bluuebunny/crossref_metadata_2025_split huggingface dataset:
1263 Does Multimorbidity Influence the Likelihood of Receiving A Total Hip Replacement for Osteoarthritis?
Authors: Ferguson R , Prieto-Alhambra D , Peat G , Jordan K , Valderas J , Yu D , Glyn-Jones  , Silman A 
Published: October 2021

Abstract

Introduction
Limited data are available on the influence of multimorbidity on the outcomes of total hip replacement for patients with hip osteoarthritis. Thus, patients with multimorbidity and their clinicians across the UK are making decisions on whether or not to proceed with total hip replacement without clear information available on the potential risks and benefits. It is not known how such patients are currently managed. The aim of this study was to investigate the influence of multimorbidity on the likelihood of receiving total hip replacement in patients with hip osteoarthritis in the UK.

Method
A cohort study was performed, with cohort comprised of all patients over 65 years with a diagnosis of hip osteoarthritis recorded in Clinical Practice Research Datalink. Severity of multimorbidity burden was measured using four different scores (Charlson Comorbidity Index, Electronic Frailty Index, count of drugs prescribed, count of primary care interactions). The outcome was total hip replacement, evaluated using Kaplan-Meier survival and competing-risk analyses.

Results
28,025 patients were included. 10,948 patients underwent total hip replacement. Increased multimorbidity burden was associated with decreased likelihood of undergoing surgery, irrespective of the method of scoring multimorbidity. Electronic Frailty Index had the largest difference between categories. Adjusted hazard ratio (‘severe multimorbidity versus ‘fit’) was 0.34 (95% CI 0.22, 0.51).

Conclusions
Patients with hip osteoarthritis and concurrent multimorbidity were up to two thirds less likely to undergo total hip replacement. Whether this difference in healthcare management is appropriate depends on to what extent multimorbidity influences the outcomes of total hip replacement.
Primary neural leprosy: clinical, neurophysiological and pathological presentation and progression
Authors: Tomaselli Pedro J , dos Santos Diogo F , dos Santos André C J , Antunes Douglas E , Marques Vanessa D , Foss Norma T , Moreira Carolina L , Nogueira Patrícia T B , Nascimento Osvaldo J M , Neder Luciano , Barreira Amilton A , Frade Marco A , Goulart Isabela M B , Marques Wilson 
Published: October 2021

Abstract
Disability in leprosy is a direct consequence of damage to the peripheral nervous system which is usually worse in patients with no skin manifestations, an underdiagnosed subtype of leprosy known as primary neural leprosy. We evaluated clinical, neurophysiological and laboratory findings of 164 patients with definite and probable primary neural leprosy diagnoses. To better understand the disease progression and to improve primary neural leprosy clinical recognition we compared the characteristics of patients with short (≤12 months) and long (&gt;12 months) disease duration.
Positive and negative symptoms mediated by small-fibres were frequent at presentation (∼95%), and symptoms tend to manifest first in the upper limbs (∼68%). There is a consistent phenotypic variability between the aforementioned groups. Deep sensory modalities were spared in patients evaluated within the first 12 months of the disease, and were only affected in patients with longer disease duration (∼12%). Deep tendon reflexes abnormalities were most frequent in patients with longer disease duration (P &lt; 0.001), as well as motor deficits (P = 0.002). Damage to large fibres (sensory and motor) is a latter event in primary neural leprosy. Grade-2 disability and nerve thickening was also more frequent in cases with long disease duration (P &lt; 0.001). Primary neural leprosy progresses over time and there is a marked difference in clinical phenotype between patients with short and long disease duration. Patients assessed within the first 12 months of symptom onset had a non-length-dependent predominant small-fibre sensory neuropathy, whilst patients with chronic disease presented an asymmetrical all diameter sensory-motor neuropathy and patchily decreased/absent deep tendon reflexes.
Clinical and Genomic Characterization of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) Infections in mRNA Vaccinated Health Care Personnel in New York City
Authors: Robilotti Elizabeth V , Whiting Karissa , Lucca Anabella , Poon Chester , Guest Rebecca , McMillen Tracy , Jani Krupa , Solovyov Alexander , Kelson Suzanne , Browne Kevin , Freeswick Scott , Hohl Tobias M , Korenstein Deborah , Ruchnewitz Denis , Lässig Michael , Łuksza Marta , Greenbaum Benjamin , Seshan Venkatraman E , Esther Babady N , Kamboj Mini 
Published: October 2021

Abstract

Background
Vaccine-induced clinical protection against severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) variants is an evolving target. There are limited genomic level data on SARS CoV-2 breakthrough infections and vaccine effectiveness (VE) since the global spread of the B.1.617.2 (Delta) variant.

Methods
In a retrospective study from 1 November 2020 to 31 August 2021, divided as pre-Delta and Delta-dominant periods, laboratory-confirmed SARS CoV-2 infections among healthcare personnel (HCP) at a large tertiary cancer center in New York City were examined to compare the weekly infection rate-ratio in vaccinated, partially vaccinated, and unvaccinated HCP. We describe the clinical and genomic epidemiologic features of post-vaccine infections to assess for selection of variants of concern (VOC)/variants of interest (VOI) in the early post-vaccine period and impact of B.1.617.2 (Delta) variant domination on VE.

Results
Among 13658 HCP in our cohort, 12379 received at least 1 dose of a messenger RNA (mRNA) vaccine. In the pre-Delta period overall VE was 94.5%. Whole genome sequencing (WGS) of 369 isolates in the pre-Delta period did not reveal a clade bias for VOC/VOI specific to post-vaccine infections. VE in the Delta dominant phase was 75.6%. No hospitalizations occurred among vaccinated HCP in the entire study period, compared to 17 hospitalizations and 1 death among unvaccinated HCP.

Conclusions
Findings show high VE among HCP in New York City in the pre-Delta phase, with moderate decline in VE post-Delta emergence. SARS CoV-2 clades were similarly distributed among vaccinated and unvaccinated infected HCP without apparent clustering during the pre-Delta period of diverse clade circulation. Strong vaccine protection against hospitalization was maintained through the entire study period.
Incidence, risk factors, and mortality of atrial fibrillation in breast cancer: a SEER-Medicare analysis
Authors: Guha Avirup , Fradley Michael G , Dent Susan F , Weintraub Neal L , Lustberg Maryam B , Alonso Alvaro , Addison Daniel 
Published: October 2021

Abstract

Aims
The national incidence, risk factors, and associated mortality of atrial fibrillation (AF) in breast cancer patients are unknown.

Methods and results
Using the Surveillance, Epidemiology, and End Results-Medicare-linked database, we identified females, ≥66 years old, with a new primary diagnosis of breast cancer from 2007 through 2014. These patients were individually matched 1:1 to Medicare enrolees without cancer, and each pair was followed for 1 year to identify a primary outcome of AF. Cumulative incidence was calculated using competing risk survival statistics. Following this, identifying risk factors of AF among breast cancer patients was conducted using the adjusted Cox proportional hazards model. Finally, Kaplan–Meier methods and adjusted Cox proportional hazards modelling were performed to estimate mortality in breast cancer patients with incident and prevalent AF. This study included 85 423 breast cancer patients. Among these 9425 (11.0%) had AF diagnosis prior to the breast cancer diagnosis. New-onset AF was diagnosed in 2993 (3.9%) patients in a 1-year period after the breast cancer diagnosis [incidence 3.3%, 95% confidence interval (CI) 3.0–3.5%, at 1 year; higher rate in the first 60 days (0.6%/month)]. Comparatively, the incidence of new-onset AF in matched non-cancer controls was 1.8% (95% CI 1.6–2.0%). Apart from traditional demographic and cardiovascular risk factors, breast cancer stage was strongly associated with the development of AF [American Joint Committee on Cancer (AJCC) Stage II/III/IV vs. I: adjusted hazard ratio (aHR) 1.51/2.63/4.21, respectively]. New-onset AF after breast cancer diagnosis (aHR 3.00) is associated with increased 1-year cardiovascular mortality.

Conclusion
AF incidence is significantly higher in women after a breast cancer diagnosis. Higher breast cancer stages at diagnos are significantly associated with a higher risk of AF. New-onset AF in the new breast cancer diagnosis setting increases 1-year cardiovascular mortality but not breast cancer-related mortality.

Key Question
What are the incidence, prevalence, risk factors and mortality outcomes of atrial fibrillation (AF) in a multi-ethnic representative United States cohort of breast cancer patients?

Key Finding
Annual incidence for AF is 3.9% with highest rate in the first 60 days after cancer diagnosis. Cancer stage and grade are the strongest risk factors for AF. New onset AF after breast cancer increases all-cause and cardiovascular mortality.

Take Home Message
AF incidence is higher in breast cancer patients and is associated with later stage and grade at diagnosis of breast cancer. Involving cardio-oncology in those who develop AF after cancer diagnosis should be encouraged to improve their cardiovascular and overall prognosis.
Developing a scale measuring the doctor–patient relationship in China from the perspective of doctors
Authors: Tao Siyi , Liu Chaojie , Wu Qunhong , Zhao Juan , Xue Yuxin , Song Weijian , Sun Minglei , Wang Chen , Zou Dandan , Liu Wei , Hao Yanhua , Jiao Mingli , Sun Hong , Li Ye , Shan Linghan , Liang Libo 
Published: October 2021

AbstractObjectivesThe doctor–patient relationship is usually measured in line with patient needs and demands. This study aimed to develop a scale measuring such a relationship from the perspective of doctors.MethodsA draft scale was developed and adapted to the hospital context of China based on several existing scales, with an intention to measure how medical doctors view and manage their relationship with patients beyond episodic clinical encounters. Two rounds of Delphi consultations involving 14 experts were conducted to seek their consensus on the inclusion and descriptions of items. This resulted in a 19-item scale measuring four domains of the relationship. The scale was validated through a survey of 1,712 medical doctors selected from 27 public hospitals in Heilongjiang province of China. The internal consistency of the scale was assessed using Cronbach’s α coefficients of the four domains. Confirmatory factor analyses were performed to test the construct validity of the scale. Linear regression analyses were performed to assess the known-group validity of the scale.ResultsThe scale measures four domains. The Cronbach’s α of the scale reached an acceptable level, ranging from 0.61 to 0.78 for its four domains. Good fitness of data into the four-domain structure of the scale was confirmed by the confirmatory factor analysis. Known-group differences were demonstrated in the regression analyses.ConclusionThe doctor–patient relationship scale developed in this study is a psychometrically valid tool assessing how medical doctors view and manage their relationship with patients in the hospital setting in China.
Machine-learning-based earthquake locations reveal the seismogenesis of the 2020 Mw 5.0 Qiaojia, Yunnan earthquake
Authors: Zhou Lianqing , Zhao Cuiping , Zhang Miao , Xu Lisheng , Cui Rensheng , Zhao Ce , Duan Mengqiao , Luo Jun 
Published: October 2021

SUMMARY
A moment magnitude (Mw) 5.0 earthquake hit Qiaojia, Yunnan, China on 18 May 2020. Its hypocentre is only approximately 20 km away from the Baihetan reservoir, the second largest hydropower station in China. The Baihetan Reservoir is located at the junction of multiple fault zones on the eastern boundary of the Sichuan-Yunnan rhombic block, an area with high background seismic activity. The Baihetan Reservoir was planned to be impounded in April 2021 and the Mw 5.0 earthquake occurred during its water-retaining. Thus, it is critical to investigate the seismogenesis of the Qiaojia Mw 5.0 main shock and evaluate the risk of inducing earthquakes near the Baihetan Reservoir after impoundment. In this study, we built a complete and accurate earthquake catalogue to analyse seismicity in the reservoir area before and after the Mw 5.0 Qiaojia earthquake. We adopted a machine learning-based seismic phase picker, PhaseNet, to automatically detect seismic picks from continuous raw seismic data. Seismic phase picks were associated and located using sequential earthquake association and location methods, including REAL, VELEST and hypoDD. We eventually obtained high-precision locations of 1640 earthquakes by the hypoDD. The distribution of earthquake locations indicates that a concealed fault nearly vertical to the surface accommodated the Mw 5.0 Qiaojia main shock. The majority of its aftershocks is located within a narrow depth range of 8–13 km, indicating that the stresses in the hypocentral area were concentrated near the hypocentre of the Mw 5.0 earthquake. Along with focal mechanism solutions, we suggested that the Mw 5.0 Qiaojia earthquake is more likely a tectonic earthquake. However, we cannot exclude the possibility that earthquakes could be induced after the impoundment of Baihetan Reservoir, because the identified concealed fault is located in the middle of many large fault zones and only 20 km away from the Baihetan Reservoir.
Equity in healthcare financing following the introduction of the unified residents’ health insurance scheme in China
Authors: Zhou Guoliang , Jan Stephen , Chen Mingsheng , Wang Zhonghua , Si Lei 
Published: October 2021

Abstract
This study sought to explore whether there are significant disparities in the financing of healthcare between urban and rural populations following the introduction in 2016 of the Urban and Rural Resident Basic Medical Insurance (URRBMI) scheme in China. We used household survey data from Heilongjiang province to estimate separate concentration curves in the financing burden and the resultant Kakwani indices (KIs) for urban and rural populations. This enabled the assessment of the progressivity (or otherwise) of this burden. The results show that in urban areas indirect taxes were proportional (KI = 0.0009, P = 0.8449), while indirect taxes in rural areas were progressive (KI = 0.0284, P = 0.0002). In both urban and rural areas, direct taxes were found to be progressive (urban: KI = 0.4628, P &lt; 0.0001; rural: KI = 0.4087, P = 0.0064), while URRBMI was regressive (urban: KI = − 0.6236, P &lt; 0.0001; rural: KI = − 0.4325, P &lt; 0.0001). Out-of-pocket payments were proportional in urban areas (KI = − 0.0064, P = 0.7490); in contrast, they were regressive in rural areas (KI = − 0.1078, P = 0.0012). Overall, the burden of healthcare finance in urban China was found to be neither regressive nor progressive (KI = − 0.0142, P = 0. 1397), whereas in rural China it was found to be regressive (KI = − 0.1208, P &lt; 0.0001). This result is driven by high reliance on regressive forms of funding, namely, fixed contributions to URRBMI, out-of-pocket costs and private health insurance. It is concluded that achieving equity in health financing in China will require strong measures to reduce the regressivity of financing, particularly for rural populations. This can be achieved through a shift towards means-adjusted URRBMI contributions, a greater reliance on tax-based financing and reducing the reliance on out-of-pocket payments and private health insurance.
Inbreeding, Native American ancestry and child mortality: linking human selection and paediatric medicine
Authors: Koenigstein Fabienne , Boekstegers Felix , Wilson James F , Fuentes-Guajardo Macarena , Gonzalez-Jose Rolando , Bedoya Gabriel , Bortolini Maria Cátira , Acuña-Alonzo Victor , Gallo Carla , Ruiz Linares Andres , Rothhammer Francisco , Lorenzo Bermejo Justo 
Published: October 2021

Abstract
The children of related parents show increased risk of early mortality. The Native American genome typically exhibits long stretches of homozygosity, and Latin Americans are highly heterogeneous regarding the individual burden of homozygosity, the proportion and the type of Native American ancestry. We analysed nationwide mortality and genome-wide genotype data from admixed Chileans to investigate the relationship between common causes of child mortality, homozygosity and Native American ancestry. Results from two-stage linear-Poisson regression revealed a strong association between the sum length of runs of homozygosity (SROH) above 1.5 Megabases (Mb) in each genome and mortality due to intracranial non-traumatic haemorrhage of foetus and newborn (5% increased risk of death per Mb in SROH, P = 1 × 10−3) and disorders related to short gestation and low birth weight (P = 3 × 10−4). The major indigenous populations in Chile are Aymara–Quechua in the north of the country and the Mapuche–Huilliche in the south. The individual proportion of Aymara–Quechua ancestry was associated with an increased risk of death due to anencephaly and similar malformations (P = 4 × 10−5), and the risk of death due to Edwards and Patau trisomy syndromes decreased 4% per 1% Aymara–Quechua ancestry proportion (P = 4 × 10−4) and 5% per 1% Mapuche–Huilliche ancestry proportion (P = 2 × 10−3). The present results suggest that short gestation, low birth weight and intracranial non-traumatic haemorrhage mediate the negative effect of inbreeding on human selection. Independent validation of the identified associations between common causes of child death, homozygosity and fine-scale ancestry proportions may inform paediatric medicine.
Phase 1 Randomized, Placebo-Controlled, Dose-Escalating Study to Evaluate OVX836, a Nucleoprotein-Based Influenza Vaccine: Intramuscular Results
Authors: Withanage Kanchanamala , De Coster Ilse , Cools Nathalie , Viviani Simonetta , Tourneur Jessika , Chevandier Marion , Lambiel Manon , Willems Paul , Le Vert Alexandre , Nicolas Florence , Van Damme Pierre 
Published: October 2021

Abstract

Background
OVX836 is a recombinant protein vaccine targeting the highly conserved influenza nucleoprotein (NP), which could confer broad-spectrum protection against this disease.

Methods
A randomized, placebo-controlled, double-blind, dose-escalating, single- center, first-in-human study was conducted in 36 healthy adults aged 18–49 years. Twelve subjects per cohort (9 vaccine and 3 placebo) received 2 OVX836 intramuscular administrations on days 1 and 28 at the dose level of 30 µg, 90 µg, or 180 µg. Safety and immunogenicity were assessed after each vaccination and for 150 days in total.

Results
OVX836 was safe and well tolerated at all dose levels, with no difference in solicited local and systemic symptoms, and unsolicited adverse events between the first and second administration, or between dose levels. All subjects presented pre-existing NP-specific immunity at baseline. OVX836 induced a significant increase in NP-specific interferon-gamma T cells and anti-NP immunoglobulin G at all dose levels after the first vaccination. The second vaccination did not further increase the response. There was a trend for a dose effect in the immune response.

Conclusions
The safety and reactogenicity profile, as well as the humoral and cellular immune responses, encourage further evaluation of OVX836 in a larger Phase 2a study.
Cl415, a carbapenem-resistant Acinetobacter baumannii isolate containing four AbaR4 and a new variant of AbGRI2, represents a novel global clone 2 strain
Authors: Liepa Rebekah , Mann Riti , Osman Marwan , Hamze Monzer , Gunawan Cindy , Hamidian Mohammad 
Published: October 2021

Abstract

Objectives
To determine the genetic context of genes conferring antibiotic resistance on the carbapenem-resistant Acinetobacter baumannii Cl415, recovered in 2017 at El Youssef Hospital Centre in Akkar Governorate, North Lebanon.

Methods
Antibiotic resistance phenotype for 22 antibiotics was determined using disc diffusion or MIC determination. The whole-genome sequence of Cl415 was determined using a combination of the Illumina MiSeq and Oxford Nanopore (MinION) platforms. Complete genome was assembled using Unicycler and antibiotic resistance determinants and ISs were identified using ResFinder and ISFinder, respectively.

Results
Cl415 is a global clone 2 (GC2) strain and belongs to the most common STs of this clone, ST2IP and ST218OX. Cl415 is resistant to several antibiotics, including aminoglycosides and carbapenems to a high level. Genomic analysis of Cl415 revealed that it carries four chromosomal AbaR4 copies. One copy was found in the comM gene replacing the AbGRI1 island. Cl415 also contains a novel variant of AbGRI2, herein called AbGRI2-15, carrying only the blaTEM and aphA1 resistance genes. Cl415 belongs to a subclade of GC2 strains that appear to have diverged recently with a wide geographical distribution.

Conclusions
The resistance gene complement of Cl415 was found in the chromosome with four oxa23 located in AbaR4 copies and the remaining genes in a novel variant of the AbGRI2 resistance island. Cl415 was isolated in Lebanon, but phylogenetic analysis suggests that Cl415 represents a new lineage with global distribution within GC2.
International knowledge spillovers
Authors: Eugster Johannes L , Ho Giang , Jaumotte Florence , Piazza Roberto 
Published: October 2021

Abstract
How important is foreign knowledge for domestic innovation outcomes? How is this relation shaped by globalization and the attendant intensification of international competition? Our empirical approach extends the previous literature by analyzing a large panel comprising industries in both advanced and emerging economies over the past two decades. We find that barriers to the domestic diffusion of foreign knowledge have fallen significantly for emerging economies. For all countries, and especially for emerging economies, inflows of foreign knowledge have a growing and quantitatively important impact on domestic innovation. Controlling for the amount of domestic R&D, we find evidence that increases in international competitive pressure at the industry level had a positive effect on domestic innovation outcomes.
Disaster Experience and Governments’ Savings: The Moderating Role of Organizational Capacity
Authors: Lee Sungyoon , Chen Gang 
Published: October 2021

Abstract
The increasing risk of natural and human-induced disasters has caused considerable costs to governments. Governments’ savings can function as a mechanism to mitigate such revenue or expenditure shocks due to disasters. While past studies have examined how recessions affect government reserves, to date, few studies have tested how a government’s past experiences of natural disasters affect the level of its savings. In this study, we use organizational learning theory as a framework to explain this relationship. We empirically parse out the effect of previous disaster experience on reserve funds (i.e., rainy-day funds) and general savings (i.e., unassigned general fund balance). We further test whether organizational capacity serves as a moderator of the relationship between past disaster experience and savings. For the analysis, this study employs a Generalized Method of Moments (GMM) to examine a sample of US states for the years from 2002 to 2017. We find that an increase in cumulative damage from prior disasters is associated with an increase in rainy-day funds and this relationship is stronger in governments with a high organizational capacity. The results remain robust to estimations with alternative measures. These findings support the organizational learning theory, which suggests that governments learn from their past experiences to increase preparedness for future disasters. We also point out the importance of financial capacity in the process of organizational learning.