinary chronic obstructive pulmonary disease (COPD) guidelines concordance within hospitals to the Theoretical Domains Framework: a mixed methods systematic review protocol
Authors: Issac Hancy , Moloney Clint , Taylor Melissa , Lea Jackie 
Published: July 2020

IntroductionMultifarious chronic obstructive pulmonary disease (COPD) guidelines have been published by local, national and global respiratory societies. These guidelines subsume holistic evidence based on recommendations to diagnose, treat, prevent and manage acute exacerbation with COPD. Despite the existing comprehensive recommendations, readmission rates and hospitalisations have increased in the last decade. Evidence to date has reported suboptimal clinical guidelines concordance. Acute exacerbations of COPD (AECOPD) is a common hospital presentation due to varied causes such as infective exacerbations, worsening disease condition, medication non-adherence, lack of education and incomprehensive discharge planning. AECOPD directly and indirectly causes economic burden, disrupts health-related quality of life (HRQol), hasten lung function decline and increases overall morbidity and mortality. COPD being a multimodal chronic disease, consistent interdisciplinary interventions from the time of admission to discharge may reduce readmissions and enhance HRQol among these patients and their families.Methods and analysisThis protocol adheres to the Joanna Briggs Institute methodology for mixed methods systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. Qualitative, quantitative and mixed methods studies will append this study to explore determinants of COPD guidelines concordance. Comprehensive three-tier search strategies will be used to search nine databases (COCHRANE, EBSCO HOST, MEDLINE, SCIENCE DIRECT, JBI, SCOPUS, WEB OF SCIENCE, WILEY and DARE) in May 2020. Two independent reviewers will screen abstracts and full-text articles in consonance with inclusion criteria. The convergent integrative method narrative review will contribute a deeper understanding of any discrepancies found in the existing evidence. Quality of the studies will be reported and Theoretical Domains Framework (TDF) will be used as a priori to synthesis data. Identified barriers, facilitators and corresponding clinical behavioural change solutions will be categorised using TDF indicators to provide future research and implementation recommendations.Ethics and disseminationEthical approval is not required and results dissemination will occur through peer-reviewed publication.
Wool-derived keratin dressings versus usual care dressings for treatment of slow healing venous leg ulceration: a randomised controlled trial (Keratin4VLU)
Authors: Jull Andrew , Wadham Angela , Bullen Chris , Parag Varsha , Weller Carolina , Waters Jill 
Published: July 2020

ObjectiveTo determine the effect of a keratin dressing for treating slow-to-heal venous leg ulcers (VLU) on VLU healing.DesignPragmatic parallel group randomised controlled trial.SettingCommunity-dwelling participants.ParticipantsPeople aged 18 or more years with VLU (either present for more than 26 weeks or ulcer area larger than 5 cm2 or both).InterventionWool-derived keratin dressing or usual care formulary of non-medicated dressings, on a background treatment with compression.Primary and secondary outcome measuresHealing at 24 weeks based on blinded assessment of ulcer photographs. Other outcomes included time to complete healing, change in ulcer area to 24 weeks, change in health-related quality of life and incidence of adverse events.ResultsWe screened 1068 patients with VLU and randomised 143 participants (51.1% of target recruitment), 71 to the keratin dressing group and 72 to the usual care group.The mean age was 66.1 years (SD 15.9) and 53 participants (37.1%) were women. There were no significant differences between the groups on the primary outcome (risk difference −6.4%, 95% CI −22.5% to 9.7%), change in ulcer area (−1.9 cm2, 95% CI −16.5 to 12.8 cm2), time to complete healing (HR 0.80, 95% CI 0.52 to 1.23) or the incidence of adverse events (incidence rate ratio 1.19, 95% CI 0.89 to 1.59) in the intention-to-treat analyses. However, the direction of effect on the primary outcome was reversed in a per protocol analysis specified a priori (risk difference 6.2%, 95% CI −12.4% to 24.9%).ConclusionThe effect of adding a keratin dressing to the treatment regimen for prognostically slow-to-heal VLU remains unclear.Trial registration numberNCT02896725
Cost–benefit analysis of surveillance for surgical site infection following caesarean section
Authors: Wloch Catherine , Van Hoek Albert Jan , Green Nathan , Conneely Joanna , Harrington Pauline , Sheridan Elizabeth , Wilson Jennie , Lamagni Theresa 
Published: July 2020

ObjectiveTo estimate the economic burden to the health service of surgical site infection following caesarean section and to identify potential savings achievable through implementation of a surveillance programme.DesignEconomic model to evaluate the costs and benefits of surveillance from community and hospital healthcare providers’ perspective.SettingEngland.ParticipantsWomen undergoing caesarean section in National Health Service hospitals.Main outcome measureCosts attributable to treatment and management of surgical site infection following caesarean section.ResultsThe costs (2010) for a hospital carrying out 800 caesarean sections a year based on infection risk of 9.6% were estimated at £18 914 (95% CI 11 521 to 29 499) with 28% accounted for by community care (£5370). With inflation to 2019 prices, this equates to an estimated cost of £5.0 m for all caesarean sections performed annually in England 2018–2019, approximately £1866 and £93 per infection managed in hospital and community, respectively. The cost of surveillance for a hospital for one calendar quarter was estimated as £3747 (2010 costs). Modelling a decrease in risk of infection of 30%, 20% or 10% between successive surveillance periods indicated that a variable intermittent surveillance strategy achieved higher or similar net savings than continuous surveillance. Breakeven was reached sooner with the variable surveillance strategy than continuous surveillance when the baseline risk of infection was 10% or 15% and smaller loses with a baseline risk of 5%.ConclusionSurveillance of surgical site infections after caesarean section with feedback of data to surgical teams offers a potentially effective means to reduce infection risk, improve patient experience and save money for the health service.
Protocol for a nationwide prospective, observational cohort study of foreign-body airway obstruction in Japan: the MOCHI registry
Authors: Norii Tatsuya , Igarashi Yutaka , Sung-Ho Kim , Nagata Shimpei , Tagami Takashi , Yoshino Yudai , Hamaguchi Takuro , Maejima Riko , Nakao Shunichiro , Albright Danielle , Yokobori Shoji , Yokota Hiroyuki , Shimazu Takeshi , Crandall Cameron 
Published: July 2020

IntroductionForeign body airway obstruction (FBAO) is a major public health issue worldwide. In 2017, there were more than 5000 fatal choking cases in the USA alone, and it was the fourth leading cause of preventable injury-related death in the home and community. In Japan, FBAO is the leading cause of accidental death and with almost 9000 fatalities annually. However, research on FBAO is limited, particularly on the impact of a foreign body (FB) removal manoeuvres by bystanders. The primary objective of this study is to determine the impact of bystander FB removal manoeuvres on 1 month neurological outcome. Our secondary objectives include (1) evaluating the efficacy of a variety of FB removal manoeuvres; (2) identifying risk factors for unsuccessful removal and (3) evaluating the impact of time intervals from incidents of FBAO to FB removal on neurological outcome.Methods and analysisWe will conduct a nationwide multi-centre prospective cohort study of patients with FBAO who present to approximately 100 emergency departments in both urban and rural areas in Japan. Research personnel at each participating site will collect variables including patient demographics, type of FB and prehospital variables, such as bystander FB removal manoeuvres, medical interventions by prehospital personnel, advanced airway management and diagnostic findings. Our primary outcome is 1 month favourable neurological outcome defined as cerebral performance category 1 or 2. Our secondary outcomes include success of FB removal manoeuvres and complications from the manoeuvres. We hypothesise that bystander FB removal manoeuvres improve patient survival with a favourable neurological outcome.Ethics and disseminationThis study received research ethics approval from Nippon Medical School Hospital (B-2019-019). Research ethics approval will be obtained from all participating sites before entering patients into the registry. The study was registered at the University Hospital Medical Information Network (UMIN) Clinical Trials Registry.Trial registration numberUMIN 000039907.
Protocol of a retrospective, multicentre observational study on hyperthermic intrathoracic chemotherapy in Germany
Authors: Markowiak Till , Koller Michael , Zeman Florian , Huppertz Gunnar , Hofmann Hans-Stefan , Ried Michael 
Published: July 2020

IntroductionObjective of the ‘German hyperthermic intrathoracic chemotherapy (HITOC) study’ is to evaluate the HITOC as additional treatment after surgical cytoreduction for malignant pleural tumours. Even though HITOC is applied with increasing frequency, there is no standardised therapy protocol concerning the technique of HITOC, the selection as well as dosage of chemotherapeutic agents and perioperative management in order to provide a safe and comparable, standardised treatment regime.Methods and analysisThis trial is a retrospective, multicentre observational study, which is funded by the German Research Foundation. Approximately 300 patients will be included. Four departments of thoracic surgery, which are performing the most HITOC procedures in Germany, are contributing to this study: Center for Thoracic Surgery at the University Hospital Regensburg, Thoracic Clinic Heidelberg of the University of Heidelberg, Center for Thoracic Surgery of the Hospital University of Munich and the Department of Thoracic Surgery at the University Hospital Freiburg. All patients who underwent surgical cytoreduction and subsequent HITOC at one of the four centres between starting the HITOC programme in 2008 and December 2019 will be included. Information on the performed HITOC will be obtained, focusing on the technique as well as the applied perfusion solution including the chemotherapeutic agent. Furthermore, parameters of the patient’s postoperative recovery will be analysed to determine 30-day morbidity and mortality.Ethics and disseminationThe approvals by the local ethics committee of the respective clinic and the three participating clinics have been obtained. The results will be presented in conferences and published in a peer-reviewed journal.Trial registration numberGerman Clinical Trials Registry (DRKS00015012; Pre-results).
Mental health status of students’ parents during COVID-19 pandemic and its influence factors
Authors: Wu Mengting , Xu Wenyan , Yao Yuhong , Zhang Lei , Guo Lei , Fan Juan , Chen Jue 
Published: July 2020

BackgroundDuring the outbreak of COVID-19, the national policy of home quarantine may affect the mental health of parents. However, few studies have investigated the mental health of parents during the COVID-19 pandemic.AimsTo investigate the depression, anxiety and stress of the students’ parents during the COVID-19 pandemic, and to explore the influence factors, especially the influence of social support and family-related factors.MethodsThe Generalised Anxiety Disorder-7, Patient Health Questionnaire-9, Perceived Stress Scale-10 and Social Support Rating Scale were applied to 1163 parents to measure the parents’ depression, anxiety, stress and social support.Results(1) The detection rates of depression and anxiety in parents were 6.1% and 4.0%. The depression, anxiety and perceived stress of parents in central China were significantly higher than those in non-central China. The anxiety of college students’ parents was lower than that of parents of the primary, middle and high school students. The depression, anxiety and perceived stress of parents with conflicts in the family were significantly higher than those with a harmonious family. Other factors that influence parents’ depression, anxiety and perceived stress include marital satisfaction, social support, parents’ history of mental illness and parenting style, etc. (2) The regression analysis results showed that perceived stress, social support, marital satisfaction, family conflicts, child’s learning stage as well as parents’ history of mental illness had significant effects on parents’ anxiety and depression.ConclusionDuring the COVID-19 pandemic, the mental health of parents was affected by a variety of factors. Good marital relationships, good social support, family harmony and parents without a history of mental illness may be protective factors for parents’ mental health, while perceived stress and child in middle or high school are risk factors for parents’ mental health.
Impact of Local Alloimmunity and Recipient Cells in Transplant Arteriosclerosis
Authors: Cai Jingjing , Deng Jiacheng , Gu Wenduo , Ni Zhichao , Liu Yuanyuan , Kamra Yogesh , Saxena Alka , Hu Yanhua , Yuan Hong , Xiao Qingzhong , Lu Yao , Xu Qingbo 
Published: July 2020

Rationale:
Transplant arteriosclerosis is the major limitation to long-term survival of solid organ transplantation. Although both immune and nonimmune cells have been suggested to contribute to this process, the complex cellular heterogeneity within the grafts, and the underlying mechanisms regulating the disease progression remain largely uncharacterized.

Objective:
We aimed to delineate the cellular heterogeneity within the allografts, and to explore possible mechanisms underlying this process.

Methods and Results:

Here, we reported the transcriptional profiling of 11 868 cells in a mouse model of transplant arteriosclerosis by single-cell RNA sequencing. Unbiased clustering analyses identified 21 cell clusters at different stages of diseases, and focused analysis revealed several previously unknown subpopulations enriched in the allografts. Interestingly, we found evidence of the local formation of tertiary lymphoid tissues and suggested a possible local modulation of alloimmune responses within the grafts. Intercellular communication analyses uncovered a potential role of several ligands and receptors, including
Ccl21a
and
Cxcr3
, in regulating lymphatic endothelial cell-induced early chemotaxis and infiltration of immune cells. In vivo mouse experiments confirmed the therapeutic potential of CCL21 and CXCR3 neutralizing antibodies in transplant arteriosclerosis. Combinational use of genetic lineage tracing and single-cell techniques further indicate the infiltration of host-derived c-Kit
+
stem cells as heterogeneous populations in the allografts. Finally, we compared the immune response between mouse allograft and atherosclerosis models in single-cell RNA-seq analysis. By analyzing susceptibility genes of disease traits, we also identified several cell clusters expressing genes associated with disease risk.

Conclusions:
Our study provides a transcriptional and cellular landscape of transplant arteriosclerosis, which could be fundamental to understanding the initiation and progression of this disease. CCL21/CXCR3 was also identified as important regulators of immune response and may serve as potential therapeutic targets in disease treatment.
Association Between the Gut Microbiota and Blood Pressure in a Population Cohort of 6953 Individuals
Authors: Palmu Joonatan , Salosensaari Aaro , Havulinna Aki S. , Cheng Susan , Inouye Michael , Jain Mohit , Salido Rodolfo A. , Sanders Karenina , Brennan Caitriona , Humphrey Gregory C. , Sanders Jon G. , Vartiainen Erkki , Laatikainen Tiina , Jousilahti Pekka , Salomaa Veikko , Knight Rob , Lahti Leo , Niiranen Teemu J. 
Published: July 2020

Background

Several small‐scale animal studies have suggested that gut microbiota and blood pressure (BP) are linked. However, results from human studies remain scarce and conflicting. We wanted to elucidate the multivariable‐adjusted association between gut metagenome and BP in a large, representative, well‐phenotyped population sample. We performed a focused analysis to examine the previously reported inverse associations between sodium intake and
Lactobacillus
abundance and between
Lactobacillus
abundance and BP.

Methods and Results

We studied a population sample of 6953 Finns aged 25 to 74 years (mean age, 49.2±12.9 years; 54.9% women). The participants underwent a health examination, which included BP measurement, stool collection, and 24‐hour urine sampling (N=829). Gut microbiota was analyzed using shallow shotgun metagenome sequencing. In age‐ and sex‐adjusted models, the α (within‐sample) and β (between‐sample) diversities of taxonomic composition were strongly related to BP indexes (
P
<0.001 for most). In multivariable‐adjusted models, β diversity was only associated with diastolic BP (
P
=0.032). However, we observed significant, mainly positive, associations between BP indexes and 45 microbial genera (
P
<0.05), of which 27 belong to the phylum
Firmicutes
. Interestingly, we found mostly negative associations between 19 distinct
Lactobacillus
species and BP indexes (
P
<0.05). Of these, greater abundance of the known probiotic
Lactobacillus paracasei
was associated with lower mean arterial pressure and lower dietary sodium intake (
P
<0.001 for both).

Conclusions

Although the associations between overall gut taxonomic composition and BP are weak, individuals with hypertension demonstrate changes in several genera. We demonstrate strong negative associations of certain
Lactobacillus
species with sodium intake and BP, highlighting the need for experimental studies.
Rethinking Public Theology in Ethiopia: Politics, Religion, and Ethnicity in a Declining National Harmony
Authors: Sonessa Wondimu Legesse 
Published: July 2020

Abstract
Ethiopia is a country of multi-ethnic and multi-religious society. Almost all of its citizens claim affiliation with either Christianity, Islam, or African traditional religions. Adherents of these religions have been coexisting in respect and peace. However, there is a growing tension between the citizens since the downfall of the dictatorial military government of Ethiopia, which was displaced by the Ethiopian People’s Revolutionary Democratic Front (EPRDF), in 1991. Politics, religion, and ethnicity are the major causes of the declining national harmony under the current government. My claim is that addressing the declining national harmony caused by the religious, political, and ethnic tensions in Ethiopia requires of the EECMY to rethink its public theology in a way that promotes a national harmony that values peace, equality, justice, democracy, and human flourishing.
Wind Profile Satellite Observation Requirements and Capabilities
Authors: Stoffelen Ad , Benedetti Angela , Borde Régis , Dabas Alain , Flamant Pierre , Forsythe Mary , Hardesty Mike , Isaksen Lars , Källén Erland , Körnich Heiner , Lee Tsengdar , Reitebuch Oliver , Rennie Michael , Riishøjgaard Lars-Peter , Schyberg Harald , Straume Anne Grete , Vaughan Michael 
Published: July 2020

Abstract
The Aeolus mission objectives are to improve numerical weather prediction (NWP) and enhance the understanding and modeling of atmospheric dynamics on global and regional scale. Given the first successes of Aeolus in NWP, it is time to look forward to future vertical wind profiling capability to fulfill the rolling requirements in operational meteorology. Requirements for wind profiles and information on vertical wind shear are constantly evolving. The need for high-quality wind and profile information to capture and initialize small-amplitude, fast-evolving, and mesoscale dynamical structures increases, as the resolution of global NWP improved well into the 3D turbulence regime on horizontal scales smaller than 500 km. In addition, advanced requirements to describe the transport and dispersion of atmospheric constituents and better depict the circulation on climate scales are well recognized. Direct wind profile observations over the oceans, tropics, and Southern Hemisphere are not provided by the current global observing system. Looking to the future, most other wind observation techniques rely on cloud or regions of water vapor and are necessarily restricted in coverage. Therefore, after its full demonstration, an operational Aeolus-like follow-on mission obtaining globally distributed wind profiles in clear air by exploiting molecular scattering remains unique.