bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short‐term outcomes in infants with mild neonatal encephalopathy: a retrospective, observational study
Authors: Aoki Yoshinori , Kono Tatsuo , Enokizono Mikako , Okazaki Kaoru 
Published: May 2021

Abstract
Background
Neonatal encephalopathy due to acute perinatal asphyxia is a major cause of perinatal brain damage. Moderate to severe neonatal encephalopathy is associated with high mortality and morbidity rates. However, the neurodevelopmental outcomes in neonates with mild neonatal encephalopathy are unclear. The primary aim of this single-center observational study was to assess the short-term outcomes in term neonates with mild neonatal encephalopathy due to perinatal asphyxia. A secondary aim was to identify predictors of poor prognosis by identifying the characteristics of these infants according to their short-term outcomes.

Methods
We retrospectively investigated all infants with perinatal asphyxia at Tokyo Metropolitan Children’s Medical Center from January 2014 to December 2019. An abnormal short-term outcome was defined as any one of the following: seizures or abnormal electroencephalography, abnormal brain magnetic resonance imaging obtained within the first 4 weeks of life, and abnormal neurological examination findings at discharge.

Results
In total, 110 term infants with perinatal asphyxia during the study period were screened and 61 were diagnosed with mild neonatal encephalopathy. Eleven (18 %) of these infants had an abnormal short-term outcome. The median Thompson score at admission was significantly higher in infants with abnormal short-term outcomes than in those with normal short-term outcomes (5 [interquartile range, 4-5.5] vs. 2 [interquartile range, 1–3], p < 0.01). Receiver operating characteristic curve analysis showed that a cutoff value of 4 had high sensitivity and specificity (90.9 and 83.0 %, respectively) for prediction of an abnormal short-term outcome.

Conclusions
18 % of infants with mild encephalopathy had an abnormal short-term outcome, such as abnormal brain magnetic resonance imaging findings. The Thompson score at admission may be a useful predictor of an abnormal short-term outcome in infants with mild neonatal encephalopathy.
Quality of pediatric clinical practice guidelines
Authors: Liu Yali , Zhang Yuan , Wang Shu , Liu Ling , Che Gang , Niu Jiahui , Ma Yuan 
Published: May 2021

Abstract
Background
There is a lack of a comprehensive evaluation for pediatric clinical practice guidelines (CPGs) published in recent years. Here, we assessed the quality of pediatric CPGs, considering factors that might affect their quality. The aim of the study is to promote a more coherent development and application of CPGs.

Methods
Pediatric CPGs published in PubMed, MedLive, Guidelines International Network, National Institute for Health and Care Excellence, and World Health Organization between 2017 and 2019 were searched and collected. Paired researchers conducted screening, data extraction, and quality assessment using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Linear regression analysis determined the factors affecting CPGs’ quality.

Results
The study included a total of 216 CPGs, which achieved a mean score of 4.26 out of 7 points (60.86%) in the AGREE II assessment. Only 6.48% of the CPGs reached the “recommend” level. The remaining 69.91% should have been modified before recommendation, while the other 23.61% did not reach the recommended level at all. The overall quality of recent pediatric CPGs was higher than previously, and the proportion of CPGs with low-quality decreased over time. However, there were still too few CPGs that reached a high-quality level. The “applicability” and “rigor of development” domains had generally low scores. CPGs formulated by developing countries or regions, those that are not under an organizations or groups responsibility, and those that used non-evidence-based methods were found to be associated with poorer quality in different domains as independent or combinational factors.

Conclusions
The quality of pediatric CPGs still needs to be improved. Specifically, a quality control before applying new CPGs should be essential to ensure their quality and applicability.
Disentangling substance use and related problems: urgency predicts substance-related problems beyond the degree of use
Authors: Hildebrandt Malin K. , Dieterich Raoul , Endrass Tanja 
Published: May 2021

Abstract
Background
Substance use disorders are reliably associated with high impulsivity and sensation seeking. Importantly, both precede problematic substance use, implicating them as risk factors. Individuals with substance use disorders show variable degrees of substance use (combined quantity and frequency) and substance-related problems and differ in both aspects from healthy controls. Dimensional research has indicated differential associations of impulsivity-related traits as well as sensation seeking with the degree of substance use and substance-related problems. The current study aimed to clarify whether impulsivity-related traits and sensation seeking predict substance-related problems above and beyond the degree of substance use and are thus specifically linked to problems, the dimension that characterizes substance use disorders.

Method
We assessed impulsivity-related traits and sensation seeking using self-report, as well as delay discounting, a behavioral indicator of impulsivity, in a sample of 258 substance-using adults.

Results
Sensation seeking and impulsivity-related traits significantly predicted the degree of substance use, with sensation seeking explaining the largest portion of variance. In contrast, self-reported impulsivity, in particular when experiencing negative emotions (urgency), but not sensation seeking or delay discounting, predicted substance-related problems when controlling for the degree of substance use.

Conclusions
This suggests that urgency, but not sensation seeking, may be specifically linked to substance-related problems and thus especially relevant for substance use disorders. Taken together, this study underlines the necessity to assess and control for the degree of substance use in risk factor research concerning substance-related problems. Thus, it may inform future research improving targeted prevention and therapy.
Assessing the household economic burden of non-communicable diseases in India: evidence from repeated cross-sectional surveys
Authors: Verma Veenapani Rajeev , Kumar Piyush , Dash Umakant 
Published: May 2021

Abstract
Background
Financing for NCDs is encumbered by out-of-pocket expenditure (OOPE) assuming catastrophic proportions. Therefore, it is imperative to investigate the extent of catastrophic health expenditure (CHE) on NCDs, which are burgeoning in India. Thus, our paper aims to examine the extent of CHE and impoverishment in India, in conjunction with socio-economic determinants impacting the CHE.

Methods
We used cross-sectional data from nationwide healthcare surveys conducted in 2014 and 2017–18. OOPE on both outpatient and inpatient treatment was coalesced to estimate CHE on NCDs. Incidence of CHE was defined as proportion of households with OOPE exceeding 10% of household expenditure. Intensity of catastrophe was ascertained by the measure of Overshoot and Mean Positive Overshoot Indices. Further, impoverishing effects of OOPE were assessed by computing Poverty Headcount Ratio and Poverty Gap Index using India’s official poverty line. Concomitantly, we estimated the inequality in incidence and intensity of catastrophic payments using Concentration Indices. Additionally, we delineated the factors associated with catastrophic expenditure using Multinomial Logistic Regression.

Results
Results indicated enormous incidence of CHE with around two-third households with NCDs facing CHE. Incidence of CHE was concentrated amongst poor that further extended from 2014(CI = − 0.027) to 2017–18(CI = − 0.065). Intensity of CHE was colossal as households spent 42.8 and 34.9% beyond threshold in 2014 and 2017-18 respectively with poor enduring greater overshoot vis-à-vis rich (CI = − 0.18 in 2014 and CI = − 0.23 in 2017–18). Significant immiserating impact of NCDs was unraveled as one-twelfth in 2014 and one-eighth households in 2017–18 with NCD burden were pushed to poverty with poverty deepening effect to the magnitude of 27.7 and 30.1% among those already below poverty on account of NCDs in 2014 and 2017–18 respectively. Further, large inter-state heterogeneities in extent of CHE and impoverishment were found and multivariate analysis indicated absence of insurance cover, visiting private providers, residing in rural areas and belonging to poorest expenditure quintile were associated with increased likelihood of incurring CHE.

Conclusion
Substantial proportion of households face CHE and subsequent impoverishment due to NCD related expenses. Concerted efforts are required to augment the financial risk protection to the households, especially in regions with higher burden of NCDs.
Necessity for subsequent surgery in women of child-bearing age with positive margins after conization
Authors: Wang Xinmei , Xu Juan , Gao Yang , Qu Pengpeng 
Published: May 2021

Abstract
Background
20–25% of women with high-grade cervical intraepithelial neoplasias (HSIL) have residual lesions after conization. The state of the margin is generally considered to be a risk factor for recurrence or persistent lesions. Predictors of positive margins and residual lesions need to be identified. A design for postoperative management and avoidance of overtreatment needs to be provided, especially for women of child-bearing age.

Methods
This study was a retrospective analysis of 1309 women of child-bearing age with HSIL, who underwent cold knife conization (CKC). Age, gravidity, parity, human papillomavirus (HPV) species, cytology, transformation zone type, results of endocervical curettage (ECC), quadrant involvement, glandular involvement, and Cervical Intraepithelial Neoplasia (CIN) grade were analyzed. Among those with positive margins, 245 patients underwent secondary surgery within three months, including CKC, a loop electrosurgical excision procedure, and total hysterectomy. Risk factors for positive margins and residual lesions were assessed.

Results
There was no significant difference in age, gravidity, parity, glandular involvement, and CIN grade between the two groups (P > 0.3). There was a significant difference in HPV species, cytology, ECC results, and quadrant involvement (P < 0.002). Multivariate analysis showed a major cytology abnormality, high-risk HPV infection, type III transformation zone, positive ECC result, and multiple quadrant involvement were independent risk factors for positive margins and residual lesions (P < 0.02). Age > 35 years was also a risk factor for residual lesions (P < 0.03).

Conclusion
High-risk women should be treated appropriately considering fertility. Patients with positive margins should be managed uniquely. Surgery for women without fertility may be appropriate. Close follow-up is necessary for women who have fertility requirements or are unwilling to undergo subsequent surgery if they have no risk factors, especially women < 35 years.
Are different medical school admission tests associated with the outcomes of a simulation-based OSCE?
Authors: Bußenius Lisa , Harendza Sigrid 
Published: May 2021

AbstractBackgroundMedical school admission procedures have the common goal to select applicants with the greatest potential of becoming successful physicians. Hamburg Medical Faculty selects medical students by grade point average (GPA) and employs a two-step selection process of a natural sciences test (HAM-Nat), in some cases followed by multiple mini-interviews (HAM-Int). Multiple mini-interviews can predict non-cognitive outcomes, while GPA has predictive validity for cognitive outcomes. The aim of our study was to explore communication skills and clinical knowledge of advanced medical students according to their respective admission procedure.MethodsIn July 2019, 146 students grouped according to their admission procedure into GPA-only (19.2 %), HAM-Nat (33.6 %), HAM-Int (30.8 %), and Waiting List (16.4 %) participated in four OSCE stations which equally assessed students’ communication skills (OSCE part 1) and clinical knowledge (OSCE part 2) in simulated patient encounters, rated by physicians with checklists. Additionally, psychosocial assessors ranked communication skills with a global rating scale (GR). The students also participated in a multiple choice (MC) exam testing clinical knowledge. Kruskal-Wallis analyses of variance of test performance and Spearman correlation of instruments were calculated.ResultsStudents from the Waiting List group performed significantly worse on the MC exam compared to GPA-only and HAM-Int (adjustedp = .029 and 0.018, respectively). No significant differences were found between the admission groups with respect to communication skills. Global Rating and OSCE part 1 (communication) correlated significantly (ρ = 0.228,p = .006) as did OSCE part 2 (clinical knowledge) and MC exam (ρ = 0.242,p = .003), indicating criterion validity. Constructs did not overlap, indicating divergent validity.ConclusionsAdvanced medical students selected for undergraduate studies by multiple mini-interviews assessing psychosocial skills showed similar communication skills compared to students admitted to medical school by other entryways. It is unclear whether these similarities are due to an effective undergraduate longitudinal communication curriculum. Assessing baseline communication skills of all medical students at entry-level may aid with this question.
Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study
Authors: Chapman Lloyd A. C. , Kushel Margot , Cox Sarah N. , Scarborough Ashley , Cawley Caroline , Nguyen Trang Q. , Rodriguez-Barraquer Isabel , Greenhouse Bryan , Imbert Elizabeth , Lo Nathan C. 
Published: May 2021

AbstractBackgroundCOVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks.MethodsWe developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase chain reaction (PCR) surveys conducted during COVID-19 outbreaks in five homeless shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak when an exposed individual is introduced into a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing, and universal mask wearing.ResultsThe proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6 to 51.6%, which translated to the basic reproduction number (R0) estimates of 2.9–6.2. With moderate community incidence (~ 30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk (R0= 1.5), moderate-risk (R0= 2.9), and high-risk (R0= 6.2) shelter were respectively 0.35, 0.13, and 0.04 for daily symptom-based screening; 0.53, 0.20, and 0.09 for twice-weekly PCR testing; 0.62, 0.27, and 0.08 for universal masking; and 0.74, 0.42, and 0.19 for these strategies in combination. The probability of averting an outbreak diminished with higher transmissibility (R0) within the simulated shelter and increasing incidence in the local community.ConclusionsIn high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom screening, frequent PCR testing, and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be employed to reduce outbreak risk.
Prognostic Value of D-dimer in patients with acute coronary syndrome treated by percutaneous coronary intervention: a retrospective cohort study
Authors: Chen Runzhen , Liu Chen , Zhou Peng , Tan Yu , Sheng Zhaoxue , Li Jiannan , Zhou Jinying , Chen Yi , Song Li , Zhao Hanjun , Yan Hongbing 
Published: May 2021

Abstract
Background
Associations between D-dimer and outcomes of patients with acute coronary syndromes (ACS) remain controversial. This study aimed to investigate the prognostic value of D-dimer in ACS patients treated by percutaneous coronary intervention (PCI).

Methods
In this observational study, 3972 consecutive patients with ACS treated by PCI were retrospectively recruited. The X-tile program was used to determine the optimal D-dimer thresholds for risk stratifications. Cox regression with multiple adjustments was used for outcome analysis. Restricted cubic spline (RCS) analysis was performed to assess the dose-response association between D-dimer and outcomes. The C-index was calculated to evaluate the additional prognostic value of D-dimer when added to clinical risk factors and commonly used clinical risk scores, with internal validations using bootstrapping methods. The primary outcome was all-cause death.

Results
During a median follow-up of 720 days, 225 deaths occurred. Based on the thresholds generated by X-tile, ACS-PCI patients with median (420–1150 ng/mL, hazard ratio [HR]: 1.58, 95 % confidence interval [CI]: 1.14–2.20, P = 0.007) and high (≥ 1150 ng/mL, HR: 1.98, 95 % CI: 1.36–2.89, P < 0.001) levels of D-dimer showed substantially higher risk of death compared to those with low D-dimer (< 420 ng/mL). RCS analysis depicted a constant relation between D-dimer and various outcomes. The addition of D-dimer levels significantly improved risk predictions for all-cause death when combined with the fully adjusted models (C-index: 0.853 vs. 0.845, P difference = 0.021), the GRACE score (C-index: 0.826 vs. 0.814, P difference = 0.027), and the TIMI score (C-index: 0.804 vs. 0.776, P difference < 0.001). The predicted mortality at the median follow-up (two years) was 1.7 %, 5.2 %, and 10.9 % for patients with low, median, and high D-dimer, respectively, which was well matched with the observed mortality (low D-dimer group: 1.2 %, median D-dimer group: 5.2 %, and high D-dimer group: 12.6 %).

Conclusions
For ACS patients treated by PCI, D-dimer level was an independent predictor for adverse outcomes, and provided additional prognostic value when combined with clinical risk factors and risk scores. Risk stratifications based on D-dimer was plausible to differentiate ACS-PCI patients with higher risk of death.
Malignant pertussis in infants: factors associated with mortality in a multicenter cohort study
Authors: Coquaz-Garoudet Mathilde , Ploin Dominique , Pouyau Robin , Hoffmann Yoav , Baleine Julien-Frederic , Boeuf Benoît , Patural Hugues , Millet Anne , Labenne Marc , Vialet Renaud , Pinquier Didier , Cotillon Marie , Rambaud Jérôme , Javouhey Etienne 
Published: May 2021

Abstract
Background
Malignant pertussis (MP) affects young infants and is characterized by respiratory distress, perpetual tachycardia and hyperleukocytosis up to 50 G/l, leading to multiple organ failure and death in 75% of cases. Leukodepletion may improve prognosis. A therapeutic strategy based on leukodepletion and extracorporeal life support (ECLS) according to different thresholds of leucocytes has been proposed by Rowlands and colleagues. We aimed at identifying factors associated with death and assess whether the respect of the Rowlands’ strategy is associated with survival.

Methods
We reviewed all MP infants hospitalized in eight French pediatric intensive care units from January 2008 to November 2013. All infants younger than 3 months of age, admitted for respiratory distress with a diagnosis of pertussis and WBC count ≥ 50 G/l were recorded. Evolution of WBC was analyzed and an optimal threshold for WBC growth was obtained using the ROC-curve method. Clinical and biological characteristics of survivors and non-survivors were compared. Therapeutic management (leukodepletion and/or ECLS) was retrospectively assessed for compliance with Rowlands’ algorithm (indication and timing of specific treatments).

Results
Twenty-three infants were included. Nine of 23 (40%) died: they presented more frequently cardiovascular failure (100% vs 36%, p = 0.003) and pulmonary hypertension (PHT; 100% vs 29%, p = 0.002) than survivors and the median [IQR] WBC growth was significantly faster among them (21.3 [9.7–28] G/l/day vs 5.9 [3.0–6.8] G/l/day, p = 0.007).
WBC growth rate > 12 G/l/day and lymphocyte/neutrophil ratio < 1 were significantly associated with death (p = 0.001 and p = 0.003, respectively).
Ten infants (43%) underwent leukodepletion, and seven (30%) underwent ECLS. Management following Rowlands’ strategy was associated with survival (100% vs 0%; p < 0.001, relative risk of death = 0.18, 95%-CI [0.05–0.64]).

Conclusions
A fast leukocyte growth and leukocytosis with neutrophil predominance during acute pertussis infection were associated with death. These findings should prompt clinicians to closely monitor white blood cells in order to early identify infants at risk of fatal outcome during the course of malignant pertussis. Such an early signal in infants at high risk of death would increase feasibility of compliant care to Rowlands’ strategy, with the expectation of a better survival.
Deciphering the role of physical activity in stress management during a global pandemic in older adult populations: a systematic review protocol
Authors: Churchill Ryan , Riadi Indira , Kervin Lucy , Teo Kelly , Cosco Theodore 
Published: May 2021

Abstract
Background
The world has changed dramatically since the beginning of 2020 due to COVID-19. As a result of the pandemic, many older adults are now experiencing an increased and unprecedented amount of psychological stress. Physical activity has been found to be an evidence-based means of combating stress among older adults to promote their quality of life. Studies have demonstrated that those who are physically active experience fewer issues in regard to their mental health, specifically depression and anxiety disorders. Engagement in physical activity may exert a protective influence over stress inducing events and future mental health outcomes. Due to exercise being inexpensive, non-invasive, and effective even via incremental increases in activity level, physical activity interventions should be investigated as a therapy for reducing stress for older adults during the current pandemic.

Methods
Four electronic databases (PubMed, PsycInfo, Web of Science, and SportDiscus) will be searched to identify randomized controlled trials that evaluate the effectiveness of physical activity or exercise programs as a psychological stress management tool in adults 50 years of age or older. Only peer-reviewed and published journal articles will be reviewed. Post-intervention psychological stress measures in comparison to baseline stress will be the primary outcome of interest. All studies will be assessed for bias using Cochrane’s risk of bias tool. A random effects meta-analysis will be investigated if sufficient evidence of homogenous research exists and the heterogeneity of effect sizes will be tabulated.

Discussion
This review will determine the effectiveness of various physical activity interventions for the treatment of psychological stress among the older adult population. This knowledge will help inform care aides, clinicians, family members, and older adults themselves of the most effective physical activity interventions in dealing with stress which is relevant to the ongoing pandemic.

Systematic review registration
PROSPERO CRD42020192546