bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multicenter evaluation of EIAs and CLIAs in the detection of hepatitis C virus antibody among blood donors in China
Authors: Chang Le , Ji Huimin , Guo Fei , Jiang Xinyi , Wang Lunan 
Published: September 2020

Abstract
Background: Recent data on the evaluation of screening serological assays on anti-HCV among a large sample of blood donors is lacking. The present study aimed to perform a multicenter evaluation of EIAs and CLIAs for detection of anti-HCV among blood donors in 16 different Chinese blood establishments.Methods: A total of 1,309 samples containing 582 anti-HCV screening negatives and 727 positives collected from 15 blood establishments all over China. A total of 10 different anti-HCV assays (8 EIAs and 2 CLIAs) were evaluated in 16 different blood centers/banks. Confirmatory testing was performed using recombinant immunoblot assay and HCV RNA tests.Results: There were 963 true negatives, 261 positives, and 85 indeterminate samples. False positive rate of screening testing was 39.67% (382/963) and the positive prediction value was only 35.76% (260/727). Roche and InTec had the highest sensitivity (98.47%) and KHB and Wantai (indirect EIA) had the highest specificity (99.23%). Ortho/Abbott together with InTec could detect all the true positives. Among samples with discrepant results by different assays, indeterminate samples showed quite different S/CO ratios detected by Roche compared with confirmed positives (4.84 vs 19.36, P<0.0001), and higher signal to cutoff (S/CO) ratios than confirmed negatives (4.84 vs 2.94, P=0.020). However, there was no difference among the three groups when detected by Abbott. When S/CO ratio went to 8.2 on Roche and 4.2 on Abbott, the PPV could achieve more than 95%.Conclusion: False reactive problem of anti-HCV screening should be solved urgently. RIBA indeterminate donations may be a special group, should be further studied.
Development of Fe3O4 core-TiO2 shell nanocomposites and nanoconjugates as a foundation for neuroblastoma radiosensitization
Authors: Liu William , Mirzoeva Salida , Yuan Ye , Deng Junjing , Chen Si , Lai Barry , Vogt Stefan , Shah Karna , Shroff Rahul , Bleher Reiner , Jin Qiaoling , Vo Nghia , Bazak Remon , Ritner Carissa , Gutionov Stanley , Raha Sumita , Sedlmair Julia , Hirschmugl Carol , Jacobsen Chris , Paunesku Tatjana , Kalapurkal John , Woloschak Gayle 
Published: September 2020

Abstract
BackgroundNeuroblastoma is the most common extracranial solid malignancy in childhood which, despite the current progress in radiotherapy and chemotherapy protocols, still has a high mortality rate in high risk tumors. Nanomedicine offers exciting and unexploited opportunities to overcome the shortcomings of conventional medicine. The photocatalytic properties of Fe3O4 core-TiO2 shell nanocomposites and their potential for cell specific targeting suggest that nanoconstructs produced using Fe3O4 core-TiO2 shell nanocomposites could be used to enhance radiation effects in neuroblastoma. In this study, we evaluated bare, metaiodobenzylguanidine (MIBG) and 3,4-Dihydroxyphenylacetic acid (DOPAC) coated Fe3O4@TiO2 as potential radiosensitizers for neuroblastoma in vitro.ResultsThe uptake of bare and MIBG coated nanocomposites modestly sensitized neuroblastoma cells to ionizing radiation. Conversely, cells exposed to DOPAC coated nanocomposites exhibited a five-fold enhanced sensitivity to radiation, increased numbers of radiation induced DNA double-strand breaks, and apoptotic cell death. The addition of a peptide mimic of the epidermal growth factor (EGF) to nanoconjugates coated with MIBG altered their intracellular distribution. Cryo X-ray fluorescence microscopy tomography of frozen hydrated cells treated with these nanoconjugates revealed cytoplasmic as well as nuclear distribution of the nanoconstructs.ConclusionsThe intracellular distribution pattern of different nanoconjugates used in this study was different for different nanoconjugate surface molecules. Cells exposed to DOPAC covered nanoconjugates showed the smallest nanoconjugate uptake, with the most prominent pattern of large intracellular aggregates. Interestingly, cells treated with this nanoconjugate also showed the most pronounced radiosensitization effect in combination with the external beam x-ray irradiation. Further studies are necessary to evaluate mechanistic basis for this increased radiosensitization effect. Preliminary studies with the nanoparticles carrying an EGF mimicking peptide showed that this approach to targeting could perhaps be combined with a different approach to radiosensitization – use of nanoconjugates in combination with the radioactive iodine. Much additional work will be necessary in order to evaluate possible benefits of targeted nanoconjugates carrying radionuclides.
Modelling Cost-Effectiveness Of Syphilis Detection Strategies In Prisoners: Exploratory Exercise In A Chilean Male Prison
Authors: Castillo-Laborde Carla , Gajardo Pedro , Ferrari Manuel Nájera-De , Matute Isabel , Hirmas-Adauy Macarena , Aguirre Pablo , Ramírez Héctor , Rámirez Daniel , Aguilera Ximena 
Published: September 2020

Abstract
BACKGROUND: Syphilis, together with other sexually transmitted infections, remains a global public health problem that is far from being controlled. People deprived of liberty are one of the vulnerable population. Control activities in prisons rely mostly on passive case detection, despite the existence of affordable alternatives that would allow switching to active case-finding strategies. Our objective was to develop a mathematical modelling framework for cost-effectiveness evaluation, from a health system perspective, of different approaches using rapid tests for the detection of syphilis in inmates' populations and to explore the results based on a Chilean male prison population. Methods: A compartmental model was developed to characterize the transmission dynamics of syphilis inside a prison with the ongoing strategy (passive case detection, with VRDL + FTA-ABS), considering the entrance and exit of inmates over a 40 year period. The model allows simulation of the implementation of a reverse algorithm for the current situation (rapid test + VDRL), different screening strategies (entry point, massive periodically; both with rapid test + VDRL) and treatment of detected cases. The parameters for the exploratory exercise were obtained from systematic searches of indexed and grey literature and field work (EQ-5D questionnaire application and key actors interviews). Probabilistic sensitivity analysis was conducted to account for uncertainty in relevant parameters. RESULTS: The proposed framework allows the evaluation of different detection strategies. In this study, all the strategies were cost-effective in the baseline scenario when considering an ICER threshold of 1 Chilean GDP per capita (US$15,000). The strategies most likely to be cost-effective (over 80% probability) were: current situation with reverse algorithm, entry point screening and mass screening every two years; the latter was the most effective, achieving the lowest prevalence (0.7% and 1.7% over the period versus the 3% prevalence in the current situation).CONCLUSIONS: Mathematical modelling that considers the performance of different test and detection strategies could be a useful tool for decision making. The exploratory results show the efficiency of adopting both the use of the rapid tests and performing active case detection to significantly reduce the burden of syphilis in Chilean prisons in the near future.
Progressive Tricuspid Regurgitation and Elevated Tricuspid Regurgitation Pressure Gradient After Transvenous Permanent Pacemaker Implantation
Authors: Lee Weichieh , Fang Hsiu-Yu , Chen Huang-Chung , Chen Yung-Lung , Tsai Tzu-Hsien , Pan Kuo-Li , Lin Yu-Sheng , Liu Wen-Hao , Chen Mien-Cheng 
Published: September 2020

Abstract
BackgroundThe association of post-implant tricuspid regurgitation (TR) and heart failure (HF) hospitalization in patients without HF and preexisting abnormal TR and TR pressure gradient (PG) remain unclear. This study aimed to explore the clinical outcomes about progressive post-implant TR after permanent pacemaker (PPM) implantation.Methods A total of 1,670 patients who underwent a single ventricular or dual-chamber transvenous PPM implantation at our hospital between January 2003 and December 2017 were included in the study. Patients with prior valvular surgery, heart failure (HF), and baseline abnormal TR and TRPG were excluded. Finally, a total of 1,075 patients were enrolled in this study. Progressive TR was defined as increased TR grade of ≥2 degrees and/or TRPG of >30 mmHg after implant.Results198 (18.4%) patients (group 1) experienced progressive post-implant TR and/or elevated TRPG. Group 1 had l larger changes in post-implant TRPG (group 1 vs. group 2; 12.8 ± 9.6 mmHg vs. 1.1 ± 7.6 mmHg; p < 0.001) than group 2 without progressive post-implant TR. Group 1 had a higher incidence of HF hospitalization compared to group 2 (13.6% vs. 4.7%; p < 0.001). Pre-implant TRPG (HR: 1.075; 95% confidence interval (CI): 1.032-1.121; p = 0.001) and post-implant left atrial dimension (HR: 1.076; 95% CI: 1.038-1.114; p < 0.001) were independent predictors of progressive post-implant TR. ConclusionsAfter a transvenous ventricular-based PPM implantation, 18.4% of patients experienced progressive post-implant TR and/or elevated TRPG. Higher pre-implant TRPG and larger post-implant LA dimension were independent predictors of progressive post-implant TR.
Impact of peer-delivered tuition/feedback on appointment to United Kingdom Higher Surgical Training
Authors: Choong Wen Ling , Joy Melvin , Madurska Marta , Tang Benjie , Ip Brian 
Published: September 2020

Abstract
Background

In the United Kingdom, Core Surgical Trainees (or equivalent) undergo a rigorous National Selection (NS) process to secure a ST3 Training Post in General or Vascular Surgery. Despite a decrease in competition ratio from 3:1 in 2012 to 1.48:1 in 2017, many applicants were unable to secure ST3 Training Posts. We hypothesise that this is due to applicant performance anxiety rather than lack of clinical experience.
Methods

This is a prospective observational study following 27 delegates who have completed a 2-day course consisting of didactic lecture and interactive practice with a 1:1 faculty:delegate ratio. The course was delivered by surgical consultants and trainees. A specific mentor was nominated to oversee the delegate’s progress throughout and post course. Personalised feedback was given by the entire faculty throughout the course. Delegates were asked to complete evaluation forms to track their perceived confidence levels of success at NS at different timeframes, measured by a visual analogue scale. Paired t -test was performed to compare the mean confidence level pre- and post- course.
Results

Evaluation forms were received from all (n = 27) delegates. Delegate self-reported confidence increased significantly for all domains except Professional Communication. 23 (85%) of the participants were successful in the NS post course. There was no statistically significant difference between UK and non-UK graduates; and first time and not-first-time applicants.
Conclusions

Peer-delivered teaching, practice and feedback as a structured interview practice course can significantly improve applicants’ overall confidence levels in preparing for the UK ST3 General and Vascular Surgery NS. Improvement in confidence levels translates to high attrition rate of ST3 Training Posts. Communication skills require longer practice time extending beyond the duration of the 2-day course.
Placing the Patient at the Centre of the Learning Environment: Effect on Agency for the Learner, the Attending Physician and the Patient
Authors: Cheema Bavenjit , Li Meredith , Ho Daniel , Amari Erica , Buckley Heather , Canfield Carolyn , Cuncic Cary , Fritz Daniel , Nimmon Laura , Enk Anneke van , Veerapen Kiran , Wisener Katherine , Holmes Cheryl Lynn 
Published: September 2020

Abstract
The authors have requested that this preprint be removed from Research Square.
Comparison of qSOFA Score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients
Authors: Koch Christian , Edinger Fabian , Fischer Tobias , Brenck Florian , Hecker Andreas , Katzer Christian , Markmann Melanie , Sander Michael , Schneck Emmanuel 
Published: September 2020

Abstract
Background It is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) score are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict sepsis and mortality in IMCU patients. Methods Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between 01/01/2012 and 09/30/2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria. Results Suspected infection was detected in 1,306 (18.3%) of IMCU, 1,365 (35.5%) of ICU, and 1,734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU: 45 [0.6%]; ICU: 250 [6.5%]; IMCU/ICU: 163 [5.8%]). All investigated scores failed to predict sepsis independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS: 0.72 [0.71-0.72]; SOFA: 0.52 [0.51-0.53]; qSOFA: 0.82 [0.79-0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53-0.54]; SOFA 0.73 [0.70-0.77]; qSOFA 0.59 [0.58-0.59]). Conclusions None of the assessed scores was sufficiently able to predict sepsis in surgical ICU or IMCU patients with suspected infection. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.
The Continuing Evolution of Community-Associated MRSA ST93-IV in Australia
Authors: Pang Stanley , Daley Denise A , Sahibzada Shafi , Mowlaboccus Shakeel , Stegger Marc , Coombs Geoffrey W 
Published: September 2020

Abstract
BackgroundThe global emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has seen the dominance of specific clones in different regions around the world with the PVL-positive ST93-IV as the predominant CA-MRSA clone in Australia. In this study we applied a genome-wide association study (GWAS) approach on a collection of Australian ST93-IV MRSA genomes to identify genetic traits that may have assisted the ongoing transmission of ST93-IV in Australia. We also compared the genomes of ST93-IV bacteraemia and non-bacteraemia isolates to identify potential virulence factors associated with bacteraemia.ResultsBased on single nucleotide polymorphism phylogenetics we identified two distinct ST93-IV clades circulating concurrently in Australia. One of the clades contained isolates primarily isolated in the northern regions of Australia whilst isolates in the second clade were distributed across the country. Analyses of the ST93-IV genome plasticity over a 15-year period (2002-2017) revealed an observed gain in accessory genes amongst the clone’s population. The GWAS analysis on the bacteraemia identified two genes that have also previously been associated to this kind of infection. ConclusionsThe emergence of a ST93-IV clade containing additional virulence genes may explain the high prevalence of ST93-IV infections amongst the indigenous population living in the northern regions of Australia. In summary, this study has shown ST93-IV is evolving with multiple additional genes possibly contributing to its dominance in the Australian community.
Evaluation of Lymphocytic Infiltration in the Bronchial Glands of Sjögren's Syndrome in Transbronchial Lung Cryobiopsy
Authors: Okabayashi Hiroko , Baba Tomohisa , Ootoshi Ryota , Shintani Ryota , Tabata Erina , Ikeda Satoshi , Niwa Takashi , Oda Tsuneyuki , Okuda Ryo , Sekine Akimasa , Kitamura Hideya , Komatsu Shigeru , Hagiwara Eri , Takemura Tamiko , Sakagami Takuro , Ogura Takashi 
Published: September 2020

Abstract
Background: Sjögren's syndrome (SS) is a systemic autoimmune disease characterized by deteriorated exocrine gland function with associated lymphocytic infiltration. However, there are few pathological studies on bronchial glands in SS. In this study, we aimed to clarify pathological features of bronchial glands in SS. Methods: We retrospectively evaluated infiltration of lymphocytes in the bronchial glands incidentally collected by transbronchial lung cryobiopsy (TBLC), which were performed for the diagnosis of diffuse lung diseases. The degrees of lymphocyte infiltration in the bronchial glands were classified into four grades (grade 0-3). We compared the degrees of infiltration of SS with those of other diffuse lung diseases. Results: TBLC for diagnosis of diffuse lung diseases were performed on 432 cases during the study period. The samples of 50 cases included bronchial glands. Of those, 20 cases were excluded due to insufficient size or influence of therapy. The remaining 30 cases included 17 of idiopathic interstitial pneumonias, 5 of chronic hypersensitivity pneumonia, 6 of connective tissue disease (SS; n=4, systemic sclerosis; n=1, dermatomyositis; n=1) and 2 of other diseases. In SS, infiltration of lymphocytes was observed in all cases; grade 1 in one, grade 2 in one, and grade 3 in two cases. In contrast, 11 of 26 in other diseases showed no lymphocytes infiltration, with the remaining 15 of grade 1 infiltration. Grade 2 or more infiltration were found only in SS but not in other diseases. Conclusion: Our results suggested that high-grade lymphocytic infiltration of bronchial glands is a distinct characteristics in SS.
Effect of Daily Chlorhexidine Bathing on Reducing Infections Caused by Multidrug-Resistant Organisms in Intensive Care Unit Patients: A Semi-Experimental Study with Parallel Controls
Authors: Huang Wenzhi , Qiao Fu , Cai Lin , Zong Zhiyong , Zhang Wei 
Published: September 2020

Abstract
Background: A number of studies have shown that daily bathing by chlorhexidine (CHG) wipes in ICU can reduce healthcare-associated infections (HAIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE). However, the impact of CHG bathing on carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Enterobacteriaceae (CRE) is not clear and remains controversial. Methods: A semi-experimental study which employs both pre-controls and a parallel control was conducted. In the intervention period (from July 1 to December 31, 2016), strengthened infection control measures and daily bathing with 2% CHG-impregnated wipes once daily was performed in the ICU. Fifty-seven non-ICU wards with the occurrence of multidrug-resistant organisms (MDRO) infections during the same time period were selected as parallel control group (only CHG bathing was not performed). The net effect of the 2% CHG daily bathing was evaluated by the difference in difference (DID) model.Results: The incidence of HAIs caused by CRPA in ICU was significantly decreased between the intervention and pre-intervention period (2.5, 95% confidence interval (CI) 1.6–3.8 vs. 4.6, 95% CI 3.3–6.3 cases /1,000 patient days, P = 0.02). Similarly, the incidence of HAIs caused by CRAB in intervention group was 19.75% lower than that in pre-intervention group (6.0, 95% CI 4.4–7.6 vs. 7.5, 95% CI 5.7–9.3 cases / 1,000 patient days, P = 0.24). The DID model analysis showed that CHG bathing reduced the incidence of CRAB- and CRPA-caused infections in ICU by 1.56 and 2.15 cases/1,000 patient days, respectively, P <0.01, and bathing of every 38 patients (95% CI, 21–268) and 39 patients (95% CI, 24–110) were able to prevent one case of HAIs of CRAB and CRPA, respectively. However, CHG bathing showed no effect on MRSA, VRE and CRE (P>0.05).Conclusion: Daily bathing with 2% CHG-impregnated wipes can reduce HAIs caused by CRAB and CRPA, while it is not effective for the prevalence of infections caused by MRSA, VRE, and CRE.
An Innovative Pharmacology Curriculum for Medical Students: Promoting Higher Order Cognition, Learner-Centered Coaching, and Constructive Feedback Through A Social Pedagogy Framework
Authors: McHugh Douglas , Yanik Andrew J , Mancini Michael R 
Published: September 2020

Abstract
BackgroundOngoing developments in medical education recognize the move to curricula that support self-regulated learning processes, skills of thinking, and the ability to adapt and navigate uncertain situations as much as the knowledge base of learners. Difficulties encountered in pursuing this reform, especially for pharmacology, include the tendency of beginner learners not to ask higher-order questions and the potential incongruency between creating authentic spaces for self-directed learning and providing external expert guidance. We tested the feasibility of developing, implementing, and sustaining an innovative model of social pedagogy as a strategy to address these challenges.MethodsConstructivism, communities of practice, and networked learning theory were selected as lenses for development of the model. 365 first-year medical students participated between 2014-2018; they were introduced to pharmacodynamics and pharmacokinetics via 15 online modules that each included: learning objectives, a clinical vignette, teaching video, cumulative concept map, and small group wiki assignment. Five-person communities organized around the 15 wiki assignments were a key component where learners answered asynchronous, case-based questions that touched iteratively on Bloom’s cognitive taxonomy levels. The social pedagogy model’s wiki assignments were explored using abductive qualitative data analysis.ResultsQualitative analysis revealed that learners acquired and applied a conceptual framework for approaching pharmacology as a discipline, and demonstrated adaptive mastery by evaluating and interacting competently with unfamiliar drug information. Learners and faculty acquired habits of self-directed assessment seeking and learner-centered coaching, respectively; specifically, the model taught learners to look outward to peers, faculty, and external sources of information for credible and constructive feedback, and that this feedback could be trusted as a basis to direct performance improvement. ConclusionsThis social pedagogy model is agnostic with regard to pharmacology and type of health professional learner; therefore, we anticipate its benefits to be transferable to other disciplines.