bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of antipsychotic drugs and cholinesterase inhibitors and risk of falls and fractures: self-controlled case series
Authors: Wang Grace Hsin-Min , Man Kenneth K C , Chang Wei-Hung , Liao Tzu-Chi , Lai Edward Chia-Cheng 
Published: September 2021

Abstract

Objective
To evaluate the association between the use of antipsychotic drugs and cholinesterase inhibitors and the risk of falls and fractures in elderly patients with major neurocognitive disorders.

Design
Self-controlled case series.

Setting
Taiwan’s National Health Insurance Database.

Participants
15 278 adults, aged ≥65, with newly prescribed antipsychotic drugs and cholinesterase inhibitors, who had an incident fall or fracture between 2006 and 2017. Prescription records of cholinesterase inhibitors confirmed the diagnosis of major neurocognitive disorders; all use of cholinesterase inhibitors was reviewed by experts.

Main outcome measures
Conditional Poisson regression was used to derive incidence rate ratios and 95% confidence intervals for evaluating the risk of falls and fractures for different treatment periods: use of cholinesterase inhibitors alone, antipsychotic drugs alone, and a combination of cholinesterase inhibitors and antipsychotic drugs, compared with the non-treatment period in the same individual. A 14 day pretreatment period was defined before starting the study drugs because of concerns about confounding by indication.

Results
The incidence of falls and fractures per 100 person years was 8.30 (95% confidence interval 8.14 to 8.46) for the non-treatment period, 52.35 (48.46 to 56.47) for the pretreatment period, and 10.55 (9.98 to 11.14), 10.34 (9.80 to 10.89), and 9.41 (8.98 to 9.86) for use of a combination of cholinesterase inhibitors and antipsychotic drugs, antipsychotic drugs alone, and cholinesterase inhibitors alone, respectively. Compared with the non-treatment period, the highest risk of falls and fractures was during the pretreatment period (adjusted incidence rate ratio 6.17, 95% confidence interval 5.69 to 6.69), followed by treatment with the combination of cholinesterase inhibitors and antipsychotic drugs (1.35, 1.26 to 1.45), antipsychotic drugs alone (1.33, 1.24 to 1.43), and cholinesterase inhibitors alone (1.17, 1.10 to 1.24).

Conclusions
The incidence of falls and fractures was high in the pretreatment period, suggesting that factors other than the study drugs, such as underlying diseases, should be taken into consideration when evaluating the association between the risk of falls and fractures and use of cholinesterase inhibitors and antipsychotic drugs. The treatment periods were also associated with a higher risk of falls and fractures compared with the non-treatment period, although the magnitude was much lower than during the pretreatment period. Strategies for prevention and close monitoring of the risk of falls are still necessary until patients regain a more stable physical and mental state.
Modelling the impact of lockdown-easing measures on cumulative COVID-19 cases and deaths in England
Authors: Ziauddeen Hisham , Subramaniam Naresh , Gurdasani Deepti 
Published: September 2021

ObjectivesTo assess the potential impacts of successive lockdown-easing measures in England, at a point in the COVID-19 pandemic when community transmission levels were relatively high.DesignWe developed a Bayesian model to infer incident cases and reproduction number (R) in England, from incident death data. We then used this to forecast excess cases and deaths in multiple plausible scenarios in whichRincreases at one or more time points.SettingEngland.ParticipantsPublicly available national incident death data for COVID-19 were examined.Primary outcomeExcess cumulative cases and deaths forecast at 90 days, in simulated scenarios of plausible increases inRafter successive easing of lockdown in England, compared with a baseline scenario whereRremained constant.ResultsOur model inferred anRof 0.75 on 13 May when England first started easing lockdown. In the most conservative scenario modelled whereRincreased to 0.80 as lockdown was eased further on 1 June and then remained constant, the model predicted an excess 257 (95% CI 108 to 492) deaths and 26 447 (95% CI 11 105 to 50 549) cumulative cases over 90 days. In the scenario with maximal increases inR(but staying ≤1), the model predicts 3174 (95% CI 1334 to 6060) excess cumulative deaths and 421 310 (95% CI 177 012 to 804 811) cases. Observed data from the forecasting period aligned most closely to the scenario in whichRincreased to 0.85 on 1 June, and 0.9 on 4 July.ConclusionsWhen levels of transmission are high, even small changes inRwith easing of lockdown can have significant impacts on expected cases and deaths, even ifRremains ≤1. This will have a major impact on population health, tracing systems and healthcare services in England. Following an elimination strategy rather than one of maintenance ofR≤1 would substantially mitigate the impact of the COVID-19 epidemic within England.
CARDEA study protocol: investigating early markers of cardiovascular disease and their association with lifestyle habits, inflammation and oxidative stress in adolescence using a cross-sectional comparison of adolescents with type 1 diabetes and healthy controls
Authors: Henderson Mélanie , Friedrich Matthias , Van Hulst Andraea , Pelletier Catherine , Barnett Tracie A , Benedetti Andrea , Bigras Jean-Luc , Drapeau Vicky , Lavoie Jean-Claude , Levy Emile , Mathieu Marie-Eve , Nuyt Anne-Monique 
Published: September 2021

IntroductionLittle is known regarding associations between potentially modifiable lifestyle habits and early markers of cardiovascular disease (CVD) in pediatric type 1 diabetes (T1D), hindering early prevention efforts. Specific objectives are: (1) compare established risk factors (dyslipidemia, hypertension) with novel early markers for CVD (cardiac phenotype, aortic distensibility, endothelial function) in adolescents with T1D and healthy age-matched and sex-matched controls; (2) examine associations between these novel early markers with: (i) lifestyle habits; (ii) adipokines and measures of inflammation; and (iii) markers of oxidative stress among adolescents with T1D and controls, and determine group differences in these associations; (3) explore, across both groups, associations between CVD markers and residential neighbourhood features.Methods and analysesUsing a cross-sectional design, we will compare 100 participants aged 14–18 years with T1D to 100 healthy controls. Measures include: anthropometrics; stage of sexual maturity (Tanner stages); physical activity (7-day accelerometry); sleep and sedentary behaviour (self-report and accelerometry); fitness (peak oxygen consumption); and dietary intake (three non-consecutive 24- hour dietary recalls). Repeated measures of blood pressure will be obtained. Lipid profiles will be determined after a 12- hour fast. Cardiac structure/function: non-contrast cardiac magnetic resonance imaging (CMR) images will evaluate volume, mass, systolic and diastolic function and myocardial fibrosis. Aortic distensibility will be determined by pulse wave velocity with elasticity and resistance studies at the central aorta. Endothelial function will be determined by flow-mediated dilation. Inflammatory markers include plasma leptin, adiponectin, tumour necrosis factor alpha (TNF-α), type I and type II TNF-α soluble receptors and interleukin-6 concentrations. Measures of endogenous antioxidants include manganese superoxide dismutase, glutathione peroxidase and glutathione in blood. Neighbourhood features include built and social environment indicators and air quality.Ethics and disseminationThis study was approved by the Sainte-Justine Hospital Research Ethics Board. Written informed assent and consent will be obtained from participants and their parents.Trial registration numberNCT04304729.
Evaluation of unmodifiable and potentially modifiable factors affecting peripheral intravenous device-related complications in neonates: a retrospective observational study
Authors: van Rens Matheus F P T , Hugill Kevin , Mahmah Mohamad A , Bayoumi Mohammad , Francia Airene L V , Garcia Krisha L P , van Loon F H J 
Published: September 2021

ObjectivesInfants in neonatal units benefit from dependable peripheral intravenous access. However, peripheral intravenous access exposes infants to high rates of clinically minor and serious complications. Despite this, little is known about the interplay of risk factors. The aim of this study was to assess the incidence and evaluate the interactions of risk factors on the occurrence of peripheral intravenous complications in a neonatal population.DesignThis was a retrospective observational study.SettingThe study was performed on the neonatal intensive care unit of the Women’s Wellness and Research Center, Hamad Medical Corporation, Qatar, as a single-site study.ParticipantsThis study included 12 978 neonates who required intravenous therapy.Outcome measurementsThe main outcome was the occurrence of any peripheral intravenous cannulation failure, leading to unplanned removal of the device before completion of the intended intravenous therapy.ResultsA mean dwell time of 36±28 hours was recorded in participants with no complications, whereas the mean dwell time was 31±23 hours in participants with an indication for premature removal of the peripheral intravenous catheter (PIVC) (p<0.001,t=11.35). Unplanned removal occurred in 59% of cases; the overall complication rate was 18 per 1000 catheter days. Unmodifiable factors affecting PIVC dwell time include lower birth (HR=0.23, 0.20 to 0.28, p<0.001) and current body weight (HR=1.06, 1.03 to 1.10, p=0.018). Cannulation site (HR=1.23, 1.16 to 1.30, p<0.001), the inserted device (HR=0.89, 0.84 to 0.94, p<0.001) and the indication for intravenous treatment (HR=0.76, 0.73 to 0.79, p<0.001) were modifiable factors.ConclusionMost infants experienced a vascular access-related complication. Given the high complication rate, PIVCs should be used judiciously and thought given prior to their use as to whether alternate means of intravenous access might be more appropriate.
Quality assessment and comparative analysis on the recommendations of current guidelines on the management of peripheral arterial disease: a systematic review protocol
Authors: Uyagu Oliseneku Damien , Ofoegbu Cosmas , Ikhidero Joseph , Chukwuka Emeka , Enwere Okezie , Ogierakhi Omokharo , Adelosoye Alex 
Published: September 2021

IntroductionPeripheral arterial disease (PAD) is the third leading atherosclerotic arterial disease. There is evidence that there is a high variation in the quality and recommendations of clinical practice guidelines for PAD, leading to the possibility of confusion among clinicians and patients. This study aims to conduct a quality assessment and comparative analysis of the clinical practice guidelines on PAD written between 2010 and 2020.Method and analysisWe aim to perform a systematic review of clinical practice guidelines written between 2010 and 2020. A search for guidelines will be conducted through medical databases Scope, Pubmed, TRIP, Guideline Clearinghouses and specialist international organisations’ specific websites. Guidelines that meet the inclusion criteria will be extracted from the search result. The Appraisal of Guidelines for Research and Evaluation II (AGREE-II instrument) will assess the quality of the selected guidelines. The recommendations, level of evidence and other relevant information will be extracted in a datasheet for qualitative analysis. The score for each guideline’s quality will be represented using charts and central tendency measures for comparison. The summary of recommendations will also be represented in tables for easy comparison for similarities and variations across sections. Finally, the level of evidence on which the recommendations are based will also be noted along with other significant characteristics such as the authors’ financial relationship to the biomedical community. We aim to point out deficiencies present in current guidelines and elucidate areas where recommendations are made with low-level evidence. The results will enable the scientific community to design future research to fill in PAD management knowledge gaps.Ethics and disseminationNo ethical approval was sought. Dissemination will be via journal articles and conference presentations.PROSPERO registration numberCRD42020219176.
Cost-effectiveness of treatment optimisation with biomarkers for immunotherapy in solid tumours: a systematic review protocol
Authors: Mucherino Sara , Lorenzoni Valentina , Orlando Valentina , Triulzi Isotta , Del Re Marzia , Capuano Annalisa , Danesi Romano , Turchetti Giuseppe , Menditto Enrica 
Published: September 2021

IntroductionThe combination of biomarkers and drugs is the subject of growing interest both from regulators, physicians and companies. This study protocol of a systematic review is aimed to describe available literature evidences about the cost-effectiveness, cost-utility or net-monetary benefit of the use of biomarkers in solid tumour as tools for customising immunotherapy to identify what further research needs.Methods and analysisA systematic review of the literature will be carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. PubMed and Embase will be queried from June 2010 to June 2021. The PICOS model will be applied: target population (P) will be patients with solid tumours treated with immune checkpoint inhibitors (ICIs); the interventions (I) will be test of the immune checkpoint predictive biomarkers; the comparator (C) will be any other targeted or non-targeted therapy; outcomes (O) evaluated will be health economic and clinical implications assessed in terms of incremental cost-effectiveness ratio, net health benefit, net monetary benefit, life years gained, quality of life, etc; study (S) considered will be economic evaluations reporting cost-effectiveness analysis, cost-utility analysis, net-monetary benefit. The quality of the evidence will be graded according to Grading of Recommendations Assessment, Development and Evaluation.Ethics and disseminationThis systematic review will assess the cost-effectiveness implications of using biomarkers in the immunotherapy with ICIs, which may help to understand whether this approach is widespread in real clinical practice. This research is exempt from ethics approval because the work is carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal.PROSPERO registration numberCRD42020201549.
Diagnostic and prognostic accuracy of Protein C in adult patients with sepsis: protocol for a systematic review and meta-analysis
Authors: Catenacci Vanessa , Sheikh Fatima , Patel Kush , Fox-Robichaud Alison 
Published: September 2021

IntroductionSepsis is a dysregulated host response to infection characterised by activation of proinflammatory and procoagulant mechanisms. Protein C (PC)’s activity as an anticoagulant and antiinflammatory molecule makes it an appealing target for sepsis biomarker studies. To date, there has been no systematic review of PC as a sepsis biomarker.ObjectivesTo evaluate the diagnostic accuracy and prognostic strength of PC as a biomarker for adult sepsis.Methods and analysisMedline, Embase, Cochrane Library, PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched from inception through 20 January 2021 for prospective observational studies that evaluate the use of PC as a diagnostic or prognostic biomarker for adult sepsis. Title and abstract screening, full-text screening and data extraction will be conducted in duplicate. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies and Quality in Prognostic Studies tools. If sufficient data are available, a meta-analysis will be conducted. The standardised mean difference and 95% CI will be calculated for prognostic and diagnostic studies. If possible, a hierarchical summary receiver operator characteristic curve will be generated to assess overall prognostic and diagnostic biomarker accuracy. I2statistics will be used to assess heterogeneity. Sensitivity analysis will be performed by removing studies with a high risk of bias and re-examining the meta-analysis results.Ethics and disseminationGiven this is a systematic review and meta-analysis, there is no requirement for ethics approval. Findings will be disseminated through a peer-reviewed publication and social media.PROSPERO registration numberCRD42021229786.
Decomposing Effects of Population Aging on Economic Growth in OECD Countries
Authors: Lee Hyun-Hoon , Shin Kwanho 
Published: September 2021

Abstract
In this paper, we investigate six channels through which population aging affects output growth per capita of 35 OECD countries where the old dependency ratio is already quite high. The six channels we consider are changes in: (i) physical capital; (ii) human capital; (iii) average working hours; (iv) labor participation rate; (v) age composition of 15–64 (the share of population aged between 15 and 64 years; and (vi) total factor productivity (TFP). We first confirm findings from previous studies that aging in OECD countries has negative effects on GDP growth per capita. We then find that the most important channel through which the negative effects of aging on economic growth operate is lowered TFP growth. Across our empirical specifications, lowered TFP growth associated with aging explains more than fully the lowered growth rate of GDP per capita. We also find evidence of demographic deficit (decreases in working age population share), but this negative effect of aging is more than nullified by compensating increases in the average working hours and the labor force participation rate. We conclude that because TFP growth rate can be permanently lowered, aging's negative effects on GDP growth per capita are expected to be permanent.
Family functioning but not social capital is associated with better mental health in adolescents affected by violence and displacement by armed conflict in Colombia
Authors: Tamayo-Aguledo William , Acosta-Ortiz Alida , Hamid Aseel , Gómez-García Carolina , García-Durán María Camila , Daccach-González Vanessa , Solmi Francesca , Bell Vaughan 
Published: September 2021

Background: The effect of the Colombian armed conflict on the mental health of adolescents is still poorly understood. Aims: Given social interventions are most likely to inform policy, we tested whether two potential intervention targets, family functioning and social capital, were associated with mental health in Colombian adolescents, and whether this was moderated by experience of violence and displacement. Methods: We examined the cross-sectional association between family functioning, cognitive social capital, structural social capital and 12-month prevalence of Composite International Diagnostic Interview (CIDI) diagnosed psychiatric disorder, using data on 12 to 17-year-old adolescents ( N = 1,754) from the 2015 National Mental Health Survey of Colombia, a nationally representative epidemiological study. We tested whether associations survived cumulative adjustment for demographic confounders, experience of non-specific violence and harm and displacement by armed conflict. Results: Neither structural nor cognitive social capital were associated with better mental health. Better family functioning was associated with reduced risk of poor mental health in an unadjusted analysis (OR 0.90 [0.85–0.96]), and after cumulative adjustments for demographic confounders (OR 0.91 [0.86–0.97]), non-specific violence and harm (OR 0.91 [0.86–0.97]) and social capital variables (OR 0.91 [0.85–0.97]). In the final model, each additional point on the family APGAR scale was associated with a 9% reduced odds of any CIDI diagnosed disorder in the last 12 months. Conclusions: Better family functioning was associated with better mental health outcomes for all adolescents. This effect remained present in those affected by the armed conflict even after accounting for potential confounders.
Fostering Inclusivity: Exploring the Impact of Identity Safety Cues and Instructor Gender on Students’ Impressions and Belonging
Authors: Maimon Melanie R. , Howansky Kristina , Sanchez Diana T. 
Published: September 2021

Background Students with marginalized identities can experience identity threats in higher education. Instructors can help improve student outcomes by using identity safety cues (ISCs), which signal to marginalized groups that their identities are valued. Objective The purpose of this study was to examine whether including ISCs in course syllabi could improve students’ belonging-related outcomes and whether these outcomes differ based on instructor gender. Method Using an experimental design, undergraduate students viewed a syllabus that included or excluded ISCs from either a White male or female professor. Participants reported their anticipated belonging and instructor impressions. Results Participants reported greater expected engagement and field belonging and had more positive impressions of the instructor when the syllabus included ISCs compared to the control syllabus. Instructor gender had a minimal impact on participants’ outcomes and impressions. Conclusion This work demonstrates including ISCs in course syllabi can positively impact students when course instructors are White men or women. Teaching Implications ISCs improved participants’ anticipated engagement and field belonging regardless of instructor gender. This work suggests instructors can improve students’ first impressions and intentions by including ISCs in their course syllabi.
Pharmacological treatment for Tourette syndrome in children and adults: What is the quality of the evidence? A systematic review
Authors: Besag Frank MC , Vasey Michael J , Lao Kim SJ , Chowdhury Uttom , Stern Jeremy S 
Published: September 2021

Background: Tourette syndrome (TS) is a neurodevelopmental disorder characterised by involuntary muscle movements manifesting as motor and vocal tics. In the majority, tics are manageable without medication. Where tics cause discomfort or impair function, behavioural or pharmaceutical treatments may be considered. Aims: To provide a meticulous examination of the quality of evidence for the current pharmacological treatments for TS. Methods: PubMed and Google Scholar were searched to identify randomised, placebo-controlled trials (RCTs) of aripiprazole, risperidone, clonidine, guanfacine, haloperidol, pimozide, tiapride and sulpiride for the treatment of tics in children and adults with TS. Quality of reporting and risk of bias were assessed against the CONSORT checklist and Cochrane risk of bias criteria, respectively. Results: Seventeen RCTs were identified. Response rates reached 88.6% for aripiprazole, 68.9% for clonidine, 62.5% for risperidone and 19% for guanfacine. Statistically significant improvements were reported for all medications compared to placebo in at least one study and for at least one measure of tic severity. Most studies predated the CONSORT and Cochrane criteria and did not score highly when assessed on these measures. Conclusions: There are relatively few placebo-controlled trials of commonly prescribed medications. Studies are often of poor quality and short duration. There is evidence for the efficacy of each medication, but no drug is clearly superior. Clonidine and guanfacine are better tolerated than antipsychotics, but less effective. There is too little evidence to determine whether adults respond differently from children.