bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in health expectancies: a systematic review of international evidence
Authors: Spiers Gemma F , Kunonga Tafadzwa Patience , Beyer Fiona , Craig Dawn , Hanratty Barbara , Jagger Carol 
Published: May 2021

ObjectivesA clear understanding of whether increases in longevity are spent in good health is necessary to support ageing, health and care-related policy.DesignWe conducted a systematic review to update and summarise evidence on trends in health expectancies, in Organisation for Economic Co-operation and Development (OECD) high-income countries.Data sourcesFour electronic databases (MEDLINE, 1946–19 September 2019; Embase 1980–2019 week 38; Scopus 1966–22 September 2019, Health Management Information Consortium, 1979–September 2019), and the UK Office for National Statistics website (November 2019).Eligibility criteriaEnglish language studies published from 2016 that reported trends in healthy, active and/or disability-free life expectancy in an OECD high-income country.Data extraction and synthesisRecords were screened independently by two researchers. Study quality was assessed using published criteria designed to identify sources of bias in studies reporting trends, and evidence summarised by narrative synthesis.FindingsTwenty-eight publications from 11 countries were included, covering periods from 6 to 40 years, between 1970 and 2017. In most countries, gains in healthy and disability-free life expectancy do not match the growth in total life expectancy. Exceptions were demonstrated for women in Sweden, where there were greater gains in disability-free years than life expectancy. Gains in healthy and disability-free life expectancy were greater for men than women in most countries except the USA (age 85), Japan (birth), Korea (age 65) and Sweden (age 77).ConclusionAn expansion of disability in later life is evident in a number of high-income countries, with implications for the sustainability of health and care systems. The recent COVID-19 pandemic may also impact health expectancies in the longer term.
Infection-associated biofilms and statins: protocol for systematic review
Authors: Valencia Dora Yesenia , Habila Magdiel , McClelland D Jean , Degarege Abraham , Madhivanan Purnima , Krupp Karl 
Published: May 2021

IntroductionOwing to their propensity for being associated with infections, biofilms have become a focus in infectious disease research. There is evidence suggesting that statins, which are commonly used for prevention of cardiovascular disease, may prevent biofilm-associated infections, but this association has not been well-understood.Methods and analysisThis systematic review protocol will include six database searches from their inception to 20 August 2020. A medical librarian will conduct the searches in PubMed, EMBASE, Web of Science, CINAHL, LILACS and CENTRAL, without any limits. Bibliographies of selected articles, previously published reviews and high-yield journals that publish on statins and/or biofilms will be searched to identify additional articles. The screening and data extraction will be conducted by two independent reviewers using DistillerSR. All included papers will also be evaluated for quality using Cochrane Risk of Bias Assessment tool, and we will examine for publication bias. If there are two or more studies with quantitative estimates that can be combined, we will conduct a meta-analysis after assessing for heterogeneity. We will report all findings according to the Preferred Reporting Items for Systematic reviews and Analyses-P framework.Ethics and disseminationThere are conflicting results on the effect of statins on biofilm-associated infections. The rise of antibiotic resistance in medical settings warrants a deeper understanding of this association, especially if statins can be used as a novel antibiotic. The findings of this review will assess the association between statin use and biofilm-associated infection to inform future medical practice. No formal ethical review is required for this protocol. All findings will be published in a peer-reviewed journal.PROSPERO registration numberCRD42020193985.
Success and limiting factors in health service innovation: a theory-generating mixed methods evaluation of UK projects
Authors: Leedham-Green Kathleen , Knight Alec , Reedy Gabriel B 
Published: May 2021

ObjectivesTo explore and explain success and limiting factors in UK health service innovation.DesignMixed methods evaluation of a series of health service innovations involving a survey and interviews, with theory-generating analysis.SettingThe research explored innovations supported by one of the UK’s Academic Health Science Networks which provides small grants, awards and structural support to health service innovators including clinical academics, health and social care professionals and third-sector organisations.ParticipantsAll recipients of funding or support 2014–2018 were invited to participate. We analysed survey responses relating to 56 innovation projects.ResultsResponses were used to conceptualise success along two axes: value creation for the intended beneficiaries and expansion beyond its original pilot. An analysis of variance between categories of success indicated that participation, motivation and evaluation were critical to value generation; organisational, educational and administrative support were critical to expansion; and leadership and collaborative expertise were critical to both value creation and expansion. Additional limiting factors derived from qualitative responses included difficulties navigating the boundaries and intersections between organisations, professions, sectors and cultures; a lack of support for innovation beyond the start-up phase; a lack of protected time; and staff burn-out and turnover.ConclusionsA nested hierarchy of innovation needs has been derived via an analysis of these factors, providing targeted suggestions to enhance the success of future innovations.
Cluster-randomised controlled trial of Stroke 1-2-0 education programme to reduce stroke prehospital delay in China: a study protocol
Authors: Wang Yong , Liu Yang , Liu Renyu , Zhao Jing 
Published: May 2021

IntroductionStroke is the leading cause of death and disability in China. The median time of stroke pre-hospital delay is more than 15 hours, mainly due to the lack of awareness on stroke symptoms and calling emergency services. We developed Stroke 1-2-0 recognition tool in China, by adapting Face, Arm, Speech and Time. Our preliminary findings suggested that Stroke 1-2-0 can improve public’s knowledge of the stroke symptoms, but its impact on the prehospital delay is still unclear. Furthermore, these findings were mainly obtained from Shanghai, one of the largest metropolises in China. However, more than half of population in China lives in the rural area. Given the striking disparities in socioeconomic status and quality of stroke care across the nation, a multicentre trial is warranted.Methods and analysisStroke 1-2-0 education programme will adopt a multicentre, cluster-randomised controlled design. We aimed to recruit 32 communities from 16 counties across China. Each county includes two communities having more than 100 000 residents. The two communities sampled in the same county will be randomly assigned to receive either Stroke 1-2-0 education programme or usual care. The primary objective of this study is to evaluate the impact of Stroke 1-2-0 public education programme in reducing stroke prehospital delay among adults residing in the community, compared with the usual care. The intervention will be implemented for 1 year. The primary outcomes are the symptom onset to hospital arrival time (‘onset-to-door time’, ODT) and 3-hour hospital arriving rate. We will use an intention-to-treat approach. A linear mixed model will be used to control for potential cluster effects.Ethics and disseminationThis study is approved by the Shanghai Minhang District Central Hospital Institutional Review Board (Shanghai, China). The findings will be disseminated via peer-reviewed publications and conference presentations.Trial registration numberChiCTR2000040782.
Trainee doctors’ experiences of learning and well-being while working in intensive care during the COVID-19 pandemic: a qualitative study using appreciative inquiry
Authors: Warren Jennifer , Plunkett Emma , Rudge James , Stamoulis Christina , Torlinski Tomasz , Tarrant Carolyn , Mullhi Randeep 
Published: May 2021

ObjectivesConcern about trainee work-related well-being has been raised in recent years and is the subject of several reviews, reports and research studies. This study aimed to understand the experiences of trainees working in a large intensive care unit during the first surge of the COVID-19 pandemic from an educational and operational perspective in order to highlight what worked and what could be improved.DesignA qualitative study using peer-to-peer semistructured interviews, developed using appreciative inquiry methodology, was conducted during July 2020. Responses were analysed using a thematic analysis technique.SettingA large, tertiary intensive care unit in the UK.ParticipantsAll trainees in anaesthesia and intensive care working on the intensive care unit during the first surge were invited to participate.ResultsForty interviews were conducted and four over-arching themes were identified. These were: feeling safe and supported; physical demands; the emotional burden of caring; and a sense of fulfilment, value and personal development. Positive aspects of the organisational response to the pandemic included communication, personal protective equipment supply, team working and well-being support. Suggestions for improvement focused on rest facilities, rota patterns and hierarchies, creating opportunities for reflection and ensuring continued educational and training opportunities despite operational demands.ConclusionsTrainees described opportunities for learning and fulfilment, as well as challenges, in working through a pandemic. Trainees described their needs and how well these were met during the pandemic. Ideas for improvement most frequently related to basic needs including safety and fatigue, but suggestions also related to supporting learning and development. The appreciative inquiry methodology of the project facilitated effective reflection on positive aspects of trainee experiences.
Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study
Authors: Scott Lauren J , Murphy Mairead , Price Sarah , Lewis Rhys , Denholm Rachel , Horwood Jeremy , Palmer Tom , Salisbury Chris 
Published: May 2021

ObjectivesTo investigate how the COVID-19 pandemic affected the number of people aged 50+ years presenting to primary care with features that could potentially indicate cancer, and to explore how reporting differed by patient characteristics and in face-to-face vs remote consultations.Design, setting and participantsA retrospective cohort study of general practitioner (GP), nurse and paramedic primary care consultations in 21 practices in South-West England covering 123 947 patients. The models compared potential cancer indicators reported in April–July 2019 with April–July 2020.Main outcome measuresPotential indicators of cancer were identified using code lists for symptoms, signs, test results and diagnoses listed in the National Institute for Health and Care Excellence suspected cancer referral guidance (NG12).ResultsDuring April–July 2019, 17% of registered patients aged 50+ years reported a potential cancer indicator in a consultation with a GP or nurse. During April–July 2020, this reduced to 11% (incidence rate ratio (IRR) 0.64, 95% CI 0.62 to 0.67, p<0.001). Reductions in potential cancer indicators were stable across age group, sex, ethnicity, index of multiple deprivation quintile and shielding status, but less marked in patients with mental health conditions than without (IRR 0.75, 95% CI 0.72 to 0.79, interaction p<0.001). Proportions of GP consultations with potential indicators of cancer reduced between 2019 and 2020 for face-to-face consultations (IRR 0.84, 95% CI 0.76 to 0.92, p<0.001) and increased for remote consultations (IRR 1.17, 95% CI 1.07 to 1.29, p=0.001), although it remained lower in remote consulting than face-to-face in April–July 2020. This difference was greater for nurse/paramedic consultations (face-to-face: IRR 0.61, 95% CI 0.44 to 0.83, p=0.002; remote: IRR 1.60, 95% CI 1.10 to 2.333, p=0.014).ConclusionThe number of patients consulting with presentations that could potentially indicate cancer reduced during the first wave of the COVID-19 pandemic. Patients should be encouraged to continue contacting primary care for persistent signs and symptoms, and GPs and nurses should be encouraged to probe patients for further information during remote consulting, in the absence of non-verbal cues.
Live streaming ward rounds using wearable technology to teach medical students: a pilot study
Authors: Mill Tobias , Parikh Shefali , Allen Archie , Dart Gemma , Lee Daniel , Richardson Charlotte , Howell Keith , Lewington Andrew 
Published: May 2021

BackgroundThe COVID-19 pandemic resulted in a loss of clinical clerkship opportunities for medical students. To address this problem while maintaining patient safety, this pilot study explored the feasibility of using a wearable headset to live stream teaching ward rounds to remotely based medical students.MethodsThree live streamed teaching ward rounds were delivered to three groups of medical students (n=53) using the Microsoft HoloLens 2 device and Microsoft Teams software, and results pooled for analysis. Feedback was gathered from students and instructors using the evaluation of technology-enhanced learning materials (ETELM). Patient feedback was gathered using the Communication Assessment Tool to explore any impact on interpersonal communication.ResultsThe response rate for the ETELM-learner perceptions was 58% (31/53), 100% for the ETELM-instructor perceptions. Students strongly agreed that the overall quality of the teaching session and instructors was excellent. However, 32% experienced issues with audio or video quality and one remote student reported cyber sickness. The statement ‘educational activities encouraged engagement with session materials/content’ returned the most varied response. Instructors reported technological problems with delivery while using the HoloLens 2 device and environmental noise in the ward was a disruptive factor. Preparation and skilled facilitation were key to delivering a high-quality teaching session. Patients reacted generally favourably to the technology and no negative effects on interpersonal communication were identified.ConclusionThe experience of live streamed ward rounds was well received by patients, medical students and teaching faculty. However, there remain limitations to the routine use of HoloLens 2 technology in our setting including steep learning curves, hardware costs and environmental factors such as noise and WiFi connectivity. Live streamed ward rounds have potential postpandemic implications for the judicious use of resources, and the possibility for few educationally minded clinicians to teach at scale in a patient-friendly manner.
First-line contact aspiration versus first-line stent retriever for acute posterior circulation strokes: an updated meta-analysis
Authors: Ye Gengfan , Wen Xuebin , Wang Hongcai , Sun Chengfeng , Pan Zhihao , Chen Maosong , Wang Boding , Li Zhenqiang 
Published: May 2021

BackgroundBoth stent retriever (SR) and contact aspiration (CA) are widely used as first-line strategies for acute posterior circulation strokes (PCS). However, it is still unclear how CA and SR compare as the first-line treatment of acute PCS. Several new studies have been published recently, so we aimed to perform an updated meta-analysis.MethodsThe meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. Random-effects models were performed to pool the outcomes and the value of I2was calculated to assess the heterogeneity.ResultsTen observational studies with 1189 patients were included, among whom 492 received first-line CA and 697 received first-line SR. The pooled results revealed that first-line CA could achieve a significantly higher proportion of modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3 (OR 1.90, 95% CI 1.33 to 2.71, I2=0%), mTICI 3 (OR 1.95, 95% CI 1.15 to 3.31, I2=59.6%), first-pass effect (OR 2.91, 95% CI 1.51 to 5.58, I2=0%), lower incidence of new-territory embolic events (OR 0.20, 95% CI 0.05 to 0.83, I2=0%), and shorter procedure time (mean difference −29.4 min, 95% CI −46.8 to −12.0 min, I2=62.8%) compared with first-line SR. At 90-day follow-up, patients subjected to first-line CA showed a higher functional independence (modified Rankin Scale score 0–2; OR 1.38, 95% CI 1.01 to 1.87, I2=23.5%) and a lower mortality (OR 0.71, 95% CI 0.50 to 1.00, p=0.050, I2=0%) than those subjected to first-line SR.ConclusionsThis meta-analysis suggests that the first-line CA strategy could achieve better recanalization and clinical outcomes for acute PCS than first-line SR. Limited by the quality of included studies, this conclusion should be drawn with caution.
Effectiveness and safety of endovascular thrombectomy for large versus medium vessel occlusions: a single-center experience
Authors: Shek Kevin , Alcock Susan , Ghrooda Esseddeeg , Trivedi Anurag , McEachern James , Kaderali Zul , Shankar Jai 
Published: May 2021

BackgroundThe effectiveness and safety of endovascular thrombectomy (EVT) for medium vessel occlusions (MeVO) in the anterior intracranial circulation for patients with acute ischemic stroke (AIS) has yet to be definitively established. We compared outcomes in patients undergoing EVT for large vessel occlusion (LVO) versus those with MeVO.MethodsThis retrospective cohort study, using an intention to treat design, compared the 90-day modified Rankin Scale (mRS) score between 43 patients with MeVO and 199 with LVO in the anterior intracranial circulation. Secondary outcome measures included vessel recanalization using the Thrombolysis in Cerebral Infarction (TICI) score, procedural complications, post-EVT intracranial hemorrhage (ICH), and infarct size.ResultsThe rate of good functional outcome (90-day mRS 0–2) was higher in patients with LVO than in those with MeVO (32.9% vs 27%), but this was not statistically significant (p=0.19). The rate of EVT procedural complications was also not significantly different between the groups (p=0.10), nor was the rate of ICH (p=0.30). There was also no significant difference in TICI scores between groups (p=0.12). Infarct size was larger in the LVO group (p<0.01). Multivariate analysis showed older age, not receiving recombinant tissue plasminogen activator (r-tPA), and larger infarct size were independent predictors of poor functional outcome at 90 days.ConclusionThe 90-day mRS and rate of periprocedural complications were not significantly different between patients treated for LVO and those treated for MeVO with EVT. Older age, not receiving r-tPA, and larger infarct size were independent predictors of poor outcome at 90 days.
Thermal, trapped and chromo-natural inflation in light of the swampland criteria and the trans-Planckian censorship conjecture
Authors: Berera Arjun , Brandenberger Robert , Kamali Vahid , Ramos Rudnei O. 
Published: May 2021

AbstractWe consider thermal, trapped and chromo-natural inflation in light of the swampland criteria and the Trans-Planckian Censorship Conjecture (TCC). Since thermal inflation occurs at energies low compared to those of Grand Unification, it is consistent with the TCC, and it is also consistent with the refined swampland conditions. Trapped and chromo-natural inflation are candidates for primordial (high energy scale) inflation. Since in both of these scenarios there are effective damping terms in the scalar field equation of motion, the models can easily be consistent with the swampland criteria. The TCC, on the other hand, constrains these scenarios to only take place at low energies.
Whole-Exome Sequencing of Radiation-Induced Thymic Lymphoma in Mouse Models Identifies Notch1 Activation as a Driver of p53 Wild-Type Lymphoma
Authors: Lee Chang-Lung , Brock Kennedy D. , Hasapis Stephanie , Zhang Dadong , Sibley Alexander B. , Qin Xiaodi , Gresham Jeremy S. , Caraballo Isibel , Luo Lixia , Daniel Andrea R. , Hilton Matthew J. , Owzar Kouros , Kirsch David G. 
Published: May 2021

AbstractMouse models of radiation-induced thymic lymphoma are widely used to study the development of radiation-induced blood cancers and to gain insights into the biology of human T-cell lymphoblastic leukemia/lymphoma. Here we aimed to identify key oncogenic drivers for the development of radiation-induced thymic lymphoma by performing whole-exome sequencing using tumors and paired normal tissues from mice with and without irradiation. Thymic lymphomas from irradiated wild-type (WT), p53+/−, and KrasLA1 mice were not observed to harbor significantly higher numbers of nonsynonymous somatic mutations compared with thymic lymphomas from unirradiated p53−/− mice. However, distinct patterns of recurrent mutations arose in genes that control the Notch1 signaling pathway based on the mutational status of p53. Preferential activation of Notch1 signaling in p53 WT lymphomas was also observed at the RNA and protein level. Reporter mice for activation of Notch1 signaling revealed that total-body irradiation (TBI) enriched Notch1hi CD44+ thymocytes that could propagate in vivo after thymocyte transplantation. Mechanistically, genetic inhibition of Notch1 signaling in immature thymocytes prevented formation of radiation-induced thymic lymphoma in p53 WT mice. Taken together, these results demonstrate a critical role of activated Notch1 signaling in driving multistep carcinogenesis of thymic lymphoma following TBI in p53 WT mice.Significance:These findings reveal the mutational landscape and key drivers in murine radiation-induced thymic lymphoma, a classic animal model that has been used to study radiation carcinogenesis for over 70 years.