bluuebunny/crossref_metadata_2025_split huggingface dataset:
Original Research: Understanding Nursing Home Staff Attitudes Toward Death and Dying: A Survey
Authors: Bui Nhat , Halifax Elizabeth , David Daniel , Hunt Lauren , Uy Edyssa , Ritchie Christine , Stephens Caroline 
Published: July 2020

ABSTRACT

Background:
Nearly 70% of nursing home residents are eligible for palliative care, yet few receive formal palliative care outside of hospice. Little is known about nursing home staff attitudes, knowledge, skills, and behaviors related to palliative care.

Methods:
We administered a modified survey measuring attitudes toward death to 146 nursing home staff members, including both clinical and nonclinical staff, from 14 nursing homes.

Results:
Nursing home staff generally reported feeling comfortable caring for the dying, but half believed the end of life is a time of great suffering. Pain control (63%), loneliness (52%), and depression (48%) were the most important issues identified with regard to these patients, and there was ambivalence about the use of strong pain medications and the utility of feeding tubes at the end of life. Top priorities identified for improving palliative care included greater family involvement (43%), education and training in pain control (50%) and in management of other symptoms (37%), and use of a palliative care team (35%) at their facility.

Conclusions:
Findings show there is a need for more palliative care training and education, which should be built on current staff knowledge, skills, and attitudes toward palliative care.
Opportunities and challenges associated with the evaluation of chimeric antigen receptor T cells in real-life
Authors: McGrath Eoin , Chabannon Christian , Terwel Sofie , Bonini Chiara , Kuball Jurgen 
Published: July 2020

Purpose of review
With the approval of the first chimeric antigen receptor (CAR)-T cell products on the market, the European Medicines Agency (EMA) required market authorization holders (MAHs) to monitor the long-term efficacy and safety of CAR-T cells for 15 years after administration. In 2019, the cellular therapy module of the European Society for Blood and Marrow Transplantation (EBMT) registry received a positive qualification opinion from the EMA indicating that the registry fulfills the essential needs to capture such data. We investigated its broader implication.

Recent findings
Since 2020, the cellular therapy module of the EBMT registry captures data to support postauthorization studies for MAHs and EMA. The process toward a positive qualification opinion has attracted interest from many other stakeholders, such as scientists and Health Technology Assessment bodies, and was the spin-off for a stimulating development which defined the need for a registry to comply with regulatory requirements, and also inspired ways to deal with CAR-T cell programs in terms of center qualifications and educational standards for professionals.

Summary
The positive qualified opinion of the EBMT registry by EMA to monitor long-term efficacy and safety of commercial CAR-T cells created opportunities and challenges and was serving as linking-pin to launch a novel CAR-T cell community.
Most Orthopaedic Studies Using the National Inpatient Sample Fail to Adhere to Recommended Research Practices: A Systematic Review
Authors: Teng Teng L. , Menendez Mariano E. , Okike Kanu , Cassidy Charles , Salzler Matthew 
Published: July 2020

Abstract

Background
The National Inpatient Sample (NIS) database is accessible, inexpensive, and increasingly used in orthopaedic research, but it has complex design features that require nuanced methodological considerations for appropriate use and interpretation. A recent study showed poor adherence to recommended research practices for the NIS across a broad spectrum of medical and surgical fields, but the degree and patterns of nonadherence among orthopaedic publications remain unclear.

Questions/purposes
In this study, we sought: (1) to quantify nonadherence to recommended research practices provided by the Agency for Healthcare Research and Quality (AHRQ) for using the NIS data in orthopaedic studies from 2016-2017; and, (2) to identify the most common nonadherence practices.

Methods
We evaluated all 136 manuscripts published across the 74 orthopaedic journals listed on Scimago Journal & Country Rank that used the NIS from January 2016 through December 2017. Of those studies, 2% (3 of 136) were excluded because NIS was not used for analysis. The studies were evaluated for adherence to seven recommended research practices by the AHRQ: (1) identifying observations as hospitalization events rather than unique patients; (2) not performing state-level analyses; (3) limiting hospital-level analyses to data from year 1988-2011; (4) not performing physician-level analyses; (5) avoiding the use of nonspecific secondary diagnosis codes to infer in-hospital events; (6) using survey-specific analysis methods that account for clustering, stratification, and weighting; and (7) accounting for data changes in trend analyses spanning major transition periods in the data set (1997-1998 and 2011-2012).

Results
Overall, 93% (124 of 133) of the studies did not adhere to one or more practices. For each of the research practices assessed, 80% (106 of 133) of the studies did not account for the clustering and stratification in survey design; 56% (75 of 133) implied records were unique patients rather than hospitalization events; 41% (54 of 133) inappropriately used secondary diagnosis codes to infer in-hospital events.

Conclusions
Nearly all manuscripts published in orthopaedic journals using the NIS database in 2016 and 2017 failed to adhere to recommended research practices. Future research quantifying variations in study results on the basis of adherence to recommended research practices would be of value.

Clinical Relevance
With the ubiquitous presence of large-database studies in orthopaedic journals, our work points to the importance of rigorous methodological appraisal when evaluating results, and encourages journals to require the use of the methodology checklists upon submission of such studies. More research is needed to determine whether deviations from recommended research practices actually lead to biased conclusions that affect patient care and policy-related decisions.
Abaloparatide followed by alendronate in women ≥80 years with osteoporosis: post hoc analysis of ACTIVExtend
Authors: Greenspan Susan L. , Fitzpatrick Lorraine A. , Mitlak Bruce , Wang Yamei , Harvey Nicholas C. , Deal Chad , Cosman Felicia , McClung Michael 
Published: July 2020

Abstract

Objective:
Fracture risk increases with age, but few studies focus on persons ≥80 years. In the ACTIVE trial, treatment with abaloparatide for 18 months reduced osteoporotic fracture risk and increased bone mineral density. These effects were maintained with 24 months alendronate treatment in ACTIVExtend. We postulated that similar improvements in bone mineral density and safety would be demonstrated in women ≥80 years.

Methods:
Post hoc analyses of bone mineral density and fracture incidence in women with osteoporosis at high risk of fracture ≥80 years from ACTIVExtend.

Results:
In total, 56 women aged ≥80 years at ACTIVE baseline entered the ACTIVExtend study; 46 of these completed the study. Mean age was 83.3 years; other baseline characteristics were similar. At the end of ACTIVE, bone mineral density increased at all sites for abaloparatide versus placebo. Bone mineral density increased in parallel in both groups during alendronate therapy (19 to 43 months) in ACTIVExtend. At month 43, mean percent change in bone mineral density from baseline was 17.2% abaloparatide/alendronate versus 8.6% placebo/alendronate (P < 0.0001) at the lumbar spine, 5.3% abaloparatide/alendronate versus 3.0% placebo/alendronate (P = 0.024) at the total hip, and 4.6% abaloparatide/alendronate versus 3.1% placebo/alendronate (P = 0.044) at the femoral neck. Fracture incidence was low and did not differ significantly between groups. Sequential treatment with abaloparatide followed by alendronate was well tolerated; the proportion of participants reporting adverse events was similar between groups.

Conclusions:
Sequential treatment with abaloparatide followed by alendronate (43 months follow-up) in this small subgroup of ACTIVExtend participants suggests abaloparatide is well tolerated and effective in women aged ≥80 years.

Video Summary:
http://links.lww.com/MENO/A618.
The Role of Psychology in the Care of Children With Pancreatitis
Authors: Rich Kristin Loiselle , Abu-El-Haija Maisam , Nathan Jaimie D. , Lynch-Jordan Anne 
Published: July 2020

Abstract
Children with acute recurrent and chronic pancreatitis experience severe abdominal pain that may be intermittent or chronic. Pain is often debilitating, causing interference with academic, social, family, and extracurricular activities that are important to youth. Disruption of these routines and the unpredictability of pain flares place children with pancreatitis at increased risk for development of anxious or depressive symptoms. Pediatric psychologists trained in cognitive-behavioral treatment are well suited to intervene on functional disability and mood disturbance, as well as teach coping skills. In an era where there is movement away from opioids, nonpharmacological strategies have an important place for pain management. In fact, positive outcomes following for children with other recurrent abdominal pain syndromes have been reported for this evidence-based intervention. In addition to pain management, pediatric psychologists can address other co-occurring behavioral and emotional problems in children with pancreatitis, such as needle phobia and poor adherence to the prescribed medical regimen.
End-of-Life Care Among Patients With Bipolar Disorder and Cancer: A Nationwide Cohort Study
Authors: Fond Guillaume , Baumstarck Karine , Auquier Pascal , Pauly Vanessa , Bernard Cecile , Orleans Veronica , Llorca Pierre-Michel , Lancon Christophe , Salas Sebastien , Boyer Laurent 
Published: July 2020

ABSTRACT

Objective
This study aimed to describe end-of-life (EOL) care in individuals with bipolar disorder (BD) who died of cancer compared with mentally healthy individuals.

Methods
This was a nationwide cohort study of all adult individuals who died of cancer in hospitals in France between 2013 and 2016. Outcomes were compared between individuals with BD and mentally healthy individuals in the last month of life including palliative care and high-intensity EOL care (chemotherapy, artificial nutrition, and other interventions). A subanalysis explored differences between patients with BD and patients with schizophrenia.

Results
The study included 2015 individuals with BD and 222,477 mentally healthy controls. Compared with the controls, individuals with BD died 5 years earlier, more often had comorbidities and thoracic cancer, and had fewer metastases, but did not have shorter delays from cancer diagnosis to death. After matching and adjustment for covariates, individuals with BD more often received palliative care in the last 3 days of life (25% versus 13%, p < .001) and less high-intensity care (e.g., chemotherapy 12% versus 15%, p = .004), but more artificial nutrition (6% versus 4.6%, p = .003). Compared with the schizophrenia comparison group, chemotherapy was received more by individuals with BD in the last 14 days of life (12.5% for BD versus 9.4%, p < .001).

Conclusions
Individuals with BD were more likely to receive palliative care and less likely to receive high-intensity EOL care, except for artificial nutrition. These results may not be specific to BD, as no difference was found between patients with BD and schizophrenia except for chemotherapy.
Hepatitis C virus modulates IgG glycosylation in HIV co-infected antiretroviral therapy suppressed individuals
Authors: Giron Leila B. , Azzoni Livio , Yin Xiangfan , Lynn Kenneth M. , Ross Brian N. , Fair Matthew , Damra Mohammad , Sciorillo Amanda C. , Liu Qin , Jacobson Jeffrey M. , Mounzer Karam , Kostman Jay R. , Abdel-Mohsen Mohamed , Montaner Luis J. , Papasavvas Emmanouil 
Published: July 2020

Objective:
Glycosylation plays a critical role in mediating several antibody (mainly immunoglobulin G; IgG) immunological functions, including antibody-dependent cell-mediated cytotoxicity (ADCC), and anti-inflammatory activities. We investigated whether IgG glycosylation and immune profile patterns are differentially modulated in mono and dual infection using samples from untreated hepatitis C virus (HCV)-infected individuals with and without co-infection with antiretroviral therapy (ART)-suppressed HIV.

Design:
IgG glycosylation, immune subsets, natural killer cell function, and liver enzymes were assessed in 14 HCV mono-infected and 27 ART-suppressed HIV/HCV co-infected participants naïve to HCV treatment. Historic IgG glycosylation data from 23 ART-suppressed chronically HIV-infected individuals were also used for comparisons.

Methods:
Plasma IgG glycosylation was assessed using capillary electrophoresis. Whole blood was used for immune subset characterization by flow cytometry. Peripheral blood mononuclear cells were used to measure constitutive and interferon-α-induced K562 target cell lysis. Statistical analysis was performed using R (3.5.0).

Results:
HIV/HCV had lower levels of pro-ADCC-associated nonfucosylated glycans when compared with HIV [e.g. di-sialylated A2 percentage (%): P = 0.04], and higher levels of T and myeloid cell activation/exhaustion when compared with HCV (e.g. CD3+CD8+CD38+ %: P < 0.001). Finally, in HCV high levels of the anti-inflammatory galactosylated and sialylated glycans were associated with low plasma levels of aspartate aminotransferase (AST), low CD8+ T-cell activation, and high CD8+ T-cell exhaustion.

Conclusion:
HCV modulates IgG glycosylation profile in HIV co-infected individuals on suppressive ART. These results could inform on the modulation of IgG glycans in other mono and dual infections.
Impact of HIV on the survival of hepatocellular carcinoma in hepatitis C virus-infected patients
Authors: Merchante Nicolás , Rodríguez-Fernández Miguel , Figueruela Blanca , Rodríguez-Arrondo Francisco , Revollo Boris , Ibarra Sofía , Téllez Francisco , Merino Esperanza , Montero-Alonso Marta , Galindo María J. , Rivero-Juárez Antonio , Santos Ignacio de Los , Delgado-Fernández Marcial , García-Deltoro Miguel , Vera-Méndez Francisco J. , García María A. , Aguirrebengoa Koldo , Portu Joseba , Ríos-Villegas María J. , Villalobos Marina , Alemán-Valls María R. , Mínguez Carlos , Galera Carlos , Macías Juan , Pineda Juan A. 
Published: July 2020

Background:
Previous studies have suggested that hepatocellular carcinoma (HCC) has an aggressive presentation and a shorter survival in people with HIV (PWH). This could be due to later diagnosis or lower rates of HCC treatment, and not to HIV infection itself.

Aim: :
To assess the impact of HIV on HCC survival in hepatitis C virus (HCV)-infected patients.

Methods:
Multicenter cohort study (1999–2018) of 342 and 135 HCC cases diagnosed in HIV/HCV-infected and HCV-monoinfected patients. Survival after HCC diagnosis and its predictors were assessed.

Results:
HCC was at Barcelona-Clinic Liver-Cancer (BCLC) stage 0/A in 114 (33%) HIV/HCV-coinfected and in 76 (56%) HCV-monoinfected individuals (P < 0.001). Of them, 97 (85%) and 50 (68%) underwent curative therapies (P = 0.001). After a median (Q1–Q3) follow-up of 11 (3–31) months, 334 (70%) patients died. Overall 1 and 3-year survival was 50 and 31% in PWH and 69 and 34% in those without HIV (P = 0.16). Among those diagnosed at BCLC stage 0/A, 1 and 3-year survival was 94 and 66% in PWH whereas it was 90 and 54% in HIV-negative patients (P = 0.006). Independent predictors of mortality were age, BCLC stage and α-fetoprotein levels. HIV infection was not independently associated with mortality [adjusted hazard ratio (AHR) 1.57; 95% confidence interval: 0.88–2.78; P = 0.12].

Conclusion:
HIV coinfection has no impact on the survival after the diagnosis of HCC in HCV-infected patients. Although overall mortality is higher in HIV/HCV-coinfected patients, this seem to be related with lower rates of early diagnosis HCC in HIV-infected patients and not with HIV infection itself or a lower access to HCC therapy.
How to build a virulence factor: the role of three novel enzymes in the biosynthesis of the Group A Carbohydrate
Authors: Zorzoli Azul , Meyer Benjamin , Wagstaff Benjamin , Dorfmueller Helge 
Published: July 2020

The Group A carbohydrate (GAC), a bacterial surface polysaccharide, is an essential virulence factor of Streptococcus pyogenes required for growth and infection of humans.In terms of its chemical composition, this peptidoglycan-anchored polymer is mainly formed by a string of rhamnose sugars, with alternated modifications of N-acetylglucosamine and glycerolphosphate. The rhamnose polysaccharide (RhaPS) that forms the backbone chain is synthesised intracellularly by the sequential action of three rhamnosyltransferases named GacB, GacC and GacG. Importantly, deletion of any of these rhamnosyltransferases causes bacterialdeath.
In this work, we used an interdisciplinary approach to demonstrate that:

1) GacB is a novel enzyme that initiates the RhaPS biosynthesis;

2) GacC catalyses the formation of a unique stem;

3) GacG elongates the RhaPS string by adding a yet unknown number of rhamnoses.

Here, we also show that homologs from different streptococcal species can substitute GacB and GacC in the RhaPS production. In particular, we demonstrate that several human pathogens from the Streptococcus genus encompassed in the Lancefield serotyping scheme, and the dental pathogen Streptococcus mutans can replace S. pyogenes’ enzymes. In contrast, the homologs from S. pneumoniae sp. D39 did not, suggesting a different structural arrangement for its surface carbohydrate.

Our results highlight the importance of the group carbohydrate biosynthesis pathways in the Streptococcus genus and open the door for the future development of multi-target compounds that could inhibit these enzymes in Streptococcus pyogenes and other pathogenic streptococci of clinical and veterinary importance.
Predominance of Streptococcus pneumoniae among TB patients complicates Dots chemotherapy at infectious diseases hospital Kano, Northwest Nigeria
Authors: Shu’aibumangari Abdurrahaman , Bello Mujitapha 
Published: July 2020

Directly observed treatment Short course regimen has been know to be efficacious in the chemotherapy management of tuberculosis. However, co- infection with other opportunistic bacteria could limit this success to the level of clinical suspecting the emergence of false positive multidrugs resistant TB among the patients which in many cases can lead to establishment of erroneous treatment schedule. Accordingly this facility based surveillance monitors co-infection with other bacteria in TB patients attending Dots clinic at IDH Kano, Nigeria with view to ascertaining the drug susceptibility so as to proffer better chemotherapy strategies. A total 35 non - duplicated positive AFB sputum sample collected from patients with pulmonary tuberculosis on Dots where processed according to standard bacteriological procedures including macroscopic, culture and microscopic examination using both AFB gram staining and culture methods for screening and isolation of other bacterial pathogens. These were confirmed biochemically. Overall 54.3% of the patients were Still AFB positive, Streptococcus pneumoniae and Staphylococcus species we’re predominat in up to 84.2% and 15.8% of the patients respectively. This study indicated secondary bacterial pathogenesis with pulmonary symptoms resembling TB among the patients including those that were even isolated for being refrectory to Dots an false positive conclusion of drug resistant TB. However, ofloxacin and ceftriaxone which show appreciable potencies against secondary bacterial pathogens identified where used to treat successfully, patients claimed posses drug resistant TB. It’s imperative that, success of Dots therapy could be improved by augumentin with very potent non TB antibacterial such as Streptococcus pneumoniae regimen.
Keys. TB.
Incidence of other bacterial pathogens among the patients suspected with pulmonary tuberculosis attending Hasiya Bayero Paediatric hospital Kano, Nigeria
Authors: Bello Mujitapha , Muhammad Dauda Mukhtar 
Published: July 2020

Tuberculosis co-infection with other bacterial pathogens is one of the major health problems especially in tuberculosis endemic region. Bacterial pathogens that localized in the lower respiratory tract are could sometimes preclude Mycobacterium tuberculosis or manifest as pulmonary symptoms that could mislead clinicians. Therefore this study was planned to examine suspected TB patients in Kano, Nigeria for other pathogenic bacteria with view to establishing frequency of occurrence towards facilitating better outcome of therapeutic cover. A total of 170 non duplicated sputum samples were collected from patients with suspected pulmonary tuberculosis. All the samples were processed according to standard bacteriological procedures including macroscopic examination, culture and microscopic examination using both Acid Fast Bacilli (AFB) staining and Gram staining methods. Isolated organisms were subjected to appropriate biochemical testes. High incidences were observed among age group 10 – 29 and 30 – 49 years with male and urban people been the predominant patients. Overall 20.6% of samples were AFB positive indicated TB co-infection while 62.4% were positive for other bacterial growth. Nalidixic acid and Nitrofurantoin found to have highest resistant among Gram negative organisms isolated following by Levofloxacin, Ceftriaxone and Ceftazidime while the Ofloxacin and Ciprofloxacin have the least resistant. Among Gram positive Ceftazidime shown to has the highest resistant and Ofloxacin found to has the least resistant. The study indicated predominance of Streptococcus pneumoniae (47.2%) and Staphylococcus species (32.1%) with an evidence of 15.1% and 2.8% co-infection with TB respectively. x
Keywords: Mycobacterium tuberculosis, Co-infection, Bacterial pathogens, pulmonary tuberculosis.
An investigation into extended spectrum beta-lactamase colonisation in travellers to Laos
Authors: Snaith Ann , Dunn Steven , Kantele Anu , Kuenzli Esther , Corander Jukka , McNally Alan 
Published: July 2020

Increased frequency of global travel has facilitated the spread of antimicrobial resistant organisms like extended spectrum β-lactamase (ESBL)- producing organisms and carbapenamase-producing Enterobacteriaceae through increased exposure and transient or persistent colonisation. This study investigates the impact of travel to Laos and of faecal colonisation with ESBLs aiming to help understand the diversity of organisms and also persistency of antimicrobial resistance (AMR) during the study and on return.
Daily faecal samples were collected from 23 doctors visiting Laos over a 21-day period which allowed detection of both constant colonisation and changes to the bowel colonisation over time. Bioinformatic techniques were used to identify ESBL-producing isolates obtained from participants and their contacts. Isolates were sequenced, assembled and annotated. SNP analysis was performed and phylogenetic trees constructed using the core SNP alignment. Escherichia coli was the most prevalent species with a highly diverse array of sequence types. Citrobacter and Klebsiella were the most abundant non-E. coli species. This study confirmed that Laos is an area with high levels of AMR with 28% isolates found to have mobile colistin resistance. There was also a highly diverse and extensive spread of unexpected blaCTX-M genes. Prolonged persistence of resistance genes in the three most prevalent study species found after travellers returned is another serious cause for concern emphasising the extended risk of spread of AMR from high risk to low risk countries. Future work will allow exploration of possible AMR transmission and horizontal transfer of resistance between isolates.