bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variables
Authors: aan de Stegge Wouter B , Schut Martijn C , Abu-Hanna Ameen , van Baal Jeff G , van Netten Jaap J , Bus Sicco A 
Published: July 2021

IntroductionWe aimed to develop a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variables and to validate its predictive performance in order to help risk assessment in this high-risk group.Research design and methodsWe used data from a prospective analysis of 304 people with foot ulcer history who had 18-month follow-up for ulcer outcome. Demographic, disease-related and organization-of-care variables were included as potential predictors. Two logistic regression prediction models were created: model 1 for all recurrent foot ulcers (n=126 events) and model 2 for recurrent plantar foot ulcers (n=70 events). We used 10-fold cross-validation, each including five multiple imputation sets for internal validation. Performance was assessed in terms of discrimination using area under the receiver operating characteristic curve (AUC) (0–1, 1=perfect discrimination), and calibration with the Brier Score (0–1, 0=complete concordance predicted vs observed values) and calibration graphs.ResultsPredictors in model 1 were: a younger age, more severe peripheral sensory neuropathy, fewer months since healing of previous ulcer, presence of a minor lesion, use of a walking aid and not monitoring foot temperatures at home. Mean AUC for model 1 was 0.69 (2SD 0.040) and mean Brier Score was 0.22 (2SD 0.011). Predictors in model 2 were: a younger age, plantar location of previous ulcer, fewer months since healing of previous ulcer, presence of a minor lesion, consumption of alcohol, use of a walking aid, and foot care received in a university medical center. Mean AUC for model 2 was 0.66 (2SD 0.023) and mean Brier Score was 0.16 (2SD 0.0048).ConclusionsThese internally validated prediction models predict with reasonable to good calibration and fair discrimination who is at highest risk of ulcer recurrence. The people at highest risk should be monitored more carefully and treated more intensively than others.Trial registration numberNTR5403.
1 An evaluation of burnout amongst defence medical services anaesthesia trainees
Authors: Pang Allan 
Published: July 2021

IntroductionMultiple studies have found burnout to be the highest amongst Anaesthetists and Intensivists. A recent report by the Royal College of Anaesthetists (RCoA) in 2017 reported a burnout rate of 85% amongst anaesthetic trainees. This project aimed to evaluate following questions:What are the levels of burnout among defence anaesthetic trainees?What are the main causes of burnout among defence anaesthetic trainees?MethodsWe conducted an on-line anonymous survey across all trainees within the military anaesthesia cadre which consisted of the following sections:DemographicsOldenburg Burnout InventoryBaseline Mental Health (PHQ 9 & GAD 7)Stressors (Severity and Frequency)ResultsWhilst the burnout rate appears relatively high at 57.9%, it was comparatively lower against the RCoA report. Army (53%) and RAF (46%) trainees had similar rates of burnout whilst the Navy (76.9%) had notably a higher rate. Gender and seniority did not seem to have an effect on burnout. The findings of this study are more in line with other baseline burnout studies than the RCoA welfare report.ConclusionsThe effect of work on personal/family life and administrative burdens seem to be consistent regardless of burnout status. The perceived degree of workload and staff/resource availability appears to be discriminatory to those labelled low risk potentially mirroring the differences seen between services and highlights potential areas to modify our risk of burnout within our cadre.
Developing a policy to reduce the salt content of food consumed outside the home in Malaysia: protocol of a qualitative study
Authors: Brown Mhairi Karen , Shahar Suzana , You Yee Xing , Michael Viola , Majid Hazreen Abdul , Manaf Zahara Abdul , Haron Hasnah , Sukiman Noor Shahida , Chia Yook Chin , He Feng J , MacGregor Graham A 
Published: July 2021

IntroductionCurrent salt intake in Malaysia is high. The existing national salt reduction policy has faced slow progress and does not yet include measures to address the out of home sector. Dishes consumed in the out of home sector are a known leading contributor to daily salt intake. This study aims to develop a salt reduction strategy, tailored to the out of home sector in Malaysia.Methods and analysisThis study is a qualitative analysis of stakeholder views towards salt reduction. Participants will be recruited from five zones of Malaysia (Western, Northern, Eastern and Southern regions and East Malaysia), including policy-makers, non-governmental organisations, food industries, school canteen operators, street food vendors and consumers, to participate in focus group discussions or in-depth interviews. Interviews will be transcribed and analysed using thematic analysis. Barriers will be identified and used to develop a tailored salt reduction strategy.Ethics and disseminationEthical approval has been obtained from the Universiti Kebangsaan Malaysia Medical Research Ethics Committee (UKM PPI/1118/JEP-2020–524), the Malaysian National Medical Research Ethics Committee (NMRR-20-1387-55481 (IIR)) and Queen Mary University of London Research Ethics Committee (QMERC2020/37) . Results will be presented orally and in report form and made available to the relevant ministries for example, Ministry of Health, Ministry of Education and Ministry of Trade to encourage adoption of strategy as policy. The findings of this study will be disseminated through conference presentations, peer-reviewed publications and webinars.
Prediction model of in-hospital mortality in intensive care unit patients with heart failure: machine learning-based, retrospective analysis of the MIMIC-III database
Authors: Li Fuhai , Xin Hui , Zhang Jidong , Fu Mingqiang , Zhou Jingmin , Lian Zhexun 
Published: July 2021

ObjectiveThe predictors of in-hospital mortality for intensive care units (ICUs)-admitted heart failure (HF) patients remain poorly characterised. We aimed to develop and validate a prediction model for all-cause in-hospital mortality among ICU-admitted HF patients.DesignA retrospective cohort study.Setting and participantsData were extracted from the Medical Information Mart for Intensive Care (MIMIC-III) database. Data on 1177 heart failure patients were analysed.MethodsPatients meeting the inclusion criteria were identified from the MIMIC-III database and randomly divided into derivation (n=825, 70%) and a validation (n=352, 30%) group. Independent risk factors for in-hospital mortality were screened using the extreme gradient boosting (XGBoost) and the least absolute shrinkage and selection operator (LASSO) regression models in the derivation sample. Multivariate logistic regression analysis was used to build prediction models in derivation group, and then validated in validation cohort. Discrimination, calibration and clinical usefulness of the predicting model were assessed using the C-index, calibration plot and decision curve analysis. After pairwise comparison, the best performing model was chosen to build a nomogram according to the regression coefficients.ResultsAmong the 1177 admissions, in-hospital mortality was 13.52%. In both groups, the XGBoost, LASSO regression and Get With the Guidelines-Heart Failure (GWTG-HF) risk score models showed acceptable discrimination. The XGBoost and LASSO regression models also showed good calibration. In pairwise comparison, the prediction effectiveness was higher with the XGBoost and LASSO regression models than with the GWTG-HF risk score model (p<0.05). The XGBoost model was chosen as our final model for its more concise and wider net beneﬁt threshold probability range and was presented as the nomogram.ConclusionsOur nomogram enabled good prediction of in-hospital mortality in ICU-admitted HF patients, which may help clinical decision-making for such patients.
Multicentre methodological study to create a publicly available score of hospital financial standing in the USA
Authors: Zinoviev Radoslav , Krumholz Harlan M , Ciccarone Richard , Antle Rick , Forman Howard P 
Published: July 2021

ObjectivesTo create a straightforward scoring procedure based on widely available, inexpensive financial data that provides an assessment of the financial health of a hospital.DesignMethodological study.SettingMulticentre study.ParticipantsAll hospitals and health systems reporting the required financial metrics in the USA in 2017 were included for a total of 1075 participants.InterventionsWe examined a list of 232 hospital financial indicators and used existing models and financial literature to select 30 metrics that sufficiently describe hospital operations. In a set of hospital financial data from 2017, we used principal coordinate analysis to assess collinearity among variables and eliminated redundant variables. We isolated 10 unique variables, each assigned a weight equal to the share of its coefficient in a regression onto Moody’s Credit Rating, our predefined gold standard. The sum of weighted variables is a single composite score named the Yale Hospital Financial Score (YHFS).Primary outcome measuresAbility to reproduce both financial trends from a ‘gold-standard’ metric and known associations with non-fiscal data.ResultsThe validity of the YHFS was evaluated by: (1) cross-validating it with previously excluded data; (2) comparing it to existing models and (3) replicating known associations with non-fiscal data. Ten per cent of the initial dataset had been reserved for validation and was not used in creating the model; the YHFS predicts 96.7% of the variation in this reserved sample, demonstrating reproducibility. The YHFS predicts 90.5% and 88.8% of the variation in Moody’s and Standard and Poor’s bond ratings, respectively, supporting its validity. As expected, larger hospitals had higher YHFS scores whereas a greater share of Medicare discharges correlated with lower YHFS scores.ConclusionsWe created a reliable and publicly available composite score of hospital financial stability.
Protocol of a tailored educational intervention for general practitioners on potentially inappropriate medications among older patients at community healthcare institutions in Beijing, China: a cluster-randomised controlled trial
Authors: Fu Mengyuan , Wushouer Haishaerjiang , Nie Xiaoyan , Li Nan , Zhang Xinyan , Wang Fang , Guan Xiaodong , Shi Luwen 
Published: July 2021

IntroductionPrescribing of potentially inappropriate medications (PIMs) has become a prominent issue of public concern among elderly patients. However, no research has involved interventions on PIMs of Chinese elderly patients seeking care at primary healthcare. This study aims to evaluate the effectiveness of a tailored educational intervention programme for general practitioners (GPs), aiming at reducing the occurrence of PIMs in elderly patients.Methods and analysisThis is a parallel group, controlled, cluster-randomised trial, with blinded evaluation of outcomes and data analysis, and un-blinded intervention. Twenty primary community healthcare stations (CHSs) in Dongcheng district in Beijing will be randomised to intervention and control arm with an allocation ratio of 1:1. GPs in CHSs randomised to the intervention arm will receive a two-component intervention: general training of PIMs and distribution of PIMs handbook. GPs in the control arm will assess and manage patients according to the institutions’ routine practice. The primary outcome is the change in PIMs patient visit rate.Ethics and disseminationEthics committee approval of this study was obtained from Peking University Institution Review Board (IRB00001052-19074). The findings will be published in scientific and conference presentations.Trial registration numberChiCTR2100047788.
Sickle Cell Disease Genomics of Africa (SickleGenAfrica) Network: ethical framework and initial qualitative findings from community engagement in Ghana, Nigeria and Tanzania
Authors: Anie Kofi A , Olayemi Edeghonghon , Paintsil Vivian , Owusu-Dabo Ellis , Adeyemo Titilope Adenike , Sani Mahmoud U , Galadanci Najibah Aliyu , Nnodu Obiageli , Tluway Furahini , Adjei David Nana , Mensah Peter , Sarfo-Antwi Joseph , Nwokobia Henry , Gambo Awwal , Benjamin Adebola , Salim Arafa , Osae-Larbi Judith A , Ofori-Acquah Solomon Fiifi 
Published: July 2021

ObjectivesTo provide lay information about genetics and sickle cell disease (SCD) and to identify and address ethical issues concerning the Sickle Cell Disease Genomics of Africa Network covering autonomy and research decision-making, risk of SCD complications and organ damage, returning of genomic findings, biorepository, data sharing, and healthcare provision for patients with SCD.DesignFocus groups using qualitative methods.SettingSix cities in Ghana, Nigeria and Tanzania within communities and secondary care.ParticipantsPatients, parents/caregivers, healthcare professionals, community leaders and government healthcare representatives.ResultsResults from 112 participants revealed similar sensitivities and aspirations around genomic research, an inclination towards autonomous decision-making for research, concerns about biobanking, anonymity in data sharing, and a preference for receiving individual genomic results. Furthermore, inadequate healthcare for patients with SCD was emphasised.ConclusionsOur findings revealed the eagerness of patients and parents/caregivers to participate in genomics research in Africa, with advice from community leaders and reassurance from health professionals and policy-makers, despite their apprehensions regarding healthcare systems.
Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience
Authors: Mahmood Kamran , Abbott Matt , Van Nostrand Keriann , Bechara Rabih , Gonzalez Anne V , Brucker Amanda , Green Cynthia L , Polage Christopher R 
Published: July 2021

ObjectiveFor the diagnosis of COVID-19, the yield of nasopharyngeal (NP) swabs is unclear, and bronchoalveolar lavage (BAL) is obtained to confirm the diagnosis. We assessed the utilisation of bronchoscopy for COVID-19 diagnosis in a multicenter study and compared the diagnostic yield of BAL versus NP swabs.MethodsThis retrospective study included all patients who were admitted with clinical presentation concerning for COVID-19 and underwent BAL from 1 March to 31 July 2020 at four tertiary care centres in North America. We also compared concordance of BAL with NP swabs for diagnosis of COVID-19 infection.ResultsFifty-three patients, with clinical suspicion for COVID-19 and admitted for respiratory failure, underwent bronchoscopy to collect BAL for SARS-CoV-2 testing. During the same period, 2039 bronchoscopies were performed on patients not infected with COVID-19. Of 42 patients with NP swabs and BAL collected within ≤7 days, 1 was NP swab negative but positive by BAL for SARS-CoV-2 (n=1/42 (2.4%)). Across a wide array of testing platforms, the overall agreement between NP swabs and BAL results was 97.6% (95% CI: 93.0% to 100%) with Cohen’s k of 0.90 (95% CI: 0.69 to 1.00). The sensitivity, specificity, positive and negative predictive values of NP swabs compared with BAL were 83.3% (95% CI: 53.5% to 100%), 100%, 100% and 97.3% (95% CI: 92.1% to 100%), respectively.ConclusionsBAL was used infrequently to assess COVID-19 in busy institutions. NP swabs have a high concordance with BAL for COVID-19 testing, but negative NP swabs should be confirmed with BAL when clinical suspicion is high.
Best supportive care and prognosis: advanced gastroesophageal adenocarcinoma
Authors: Cavanagh Kirsty E , Baxter Mark A , Petty Russell D 
Published: July 2021

ObjectivesReal-world data are lacking on survival in patients with advanced gastroesophageal adenocarcinoma (GOA) treated with best supportive care (BSC) alone. This knowledge is vital to personalise cancer treatment and obtain informed consent. This study aimed to define and compare survival in patients with advanced GOA treated with and without palliative chemotherapy (CTx), and to explore the factors that impact prognosis.MethodsPatients in NHS Tayside, Scotland, diagnosed with advanced GOA (defined as non-resectable) over a 2-year period were identified retrospectively. Clinical data were obtained from electronic records. Kaplan-Meier and Cox regression analysis were performed to determine median overall survival (mOS) and investigate contributing factors.Results127 eligible patients were identified. There was a significant difference in mOS between patients in the BSC and CTx groups (3.1 months vs 8.9 months, p=0.00089). This was maintained when those deemed not fit for CTx were removed. One-year survival was 16% versus 33%. Cox regression analysis in the BSC group identified stage (p<0.001) and Eastern Cooperative Oncology Group performance status (ECOG PS) (p=0.013) as having independent predictive value for survival. Age was not related to outcome. Palliative stents were inserted in 48 patients (37.8%).ConclusionsTo our knowledge, this is the largest reported study in Europe of outcomes in patients with advanced GOA treated with BSC only. The mOS with BSC is approximately 3 months. Cancer stage and ECOG PS have a role in prognostication at diagnosis. Our findings support the benefit of palliative chemotherapy in this population, and real-world survival corresponds to published trial data.
CX-072 (pacmilimab), a Probody®PD-L1 inhibitor, in advanced or recurrent solid tumors (PROCLAIM-CX-072): an open-label dose-finding and first-in-human study
Authors: Naing Aung , Thistlethwaite Fiona , De Vries Elisabeth G.E. , Eskens Ferry A.L.M. , Uboha Nataliya , Ott Patrick A. , LoRusso Patricia , Garcia-Corbacho Javier , Boni Valentina , Bendell Johanna , Autio Karen A. , Randhawa Manreet , Durm Greg , Gil-Martin Marta , Stroh Mark , Hannah Alison L. , Arkenau Hendrik-Tobias , Spira Alexander 
Published: July 2021

BackgroundProbody®therapeutics are antibody prodrugs that are activated in the tumor microenvironment by tumor-associated proteases, thereby restricting the activity to the tumor microenvironment and minimizing ‘off-tumor’ toxicity. We report dose-escalation and single-agent expansion phase data from the first-in-human study of CX-072 (pacmilimab), a Probody checkpoint inhibitor directed against programmed death-ligand 1 (PD-L1).MethodsIn the dose-escalation phase of this multicenter, open-label study (NCT03013491), adults with advanced solid tumors (naive to programmed-death-1/PD-L1 or cytotoxic T-lymphocyte-associated antigen 4 inhibitors) were enrolled into one of seven dose-escalation cohorts, with pacmilimab administered intravenously every 14 days. The primary endpoints were safety and determination of the maximum tolerated dose (MTD). In the expansion phase, patients with one of six prespecified malignancies (triple-negative breast cancer [TNBC]; anal squamous cell carcinoma [aSCC]; cutaneous SCC [cSCC]; undifferentiated pleomorphic sarcoma [UPS]; small bowel adenocarcinoma [SBA]; and thymic epithelial tumor [TET]); or high tumor mutational burden (hTMB) tumors were enrolled. The primary endpoint was objective response (Response Evaluation Criteria In Solid Tumors v.1.1).ResultsAn MTD was not reached with doses up to 30 mg/kg. A recommended phase 2 dose (RP2D) of 10 mg/kg was chosen based on pharmacokinetic and pharmacodynamic findings in the expansion phase. Ninety-eight patients enrolled in the expansion phase: TNBC (n=14), aSCC (n=14), cSCC (n=14), UPS (n=20), SBA (n=14), TET (n=8), and hTMB tumors (n=14). Of 114 patients receiving pacmilimab at the RP2D, grade ≥3 treatment-related adverse events (TRAEs) were reported in 10 patients (9%), serious TRAEs in six patients (5%), and treatment discontinuation due to TRAEs in two patients (2%). Grade ≥3 immune-related AEs occurred in two patients (rash, myocarditis). High PD-L1 expression (ie, >50% Tumor Proportion Score) was observed in 22/144 (19%) patients. Confirmed objective responses were observed in patients with cSCC (n=5, including one complete response), hTMB (n=4, including one complete response), aSCC (n=2), TNBC (n=1), UPS (n=1), and anaplastic thyroid cancer (n=1).ConclusionsPacmilimab can be administered safely at the RP2D of 10 mg/kg every 14 days. At this dose, pacmilimab had a low rate of immune-mediated toxicity and showed signs of antitumor activity in patients not selected for high PD-L1 expression.Trial registration numberNCT03013491.
Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline
Authors: McKnight Gerard Hywel Owen , Yalamanchili Seema , Sanchez-Thompson Natalia , Guidozzi Nadia , Dunhill-Turner Natasha , Holborow Alex , Batrick Nicola , Hettiaratchy Shehan , Khan Mansoor , Kashef Elika , Aylwin Chris , Frith Dan 
Published: July 2021

BackgroundPenetrating gluteal injuries (PGIs) are an increasingly common presentation to major trauma centers (MTCs) in the UK and especially in London. PGIs can be associated with mortality and significant morbidity. There is a paucity of consistent guidance on how best to investigate and manage these patients.MethodsA retrospective cohort study was performed by interrogating prospectively collected patient records for PGI presenting to a level 1 MTC in London between 2017 and 2019.ResultsThere were 125 presentations with PGI, accounting for 6.86% of all penetrating injuries. Of these, 95.2% (119) were male, with a median age of 21 (IQR 18–29), and 20.80% (26) were under 18. Compared with the 3 years prior to this study, the number of PGI increased by 87%. The absolute risk (AR) of injury to a significant structure was 27.20%; the most frequently injured structure was a blood vessel (17.60%), followed by the rectum (4.80%) and the urethra (1.60%). The AR by anatomic quadrant of injury was highest in the lower inner quadrant (56%) and lowest in the upper outer quadrant (14%). CT scanning had an overall sensitivity of 50% and specificity of 92.38% in identifying rectal injury.DiscussionThe anatomic quadrant of injury can be helpful in stratifying risk of rectal and urethral injuries when assessing a patient in the emergency department. Given the low sensitivity in identifying rectal injury on initial CT, this data supports assesing any patients considered at high risk of rectal injury with an examination under general anesthetic with or without rigid sigmoidoscopy . The pathway has created a clear tool that optimizes investigation and treatment, minimizing the likelihood of missed injury or unnecessary use of resources. It therefore represents a potential pathway other centers receiving a similar trauma burden could consider adopting.Level of evidence2b.
Hadronic light-by-light contribution to $$(g-2)_\mu $$ from lattice QCD: a complete calculation
Authors: Chao En-Hung , Hudspith Renwick J. , Gérardin Antoine , Green Jeremy R. , Meyer Harvey B. , Ottnad Konstantin 
Published: July 2021

AbstractWe compute the hadronic light-by-light scattering contribution to the muon $$g-2$$

g
-
2

from the up, down, and strange-quark sector directly using lattice QCD. Our calculation features evaluations of all possible Wick-contractions of the relevant hadronic four-point function and incorporates several different pion masses, volumes, and lattice-spacings. We obtain a value of $$a_\mu ^{\text {Hlbl}}= 106.8(15.9) \times 10^{-11}$$

a
μ
Hlbl

=
106.8

(
15.9
)

×

10

-
11

(adding statistical and systematic errors in quadrature), which is consistent with current phenomenological estimates and a previous lattice determination. It now appears conclusive that the hadronic light-by-light contribution cannot explain the current tension between theory and experiment for the muon $$g-2$$

g
-
2

.