bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peripherally inserted central venous catheter in upper extremities leads to an increase in D-dimer and deep vein thrombosis in lower extremities
Authors: Liu Wanli , He Lianxiang , Zeng Wenjing , Yue Liqing , Wei Jie , Zeng Shuangshuang , Wang Xiang , Gong Zhicheng 
Published: April 2021

AbstractBackgroundThe purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer.MethodsThis was a retrospective cohort study with 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated.ResultsUnivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 4 times and tripled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs.ConclusionsPICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.
Evaluating medical education regulation changes in Brazil: workforce impact
Authors: Figueiredo Alexandre Medeiros , McKinley Danette Waller , Massuda Adriano , Azevedo George Dantas 
Published: April 2021

Abstract
Background
Shortages and inequitable distribution of physicians is an obstacle to move towards Universal Health Coverage, especially in low-income and middle-income countries. In Brazil, expansion of medical school enrollment, curricula changes and recruitment programs were established to increase the number of physicians in underserved areas. This study seeks to analyze the impact of these measures in reduce inequities in access to medical education and physicians’ distribution.

Methods
This is an observational study that analyzes changes in the number of undergraduate medical places and number of physicians per inhabitants in different areas in Brazil between the years 2010 and 2018. Data regarding the number of undergraduate medical places, number and the practice location of physicians were obtained in public databases. Municipalities with less than 20,000 inhabitants were considered underserved areas. Data regarding access to antenatal visits were analyzed as a proxy for impact in access to healthcare.

Results
From 2010 to 2018, 19,519 new medical undergraduate places were created which represents an increase of 120.2%. The increase in the number of physicians engaged in the workforce throughout the period was 113,702 physicians, 74,771 of these physicians in the Unified Health System. The greatest increase in the physicians per 1000 inhabitants ratio in the municipalities with the smallest population, the lowest Gross Domestic Product per capita and in those located in the states with the lowest concentration of physicians occurred in the 2013–2015 period. Increase in physician supply improved access to antenatal care.

Conclusions
There was an expansion in the number of undergraduate medical places and medical workforce in all groups of municipalities assessed in Brazil. Medical undergraduate places expansion in the federal public schools was more efficient to reduce regional inequities in access to medical education than private sector expansion. The recruitment component of More Doctors for Brazil Program demonstrated effectiveness to increase the number of physicians in underserved areas. Our results indicate the importance of public policies to face inequities in access to medical education and physician shortages and the necessity of continuous assessment during the period of implementation, especially in the context of political and economic changes.
Time trends in pediatric hand fracture incidence in Malmö, Sweden, 1950–2016
Authors: Bergman Erika , Lempesis Vasileios , Jehpsson Lars , Rosengren Björn E. , Karlsson Magnus K. 
Published: April 2021

Abstract
Background
The hand is the second most fractured region in children. It is therefore important to update fracture epidemiology to be able to identify time trends for adequate health care planning. This study reports pediatric hand fracture incidence 2014–2016 and, using published data, also long-term time trends in 1950–2016.

Patients and methods
The Swedish city of Malmö, with 328,494 inhabitants in 2016, has only one hospital. We used the hospital radiological archive, medical charts, and diagnosis registry to identify hand fractures in city residents < 16 years in 2014–2016. These data were compared to those from three published studies that evaluated periods in 1950–2006. Differences between two periods were calculated as both unadjusted and age- and sex-adjusted incident rate ratios (IRR) with 95% confidence intervals (95% CI). We used joinpoint regression to estimate time trends during the entire period and present annual percent changes (APC) with 95% CI.

Results
In 2014–2016 phalangeal fractures accounted for 71% of all hand fractures, metacarpal fractures for 24%, and carpal fractures for 5%. We identified 615 hand fractures (419 in boys and 196 in girls) during 181,617 person-years in 2014–2016, resulting in an unadjusted pediatric hand fracture incidence of 339/100,000 person-years (boys 452/100,000 person-years and girls 220/100,000 person-years). The age-adjusted incidence 2014–2016 was similar to 2005–2006, the most recently evaluated period (IRR in boys 0.9; 95% CI 0.8 to 1.01, and in girls 1.0; 95% CI 0.8 to 1.2). Looking at the entire period 1950–2016, we found that age-adjusted incidence increased in 1950–1979, in boys by APC + 3.8%; 95% CI 3.0 to 4.5 and in girls by + 3.9%; 95% CI 2.8 to 5.0, but decreased in 1979–2016, in boys by − 0.7%; 95% CI − 1.4 to − 0.003, and girls by − 1.3%; 95% CI − 2.4 to − 0.1.

Conclusions
Phalangeal fractures accounted for about three quarters of all hand fractures. The age-adjusted hand fracture incidence increased in both sexes in 1950–1979 and decreased in 1979–2016.

Level of evidence
III
Prevalence of thyroid carcinoma in nodules with thy 3 cytology: the role of preoperative ultrasonography and strain elastography
Authors: Pikis Giorgos , Kandaraki Eleni , Lamnisos Demetris , Abbara Sereen , Kyriakou Katerina , Economides Aliki , Economides Panayiotis A. 
Published: April 2021

AbstractBackgroundFine needle aspiration (FNA) cytology, the gold standard in assessing thyroid nodules, is limited by its inability to determine the true risk of malignancy in Thy 3 nodules. Most patients with Thy3 cytology undergo surgery to establish a histologic diagnosis. The aims of this study were to evaluate the prevalence of malignancy in Thy3 nodules, to examine the ultrasound (US) characteristics that are associated with a high cancer risk and to assess the role of real-time strain elastography.MethodsRetrospective cohort study of 99 nodules with Thy3 cytology in 99 patients who underwent thyroidectomy over a three-year period. Grayscale US, Doppler and real-time strain elastography data were evaluated.ResultsEighty-one nodules (81.82%) were benign, 18 (18.18%) were malignant, and almost all were papillary thyroid carcinoma (PTC). Univariable analysis revealed irregular margins (p = 0.02), ill-defined borders (p ≤ 0.001), a taller than wide shape (p ≤ 0.001) and the elasticity score (p = 0.02) as significant predictors of malignancy. Multivariable analysis showed that ill-defined borders and the elasticity score were significant and independent factors associated with malignancy. All soft nodules (elasticity scores 1–2) were benign (sensitivity 100%, specificity 33%, NPV 100%, and PPV 23%). There was a higher rate of malignancy in Thy3a nodules than in Thy3f nodules (42.86% versus 11.54%) (p ≤ 0.001).ConclusionsIrregular margins, ill-defined borders, a taller than wide shape and low elasticity were associated with malignancy. Elastography should be performed when evaluating Thy3 nodules.
Early stage epithelial ovarian cancer metastasis through peritoneal fluid circulation
Authors: Purbadi Sigit , Anggraeni Tricia Dewi , Vitria Angelina 
Published: April 2021

Abstract
Background
Although epithelial ovarian cancer (EOC) spreads through peritoneal circulation, all patients with clinical early-stage ovarian cancer (OC) benefit from routine surgical staging is still unclear.

Methods
This cross-sectional study used data from medical records of patients with clinical early-stage EOC who received complete surgical staging from 2006 to 2016 at our hospital. We excluded patients with non-epithelial OC or with stage IV disease.

Results
Among 50 patients with clinical early-stage EOC who underwent surgical staging, biopsies showed EOC cells in peritoneal fluid for 12 patients (24%), in peritoneal tissue for ten patients (20%), and omental tissue for eight patients (16%). Of those 50 patients, 40 patients had undergone peritoneal biopsies, and the other five patients also had omental biopsies. The results showed that only one (2.5%) from 40 patients with peritoneal biopsy and three (6.7%) from 45 patients with omental biopsy had no visible nodules. From cytology examination, 3 out of 26 patients (11.5%) showed positive cytology from peritoneal washing.

Conclusions
Routine peritoneal biopsies do not seem advantageous for patients with clinical early-stage EOC as negative visible nodules with positive biopsy results were only 1 in 40 cases. However, further study with a larger cohort is needed to obtain more information on peritoneal fluid metastasis patterns.
Normalization of blood clotting characteristics using prothrombin complex concentrate, fibrinogen and FXIII in an albumin based fluid: experimental studies in thromboelastometry
Authors: Koller Tobias , Kinast Nadia , Castellanos Andres Guilarte , Garcia Sergio Perez , Iglesias Pilar Paniagua , Vintro Xavi León , Arranz Jose Mateo , Seto Noelia Vilalta , García Ma. Victòria Moral , Moreno-Castaño Ana Belén , Aznar-Salatti Jose , Albaladejo Gines Escolar , Diaz-Ricart Maribel 
Published: April 2021

Abstract
Background
Colloid fluids supplemented with adequate combinations of coagulation factor concentrates with the capability to restore coagulation could be a desirable future treatment component in massive transfusion.

Methods
Starting from a coagulation factor and blood cell-free albumin solution we added Prothrombin Complex Concentrate, Fibrinogen Concentrate and Factor XIII in different combinations and concentrations to analyze their properties to restore thromboelastometry parameters without the use of plasma. Further analysis under the presence of platelets was performed for comparability to whole blood conditions.

Results
Albumin solutions enriched with Fibrinogen Concentrate, Factor XIII and Prothrombin Complex Concentrate at optimized concentrations show restoring coagulation potential. Prothrombin Complex Concentrate showed sufficient thrombin formation for inducing fibrinogen polymerization. The combination of Prothrombin Complex Concentrate and Fibrinogen Concentrate led to the formation of a stable in vitro fibrin clot. Fibrinogen and Factor XIII showed excellent capacity to improve fibrin clot firmness expressed as Amplitude at 10 min and Maximal Clot Firmness. Fibrinogen alone, or in combination with Factor XIII, was able to restore normal Amplitude at 10 min and Maximal Clot Firmness values. In the presence of platelets, the thromboelastometry surrogate parameter for thrombin generation (Clotting Time) improves and normalizes when compared to whole blood.

Conclusions
Combinations of coagulation factor concentrates suspended in albumin solutions can restore thromboelastometry parameters in the absence of plasma. This kind of artificial colloid fluids with coagulation-restoring characteristics might offer new treatment alternatives for massive transfusion.

Trial registration
Study registered at the institutional ethic committee “Institut de Recerca, Hospital Santa Creu i Sant Pau, with protocol number IIBSP-CFC-2013-165.
Impact of national guidelines on use of BRCA1/2 germline testing, risk management advice given to women with pathogenic BRCA1/2 variants and uptake of advice
Authors:   for the ICCon Audit Study Collaborative Group, Meiser Bettina , Kaur Rajneesh , Morrow April , Peate Michelle , Wong W. K. Tim , McPike Emily , Cops Elisa , Nichols Cassandra , Austin Rachel , Fine Miriam , Thrupp Letitia , Ward Robyn , Macrae Finlay , Hiller Janet E. , Trainer Alison H. , Mitchell Gillian 
Published: April 2021

Abstract
Background
This nationwide study assessed the impact of nationally agreed cancer genetics guidelines on use of BRCA1/2 germline testing, risk management advice given by health professionals to women with pathogenic BRCA1/2 variants and uptake of such advice by patients.

Methods
Clinic files of 883 women who had initial proband screens for BRCA1/2 pathogenic variants at 12 familial cancer clinics between July 2008–July 2009 (i.e. before guideline release), July 2010–July 2011 and July 2012–July 2013 (both after guideline release) were audited to determine reason given for genetic testing. Separately, the clinic files of 599 female carriers without a personal history of breast/ovarian cancer who underwent BRCA1/2 predictive genetic testing and received their results pre- and post-guideline were audited to ascertain the risk management advice given by health professionals. Carriers included in this audit were invited to participate in a telephone interview to assess uptake of advice, and 329 agreed to participate.

Results
There were no significant changes in the percentages of tested patients meeting at least one published indication for genetic testing - 79, 77 and 78% of files met criteria before guideline, and two-, and four-years post-guideline, respectively (χ = 0.25, p = 0.88). Rates of documentation of post-test risk management advice as per guidelines increased significantly from pre- to post-guideline for 6/9 risk management strategies. The strategies with the highest compliance amongst carriers or awareness post-release of guidelines were annual magnetic resonance imaging plus mammography in women 30–50 years (97%) and annual mammography in women > 50 years (92%). Of women aged over 40 years, 41% had a risk-reducing bilateral mastectomy. Amongst women aged > 40 years, 75% had a risk-reducing salpingo-oophorectomy. Amongst women who had not had a risk-reducing bilateral mastectomy, only 6% took risk-reducing medication. Fear of side-effects was cited as the main reasons for not taking these medicines by 73% of women.

Conclusions
Guidelines did not change the percentages of tested patients meeting genetic testing criteria but improved documentation of risk management advice by health professionals. Effective approaches to enhance compliance with guidelines are needed to improve risk management and quality of care.
Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis
Authors: Yasuda Hideto , Okano Hiromu , Mayumi Takuya , Narita Chihiro , Onodera Yu , Nakane Masaki , Shime Nobuaki 
Published: April 2021

AbstractBackgroundHigh-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, and COT) in reducing the mortality and reintubation risk.MethodsThe Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients who were aged ≥ 16 years, underwent invasive mechanical ventilation for > 12 h for acute respiratory failure, and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effect meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared.ResultsAfter evaluating 4631 records, 15 studies and 2600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval] 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared to COT use. The associations of mortality with NPPV and HFNC use with respect to either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval] 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively).ConclusionNPPV or HFNC use may not reduce the risk of short-term mortality; however, they may reduce the risk of endotracheal reintubation.Trial registration number and date of registrationPROSPERO (registration number: CRD42020139112, 01/21/2020).
Giving schools a nudge: can behavioural insights improve recruitment of schools to randomised controlled trials?
Authors: Warner Georgina , Osman Fatumo , McDiarmid Serena , Sarkadi Anna 
Published: April 2021

Abstract
Objective
It is widely acknowledged that recruitment to randomised controlled trials (RCTs) is challenging, particularly trials that operate across multiple sites. A research area in need of further high-quality evaluation, including RCTs, is school-based mental health interventions for refugee children and adolescents. However, engaging schools with interventions and associated evaluations can be challenging. This paper explores the application of behavioural insights, i.e. evidence-based understanding of how people behave and make decisions, to RCT recruitment at the school level via email communications. A pilot study of applying behavioural insights to mail outs attempting to recruit schools to a RCT of a trauma-focused group intervention for refugee children and adolescents experiencing symptoms of post-traumatic stress is reported. Rates of school involvement between the behavioural insights approach (n = 31) and a standard outreach approach (n = 65) are compared.

Results
Schools were more likely to give a positive response to the mail out designed using the behavioural insights framework than standard outreach. Accounts of recruitment strategies such as this are valuable additions to the literature on RCT methodology given the potential for recruitment issues to affect trial operations.
Boundedness of composition operators on Morrey spaces and weak Morrey spaces
Authors: Hatano Naoya , Ikeda Masahiro , Ishikawa Isao , Sawano Yoshihiro 
Published: April 2021

AbstractIn this study, we investigate the boundedness of composition operators acting on Morrey spaces and weak Morrey spaces. The primary aim of this study is to investigate a necessary and sufficient condition on the boundedness of the composition operator induced by a diffeomorphism on Morrey spaces. In particular, detailed information is derived from the boundedness, i.e., the bi-Lipschitz continuity of the mapping that induces the composition operator follows from the continuity of the composition mapping. The idea of the proof is to determine the Morrey norm of the characteristic functions, and employ a specific function composed of a characteristic function. As this specific function belongs to Morrey spaces but not to Lebesgue spaces, the result reveals a new phenomenon not observed in Lebesgue spaces. Subsequently, we prove the boundedness of the composition operator induced by a mapping that satisfies a suitable volume estimate on general weak-type spaces generated by normed spaces. As a corollary, a necessary and sufficient condition for the boundedness of the composition operator on weak Morrey spaces is provided.
Local Muckenhoupt class for variable exponents
Authors: Nogayama Toru , Sawano Yoshihiro 
Published: April 2021

AbstractThis work extends the theory of Rychkov, who developed the theory of$A_{p}^{\mathrm{loc}}$Aplocweights. It also extends the work by Cruz-Uribe SFO, Fiorenza, and Neugebauer. The class$A_{p(\cdot )}^{\mathrm{loc}}$Ap(⋅)locis defined. The weighted inequality for the local Hardy–Littlewood maximal operator on Lebesgue spaces with variable exponents is proven. Cruz-Uribe SFO, Fiorenza, and Neugebauer considered the Muckenhoupt class for Lebesgue spaces with variable exponents. However, due to the setting of variable exponents, a new method for extending weights is needed. The proposed extension method differs from that by Rychkov. A passage to the vector-valued inequality is realized by means of the extrapolation technique. This technique is an adaptation of the work by Cruz-Uribe and Wang. Additionally, a theory of extrapolation adapted to our class of weights is also obtained.
Dip angles of active faults from the surface to the seismogenic zone inferred from a 2D numerical analysis of visco-elasto-plastic models: a case study for the Osaka Plain
Authors: Nishiwaki Hayami , Okudaira Takamoto , Ishii Kazuhiko , Mitamura Muneki 
Published: April 2021

AbstractThe geometries (i.e., dip angles) of active faults from the surface to the seismogenic zone are the most important factors used to evaluate earthquake ground motion, which is crucial for seismic hazard assessments in urban areas. In Osaka, a metropolitan city in Japan, there are several active faults (e.g., the Uemachi and Ikoma faults), which are inferred from the topography, the attitude of active faults in surface trenches, the seismic reflection profile at shallow depths (less than 2 km), and the three-dimensional distribution of the Quaternary sedimentary layers. The Uemachi and Ikoma faults are N–S-striking fault systems with total lengths of 42 km and 38 km, respectively, with the former being located ~ 12 km west of the latter; however, the geometries of each of the active faults within the seismogenic zone are not clear. In this study, to examine the geometries of the Uemachi and Ikoma faults from the surface to the seismogenic zone, we analyze the development of the geological structures of sedimentary layers based on numerical simulations of a two-dimensional visco-elasto-plastic body under a horizontal compressive stress field, including preexisting high-strained weak zones (i.e., faults) and surface sedimentation processes, and evaluate the relationship between the observed geological structures of the Quaternary sediments (i.e., the Osaka Group) in the Osaka Plain and the model results. As a result, we propose geometries of the Uemachi and Ikoma faults from the surface to the seismogenic zone. When the friction coefficient of the faults is ~ 0.5, the dip angles of the Uemachi and Ikoma faults near the surface are ~ 30°–40° and the Uemachi fault has a downward convex curve at the bottom of the seismogenic zone, but does not converge to the Ikoma fault. Based on the analysis in this study, the dip angle of the Uemachi fault zone is estimated to be approximately 30°–40°, which is lower than that estimated in the previous studies. If the active fault has a low angle, the width of the fault plane is long, and thus the estimated seismic moment will be large.