bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing best practices for PPE Portraits across 25 sites: a systematic assessment of implementation and spread of adaptations using FRAME
Authors: Baratta Juliana , Amano Alexis , Parsons Paige K , Vilendrer Stacie , Winter Shira G. , Verano Mae-Richelle , Perez Cynthia , Kalanithi Lucy , Asch Steven M , Heffernan Mary Beth , Brown-Johnson Cati 
Published: October 2021

Abstract
Background
Adaptation, a form of modification that aims to improve an intervention’s acceptability and sustainability in each context, is essential to successful implementation in some settings. Due to the COVID-19 pandemic, clinicians have rapidly adapted how they deliver patient care. PPE Portraits are a form of adaptation, whereby health workers affix a postcard size portrait of themselves to the front of their personal protective equipment (PPE) to foster human connection during COVID-19.

Methods
We used the expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME) method to better understand the reasoning behind and results of each adaptation. We hypothesized that using the FRAME in conjunction with design-thinking would lead to emerging best practices and that we would find adaptation similarities across sites. Throughout multiple implementations across 25 institutions, we piloted, tracked, and analyzed adaptations using FRAME and design thinking. For each adaptation, we assessed the stage of implementation, whether the change was planned, decision makers involved, level of delivery impacted, fidelity to original intervention, and the goal and reasoning for adaptation. We added three crucial components to the FRAME: original purpose of the adaptation, unintended consequences, and alternative adaptations.

Results
When implementing PPE Portraits across settings, from a local assisted living center’s memory unit to a pediatric emergency department, several requests for adaptations arose during early development stages before implementation. Adaptations primarily related to (1) provider convenience and comfort, (2) patient populations, and (3) scale. Providers preferred smaller portraits and rounded (rather than square) laminated edges that could potentially injure a patient. Affixing the portrait with a magnet was rejected given the potential choking hazard the magnetic strip presented for children. Other adaptations, related to ease of dissemination, included slowing the process down during early development and providing buttons, which could be produced easily at scale.

Conclusions
The FRAME was used to curate the reasoning for each adaptation and to inform future dissemination. We look forward to utilizing FRAME including our additions and design thinking, to build out a range of PPE Portrait best practices with accompanying costs and benefits.
Whether high government subsidies reduce the healthcare provision of township healthcare centers in rural China
Authors: Shen Chi , Zhou Zhongliang , Lai Sha , Dong Wanyue , Zhao Yaxin , Cao Dan , Zhao Dantong , Ren Yangling , Fan Xiaojing 
Published: October 2021

Abstract
Background
China’s government launched a large-scale healthcare reform from 2009. One of the main targets of this round reform was to improve the primary health care system. Major reforms for primary healthcare institutions include increasing government investment. However, there are insufficient empirical studies based on large sample to catch long-term effect of increased government subsidy and lack of sufficient incentives on township healthcare centers (THCs), therefore, this study aims to provide additional empirical evidence on the concern by conducting an empirical analysis of THCs in Shaanxi province in China.

Methods
We collected nine years (2009 to 2017) data of THCs from the Health Finance Annual Report System (HFARS) that was acquired from the Health Commission of Shaanxi Province. We applied two-way fixed effect model and continue difference-in-difference (DID) model to estimate the effect of percentage of government subsidy on medical provision.

Results
A clear jump of the average percentage of government subsidy to total revenue of THCs can be found in Shaanxi province in 2011, and the average percentage has been more than 60% after 2011. Continue DID models indicate every 1% percentage of government subsidy to total revenue increase after 2011 resulted in a decrease of 1.1 to 3.5% in THCs healthcare provision (1.9% in medical revenue, 1.2% in outpatient visit, 3.5% in total occupy beds of inpatient, 1.1% in surgery revenue, 2.1% in sickbed utilization rate). The results show that the THCs with high government subsidy reduce the number of medical services after 2011.

Conclusions
We think that it is no doubt that the government should take more responsibility for the financing of primary healthcare institutions, the problem is when government plays a central role in the financing and delivery of primary health care services, more effective incentives should be developed.
The degree of equity and coupling coordination of staff in primary medical and health care institutions in China 2013–2019
Authors: Ren Weicun , Tarimo Clifford Silver , Sun Lei , Mu Zihan , Ma Qian , Wu Jian , Miao Yudong 
Published: October 2021

Abstract
Background
Primary medical and health care facilities are the first lines of defense for the health of population. This study aims to evaluate the current state and trend of equity and coupling coordination degree (CCD) of staff in primary medical and health care institutions (SPMHCI) based on the quantity and living standards of citizens in China 2013–2019. The research findings are expected to serve as a guideline for the allocation of SPMHCI.

Methods
The data used in this study including the quantity and living standards of citizens, as well as the number of SPMHCI in 31 provincial administrative regions of China, were obtained from the China Statistical Yearbook and the China Health Statistics Yearbook. The equity and CCD for SPMHCI were analyzed by using the Gini coefficient and the CCD model, and the Grey forecasting model GM (1, 1) (GM) was used to predict the equity and CCD from 2020 to 2022.

Results
Between 2013 and 2019, the number of SPMHCI increased from 3.17 million to 3.50 million, and the population-based Gini coefficient declined from 0.0704 to 0.0513. In urban and rural areas, the Gini coefficients decreased from 0.1185 and 0.0737 to 0.1025 and 0.0611, respectively. The CCD between SPMHCI and citizens’ living standards (CLS) changed from 0.5691, 0.5813, 0.5818 to 0.5650, 0.5634, 0.6088 at national, urban, and rural levels, respectively. The forecasting results of GM revealed that at the national, urban and rural levels from 2020 to 2022, the Gini coefficient would rise at a rate of − 13.53, − 5.77%, and − 6.10%, respectively, while the CCD would grow at a rate of - 0.89, 1.06, and 0.87%, respectively.

Conclusions
In China, the number of SPMHCI has increased significantly, with an equitable allocation based on the population. The interaction between SPMHCI and CLS is sufficient, but the degree of mutual promotion is moderate. The government could optimize SPMHCI and improve the chronic disease management services to improve CLS and to ensure the continued operation of primary medical and health care institutions in urban areas.
SARS-CoV-2 and EBV; the cost of a second mitochondrial “whammy”?
Authors: Nunn Alistair V.W. , Guy Geoffrey W. , Botchway Stanley W. , Bell Jimmy D. 
Published: October 2021

AbstractWe, and others, have suggested that as the SARS-CoV-2 virus may modulate mitochondrial function, good mitochondrial reserve and health could be key in determining disease severity when exposed to this virus, as the immune system itself is dependent on this organelle’s function. With the recent publication of a paper showing that long COVID could be associated with the reactivation of the Epstein Barr Virus, which is well known to manipulate mitochondria, we suggest that this could represent a second mitochondrial “whammy” that might support the mitochondrial hypothesis underlying COVID-19 severity and potentially, the occurrence of longer-term symptoms. As mitochondrial function declines with age, this could be an important factor in why older populations are more susceptible. Key factors which ensure optimal mitochondrial health are generally those that ensure healthy ageing, such as a good lifestyle with plenty of physical activity. The ability of viruses to manipulate mitochondrial function is well described, and it is now also thought that for evolutionary reasons, they also manipulate the ageing process. Given that slowing the ageing process could well be linked to better economic outcomes, the link between mitochondrial health, economics, COVID-19 and other viruses, as well as lifestyle, needs to be considered.
The association between dietary fats and the incidence risk of cardiovascular outcomes: Tehran Lipid and Glucose Study
Authors: Gaeini Zahra , Mirmiran Parvin , Bahadoran Zahra , Aghayan Maryam , Azizi Fereidoun 
Published: October 2021

AbstractBackgroundThe association between dietary fats and the risk of cardiovascular disease (CVD) is under debate. We aimed to determine the potential effects of dietary saturated fats (SFA), mono-unsaturated (MUFA) and poly-unsaturated (PUFA) fatty acids on the occurrence of CVD in an adult Asian population.MethodsThis study was conducted within the framework of the Tehran Lipid and Glucose Study on 2809 CVD-free adults, aged ≥ 19 years. Dietary intakes of fats were estimated using a validated 168-items semi-quantitative food frequency questionnaire, at baseline. Adjusted hazard ratios and 95% confidence intervals of CVD were calculated in tertile categories of dietary fats. The risk of CVD was estimated with multivariable Cox regression for the substitution of total fat or SFA with other macronutrients.ResultsDuring 10.6 years of follow up, the incidence rate of CVD events was 7.1%. Mean (± SD) age of the participants was 39 (± 14) years and 43.9% were men. Total fat, animal and plant sources of fats were not associated with risk of CVD events. No significant associations were found between total SFA, lauric acid, myristic acid, stearic acid, palmitic acid as well as MUFA and PUFA and CVD incidence. Substitutions of total fats or SFA with other macronutrients were not associated with CVD risk.ConclusionsIn this study, no significant associations were found between dietary fats and CVD risk. Considering the emerging body of literature that suggests no association between fats and CVD risk, reconsideration of dietary recommendations regarding low fat diets to prevent CVD, seems to be essential.
The transmission ecology of Tahyna orthobunyavirus in Austria as revealed by longitudinal mosquito sampling and blood meal analysis in floodplain habitats
Authors: Camp Jeremy V. , Kniha Edwin , Obwaller Adelheid G. , Walochnik Julia , Nowotny Norbert 
Published: October 2021

Abstract
Background
Tahyna orthobunyavirus (TAHV) is a mosquito-borne virus that may cause mild flu-like symptoms or neurological symptoms in humans. It is historically associated with floodplain habitats in Central Europe, and the mammalophilic floodwater mosquito, Aedes vexans, is thought to be the principal vector. There are few contemporary reports of TAHV transmission ecology within mosquitoes or their vertebrate hosts, and virus infections are rarely reported (and probably seldom diagnosed). The objectives of this study were to survey the mosquito population for TAHV in three floodwater habitats and describe host usage by the predominant floodwater mosquito species to potentially define TAHV transmission at these foci.

Methods
We performed longitudinal mosquito sampling along three major rivers in eastern Austria to characterize the mosquito community in floodplain habitats, and tested for the presence of TAHV in pools of mosquitoes. We characterized TAHV rescued from mosquito pool homogenate by sequencing. We surveyed mosquito host selection by analyzing mosquito blood meals.

Results
We identified TAHV in two pools of Ae. vexans captured along the Leitha River. This mosquito, and other floodwater mosquitoes, used large mammals (red deer, roe deer, wild boar) as their hosts. The sequence of the rescued virus was remarkably similar to other TAHV isolates from the region, dating back to the first isolate of TAHV in 1958.

Conclusions
In general, we confirmed that TAHV is most likely being transmitted by Ae. vexans, although the precise contribution of vertebrate-amplifying hosts to the ecological maintenance of the virus is unclear. The pattern of host selection matches the estimated exposure of the same large mammal species in the region to TAHV based on a recent serosurvey, but hares were also hosts at the site where TAHV was detected. We also confirm humans as hosts of two floodwater mosquito species, providing a potential mechanism for spillover of TAHV or other mosquito-borne viruses.

Graphical Abstract
Adult stem cell transplantation combined with conventional therapy for the treatment of end-stage liver disease: a systematic review and meta-analysis
Authors: Zhu Chen-Hui , Zhang Dian-Han , Zhu Chen-Wei , Xu Jing , Guo Chuan-Long , Wu Xiang-Gen , Cao Qi-Long , Di Guo-Hu 
Published: October 2021

AbstractEnd-stage liver disease (ESLD) is characterized by the deterioration of liver function and a subsequent high mortality rate. Studies have investigated the use of adult stem cells to treat ESLD. Here, a systematic review and meta-analysis was conducted to determine the efficacy of a combination therapy with adult stem cell transplantation and traditional medicine for treating ESLD. Four databases—including PubMed, Web of Science, Embase, and Cochrane Library—were investigated for studies published before January 31, 2021. The main outcome indicators were liver function index, model for end-stage liver disease (MELD) scores, and Child‒Turcotte‒Pugh (CTP) scores. Altogether, 1604 articles were retrieved, of which eight met the eligibility criteria; these studies included data for 579 patients with ESLD. Combination of adult stem cell transplantation with conventional medicine significantly improved its efficacy with respect to liver function index, CTP and MELD scores, but this effect gradually decreased over time. Moreover, a single injection of stem cells was more effective than two injections with respect to MELD and CTP scores and total bilirubin (TBIL) and albumin (ALB) levels, with no significant difference in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. With respect to the TBIL levels, patients receiving mononuclear cells (MNCs) experienced a significantly greater therapeutic effect—starting from twenty-four weeks after the treatment—whereas with respect to ALB levels, CD34+autologous peripheral blood stem cells (CD34+APBSCs) and MNCs had similar therapeutic effects. Severe complications associated with adult stem cell treatment were not observed. Although the benefits of combination therapy with respect to improving liver function were slightly better than those of the traditional treatment alone, they gradually decreased over time.Systematic review registration: PROSPERO registration number: CRD42021238576.
Dose escalation biodistribution, positron emission tomography/computed tomography imaging and dosimetry of a highly specific radionuclide-labeled non-blocking nanobody
Authors: Yang Yanling , Wang Chao , Wang Yan , Sun Yan , Huang Xing , Huang Minzhou , Xu Hui , Fan Huaying , Chen Daquan , Zhao Feng 
Published: October 2021

Abstract
Background
Immunotherapy is a valuable option for cancer treatment, and the curative effect of anti-PD-1/PD-L1 therapy correlates closely with PD-L1 expression levels. Positron emission tomography (PET) imaging of PD-L1 expression is feasible using 68Ga-NOTA-Nb109 nanobody. 68Ga-NOTA-Nb109 was generated by radionuclide (68Ga) labeling of Nb109 using a NOTA chelator. To facilitate clinical trials, we explored the optimal dose range of 68Ga-NOTA-Nb109 in BALB/c A375-hPD-L1 tumor-burdened nude mice and C57-hPD-L1 transgenic MC38-hPD-L1 tumor-burdened mice by administration of a single intravenous dose of 68Ga-NOTA-Nb109 and confirmed the dose in cynomolgus monkeys. The biodistribution data of cynomolgus monkey PET images were extrapolated to estimate the radiation dose for the adult male and female using OLINDA2.1 software.

Results
68Ga-NOTA-Nb109 was stable in physiologic media and human serum. Ex vivo biodistribution studies showed rapid and specific uptake in A375-hPD-L1 or MC38-hPD-L1 tumors. The estimated ED50 was approximately 5.4 µg in humanized mice. The injected mass (0.3–100 µg in nude mice and approximately 1–100 µg in humanized mice) greatly influenced the general biodistribution, with a better tumor-to-background ratio acquired at lower doses of Nb109 (0.3–10 µg in nude mice and approximately 1 µg in humanized mice), indicating maximum uptake in tumors at administered mass doses below the estimated ED50. Therefore, a single 15-μg/kg dose was adopted for the PET/CT imaging in the cynomolgus monkey. The highest specific and persistent uptake of the tracer was detected in the spleen, except the levels in the kidney and urine bladder, which was related to metabolism and excretion. The spleen-to-muscle ratio of the tracer exceeded 10 from immediately to 4 h after administration, indicating that the dose was appropriate. The estimated effective dose was calculated to yield a radiation dose of 4.1 mSv to a patient after injecting 185 MBq of 68Ga-NOTA-Nb109.

Conclusion
68Ga-NOTA-Nb109 showed specific accumulation in hPD-L1 xenografts in ex vivo biodistribution studies and monkey PET/CT imaging. The dose escalation distribution data provided a recommended dose range for further use, and the safety of the tracer was confirmed in dosimetry studies.
Cost-effectiveness analysis of Vaborem in Carbapenem-resistant Enterobacterales (CRE) -Klebsiella pneumoniae infections in Italy
Authors: Mennini Francesco Saverio , Gori Mario , Vlachaki Ioanna , Fiorentino Francesca , Malfa Paola La , Urbinati Duccio , Andreoni Massimo 
Published: October 2021

Abstract
Background
Vaborem is a fixed dose combination of vaborbactam and meropenem with potent activity against target Carbapenem-resistant Enterobacterales (CRE) pathogens, optimally developed for Klebsiella pneumoniae carbapenemase (KPC). The study aims to evaluate the cost-effectiveness of Vaborem versus best available therapy (BAT) for the treatment of patients with CRE-KPC associated infections in the Italian setting.

Methods
A cost-effectiveness analysis was conducted based on a decision tree model that simulates the clinical pathway followed by physicians treating patients with a confirmed CRE-KPC infection in a 5-year time horizon. The Italian National Health System perspective was adopted with a 3% discount rate. The clinical inputs were mostly sourced from the phase 3, randomised, clinical trial (TANGO II). Unit costs were retrieved from the Italian official drug pricing list and legislation, while patient resource use was validated by a national expert. Model outcomes included life years (LYs) and quality adjusted life years (QALYs) gained, incremental costs, incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR). Deterministic and probabilistic sensitivity analyses were also performed.

Results
Vaborem is expected to decrease the burden associated with treatment failure and reduce the need for chronic renal replacement therapy while costs related to drug acquisition and long-term care (due to higher survival) may increase. Treatment with Vaborem versus BAT leads to a gain of 0.475 LYs, 0.384 QALYs, and incremental costs of €3549, resulting in an ICER and ICUR of €7473/LY and €9246/QALY, respectively. Sensitivity analyses proved the robustness of the model and also revealed that the probability of Vaborem being cost-effective reaches 90% when willingness to pay is €15,850/QALY.

Conclusions
In the Italian setting, the introduction of Vaborem will lead to a substantial increase in the quality of life together with a minimal cost impact, therefore Vaborem is expected to be a cost-effective strategy compared to BAT.
The prognostic significance of the alterations of pulmonary hemodynamics in patients with pulmonary arterial hypertension: a meta-regression analysis of randomized controlled trials
Authors: Sung Shih-Hsien , Yeh Wan-Yu , Chiang Chern-En , Huang Chi-Jung , Huang Wei-Ming , Chen Chen-Huan , Cheng Hao-Min 
Published: October 2021

Abstract
Background
Hemodynamic assessment in patients with pulmonary arterial hypertension (PAH) is essential for risk stratification and pharmacological management. However, the prognostic value of the hemodynamic changes after treatment is less well established.

Objectives
We investigated the prognostic impacts of the changes in hemodynamic indices, including mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), right atrial pressure (RAP), and cardiac output index (CI). We conducted this systematic review with meta-regression analysis on existing clinical trials.

Methods
We searched and identified all relevant randomized controlled trials from multiple databases. An analogous R2 index was used to quantify the proportion of variance explained by each predictor in the association with PAH patients’ prognosis. A total of 21 trials and 3306 individuals were enrolled.

Results
The changes in mPAP, PVR, RAP, and CI were all significantly associated with the change in 6MWD (∆6MWD). The change in mPAP was with the highest explanatory power for ∆6MWD (R2 analog = 0.740). Additionally, the changes in mPAP, PVR, and CI were independently predictive of adverse clinical events. The change in mPAP had the highest explanatory power for the clinical events (R2 analog = 0.911). Furthermore, the change in PVR was with the highest explanatory power for total mortality of PAH patients (R2 analog = 0.612).

Conclusion
Hemodynamic changes after treatment, including mPAP, PVR, CI, and RAP, were significantly associated with adverse clinical events or mortality in treated PAH patients. It is recommended that further studies be conducted to evaluate the changes in hemodynamic indices to guide drug titration.

Systematic review registration
PROSPERO CRD42019125157
Image quality and quantification accuracy dependence on patient body mass in 89Zr PET/CT imaging
Authors: Tateishi Ukihide , Daisaki Hiromitsu , Tsuchiya Junichi , Kojima Yuji , Takino Keisuke , Shimada Naoki , Yokoyama Kota 
Published: October 2021

Abstract
Background
This study was conducted to clarify how patient body mass affects the image quality and quantification accuracy of images obtained using 89Zr PET/CT. 89Zr PET/CT images from time-of-flight (TOF) PET/CT and semiconductor (SC) PET/CT were obtained using three types (M, L, LL; corresponding to increasing patient body weight) of custom-made body phantoms designed similarly to the National Electrical Manufacturers Association (NEMA) IEC body phantom. The phantom data were analyzed visually and quantitatively to derive image quality metrics, namely detectability of the 10-mm-diameter hot sphere, percent contrast for the 10-mm-diameter hot sphere (QH,10 mm), percent background variability (N10mm), contrast-to-noise ratio (QH,10 mm/N10mm), and coefficient of variation of the background area (CVBG).

Results
Visual assessment revealed that all the 10-mm-diameter hot spheres of the three types of phantoms were identifiable on both SC and TOF PET/CT images. The N10mm and CVBG values were within the proposed reference levels, and decreased with acquisition duration for both PET/CT types. At 10-min acquisition, the QH,10 mm/N10mm of SC PET/CT was greater than the proposed reference level in all phantoms. However, the QH,10 mm/N10mm of TOF PET/CT was greater than the proposed reference level in M-type phantom alone. All the SUVBG values were within 1.00 ± 0.05 for both PET/CT types.

Conclusions
This study showed that the image quality and quantification accuracy depend on the patient’s body mass, suggesting that acquisition time on 89Zr PET/CT should be changed according to the patient’s body mass.