bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of point-of-care tests in the management of febrile children: a qualitative study of hospital-based doctors and nurses in England
Authors: Li Edmond , Dewez Juan Emmanuel , Luu Queena , Emonts Marieke , Maconochie Ian , Nijman Ruud , Yeung Shunmay 
Published: May 2021

ObjectivesThe use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers’ views about their use in febrile children. The aim of this study was to explore the perceptions of hospital-based doctors and nurses regarding the use of POCTs in England.Study designQualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically.SettingTwo university teaching hospitals in London and Newcastle.Participants24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses).ResultsThere were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1–2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely.ConclusionIn this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinicians in different settings will be critical in ensuring the optimal design and deployment of current and future tests.
Evaluating quality in adolescent mental health services: a systematic review
Authors: Quinlan-Davidson Meaghen , Roberts Kathryn J , Devakumar Delan , Sawyer Susan M. , Cortez Rafael , Kiss Ligia 
Published: May 2021

ObjectivesTo evaluate the quality of adolescent mental health service provision globally, according to the WHO Global Standards of adolescent mental health literacy, appropriate package of services and provider competencies.Design and data sourcesSystematic review of 5 databases, and screening of eligible articles, from 1 January 2008 to 31 December 2020.Study eligibility criteriaWe focused on quantitative and mixed-method studies that evaluated adolescent mental health literacy, appropriate package of services and provider competencies in mental health services, and that targeted depression, anxiety and post-traumatic stress disorder among adolescents (10–19 years). This included adolescents exposed to interventions or strategies within mental health services.Study appraisal and synthesis methodsStudy quality was assessed using the National Institutes for Health Study Quality Assessment Tools. Data were extracted and grouped based on WHO quality Standards.ResultsOf the 20 104 studies identified, 20 articles were included. The majority of studies came from high-income countries, with one from a low-income country. Most of the studies did not conceptualise quality. Results found that an online decision aid was evaluated to increase adolescent mental health literacy. Studies that targeted an appropriate package of services evaluated the quality of engagement between the therapist and adolescent, patient-centred communication, mental health service use, linkages to mental health services, health facility culture and intensive community treatment. Provider competencies focused on studies that evaluated confidence in managing and referring adolescents, collaboration between health facility levels, evidence-based practices and technology use.Conclusions and implicationsThere is limited evidence on quality measures in adolescent mental health services (as conforms to the WHO Global Standards), pointing to a global evidence gap for adolescent mental health services. There are several challenges to overcome, including a need to develop consensus on quality and methods to measure quality in mental health settings.PROSPERO registration numberCRD42020161318.
Barriers-enablers-ownership approach: a mixed methods analysis of a social intervention to improve surgical antibiotic prescribing in hospitals
Authors: Broom Jennifer , Broom Alex , Anstey Chris , Kenny Katherine , Young Sharon , Grieve David , Sowden David , Jangam Aishwarya , Henderson Andrew , Melon Alexandra , Tabone Renee , Farquhar Drew , Harding Henry , Panahi Seyed Ehsan , Chin Tyler , Abdullah Mariya , Waterhouse Louise , Lo Clarissa , Parker Rhiannon , Bui The Lan , Wallis Marianne C 
Published: May 2021

ObjectivesTo assess an intervention for surgical antibiotic prophylaxis (SAP) improvement within surgical teams focused on addressing barriers and fostering enablers and ownership of guideline compliance.DesignThe Queensland Surgical Antibiotic Prophylaxis (QSAP) study was a multicentre, mixed methods study designed to address barriers and enablers to SAP compliance and facilitate engagement in self-directed audit/feedback and assess the efficacy of the intervention in improving compliance with SAP guidelines. The implementation was assessed using a 24-month interrupted time series design coupled with a qualitative evaluation.SettingThe study was undertaken at three hospitals (one regional, two metropolitan) in Australia.ParticipantsSAP-prescribing decisions for 1757 patients undergoing general surgical procedures from three health services were included. Six bimonthly time points, pre-implementation and post implementation of the intervention, were measured. Qualitative interviews were performed with 29 clinical team members. SAP improvements varied across site and time periods.InterventionQSAP embedded ownership of quality improvement in SAP within surgical teams and used known social influences to address barriers to and enablers of optimal SAP prescribing.ResultsThe site that reported senior surgeon engagement showed steady and consistent improvement in prescribing over 24 months (prestudy and poststudy). Multiple factors, including resource issues, influenced engagement and sites/time points where these were present had no improvement in guideline compliance.ConclusionsThe barriers-enablers-ownership model shows promise in its ability to facilitate prescribing improvements and could be expanded into other areas of antimicrobial stewardship. Senior ownership was a predictor of success (or failure) of the intervention across sites and time periods. The key role of senior leaders in change leadership indicates the critical need to engage other specialties in the stewardship agenda. The influence of contextual factors in limiting engagement clearly identifies issues of resource distributions/inequalities within health systems as limiting antimicrobial optimisation potential.
Cross-sectional survey on physician burnout during the COVID-19 pandemic in Vancouver, Canada: the role of gender, ethnicity and sexual orientation
Authors: Khan Nadia , Palepu Anita , Dodek Peter , Salmon Amy , Leitch Heather , Ruzycki Shannon , Townson Andrea , Lacaille Diane 
Published: May 2021

ObjectiveTo determine the prevalence of physician burnout during the pandemic and differences by gender, ethnicity or sexual orientation.Design, setting and participantsWe conducted a cross-sectional survey (August–October in 2020) of internal medicine physicians at two academic hospitals in Vancouver, Canada.Primary and secondary outcomesPhysician burnout and its components, emotional exhaustion, depersonalisation and personal accomplishment were measured using the Maslach Burnout Inventory.ResultsThe response rate was 38% (n=302/803 respondents, 49% women,). The prevalence of burnout was 68% (emotional exhaustion 63%, depersonalisation 39%) and feeling low personal accomplishment 22%. In addition, 21% reported that they were considering quitting the profession or had quit a position. Women were more likely to report emotional exhaustion (OR 2.00, 95% CI: 1.07 to 3.73, p=0.03) and feeling low personal accomplishment (OR 2.26, 95% CI: 1.09 to 4.70, p=0.03) than men. Visible ethnic minority physicians were more likely to report feeling lower personal accomplishment than white physicians (OR 1.81, 95% CI: 1.28 to 2.55, p=0.001). There was no difference in emotional exhaustion or depersonalisation by ethnicity or sexual orientation. Physicians who reported that COVID-19 affected their burnout were more likely to report any burnout (OR: 3.74, 95% CI: 1.99 to 7.01, p<0.001) and consideration of quitting or quit (OR: 3.20, 95% CI: 1.34 to 7.66, p=0.009).ConclusionBurnout affects 2 out of 3 internal medicine physicians during the pandemic. Women, ethnic minority physicians and those who feel that COVID-19 affects burnout were more likely to report components of burnout. Further understanding of factors driving feelings of low personal accomplishment in women and ethnic minority physicians is needed.
Left ventricular twist predicts mortality in severe aortic stenosis
Authors: Erhart Ladina , Donati Thierry , Anwer Shehab , Schindler Matthias , Gremminger Miriam , Renzulli Melanie , Kuzo Nazar , Walther Anna L , Zürcher Dominik , Hosseini Sara , Eberhard Matthias , Stähli Barbara E , Tanner Felix C 
Published: May 2021

ObjectiveLeft ventricular (LV) twist is a major component of ventricular mechanics reflecting the helical orientation of cardiac fibres and compensating for afterload mismatch. However, it is not known whether it determines outcome after transcatheter aortic valve implantation (TAVI). This study sought to investigate TAVI-induced short-term changes of LV twist and to define its role in outcome prediction.MethodsA total of 146 patients (median age 81.78 years, 50.7% male) undergoing TAVI for severe aortic stenosis were included. LV rotation and twist were determined by speckle tracking echocardiography within 3 months before and 2 weeks after TAVI. All-cause mortality at 2 years was defined as primary end point.ResultsPatients who survived exhibited a higher apical peak systolic rotation (APSR) (p<0.001), twist (p=0.003) and torsion (p=0.019) pre-TAVI compared with those who died (n=22). Within 2 weeks after TAVI, APSR, twist and torsion decreased in patients who survived (all p<0.001), while no change occurred in those who died. Cox regression analysis showed an association of pre-TAVI APSR (HR 0.92, p=0.010), twist (HR 0.93, p=0.018) and torsion (HR 0.68, p=0.040) with all-cause mortality and an even stronger association of the respective changes after TAVI (∆APSR: HR 1.15, p<0.001; ∆twist: HR 1.14, p<0.001; ∆torsion: HR 2.53, p<0.001). All the parameters determined outcome independently of global longitudinal strain (GLS) and LV ejection fraction (LVEF).ConclusionAPSR, twist and torsion pre-TAVI as well as their change within 2 weeks after TAVI predict 2-year all-cause mortality after TAVI, adding incremental prognostic value to LVEF and GLS.
Cell-free DNA copy number variations predict efficacy of immune checkpoint inhibitor-based therapy in hepatobiliary cancers
Authors: Yang Xu , Hu Ying , Yang Keyan , Wang Dongxu , Lin Jianzhen , Long Junyu , Xie Fucun , Mao Jinzhu , Bian Jin , Guan Mei , Pan Jie , Huo Li , Hu Ke , Yang Xiaobo , Mao Yilei , Sang Xinting , Zhang Jiao , Wang Xi , Zhang Henghui , Zhao Haitao 
Published: May 2021

BackgroundThis study was designed to screen potential biomarkers in plasma cell-free DNA (cfDNA) for predicting the clinical outcome of immune checkpoint inhibitor (ICI)-based therapy in advanced hepatobiliary cancers.MethodsThree cohorts including 187 patients with hepatobiliary cancers were recruited from clinical trials at the Peking Union Medical College Hospital. Forty-three patients received combination therapy of programmed cell death protein 1 (PD-1) inhibitor with lenvatinib (ICI cohort 1), 108 patients received ICI-based therapy (ICI cohort 2) and 36 patients received non-ICI therapy (non-ICI cohort). The plasma cfDNA and blood cell DNA mutation profiles were assessed to identify efficacy biomarkers by a cancer gene-targeted next-generation sequencing panel.ResultsBased on the copy number variations (CNVs) in plasma cfDNA, the CNV risk score model was constructed to predict survival by using the least absolute shrinkage and selection operator Cox regression methods. The results of the two independent ICI-based therapy cohorts showed that patients with lower CNV risk scores had longer overall survival (OS) and progression-free survival (PFS) than those with high CNV risk scores (log-rank p<0.01). In the non-ICI cohort, the CNV risk score was not associated with PFS or OS. Furthermore, the results indicated that 53% of patients with low CNV risk scores achieved durable clinical benefit; in contrast, 88% of patients with high CNV risk scores could not benefit from combination therapy (p<0.05).ConclusionsThe CNVs in plasma cfDNA could predict the clinical outcome of the combination therapy of PD-1 inhibitor with lenvatinib and other ICI-based therapies in hepatobiliary cancers.
uPAR+ extracellular vesicles: a robust biomarker of resistance to checkpoint inhibitor immunotherapy in metastatic melanoma patients
Authors: Porcelli Letizia , Guida Michele , De Summa Simona , Di Fonte Roberta , De Risi Ivana , Garofoli Marianna , Caputo Mariapia , Negri Antonio , Strippoli Sabino , Serratì Simona , Azzariti Amalia 
Published: May 2021

BackgroundEmerging evidence has highlighted the importance of extracellular vesicle (EV)-based biomarkers of resistance to immunotherapy with checkpoint inhibitors in metastatic melanoma. Considering the tumor-promoting implications of urokinase-type plasminogen activator receptor (uPAR) signaling, this study aimed to assess uPAR expression in the plasma-derived EVs of patients with metastatic melanoma to determine its potential correlation with clinical outcomes.MethodsBlood samples from 71 patients with metastatic melanoma were collected before initiating immunotherapy. Tumor-derived and immune cell-derived EVs were isolated and analyzed to assess the relative percentage of uPAR+ EVs. The associations between uPAR and clinical outcomes, sex, BRAF status, baseline lactate dehydrogenase levels and number of metastatic sites were assessed.ResultsResponders had a significantly lower percentage of tumor-derived, dendritic cell (DC)-derived and CD8+ T cell-derived uPAR +EVs at baseline than non-responders. The Kaplan-Meier survival curves for the uPAR+EV quartiles indicated that higher levels of melanoma-derived uPAR+ EVs were strongly correlated with poorer progression-free survival (p<0.0001) and overall survival (p<0.0001). We also found a statistically significant correlation between lower levels of uPAR+ EVs from both CD8+ T cells and DCs and better survival.ConclusionsOur results indicate that higher levels of tumor-derived, DC-derived and CD8+ T cell-derived uPAR+ EVs in non-responders may represent a new biomarker of innate resistance to immunotherapy with checkpoint inhibitors. Moreover, uPAR+ EVs represent a new potential target for future therapeutic approaches.
Tocilizumab increases citrullinated histone 3 in non-ST segment elevation myocardial infarction
Authors: Helseth Ragnhild , Kleveland Ola , Ueland Thor , Wiseth Rune , Damas Jan Kristian , Broch Kaspar , Michelsen Annika , Bendz Bjørn , Gullestad Lars , Aukrust Pål , Seljeflot Ingebjørg 
Published: May 2021

ObjectiveBeyond reducing inflammation and troponin T (TnT) release, the interleukin-6 receptor antagonist tocilizumab reduces neutrophil counts in patients with non-ST segment elevation myocardial infarction (NSTEMI). It is unclear if this is related to formation of neutrophil extracellular traps (NETs), carrying inflammatory and thrombotic properties.MethodsIn a placebo-controlled trial, 117 patients with NSTEMI were randomised to a single dose of tocilizumab (n=58) or placebo (n=59) before coronary angiography. The NETs related markers double-stranded DNA (dsDNA), myloperoxidase–DNA (MPO–DNA) and citrullinated histone 3 (H3Cit) were measured at five consecutive time points during hospitalisation (days 1–3).ResultsOur major findings were: (1) H3Cit levels were significantly higher in the tocilizumab compared with the placebo group at all time points (all p<0.05), and H3Cit area under the curve (AUC) was 2.3 fold higher in the tocilizumab compared with placebo group (p<0.0001). (2) MPO–DNA and dsDNA did not differ between the groups. (3) In both treatment arms, dsDNA AUC was associated with TnT AUC. (4) Neutrophil count AUC correlated inversely to H3Cit AUC (p=0.015) in the total population.ConclusionsIn patients with NSTEMI, treatment with tocilizumab is associated with increased circulating H3Cit levels, suggesting that tocilizumab enhances NETosis. Further studies should clarify whether NETosis is a relevant side effect of tocilizumab. Regardless of tocilizumab, dsDNA associated with TnT release, indicating a link between extracellular nuclear material and myocardial injury.
Comment on “Population genetics revealMyotis keenii(Keen’s myotis) andMyotis evotis(long-eared myotis) to be a single species”
Authors: Morales Ariadna E. , Fenton M. Brock , Carstens Bryan C. , Simmons Nancy B. 
Published: May 2021

Genetic exchange and hybridization appear common among the western long-eared bats from North America. Multiple sources of evidence indicate that lineages within this group are evolving independently, despite genetic exchange. However, evidence of gene flow raises questions about the species-level status of some lineages. C.L. Lausen et al. (2019. Can. J. Zool. 97(3): 267–279) proposed that Myotis evotis (H. Allen, 1864) (long-eared myotis) and Myotis keenii (Merriam, 1895) (Keen’s myotis) are one species, not two. This conclusion is based on analyses of cytochrome b and microsatellite data suggesting gene flow between these taxa. Microsatellites are not reliable markers for identifying species because homoplasy can be a major confounding factor, which appears to be true in this case. We reanalyzed the dataset of C.L. Lausen et al. (2019) and show that it is not reliable to distinguish between gene flow or homoplasy, and that these data do not support the conclusion that M. evotis and M. keenii represent a single species. Previous morphological and genomic studies indicate that these are separate species despite previous genetic exchange between them. Failing to recognize that gene flow can occur between independently evolving lineages is counterproductive for conservation because it can lead to neglect of important independent lineages, and likewise failing to use proper tools to delimit species is counterproductive to efforts to quantify biodiversity and design conservation strategies.
Quasinormal modes and their anomalous behavior for black holes in f(R) gravity
Authors: Aragón Almendra , González P. A. , Papantonopoulos Eleftherios , Vásquez Yerko 
Published: May 2021

AbstractWe study the propagation of scalar fields in the background of an asymptotically de Sitter black hole solution in f(R) gravity. The aim of this work is to analyze in modified theories of gravity the existence of an anomalous decay rate of the quasinormal modes (QNMs) of a massive scalar field which was recently reported in Schwarzschild black hole backgrounds, in which the longest-lived modes are the ones with higher angular number, for a scalar field mass smaller than a critical value, while that beyond this value the behavior is inverted. We study the QNMs for various overtone numbers and they depend on a parameter $$\beta $$
β
which appears in the metric and characterizes the f(R) gravity. For small $$\beta $$
β
, i.e. small deviations from the Schwarzschild–dS black hole the anomalous behavior in the QNMs is present for the photon sphere modes, and the critical value of the mass of the scalar field depends on the parameter $$\beta $$
β
while for large $$\beta $$
β
, i.e. large deviations, the anomalous behavior and the critical mass does not appear. Also, the critical mass of the scalar field increases when the overtone number increases until the f(R) gravity parameter $$\beta $$
β
approaches the near extremal limit at which the critical mass of the scalar field does not depend anymore on the overtone number. The imaginary part of the quasinormal frequencies is always negative leading to a stable propagation of the scalar fields in this background.
Seismic glitchness at Sos Enattos site: impact on intermediate black hole binaries detection efficiency
Authors: Allocca A. , Berbellini A. , Boschi L. , Calloni E. , Cardello G. L. , Cardini A. , Carpinelli M. , Contu A. , D’Onofrio L. , D’Urso D. , Dell’Aquila D. , Rosa R. De , Fiore L. Di , Giovanni M. Di , Pace S. Di , Errico L. , Fiori I. , Giunchi C. , Grado A. , Harms J. , Majorana E. , Mangano V. , Marsella M , Migoni C. , Naticchioni L. , Olivieri M. , Oggiano G. , Paoletti F. , Punturo M. , Puppo P. , Rapagnani P. , Ricci F. , Rozza D. , Saccorotti G. , Sequino V. , Sipala V. , Melo I. Tosta E , Trozzo L. 
Published: May 2021

AbstractThird-generation gravitational wave observatories will extend the lower frequency limit of the observation band toward 2 Hz, where new sources of gravitational waves, in particular intermediate-mass black holes (IMBH), will be detected. In this frequency region, seismic noise will play an important role, mainly through the so-called Newtonian noise, i.e., the gravity-mediated coupling between ground motion and test mass displacements. The signal lifetime of such sources in the detector is of the order of tens of seconds. In order to determine whether a candidate site to host the Einstein Telescope observatory is particularly suitable to observe such sources, it is necessary to estimate the probability distributions that, in the characteristic time scale of the signal, the sensitivity of the detector is not perturbed by Newtonian noise. In this paper, a first analysis is presented, focused on the Sos Enattos site (Sardinia, Italy), a candidate to host the Einstein Telescope. Starting from a long data set of seismic noise, this distribution is evaluated considering both the presently designed triangular ET configuration and also the classical ”L” configuration.