bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spindle cell tumor with CD34 and S100 co‐expression and distinctive stromal and perivascular hyalinization showing EML4‐ALK fusion
Authors: Abs Diane , Landman Samuel , Osio Amélie , Lepesant Pauline , Schneider Pierre , Obadia Déborah , Moguelet Philippe , Farges Cécile , Poirot Brigitte , Lehmann‐Che Jacqueline , Lebbé Céleste , Battistella Maxime 
Published: November 2020

AbstractRecently, a novel group of CD34+ and S100+ spindle cell tumors with distinctive stromal and perivascular hyalinization showing recurrent gene fusions involving RAF1, BRAF, NTRK1/2/3, and RET has been identified. ALK rearrangements have been rarely reported in this group of tumors. We report a 24‐year‐old woman with a 1.5‐cm pink mass of the scalp. The tumor was made of spindle cells organized in fascicles or haphazardly arranged in a patternless architecture, with areas of stromal and perivascular hyalinization. The tumor cells diffusely expressed CD34 and S100, without SOX‐10 expression. The tumor showed diffuse immunopositivity for ALK. RNA sequencing using next‐generation sequencing (NGS) detected an EML4‐ALK fusion. This case extends the spectrum of this newly described group of CD34+/S100+ spindle cell tumors at the molecular‐genetic level. Dermatopathologists should be aware of this recent entity, as it may fall in the differential diagnosis of many other spindle cell tumors with CD34 expression. NGS‐based techniques should be performed when facing spindle cell tumors with similar morphology and immunophenotype. Identification of kinase fusions is essential for the precise classification and better knowledge of these tumors, and for targeted therapy in rare aggressive cases.
Significant structural evolution of a long‐term fallow soil in response to agricultural management practices requires at least 10 years after conversion
Authors: Bacq‐Labreuil Aurelie , Neal Andrew L. , Crawford John , Mooney Sacha J. , Akkari Elsy , Zhang Xiaoxian , Clark Ian , Ritz Karl 
Published: November 2020

AbstractAgricultural practices can have significant effects on the physical and biological properties of soil. The aim of this study was to understand how the physical structure of a compromised soil, arising from long‐term bare‐fallow management, was modified by adopting different field management practices. We hypothesized that changing agricultural practices from bare‐fallow to arable or grassland would influence the modification of pore structure via an increase in porosity and pore connectivity, and a more homogenous distribution of pore sizes, and that this change exerts a rapid evolution of soil structure following conversion. Soil aggregates (<2 mm) collected in successive years from field plots subjected to three contrasting managements were studied: bare‐fallow, bare‐fallow converted to arable, and bare‐fallow converted to grassland. Soil structure was assessed by X‐ray computed tomography on the aggregates at 1.5 μm resolution, capturing detail relevant to soil biophysical processes. The grassland system increased porosity, diversity of pore sizes, pore connectivity and pore‐surface density significantly over the decade following conversion. However, measured at this resolution, the evolution of most of these metrics of soil structure required approximately 10 years post‐conversion to show a significant effect. The arable system did not influence soil structural evolution significantly. Only pore size distribution was modified in grassland in a shorter time frame (2 years post‐conversion). Hence, evolution of soil structural characteristics appears to require at least a decadal timescale following conversion to grassland.Highlights
The physical structure of a compromised soil was modified by adopting plant‐based field management practices.
Conversion to grassland increased pore size diversity after 2 years.
Porosity, pore connectivity and pore surface density showed a significant modification between 7 and 10 years after conversion.
A Rubric for the Detection of Students in Crisis
Authors: Burkhardt Amy , Lottridge Susan , Woolf Sherri 
Published: November 2020

AbstractFor some students, standardized tests serve as a conduit to disclose sensitive issues of harm or distress that may otherwise go unreported. By detecting this writing, known as crisis papers, testing programs have a unique opportunity to assist in mitigating the risk of harm to these students. The use of machine learning to automatically detect such writing is necessary in the context of online tests and automated scoring. To achieve a detection system that is accurate, humans must first consistently label the data that are used to train the model. This paper argues that the existing guidelines are not sufficient for this task and proposes a three‐level rubric to guide the collection of the training data. In showcasing the fundamental machine learning procedures for creating an automatic text classification system, the following evidence emerges as support of the operational use of this rubric. First, hand‐scorers largely agree with one another in assigning labels to text according to the rubric. Additionally, when this labeled data are used to train a baseline classifier, the model exhibits promising performance. Recommendations are made for improving the hand‐scoring training process, with the ultimate goal of quickly and accurately assisting students in crisis.
Professional judgement in clinical practice (part 1): Recovering original, moderate evidence‐based health care
Authors: Mugerauer Robert 
Published: November 2020

AbstractEvidence‐based medicine announced its entry as heralding a new paradigm in health care practices, but it has been widely criticized for lacking a coherent theoretical basis. This paper presents the first part of a three‐article series examining the epistemological, practical, and ethical dimensions of strong EBM, as well as considering alternatives that promise potential solutions to chronic conceptual and practical problems. While the focus is on the details of the arguments and evidence in thoughtful debates over the last 30 years, it is worthwhile to keep in mind the overall trajectory of modern thought, because strong EBM continues discredited positivist positions, thus repeating its major assumptions and inadequacies, now transferred to the medical sphere and vocabulary. Part 1 of the series examines the development of strong EBM by clarifying and critiquing its somewhat discontinuous accounts of scientific knowledge and epistemology, evidence, the differences between statistical probability in regard to populations and understanding the health of individuals, and its claims for direct transfer of research findings to clinical settings—all of which raises more questions regarding its application to provider‐patient decision making, pedagogy, and policy.
Clinical and economic impact of intensive care unit-acquired bloodstream infections in Taiwan: a nationwide population-based retrospective cohort study
Authors: Wang Yung-Chih , Shih Shu-Man , Chen Yung-Tai , Hsiung Chao Agnes , Kuo Shu-Chen 
Published: November 2020

ObjectivesTo estimate the clinical and economic impact of intensive care unit-acquired bloodstream infections in Taiwan.DesignRetrospective cohort study.SettingNationwide Taiwanese population in the National Health Insurance Research Database and the Taiwan Nosocomial Infections Surveillance (2007–2015) dataset.ParticipantsThe first episodes of intensive care unit-acquired bloodstream infections in patients ≥20 years of age in the datasets. Propensity score-matching (1:2) of demographic data, comorbidities and disease severity was performed to select a comparison cohort from a pool of intensive care unit patients without intensive care unit-acquired infections from the same datasets.Primary and secondary outcome measuresThe mortality rate, length of hospitalisation and healthcare cost.ResultsAfter matching, the in-hospital mortality of 14 234 patients with intensive care unit-acquired bloodstream infections was 44.23%, compared with 33.48% for 28 468 intensive care unit patients without infections. The 14-day mortality rate was also higher in the bloodstream infections cohort (4323, 30.37% vs 6766 deaths, 23.77%, respectively; p<0.001). Furthermore, the patients with intensive care unit-acquired bloodstream infections had a prolonged length of hospitalisation after their index date (18 days (IQR 7–39) vs 10 days (IQR 4–21), respectively; p<0.001) and a higher healthcare cost (US$16 038 (IQR 9667–25 946) vs US$10 372 (IQR 6289–16 932), respectively; p<0.001). The excessive hospital stay and healthcare cost per case were 12.69 days and US$7669, respectively. Similar results were observed in subgroup analyses of various WHO’s priority pathogens and Candida spp.ConclusionsIntensive care unit-acquired bloodstream infections in critically ill patients were associated with increased mortality, longer hospital stays and higher healthcare costs.
Patients’ aged ≥65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital: a longitudinal and comparative study
Authors: Forsgärde Elin-Sofie , Elmqvist Carina , Fridlund Bengt , Svensson Anders , Andersson Richard , Rööst Mattias 
Published: November 2020

ObjectivesPatients ≥65 years old represent 30%–50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients’ aged ≥65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals.DesignA longitudinal and comparative database study.SettingAmbulance service in a Swedish region.Participants32 085 AAs with patients ≥65 years old during the years 2014, 2016 and 2018. Exclusion criteria: AAs with interhospital patient transfers and lack of patients’ dispositions data.Outcome measuresDependent factors: conveyance and non-conveyance to hospitals. Independent factors: age, sex, symptom, triage level, scene, time, day and season.ResultsThe majority (n=29 060; 90.6%) of patients’ dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p<0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85–89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections.ConclusionsThe study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients ≥65 years old.
Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice
Authors: Chiang Jason I , Furler John , Mair Frances , Jani Bhautesh D , Nicholl Barbara I , Thuraisingam Sharmala , Manski-Nankervis Jo-Anne 
Published: November 2020

ObjectivesTo explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c).DesignCross-sectional study.SettingAustralian general practice.Participants69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients).Primary and secondary outcome measuresPrevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).ResultsMean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c.ConclusionsMultimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care.
Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review
Authors: Capion Tenna , Lilja-Cyron Alexander , Juhler Marianne , Mathiesen Tiit Illimar , Wetterslev Jørn 
Published: November 2020

ObjectivesTo summarise the evidence on benefits and harms of prompt closure versus gradual weaning of external ventricular drainage (EVD) in patients with hydrocephalus following aneurysmal subarachnoid haemorrhage (aSAH) based on randomised clinical trials (RCTs) in humans.SettingRCTs comparing prompt closure versus gradual weaning of EVD in adult patients with hydrocephalus following aSAH were included.ParticipantsPatients aged equal to or greater than 18 years with an EVD due to hydrocephalus following aSAH were eligible for inclusion.Primary and secondary outcome measuresPrimary outcomes were all-cause mortality, any serious adverse event, rate of ventriculoperitoneal (VP) shunt placement and quality of life. Secondary outcomes were patients with shunt failure, hospital and neuro intensive care unit (NICU) length of stay (LOS) and complications related to treatment with an EVD. Data permitted report of rate of VP shunt placement, and hospital and NICU LOS.ResultsSix studies were assessed in full text. One RCT with 81 patients was included. Rate of VP shunt placement was 63.4% in the rapid weaning group (ie, prompt closure of the EVD; 41 patients) and 62.5% in the gradual weaning group (40 patients; p=0.932). LOS in hospital and NICU was significantly shorter in the rapidly weaned group compared with the gradually weaned group (mean 19.1 vs 21.5 days in hospital (p=0.03); and mean 14.1 vs 16.9 days in NICU (p=0.0002)). Data were insufficient to conduct meta-analysis, trial sequential analysis or subgroup analysis of heterogeneity and sensitivity. One RCT is currently ongoing.ConclusionsWe found insufficient evidence to favour any of the two strategies for EVD discontinuation in patients with hydrocephalus following aSAH.PROSPERO registration numberCRD42018108801.
Protocol for the cultural adaptation of pulmonary rehabilitation and subsequent testing in a randomised controlled feasibility trial for adults with chronic obstructive pulmonary disease in Sri Lanka
Authors: Jayamaha Akila R , Perera Chamilya H , Orme Mark W , Jones Amy V , Wijayasiri Upendra K D C , Amarasekara Thamara D , Karunatillake Ravini S , Fernando Amitha , Seneviratne Anthony L P , Barton Andy , Jones Rupert , Yusuf Zainab K , Miah Ruhme B , Malcolm Dominic , Matheson Jesse A , Free Robert C , Manise Adrian , Steiner Michael C , Wimalasekera Savithri W , Singh Sally J 
Published: November 2020

IntroductionInternational guidelines recommend pulmonary rehabilitation (PR) should be offered to adults living with chronic obstructive pulmonary disease (COPD), but PR availability is limited in Sri Lanka. Culturally appropriate PR needs to be designed and implemented in Sri Lanka. The study aims to adapt PR to the Sri Lankan context and determine the feasibility of conducting a future trial of the adapted PR in Sri Lanka.Methods and analysisEligible participants will be identified and will be invited to take part in the randomised controlled feasibility trial, which will be conducted in Central Chest Clinic, Colombo, Sri Lanka. A total of 50 participants will be recruited (anticipated from April 2021) to the trial and randomised (1:1) into one of two groups; control group receiving usual care or the intervention group receiving adapted PR. The trial intervention is a Sri Lankan-specific PR programme, which will consist of 12 sessions of exercise and health education, delivered over 6 weeks. Focus groups with adults living with COPD, caregivers and nurses and in-depth interviews with doctors and physiotherapist will be conducted to inform the Sri Lankan specific PR adaptations. After completion of PR, routine measures in both groups will be assessed by a blinded assessor. The primary outcome measure is feasibility, including assessing eligibility, uptake and completion. Qualitative evaluation of the trial using focus groups with participants and in-depth interviews with PR deliverers will be conducted to further determine feasibility and acceptability of PR, as well as the ability to run a larger future trial.Ethics and disseminationEthical approval was obtained from the ethics review committee of Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka and University of Leicester, UK. The results of the trial will be disseminated through patient and public involvement events, local and international conference proceedings, and peer-reviewed journals.Trial registration numberISRCTN13367735
How can patient experience scores be used to predict quality inspection ratings? A retrospective cross-sectional study of national primary care datasets in the UK
Authors: Tallett Amy , Poots Alan J , Graham Chris , Peters Michele , Corbett Rory , Sizmur Steve , Forder Julien 
Published: November 2020

ObjectivesThe relationship between patient feedback in the General Practice Patient Survey (GPPS) and Care Quality Commission (CQC) inspections of practices was investigated to understand whether there is an association between patient views and regulator ratings of quality. The specific aims were to understand whether patients’ self-reported experiences of primary care can predict CQC inspection ratings of GP practices by: (i) Measuring the association between GPPS results and CQC inspection ratings of GP practices; (ii) Building a predictive model of GP practice quality ratings that use GPPS results; and (iii) Evaluating the predictive model for risk stratification.DesignRetrospective analysis of routinely collected data using decision tree modelling.SettingPrimary care: GP practices in England.Primary and secondary outcome measuresGPPS scores and GP practice CQC inspection ratings during 2018.ResultsMost GP practices (72%, 974/1350) were rated as ‘Good’ overall by CQC. Simply assuming that all practices will be rated as ‘Good’ results in a correct prediction 72% of the time, and it was not possible to improve on this overall level of predictive accuracy using decision tree modelling (correct in 73% of cases). However, a set of GPPS questions were found to have value in identifying practices at elevated risk of a poor inspection rating.ConclusionsAlthough there were some associations between GPPS data and CQC inspection ratings, there were limitations to the use of GPPS data for predictive analysis. This is a likely result of the majority of CQC inspections of GPs resulting in a ‘Good’ or ‘Outstanding’ rating. However, some GPPS questions were found to have value in identifying practices at higher risk of an ‘Inadequate’ or ‘Requires Improvement’ rating, and this may be valuable for surveillance purposes. For example, the CQC could use key questions from the survey to target inspection planning.
Needs of LMIC-based tobacco control advocates to counter tobacco industry policy interference: insights from semi-structured interviews
Authors: Matthes Britta Katharina , Robertson Lindsay , Gilmore Anna B 
Published: November 2020

IntroductionAdvocacy is vital for advancing tobacco control and there has been considerable investment in this area. While much is known about tobacco industry interference (TII), there is little research on advocates’ efforts in countering TII and what they need to succeed. We sought to examine this and focused on low- and middle-income countries (LMICs) where adoption and implementation of the Framework Convention on Tobacco Control (FCTC) tend to remain slower and weaker.MethodWe interviewed 22 advocates from eight LMICs with recent progress in a tobacco control policy. We explored participants’ experiences in countering TII, including the activities they undertake, challenges they encounter and how their efforts could be enhanced. We used Qualitative Description to analyse transcripts and validated findings through participant feedback.ResultsWe identified four main areas of countering activities: (1) generating and compiling data and evidence, (2) accessing policymakers and restricting industry access, (3) working with media and (4) engaging in a national coalition. Each area was linked to challenges, including (1) lack of data, (2) no/weak implementation of FCTC Article 5.3, (3) industry ties with media professionals and (4) advocates’ limited capacity. To address these challenges, participants suggested initiatives, including access to country-specific data, building advocates’ skills in compiling and using such data in research and monitoring, and in coalition development; others aiming at training journalists to question and investigate TII; and finally, diverse interventions intended to advance a whole-of-government approach to tobacco control. Structural changes to tobacco control funding and coordination were suggested to facilitate the proposed measures.ConclusionThis research highlights that following years of investment in tobacco control in LMICs, there is growing confidence in addressing TII. We identify straightforward initiatives that could strengthen such efforts. This research also underscores that more structural changes to enhance tobacco control capacity building should be considered.