bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of syphilis infection and associated sociodemographic factors among antenatal-care attendees in Meghalaya, India: Revisiting HIV Sentinel Surveillance data
Authors: Biswas Subrata , Ghosh Piyali , Debnath Falguni , Chakraborty Debjit , Saha Malay Kumar , Dutta Shanta 
Published: December 2021

Background Despite relatively simple prevention and treatment, syphilis remains a major social and public health concern worldwide, particularly in developing nations. Objective To estimate the prevalence and to determine the sociodemographic factors associated with syphilis infection among antenatal-care (ANC) attendees in Meghalaya, India. Materials and Method A facility-based cross-sectional study was conducted utilizing National HIV Sentinel Surveillance of Meghalaya, January–March 2017. Pregnant women aged 15–49 years ( n = 3015) were recruited consecutively, interviewed, and tested for syphilis by Venereal Disease Research Laboratory test in eight selected ANC sites representing all districts of Meghalaya. Results Prevalence of syphilis was found to be 1.03 % (95% CI = 0.67–1.39) (31/3015). Prevalence was maximum among illiterates with gradual lowering of adjusted odds ratio (AOR) with improvement of education. Women whose husbands had no income were associated with higher risk (AOR = 4.97, 95% CI = 1.11–22.20) of syphilis. Significant risk (OR = 2.42, 95% CI = 1.02–5.74) was also observed with Jaintia Hills residents as compared to Garo Hills. Conclusions As high prevalence of gestational syphilis was identified in Meghalaya along with important sociodemographic predictors, evidence to policy translation is required at state and national level to scale up prevention, screening, and management of syphilis
Resuscitation Decisions for Extremely Premature Infants: A UK NICU Experience
Authors: Peterson Jennifer , Kahvo Mia , Tharumakunarajah Ramiyya , Malik Nabiah , Ranganna Ranganath 
Published: December 2021

Background: Improvements in extreme preterm infant outcomes have led to an increasing recognition of the importance of antenatal optimization and delivery room (DR) management strategies for these infants. Methods: Retrospective cohort evaluation of every infant born at 22+0 to 25+6 weeks gestation in St Mary’s tertiary NICU between 2008 and 2018. Aiming to evaluate utilization of chest compressions and resuscitation medications during DR-resuscitation of extremely premature infants. Results: This study found that 90% of infants 22+0 to 22+6 weeks did not receive antenatal steroids. Whereas, for infants born between 23+0 and 23+6 weeks gestation, 75% did receive antenatal steroids. This difference is significant ( P value = .00006). This study shows there is a predisposition to not provide DR-chest compressions (DR-CC) and/or adrenaline (DR-CC+/−A) to extremely preterm For infants that received DR-CC, there was no statistically significant increase in death and no clear association with poorer long-term outcomes in survivors. Conclusions: Marked differences in provision of perinatal care were found dependent on gestational age. If infants are inadequately prepared for delivery and resuscitative measures are not fully utilized, it cannot be clear whether subsequently increased rates of death in the lower gestational age groups are solely due to gestational age or are influenced by the lack of preparative management.
Is there a missing-middle in Australian mental health care?
Authors: Looi Jeffrey CL , Kisely Stephen R , Allison Stephen , Bastiampillai Tarun 
Published: December 2021

Objective The term ‘missing-middle’ has been prominent in discourse relating to provision of mental health care in Australia, particularly by proponents of non-governmental youth mental health services such as headspace and related adult services. We investigate whether there is an empirical basis for use of the ‘missing-middle’ term, founded on qualitative and quantitative research. Conclusions Despite the widespread use of the term ‘missing-middle’ for advocacy in Australia, there is a lack of research characterising the epidemiological characteristics of the group. The validity of advocacy predicated on the basis of the ‘missing-middle’ care-gap should be reconsidered. Research, such as systematic service mapping and health needs assessment, is a necessary foundation for evidence-based mental healthcare policy, planning and implementation. Without such research, vital government funds may be deployed to ‘missing-middle’ programmes that may not improve Australian public health outcomes.
Effect of a mindfulness programme training on mental toughness and psychological well-being of female athletes
Authors: Ajilchi Bita , Mohebi Mahmoud , Zarei Sahar , Kisely Steve 
Published: December 2021

Objectives Research has shown that mindfulness in athletes is associated with positive outcomes. We therefore assessed the effect of mindfulness training on increasing mental toughness (MT) and psychological well-being (PWB). Methods This was a parallel-group, pre-and post-test, randomised controlled pilot trial. Forty-five female athletes from Iranian universities in Tehran were randomly assigned into experimental ( n = 23) and control groups ( n = 22). Forty-two completed the trial. The mindfulness training group received the Mindfulness–Acceptance–Commitment programme for 7 weeks. All subjects completed the Mindfulness Inventory for Sport (MIS), Sports Mental Toughness Questionnaire and PWB Scale. Data were analysed using mixed analysis of variance. Results Mindfulness training increased mindfulness in the experimental group ( p < 0.01). In turn, increased mindfulness led to increased MT and PWB at 2-month follow-up ( p < 0.05). Conclusions Given that mindfulness training may increase the MT and PWB of athletes, these techniques should be considered for inclusion in sports coaching.
The impact of COVID-19 lockdown on the well-being of clients of a specialist personality disorder service
Authors: Heidari Parvaneh , Broadbear Jillian H , Cheney Lukas , Dharwadkar Nitin P , Rao Sathya 
Published: December 2021

Objective The aim of this study was to investigate the well-being of people with severe borderline personality disorder (BPD) during the first wave of COVID-19 social restrictions. Method Clients of an outpatient specialist personality disorder clinic ( n = 77) were invited to the study. An online survey was conducted including a range of open-ended questions exploring well-being and the Coronavirus Anxiety Scale (CAS) which assesses ‘coronaphobia’. Qualitative data were analysed using inductive content analysis with NVivo software. CAS data were analysed descriptively using SPSS version 25. Results Thirty-six surveys were completed (48% response rate). Many participants experienced significant challenges to their overall well-being during lockdown although some reported improvements in psychosocial functioning. Three participants (8.3%) experienced clinically significant ‘coronaphobia’. Conclusion The self-reported physical and mental health of participants with BPD demonstrated resilience, suggesting that the capacity to maintain treatment via telehealth helped to mitigate many of the adverse aspects of social restrictions. This study was conducted during the first wave of social restrictions; subsequent studies will reveal longer-term effects of extended community lockdowns.
Improving services for those who serve: A private practice initiative to improve psychiatric care for first responder and military patients
Authors: Jamalulhak Amir Izzat , Galletly Cherrie , Ford Nick 
Published: December 2021

Objectives Professional isolation and limited opportunities for multidisciplinary collaborations are well-recognised challenges for psychiatrists in private practice. This narrative paper describes the development of a private practice group to assist first responders (FRs) and military patients located in Adelaide, South Australia. The aims included both peer review, and interdisciplinary communication and collaboration. Relevant personnel in the ambulance, police and fire services, military and veterans’ groups, and the compensation system, participated in monthly meetings. Lack of timely access to psychiatric care for FR and military patients was identified as a problem and an expedited referral service was established. Conclusions The Closing the Gap Group was established in 2017. The terminology refers to the gap between treating psychiatrists and the complex organisations that manage the workplace context for FR/military patients. This initiative provides a template for private practice innovations to improve psychiatrists’ skills and knowledge, along with better engagement and understanding between private psychiatrists and relevant community organisations.
Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity
Authors: Lee Hee Young , Barbachan Mansur Nacime Salomao , Lalevée Matthieu , Dibbern Kevin N. , Myerson Mark S. , Ellis Scott J. , Femino John E. ,   Progressive Collapsing Foot Deformity Consensus Group, de Cesar Netto Cesar 
Published: December 2021

Background: Historical concept of flatfoot as posterior tibial tendon dysfunction (PTTD) has been questioned. Recently, the consensus group published a new classification system and recommended renaming PTTD to Progressive Collapsing Foot Deformity (PCFD). The new PCFD classification could be effective in providing comprehensive information on the deformity. To date, there has been no study reporting intra- and interobserver reliability and the frequency of each class in PCFD classification. Methods: This was a single-center, retrospective study conducted from prospectively collected registry data. A consecutive cohort of PCFD patients evaluated from February 2015 to October 2020 was included, consisting of 92 feet in 84 patients. Classification of each patient was made using characteristic clinical and radiographic findings by 3 independent observers. Frequencies of each class and subclass were assessed. Intraobserver and inteobserver reliabilities were analyzed with Cohen kappa and Fleiss kappa, respectively. Results: Mean sample age was 54.4, 38% was male and 62% were female. 1ABC (25.4%) was the most common subclass, followed by 1AC (8.7%) and 1ABCD (6.9%). Only a small percentage of patients had isolated deformity. Class A was the most frequent component (89.5%), followed by C in 86.2% of the cases. Moderate interobserver reliability (Fleiss kappa = 0.561, P < .001, 95% CI 0.528-0.594) was found for overall classification. Very good intraobserver reliability was found (Cohen kappa = 0.851, P < .001, 95% CI 0.777-0.926). Conclusion: Almost half (49.3%) of patients had a presentation dominantly involving the hindfoot (A) with various combinations of midfoot and/or forefoot deformity (B), (C) with or without subtalar joint involvement (D). The new system may cover all possible combinations of the PCFD, providing a comprehensive description and guiding treatment in a systematic and individualized manner, but this initial study suggests an opportunity to improve overall interobserver reliability. Level of Evidence: Level III, retrospective diagnostic study.
Association Between Opioid Use and Diabetes in Patients With Ankle Fracture Repair
Authors: Song Wenye , Shibuya Naohiro , Jupiter Daniel C. 
Published: December 2021

Background: Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Ankle fracture patients with diabetes may experience prolonged healing, higher risk of hardware failure, an increased risk of wound dehiscence and infection, and higher pain scores pre- and postoperatively, compared to patients without diabetes. However, the duration of opioid use among this patient cohort has not been previously evaluated. The purpose of this study is to retrospectively compare the time span of opioid utilization between ankle fracture patients with and without diabetes mellitus. Methods: We conducted a retrospective cohort study using our institution’s TriNetX database. A total of 640 ankle fracture patients were included in the analysis, of whom 73 had diabetes. All dates of opioid use for each patient were extracted from the data set, including the first and last date of opioid prescription. Descriptive analysis and logistic regression models were employed to explore the differences in opioid use between patients with and without diabetes after ankle fracture repair. A 2-tailed P value of .05 was set as the threshold for statistical significance. Results: Logistic regression models revealed that patients with diabetes are less likely to stop using opioids within 90 days, or within 180 days, after repair compared to patients without diabetes. Female sex, neuropathy, and prefracture opioid use are also associated with prolonged opioid use after ankle fracture repair. Conclusion: In our study cohort, ankle fracture patients with diabetes were more likely to require prolonged opioid use after fracture repair. Level of Evidence: Level III, prognostic.
Asparaginase activity monitoring and management of asparaginase hypersensitivity reactions in Canada
Authors: Pike Meghan , Kulkarni Ketan , MacDonald Tamara 
Published: December 2021

Introduction Pegaspargase can cause anti-asparaginase antibody formation, which can decrease its effectiveness without causing any clinically apparent reaction (silent inactivation). When a patient has silent inactivation, a switch to Erwinia anti-asparaginase is warranted, but there is currently a global shortage of Erwinia. The only way to identify silent inactivation is to measure an asparaginase level. However, routine asparaginase level monitoring is not currently standard of care at all Canadian centers. This study aims to identify variations in practice regarding asparaginase level monitoring and Erwinia use. Methods A 21-item survey was developed using OPINIO software and distributed to all Pediatric Hematology–Oncologists in Canada from February to October 2020. Results Respondents represented 15 hospitals across each region of Canada (response rate = 52%). Only 39.2% of respondents reported routinely measuring asparaginase levels, yet 53% of respondents have modified therapy from pegaspargase to Erwinia in up to half of their patients. The most common reason for not measuring asparaginase levels was not knowing how to use levels clinically (25.5%). There was variation in the timing of levels and their target. Conclusions We identified substantial variation in asparaginase activity monitoring practices across Canada. Therefore, future research should aim to develop a national practice guideline on asparaginase activity monitoring.
Intraocular lens power calculation in virgin eyes: Accuracy of the Barrett Universal II formula and a Ray tracing software
Authors: Fernández-Rosés Joaquim , Lamarca José , Piñero David P. , Barraquer Rafael I. 
Published: December 2021

Purpose To compare the accuracy of Sirius ray tracing software with the Barrett Universal II formula for intraocular lens power prediction in virgin eyes. Methods Retrospective case series including 86 eyes that have undergone uneventful cataract surgery with SN60WF implantation. The median absolute error, mean prediction error, variance, and the percentage of eyes within ± 0.25 D, ± 0.50 D, ± 0.75 D, and ± 1.00 D of the prediction error in refraction were calculated. The correlation of prediction error with different baseline parameters was investigated. Results No differences were found between the median absolute error of the Barrett Universal II formula (0.226 D) and the ray tracing software with different intraocular lens centerings; apex (0.331 D), limbus (0.345 D), and pupil (0.342 D) ( p = 0.084). The variance, from lowest to highest, was the Barrett Universal II (0.144 D2), ray tracing-limbus (0.285 D2), ray tracing-pupil (0.285 D2), and ray tracing-apex (0.287 D2) ( p = 0.027). The Barrett Universal II formula showed a higher percentage of eyes within ± 0.25 D (56.98%), ± 0.50 D (82.56%), and ± 0.75 D (93.02%) compared to ray tracing software ( p < 0.01). A significant correlation between the prediction error of the Barrett Universal II formula and corneal diameter (r = 0.322, p = 0.002) and pupil diameter (r = 0.230, p = 0.033) was found. Also, a positive correlation between the prediction error of Sirius ray tracing and axial length ( p < 0.001) and pupil diameter ( p = 0.01) was found. Conclusion There is a trend of the Barrett Universal II formula to be more accurate than Sirius ray tracing software for intraocular lens power calculation in virgin eyes. This should be confirmed in future prospective comparative studies.
The effect of tourism source market structure on international tourism revenues in Turkey
Authors: Ağazade Seymur 
Published: December 2021

The current study calculates an indicator of tourism source market structure and investigates its impact on international tourism revenues in Turkey. This structure may influence the tourism performance through its consequences on the competitiveness and risk structure of the sector. The calculation of tourism source market structure in this study is based on the normalized Herfindahl–Hirschman Index and number of tourists by nationality. The ARDL co-integration framework is the method used and the estimation covers the period between January 2008 and September 2019. The calculated tourism source market structure indicator showed decreasing trend in the research period indicating that the tourism source market diversified in some extent. The co-integration is supported, and in the long-term model a 1% decrease in the tourism source market concentration found to increase international tourism revenues by 1.9078%. Furthermore, the error correction model indicated that it takes 7.16 months for deviations from the long-run relationship to return to the equilibrium.
Diffusing capacity in chronic obstructive pulmonary disease assessment: A meta-analysis
Authors: Ni Yingmeng , Yu Youchao , Dai Ranran , Shi Guochao 
Published: December 2021

To achieve a multidimensional evaluation of chronic obstructive pulmonary disease (COPD) patients, the spirometry measures are supplemented by assessment of symptoms, risk of exacerbations, and CT imaging. However, the measurement of diffusing capacity of the lung for carbon monoxide (DLCO) is not included in most common used models of COPD assessment. Here, we conducted a meta-analysis to evaluate the role of DLCO in COPD assessment. The studies were identified by searching the terms “diffusing capacity” OR “diffusing capacity for carbon monoxide” or “DLCO” AND “COPD” AND “assessment” in Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Scopus, and Web of Science databases. The mean difference of DLCO % predict was assessed in COPD patient with different severity (according to GOLD stage and GOLD group), between COPD patients with or without with frequent exacerbation, between survivors and non-survivors, between emphysema dominant and non-emphysema dominant COPD patients, and between COPD patients with or without pulmonary hypertension. 43 studies were included in the meta-analysis. DLCO % predicted was significantly lower in COPD patients with more severe airflow limitation (stage II/IV), more symptoms (group B/D), and high exacerbation risk (group C/D). Lower DLCO % predicted was also found in exacerbation patients and non-survivors. Low DLCO % predicted was related to emphysema dominant phenotype, and COPD patients with PH. The current meta-analysis suggested that DLCO % predicted might be an important measurement for COPD patients in terms of severity, exacerbation risk, mortality, emphysema domination, and presence of pulmonary hypertension. As diffusion capacity reflects pulmonary ventilation and perfusion at the same time, the predictive value of DLCO or DLCO combined with other criteria worth further exploration.
Caution: Air Embolism Related to Heli-Fx EndoAnchor System in Zone 2 Thoracic Aneurysm Repair
Authors: Rosu Cristian , Ruz Ricardo , Overbeek Charles , Elkouri Stéphane 
Published: December 2021

Purpose We report a case of significant air embolization to the ascending aorta immediately following deployment of EndoAnchors in the aortic arch during a procedure to correct a type 1A endoleak. Case report The novel Heli-Fx EndoAnchor system (Medtronic Vascular, Santa Rosa, CA, USA) was used to deploy helical anchors in the distal aortic arch during a procedure to correct a type 1A endoleak following Zone 2 thoracic endovascular aortic repair of a saccular proximal descending thoracic aorta aneurysm (DTAA). The patient developed ST-segment elevations principally in the inferior leads and severe hypotension moments after EndoAnchor deployment at the proximal edge of the endograft. Transesophageal echocardiogram revealed severe right ventricular hypokinesis and a large amount of air in the ascending aorta. Subsequent management and clinical and radiological 30-day follow-up is presented in addition to a review of the literature and ex vivo testing with the Heli-Fx system to examine potential causes and solutions. Conclusion Precautions, such as pressurized saline infusion to the side port of guiding sheath, should be used whenever manipulating catheters and sheaths such as the EndoAnchor system in the aortic arch to prevent this potentially lethal complication.
Brucella aortitis managed with debridement, extra-anatomical bypass, and long-term antimicrobial therapy
Authors: Perry John , Alslaim Hossam , Agarwal Gautam 
Published: December 2021

Objectives This report aims to review the management and outcomes of Brucella-associated mycotic aortic aneurysms. Methods This is a retrospective chart review at a tertiary-level healthcare system. IRB approval was waived per policy. Results We describe a case of Brucella aortitis acquired from habitual contact with wild hogs. Clinical presentation included lower back pain and elevated white blood cell count. Diagnosis was confirmed with imaging showing an infrarenal abdominal aortic aneurysm and serology revealing elevated Brucella antibodies titers. The patient was initially managed with endovascular aortic repair and combined oral and intravenous antibiotics therapy. He then underwent explanation and extra-anatomical bypass due to symptomatic periaortic infection and interval development of type I endoleak. The patient was asymptomatic after his final operation at 24 months of follow-up and remained on suppressive oral antibiotic therapy. Conclusions An aortic aneurysm secondary to Brucella is a rare entity. A detailed history of long-term exposure to animals may be a clue to obtain serologic testing. Operative debridement and re-establishing of reliable blood flow combined with long-term antibiotic suppression are the mainstay of treatment.