bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapy adjustments in people with type 1 diabetes with impaired hypoglycemia awareness on multiple daily injections using real-time continuous glucose monitoring: a mechanistic analysis of the HypoDE study
Authors: Waldenmaier Delia , Freckmann Guido , Pleus Stefan , Hermanns Norbert , Ehrmann Dominic , Heinemann Lutz , Haug Cornelia 
Published: April 2021

IntroductionStudies have shown beneficial effects of real-time continuous glucose monitoring (rtCGM) usage on clinical outcomes. The objective of this analysis was to identify which therapy adjustments were made by people with type 1 diabetes with impaired hypoglycemia awareness during rtCGM usage enabling reductions in the number of low glucose events observed in the HypoDE (Hypoglycemia in Deutschland) study.Research design and methodsIn the multicenter randomized controlled trial in people with type 1 diabetes on multiple daily injections with impaired hypoglycemia awareness, participants recorded their diabetes therapy in 7-day logbooks at baseline and at 6-month follow-up. They used rtCGM or self-monitoring of blood glucose for therapy adjustments. This mechanistic analysis looked at changes in various aspects of therapy.ResultsLogbooks were completed by 70 participants in the rtCGM group and 65 participants in the control group. Participants in the rtCGM group kept their total carbohydrate consumption, daily insulin doses and distribution constant during the study. However, they reported an increased intake of rescue carbohydrates (0.8±0.6 (mean±SD) vs 1.0±0.8 intake/day; baseline-adjusted between-group difference 0.3 intake (0.1–0.5), p=0.031). The glucose threshold at which rescue carbohydrate intake was initiated was elevated from 71±13 mg/dL (3.9±0.7 mmol/L) to 79±14 mg/dL (4.4±0.8 mmol/L) (adjusted between-group difference +7.6 mg/dL (2.4–12.8) (+0.4 mmol/L (0.1–0.7)); p=0.005) in the rtCGM group. Regression analysis showed that follow-up low glucose events were associated with group allocation (p<0.001), low glucose events at baseline (p=0.016) and rescue threshold (p=0.001).ConclusionsNo major adjustments in insulin therapy were made by study participants with impaired hypoglycemia awareness; however, they were more active in preventing hypoglycemia by taking rescue carbohydrates earlier and more often.Trial registration numberNCT02671968.
‘It brings light to what you really put into your body’: a focus group study of reactions to messages about nicotine reduction in cigarettes
Authors: Duong Hue Trong , Loud Emily E , Thrasher James F , Henderson Katherine C , Ashley David L , Popova Lucy 
Published: April 2021

ObjectiveIn 2017, the US Food and Drug Administration (FDA) announced a proposed regulation to lower nicotine in cigarettes to minimally addictive levels to help smokers quit. We sought to explore effective message strategies communicating about nicotine reduction in cigarettes across the different key audiences that the regulation is most likely to influence.MethodsWe designed four types of messages: efficacy messages, risk messages, a message about alternative sources of nicotine and a compensation message. Sixteen virtual focus groups were conducted in Atlanta and San Francisco in April–May 2020. Data were analysed in NVivo 12.0 using a thematic analysis approach.FindingsExclusive smokers were receptive to both efficacy messages and risk messages. Dual users were the only group that was open to resorting to alternative sources of nicotine. Former smokers were critical of these messages as promoting the new kinds of cigarettes and potentially encouraging initiation and relapse of smoking. Non-smokers felt that efficacy messages downplayed the risks of smoking and did not scare people away from smoking. Presenting information that very low nicotine cigarettes (VLNCs) still contain harmful chemicals made smokers question continued smoking in the absence of nicotine and view VLNCs as harmful.ConclusionsMessages communicating about nicotine reduction in cigarettes might help to motivate smokers to quit and can correct the misperceptions that VLNCs are less harmful. The FDA should consider specific target audiences and use different messages that complement each other in communicating about this regulation.
Scalar fully-heavy tetraquark states $$QQ^\prime {\bar{Q}} \bar{Q^\prime }$$ in QCD sum rules
Authors: Yang Bo-Cheng , Tang Liang , Qiao Cong-Feng 
Published: April 2021

AbstractVery recently, the LHCb Collaboration observed distinct structures with the $$cc{\bar{c}}{\bar{c}}$$

c
c

c

¯

c

¯

in the $$J/\Psi $$

J
/
Ψ

-pair mass spectrum. In this work, we construct four scalar ($$J^{PC} = 0^{++}$$

J

PC

=

0

+
+

) $$[8_c]_{Q\bar{Q^\prime }}\otimes [8_c]_{Q^\prime {\bar{Q}}}$$

[

8
c

]

Q

Q
′

¯

⊗

[

8
c

]

Q
′

Q

¯

type currents to investigate the fully-heavy tetraquark state $$Q Q^\prime {\bar{Q}} \bar{Q^\prime }$$

Q

Q
′

Q

¯

Q
′

¯

in the framework of QCD sum rules, where $$Q=c, b$$

Q
=
c
,
b

and $$Q^\prime = c, b$$

Q
′

=
c
,
b

. Our results suggest that the broad structure around 6.2-6.8 GeV can be interpreted as the $$0^{++}$$

0

+
+

octet–octet tetraquark states with masses $$6.44\pm 0.11$$

6.44
±
0.11

GeV and $$6.52\pm 0.10$$

6.52
±
0.10

GeV, and the narrow structure around 6.9 GeV can be interpreted as the $$0^{++}$$

0

+
+

octet–octet tetraquark states with masses $$6.87\pm 0.11$$

6.87
±
0.11

GeV and $$6.96\pm 0.11$$

6.96
±
0.11

GeV, respectively. Extending to the b-quark sector,the masses of their fully-bottom partners are found to be around 18.38-18.59 GeV. Additionally, we also analyze the spectra of the $$[8_c]_{c{\bar{c}}}\otimes [8_c]_{b {\bar{b}}}$$

[

8
c

]

c

c

¯

⊗

[

8
c

]

b

b

¯

and $$[8_c]_{c{\bar{b}}}\otimes [8_c]_{b {\bar{c}}}$$

[

8
c

]

c

b

¯

⊗

[

8
c

]

b

c

¯

tetraquark states, which lie in the range of 12.51–12.74 GeV and 12.49–12.81 GeV, respectively.
Patients With Rheumatoid Arthritis With an Inadequate Response to Disease‐Modifying Antirheumatic Drugs at a Higher Risk of Acute Coronary Syndrome
Authors: Hsu Chung‐Yuan , Su Yu‐Jih , Chen Jia‐Feng , Sun Chi‐Chin , Cheng Tien‐Tsai , Tsai Tzu‐Hsien , Lin Shang‐Hong , Chang Cheng‐Chieh , Chen Tien‐Hsing 
Published: April 2021

Background
Cardiovascular disease is the most common cause of death in patients with rheumatoid arthritis. It is believed that using disease‐modifying antirheumatic drugs (DMARDs) to control inflammation can reduce the risk of cardiovascular disease. In this study, we investigated whether patients who responded differently to DMARDs might sustain different cardiovascular events.

Methods and Results
We designed a cohort study using the Chang Gung Research Database. We identified 7114 patients diagnosed with rheumatoid arthritis. After strict exclusion criteria, we collected 663 individuals as an inadequate response to DMARDs group. Then, 2034 individuals were included as the control group. The end point was composite vascular outcomes, including acute coronary syndrome or ischemic stroke. We used the inverse probability of treatment weighting to keep the covariates between these 2 groups well balanced. We compared the risk of these outcomes using the Cox proportional hazards model. The mean follow‐up time was 4.7 years. During follow‐up, there were 7.5% and 6.4% of patients with composite vascular outcomes in the DMARD‐inadequate response and control groups, respectively. There was no significant difference in the risk of composite vascular outcomes (95% CI, 0.94–1.41) and ischemic stroke (95% CI, 0.84–1.36). The risk of acute coronary syndrome was significantly higher in the DMARD‐inadequate response group (hazard ratio, 1.45; 95% CI, 1.02–2.05).

Conclusions
Patients with DMARD‐inadequate response rheumatoid arthritis have a higher risk of developing acute coronary syndrome than those whose disease can be controlled by DMARDs.
Aspirin Alone Versus Dual Antiplatelet Therapy After Transcatheter Aortic Valve Implantation: A Systematic Review and Patient‐Level Meta‐Analysis
Authors: Brouwer Jorn , Nijenhuis Vincent J. , Rodés‐Cabau Josep , Stabile Eugenio , Barbanti Marco , Costa Giuliano , Mahmoodi Bakhtawar K. , ten Berg Jurrien M. 
Published: April 2021

Background
In patients undergoing transcatheter aortic valve implantation without an indication for oral anticoagulation, it is unclear whether single or dual antiplatelet therapy (DAPT) is necessary to minimize both the bleeding and thromboembolic risk. In this patient‐level meta‐analysis, we further investigate the effect of aspirin alone compared with DAPT for preventing both thromboembolic and bleeding events after transcatheter aortic valve implantation.

Methods and Results

We conducted a systematic review of all available randomized controlled trials comparing aspirin with DAPT. In total, 1086 patients were included across 4 eligible trials. The primary outcomes were the composite of all‐cause mortality, major or life‐threatening bleeding, stroke or myocardial infarction (first composite outcome), and the same composite excluding bleeding (second composite outcome), both tested at 30 days and 3 months. The first composite outcome occurred significantly less in the aspirin‐alone group at 30 days (10.3% versus 14.7%, odds ratio [OR], 0.67; 95% CI, 0.46–0.97,
P
=0.034) and 3 months (11.0% versus 16.5%, hazard ratio [HR], 0.66; 95% CI, 0.47–0.94,
P
=0.02), compared with the DAPT group. The second composite outcome occurred in 5.5% and 6.6% at 30 days (OR, 0.83; 95% CI, 0.50–1.38,
P
=0.47) and in 6.9% and 8.5% at 3 months in the aspirin‐alone group compared with the DAPT group (HR, 0.82; 95% CI, 0.52–1.29,
P
=0.39), respectively.

Conclusions
In patients without an indication for oral anticoagulation undergoing transcatheter aortic valve implantation, aspirin alone significantly reduced the composite of thromboembolic and bleeding events, and does not increase the composite of thromboembolic events after transcatheter aortic valve implantation, compared with DAPT.
Microphysical and Polarimetric Radar Modeling of Hydrometeor Refreezing
Authors: Tobin Dana M. , Kumjian Matthew R. 
Published: April 2021

AbstractA unique polarimetric radar signature indicative of hydrometeor refreezing during ice pellet events has been documented in several recent studies, yet the underlying microphysical causes remain unknown. The signature is characterized by enhancements in differential reflectivity (ZDR), specific differential phase (KDP), and linear depolarization ratio (LDR), and a reduction in copolar correlation coefficient (ρhv) within a layer of decreasing radar reflectivity factor at horizontal polarization (ZH). In previous studies, the leading hypothesis for the observed radar signature is the preferential refreezing of small drops. Here, a simplified, one-dimensional, explicit bin microphysics model is developed to simulate the refreezing of fully melted hydrometeors, and coupled with a polarimetric radar forward operator to quantify the impact of preferential refreezing on simulated radar signatures. The modeling results demonstrate that preferential refreezing is insufficient by itself to produce the observed signatures. In contrast, simulations considering an ice shell growing asymmetrically around a freezing particle (i.e., emulating a thicker ice shell on the bottom of a falling particle) produce realistic ZDR enhancements, and also closely replicate observed features in ZH, KDP, LDR, and ρhv. Simulations that assume no increase in particle wobbling with freezing produce an even greater ZDR enhancement, but this comes at the expense of reducing the LDR enhancement. It is suggested that the polarimetric refreezing signature is instead strongly related to both the distribution of the unfrozen liquid portion within a freezing particle and the orientation of this liquid with respect to the horizontal.
A Portrait of Contrasts in Disaster Risk Response: A Post-Haiyan Study of Coron, Philippines
Authors: Ponce de Leon Inez Z. 
Published: April 2021

AbstractSupertyphoon Haiyan hit the Philippines in 2013, causing massive damage and loss of lives. The media blamed the government for faulty warnings, including using the term “storm surge,” which people reportedly did not understand. As a result, the national agency tasked with disaster risk management recommended translating the term for better response in future storms. Such an approach shortchanges the complexity of risk construction and dismisses the possibility that different communities also have different understandings of risk. In this study, the researcher examined the special case of Coron, Palawan: a major tourist destination that is rarely hit by storms but that became the site of Haiyan’s last landfall. Guided by encoding–decoding theory, the researcher interviewed local government officials and carried out focus group discussions with representatives of two communities (whose names have been hidden under pseudonyms for this study): Central, close to the municipal center, and Island, a coastal village far away from potential aid and rescue. The researcher found a portrait of contrasts that split Coron: a mayor who surrendered all control and a risk management officer who planned for long-term hazard response—Island waiting for government instructions despite knowing about storm behavior and Central taking the initiative to create long-term solutions. Island also knew what storm surges were and did not need translation of the term. These findings show that risk constructions can differ even at the municipal level, which should prompt further research into the role of local knowledge in understanding risk and hazard warnings.
Cost-Benefit Analysis of Robotic vs. Laparoscopic Hepatectomy: A Propensity-Matched Retrospective Cohort Study of American College of Surgeons National Surgical Quality Improvement Program Database
Authors: Miller Henry P. , Hakim Abraham , Kellish Alec , Wozniak Marisa , Gaughan John , Sensenig Richard , Atabek Umur M. , Spitz Francis R. , Hong Young K. 
Published: April 2021

Background Robotic and laparoscopic hepatectomies having increased utilization as minimally invasive techniques are explored for hepatobiliary malignancies. Although the data on outcomes from these 2 approaches are emerging, the cost-benefit analysis of these approaches remains sparse. This study compares the costs associated with robotic vs. laparoscopic liver resections, taking into account 30-day complications. Methods Using the American College of Surgeons National Surgical Quality Improvement Program database, a propensity-matched cohort of patients with laparoscopic or robotic liver resections between 2014 and 2017 was identified. Costs were assigned to perioperative variables, including operating room (OR) time, length of stay, blood transfusions, and 30-day complications. Cost estimates were obtained from the Centers for Medicare and Medicaid Services billing data (2017), American Hospital Association data (2017), relevant literature, and local institutional cost data. Results In our matched cohort of 454 patients (227 per group), total costs associated with laparoscopic liver resections were estimated at $5.5 M ($24 K per patient) vs. $6.8 M ($29.8 K per patient) for robotic liver resections (21.3% difference, P < .001). The higher cost associated with robotic hepatectomies was related to blood transfusions ($22.0 K vs. $12.1 K, P = .02), length of stay ($2.05 M vs. $1.76 M, P = .046), and OR time ($4.01 M vs. $3.24 M, P < .0001). Discussion Robotic hepatectomies were associated with higher costs compared to laparoscopic hepatectomies. The 2 major contributors to the cost disparity were increased OR time and increased length of stay. Future studies are warranted to analyze high-volume Minimally Invasive Surgery surgeons’ impact in specialty centers on potentially mitigating this current cost disparity.
Aging with multiple sclerosis: A longitudinal study of physical function, mental health, and memory in two cohorts of US women
Authors: Cortese Marianna , Bjornevik Kjetil , Chitnis Tanuja , Ascherio Alberto , Munger Kassandra L 
Published: April 2021

Background: It is unknown how individuals with multiple sclerosis (MS) age compared to unaffected peers. Objectives: The objective of the study is to describe the impact of MS on health and functioning in aging women. Methods: We used 10-item Physical Functioning Scale (PF10) scores (from the Short Form-36 (SF-36)) and other indicators of general, physical, mental health, and memory collected repeatedly over 25 years with self-administered questionnaires among participants in the Nurses’ Health Study ( n = 121,700 recruited at ages 30–55) and Nurses’ Health Study II ( n = 116,429 recruited at ages 25–42) to compare women with MS ( n = 733) to unaffected peers in their health and disability, and describe/quantify the burden of aging with MS. Results: Women with MS had a consistently lower PF10 by 0.9–1.7 standard deviations with greater overall variability than unaffected women. PF10-scores gradually decreased with increasing age in both groups, but MS cases declined 3–4 times faster in midlife, while decline was similar in old age. The physical function score of 45-year-old women with MS was comparable to that of 75-year-old unaffected women; 70-year-old women with MS scored similarly to 85-year-old unaffected women. MS cases also reported worse health/more disability throughout adulthood on the other indicators. Conclusion: The age-related decline in physical health is accelerated by 15–30 years in MS patients compared to unaffected peers.
Is orthodontic treatment associated with changes in self-esteem during adolescence? A longitudinal study
Authors: Vulugundam Srichitra , Abreu Lucas Guimarães , Bernabé Eduardo 
Published: April 2021

Objective: This study explored the association between history of orthodontic treatment and changes in self-esteem among British adolescents. Design: Birth cohort study. Setting: United Kingdom. Participants: Data from 2600 participants of the British Cohort Study were analysed. Methods: Participants completed the Lawrence Self-Esteem Questionnaire (LAWSEQ) at the ages of 10 and 16 years. The change in LAWSEQ score over six years was the outcome. Participants were divided into two groups according to parental reports of orthodontic treatment at the same ages. The association between history of orthodontic treatment and six-year changes in LAWSEQ score was tested in linear regression models adjusting for demographic factors (adolescents’ sex and ethnicity), family socioeconomic status (parental social class and mothers’ education), perceived orthodontic treatment need and baseline LAWSEQ score. Results: According to parental reports, 8% of participants had a history of orthodontic treatment. The mean LAWSEQ score at baseline was 13.7 (95% confidence interval [CI] 13.6–13.9) and increased significantly over time by 1.7 units (95% CI 1.5–1.9). Orthodontic treatment history was positively, albeit not significantly, associated with change in LAWSEQ score (coefficient: 0.08, 95% CI –0.56 to 0.72). The direction of the association reversed but remained non-significant after adjustment for all confounders (coefficient: –0.19; 95% CI –0.68 to 0.30). Improvements in self-esteem were positively associated with mothers’ education (coefficient: 0.85; 95% CI 0.09–1.61) and negatively associated with self-esteem at baseline (coefficient –0.79; 95% CI –0.82 to –0.75). Conclusion: This six-year longitudinal study provided no evidence for an association between history of orthodontic treatment and changes in self-esteem during adolescence.
Switch from intravenous to subcutaneous immunoglobulin IgPro20 in CIDP patients: a prospective observational study under real-world conditions
Authors: Gingele Stefan , Koch Moritz , Saparilla Anna Christina , Körner Gudrun M. , von Hörsten Jarle , Gingele Marina , Seeliger Tabea , Konen Franz Felix , Hümmert Martin W. , Neyazi Alexandra , Stangel Martin , Skripuletz Thomas 
Published: April 2021

Background: IgPro20 is the first approved subcutaneous immunoglobulin (SCIg) preparation for the treatment of patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Two different doses of the SCIg preparation were investigated in the pivotal PATH study. Real-world data, and particularly the efficacy of an equivalent dose switch from intravenous immunoglobulin (IVIg) to SCIg, are still not available. Methods: In this prospective observational study, 41 patients with CIDP treated with intravenous immunoglobulin (IVIg) were changed to an equivalent (1:1) dose of IgPro20 1 week after last IVIg treatment. Patients were examined at the time of switch from IVIg to SCIg, after 3 and after 6 months and efficacy, treatment preferences and systemic and local reactions were assessed. Results: Various clinical outcome parameters demonstrated overall stability regarding disability, general activity and social participation, grip and muscle strength, as well as gait impairment. Treatment satisfaction remained unchanged between IVIg and SCIg therapy. However, 88% of patients favoured treatment with subcutaneous IgPro20 over IVIg 6 months after switch to IgPro20. Conclusion: Results demonstrate that the switch of IVIg to an equivalent dose of SCIg represents an effective and preferred treatment option for CIDP patients.
Eye Protection in ENT Practice During the COVID‐19 Pandemic
Authors: Ng Jia Hui , Daniel Dan , Sadovoy Anton , Teo Constance Ee Hoon 
Published: April 2021

ObjectivesThere is a lack of evidence‐based guidelines with regard to eye protection for aerosol‐generating procedures in otolaryngology practice. In addition, some recommended personal protective equipment (PPE) is not compatible with commonly used ENT equipment. This study aims to investigate the degree of eye protection that commonly used PPE gives.Study DesignSimulation model.SettingSimulation laboratory.MethodsA custom‐built setup was utilized to simulate the clinical scenario of a patient cough in proximity of a health care worker. A system that sprays a xanthan‐fluorescein mixture was set up and calibrated to simulate a human cough. A mannequin with cellulose paper placed on its forehead, eyes, and mouth was fitted with various PPE combinations and exposed to the simulated cough. The degree of contamination on the cellulose papers was quantified with a fluorescent microscope able to detect aerosols ≥10 µm.ResultsWhen no eye protection was worn, 278 droplets/aerosols reached the eye area. The use of the surgical mask with an attached upward‐facing shield alone resulted in only 2 droplets/aerosols reaching the eye area. In this experiment, safety glasses and goggles performed equally, as the addition of either brought the number of droplets/aerosols reaching the eye down to 0.ConclusionWhen used with an upward‐facing face shield, there was no difference in the eye protection rendered by safety goggles or glasses in this study. Safety glasses may be considered a viable alternative to safety goggles in aerosol‐generating procedures.