bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of tranexamic acid on the prognosis of patients with traumatic brain injury undergoing craniotomy: study protocol for a randomised controlled trial
Authors: Wu Bei , Lu Yu , Yu Yun , Yue Hongli , Wang Jie , Chong Yingzi , Cui Weihua 
Published: November 2021

IntroductionAbnormal coagulation function aggravates the prognosis of patients with traumatic brain injury (TBI). It was reported that the antifibrinolytic drug tranexamic acid (TXA) could reduce intracranial haemorrhage and mortality in non-operative patients with TBI. However, there is a lack of evaluation of TXA in patients with TBI undergoing craniotomy.Methods and analysisThis is a single-centre randomised controlled, double-blind, parallel study aiming to investigate the effectiveness and safety of TXA in patients with TBI during the perioperative period. Blood loss and transfusion, neurological function, adverse events, mortality and serum immune-inflammatory cytokines will be collected and analysed.Ethics and disseminationEthical approval has been granted by the Medical Ethics Committee of Beijing Tian Tan Hospital, Capital Medical University (reference number KY 2020-136-03). The results of this study will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals.Trial registration numberChiCTR2100041911.
Ethnicity matters in perceived impacts and information sources of COVID-19 among mothers with young children in Australia: a cross-sectional study
Authors: Wen Li Ming , Xu Huilan , Jawad Danielle , Buchanan Limin , Rissel Chris , Phongsavan Philayrath , Baur Louise A , Taki Sarah 
Published: November 2021

ObjectivesThis study aimed to investigate perceived impacts, ways of communication with professionals and information sources related to COVID-19, and explore whether these impacts or information sources were associated with ethnicity that is, language spoken at home.DesignA cross-sectional study.SettingSydney, Australia during the period from March to October 2020.ParticipantsMothers of young children participating in an existing trial.Outcome measuresMothers were asked to respond to a set of survey questions related to COVID-19 via telephone. The questions included a mental health scale, and how they communicated with health professionals and their information sources related to COVID-19 during the COVID-19 pandemic.ResultsOf 537 mothers who completed the survey (81% response rate), 45% reported they spoke a language other than English at home. Overall, 136 (26%) reported experiencing mental distress. 234 (44%) reported that COVID-19 affected the way they receive and communicate health-related information with health professionals, especially for those from non-English speaking backgrounds with an adjusted odds ratio (AOR) 1.58 (95% CI 1.10 to 2.27). They were less likely to use a face-to-face service (AOR 0.55, 95% CI 0.37 to 0.80) and more likely to use social media (AOR 2.11, 95% CI 1.40 to 3.17) for health-related information. Regarding sources of COVID-19-related information, mothers from non-English-speaking backgrounds were more likely to rely on family members (AOR 1.49, 95% CI 1.01 to 2.19) and social media (AOR 3.34, 95% CI 2.05 to 5.43).ConclusionsCOVID-19 has significantly impacted mothers with young children in regard to their mental health, means of communication with health professionals and sources of health information. Mothers from non-English-speaking communities were less likely to use a face-to-face service, and more likely to seek information from family members and social media. Appropriate health support for non-English-speaking community needs to take these factors into account.Trial registration numberANZCTR:12618001571268.they
Surveying and mapping breast cancer services in Ghana: a cross-sectional pilot study in the Eastern Region
Authors: Moustafa Moustafa , Mali Meghan Eileen , Lopez-Verdugo Fidel , Sanyang Ousman , Nellermoe Jonathan , Price Raymond R , Manortey Stephen , Biritwum-Nyarko Alberta , Ofei Irina , Sorensen Justin , Goldsmith Alison , Brownson Kirstyn E , Kumah Augustine , Sutherland Edward 
Published: November 2021

ObjectivesDefine the services available for the care of breast cancer at hospitals in the Eastern Region of Ghana, identify areas of the region with limited access to care through geospatial mapping, and test a novel survey instrument in anticipation of a nationwide scale up of the study.DesignA cross-sectional, facility-based survey study.SettingThis study was conducted at 33 of the 34 hospitals in the Eastern Region of Ghana from March 2020 to May 2020.ParticipantsThe 33 hospitals surveyed represented 97% of all hospitals in the region. This included private, government, quasi-government and faith-based organisation owned hospitals.ResultsSixteen hospitals (82%) surveyed provided basic screening services, 11 (33%) provided pathological diagnosis and 3 (9%) provided those services in addition to basic surgical care.53%, 64% and 78% of the population lived within 10 km, 25 km and 45 km of screening, diagnostic and treatment services respectively. Limited chemotherapy was available at two hospitals (6%), endocrine therapy at one hospital (3%) and radiotherapy was not available. Twenty-nine hospitals (88%) employed a general practitioner and 13 (39%) employed a surgeon. Oncology specialists, pathology personnel and a plastic surgeon were only available in one hospital (3%) in the Eastern Region.ConclusionsAlthough 16 hospitals (82%) provided screening, only half the population lived within reasonable distance of these services. Few hospitals offered diagnosis and surgical services, but 64% and 78% of the population lived within a reasonable distance of these hospitals. Geospatial analysis suggested two priorities to cost-effectively expand breast cancer services: (1) increase the number of health facilities providing screening services and (2) centralise basic imaging, pathological and surgical services at targeted hospitals.
Continuum of maternal healthcare services utilisation and associated factors among women who gave birth in Siyadebirena Wayu district, Ethiopia: community-based cross-sectional study
Authors: Sertsewold Seblewongel Gebretsadik , Debie Ayal , Geberu Demiss Mulatu 
Published: November 2021

ObjectiveThis study aimed to analyse the prevalence and factors associated with continuum of maternal healthcare services among women who gave birth in Siyadebirena Wayu district, Central Ethiopia.DesignCommunity-based cross-sectional study.SettingAt eight Kebeles in Central Ethiopia.ParticipantsThe study was done on 614 women aged 15–49 years using interviewer-administered structured questionnaire. Following proportional allocation of the sample, we used simple random sampling technique to select study participants.MethodsBinary logistic regression model was fitted to identify the factors associated with the outcome. Variables with p<0.2 in the bivariable analysis were the candidates for multivariable analysis. A p<0.05 and adjusted OR (AOR) with 95% CI were taken to declare the factors and the strengths of association with continuum of maternal healthcare utilisation.OutcomeContinuum of maternal healthcare utilisation.ResultsOnly 16.1% (95% CI 13.3% to 19.0%) of the women had used a complete continuum of maternal health services. Variables, such as contraceptive use (AOR 4.95; 95% CI 1.61 to 15.20), autonomy (AOR 4.45; 95% CI 1.69 to 11.60), urban residence (AOR 3.91; 95% CI 1.06 to 14.39), educated women (AOR 5.36; 95% CI 1.15 to 25.06), took less than 30 min to reach a health facility (AOR 3.17; 95% CI 1.38 to 7.25), use public transportation (AOR 2.48; 95% CI 1.12 to 5.52) and good knowledge (AOR 9.88; 95% CI 3.89 to 25.0) were positively associated with continuum of maternal healthcare. In the contrary, women who had third child birth order (AOR 0.22; 95% CI 0.06 to 0.8) was negatively associated.ConclusionsOverall, the level of the continuum of maternal healthcare services utilisation was low compared with the national and global targets. Therefore, programme planners and implementer had better conduct health education to enhance the awareness of women about continuum of maternal healthcare services. Healthcare sector policy-makers and managers shall also scale up healthcare facilities to improve access to maternal healthcare services.
Point-of-care testing in a high-income country paediatric emergency department: a qualitative study in Sweden
Authors: Rasti Reza , Brännström Johanna , Mårtensson Andreas , Zenk Ingela , Gantelius Jesper , Gaudenzi Giulia , Alvesson Helle Mölsted , Alfvén Tobias 
Published: November 2021

ObjectivesIn many resource-limited health systems, point-of-care tests (POCTs) are the only means for clinical patient sample analyses. However, the speed and simplicity of POCTs also makes their use appealing to clinicians in high-income countries (HICs), despite greater laboratory accessibility. Although also part of the clinical routine in HICs, clinician perceptions of the utility of POCTs are relatively unknown in such settings as compared with others. In a Swedish paediatric emergency department (PED) where POCT use is routine, we aimed to characterise healthcare providers’ perspectives on the clinical utility of POCTs and explore their implementation in the local setting; to discuss and compare such perspectives, to those reported in other settings; and finally, to gather requests for ideal novel POCTs.DesignQualitative focus group discussions study. A data-driven content analysis approach was used for analysis.SettingThe PED of a secondary paediatric hospital in Stockholm, Sweden.ParticipantsTwenty-four healthcare providers clinically active at the PED were enrolled in six focus groups.ResultsA range of POCTs was routinely used. The emerging themeUtility of our POCT use is double-edgedillustrated the perceived utility of POCTs. While POCT services were considered to have clinical and social value, the local routine for their use was named to distract clinicians from the care for patients. Requests were made for ideal POCTs and their implementation.ConclusionDespite their clinical integration, deficient implementation routines limit the benefits of POCT services to this well-resourced paediatric clinic. As such deficiencies are shared with other settings, it is suggested that some characteristics of POCTs and of their utility are less related to resource level and more to policy deficiency. To address this, we propose the appointment of skilled laboratory personnel as ambassadors to hospital clinics offering POCT services, to ensure higher utility of such services.
Clinical effectiveness and bacteriological eradication of three different Short-COurse antibiotic regimens and single-dose fosfomycin for uncomplicated lower Urinary Tract infections in adult women (SCOUT study): study protocol for a randomised clinical trial
Authors: Garcia-Sangenís Ana , Morros Rosa , Aguilar-Sánchez Mercedes , Medina-Perucha Laura , Leiva Alfonso , Ripoll Joana , Martínez-Pecharromán Mar , Bartolomé-Moreno Cruz B , Magallon Botaya Rosa , Marín-Cañada Jaime , Molero José M , Moragas Ana , Troncoso Amelia , Monfà Ramon , Llor Carl 
Published: November 2021

IntroductionUncomplicated lower urinary tract infections (uLUTI) are a common problem in primary care. Current local guidelines recommend the use of a single 3 g dose of fosfomycin. However, most general practitioners (GP) prefer short-course therapies to single-dose therapy. No study has compared head-to-head short-course antimicrobial agents for uLUTIs. Therefore, the aim of this randomised clinical trial is to compare three different short-course antibiotic therapies with a single-dose of fosfomycin for these infections.Methods and analysisThis will be a pragmatic, multicentre, parallel group, open trial. Women aged 18 or older and with symptoms of uLUTI and a positive urine dipstick analysis will be randomised to one of the following four groups: a single dose of 3 g of fosfomycin, 2 days of 3 g of fosfomycin o.d., 3 days of pivmecillinam 400 mg three times per day (t.i.d) or 5 days of nitrofurantoin 100 mg t.i.d. A total sample of 1120 patients was calculated. The primary endpoint is clinical effectiveness at day 7, defined as cure of symptoms reported by the patients in a diary including four symptoms: dysuria, urgency, frequency and suprapubic pain, which will be scored on a 4-point severity scale (not present/mild/moderate/severe). Follow-up visits are scheduled at days 7 (phone call), 14 and 28 for assessing evolution. Urine samples will be collected in the three on-site visits and urine cultures performed. If positive, antibiograms for the three antibiotics studied will be performed. Bacterial eradication will be measured at days 14 and 28.Ethics and disseminationThe study was approved by the Ethical Board of IDIAP Jordi Gol (reference number: 21/173-AC) and Spanish Agency of Medicines and Medical Devices. The findings of this trial will be disseminated through research conferences and peer-review journals.Trial registration numberNCT04959331; EudraCT Number: 2021-001332-26.Time scheduleJanuary 2022 to April 2023.
Interventions to reduce the incidence of surgical site infection in colorectal resections: systematic review with multicomponent network meta-analysis (INTRISSI): study protocol
Authors: Friedrichs Juliane , Seide Svenja , Vey Johannes , Zimmermann Samuel , Hardt Julia , Kleeff Jorg , Klose Johannes , Michalski Christoph W , Kieser Meinhard , Pilz Maximilian , Ronellenfitsch Ulrich 
Published: November 2021

ObjectiveTo assess the relative contribution of intravenous antibiotic prophylaxis, mechanical bowel preparation, oral antibiotic prophylaxis, and combinations thereof towards the reduction of surgical site infection (SSI) incidence in elective colorectal resections.Methods and analysisA systematic search of randomised controlled trials comparing interventions to reduce SSI incidence will be conducted with predefined search terms in the following databases: MEDLINE, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR). Additionally, several online databases will be searched for ongoing trials, and conference proceedings and reference lists of retrieved articles will be hand searched. The title–abstract screening will be partly performed by means of a semiautomated supervised machine learning approach, which will be trained on a subset of the identified titles and abstracts identified through traditional screening methods.The primary analysis will be a multicomponent network meta-analysis, as we expect to identify studies that investigate combinations of interventions (eg, mechanical bowel preparation combined with oral antibiotics) as well as studies that focus on individual components (mechanical bowel preparation or oral antibiotics). By means of a multicomponent network meta-analysis, we aim at estimating the effects of the separate components along the effects of the observed combinations. To account for between-trial heterogeneity, a random-effect approach will be combined with inverse variance weighting for estimation of the treatment effects. Associated 95% CIs will be calculated as well as the ranking for each component in the network using P scores. Results will be visualised by network graphics and forest plots of the overall pairwise effect estimates. Comparison-adjusted funnel plots will be used to assess publication bias.Ethics and disseminationEthical approval by the Ethical Committee of the Medical Faculty of the Martin-Luther-University Halle-Wittenberg (ID of approval: 2021–148). Results shall be disseminated directly to decision-makers (eg, surgeons, gastroenterologists, wound care specialists) by means of publication in peer-reviewed journals, presentation at conferences and through the media (eg, radio, TV, etc).PROSPERO registration numberCRD42021267322.
International variation in oesophageal and gastric cancer survival 2012–2014: differences by histological subtype and stage at diagnosis (an ICBP SURVMARK-2 population-based study)
Authors: Arnold Melina , Morgan Eileen , Bardot Aude , Rutherford Mark J , Ferlay Jacques , Little Alana , Møller Bjorn , Bucher Oliver , De Prithwish , Woods Ryan R , Saint-Jacques Nathalie , Gavin Anna T , Engholm Gerda , Achiam Michael P , Porter Geoff , Walsh Paul M , Vernon Sally , Kozie Serena , Ramanakumar Agnihotram V , Lynch Charlotte , Harrison Samantha , Merrett Neil , O’Connell Dianne L , Mala Tom , Elwood Mark , Zalcberg John , Huws Dyfed W , Ransom David , Bray Freddie , Soerjomataram Isabelle 
Published: November 2021

ObjectiveTo provide the first international comparison of oesophageal and gastric cancer survival by stage at diagnosis and histological subtype across high-income countries with similar access to healthcare.MethodsAs part of the ICBP SURVMARK-2 project, data from 28 923 patients with oesophageal cancer and 25 946 patients with gastric cancer diagnosed during 2012–2014 from 14 cancer registries in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK) were included. 1-year and 3-year age-standardised net survival were estimated by stage at diagnosis, histological subtype (oesophageal adenocarcinoma (OAC) and oesophageal squamous cell carcinoma (OSCC)) and country.ResultsOesophageal cancer survival was highest in Ireland and lowest in Canada at 1 (50.3% vs 41.3%, respectively) and 3 years (27.0% vs 19.2%) postdiagnosis. Survival from gastric cancer was highest in Australia and lowest in the UK, for both 1-year (55.2% vs 44.8%, respectively) and 3-year survival (33.7% vs 22.3%). Most patients with oesophageal and gastric cancer had regional or distant disease, with proportions ranging between 56% and 90% across countries. Stage-specific analyses showed that variation between countries was greatest for localised disease, where survival ranged between 66.6% in Australia and 83.2% in the UK for oesophageal cancer and between 75.5% in Australia and 94.3% in New Zealand for gastric cancer at 1-year postdiagnosis. While survival for OAC was generally higher than that for OSCC, disparities across countries were similar for both histological subtypes.ConclusionSurvival from oesophageal and gastric cancer varies across high-income countries including within stage groups, particularly for localised disease. Disparities can partly be explained by earlier diagnosis resulting in more favourable stage distributions, and distributions of histological subtypes of oesophageal cancer across countries. Yet, differences in treatment, and also in cancer registration practice and the use of different staging methods and systems, across countries may have impacted the comparisons. While primary prevention remains key, advancements in early detection research are promising and will likely allow for additional risk stratification and survival improvements in the future.
Implementation of an early rule-out pathway for myocardial infarction using a high-sensitivity cardiac troponin T assay
Authors: Sandeman Dennis , Syed Maaz B J , Kimenai Dorien M , Lee Kuan Ken , Anand Atul , Joshi Shruti S , Dinnel Lorraine , Wenham Philip R , Campbell Ken , Jarvie Mary , Galloway Donna , Anderson Mhairi , Roy Bappa , Andrews Jack P M , Strachan Fiona E , Ferry Amy V , Chapman Andrew R , Elsby Sarah , Francis Mark , Cargill Robert , Shah Anoop S V , Mills Nicholas L 
Published: November 2021

ObjectivesPatients with suspected acute coronary syndrome and high-sensitivity cardiac troponin (hs-cTn) concentrations below the limit of detection at presentation are low risk. We aim to determine whether implementing this approach facilitates the safe early discharge of patients.MethodsIn a prospective single-centre cohort study, consecutive patients with suspected acute coronary syndrome were included before (standard care) and after (intervention) implementation of an early rule-out pathway. During standard care, myocardial infarction was ruled out if hs-cTnT concentrations were <99th centile (14 ng/L) at presentation and at 6–12 hours after symptom onset. In the intervention, patients were ruled out if hs-cTnT concentrations were <5 ng/L at presentation and symptoms present for ≥3 hours or were ≥5 ng/L and unchanged within the reference range at 3 hours. We compared duration of stay (efficacy) and all-cause death at 1 year (safety) before and after implementation.ResultsWe included 10 315 consecutive patients (64±16 years, 46% women) with 6642 (64%) and 3673 (36%) in the standard care and intervention groups, respectively. Duration of stay was reduced from 534 (IQR, 220–2279) to 390 (IQR, 218–1910) min (p<0.001) after implementation. At 1 year, all-cause death occurred in 10.9% (721 of 6642) and 10.4% (381 of 3673) of patients in the standard care group (referent) and intervention group, respectively (adjusted OR 1.02, 95% CI 0.88 to 1.18).ConclusionIn patients with suspected acute coronary syndrome, implementing an early rule-out pathway using hs-cTnT concentrations <5 ng/L at presentation reduced the duration of stay in hospital without compromising safety.
Variational theory of the Ricci curvature tensor dynamics
Authors: Cremaschini Claudio , Kovář Jiří , Stuchlík Zdeněk , Tessarotto Massimo 
Published: November 2021

AbstractIn this letter a new Lagrangian variational principle is proved to hold for the Einstein field equations, in which the independent variational tensor field is identified with the Ricci curvature tensor $$R^{\mu \nu }$$

R

μ
ν

rather than the metric tensor $$g_{\mu \nu }$$

g

μ
ν

. The corresponding Lagrangian function, denoted as $$L_{R}$$

L
R

, is realized by a polynomial expression of the Ricci 4-scalar $$R\equiv g_{\mu \nu }R^{\mu \nu }$$

R
≡

g

μ
ν

R

μ
ν

and of the quadratic curvature 4-scalar $$\rho \equiv R^{\mu \nu }R_{\mu \nu }$$

ρ
≡

R

μ
ν

R

μ
ν

. The Lagrangian variational principle applies both to vacuum and non-vacuum cases and for its validity it demands a non-vanishing, and actually also positive, cosmological constant $$\Lambda >0$$

Λ
>
0

. Then, by implementing the deDonder–Weyl formalism, the physical conditions for the existence of a manifestly-covariant Hamiltonian structure associated with such a Lagrangian formulation are investigated. As a consequence, it is proved that the Ricci tensor can obey a Hamiltonian dynamics which is consistent with the solutions predicted by the Einstein field equations.
Wormhole geometries in f(Q) gravity and the energy conditions
Authors: Banerjee Ayan , Pradhan Anirudh , Tangphati Takol , Rahaman Farook 
Published: November 2021

AbstractFollowing the recent theory of f(Q) gravity, we continue to investigate the possible existence of wormhole geometries, where Q is the non-metricity scalar. Recently, the non-metricity scalar and the corresponding field equations have been studied for some spherically symmetric configurations in Mustafa (Phys Lett B 821:136612, 2021) and Lin and Zhai (Phys Rev D 103:124001, 2021). One can note that field equations are different in these two studies. Following Lin and Zhai (2021), we systematically study the field equations for wormhole solutions and found the violation of null energy conditions in the throat neighborhood. More specifically, considering specific choices for the f(Q) form and for constant redshift with different shape functions, we present a class of solutions for static and spherically symmetric wormholes. Our survey indicates that wormhole solutions could not exist for specific form function $$f(Q)= Q+ \alpha Q^2$$

f

(
Q
)

=
Q
+
α

Q
2

. To summarize, exact wormhole models can be constructed with violation of the null energy condition throughout the spacetime while being $$\rho \ge 0$$

ρ
≥
0

and vice versa.