bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of the Assistive Product List (APL) in Malawi through development of appropriate policy and systems: an action research protocol
Authors: Ebuenyi Ikenna D , Smith Emma M , Kafumba Juba , Jamali Monica Z , Munthali Alister , MacLachlan Malcolm 
Published: November 2020

IntroductionAssistive technology (AT) is important for the achievement of the sustainable development goals (SDGs) for persons with disabilities (PWD). Increasingly, studies suggest a significant gap between the need for and demand for and provisions of AT for PWD in low-income and middle-income settings. Evidence from high income countries highlights the importance of robust AT policies to the achievement of the recommendations of the World Health Assembly on AT. In Malawi, there is no standalone AT policy. The objectives of the Assistive Product List Implementation Creating Enablement of inclusive SDGs (APPLICABLE) project, are to propose and facilitate the development of a framework for creating effective national AT policy and specify a system capable of implementing such policies in low-income countries such as Malawi.Method and analysisWe propose an action research process with stakeholders in AT in Malawi. APPLICABLE will adopt an action research paradigm, through developing a shared research agenda with stakeholders and including users of AT. This involves the formation of an Action Research Group that will specify the priorities for practice—and policy-based evidence, in order to facilitate the development of contextually realistic and achievable policy aspirations on AT in Malawi and provide system strengthening recommendations that will ensure that the policy is implementable for their realisation. We will undertake an evaluation of this policy by measuring supply and support for specific AT prior to, and following the implementation of the policy recommendations.Ethics and disseminationThe study protocol was approved by Maynooth University Research Ethics Committee (SRESC-2019-2378566) and University of Malawi Research Ethics Committee (P.01/20/10). Findings from the study will be disseminated by publication in peer-reviewed journals, presentations to stakeholders in Malawi, Ireland and international audiences at international conferences.
Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study
Authors: Eastwood Kathryn , Nambiar Dhanya , Dwyer Rosamond , Lowthian Judy A , Cameron Peter , Smith Karen 
Published: November 2020

BackgroundMost calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches.ObjectivesTo examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch.DesignA retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted.SettingThe secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period.ParticipantsThere were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses.Main outcome measuresDescriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients.ResultsThe dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005).ConclusionSecondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.
Information given by websites selling home self-sampling COVID-19 tests: an analysis of accuracy and completeness
Authors: Taylor-Phillips Sian , Berhane Sarah , Sitch Alice J , Freeman Karoline , Price Malcolm James , Davenport Clare , Geppert Julia , Harris Isobel M , Osokogu Osemeke , Skrybant Magdalena , Deeks Jonathan J 
Published: November 2020

ObjectivesTo assess the accuracy and completeness of information provided by websites selling home self-sampling and testing kits for COVID-19.DesignCross-sectional observational study.SettingAll websites (n=27) selling direct to user home self-sampling and testing kits for COVID-19 (41 tests) in the UK (39 tests) and USA (two tests) identified by a website search on 23 May 2020.Main outcome measuresThirteen predefined basic information items to communicate to a user, including who should be tested, when and how testing should be done, test accuracy, and interpretation of results.ResultsMany websites did not provide the name or manufacturer of the test (32/41; 78%), when to use the test (10/41; 24%), test accuracy (12/41; 29%), and how to interpret results (21/41; 51%). Sensitivity and specificity were the most commonly reported test accuracy measures (either reported for 27/41 [66%] tests): we could only link these figures to manufacturers’ documents or publications for four (10%) tests. Predictive values, most relevant to users, were rarely reported (five [12%] tests reported positive predictive values). For molecular virus tests, 9/23 (39%) websites explained that test positives should self-isolate, and 8/23 (35%) explained that test negatives may still have the disease. For antibody tests, 12/18 (67%) websites explained that testing positive does not necessarily infer immunity from future infection. Seven (39%) websites selling antibody tests claimed the test had a CE mark, when they were for a different intended use (venous blood rather than finger-prick samples).ConclusionsAt the point of online purchase of home self-sampling COVID-19 tests, users in the UK are provided with incomplete, and, in some cases, misleading information on test accuracy, intended use, and test interpretation. Best practice guidance for communication about tests to the public should be developed and enforced for online sales of COVID-19 tests.
Evidence for B cell maturation but not trained immunity in uninfected infants exposed to hepatitis C virus
Authors: Lutckii Anton , Strunz Benedikt , Zhirkov Anton , Filipovich Olga , Rukoiatkina Elena , Gusev Denis , Lobzin Yuriy , Fischler Björn , Aleman Soo , Sällberg Matti , Björkström Niklas K 
Published: November 2020

ObjectivesVertical transmission of hepatitis C virus (HCV) is rare compared with other chronic viral infections, despite that newborns have an immature, and possibly more susceptible, immune system. It further remains unclear to what extent prenatal and perinatal exposure to HCV affects immune system development in neonates.DesignTo address this, we studied B cells, innate immune cells and soluble factors in a cohort of 62 children that were either unexposed, exposed uninfected or infected with HCV. Forty of these infants were followed longitudinally from birth up until 18 months of age.ResultsAs expected, evidence for B cell maturation was observed with increased age in children, whereas few age-related changes were noticed among innate immune cells. HCV-infected children had a high frequency of HCV-specific IgG-secreting B cells. Such a response was also detected in some exposed but uninfected children but not in uninfected controls. Consistent with this, both HCV-exposed uninfected and HCV-infected infants had evidence of early B cell immune maturation with an increased proportion of IgA-positive plasma cells and upregulated CD40 expression. In contrast, actual HCV viraemia, but not mere exposure, led to alterations within myeloid immune cell populations, natural killer (NK) cells and a distinct soluble factor profile with increased levels of inflammatory cytokines and chemokines.ConclusionOur data reveal that exposure to, and infection with, HCV causes disparate effects on adaptive B cells and innate immune cell such as myeloid cells and NK cells in infants.
Pain patterns in chronic pancreatitis: a nationwide longitudinal cohort study
Authors: Kempeneers Marinus A , Issa Yama , Verdonk Robert C , Bruno Marco , Fockens P , van Goor Harry , Alofs Eline , Bollen Thomas L , Bouwense Stefan , van Dalen Anne S H M , van Dieren Susan , van Dullemen Hendrik M , van Geenen Erwin-Jan , Hoge Chantal , van Hooft Jeanin E , Kager Liesbeth M , Keulemans Yolande , Nooijen Lynn E , Poley Jan-Werner , Seerden Tom C J , Tan Adriaan , Thijs Willem , Timmer Robin , Vleggaar Frank , Witteman Ben , Ahmed Ali Usama , Besselink Marc G , Boermeester Marja A , van Santvoort Hjalmar C 
Published: November 2020

ObjectivePain in chronic pancreatitis is subdivided in a continuous or intermittent pattern, each thought to represent a different entity, requiring specific treatment. Because evidence is missing, we studied pain patterns in a prospective longitudinal nationwide study.Design1131 patients with chronic pancreatitis (fulfilling M-ANNHEIM criteria) were included between 2011 and 2018 in 30 Dutch hospitals. Patients with continuous or intermittent pain were compared for demographics, pain characteristics, quality of life (Short-Form 36), imaging findings, disease duration and treatment. Alternation of pain pattern and associated variables were longitudinally assessed using a multivariable multinomial logistic regression model.ResultsAt inclusion, 589 patients (52%) had continuous pain, 231 patients (20%) had intermittent pain and 311 patients (28%) had no pain. Patients with continuous pain had more severe pain, used more opioids and neuropathic pain medication, and had a lower quality of life. There were no differences between pain patterns for morphological findings on imaging, disease duration and treatment. During a median follow-up of 47 months, 552 of 905 patients (61%) alternated at least once between pain patterns. All alternations were associated with the Visual Analogue Scale pain intensity score and surgery was only associated with the change from pain to no pain.ConclusionContinuous and intermittent pain patterns in chronic pancreatitis do not seem to be the result of distinctly different pathophysiological entities. The subjectively reported character of pain is not related to imaging findings or disease duration. Pain patterns often change over time and are merely a feature of how severity of pain is experienced.
Long-term instability of the intestinal microbiome is associated with metabolic
liver disease, low microbiota diversity, diabetes mellitus and impaired exocrine
pancreatic function
Authors: Frost Fabian , Kacprowski Tim , Rühlemann Malte , Pietzner Maik , Bang Corinna , Franke Andre , Nauck Matthias , Völker Uwe , Völzke Henry , Dörr Marcus , Baumbach Jan , Sendler Matthias , Schulz Christian , Mayerle Julia , Weiss Frank U , Homuth Georg , Lerch Markus M 
Published: November 2020

Objective
The intestinal microbiome affects the prevalence and pathophysiology of a
variety of diseases ranging from inflammation to cancer. A reduced taxonomic or
functional diversity of the microbiome was often observed in association with poorer
health outcomes or disease in general. Conversely, factors or manifest diseases that
determine the long-term stability or instability of the microbiome are largely
unknown. We aimed to identify disease-relevant phenotypes associated with faecal
microbiota (in-)stability.

Design
A total of 2564 paired faecal samples from 1282 participants of the
population-based Study of Health in Pomerania (SHIP) were collected at a 5-year
(median) interval and microbiota profiles determined by 16S
rRNA gene sequencing. The changes in faecal microbiota over time were
associated with highly standardised and comprehensive phenotypic data to determine
factors related to microbiota (in-)stability.

Results
The overall microbiome landscape remained remarkably stable over time. The
greatest microbiome instability was associated with factors contributing to metabolic
syndrome such as fatty liver disease and diabetes mellitus. These, in turn, were
associated with an increase in facultative pathogens such as
Enterobacteriaceae or
Escherichia/Shigella. Greatest stability of the
microbiome was determined by higher initial alpha diversity, female sex, high
household income and preserved exocrine pancreatic function. Participants who newly
developed fatty liver disease or diabetes during the 5-year follow-up already
displayed significant microbiota changes at study entry when the diseases were
absent.

Conclusion
This study identifies distinct components of metabolic liver disease to be
associated with instability of the intestinal microbiome, increased abundance of
facultative pathogens and thus greater susceptibility toward dysbiosis-associated
diseases.
Statistically significant but clinically unimportant: a systematic review and meta-analysis of the analgesic benefits of erector spinae plane block following breast cancer surgery
Authors: Hussain Nasir , Brull Richard , Noble Jordan , Weaver Tristan , Essandoh Michael , McCartney Colin JL , Abdallah Faraj W 
Published: November 2020

The novel erector spinae plane block (ESPB) has been reported to provide important postoperative analgesic benefits following a variety of truncal and abdominal surgical procedures. However, evidence of its analgesic efficacy following breast cancer surgery, compared with parenteral analgesia, is unclear. This meta-analysis evaluates the analgesic benefits of adding ESPB to parenteral analgesia following breast cancer surgery.Databases were searched for breast tumor resection trials comparing ESPB to parenteral analgesia. The two co-primary outcomes examined were 24-hour postoperative oral morphine equivalent consumption and area-under-curve of rest pain scores. We considered reductions equivalent to 3.3 cm.h and 30 mg oral morphine in the first 24 hours postoperatively for the two co-primary outcomes, respectively, to be clinically important. We also assessed opioid-related side effects and long-term outcomes, including health-related quality of life, persistent postsurgical pain and opioid dependence. Results were pooled using random effects modeling.Twelve trials (699 patients) were analyzed. Moderate quality evidence suggested that ESPB decreased 24-hour morphine consumption and area-under-curve of rest pain by a mean difference (95% CI) of −17.60 mg (−24.27 to −10.93) and -2.74 cm.h (−3.09 to −2.39), respectively; but these differences were not clinically important. High-quality evidence suggested that ESPB decreased opioid-related side effects compared with parenteral analgesia by an OR (95% CI) of 0.43 (0.28 to 0.66). None of the studies evaluated long-term block benefits.Adding ESPB to parenteral analgesia provides statistically significant but clinically unimportant short-term benefits following breast cancer surgery. Current evidence does not support routine use of ESPB. Given the very modest short-term benefits and risk of complications, the block should be considered on a case-by-case basis.
Long‐Term Fate of the Truncal Valve
Authors: Gellis Laura , Binney Geoffrey , Alshawabkeh Laith , Lu Minmin , Landzberg Michael J. , Mayer John E. , Mullen Mary P. , Valente Anne Marie , Sleeper Lynn A. , Brown David W. 
Published: November 2020

Background
Long‐term survival in patients with truncus arteriosus is favorable, but there remains significant morbidity associated with ongoing reinterventions. We aimed to study the long‐term outcomes of the truncal valve and identify risk factors associated with truncal valve intervention.

Methods and Results

We retrospectively reviewed patients who underwent initial truncus arteriosus repair at our institution from 1985 to 2016. Analysis was performed on the 148 patients who were discharged from the hospital and survived ≥30 days postoperatively using multivariable competing risks Cox regression modeling. Median follow‐up time was 12.6 years (interquartile range, 5.0–22.1 years) after discharge from full repair. Thirty patients (20%) underwent at least one intervention on the truncal valve during follow‐up. Survival at 1, 10, and 20 years was 93.1%, 87.0%, and 80.9%, respectively. The cumulative incidence of any truncal valve intervention by 20 years was 25.6%. Independent risk factors for truncal valve intervention included moderate or greater truncal valve regurgitation (hazard ratio [HR], 4.77;
P
<0.001) or stenosis (HR, 4.12;
P
<0.001) before full truncus arteriosus repair and moderate or greater truncal valve regurgitation at discharge after full repair (HR, 8.60;
P
<0.001). During follow‐up, 33 of 134 patients (25%) progressed to moderate or greater truncal valve regurgitation. A larger truncal valve root
z
‐score before truncus arteriosus full repair and during follow‐up was associated with worsening truncal valve regurgitation.

Conclusions

Long‐term rates of truncal valve intervention are significant. At least moderate initial truncal valve stenosis and initial or residual regurgitation are independent risk factors associated with truncal valve intervention. Larger truncal valve root
z
‐score is associated with significant truncal valve regurgitation and may identify a subset of patients at risk for truncal valve dysfunction over time.
Tigris Basin Landscapes: Sensitivity of Vegetation Index NDVI to Climate Variability Derived from Observational and Reanalysis Data
Authors: Alhumaima A. S. , Abdullaev S. M. 
Published: November 2020

AbstractThe primary aim of this work is to study the response of the normalized difference vegetation index (NDVI) of landscapes in the lower Tigris basin to current global and regional climate variability presented, respectively, by the global circulation indices and monthly temperatures and precipitation extracted from five observational/reanalysis datasets. The second task is to find the dataset that best reflects the regional vegetation and climate conditions. Comparison of the Köppen–Trewartha bioclimatic landscapes with the positions of botanical districts, land-cover types, and streamflow estimates led to the conclusion that only two datasets correctly describe regional climatic zones. Therefore, searching for the NDVI response to regional climate variability requires the use of normalized analogs of temperatures and precipitations, as well as the Spearman rank correlation. We found that March/April NDVI, as proxies of the maximum biological productivity of the regional landscapes, are strongly correlated with October–March precipitation derived from three datasets and January–March temperatures derived from one dataset. We discovered the significant impact of autumn–winter El Niño–Southern Oscillation and winter Indian Oceanic dipole states on regional weather (e.g., all five recent severe droughts occurred during strong La Niña events). However, the strength of this impact on the vegetation was clearly linked to the zonal landscape type. By selecting pairs of the temperature/precipitation time series that best correlated with NDVI at a given landscape, we have built a synthetic climate dataset. The landscape approach presented in this work can be used to validate the viability of any dataset when assessing the impacts of climate change and variability on weather-dependent components of Earth’s surface.
Timing of Anterior Cruciate Ligament Reconstruction and Relationship With Meniscal Tears: A Systematic Review and Meta-analysis
Authors: Prodromidis Apostolos D. , Drosatou Chrysoula , Thivaios Georgios C. , Zreik Nasri , Charalambous Charalambos P. 
Published: November 2020

Background: Anterior cruciate ligament (ACL) ruptures are common, but the ideal timing for ACL reconstruction after injury is unclear with regard to meniscal insult. Purpose: To determine whether there is a relationship between timing from ACL rupture to ACL reconstruction and development of meniscal tears within this period. Study Design: Systematic review and meta-analysis. Methods: A systematic literature search was undertaken independently by 2 reviewers using the Cochrane method for systematic reviews in 5 online databases. The reviewers performed independent data extraction and assessment of risk of bias and study quality. The search included any comparative study, including randomized controlled trials (RCTs), prospective and retrospective cohort studies, and case-control studies of an adult population, that assessed the relationship between timing of ACL reconstruction surgery and rates of meniscal tears. Results: After screening, 12 studies (No. of participants = 3042) out of 3390 records were included for analysis: 3 RCTs (n = 272), 2 prospective cohort studies (n = 307), and 7 retrospective cohort studies (n = 2463). In analysis of these studies, rates of reported meniscal tears were compared for ACL procedures performed at 3 and 6 months after injury. Meta-analysis of 5 studies (n = 2012) showed that ACL reconstruction performed >3 months after injury was associated with a higher rate of medial meniscal tears compared with ACL reconstruction performed within 3 months of injury (estimated OR, 2.235; 95% CI, 1.183-4.223; P = .013) but not with a higher rate of lateral meniscal tears. Similarly, meta-analysis of 4 studies (n = 990) showed that ACL reconstruction performed >6 months after injury was associated with a higher rate of medial meniscal tears compared with ACL reconstruction performed within 6 months of injury (estimated OR, 2.487; 95% CI, 1.241-4.984; P = .01) but not with a higher rate of lateral meniscal tears. Conclusion: Our results suggest that delay of ACL reconstruction surgery >3 months after injury is associated with a higher rate of medial meniscal tears within this prereconstruction time frame. Further high-quality prospective studies may help determine whether this is a causal effect. However, based on current evidence, in those patients for whom ACL reconstruction is indicated, ACL reconstruction within 3 months of injury may be recommended. Registration: CRD42016032846 (PROSPERO)