bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low ferritin levels appear to be associated with worsened health in male repeat blood donors
Authors: Palokangas Elina , Lobier Muriel , Partanen Jukka , Castrén Johanna , Arvas Mikko 
Published: April 2021

Background and objectivesFrequent blood donation depletes iron stores of blood donors. Iron depletion may lead to anaemia, but the health effects of iron depletion without anaemia in healthy blood donors are not well understood. We studied in the FinDonor cohort whether worsening of self‐rated health of blood donors during the study period was associated with biomarkers for iron levels or other self‐reported changes in lifestyle.Materials and methodsWe included 1416 participants from the cohort who answered an 89‐item questionnaire on their health and lifestyle during their enrolment visit and again at the end of the study. We performed multivariate logistic regression to test if blood donation‐related factors affected the probability of reporting worsened health. To set these findings into a more holistic context of health, we subsequently analysed all other questionnaire items with a data‐driven exploratory analysis.ResultsWe found that donation frequency in men and post‐menopausal women and ferritin level only in men was associated negatively with worsened health between questionnaires. In the exploratory analysis, stable physical condition was the only questionnaire item that was associated negatively with worsened health in both women and men.ConclusionOur results suggest that low ferritin level is associated with worsened health even in non‐anaemic repeat donors, although we find that when health is analysed more holistically, ferritin and other factors primarily related to blood donation lose their importance.
Evaluation of a collaborator objective structured clinical examination (COSCE) in postgraduate medical education
Authors: Curran Vernon , Reid Adam , Coombs Heidi , Pike Pam , Farrell James , McPherson Ian , O'Dea Jennifer , Curtis Bryan , Trahey Julia 
Published: April 2021

Background: Effective intra- and interprofessional collaboration abilities are necessary for safe and effective medical care, however such roles are often informally taught in postgraduate medical education with lack of opportunity for practice and feedback. The Objective Structured Clinical Encounter (OSCE) is a common approach in medical education. Adaptations of the OSCE have been found useful in the assessment of collaborator competencies amongst interprofessional student groups and assessment of intrinsic roles, like collaboration.Objective: The purpose of this study was to evaluate the effectiveness of a Collaborator Objective Structured Clinical Encounter (COSCE) as a method of formative assessment on collaborator competencies for postgraduate trainees. Methods: This study involved a one group, pretest-posttest evaluation conducted in 2018. PGY1 residents completed a Team Skills Scale immediately before and after COSCE participation, completed an evaluation survey to report satisfaction, and were assessed by facilitators and peer assessors using a COSCE rubric.Results: Residents reported significant improvement in their pre (N=35) to post-team skills (N=37) scores and an overall positive level of satisfaction with the COSCE experience (N=37/39, 94.9% response rate). Transfer of care skills (e.g., handover) demonstrated the lowest performance scores across all COSCE stations. Peer assessor (N = 204) and facilitator scores (N = 47) also indicated a moderate level of interrelatedness. Conclusion: A COSCE is a feasible method of formative assessment, fostering reflection and learning, and providing feedback on collaborator skills early in postgraduate medical education. Peer assessment may also hold promise as a formative assessment method on intra- and interprofessional collaboration.
Recommendations by the European Network of Paediatric Research at the European Medicines Agency (Enpr-EMA) Working Group on preparedness of clinical trials about paediatric medicines process
Authors: Siapkara Angeliki , Fracasso Claudio , Egger Gunter F , Rizzari Carmelo , Trasorras Cristina Serén , Athanasiou Dimitrios , Turner Mark A 
Published: April 2021

Conduct of clinical trials in babies, children and young people is often hindered by issues that could have been foreseen before the trial opened; that is, some clinical trials are often underprepared. In order to identify a good approach to trial preparedness, the European Network of Paediatric Research at the European Medicines Agency formed a working group. The Working Group included representation from regulators, industry, academics, paediatric clinical research networks and parents.The Working Group consulted widely about how to prepare for paediatric clinical trials. The Group’s detailed recommendations have been published (https://www.ema.europa.eu/en/documents/other/preparedness-medicines-clinical-trials-paediatrics-recommendations-enpr-ema-working-group-trial_en.pdf).This paper is a summary of the key recommendations including the following: start early, preferably in parallel to designing the medicine’s development plan and individual protocols; identify the rationale and clinical need; listen to the perspectives of children and families, and of patient advocacy groups; identify how many people will be eligible for the trial; identify the resources needed, such as clinical facilities (including play therapy) and out-of-pocket expenditure by participants and their families; use all available data to estimate what is possible; present information about preparedness in a structured way; deploy proportionate resources to support the preparation of trials.A well-prepared, well-designed trial is likely to require fewer changes during its course, be run in a shorter time frame and achieve expected objectives.
Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014
Authors: Macharia Peter M , Joseph Noel K , Sartorius Benn , Snow Robert W , Okiro Emelda A 
Published: April 2021

BackgroundTo improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning units. Therefore, we aimed to provide subnational estimates of factors associated with child survival while elucidating areas of progress, stagnation and decline in Kenya.MethodsTwenty household surveys and three population censuses conducted since 1989 were assembled and spatially aligned to 47 subnational Kenyan county boundaries. Bayesian spatio-temporal Gaussian process regression models accounting for inadequate sample size and spatio-temporal relatedness were fitted for 43 factors at county level between 1993 and 2014.ResultsNationally, the coverage and prevalence were highly variable with 38 factors recording an improvement. The absolute percentage change (1993–2014) was heterogeneous ranging between 1% and 898%. At the county level, the estimates varied across space and over time with a majority showing improvements after 2008 which was preceded by a period of deterioration (late-1990 to early-2000). Counties in Northern Kenya were consistently observed to have lower coverage of interventions and remained disadvantaged in 2014 while areas around Central Kenya had and historically have had higher coverage across all intervention domains. Most factors in Western and South-East Kenya recorded moderate intervention coverage although having a high infection prevalence of both HIV and malaria.ConclusionThe heterogeneous estimates necessitates prioritisation of the marginalised counties to achieve health equity and improve child survival uniformly across the country. Efforts are required to narrow the gap between counties across all the drivers of child survival. The generated estimates will facilitate improved benchmarking and establish a baseline for monitoring child development goals at subnational level.
Awareness on menstrual hygiene management in Bangladesh and the possibilities of media interventions: using a nationwide cross-sectional survey
Authors: Afiaz Awan , Biswas Raaj Kishore 
Published: April 2021

ObjectivesMenstrual hygiene management (MHM) has become a growing public health concern in many low-income and middle-income nations for its association with several health risks. This study observed types of menstrual absorbents used among women in Bangladesh and analysed the associated sociodemographic factors with the hypothesis that mass media can increase awareness regarding MHM. The study includes recommendations for possible intervention strategies designed to address this lack of awareness.Design and participantsThe analysis used the data from the nationally representative Bangladesh Multiple Indicator Cluster Survey 2019 that employed a two-stage, stratified cluster sampling approach, with a study sample of 54 242 women aged between 15 and 49 years. A generalised linear model was fitted to the data adjusting for survey weights and cluster/strata variations along with bivariate analyses and spatial mapping.ResultsOnly a quarter of women (24.3%) used modern absorbents for MHM with most resorting to unhygienic traditional practices. Spatial distribution showed that the use of modern absorbent of MHM was limited to the major cities. The women who had mobile phones and regular access to the media were nearly 43% (adjusted OR (AOR) 1.43 with 95% CI 1.33 to 1.54) and 47% (AOR 1.47 with 95% CI 1.35 to 1.60) more likely to use the modern absorbents of MHM, respectively. Furthermore, educated women living in urban solvent households with educated house heads were also found to use modern absorbents of MHM.ConclusionsThere appeared to be scope for interventions through a combined national effort to raise awareness using multifaceted media channels regarding MHM among women in order to meet the Sustainable Development Goals 3.7 and 6.2 of addressing women’s healthcare and hygiene needs.
Effect of interventions based on educational technologies on the prevention of sexually transmitted infections in incarcerated women: protocol of a systematic review and meta-analysis
Authors: Carvalho Isaiane da Silva , Mendes Ryanne Carolynne Marques Gomes , Melo Priscila de Oliveira Cabral , Simões Caroline Ferraz , Leal Luciana Pedrosa , Guedes Tatiane Gomes , Ormeno Gabriela Isabel Reyes , Linhares Francisca Márcia Pereira 
Published: April 2021

IntroductionPrisons are places with high vulnerability and high risk for the development of sexually transmitted infections. World Health Agencies recommend establishing intervention measures, such as information and education, on the prevention of diseases. Thus, technologies as tools for health education have been used to reduce sexually transmitted infections. However, no systematic review has investigated the effectiveness of these interventions. Therefore, this review’s objective is to examine the effect of educational technologies used for preventing sexually transmitted infections in incarcerated women.Methods and analysisPreferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be strictly followed. The following electronic databases will be searched: Scopus; Cumulative Index of Nursing and Allied Health, Education Resources Information Center, Embase, PsycINFO, PubMed/Medline, Web of Science and Google Scholar. Randomised clinical trials of interventions that used educational technologies to prevent sexually transmitted infections in incarcerated women will be searched in the databases from the beginning of 2020 until December by two researchers independently. A narrative synthesis will be constructed for all included studies, and if there are sufficient data, a meta-analysis will be performed using the Review Manager software (V.5.3). Continuous results will be presented as the weighted mean difference or the standardised mean difference with 95% CIs. Under the heterogeneity of the included studies, a random-effects or fixed-effects model will be used. The studies’ heterogeneity will be assessed by the I2method. The sensitivity analysis will be carried out to examine the magnitude of each study’s influence on the general results. A significance level of p≤0.05 will be adopted.Ethics and disclosureEthical approval is not required because no primary data will be collected. The results will be published in journals reviewed by peers.PROSPERO registration numberCRD42020163820.
Assessment of burden of drug-resistant tuberculosis at a tertiary care centre in northern India: a prospective single centre cohort study
Authors: Misra Richa , Kesarwani Vasudha , Nath Alok 
Published: April 2021

ObjectivesWe aim to define the burden of rifampicin monoresistant tuberculosis (TB) at a tertiary care centre in northern India as well as determine the second-line drug susceptibilities (SL-DST) in a subset of patients.MethodsA total of 3045 pulmonary (n=1883) and extrapulmonary (n=1162) samples from likely patients with TB were subjected to microscopy, culture and the Xpert MTB/RIF assay from March 2017 to June 2019. SL-DST testing by line probe assay version 2 for fluoroquinolones (FQs) and second-line injectable drugs were performed on 62 samples.ResultsOut of 3045 samples processed in our laboratory during the study period, 36.1% (1101/3045) were positive for Mycobacterium tuberculosis complex (MTBC) and 21.6% were rifampicin monoresistant (223/1032). The rate of rifampicin resistance in pulmonary samples was 23.5% (166/706) and in extrapulmonary cases, it was 17.4% (57/326). Out of 62 cases included for second-line testing, 48 were resistant to FQs (77.4%) while 11 were extensively drug resistant.ConclusionsIndia urgently needs to arrest an emerging multidrug-resistant TB epidemic with associated resistance to FQs. A robust surveillance system is needed to execute the National Strategic Plan for 2017–2025.
Mortality benefit of crystalloids administered in 1–6 hours in septic adults in the ED: systematic review with narrative synthesis
Authors: Xantus Gabor Zoltan , Allen Penny , Norman Sharon , Kanizsai Peter Laszlo 
Published: April 2021

BackgroundBased on the 2018 update of the Surviving Sepsis Campaign, the Committee for Quality Improvement of the NHSs of England recommended the instigation of the elements of the ‘Sepsis-6 bundle’ within 1 hour to adult patients screened positive for sepsis. This bundle includes a bolus infusion of 30 mL/kg crystalloids in the ED. Besides the UK, both in the USA and Australia, compliance with similar 1-hour targets became an important quality indicator. However, the supporting evidence may neither be contemporaneous nor necessarily valid for emergency medicine settings.MethodA systematic review was designed and registered at PROSPERO to assess available emergency medicine/prehospital evidence published between 2012 and 2020, investigating the clinical benefits associated with a bolus infusion of a minimum 30 mL/kg crystalloids within 1 hour to adult patients screened positive for sepsis. Due to the small number of papers that addressed this volume of fluids in 1 hour, we expanded the search to include studies looking at 1–6 hours.ResultsSeven full-text articles were identified, which investigated various aspects of the fluid resuscitation in adult sepsis. However, none answered completely to the original research question aimed to determine either the effect of time-to-crystalloids or the optimal fluid volume of resuscitation. Our findings demonstrated that in the USA/UK/Australia/Canada, adult ED septic patients receive 23–43 mL/kg of crystalloids during the first 6 hours of resuscitation without significant differences either in mortality or in adverse effects.ConclusionThis systematic review did not find high-quality evidence supporting the administration of 30 mL/kg crystalloid bolus to adult septic patients within 1 hour of presentation in the ED. Future research must investigate both the benefits and the potential harms of the recommended intervention.
Identifying clot composition using intravascular diffuse reflectance spectroscopy in a porcine model of endovascular thrombectomy
Authors: Skyrman Simon , Burström Gustav , Aspegren Oskar , Lucassen Gerald , Elmi-Terander Adrian , Edström Erik , Arnberg Fabian , Ohlsson Marcus , Mueller Manfred , Andersson Tommy 
Published: April 2021

BackgroundEndovascular thrombectomy has revolutionized the management of acute ischemic stroke and proven superior to stand-alone intravenous thrombolysis for large vessel occlusions. However, failed or delayed revascularization may occur as a result of a mismatch between removal technique and clot composition. Determination of clot composition before thrombectomy provides the possibility to adapt the technique to improve clot removal efficacy. We evaluated the application of diffuse reflectance spectroscopy (DRS) for intravascular determination of clot composition in vivo.MethodsThree clot types, enriched in red blood cells or fibrin or with a mixed content, were prepared from porcine blood and injected into the external carotids of a domestic pig. A guidewire-like DRS probe was used to investigate the optical spectra of clots, blood and vessel wall. Measurement positions were confirmed with angiography. Spectra were analyzed by fitting an optical model to derive physiological parameters. To evaluate the method’s accuracy, photon scattering and blood and methemoglobin contents were included in a decision tree model and a random forest classification.ResultsDRS could differentiate between the three different clot types, blood and vessel wall in vivo (p<0.0001). The sensitivity and specificity for detection was 73.8% and 98.8% for red blood cell clots, 80.6% and 97.8% for fibrin clots, and 100% and 100% for mixed clots, respectively.ConclusionIntravascular DRS applied via a custom guidewire can be used for reliable determination of clot composition in vivo. This novel approach has the potential to increase efficacy of thrombectomy procedures in ischemic stroke.
Catheter tip distensibility substantially influences the aspiration force of thrombectomy devices
Authors: Li Jiahui , Castaño Oscar , Tomasello Alejandro , de Dios Lascuevas Marta , Canals Pere , Engel Elisabeth , Ribo Marc 
Published: April 2021

BackgroundA direct aspiration first pass thrombectomy (ADAPT) is a fast-growing technique for which a broad catalog of catheters that provide a wide range of aspiration forces can be used. We aimed to characterize different catheters' aspiration performance on stiff clots in an in vitro vascular model. We hypothesized that labeled catheter inner diameter (labeled-ID) is not the only parameter that affects the aspiration force (asp-F) and that thrombus–catheter tip interaction and distensibility also play a major role.MethodsWe designed an experimental setup consisting of a 3D-printed carotid artery immersed in a water deposit. We measured asp-F and distensibility of catheter tips when performing ADAPT on a stiff clot analog larger than catheter labeled-ID. Correlations between asp-F, catheter ID, and tip distensibility were statistically assessed.ResultsExperimental asp-F and catheter labeled-ID were correlated (r=0.9601; P<0.01). The relative difference between experimental and theoretical asp-F (obtained by the product of the tip’s section area by the vacuum pressure) correlated with tip’s distensibility (r=0.9050; P<0.01), evidencing that ADAPT performance is highly influenced by catheter tip shape-adaptability to the clot and that the effective ID (eff-ID) may differ from the labeled-ID specified by manufacturers. Eff-ID showed the highest correlation with experimental asp-F (r=0.9944; P<0.01), confirming that eff-ID rather than labeled-ID should be considered to better estimate the device efficiency.ConclusionsCatheter tip distensibility can induce a significant impact on ADAPT performance when retrieving a stiff clot larger than the device ID. Our findings might contribute to optimizing thrombectomy strategies and the design of novel aspiration catheters.
Lung cancer probability and clinical outcomes of baseline and new subsolid nodules detected on low-dose CT screening
Authors: Kim Yeon Wook , Kwon Byoung Soo , Lim Sung Yoon , Lee Yeon Joo , Park Jong Sun , Cho Young-Jae , Yoon Ho Il , Lee Kyung Won , Lee Jae Ho , Chung Jin-Haeng , Ji Eunjeong , Lee Choon-Taek 
Published: April 2021

BackgroundLimited data are available regarding the management of subsolid nodules detected on lung cancer screening with low-dose CT (LDCT). We aimed to determine the characteristics of screen-detected subsolid nodules, and to evaluate the probability of lung cancer and the clinical course of subsolid nodules detected at baseline and during follow-up screening.MethodsWe evaluated 50 132 asymptomatic adults (22 631 never-smokers and 27 501 ever-smokers) who underwent LDCT screening for lung cancer between May 2003 and June 2019 at a tertiary centre in South Korea. The incidence, characteristics and clinical outcomes of the baseline and new screen-detected subsolid nodules were determined.ResultsA total of 6725 subsolid nodules (5116 pure ground glass opacity nodules and 1609 part-solid nodules) were detected in 4545 participants (1484 new subsolid nodules detected in 937 (1.9%) participants; the overall incidence of subsolid nodules: 10.7% in never-smokers and 7.7% in ever-smokers, p<0.001). Among 4918 subsolid nodules that underwent follow-up with CT scans (the mean number of CT scans, including the baseline LDCT scan: 4.6), 2116 nodules (30.0% of baseline subsolid nodules and 78.9% of new subsolid nodules) resolved spontaneously. Among 293 biopsied subsolid nodules, 227 (77.5%) nodules were diagnosed as lung cancer, of which 226 (99.6%) were adenocarcinomas. No significant difference was observed in pathological invasiveness or the initial stage between the baseline and new cancerous subsolid nodules. Multivariable analyses revealed that new detection at follow-up screening was significantly associated with a lower probability of lung cancer (OR 0.26, 95% CI 0.14 to 0.49) and overall growth (OR 0.39, 95% CI 0.26 to 0.59), but with a higher probability of resolution (OR 6.30, 95% CI 5.09 to 7.81).ConclusionsLDCT screening led to a considerably high rate of subsolid nodule detection, particularly in never-smokers. Compared with the baseline subsolid nodules, the new subsolid nodules were associated with a lower probability of lung cancer and higher probability of spontaneous resolution, indicating their more inflammatory nature. Less aggressive follow-up may be allowed for new subsolid nodules, particularly in screening programmes for Asian populations.
Dung analysis of the East Milford mastodons: dietary and environmental reconstructions from central Nova Scotia at ∼75 ka years BP
Authors: Cocker Scott L. , Pisaric Michael F.J. , McCarthy Francine M.G. , Vermaire Jesse C. , Beaupre Patrick , Cwynar Les C. 
Published: April 2021

To reconstruct a mastodon diet and provide a snapshot view of environmental conditions in eastern Canada prior to the onset of the Wisconsinan glaciation, we analysed the faunal and floral components of dung associated with juvenile mastodon remains from East Milford, Nova Scotia, dated to 74.9 ± 5.0 ka cal BP. The diverse assemblage of pollen, non-pollen palynomorphs, plant macrofossils, and macroinvertebrate remains in the dung suggests that the mastodons lived in a spruce-dominated mixed coniferous–deciduous forest with a strong boreal aspect interspersed with wetlands rich in charophytes, sedges, cattails, bulrushes, and bryophytes. The abundance of spruce needles and birch samaras in the dung sample is consistent with an inferred browsing behaviour, having been reported for other mammutid species previously. The limited diversity and near-absence of coprophilous fungi, such as Sporormiella, in the dung could have an impact on understanding the influence of feeding strategies on the presence of coprophilous taxa in sedimentary records, and thus interpretations of megafaunal abundance. The dung also yielded the earliest known Canadian remains of the bark beetle Polygraphus cf. rufipennis, gemmulae of the freshwater sponge Eunapius cf. fragilis, and loricae of the rotifer Keratella cochlearis.