bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility of using an Early Warning Score for preterm or low birthweight infants in a low-resource setting: results of a mixed-methods study at a national referral hospital in Kenya
Authors: Mitchell Eleanor J , Qureshi Zahida P , Were Fredrick , Daniels Jane , Gwako George , Osoti Alfred , Opira Jacqueline , Bradshaw Lucy , Oliver Mary , Pallotti Phoebe , Ojha Shalini 
Published: October 2020

IntroductionFifteen million babies are born prematurely, before 37 weeks gestational age, globally. More than 80% of these are in sub-Saharan Africa and Asia. 35% of all deaths in the first month of life are due to prematurity and the neonatal mortality rate is eight times higher in low-income and middle-income countries (LMICs) than in Europe. Early Warning Scores (EWS) are a way of recording vital signs using standardised charts to easily identify adverse clinical signs and escalate care appropriately. A range of EWS have been developed for neonates, though none in LMICs. This paper reports the findings of early work to examine if the use of EWS is feasible in LMICs.MethodsWe conducted an observational study to understand current practices for monitoring of preterm infants at a large national referral hospital in Nairobi, Kenya. Using hospital records, data were collected over an 8-week period in 2019 on all live born infants born at <37 weeks and/or <2500 g (n=294, 255 mothers) in the first week of life. Using a chart adopted from the EWS developed by the British Association of Perinatal Medicine, we plotted infants’ vital signs. In addition, we held group discussions with stakeholders in Kenya to examine opinions on use of EWS.ResultsRecording of vital signs was variable; only 63% of infants had at least one temperature recorded and 53% had at least one heart rate and respiratory rate recorded. Stakeholders liked the traffic-light system and simplicity of the chart, though recognised challenges, such as staffing levels and ability to print in colour, to its adoption.ConclusionEWS may standardise documentation and identify infants who are at higher risk of an adverse outcome. However, human and non-human resource issues would need to be explored further before development of an EWS for LMICs.
Conditionally positive: a qualitative study of public perceptions about using health data for artificial intelligence research
Authors: McCradden Melissa D , Sarker Tasmie , Paprica P Alison 
Published: October 2020

ObjectivesGiven widespread interest in applying artificial intelligence (AI) to health data to improve patient care and health system efficiency, there is a need to understand the perspectives of the general public regarding the use of health data in AI research.DesignA qualitative study involving six focus groups with members of the public. Participants discussed their views about AI in general, then were asked to share their thoughts about three realistic health AI research scenarios. Data were analysed using qualitative description thematic analysis.SettingsTwo cities in Ontario, Canada: Sudbury (400 km north of Toronto) and Mississauga (part of the Greater Toronto Area).ParticipantsForty-one purposively sampled members of the public (21M:20F, 25–65 years, median age 40).ResultsParticipants had low levels of prior knowledge of AI and mixed, mostly negative, perceptions of AI in general. Most endorsed using data for health AI research when there is strong potential for public benefit, providing that concerns about privacy, commercial motives and other risks were addressed. Inductive thematic analysis identified AI-specific hopes (eg, potential for faster and more accurate analyses, ability to use more data), fears (eg, loss of human touch, skill depreciation from over-reliance on machines) and conditions (eg, human verification of computer-aided decisions, transparency). There were mixed views about whether data subject consent is required for health AI research, with most participants wanting to know if, how and by whom their data were used. Though it was not an objective of the study, realistic health AI scenarios were found to have an educational effect.ConclusionsNotwithstanding concerns and limited knowledge about AI in general, most members of the general public in six focus groups in Ontario, Canada perceived benefits from health AI and conditionally supported the use of health data for AI research.
Predicting pain recovery in patients with acute low back pain: a study protocol for a broad validation of a prognosis prediction model
Authors: Silva Fernanda Gonçalves , Mota da Silva Tatiane , Palomo Gabriele Alves , Hancock Mark Jonathan , Costa Lucíola da Cunha Menezes , Costa Leonardo Oliveira Pena 
Published: October 2020

BackgroundThe clinical course of acute low back pain (LBP) is generally favourable; however, there is significant variability in the prognosis of these patients. A clinical prediction model to predict the likelihood of pain recovery at three time points for patients with acute LBP has recently been developed. The aim of this study is to conduct a broad validation test of this clinical prediction model, by testing its performance in a new sample of patients and a different setting.MethodsThe validation study with a prospective cohort design will recruit 420 patients with recent onset non-specific acute LBP, with moderate pain intensity, seeking care in the emergency departments of hospitals in São Paulo, Brazil. The primary outcome measure will be days to recovery from pain. The predicted probability of pain recovery for each individual will be computed based on predictions of the development model and this will be used to test the performance (calibration and discrimination) in the validation dataset.DiscussionThe findings of this study will better inform about the performance of the clinical prediction model, helping both clinicians and patients. If the model’s performance is acceptable, then future research should evaluate the impact of the prediction model, assessing whether it produces a change in clinicians’ behaviour and/or an improvement in patient outcomes.Ethics and disseminationEthics were granted by the Research Ethics Committee of the Universidade Cidade de São Paulo, #20310419.4.0000.0064. Study findings will be disseminated widely through peer-reviewed publications and conference presentations.
Autofluorescence of choroidal vessels in Bietti’s crystalline dystrophy
Authors: Ameri Hossein , Su Erin , Dowd-Schoeman Tyler J 
Published: October 2020

ObjectiveTo describe the pattern of fundus autofluorescence (FAF) in Bietti’s crystalline dystrophy (BCD).Methods and analysisFrom the National Institutes of Health EyeGene database of 2769 patients with known pathogenic mutations, 5 patients with BCD-causing CYP4V2 mutations who had FAF images were selected. Demographic and genetic information and imaging files were obtained. From the FAF imaging files, unique autofluorescence (AF) patterns and correlation with retinal structures were assessed by three investigators for clinical significance.ResultsFive patients (four males, one female; mean age 56 years, range 42–76 years) were included, all with different CYP4V2 mutations. All patients displayed varying degrees of hypo-AF in the posterior pole. In four out of five patients, there was a relative hyper-AF of choroidal vessels within the hypo-AF area; this feature was limited to sclerotic vessels only. A transitional zone of speckled AF was visible around the hypo-AF area. This zone corresponded to the area containing retinal crystals on colour fundus photography; however, retinal crystals did not demonstrate hyper or hypo-AF.ConclusionsThis study presents a previously unreported characteristic finding in patients with BCD with CYP4V2 mutations. AF of choroidal vessels may aid in differentiating BCD from other retinal dystrophies.
Effect of the Carer Support Needs Assessment Tool intervention (CSNAT-I) in the Danish specialised palliative care setting: a stepped-wedge cluster randomised controlled trial
Authors: Lund Line , Ross Lone , Petersen Morten Aagaard , Blach Annemette , Rosted Elizabeth , Bollig Georg , Juhl Gitte Irene , Farholt Hanne Bollerup , Winther Helen , Laursen Louise , Hasse Marianne , Weensgaard Signe , Guldin Mai-Britt , Ewing Gail , Grande Gunn , Groenvold Mogens 
Published: October 2020

BackgroundThe Carer Support Needs Assessment Tool intervention (CSNAT-I) has been shown to improve end-of-life care support for informal caregivers. This study investigated the impact of the CSNAT-I on caregivers of patients recently enrolled in specialised palliative care (SPC) at home in Denmark.MethodsA stepped-wedge cluster randomised controlled trial with nine clusters (ie, SPC teams). Outcome measures were collected using caregiver questionnaires at baseline (T0) and 2-week (T1) and 4-week (T2) follow-up.ResultsA total of 437 caregivers were enrolled (control group, n=255; intervention group, n=182). No intervention effect was found on the primary outcome, caregiver strain at T1 (p=0.1865). However, positive effects were found at T1 and T2 on attention to caregivers’ well-being (p<0.0001), quality of information and communication (p<0.0001), amount of information (T1: p=0.0002; T2: p<0.0001), involvement (T1: p=0.0045; T2: p<0.0001), talking about greatest burdens (p<0.0001) and assistance in managing greatest burdens (p<0.0001). The effect sizes of these differences were medium or large and seemed to increase from T1 to T2. At T1, positive effects were found on distress (p=0.0178) and home care responsibility (p=0.0024). No effect was found on the remaining outcomes.ConclusionAlthough no effect was found on caregiver strain, the CSNAT-I showed positive effects on caregiver distress, home care responsibility and key outcomes regarding caregivers’ experience of the interaction with healthcare professionals.Trial registration numberNCT03466580.
Modulating the Infarcted Ventricle'S Refractoriness with An Epicardial Biomaterial
Authors: Chinyere Ikeotunye Royal , Hutchinson Mathew , Moukabary Talal , Koevary Jen Watson , Juneman Elizabeth , Goldman Steven , Lancaster Jordan J 
Published: October 2020

Patients diagnosed with heart failure with reduced ejection fraction (HFrEF) are at increased risk of monomorphic ventricular tachycardia (VT) and ventricular fibrillation. The presence of myocardial fibrosis provides both anatomical and functional barriers that promote arrhythmias in these patients. Propagation of VT in a reentrant circuit depends on the presence of excitable myocardium and the refractoriness of the circuit. We hypothesize that myocardial refractoriness can be modulated surgically in a model of HFrEF, leading to decreased susceptibility to VT. Male Sprague-Dawley rats were infarcted via permanent left coronary artery ligation. At 3 weeks post-infarction, engineered grafts composed of human dermal fibroblasts cultured into a polyglactin-910 biomaterial were implanted onto the epicardium to cover the area of infarction. Three weeks post-graft treatment, all rats underwent a terminal electrophysiologic study to compare monophasic action potential electroanatomic maps and susceptibility to inducible monomorphic VT. HFrEF rats (n=29) demonstrated a longer (p=0.0191) ventricular effective refractory period (ERP) and a greater (p=0.0394) VT inducibility compared with sham (n=7). HFrEF rats treated with the graft (n=12) exhibited no change in capture threshold (p=0.3220), but had a longer ventricular ERP (p=0.0029) compared with HFrEF. No statistically significant change in VT incidence was found between HFrEF rats treated with the graft and untreated HFrEF rats (p=0.0834). Surgical deployment of a fibroblast-containing biomaterial in a rodent ischemic cardiomyopathy model prolonged ventricular ERP as measured by programmed electrical stimulation. This hypothesis-generating study warrants additional studies to further characterize the antiarrhythmic or proarrhythmic effects of this novel surgical therapy.
Intratumoral injection reduces toxicity and antibody-mediated neutralization of immunocytokine in a mouse melanoma model
Authors: Baniel Claire C , Sumiec Elizabeth G , Hank Jacqueline A , Bates Amber M , Erbe Amy K , Pieper Alexander A , Hoefges Anna G , Patel Ravi B , Rakhmilevich Alexander L , Morris Zachary S , Sondel Paul M 
Published: October 2020

BackgroundSome patients with cancer treated with anticancer monoclonal antibodies (mAbs) develop antidrug antibodies (ADAs) that recognize and bind the therapeutic antibody. This response may neutralize the therapeutic mAb, interfere with mAb effector function or cause toxicities. We investigated the potential influence of ADA to modify the tumor-binding capability of a tumor-reactive ‘immunocytokine’ (IC), namely, a fusion protein (hu14.18-IL2) consisting of a humanized, tumor-reactive, anti-GD2 mAb genetically linked to interleukin 2. We characterize the role of treatment delivery of IC (intravenous vs intratumoral) on the impact of ADA on therapeutic outcome following IC treatments in an established antimelanoma (MEL) regimen involving radiotherapy (RT) +IC.MethodsC57BL/6 mice were injected with human IgG or the hu14.18-IL2 IC to develop a mouse anti-human antibody (MAHA) response (MAHA+). In vitro assays were performed to assess ADA binding to IC using sera from MAHA+ and MAHA− mice. In vivo experiments assessed the levels of IC bound to tumor in MAHA+ and MAHA− mice, and the influence of IC route of delivery on its ability to bind to B78 (GD2+) MEL tumors.ResultsMAHA is inducible in C57BL/6 mice. In vitro assays show that MAHA is capable of inhibiting the binding of IC to GD2 antigen on B78 cells, resulting in impaired ADCC mediated by IC. When B78-bearing mice are injected intravenously with IC, less IC binds to B78-MEL tumors in MAHA+ mice than in MAHA− mice. In contrast, when IC is injected intratumorally in tumor-bearing mice, the presence of MAHA does not detectibly impact IC binding to the tumor. Combination therapy with RT+IT-IC showed improved tumor regression compared with RT alone in MAHA+ mice. If given intratumorally, IC could be safely readministered in tumor-bearing MAHA+ mice, while intravenous injections of IC in MAHA+ mice caused severe toxicity. Histamine levels were elevated in MAHA+ mice compared with MAHA− mice after reintroduction of IC.ConclusionsIntratumoral injection may be a means of overcoming ADA neutralization of therapeutic activity of tumor-reactive mAbs or ICs and may reduce systemic toxicity, which could have significant translational relevance.
Genetically engineered macrophages persist in solid tumors and locally deliver therapeutic proteins to activate immune responses
Authors: Brempelis Katherine J , Cowan Courtney M , Kreuser Shannon A , Labadie Kevin P , Prieskorn Brooke M , Lieberman Nicole A P , Ene Chibawanye I , Moyes Kara W , Chinn Harrison , DeGolier Kole R , Matsumoto Lisa R , Daniel Sara K , Yokoyama Jason K , Davis Amira D , Hoglund Virginia J , Smythe Kimberly S , Balcaitis Stephanie D , Jensen Michael C , Ellenbogen Richard G , Campbell Jean S , Pierce Robert H , Holland Eric C , Pillarisetty Venu G , Crane Courtney A 
Published: October 2020

BackgroundThough currently approved immunotherapies, including chimeric antigen receptor T cells and checkpoint blockade antibodies, have been successfully used to treat hematological and some solid tumor cancers, many solid tumors remain resistant to these modes of treatment. In solid tumors, the development of effective antitumor immune responses is hampered by restricted immune cell infiltration and an immunosuppressive tumor microenvironment (TME). An immunotherapy that infiltrates and persists in the solid TME, while providing local, stable levels of therapeutic to activate or reinvigorate antitumor immunity could overcome these challenges faced by current immunotherapies.MethodsUsing lentivirus-driven engineering, we programmed human and murine macrophages to express therapeutic payloads, including Interleukin (IL)-12. In vitro coculture studies were used to evaluate the effect of genetically engineered macrophages (GEMs) secreting IL-12 on T cells and on the GEMs themselves. The effects of IL-12 GEMs on gene expression profiles within the TME and tumor burden were evaluated in syngeneic mouse models of glioblastoma and melanoma and in human tumor slices isolated from patients with advanced gastrointestinal malignancies.ResultsHere, we present a cellular immunotherapy platform using lentivirus-driven genetic engineering of human and mouse macrophages to constitutively express proteins, including secreted cytokines and full-length checkpoint antibodies, as well as cytoplasmic and surface proteins that overcomes these barriers. GEMs traffic to, persist in, and express lentiviral payloads in xenograft mouse models of glioblastoma, and express a non-signaling truncated CD19 surface protein for elimination. IL-12-secreting GEMs activated T cells and induced interferon-gamma (IFNγ) in vitro and slowed tumor growth resulting in extended survival in vivo. In a syngeneic glioblastoma model, IFNγ signaling cascades were also observed in mice treated with mouse bone-marrow-derived GEMs secreting murine IL-12. These findings were reproduced in ex vivo tumor slices comprised of intact MEs. In this setting, IL-12 GEMs induced tumor cell death, chemokines and IFNγ-stimulated genes and proteins.ConclusionsOur data demonstrate that GEMs can precisely deliver titratable doses of therapeutic proteins to the TME to improve safety, tissue penetrance, targeted delivery and pharmacokinetics.
Impact of hyperglycaemia on complications in patients who had a stroke after thrombolysis
Authors: Cheng Yani , Luo Ji , Lin Yanyan , Zeng Yifan , Yu Junru , Lin Yuanshao 
Published: October 2020

ABSTRACTBackgroundWe sought to investigate whether admission hyperglycaemia is associated with complications in patients who had an acute ischaemic stroke (AIS) treated with intravenous recombinant tissue plasminogen activator and, if so, whether complications during hospitalisation modify the effect of hyperglycaemia on 3-month poor outcome after thrombolysis.MethodsPatients who were diagnosed with AIS after thrombolysis between July 2016 and January 2019 were enrolled in this study. Five prespecified complications, including infections, brain oedema, deep vein thrombosis (DVT), haemorrhagic transformation (HT) and gastrointestinal bleeding, were recorded during hospitalisation.ResultsOf 388 patients, 143 (36.86%) presented with hyperglycaemia. Patients with hyperglycaemia were more likely to experience one or more complications than patients without hyperglycaemia. After adjustment for potential confounders, hyperglycaemia was associated with brain oedema (OR 2.39; 95% CI 1.08 to 5.30), HT (OR 2.16, 95% CI 1.06 to 4.41), symptomatic intracerebral haemorrhage (sICH) (OR 7.32, 95% CI 2.35 to 22.80) and gastrointestinal bleeding (OR 3.62; 95% CI 1.93 to 6.80), but was not linked to infections (OR 1.48, 95% CI 0.76 to 2.9) and DVT (OR 0.60, 95% CI 0.23 to 1.5). Additional adjustment for the complications in the clinical outcome analysis, done to assess these complications as an intermediate in the pathway from admission hyperglycaemia to clinical outcome, did not substantially change the model (all p for interaction &gt;0.05).ConclusionHyperglycaemia is an independent predictor of complications following stroke after thrombolysis, especially for brain oedema, gastrointestinal bleeding, HT and sICH. Complications during hospitalisation did not modify the effect of hyperglycaemia on the poor outcome at 3 months in ischaemic stroke.
Quantifying poor working equid welfare in Nepalese brick kilns using a welfare assessment tool
Authors: Rodrigues Joao Brandao , Sullivan Rebekah J E , Judge Andrew , Norris Stuart Lee , Burden Faith A 
Published: October 2020

BackgroundAcross Asia the brick‐kiln industry is expanding. In Nepal, urban dwelling has increased in recent years, raising requirement for low‐cost, mass produced bricks to meet the population needs. Working equids (WEs) play a key role in non‐mechanised kilns. Assessing the welfare of these equids is the starting point to addressing concerns. In line with One Welfare principles, the health and welfare of animals, people and the kiln environment are interlinked.Materials and methodsIn December 2019, 119 WEs were assessed in seven brick kilns in three districts of Nepal, using the Equid Assessment Research and Scoping tool, developed by The Donkey Sanctuary. The objective was to measure welfare at the start of the brick kiln season.ResultsHorses were the predominant species of WE. Hazardous housing and environments were seen in all kilns. Behaviour responses were mixed. Owner responses and animal examination indicated poor working conditions. Signs of harmful practice were evident in most animals. The majority were underweight, with poor general health, skin alterations and musculoskeletal issues.ConclusionThe welfare of equids prior to starting brick kiln work is poor, posing significant concerns for the actual working period. Intervention to enhance health and welfare is required.
Electrical neutrality and $$\beta $$-equilibrium conditions in dense quark matter: generation of charged pion condensation by chiral imbalance
Authors: Khunjua T. G. , Klimenko K. G. , Zhokhov R. N. 
Published: October 2020

AbstractThe phase diagram of dense quark matter with chiral imbalance is considered with the conditions of electric neutrality and $$\beta $$
β
-equilibrium. It has been shown recently that chiral imbalance can generate charged pion condensation (PC) in dense quark matter. It was, therefore, interesting to verify that this phenomenon takes place in realistic physical scenarios such as electrically neutral quark matter in $$\beta $$
β
-equilibrium, because a window of charged PC at dense quark matter phase diagram (without chiral imbalance) predicted earlier was closed by the consideration of these conditions at the physical current quark mass. In this paper it has been shown that the charged PC phenomenon is generated by chiral imbalance in the dense electric neutral quark/baryonic matter in $$\beta $$
β
-equilibrium, i.e. matter in neutron stars. It has also been demonstrated that charged PC is an inevitable phenomenon in dense quark matter with chiral imbalance if there is nonzero chiral imbalance in two forms, chiral and chiral isospin one. It seems that in this case charged PC phase can be hardly avoided by any physical constraint on isospin imbalance and that this conclusion can be probably generalized from neutron star matter to the matter produced in heavy ion collisions or in neutron star mergers. The chiral limit and the physical point (physical pion mass) have both been considered and it was shown that the appearance of charged PC is not much affected by the consideration of nonzero current quark mass.