bluuebunny/crossref_metadata_2025_split huggingface dataset:
Uso de heurísticos en la evaluación de las fuentes históricas en el aula de clase
Authors: Castellanos Páez Virgelina , Navarro Roldán Claudia Patricia 
Published: November 2020

Objetivo. Describir cómo el uso de heurísticos en la evaluación de la evidencia histórica posibilita laconstrucción del conocimiento sobre la historia de los derechos humanos en una clase de Ciencias Sociales.Método. Estudio cualitativo, con método de análisis del discurso, para analizar cómo la maestra y sus estudiantes de 8º grado (n = 32) usan y evalúan la evidencia histórica. Cinco sesiones de clase fueron videograbadas (250 minutos), transcritas, segmentadas y codificadas con las categorías heurísticas de Sam Wineburg. Resultados. La categoría enunciación de fuentes históricas fue la más usada para ofrecer credibilidad al relato o incluir secuencialidad temporal a los eventos del relato. La formulación de preguntas orientó la interacción entre maestra y estudiantes, y las preguntas de tipo reflexivo posibilitaron la enunciación de fuentes históricas en los estudiantes. Conclusión. Se reconstruyó la historia haciendo uso de fuentes secundarias, particularmente los libros de texto, a los cuales la maestra y sus estudiantes otorgaron credibilidad, sin someterlos a evaluación ni contrastación. Ni la maestra ni los estudiantes relativizaron, analizaron o interpretaron el conocimiento histórico reproducido en ellas. Esto hizo evidente que desconocían la forma correcta de tratar la evidencia histórica. Se sugiere explicar en la instrucción escolar tanto el uso de la heurística, para evaluar las fuentes históricas, como el uso de preguntas reflexivas.
High hopes: lower risk of death due to mental disorders and self-harm in a century-long US Olympian cohort compared with the general population
Authors: Duncombe Stephanie L. , Tanaka Hirofumi , De Larochelambert Quentin , Schipman Julien , Toussaint Jean-François , Antero Juliana 
Published: November 2020

ObjectiveTo determine the risk of death due to prominent mental disorders, substance abuse, and self-harm among US Olympians compared with the general population.MethodsAll female (n=2301) and male (n=5823) US Olympians who participated in the summer or winter Games between 1912 and 2012 were followed until 2016. The National Death Index certified their vital statuses and causes of death. We performed a Standard Mortality Ratio (SMR) analysis for all causes studied and applied the years-saved (YS) method to quantify differences in the risk of death for (1) anxiety, depression and self-harm and (2) substance abuse and eating disorders. Additionally, we examined the YS across sports with greater than 100 total deaths and between medalists and non-medalists.ResultsUS Olympians had a 32% (SMR=0.68, 95% CI 0.49 to 0.91) lower risk of death compared with the general population, resulting in a longevity advantage of 0.21 YS (95% CI 0.14 to 0.29) for deaths by depression, anxiety and self-harm and 0.12 years (95% CI 0.08 to 0.15) for substance abuse and eating disorders. There were no significant differences between medalists and non-medalists, but findings varied by sports. Most sports (eg, athletics, swimming, rowing) had significantly lower risks of deaths than the general population with the exceptions of fencing and shooting. Shooting showed a trend towards a higher risk through suicide by firearm.ConclusionOlympians have a lower risk of death, favouring an increased longevity compared with the general population for mental disorders, substance abuse and suicides.
Injury incidence, severity and profile in Olympic combat sports: a comparative analysis of 7712 athlete exposures from three consecutive Olympic Games
Authors: Lystad Reidar P , Alevras Alexander , Rudy Iris , Soligard Torbjørn , Engebretsen Lars 
Published: November 2020

ObjectivesTo describe and compare the epidemiology of competition injuries in unarmed combat sports (ie, boxing, judo, taekwondo and wrestling) in three consecutive Olympic Games.MethodsProspective cohort study using injury data from the IOC injury surveillance system and exposure data from official tournament records at three consecutive Olympic Games (ie, Beijing 2008, London 2012 and Rio de Janeiro 2016). Competition injury incidence rates per 1000 min of exposure (IIRME) were calculated with 95% CIs using standard formulae for Poisson rates.ResultsThe overall IIRMEwas 7.8 (95% CI 7.0 to 8.7). The IIRMEin judo (9.6 (95% CI 7.8 to 11.7)), boxing (9.2 (95% CI 7.6 to 10.9)) and taekwondo (7.7 (95% CI 5.6 to 10.5)) were significantly higher than in wrestling (4.8 (95% CI 3.6 to 6.2)). The proportion of injuries resulting in >7 days absence from competition or training was higher in wrestling (39.6%), judo (35.9%) and taekwondo (32.5%) than in boxing (21.0%). There was no difference in injury risk by sex, weight category or tournament round, but athletes that lost had significantly higher IIRMEcompared with their winning opponents (rate ratio 3.59 (95% CI 2.68 to 4.79)).ConclusionOlympic combat sport athletes sustained, on average, one injury every 2.1 hours of competition. The risk of injury was significantly higher in boxing, judo and taekwondo than in wrestling. About 30% of injuries sustained during competition resulted in >7 days absence from competition or training. There is a need for identifying modifiable risk factors for injury in Olympic combat sports, which in turn can be targeted by injury prevention initiatives to reduce the burden of injury among combat sport athletes.
Caucasian and Asian difference in role of type 1 diabetes on large-for-gestational-age neonates
Authors: Guo Yanfang , Luo Rong , Corsi Daniel J , Retnakaran Ravi , Walker Mark C , Wen Shi Wu 
Published: November 2020

IntroductionRacial differences in the association between type 1 diabetes mellitus (T1DM) and large-for-gestational-age (LGA) neonates remain unclear. The objective of this study was to compare the effect of T1DM on LGA neonates between Caucasian and Asian women.Research design and methodsA population-based retrospective cohort study was conducted among Caucasian and Asian women who had prenatal screening and gave a singleton live birth in an Ontario hospital between April 2015 and March 2018. Multivariable log-binomial regression models were used to estimate the adjusted relative risks (aRRs) and 95% CIs of T1DM on LGA for Caucasian and Asian women. Relative contribution of T1DM to LGA was examined by multivariable logistic regression model, stratified by Caucasian and Asian women.ResultsA total of 232 503 women (69.4% Caucasians and 30.6% Asians) were included in the final analysis. The rate of T1DM was higher in Caucasians (0.5%) than in Asians (0.2%), and the rate of LGA neonates was also higher in Caucasians (11.0%) than in Asians (5.0%). The association between T1DM and LGA in Caucasians (aRR 4.18, 95% CI (3.84 to 4.55)) was more robust than that in Asians (aRR 2.11, 95% CI (1.24 to 3.59)). T1DM was the fourth strongest contributor to LGA in Caucasians, while T1DM was the seventh contributor to LGA in Asians.ConclusionsT1DM plays a more substantial role in LGA among Caucasians than Asians. Clinicians should be aware of the Caucasian–Asian differences of effects of T1DM on LGA when developing pregnancy management strategies.
Life in lockdown: experiences of patients with IBD during COVID-19
Authors: Harris Richard James , Downey Louise , Smith Trevor R , Cummings J R Fraser , Felwick Richard , Gwiggner Markus 
Published: November 2020

ObjectiveCOVID-19 has disrupted the normal way of life in the UK, but for some patients with inflammatory bowel disease (IBD), the impact of this unprecedented global emergency was far greater. We aimed to assess the experience of patients with IBD during the COVID-19 lockdown.DesignWe designed a survey focused on the impact of COVID-19 on IBD healthcare, social and psychological well-being and quality of life. To capture those most likely to be affected we targeted survey invitations at our British Society of Gastroenterology (BSG) defined high and moderate-risk IBD population. Access to the survey was also available via our trust’s social media pages.Results685 responses were received. 76% of respondents categorised themselves in BSG defined moderate or high-risk groups, requiring stringent social distancing or shielding. 87% did not change their IBD medication, with most reported changes initiated by the IBD team. 39% were worried about their IBD care, but most services were largely uninterrupted. 90% received ‘at-risk’ notification often from multiple sources, but 17% not until May. The majority reported a negative impact of COVID-19 on their quality of life and significantly increased perceived stress. Patients expressed a strong wish of having future care delivered remotely.ConclusionCOVID-19 has had a significant negative impact on psychological well-being of patients with IBD. Local IBD services must have a robust data set of vulnerable patients and be designated future responsibility for prompt communication of advice to avoid delayed and sometimes conflicting information. Remote patient management systems should be further developed and embedded in clinical practice.
Does a ketogenic diet lower a very high Lp(a)? A striking experiment in a male physician
Authors: Scholl Johannes Georg 
Published: November 2020

The level of lipoprotein(a) (Lp(a)), an important cardiovascular risk factor, is considered to be genetically determined. I am a 55-year-old male physician specialised in preventive medicine and a hobby triathlete with a body mass index of 24.9 kg/m2and a maximum oxygen consumption (VO2max) of ~50 mL/(kg×min), with an average of 7–10 hours of exercise per week.I discovered my own Lp(a) at 92–97 mg/dL in 2004 and measured a maximum Lp(a) of 108 mg/dL in 2013. Surprisingly, I observed a much lower Lp(a) of 65 mg/dL in 2018. This happened after I had adopted a very-low-carb ketogenic diet for long-term endurance exercise.My n=1 experiment in July 2020 demonstrated an increase in Lp(a) back to 101 mg/dL on a very high-carb diet within 2 weeks, and a drop back to 74 mg/dL after 3 weeks on the ketogenic diet afterwards. The observed large changes in my Lp(a) were thus reproducible by a change in carbohydrate consumption and might have clinical relevance for patients as well as researchers in the field of Lp(a).
Weaning strategies for the withdrawal of non-invasive respiratory support applying continuous positive airway pressure in preterm infants: a systematic review and meta-analysis
Authors: van Delft Brenda , Van Ginderdeuren Filip , Lefevere Julie , van Delft Christel , Cools Filip 
Published: November 2020

BackgroundThe optimal method to wean preterm infants from non-invasive respiratory support (NIVRS) with nasal continuous positive airway pressure (CPAP) or high-flow nasal cannula is still unclear, and methods used vary considerably between neonatal units.ObjectivePerform a systematic review and meta-analysis to determine the most effective strategy for weaning preterm infants born before 37 weeks’ gestation from NIVRS.MethodEMBASE, MEDLINE, CINAHL, Google and Cochrane Central Register of Controlled Trials were searched for randomised controlled trials comparing different weaning strategies of NIVRS in infants born before 37 weeks’ gestation.ResultsFifteen trials (1.547 infants) were included. With gradual pressure wean, the relative risk of successful weaning at the first attempt was 1.30 (95% CI 0.93 to 1.83), as compared with sudden discontinuation. Infants were weaned at a later postmenstrual age (PMA) (median difference (MD) 0.93 weeks (95% CI 0.19 to 1.67)). A stepdown strategy to nasal cannula resulted in an almost 3-week reduction in the PMA at successful weaning (MD −2.70 (95% CI −3.87 to −1.52)) but was associated with a significantly longer duration of oxygen supplementation (MD 7.80 days (95% CI 5.31 to 10.28)). A strategy using interval training had no clinical benefits. None of the strategies had any effect on the risk of chronic lung disease or the duration of hospital stay.ConclusionA strategy of gradual weaning of airway pressure might increase the chances of successful weaning. Stepdown strategy from CPAP to nasal cannula is a useful alternative resulting in an earlier weaning, but the focus should remain on continued weaning in order to avoid prolonged oxygen supplementation. Interval training should probably not be used.
Acceptability of remote prescribing and postal delivery services for contraceptive pills and treatment of uncomplicatedChlamydia trachomatis
Authors: Nadarzynski Tom , Symonds Ynez , Carroll Robert , Gibbs Jo , Kidsley Sally , Graham Cynthia Ann 
Published: November 2020

ObjectivesThe digitalisation of sexual and reproductive health (SRH) services offers valuable opportunities to deliver contraceptive pills and chlamydia treatment by post. We aimed to examine the acceptability of remote prescribing and ‘medication-by-post’ in SRH.Study designAn online survey assessing attitudes towards remote management was distributed in three UK SRH clinics and via an integrated sexually transmitted infection (STI) postal self-sampling service. Logistic regressions were performed to identify potential correlates.ResultsThere were 1281 participants (74% female and 49% <25 years old). Some 8% of participants reported having received medication via post and 83% were willing to receive chlamydia treatment and contraceptive pills by post. Lower acceptability was observed among participants who were: >45 years old (OR 0.43 (95% CI 0.23–0.81)), screened for STIs less than once annually (OR 0.63 (0.42–0.93)), concerned about confidentiality (OR 0.21 (0.90–0.50)), concerned about absence during delivery (OR 0.09 (0.02–0.32)) or unwilling to provide blood pressure readings (OR 0.22 (0.04–0.97)). Higher acceptability was observed among participants who reported: previously receiving medication by post (OR 4.63 (1.44–14.8)), preference for home delivery over clinic collection (OR 24.1 (11.1–51.9)), preference for home STI testing (OR 10.3 (6.16–17.4)), ability to communicate with health advisors (OR 4.01 (1.03–15.6)) and willingness to: register their real name (OR 3.09 (1.43–10.6)), complete online health questionnaires (OR 3.09 (1.43–10.6)) and use generic contraceptive pills (OR 2.88 (1.21–6.83)).ConclusionsPostal treatment and entering information online to allow remote prescribing were acceptable methods for SRH services and should be considered alongside medication collection in pharmacies. These methods could be particularly useful for patients facing barriers in accessing SRH. The cost-effectiveness and implementation of these novel methods of service delivery should be further investigated.
Provider perspectives in implementing the Postpartum Intrauterine Device Initiative in Sri Lanka: a qualitative study
Authors: de Silva Ranjith , Huber-Krum Sarah , Samarasekera Arnjali , Karra Mahesh , Pearson Erin , Senanayake Hemantha , Canning David , Shah Iqbal 
Published: November 2020

BackgroundIntegration of maternal care and family planning services has the potential to reduce unintended pregnancies and closely spaced births, leading to reductions in maternal mortality and morbidity. However, few models exist detailing how to implement/integrate such services. This study explored the implementation of the Postpartum Intrauterine Device (PPIUD) Initiative in Sri Lanka, which trained healthcare providers on how to counsel women about contraception during routine antenatal care and insert PPIUD immediately following delivery.MethodsWe applied a qualitative design to ascertain the perspectives of maternal health service providers who participated in the PPIUD Initiative. We conducted 12 in-depth interviews with providers. We used thematic analysis to analyse the data and the results were interpreted within the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.ResultsFindings indicated that providers were willing to adopt the intervention and reiterated the importance of postpartum family planning. However, the intervention was not consistently implemented as intended, including provider bias in counselling and lack of attention to women’s preferences. Organisational barriers to implementation included time constraints and inadequate training. Providers suggested that a range of paramedical staff be trained in counselling and PPIUD insertion to mitigate barriers and to facilitate scaling up the intervention.ConclusionsTo improve and scale up the PPIUD Initiative, training efforts should be expanded to primary and secondary care facilities and implementation strategies better utilised (eg, on-the-job training). The training can be strengthened by improving providers’ knowledge of all types of methods and interpersonal communication skills, and emphasising the importance of unbiased, evidence-based contraceptive counselling techniques.
MRE combined with FIB-4 (MEFIB) index in detection of candidates for pharmacological treatment of NASH-related fibrosis
Authors: Jung Jinho , Loomba Rohan R , Imajo Kento , Madamba Egbert , Gandhi Sanil , Bettencourt Ricki , Singh Seema , Hernandez Carolyn , Valasek Mark A , Behling Cynthia , Richards Lisa , Fowler Katie , Sirlin Claude B , Nakajima Atsushi , Loomba Rohit 
Published: November 2020

ObjectivePatients with non-alcoholic fatty liver disease (NAFLD) with ≥stage 2 fibrosis are at increased risk for liver-related mortality and are candidates for pharmacological therapies for treatment of NAFLD. The aim of this prospective cohort study is to examine the diagnostic accuracy of MR elastography (MRE) combined with fibrosis-4 (FIB-4) in diagnosing ≥stage 2 fibrosis (candidates for pharmacological therapies).DesignThis is a cross-sectional analysis of a prospective cohort (University of California at San Diego (UCSD)-NAFLD) including 238 consecutive patients with contemporaneous MRE and biopsy-proven NAFLD. Non-alcoholic steatohepatitis-Clinical Research Network-Histologic Scoring System was used to assess histology. The radiologist and pathologist were blinded to clinical, pathological and imaging data, respectively. Receiver operating characteristics (ROCs) were determined to examine the diagnostic accuracy of MRE and FIB-4 for diagnosis of ≥stage 2 fibrosis in NAFLD. We then validated these findings in an independent validation cohort derived from Yokohama City University in Japan (Japan-NAFLD Cohort; N=222 patients).ResultsIn the UCSD-NAFLD (training) Cohort, MRE demonstrated a clinically significant diagnostic accuracy for the detection of ≥stage 2 fibrosis with an area under the ROC curve (AUROC) of 0.93 (95% CI 0.90 to 0.97) vs FIB-4 with an AUROC of 0.78 (95% CI 0.71 to 0.85), which was both clinically and statistically significant (p<0.0001). We then combined MRE with FIB-4 (MRE ≥3.3 kPa and FIB-4 ≥1.6) to develop a clinical prediction rule to rule in ≥stage 2 fibrosis patients which had positive predictive value (PPV) of 97.1% (p<0.02) in the UCSD-NAFLD cohort (AUROC of 0.90 (95% CI 0.85 to 0.95)) which remained significant at PPV of 91.0% (p<0.003) in the Japan-NAFLD Cohort (AUROC of 0.84 (95% CI 0.78 to 0.89)).ConclusionMRE combined with FIB-4 (MEFIB) index may be used for non-invasive identification of candidates for (≥stage 2 fibrosis) pharmacological therapy among patients with NAFLD with a high PPV.
Long-term outcomes of adult out-of-hospital cardiac arrest in Queensland, Australia (2002–2014): incidence and temporal trends
Authors: Pemberton Katherine , Franklin Richard C , Bosley Emma , Watt Kerrianne 
Published: November 2020

ObjectiveTo describe annual incidence and temporal trends (2002–2014) in incidence of long-term outcomes of adult out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology attended by Queensland Ambulance Service (QAS) paramedics, by age, gender, geographical remoteness and socioeconomic status (SES).MethodsThis is a retrospective cohort study. Cases were identified using the QAS OHCA Registry and were linked with entries in the Queensland Hospital Admitted Patient Data Collection and the Queensland Registrar General Death Registry. Population data were obtained from the Australian Bureau of Statistics to calculate incidence. Inclusion criteria were adult (18+ years) residents of Queensland who suffered OHCA of presumed cardiac aetiology and survived to hospital admission. Analyses were undertaken by three mutually exclusive outcomes: (1) survival to less than 30 days (Surv<30 days); (2) survival from 30 to 364 days (Surv30–364 days); and (3) survival to 365 days or more (Surv365+ days). Incidence rates were calculated for each year by gender, age, remoteness and SES. Temporal trends were analysed.ResultsOver the 13 years there were 4393 cases for analyses. The incidence of total admitted events (9.72–10.13; p<0.01), Surv30–364 days (0.18–0.42; p<0.05) and Surv365+ days (1.94–4.02; p<0.001) increased significantly over time; no trends were observed for Surv<30 days. An increase in Surv365+ days over time was observed in all remoteness categories and most SES categories.ConclusionEvidence suggests that implemented strategies to improve outcomes from OHCA have been successful and penetrated groups living in more remote locations and the lower socioeconomic groups. These populations still require focus. Ongoing reporting of long-term outcomes from OHCA should be undertaken using population-based incidence.
Clinical features which predict neuronal surface autoantibodies in new-onset focal epilepsy: implications for immunotherapies
Authors: McGinty Ronan N , Handel Adam , Moloney Teresa , Ramesh Archana , Fower Andrew , Torzillo Emma , Kramer Holger , Howell Stephen , Waters Patrick , Adcock Jane , Sen Arjune , Lang Bethan , Irani Sarosh R 
Published: November 2020

ObjectiveTo generate a score which clinically identifies surface-directed autoantibodies in adults with new-onset focal epilepsy, and evaluate the value of immunotherapy in this clinical setting.MethodsProspective clinical and autoantibody evaluations in a cohort of 219 consecutive patients with new-onset focal epilepsy.Results10.5% (23/219) of people with new-onset focal epilepsy had detectable serum autoantibodies to known or novel cell surface antigenic targets. 9/23 with autoantibodies were diagnosed with encephalitis, by contrast to 0/196 without autoantibodies (p<0.0001). Multivariate analysis identified six features which predicted autoantibody positivity (area under the curve=0.83): age ≥54 years, ictal piloerection, lowered self-reported mood, reduced attention, MRI limbic system changes and the absence of conventional epilepsy risk factors. 11/14 (79%) patients with detectable autoantibodies, but without encephalitis, showed excellent long-term outcomes (modified Rankin Score=0) despite no immunotherapy. These outcomes were superior to those of immunotherapy-treated patients with confirmed autoantibody-mediated encephalitis (p<0.05).ConclusionsSeizure semiology, cognitive and mood phenotypes, alongside inflammatory investigation findings, aid the identification of surface autoantibodies among unselected people with new-onset focal epilepsy. The excellent immunotherapy-independent outcomes of autoantibody-positive patients without encephalitis suggests immunotherapy administration should be guided by clinical features of encephalitis, rather than autoantibody positivity. Our findings suggest that, in this cohort, immunotherapy-responsive seizure syndromes with autoantibodies largely fall under the umbrella of autoimmune encephalitis.