bluuebunny/crossref_metadata_2025_split huggingface dataset:
Classification and effectiveness of different oxygenation goals in mechanically ventilated critically ill patients: network meta-analysis of randomised controlled trials
Authors: Zhao Xu , Xiao Huaping , Dai Feng , Brodie Daniel , Meng Lingzhong 
Published: February 2021

BackgroundThe optimal oxygenation in mechanically ventilated critically ill patients remains unclear.MethodsWe performed a systematic review of randomised controlled trials (RCTs) with the aim to classify oxygenation goals and investigate their relative effectiveness. RCTs investigating different oxygenation goal-directed mechanical ventilation in critically ill adult patients were eligible for the analysis. The trinary classification classified oxygenation goals into conservative (partial pressure of arterial oxygen (PaO2) 55–90 mmHg), moderate (PaO290–150 mmHg) and liberal (PaO2>150 mmHg). The quadruple classification further divided the conservative goal from the trinary classification into far-conservative (PaO255–70 mmHg) and conservative (PaO270–90 mmHg) goals. The primary outcome was 30-day mortality. The secondary outcomes included intensive care unit, hospital and 90-day mortalities. The effectiveness was estimated by the relative risk and 95% credible interval (CrI) using network meta-analysis and visualised using surface under the cumulative ranking curve (SUCRA) scores and survival curves.ResultsWe identified eight eligible studies involving 2532 patients. There were no differences between conservative and moderate goals (relative risk 1.08, 95% CrI 0.85–1.36; moderate quality), between moderate and liberal goals (relative risk 0.83, 95% CrI 0.61–1.10; low quality) or between conservative and liberal goals (relative risk 0.89, 95% CrI 0.61–1.30; low quality) based on the trinary classification. There were no differences in secondary outcomes among the different goals. The results were consistent between the trinary and quadruple classifications. The SUCRA scores and survival curves suggested that the moderate goal in the trinary and quadruple classifications and the conservative goal in the quadruple classification may be superior to the liberal and far-conservative goals.ConclusionsDifferent oxygenation goals do not lead to different mortalities in mechanically ventilated critically ill patients. The potential superiority of maintainingPaO2in the range 70–150 mmHg remains to be validated.
Comparison of the effectiveness of position change for patients with pain and vascular complications after transfemoral coronary angiography: a randomized clinical trial
Authors: Niknam Sarabi Hojjat , Farsi Zahra , Butler Samantha , Pishgooie Amir Hosein 
Published: February 2021

Abstract
Background
Prolonged immobilization after transfemoral coronary angiography (TFA) may cause pain and vascular complications in patients. This study aimed to evaluate the effectiveness of a change in position to decrease pain and vascular complications for patients after TFA.

Methods
This randomized clinical trial was conducted in 2020. Purposive sampling of 72 eligible patients undergoing TFA were selected and randomly assigned to either an experimental or control group. Patients in the experimental group (EG) were placed in a supine position for 2 h after angiography, followed by a semi-seated position with the bed angle gradually increased to 45° over 4 h. Patients in the control group (CG) remained in the supine position for 6 h. Vital signs, groin, back and leg pain, hematoma, hemorrhage, and urinary retention were assessed in both groups before, immediately after, and over 6 h after angiography. The Visual Analogue Scale was used to measure pain, the Christensen scale to measure hematoma, counting bloody gases to measure hemorrhage, and patient self-rating to determine urinary retention.

Results
There was no significant difference between EG and CG on score of groin (2.69 ± 1.00 vs. 2.61 ± 1.00, P = 0.74), back (2.19 ± 0.98 vs. 2.47 ± 0.87, P = 0.21), and leg pain (2.14 ± 0.71 vs. 2.50 ± 1.08, P = 0.27) before the TFA. However, from the second hour to the sixth hour after the TFA, the pain in the EG was significantly less than the CG (P < 0.001). So that pain in the groin (1.36 ± 0.48 vs. 3.28 ± 0.81), back (1.25 ± 0.50 vs. 3.81 ± 1.06), and leg (1.44 ± 0.55 vs. 3.28 ± 0.81) for the EG patients was significantly less than the CG in the sixth hour after TFA (P < 0.001). No patients experienced hematoma. No differences were noted between groups in hemorrhage and urinary retention.

Conclusions
Position change to a semi-seated position in patients after TFA is effective and safe for reduction of pain without increasing vascular complications.

Trial registration

Iranian Registry of Clinical Trials: IRCT registration number: IRCT20200410047011N1, Registration date: 30/04/2020
Muscle quantity and function measurements are acceptable to older adults during and post- hospitalisation: results of a questionnaire-based study
Authors: Welch Carly , Greig Carolyn , Masud Tahir , Jackson Thomas A. 
Published: February 2021

Abstract
Background
To evaluate the acceptability of handgrip strength, gait speed, quadriceps ultrasound, and Bioelectrical Impedance Analysis (BIA) to older adults conducted during and following hospitalisation.

Methods
Questionnaire-based study conducted upon completion of prospective cohort study, with follow-up in either Queen Elizabeth Hospital Birmingham (QEHB), UK, or participant’s own home following recent admission to QEHB. Outcome measures were acceptability as defined by total multi-domain score for each test (maximum score 35), and by frailty status.

Results
Forty adults aged 70 years and older admitted for emergency abdominal surgery, elective colorectal surgery, or acute bacterial infections (general medicine) participated. Handgrip strength (median 33, IQR 30–35; p = 0.001), gait speed (median 32, IQR 30–35; p = 0.002), ultrasound quadriceps (median 33, IQR 31–35; p = 0.001), and BIA (median 33.5, IQR 31–35; p = 0.001) were considered highly acceptable. Participants responded positively that they enjoyed participating in these tests, and considered these tests of importance. There was no difference in scores between tests (p = 0.166). Individual total test scores did not differ between patients with and without frailty. Qualitative data are also presented on drivers for research participation.

Conclusions
Handgrip strength, gait speed, ultrasound quadriceps, and BIA are acceptable tests to older adults during and following hospitalisation. Our results may serve as standards when evaluating acceptability of other tests.

Trial registration
Prospectively registered February 2019: https://clinicaltrials.gov/ct2/show/NCT03858192
A two-component intervention to improve hand hygiene practices and promote alcohol-based hand rub use among people who inject drugs: a mixed-methods evaluation
Authors: Mezaache Salim , Briand-Madrid Laélia , Rahni Linda , Poireau Julien , Branchu Fiona , Moudachirou Khafil , Wendzinski Yourine , Carrieri Patrizia , Roux Perrine 
Published: February 2021

Abstract
Background
Inconsistent hand hygiene puts people who inject drugs (PWID) at high risk of infectious diseases, in particular skin and soft tissue infections. In healthcare settings, handwashing with alcohol-based hand rubs (ABRH) is recommended before aseptic procedures including intravenous injections. We aimed to evaluate the acceptability, safety and preliminary efficacy of an intervention combining ABHR provision and educational training for PWID.

Methods
A mixed-methods design was used including a pre-post quantitative study and a qualitative study. Participants were active PWID recruited in 4 harm reduction programmes of France and followed up for 6 weeks. After baseline assessment, participants received a face-to-face educational intervention. ABHR was then provided throughout the study period. Quantitative data were collected through questionnaires at baseline, and weeks 2 (W2) and 6 (W6) post-intervention. Qualitative data were collected through focus groups with participants who completed the 6-week study.

Results
Among the 59 participants included, 48 (81%) and 43 (73%) attended W2 and W6 visits, respectively. ABHR acceptability was high and adoption rates were 50% (W2) and 61% (W6). Only a minority of participants reported adverse skin reactions (ranging from 2 to 6%). Preliminary efficacy of the intervention was shown through increased hand hygiene frequency (multivariable linear mixed model: coef. W2 = 0.58, p = 0.002; coef. W6 = 0.61, p = 0.002) and fewer self-reported injecting-related infections (multivariable logistic mixed model: AOR W6 = 0.23, p = 0.021). Two focus groups were conducted with 10 participants and showed that young PWID and those living in unstable housing benefited most from the intervention.

Conclusions
ABHR for hand hygiene prior to injection are acceptable to and safe for PWID, particularly those living in unstable housing. The intervention’s educational component was crucial to ensure adoption of safe practices. We also provide preliminary evidence of the intervention’s efficacy through increased hand hygiene frequency and a reduced risk of infection.
Partnership among hospitals to reduce healthcare associated infections: a quasi-experimental study in Brazilian ICUs
Authors: de Melo Ladjane Santos Wolmer , de Abreu Maria Verônica Monteiro , de Oliveira Santos Bernuarda Roberta , das Graças Washington Casimiro Carr Maria , de Souza Maria Fernanda Aparecida Moura , de Albuquerque Maria Carolina Andrade Lins , de Lacerda Vidal Claudia Fernanda , Lacerda Heloisa Ramos 
Published: February 2021

Abstract
Background
Healthcare-associated infections (HAIs) are relevant in developing countries where frequencies can be at least 3 times higher than in developed countries. The purpose of this research was to describe the intervention implemented in intensive care units (ICUs) to reduce HAIs through collaborative project and analyze the variation over 18 months in the incidence density (ID) of the three main HAIs: ventilator associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs) and catheter-related urinary tract infections (CAUTIs) and also the length of stay and mortality in these ICUs.

Methods
A quasi-experimental study in five public adult clinical-surgical ICUs, to reduce HAIs, through interventions using the BTS-IHI “Improvement Model”, during 18 months. In the project, promoted by the Ministry of Health, Brazilian philanthropic hospitals certified for excellence (HE), those mostly private, certified as excellence and exempt from security contributions, regularly trained and monitored public hospitals in diagnostics, data collection and in developing cycles to improve quality and to prevent HAIs (bundles). In the analysis regarding the length of stay, mortality, the IDs of VAP, CLABSIs and CAUTIs over time, a Generalized Estimating Equation (GEE) model was applied for continuous variables, using the constant correlation (exchangeable) between assessments over time. The model estimated the average difference (β coefficient of the model) of the measures analyzed during two periods: a period in the year 2017 (prior to implementing the project) and in the years 2018 and 2019 (during the project).

Result
A mean monthly reduction of 0.427 in VAP ID (p = 0.002) with 33.8% decrease at the end of the period and 0.351 in CAUTI ID (p = 0.009) with 45% final decrease. The mean monthly reduction of 0.252 for CLABSIs was not significant (p = 0.068). Length of stay and mortality rates had no significant variation.

Conclusions
Given the success in reducing VAP and CAUTIs in a few months of interventions, the achievement of the collaborative project is evident. This partnership among public hospitals/HE may be applied to other ICUs including countries with fewer resources.
Discovery of breast cancer risk genes and establishment of a prediction model based on estrogen metabolism regulation
Authors: Zhao Feng , Hao Zhixiang , Zhong Yanan , Xu Yinxue , Guo Meng , Zhang Bei , Yin Xiaoxing , Li Ying , Zhou Xueyan 
Published: February 2021

Abstract
Background
Multiple common variants identified by genome-wide association studies have shown limited evidence of the risk of breast cancer in Chinese individuals. In this study, we aimed to uncover the relationship between estrogen levels and the genetic polymorphism of estrogen metabolism-related enzymes in breast cancer (BC) and establish a risk prediction model composed of estrogen-metabolizing enzyme genes and GWAS-identified breast cancer-related genes based on a polygenic risk score.

Methods
Unrelated BC patients and healthy subjects were recruited for analysis of estrogen levels and single nucleotide polymorphisms (SNPs) in genes encoding estrogen metabolism-related enzymes. The polygenic risk score (PRS) was used to explore the combined effect of multiple genes, which was calculated using a Bayesian approach. An independent sample t-test was used to evaluate the differences between PRS scores of BC and healthy subjects. The discriminatory accuracy of the models was compared using the area under the receiver operating characteristic (ROC) curve.

Results
The estrogen homeostasis profile was disturbed in BC patients, with parent estrogens (E1, E2) and carcinogenic catechol estrogens (2/4-OHE1, 2-OHE2, 4-OHE2) significantly accumulating in the serum of BC patients. We then established a PRS model to evaluate the role of SNPs in multiple genes. PRS model 1 (M1) was established from SNPs in 6 GWAS-identified high risk genes. On the basis of M1, we added SNPs from 7 estrogen metabolism enzyme genes to establish PRS model 2 (M2). The independent sample t-test results showed that there was no difference between BC and healthy subjects in M1 (P = 0.17); however, there was a significant difference between BC and healthy subjects in M2 (P = 4.9*10− 5). The ROC curve results showed that the accuracy of M2 (AUC = 62.18%) in breast cancer risk identification was better than that of M1 (AUC = 54.56%).

Conclusion
Estrogen and related metabolic enzyme gene polymorphisms are closely related to BC. The model constructed by adding estrogen metabolic enzyme gene SNPs has a good predictive ability for breast cancer risk, and the accuracy is greatly improved compared with that of the PRS model that only includes GWAS-identified gene SNPs.
A geospatiotemporal and causal inference epidemiological exploration of substance and cannabinoid exposure as drivers of rising US pediatric cancer rates
Authors: Reece Albert Stuart , Hulse Gary Kenneth 
Published: February 2021

Abstract
Background
Age-adjusted US total pediatric cancer incidence rates (TPCIR) rose 49% 1975–2015 for unknown reasons. Prenatal cannabis exposure has been linked with several pediatric cancers which together comprise the majority of pediatric cancer types. We investigated whether cannabis use was related spatiotemporally and causally to TPCIR.

Methods
State-based age-adjusted TPCIR data was taken from the CDC Surveillance, Epidemiology and End Results cancer database 2003–2017. Drug exposure was taken from the nationally-representative National Survey of Drug Use and Health, response rate 74.1%. Drugs included were: tobacco, alcohol, cannabis, opioid analgesics and cocaine. This was supplemented by cannabinoid concentration data from the Drug Enforcement Agency and ethnicity and median household income data from US Census.

Results
TPCIR rose while all drug use nationally fell, except for cannabis which rose. TPCIR in the highest cannabis use quintile was greater than in the lowest (β-estimate = 1.31 (95%C.I. 0.82, 1.80), P = 1.80 × 10− 7) and the time:highest two quintiles interaction was significant (β-estimate = 0.1395 (0.82, 1.80), P = 1.00 × 10− 14). In robust inverse probability weighted additive regression models cannabis was independently associated with TPCIR (β-estimate = 9.55 (3.95, 15.15), P = 0.0016). In interactive geospatiotemporal models including all drug, ethnic and income variables cannabis use was independently significant (β-estimate = 45.67 (18.77, 72.56), P = 0.0009). In geospatial models temporally lagged to 1,2,4 and 6 years interactive terms including cannabis were significant. Cannabis interactive terms at one and two degrees of spatial lagging were significant (from β-estimate = 3954.04 (1565.01, 6343.09), P = 0.0012). The interaction between the cannabinoids THC and cannabigerol was significant at zero, 2 and 6 years lag (from β-estimate = 46.22 (30.06, 62.38), P = 2.10 × 10− 8). Cannabis legalization was associated with higher TPCIR (β-estimate = 1.51 (0.68, 2.35), P = 0.0004) and cannabis-liberal regimes were associated with higher time:TPCIR interaction (β-estimate = 1.87 × 10− 4, (2.9 × 10− 5, 2.45 × 10− 4), P = 0.0208). 33/56 minimum e-Values were > 5 and 6 were infinite.

Conclusion
Data confirm a close relationship across space and lagged time between cannabis and TPCIR which was robust to adjustment, supported by inverse probability weighting procedures and accompanied by high e-Values making confounding unlikely and establishing the causal relationship. Cannabis-liberal jurisdictions were associated with higher rates of TPCIR and a faster rate of TPCIR increase. Data inform the broader general consideration of cannabinoid-induced genotoxicity.
Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017
Authors: Amini Maedeh , Zayeri Farid , Salehi Masoud 
Published: February 2021

Abstract
Background
Cardiovascular diseases (CVDs) are one of the global leading causes of concern due to the rising prevalence and consequence of mortality and disability with a heavy economic burden. The objective of the current study was to analyze the trend in CVD incidence, mortality, and mortality-to-incidence ratio (MIR) across the world over 28 years.

Methods
The age-standardized CVD mortality and incidence rates were retrieved from the Global Burden of Disease (GBD) Study 2017 for both genders and different world super regions with available data every year during the period 1990–2017. Additionally, the Human Development Index was sourced from the United Nations Development Programme (UNDP) database for all countries at the same time interval. The marginal modeling approach was implemented to evaluate the mean trend of CVD incidence, mortality, and MIR for 195 countries and separately for developing and developed countries and also clarify the relationship between the indices and Human Development Index (HDI) from 1990 to 2017.

Results
The obtained estimates identified that the global mean trend of CVD incidence had an ascending trend until 1996 followed by a descending trend after this year. Nearly all of the countries experienced a significant declining mortality trend from 1990 to 2017. Likewise, the global mean MIR rate had a significant trivial decrement trend with a gentle slope of 0.004 over the time interval. As such, the reduction in incidence and mortality rates for developed countries was significantly faster than developing counterparts in the period 1990–2017 (p < 0.05). Nevertheless, the developing nations had a more rather shallow decrease in MIR compared to developed ones.

Conclusions
Generally, the findings of this study revealed that there was an overall downward trend in CVD incidence and mortality rates, while the survival rate of CVD patients was rather stable. These results send a satisfactory message that global effort for controlling the CVD burden was quite successful. Nonetheless, there is an urgent need for more efforts to improve the survival rate of patients and lower the burden of this disease in some areas with an increasing trend of either incidence or mortality.
Having less and wanting more: an investigation of socioeconomic status and reinforcement pathology
Authors: Crandall Amanda K. , Ziegler Amanda M. , Mansouri Tegan , Matteson Jalen , Isenhart Emily , Carter Autum , Balantekin Katherine N. , Temple Jennifer L. 
Published: February 2021

Abstract
Background
In the United states obesity and socioeconomic status (SES), or one’s standing in society based on income, education, and/or occupation, are strongly associated. The mechanisms for this relationship may include having high levels of motivation to get food (reinforcing value of food; RRV) and low levels of inhibitory control (delay discounting; DD) which, when combined, is referred to as reinforcement pathology (RP). We sought to examine the relationships among multiple measures of household SES, RP, and age-adjusted body mass index (zBMI) among adolescents.

Methods
These data were collected as part of ongoing longitudinal study of risk factors for obesity in 244 adolescents. The adolescents and one parent/guardian had height and weight measured and completed surveys. The adolescents completed an adjusting amount DD task and a computer-based RRV task. Analyses consisted of correlations among measures of SES and RRV, DD, and BMI z-scores. In the case of significant associations, multiple regression models were created with theoretically informed covariates.

Results
Household income, parent/guardian education, parent/guardian occupation, and food insecurity status were all related to one another. Among the adolescents, a significant portion of the variance in RRV was accounted for by household income after controlling for covariates. For DD, it was parent/guardian education that was most associated after controlling for covariates.

Conclusion
When low income and low parent/guardian education occur together, there may be an increased risk of RP. Separately, food insecurity was predictive of higher parent/guardian BMI. Future research should continue to explore the effects of low income and parent/guardian education on RP among youth by examining them over time.
Plasma mitochondrial DNA levels are associated with acute lung injury and mortality in septic patients
Authors: Mao Jia-yu , Li Dong-kai , Zhang Hong-min , Wang Xiao-ting , Liu Da-wei 
Published: February 2021

Abstract
Background
Mitochondrial DNA (mtDNA) is a critical activator of inflammation. Circulating mtDNA released causes lung injury in experimental models. We hypothesized that elevated plasma mtDNA levels are associated with acute lung injury (ALI) in septic patients.

Methods
We enrolled 66 patients with sepsis admitted to the Department of Critical Care Medicine of Peking Union Medical College Hospital between January 2019 and October 2019. Respiratory, hemodynamic and bedside echocardiographic parameters were recorded. Plasma mtDNA, procalcitonin, interleukin 6, and interleukin 8 levels were examined.

Results
Plasma mtDNA levels within 24 h after admission were significantly increased in the group of septic patients with ALI [5.01 (3.38–6.64) vs 4.13 (3.20–5.07) log copies/µL, p 0.0172]. mtDNA levels were independently associated with mortality (hazard ratio, 3.2052; 95% CI 1.1608–8.8500; p 0.0253) and ALI risk (odds ratio 2.7506; 95% CI 1.1647–6.4959; p 0.0210). Patients with high mtDNA levels had worse outcomes, and post hoc tests showed significant differences in 28-day survival rates. Increased mtDNA levels were seen in patients with abdominal infection.

Conclusions
Increased plasma mtDNA levels within 24 h after admission were significantly associated with ALI incidence and mortality in septic patients.