bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experiences with opt-in, at-home screening for SARS-CoV-2 at a primary school in Germany: an implementation study
Authors: Wachinger Jonas , Schirmer Maximilian , Täuber Nicole , McMahon Shannon A , Denkinger Claudia M 
Published: October 2021

BackgroundOver the course of the pandemic, many countries have repeatedly closed schools and shifted schoolchildren to remote learning. However, evidence for negative mental and physiological health consequences of such measures for schoolchildren is increasing, highlighting the need for evidence-based recommendations on how to safely reopen schools. This study aims to assess implementation experiences, acceptability and feasibility of opt-in, at-home SARS-CoV-2 screening using rapid diagnostic tests (RDTs) to facilitate safe face-to-face teaching during a pandemic.MethodsWe present data from a prospective study implementing an RDT-based screening programme at a primary school in southwest Germany. In addition to quantitative data collected to assess screening diagnostic yield (number of participants, tests handed out to participants, positive RDT results reported), we conducted qualitative in-depth interviews with participating pupils, parents and school stakeholders to elicit implementation experiences and screening perceptions.ResultsThe screening intervention was highly accepted and appreciated among participants; no screening-associated positive RDT was reported over the duration of the study. Self-testing at home before coming to school was feasible, but more positive consequences of screening participation (eg, easing of mask mandates) besides a personal feeling of safety would have been appreciated across respondent groups. Participants preferred home-based RDTs over some other measures, particularly mask mandates. Despite the RDTs being licensed as self-tests in Germany, additional training can help avoid mistakes, and ensuring intervention ownership and improving pre-implementation communication can facilitate buy-in.ConclusionsAntigen-RDT-based SARS-CoV-2 screening programmes relying on self-testing at home are a feasible and acceptable supplement to the public health toolbox to facilitate a safe return to face-to-face teaching at schools.Trial registration numberDRKS00024845.
Assessing the development status of intraoperative fluorescence imaging for perfusion assessments, using the IDEAL framework
Authors: Ishizawa Takeaki , McCulloch Peter , Muehrcke Derek , Carus Thomas , Wiesel Ory , Dapri Giovanni , Schneider-Koriath Sylke , Wexner Steven D , Abu-Gazala Mahmoud , Boni Luigi , Cassinotti Elisa , Sabbagh Charles , Cahill Ronan , Ris Frederic , Carvello Michele , Spinelli Antonino , Vibert Eric , Terasawa Muga , Takao Mikiya , Hasegawa Kiyoshi , Schols Rutger M , Pruimboom Tim , Murai Yasuo , Matano Fumihiro , Bouvet Michael , Diana Michele , Kokudo Norihiro , Dip Fernando , White Kevin , Rosenthal Raul J 
Published: October 2021

ObjectivesIntraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: assessing tissue perfusion; identifying/localizing cancer; mapping lymphatic systems; and visualizing anatomy. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging for perfusion assessments using the Idea, Development,Exploration, Assessment, Long Term Study (IDEAL) framework, which was designed for describing the stages of innovation in surgery and other interventional procedures.DesignNarrative literature review with analysis of IDEAL stage of each field of study.SettingAll publications on intraoperative fluorescence imaging for perfusion assessments reported in PubMed through 2019 were identified for six surgical procedures: coronary artery bypass grafting (CABG), upper gastrointestinal (GI) surgery, colorectal surgery, solid organ transplantation, reconstructive surgery, and cerebral aneurysm surgery.Main outcome measuresThe IDEAL stage of research evidence was determined for each specialty field using a previously described approach.Results196 articles (15 003 cases) were selected for analysis. Current status of research evidence was determined to be IDEAL Stage 2a for upper GI and transplantation surgery, IDEAL 2b for CABG, colorectal and cerebral aneurysm surgery, and IDEAL Stage 3 for reconstructive surgery. Using the technique resulted in a high (up to 50%) rate of revisions among surgical procedures, but its efficacy improving postoperative outcomes has not yet been demonstrated by randomized controlled trials in any discipline. Only one possible adverse reaction to intravenous indocyanine green was reported.ConclusionsUsing fluorescence imaging intraoperatively to assess perfusion is feasible and appears useful for surgical decision making across a range of disciplines. Identifying the IDEAL stage of current research knowledge aids in planning further studies to establish the potential for patient benefit.
Spiritual interventions for cancer pain: a systematic review and narrative synthesis
Authors: Hindmarch Thomas , Dalrymple James , Smith Matthew , Barclay Stephen 
Published: October 2021

BackgroundPain is a common and debilitating cancer-related symptom. In palliative care, physical, psychological, social and spiritual factors are thought to contribute to individual experience of pain. Consequently, spiritual care interventions are advocated in the management of cancer-related pain.AimTo systematically review the published literature concerning spiritual interventions in the management of cancer-related pain.MethodologySeven databases (Medline, CINAHL, EMBASE, PsycINFO, Cochrane, Scopus and Web of Science) were searched for quantitative studies of pain in patients with cancer receiving spiritual care interventions, with additional reference and citation searches. Research quality and relevance was appraised using Gough’s ‘Weight of Evidence’ framework prior to narrative synthesis.ResultsThe search identified 12 822 articles, of which 11 were included in the synthesis. Few studies have investigated spiritual interventions in the management of cancer pain: a minority of these demonstrate statistical benefit. Some evidence suggests spiritual care may aid in coping with pain, rather than altering pain intensity. Spiritual interventions are well received by patients with cancer and do not appear to cause harm.ConclusionCurrent evidence provides limited support for the use of spiritual care interventions in the management of cancer pain. The paucity and heterogeneity of literature points to a need for high-quality research with judgements of spiritual intervention efficacy made on an individual basis.PROSPERO registration numberCRD42020190194.
Humoral immunity to SARS-CoV-2 mRNA vaccination in multiple sclerosis: the relevance of time since last rituximab infusion and first experience from sporadic revaccinations
Authors: König Marton , Lorentzen Åslaug Rudjord , Torgauten Hilde Marie , Tran The Trung , Schikora-Rustad Stine , Vaage Eline Benno , Mygland Åse , Wergeland Stig , Aarseth Jan , Aaberge Ingeborg Aase S , Torkildsen Øivind , Holmøy Trygve , Berge Tone , Myhr Kjell-Morten , Harbo Hanne Flinstad , Andersen Jan Terje , Munthe Ludvig Andre , Søraas Arne , Celius Elisabeth Gulowsen , Vaage John Torgils , Lund-Johansen Fridtjof , Nygaard Gro Owren 
Published: October 2021

IntroductionThe effect of disease-modifying therapies (DMT) on vaccine responses is largely unknown. Understanding the development of protective immunity is of paramount importance to fight the COVID-19 pandemic.ObjectiveTo characterise humoral immunity after mRNA-COVID-19 vaccination of people with multiple sclerosis (pwMS).MethodsAll pwMS in Norway fully vaccinated against SARS-CoV-2 were invited to a national screening study. Humoral immunity was assessed by measuring anti-SARS-CoV-2 SPIKE RBD IgG response 3–12 weeks after full vaccination, and compared with healthy subjects.Results528 pwMS and 627 healthy subjects were included. Reduced humoral immunity (anti-SARS-CoV-2 IgG <70 arbitrary units) was present in 82% and 80% of all pwMS treated with fingolimod and rituximab, respectively, while patients treated with other DMT showed similar rates as healthy subjects and untreated pwMS. We found a significant correlation between time since the last rituximab dose and the development of humoral immunity. Revaccination in two seronegative patients induced a weak antibody response.ConclusionsPatients treated with fingolimod or rituximab should be informed about the risk of reduced humoral immunity and vaccinations should be timed carefully in rituximab patients. Our results identify the need for studies regarding the durability of vaccine responses, the role of cellular immunity and revaccinations.
Relational aspects of regulating clinical work: examining electronic and in-person compliance mechanisms
Authors: Bajpai Kartikeya , Chown Jillian , Astik Gopi , Green Kristine 
Published: October 2021

BackgroundClinical documentation quality is an important way to facilitate clinical communication, improve patient safety metrics and optimise hospital coding and public reporting. However, the monitoring of clinicians by external individuals (ie, those outside the profession or emanating from outside clinical teams) raises difficult questions relating to the autonomy of clinicians and an organisation’s control over clinical work. Typically, documentation improvement initiatives have relied solely on electronic monitoring systems to vet clinician documentation. In such systems, quality personnel monitor clinical documentation and, on encountering potentially problematic content, use an electronic querying system to ask the clinicians to voluntarily clarify or modify the text if appropriate. Importantly, clinicians retain their professional autonomy and can choose to disagree with documentation requests. The current study empirically examines a clinical documentation improvement program which takes a different approach. This programme uses two modes of querying clinicians: (1) conventional electronic documentation clarification queries and (2) in-person verbal documentation clarification requests.MethodsWe conducted regression analyses using archival documentation query data (n=19 650) from an American teaching hospital to compare the efficacy of conventional electronic documentation clarification queries and in-person verbal documentation clarification requests. Our dependent variable is the length of time between the documentation clarification request and the resolution of the query (ie, the time until a clinician responds).FindingsOur analyses demonstrate that in-person verbal documentation clarification requests are associated with a 30-hour reduction in the time it takes for a query to be resolved relative to electronic-only queries.Practical implicationsThe results suggest that while electronic regulatory systems might afford hospitals with opportunities to scale quality initiatives in a cost-effective manner, organisational efforts to influence clinical work may yet benefit from the human touch of in-person regulator–clinician interaction. Furthermore, the replacement of in-person compliance interactions with digital compliance requests can potentially produce negative compliance outcomes.
PRospective Evaluation of natriuretic peptide-based reFERral of patients with chronic heart failure in primary care (PREFER): a real-world study
Authors: Hobbs FD Richard , Hussain Rizwan I , Vitale Cristina , Pinto Yigal M , Bueno Hector , Lequeux Benoit , Pauschinger Matthias , Obermeier Michael , Ferber Philippe C , Gustafsson Finn 
Published: October 2021

ObjectiveTo assess current management practice of heart failure with reduced ejection fraction (HFrEF) in multinational primary care (PC) and determine whether N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP)-guided referral of HFrEF patients from PC to a cardiologist could improve care, defined as adherence to European Society of Cardiology (ESC) guideline-recommended pharmacotherapy.MethodsPRospective Evaluation of natriuretic peptide-based reFERral of patients with chronic HF in PC (PREFER) study enrolled HFrEF patients from PC considered clinically stable and those with NT-pro-BNP ≥600 pg/mL were referred to a cardiologist for optimisation of HF treatment. The primary outcome of adherence to ESC HF guidelines after referral to specialist was assessed at the second visit within 4 weeks of cardiologist’s referral and no later than 6 months after the baseline visit. Based on futility interim analysis, the study was terminated early.ResultsIn total, 1415 HFrEF patients from 223 PCs from 18 countries in Europe were enrolled. Of these, 1324 (96.9%) were considered clinically stable and 920 (65.0%) had NT-pro-BNP ≥600 pg/mL (mean: 2631 pg/mL). In total, 861 (60.8%) patients fulfilled both criteria and were referred to a cardiologist. Before cardiologist consultation, 10.1% of patients were on ESC guideline-recommended HFrEF medications and 2.7% were on recommended dosages of HFrEF medication (defined as ≥50% of ESC guideline-recommended dose). Postreferral, prescribed HFrEF drugs remained largely unchanged except for an increase in diuretics (+4.6%) and mineralocorticoid receptor antagonists (+7.9%). No significant increase in patients’ adherence to guideline-defined drug combinations (11.2% post-referral vs 10.1% baseline) or drug combinations and dosages (3.3% postreferral vs 2.7% baseline) was observed after cardiologist consultation.ConclusionsPREFER demonstrates substantial suboptimal treatment of HFrEF patients in the real world. Referral of patients with elevated NT-pro-BNP levels from PC to cardiologist did not result in meaningful treatment optimisation for treatments with known mortality and morbidity benefit.
Valve disease and aortopathy associations of bicuspid aortic valve phenotypes differ between men and women
Authors: Granath Carl , Mohamed Salah A , Olsson Christian , Grattan Michael , Mertens Luc , Franco-Cereceda Anders , Björck Hanna M 
Published: October 2021

ObjectiveDetermine whether associations between bicuspid aortic valve (BAV) phenotypes, valve disease and aortopathy differ between sexes.Methods1045 patients with BAV (76.0% men, n=794) from two surgical centres were included in this cross-sectional study. Valve phenotype was classified intraoperatively as right–left (RL), right-non-coronary (RN), left-non-coronary (LN) or 2-sinus BAV. Echocardiography was used to determine type and degree of valve disease, and aortic dimensions. Aortic dilatation was defined as diameter ≥4.5 cm.ResultsRL was the most common phenotype (73.6%), followed by RN (16.2%), 2-sinus BAV (9.2%) and LN (1.1%), with no difference in phenotype distribution between men and women (p=0.634). Aortic valve insufficiency (AI) prevalence differed significantly with valve phenotype in men (p=0.047), with RL and LN having the highest prevalence (34.1% and 44.0%, respectively). In women, RN had a higher proportion of AI than RL (21.3% vs 7.3%, p=0.017). Men with RL had larger root dimensions, in particular at the sinus (mean difference 0.24 cm compared with RN, p=0.002). Men with 2-sinus BAV had the highest prevalence of root phenotype dilatation (7.0%, other phenotypes ≤2.3%, p=0.031), whereas women with 2-sinus BAV did not have root dilatation and smaller sinus dimensions (mean difference: 0.35 cm compared with RL, p=0.021). Aortic root segments were larger in men with AI compared with aortic stenosis (sinus mean difference: 0.40 cm, p<0.001). The difference was even larger in women (mean difference: 0.78 cm, p<0.001), and women with AI also had larger tubular segments (mean difference: 0.61 cm, p=0.001).ConclusionsThere are significant sex differences in clinical associations of BAV phenotypes, which should be considered in further studies on the role of phenotypes in individualised patient management.
TNFi is associated with positive outcome, but JAKi and rituximab are associated with negative outcome of SARS-CoV-2 infection in patients with RMD
Authors: Regierer Anne Constanze , Hasseli Rebecca , Schäfer Martin , Hoyer Bimba F , Krause Andreas , Lorenz Hanns-Martin , Pfeil Alexander , Richter Jutta , Schmeiser Tim , Schulze-Koops Hendrik , Strangfeld Anja , Voll Reinhard E , Specker Christof , Mueller-Ladner Ulf 
Published: October 2021

IntroductionSeveral risk factors for severe COVID-19 specific for patients with inflammatory rheumatic and musculoskeletal diseases (RMDs) have been identified so far. Evidence regarding the influence of different RMD treatments on outcomes of SARS-CoV-2 infection is still poor.MethodsData from the German COVID-19-RMD registry collected between 30 March 2020 and 9 April 2021 were analysed. Ordinal outcome of COVID-19 severity was defined: (1) not hospitalised, (2) hospitalised/not invasively ventilated and (3) invasively ventilated/deceased. Independent associations between demographic and disease features and outcome of COVID-19 were estimated by multivariable ordinal logistic regression using proportional odds model.Results2274 patients were included. 83 (3.6%) patients died. Age, male sex, cardiovascular disease, hypertension, chronic lung diseases and chronic kidney disease were independently associated with worse outcome of SARS-CoV-2 infection. Compared with rheumatoid arthritis, patients with psoriatic arthritis showed a better outcome. Disease activity and glucocorticoids were associated with worse outcome. Compared with methotrexate (MTX), TNF inhibitors (TNFi) showed a significant association with better outcome of SARS-CoV-2 infection (OR 0.6, 95% CI0.4 to 0.9). Immunosuppressants (mycophenolate mofetil, azathioprine, cyclophosphamide and ciclosporin) (OR 2.2, 95% CI 1.3 to 3.9), Janus kinase inhibitor (JAKi) (OR 1.8, 95% CI 1.1 to 2.7) and rituximab (OR 5.4, 95% CI 3.3 to 8.8) were independently associated with worse outcome.ConclusionGeneral risk factors for severity of COVID-19 play a similar role in patients with RMDs as in the normal population. Influence of disease activity on COVID-19 outcome is of great importance as patients with high disease activity—even without glucocorticoids—have a worse outcome. Patients on TNFi show a better outcome of SARS-CoV-2 infection than patients on MTX. Immunosuppressants, rituximab and JAKi are associated with more severe course.
Production performance and metabolic characteristics of cows fed whole plant faba bean silage in comparison with barley and corn silage
Authors: Guevara-Oquendo Victor H. , Christensen David A. , Refat Basim , Rodriguez-Espinosa Maria E. , Feng Xin , Yu Peiqiang 
Published: October 2021

This study aims to determine the effect of partial (50% and 75%) and complete (100%) replacement of barley and corn silage with whole plant faba bean silage on milk production, feed intake and efficiency, digestibility, and rumen fermentation characteristics of high producing cows. A repeated 4 × 4 Latin square (early lactating cows: four cannulated and four non-cannulated) design was used. The silage used for four treatments were different: control diet (T0; 18.37% corn silage + 12.23% barley silage), diet one (T50; 9.18% corn silage + 6.12% barley silage + 15.30% faba bean silage), diet two (T75; 4.59% corn silage + 3.06% barley silage + 22.95% faba bean silage), and diet three (T100; 30.60% faba bean silage). The results showed that fat corrected milk (3.5% FCM) and energy corrected milk (ECM) were linearly increased with increasing level of whole plant faba bean silage in the diets. The starch digestibility was linearly decreased from 95.3% to 90.4% with increasing supplementation using faba bean silage. Rumen fermentation characteristics (pH, ammonia, volatile fatty acids) were similar among all the treatments. In conclusion, the inclusion of whole plant faba bean silage improved FCM, ECM, milk fat yield, and efficiency without negatively affecting the intake of dry matter. This study showed that whole plant faba bean silage can be used as an alternative feed for dairy cows.
Force dynamics and the gravitational collapse of compact stellar objects
Authors: Bogadi Robert S. , Govender Megandhren , Moyo Sibusiso 
Published: October 2021

AbstractWe investigate the nature of the forces involved during the collapse of a compact stellar object such as an unstable neutron star. The collapse ensues from an initial static configuration described by the Vaidya–Tikekar solution until the time of formation of the horizon. As the object collapses it radiates energy to the exterior spacetime in the form of a radial heat flux. The matching of the interior to the exterior Vaidya spacetime determines the temporal behaviour of the solution. Utilizing a dynamical Tolman–Oppenheimer–Volkoff equation, we investigate the evolution of the various forces at play within the collapsing fluid sphere. A novel connection has been made between structurally fundamental quantities (forces) and the spacetime geometry of the gravitational formalism used.
Optimization of Lactic Acid Production from Pineapple By-Products and an Inexpensive Nitrogen Source Using Lactiplantibacillus plantarum strain 4O8
Authors: Ngouénam Joel Romial , Kaktcham Pierre Marie , Momo Kenfack Chancel Hector , Foko Kouam Edith Marius , Ngoufack François Zambou 
Published: October 2021

Lactic acid (LA) is used in food, cosmetic, chemical, and pharmaceutical industries and has recently attracted much attention in the production of biodegradable polymers. The expensive substances including carbon and nitrogen sources involved in its fermentative synthesis and the increasing market demand of LA have prompted scientists to look for inexpensive raw materials from which it can be produced. This research was aimed at determining the optimum conditions of lactic acid (LA) production from pineapple by-products and an inexpensive nitrogen source using Lactiplantibacillus plantarum strain 4O8. After collection and preparation of the carbon source (pineapple by-products) and nitrogen sources (by-products from fish, chicken, and beer brewing industries), they were used for the formulation of 4 different media in terms of nitrogen sources. Then, the proximate compositions of promising nitrogen sources were determined. This was followed by the screening of factors (temperature, carbon source, nitrogen source, MgSO4, MnSO4, FeSO4, KH2PO4, and KHPO4) influencing the production of LA using the definitive plan. Lastly, the optimization process was done using the central composite design. The highest LA productions (

14.64
±
0.05

g
/
l

and

13.4
±
0.02

g
/
l

) were obtained in production medium supplemented with chicken and fish by-products, respectively, making them the most promising sources of nitrogen. The proximate analysis of these nitrogen sources revealed that their protein contents were

83.00
±
1.41
%

DM and

74.00
±
1.41
%

DM for chicken by-products and fish by-products, respectively. Concerning the screening of factors, temperature, nitrogen source, and carbon source were the factors that showed a major impact on LA production in the production medium containing chicken by-products as nitrogen source. A pineapple by-product concentration of 141.75 g/l, a nitrogen source volume of 108.99 ml/l, and a temperature of 30.89°C were recorded as the optimum conditions for LA production. The optimization led to a 2.73-fold increase in LA production when compared with the production medium without nitrogen source. According to these results, chicken by-products are a promising and an inexpensive nitrogen source that can be an alternative to yeast extract in lactic acid production.