bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neuromodulatory therapies for patients with prolonged disorders of consciousness
Authors: Wu Yue-Hao , Yu Jie , Hong Li-Rong , Luo Ben-Yan 
Published: March 2021

Abstract

Background:
Reviving patients with prolonged disorders of consciousness (DOCs) has always been focused and challenging in medical research. Owing to the limited effectiveness of available medicine, recent research has increasingly turned towards neuromodulatory therapies, involving the stimulation of neural circuits. We summarised the progression of research regarding neuromodulatory therapies in the field of DOCs, compared the differences among different studies, in an attempt to explore optimal stimulation patterns and parameters, and analyzed the major limitations of the relevant studies to facilitate future research.

Methods:
We performed a search in the PubMed database, using the concepts of DOCs and neuromodulation. Inclusion criteria were: articles in English, published after 2002, and reporting clinical trials of neuromodulatory therapies in human patients with DOCs.

Results:
Overall, 187 published articles met the search criteria, and 60 articles met the inclusion criteria. There are differences among these studies regarding the clinical efficacies of neurostimulation techniques for patients with DOCs, and large-sample studies are still lacking.

Conclusions:
Neuromodulatory techniques were used as trial therapies for DOCs wherein their curative effects were controversial. The difficulties in detecting residual consciousness, the confounding effect between the natural course of the disease and therapeutic effect, and the heterogeneity across patients are the major limitations. Large-sample, well-designed studies, and innovations for both treatment and assessment are anticipated in future research.
Association between cumulative blood pressure and long-term risk of cardiovascular disease: findings from the 26-year Chinese Multi-provincial Cohort Study-Beijing Project
Authors: Liu Shuai , Zhao Dong , Wang Miao , Qi Yue , Sun Jia-Yi , Liu Jun , Li Yan , Liu Jing 
Published: March 2021

Abstract

Background:
Cumulative blood pressure (BP), a measure incorporating the level and duration of BP exposure, is associated with the risk of cardiovascular disease (CVD). However, the level at which cumulative BP could significantly increase the risk remains unclear. This study aimed to investigate the association of 15-year cumulative BP levels with the long-term risk of CVD, and to examine whether the association is independent of BP levels at one examination.

Methods:
Data from a 26-year follow-up of the Chinese Multi-provincial Cohort Study-Beijing Project were analyzed. Cumulative BP levels between 1992 and 2007 were calculated among 2429 participants free of CVD in 2007. Cardiovascular events (including coronary heart disease and stroke) occurring from 2007 to 2018 were registered. Adjusted hazard ratios (HRs) for CVD incidence associated with quartiles of cumulative systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated.

Results:
Of the 2429 participants, 42.9% (1042) were men, and the mean age in 2007 was 62.1 ± 7.9 years. Totally, 207 CVD events occurred during the follow-up from 2007 to 2018. Participants with higher levels of cumulative SBP or DBP exhibited a higher incidence rate of CVD (P < 0.001). Compared with the lowest quartile of cumulative SBP, the HR for CVD was 1.03 (95% confidence interval [CI]: 0.59–1.81), 1.69 (95% CI: 0.99–2.87), and 2.20 (95% CI: 1.21–3.98) for the second to the fourth quartile of cumulative SBP, and 1.46 (95% CI: 0.86–2.48), 1.99 (95% CI: 1.18–3.35), and 2.08 (95% CI: 1.17–3.71) for the second to the fourth quartile of cumulative DBP, respectively. In further cross-combined group analyses with BP measurements in 2007, 15-year cumulative BP levels higher than the median, that is, 1970.8/1239.9 mmHg·year for cumulative SBP/DBP, which were equivalent to maintaining SBP/DBP levels of 131/83 mmHg or above on average in 15 years, were associated with higher risk of CVD in subsequent years independent of BP measurements at one-time point.

Conclusion:
Cumulative exposure to moderate elevation of BP is independently associated with increased future cardiovascular risk.
Lower Levels of Trust in the Medical Profession Among White, Younger, and More-educated Individuals With Cancer
Authors: Grant Stephen , Liao Kaiping , Miller Christopher , Peterson Susan , Elting Linda , Guadagnolo B. Ashleigh 
Published: March 2021

Introduction:
Levels of medical mistrust have historically been higher among racial/ethnic minority patients compared with whites, largely owing to societal and health system inequities and history of discrimination or experimentation. However, recently trust in physicians has declined in the United States in general. We investigated trust in physicians among a large cohort of cancer patients residing in Texas.

Methods:
A sample of recently diagnosed cancer patients in Texas were identified from the Texas Cancer Registry with 1344 patients returning surveys between March 2017 and March 2020. The multiscale inventory was mailed to each individual and included the Trust in the Medical Profession Scale which assesses levels of agreement with 11 trust-related statements. Multivariable linear regression models were constructed to assess the adjusted relationship between trust in the medical profession aggregate score and sociodemographic and clinical factors.

Results:
A total of 1250 surveys were evaluable for trust in the medical profession. The mean aggregate trust score for all patients was 37.3 (95% confidence interval: 36.8-37.7). Unadjusted trust scores were higher for Hispanic (40.5) and black (38.2) respondents compared with white (36.4) (P<0.001). Multivariable analyses showed white, younger, more-educated, or those with lower levels of self-reported health estimated toward lower adjusted scores for trust in the medical profession.

Conclusions:
We observed relatively higher levels of medical mistrust among white, younger, more-educated individuals with cancer or those with poorer health. While the relatively higher trust among minority individuals is encouraging, these findings raise the possibility that recent societal trends toward mistrust in science may have implications for cancer care.
Immunologic and Epidemiologic Drivers of Norovirus Transmission in Daycare and School Outbreaks
Authors: Havumaki Joshua , Eisenberg Joseph N. S. , Mattison Claire P. , Lopman Benjamin A. , Ortega-Sanchez Ismael R. , Hall Aron J. , Hutton David W. , Eisenberg Marisa C. 
Published: March 2021

Background:
Norovirus outbreaks are notoriously explosive, with dramatic symptomology and rapid disease spread. Children are particularly vulnerable to infection and drive norovirus transmission due to their high contact rates with each other and the environment. Despite the explosive nature of norovirus outbreaks, attack rates in schools and daycares remain low with the majority of students not reporting symptoms.

Methods:
We explore immunologic and epidemiologic mechanisms that may underlie epidemic norovirus transmission dynamics using a disease transmission model. Towards this end, we compared different model scenarios, including innate resistance and acquired immunity (collectively denoted ‘immunity’), stochastic extinction, and an individual exclusion intervention. We calibrated our model to daycare and school outbreaks from national surveillance data.

Results:
Including immunity in the model led to attack rates that were consistent with the data. However, immunity alone resulted in the majority of outbreak durations being relatively short. The addition of individual exclusion (to the immunity model) extended outbreak durations by reducing the amount of time that symptomatic people contribute to transmission. Including both immunity and individual exclusion mechanisms resulted in simulations where both attack rates and outbreak durations were consistent with surveillance data.

Conclusions:
The epidemiology of norovirus outbreaks in daycare and school settings cannot be well described by a simple transmission model in which all individuals start as fully susceptible. More studies on how best to design interventions which leverage population immunity and encourage more rigorous individual exclusion may improve venue-level control measures. See video abstract at http://links.lww.com/EDE/B795.
Instability of Variable-selection Algorithms Used to Identify True Predictors of an Outcome in Intermediate-dimension Epidemiologic Studies
Authors: Cadiou Solène , Slama Rémy 
Published: March 2021

Background:
Machine-learning algorithms are increasingly used in epidemiology to identify true predictors of a health outcome when many potential predictors are measured. However, these algorithms can provide different outputs when repeatedly applied to the same dataset, which can compromise research reproducibility. We aimed to illustrate that commonly used algorithms are unstable and, using the example of Least Absolute Shrinkage and Selection Operator (LASSO), that stabilization method choice is crucial.

Methods:
In a simulation study, we tested the stability and performance of widely used machine-learning algorithms (LASSO, Elastic-Net, and Deletion-Substitution-Addition [DSA]). We then assessed the effectiveness of six methods to stabilize LASSO and their impact on performance. We assumed that a linear combination of factors drawn from a simulated set of 173 quantitative variables assessed in 1,301 subjects influenced to varying extents a continuous health outcome. We assessed model stability, sensitivity, and false discovery proportion.

Results:
All tested algorithms were unstable. For LASSO, stabilization methods improved stability without ensuring perfect stability, a finding confirmed by application to an exposome study. Stabilization methods also affected performance. Specifically, stabilization based on hyperparameter optimization, frequently implemented in epidemiology, increased the false discovery proportion dramatically when predictors explained a low share of outcome variability. In contrast, stabilization based on stability selection procedure often decreased the false discovery proportion, while sometimes simultaneously lowering sensitivity.

Conclusions:
Machine-learning methods instability should concern epidemiologists relying on them for variable selection, as stabilizing a model can impact its performance. For LASSO, stabilization methods based on stability selection procedure (rather than addressing prediction stability) should be preferred to identify true predictors.
Lessons from COVID-19 mortality data across countries
Authors: Corrao Giovanni , Rea Federico , Blangiardo Gian Carlo 
Published: March 2021

Objective:
Several online sources provide up-to-date open-access data on numbers, rates and proportions of COVID-19 deaths. Our article aims of comparing and interpreting between-country trends of mortality rate, case-fatality and all-cause excess mortality.

Methods:
We used data from open databases (Our World in Data mostly) for comparing mortality of eleven western countries (Austria, Belgium, Canada, France, Germany, Italy, Netherlands, Spain, Sweden, UK, USA). Between-country trends in mortality rate and case-fatality (both including deaths for COVID-19 as numerator and therefore labelled as COVID-19 mortality metrics) and all-cause excess mortality (i.e. observed deaths during the epidemic compared with those expected based on mortality in the same periods of previous years) were compared.

Results:
Although Belgium ranks first in mortality from COVID-19 (possibly due to the broadest criterion for attributing a death to COVID-19), it does not rank first for all-cause excess mortality. Conversely, compared with Belgium, the UK, Italy and Spain have reported lower COVID-19 mortality (possibly due to the narrower definitions for a COVID-19 death) but higher all-cause excess mortality. Germany and Austria are the unique countries for which COVID-19 mortality, case-fatality and all-cause excess mortality consistently exhibited the lowest rates.

Conclusion:
Between-country heterogeneity of COVID-19 mortality metrics could be largely explained by differences of criteria for attributing a death to COVID-19; in age/comorbidity structures; in policies for identifying asymptomatic people affected from SARS-CoV-2 infection. All-cause excess mortality is recommended as a more reliable metric for comparing countries.
How to Estimate QT Interval in Patients With Left or Right Bundle Branch Block
Authors: Fredholm Kristian , Højlund Mikkel , Bjerregaard Mads Rye , Nielsen Jens Cosedis , Fink-Jensen Anders , Correll Christoph U. 
Published: March 2021

Abstract

Purpose/Background
Prolonged QT interval related to psychopharmacological treatment is a risk factor for potentially life-threatening arrhythmias. Electrocardiographic measurements are recommended in patients with cardiovascular risk factors before initiating treatment with potentially QT-prolonging medications, such as certain antidepressants or antipsychotics. In patients with left bundle branch block (LBBB) or right bundle branch block (RBBB), conventional QT-estimation methods will lead to overestimation of the QT interval, as the conduction defect, reflected by the QRS duration, will increase the QT interval without representing longer repolarization as in drug-induced QT prolongation.

Methods/Procedures
We conducted a systematic review of methods to estimate QT interval in the presence of LBBB or RBBB. We searched electronic databases Embase and Medline (last search, August 12, 2020).

Findings/Results
We found 8 different methods, including linear correction formulae with and without correction for heart rate, or simpler formula correcting QRS duration with empirically derived modifiers. Only 3 of 8 methods were applicable in the presence of RBBB, whereas all 8 methods could be applied in the presence of LBBB.

Implications/Conclusions
The QT interval is overestimated in patients with LBBB or RBBB, when using conventional measurements. Several alternative correction formulae exist, which can be applied using standard measurements from ordinary electrocardiographic readings. However, it is currently unknown whether or not the QT prolongation observed in the presence of bundle branch block significantly increases the risk of arrhythmias, as these formulae have not been tested against patient-specific clinical outcomes.
Nursing Leadership in COVID-19 Education—Chronologic Indexing of Information and Assurance of Receipt of Information
Authors: Baghchechi Mohsen , Saldana Irene , Jacob Sharon E. 
Published: March 2021

ABSTRACT
In December 2019, a cluster of patients in Wuhan, Hubei Province, China, presented with severe atypical pneumonia. Because of the association with a novel coronavirus strain, the disease was coined COVID-19. Preventing the spread of the virus through extensive education became the primary intervention point in the containment of COVID-19. Resource and labor mapping shifted to adapt to the pandemic. Nurse practitioners have transitioned to frontline community health and prevention roles in safety education and regulatory resource management.
Iron deficiency in infancy: current insights
Authors: Berglund Staffan K. , Domellöf Magnus 
Published: March 2021

Purpose of review
Iron deficiency is the most common micronutrient deficiency and infants are at particular risk. The purpose of this review is to summarize recent studies that explored the metabolism of iron in infants as well as the risks and benefits of iron supplementation in different populations.

Recent findings
The ability of infants to regulate iron homeostasis is not fully known but most likely different from adults. Reducing iron deficiency has beneficial effects on neurodevelopment but iron overload may have adverse functional effects including diarrhea and even poor neurodevelopment. Recent studies have confirmed benefits of delayed cord clamping and supplementation of infants in risk groups while iron supplementation to pregnant women has shown limited effect in the offspring with regard to iron status and neurodevelopment. Further support is given to the recommendation that exclusive breast feeding, without supplementation, is safe for normal birth weight infants until 6 months whereafter an iron-rich diet should be given.

Summary
Iron deficiency negatively impacts global health but efforts to identify optimal interventions are progressing. Yet, questions remain, particularly regarding long-term risks, benefits and optimal interventions for low birth weight infants as well as the level of iron fortification in infant formula.
COVID-19 new diagnostics development: novel detection methods for SARS-CoV-2 infection and considerations for their translation to routine use
Authors: Huggett Jim F. , Moran-Gilad Jacob , Lee J. Eugene 
Published: March 2021

Purpose of review
COVID-19 has put the in-vitro-diagnostic community under an unprecedented spotlight, with a global requirement for accurate SARS-CoV-2 tests. This review will outline technological responses to this need and the analytical considerations required for their translation to routine use.

Recent findings
SARS-CoV-2 diagnostic solutions directly detect the virus or measure host-derived surrogate markers of infection. With pressure upon supply chains for the ‘traditional’ molecular approaches, a wide variety of analytical tools spanning the molecular, serology, imaging and chemistry space are being developed, including high throughput solutions and simplified near-patient formats.

Summary
The unique genetic nature of SARS-CoV-2 means high analytical specificity is achievable by most diagnostic formats. However, clinical sensitivity assessment is complicated by wide discrepancies in analytical range and challenges associated with standardising these differences. When coupled with the acute nature of SARS-CoV-2 infection, reported precise metrics of test performance must be questioned. The response to SARS-CoV-2 has delivered considerable diagnostic innovation, but for a technology to be maximised, it must be demonstrably reproducible and fit for purpose. If novel diagnostic solutions for SARS-CoV-2 are to succeed, equally innovative mechanisms are needed to ensure widespread clinical and surveillance application, enabling agreed standards and metrics to ensure comparability.
A network meta-analysis protocol of efficacy and safety evaluation of different surgery regimens for varicocele patients with infertility
Authors: Zhao Xiao-dong , Ma Xiao-ling , Ma Peng-cheng , Wang Jian-wen 
Published: March 2021

Abstract

Background:
Surgical treatment of varicocele is still one of the most common important treatments for male infertility. Surgery regimens for varicocele (VC) is various, including high ligation, sub-inguinal, inguinal, retroperitoneal, laparoscopic, and microsurgery. The surgery regimens applied for VC patients are various in clinic, however, the significance, advantages, and disadvantages of different varicocelectomies for male infertility are still in controversial. Therefore, this network meta-analysis is mainly to assess the relative efficacy and safety of different surgery regimens for VC patients with infertility.

Methods:
To compare the relative efficacy and safety among different varicocelectomies for VC patients, we systematic searched randomized controlled trials (RCTs) and non-RCTs were in five electronic databases: Pubmed, Web of Science, EMBASE database, Clinical Trials, and Cochrane Library. Using R-3.4.1 software to process and analyze data. The bias risk of RCTs and non-RCTs will be evaluated through the tool of Cochrane Handbook version 5.1.0 and non-randomized studies of interventions (ROBINS-I), respectively.

Results and conclusion:
The result of this network meta-analysis aim is to evaluate the relative effectiveness and safety and rank the interventions among all surgery methods for VC patients and provide more evidence-based guidance in clinical practice.

Protocol registration number:
CRD42020162051.
Oral high dose vitamin D for the treatment of diabetic patients with COVID-19
Authors: Nie Xiaoya , Chen Jiaoxue , Ye Fang , Wang Hui , Tang Liang , Wang Lang 
Published: March 2021

Abstract

Background:
Type 2 diabetes mellitus patients complicated with infections experience severe vitamin D deficiency. High-dose vitamin D is applied to the treatment of corona virus disease 2019 (COVID-19) by some researchers, and good results have been achieved. However, the efficacy of vitamin D in the treatment of infections in COVID-19 patients with diabetes remains unclarified. This study aims to explore the effect of oral high-dose vitamin D in the treatment of diabetic patients with COVID-19.

Methods:
Randomized controlled trials about the application of high-dose vitamin D in the treatment of diabetic patients with COVID-19 will be retrieved from such electronic databases as Embase, PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure database, Chinese Wanfang database and Chinese Biomedical Literature database. The retrieval time is from their inception to December 2020. According to the pre-designed inclusion/exclusion criteria, the data will be extracted independently by two researchers. The risk of bias of the included studies will be assessed by the Cochrane collaboration's tool. Meta-analysis will be conducted by using Revman 5.3 software.

Results:
A high-quality and comprehensive evaluation of oral high-dose vitamin D for the treatment of diabetic patients with COVID-19 will be made.

Conclusion:
The article will provide more convincing evidence and evidence-based guidance for clinical practice.

Ethics and dissemination:
The private information of individuals will not be made public, and this systematic evaluation will also not infringe on the rights of participants. Ethical approval is not required. Research results may be published in a peer-reviewed journal or disseminated in relevant conferences.

PROSPERO Registration Number:
CRD42020214284.
Low back pain
Authors: Zuo Jianjian , Pan Xuming , Shen Weiqiang 
Published: March 2021

Abstract

Objective:
To establish whether early use of magnetic resonance imaging (MRI) or computed tomography (CT) influences treatment and outcome of patients with low back pain.

Methods:
This study will be implemented from March 2021 to March 2022 at Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University. The experiment was granted through the Research Ethics Committee of Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University (R609320987). Patients who have symptomatic lumbar spine disorders at presentation are eligible for the trial if there is clinical uncertainty about the need for imaging (MRI or CT). Patients are excluded who required immediate referral for imaging (those who had signs suggestive of serious abnormalities or disease or who required surgical intervention), who have undergone MR imaging or CT of the spine within 1 year, who do not need imaging, and who have pain of a nonspinal origin. The primary outcome measure is the Aberdeen Low Back Pain (ALBP) score. Other principal outcome measure is the Short Form 36.

Results:
Table 1 will show the quality of life outcome measures between groups.

Conclusion:
This study may guide the policy makers to develop an evidence-based protocol to assess the effect of early use of MRI or CT in the treatment of patients with low back pain.