bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiological characteristics and risk factors of biliary atresia: a case–control study
Authors: Jiang Jingying , Wan Rou , He Shiwei , Wu Ying , Shen Zhen , Chen Gong , Sun Song , Yan Weili , Zheng Shan 
Published: December 2021

ObjectivesBiliary atresia (BA) is regarded as a serious neonatal hepatobiliary disease, and its aetiology and pathogenesis remain unclear. Epidemiological studies are limited, especially for the data from China. This study aims to explore risk factors of BA and provide new evidence to improve understanding of its aetiology.DesignThis is a case–control study from 1 January 2015 to 31 December 2016.SettingCases were consecutively recruited from an urban tertiary care academic children’s hospital in Shanghai, China, while the controls were recruited from a community hospital in Shanghai through a random sampling system.Participants721 patients suspected for BA who planned to take the diagnostic surgery were enrolled preoperatively. 613 were diagnosed with BA and recruited into the case group. Meanwhile, 688 infants without any observed major congenital anomalies or jaundice were enrolled. Finally, 594 valid questionnaires from the case group and 681 from the control group were obtained.Primary and secondary outcome measuresStandardised questionnaires were used for data collection. Multivariate logistic regression analysis was performed to evaluate associations reported as ORs and precision, by adjusting covariates.ResultsAnxiety or stress during pregnancy was strongly associated with increased risk of BA (OR 8.36 (95% CI: 4.08 to 17.15); p<0.001), respectively. Lower birth weight, fathers from ethnic minorities of China, older age of fathers, lower income of parents, and exposure to infection, diseases and medication during pregnancy all made differences.ConclusionsSocial factors including the educational and economic background and its related anxiety and stress during pregnancy might be noticed in the occurrence of BA. Maternal infections during pregnancy in the prevalence of BA were demonstrated.Trial registration numberChiCTR-IPR-15005885.
Chlorhexidine oral rinses for symptomatic COPD: a randomised, blind, placebo-controlled preliminary study
Authors: Pragman Alexa A , Fieberg Ann M , Reilly Cavan S , Wendt Christine 
Published: December 2021

ObjectivesDetermine the effect of twice-daily chlorhexidine oral rinses on oral and lung microbiota biomass and respiratory symptoms.SettingSingle centre.ParticipantsParticipants were aged 40–85 with chronic obstructive pulmonary disease (COPD) and chronic productive cough or COPD exacerbation within the last year. Exclusions included antibiotics in the previous 2 months and/or those with less than four teeth. Forty-four participants were recruited and 40 completed the study.InterventionParticipants were randomised 1:1 to twice-daily 0.12% chlorhexidine oral rinses versus placebo for 2 months along with daily diaries. St. George’s Respiratory Questionnaire (SGRQ), blood tests, oral rinse and induced sputum were collected at randomisation and the final visit.Primary and secondary outcomesPrimary outcome was a change in oral and sputum microbiota biomass. Secondary outcomes included: sputum and oral microbiota Shannon and Simpson diversity and taxonomy; inflammatory markers; Breathlessness, Cough and Sputum Scale and SGRQ scores.ResultsNeither the oral microbiota nor the sputum microbiota biomass decreased significantly in those using chlorhexidine compared with placebo (oral microbiota mean log10difference (SE)=−0.103 (0.23), 95% CI −0.59 to 0.38, p=0.665; sputum microbiota 0.80 (0.46), 95% CI −0.15 to 1.75, p=0.096). Chlorhexidine decreased both oral and sputum microbiota alpha (Shannon) diversity (linear regression estimate (SE) oral: −0.349 (0.091), p=0.001; sputum −0.622 (0.169), p=0.001). Chlorhexidine use did not decrease systemic inflammatory markers compared with placebo (C reactive protein (chlorhexidine 1.8±7.5 vs placebo 0.4±6.8, p=0.467), fibrinogen (22.5±77.8 vs 10.0±77.0, p=0.406) or leucocytes (0.2±1.8 vs 0.5±1.8, p=0.560)). Chlorhexidine use decreased SGRQ scores compared with placebo (chlorhexidine −4.7±8.0 vs placebo 1.7±8.9, p=0.032).ConclusionsWe did not detect a significant difference in microbiota biomass due to chlorhexidine use. Chlorhexidine decreased oral and sputum microbiota alpha diversity and improved respiratory health-related quality of life compared with placebo.Trial registrationNCT02252588.
Effectiveness and cost-effectiveness of a structured social coaching intervention for people with psychosis (SCENE): protocol for a randomised controlled trial
Authors: Giacco Domenico , Chevalier Agnes , Patterson Megan , Hamborg Thomas , Mortimer Rianna , Feng Yan , Webber Martin , Xanthopoulou Penny , Priebe Stefan 
Published: December 2021

IntroductionPeople with psychosis tend to have smaller social networks than both people in the general population and other people with long-term health conditions. Small social networks are associated with poor quality of life. Preliminary evidence suggests that coaching patients to increase their social contacts may be effective. In this study, we assessed whether structured social coaching improves the quality of life of patients with psychosis (primary outcome) compared with an active control group, receiving information on local social activities.Methods and analysisA structured social coaching intervention was developed based on the literature and refined through stakeholder involvement. It draws on principles from motivational interviewing, solution focused therapy and structured information giving. It is provided over a 6-month period and can be delivered by a range of different mental health professionals. Its effectiveness and cost-effectiveness are assessed in a randomised controlled trial, compared with an active control group, in which participants are given an information booklet on local social activities. Participants are aged 18 or over, have a primary diagnosis of a psychotic disorder (International Classification of Disease: F20–29) and capacity to provide informed consent. Participants are assessed at baseline and at 6, 12 and 18 months after individual randomisation. The primary outcome is quality of life at 6 months (Manchester Short Assessment of Quality of Life). We hypothesise that the effects on quality of life are mediated by an increase in social contacts. Secondary outcomes are symptoms, social situation and time spent in social activities. Costs and cost-effectiveness analyses will consider service use and health-related quality of life.Ethics and disseminationNational Health Service REC London Hampstead (19/LO/0088) provided a favourable opinion. Findings will be disseminated through a website, social media, scientific papers and user-friendly reports, in collaboration with a lived experience advisory panel.Trial registration numberISRCTN15815862.
Differences in risk factors associated with single and multiple concurrent forms of undernutrition (stunting, wasting or underweight) among children under 5 in Bangladesh: a nationally representative cross-sectional study
Authors: Chowdhury Mohammad Rocky Khan , Khan Hafiz T A , Rashid Mamunur , Kabir Russell , Islam Sazin , Shariful Islam Md , Kader Manzur 
Published: December 2021

ObjectivesThe study aims to differentiate the risk factors of single and multiple concurrent forms of undernutrition among children under 5 in Bangladesh.DesignA nationally representative cross-sectional study.SettingBangladesh.RespondentsChildren age under 5 years of age.Outcome measureThis study considered two dichotomous outcomes: single form (children without single form and with single form) and multiple concurrent forms (children without multiple forms and with multiple forms) of undernutrition.Statistical analysisAdjusted OR (AOR) and CI of potential risk factors were calculated using logistic regression analysis.ResultsAround 38.2% of children under 5 in Bangladesh are suffering from undernutrition. The prevalence of multiple concurrent forms and single form of child undernutrition was 19.3% and 18.9%, respectively. The key risk factors of multiple concurrent forms of undernutrition were children born with low birth weight (AOR 3.76, 95% CI 2.78 to 5.10); children in the age group 24–35 months (AOR 2.70, 95% CI 2.20 to 3.30) and in the lowest socioeconomic quintile (AOR 2.57, 95% CI 2.05 to 3.23). In contrast, those children in the age group 24–35 months (AOR 1.94, 95% CI 1.61 to 2.34), in the lowest socioeconomic quintile (AOR 1.79, 95% CI 1.45 to 2.21) and born with low birth weight (AOR 1.52, 95% CI 1.11 to 2.08) were significantly associated with a single form of undernutrition. Parental education, father’s occupation, children’s age and birth order were the differentiating risk factors for multiple concurrent forms and single form of undernutrition.ConclusionOne-fifth of children under 5 years of age are suffering multiple concurrent forms of undernutrition, which is similar to the numbers suffering the single form. Parental education, father’s occupation, children’s age and birth order disproportionately affect the multiple concurrent forms and single form of undernutrition, which should be considered to formulate an evidence-based strategy for reducing undernutrition among these children.
Analysis ofCYP2C19genetic variants with ischaemic events in UK patients prescribed clopidogrel in primary care: a retrospective cohort study
Authors: Pilling Luke C , Türkmen Deniz , Fullalove Hannah , Atkins Janice L , Delgado Joao , Kuo Chia-Ling , Kuchel George A , Ferrucci Luigi , Bowden Jack , Masoli Jane A H , Melzer David 
Published: December 2021

ObjectiveTo determine whetherCYP2C19loss-of-function (LoF) alleles increase risk of ischaemic stroke and myocardial infarction (MI) in UK primary care patients prescribed clopidogrel.DesignRetrospective cohort analysis.SettingPrimary care practices in the UK from January 1999 to September 2017.Participants7483 European-ancestry adults from the UK Biobank study with genetic and linked primary care data, aged 36–79 years at time of first clopidogrel prescription.InterventionsClopidogrel prescription in primary care, mean duration 2.6 years (range 2 months to 18 years).Main outcome measureHospital inpatient-diagnosed ischaemic stroke, MI or angina while treated with clopidogrel.Results28.7% of participants carried at least one CYP2C19LoF variant. LoF carriers had higher rates of incident ischaemic stroke while treated with clopidogrel compared with those without the variants (8 per 1000 person-years vs 5.2 per 1000 person-years; HR 1.53, 95% CIs 1.04 to 2.26, p=0.031). LoF carriers also had increased risk of MI (HR 1.14, 95% CI 1.04 to 1.26, p=0.008). In combined analysis LoF carriers had increased risk of any ischaemic event (stroke or MI) (HR 1.17, 95% CI 1.06 to 1.29, p=0.002). Adjustment for aspirin coprescription produced similar estimates. In lifetables using observed incidence rates, 22.5% (95% CI 14.4% to 34.0%) ofCYP2C19LoF carriers on clopidogrel were projected to develop an ischaemic stroke by age 79 (oldest age in the study), compared with 15.4% (95% CI 11.4% to 20.5%) in non-carriers, that is, 7.1% excess stroke incidence in LoF carriers by age 79.ConclusionsA substantial proportion of the UK population carry genetic variants that reduce metabolism of clopidogrel to its active form. In family practice patients on clopidogrel,CYP2C19LoF variants are associated with substantially higher incidence of ischaemic events. Genotype-guided selection of antiplatelet medications may improve outcomes in patients carryingCYP2C19genetic variants.
Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda: analysis of cross-sectional, demographic and health surveys data
Authors: Arunda Malachi Ochieng , Agardh Anette , Asamoah Benedict Oppong 
Published: December 2021

ObjectivesTo examine how maternal and sociodemographic factors determine continued care-seeking behaviour from pregnancy to postnatal period in Kenya and Uganda and to determine associated neonatal survival outcomes.DesignA population-based analysis of cross-sectional data using multinomial and binary logistic regressions.SettingCountrywide, Kenya and Uganda.ParticipantsMost recent live births of 24 502 mothers within 1–59 months prior to the 2014–2016 Demographic and Health Surveys.OutcomesCare-seeking continuum and neonatal mortality.ResultsOverall, 57% of the mothers had four or more antenatal care (ANC) contacts, of which 73% and 41% had facility births and postnatal care (PNC), respectively. Maternal/paternal education versus no education was associated with continued care seeking in majority of care-seeking classes; relative risk ratios (RRRs) ranged from 2.1 to 8.0 (95% CI 1.1 to 16.3). Similarly, exposure to mass media was generally associated with continued care seekin; RRRs ranged from 1.8 to 3.2 (95% CI 1.2 to 5.4). Care-seeking tendency reduced if a husband made major maternal care-seeking decisions. Transportation problems and living in rural versus urban were largely associated with lower continued care use; RRR ranged from 0.4 to 0.7 (95% CI 0.3 to 0.9). The twolowestcare-seeking categories with no ANC and no PNC indicated the highest odds for neonatal mortality (adjusted OR 4.2, 95% CI 1.6 to 10.9). 23% neonatal deaths were attributable to inadequate maternal care attendance.ConclusionStrategies such as mobile health specifically for promoting continued maternal care use up to postnatal could be integrated in the existing structures. Another strategy would be to develop and employ a brief standard questionnaire to determine a mother’s continued care-seeking level during the first ANC visit and to use the information to close the care-seeking gaps. Strengthening the community health workers system to be an integral part of promoting continued care seeking could enhance care seeking as a stand-alone strategy or as a component of aforementioned suggested strategies.
Health-seeking behaviours in a malaria endemic district in Lao People’s Democratic Republic: a mixed methods study
Authors: Ong Ken Ing Cherng , Khattignavong Phonepadith , Keomalaphet Sengdeuane , Iwagami Moritoshi , Brey Paul , Kano Shigeyuki , Jimba Masamine 
Published: December 2021

ObjectivesThis mixed methods study was conducted to explore the barriers and facilitators for health-seeking behaviours in a malaria endemic district in Lao PDR.DesignA convergent mixed methods design.SettingTwo malaria endemic villages in Thapangthong district, Savannakhet Province, Lao PDR.ParticipantsVillagers and healthcare workers in the two villages in Thapangthong district.MethodsIn the quantitative part, a pretested questionnaire was used to identify the health-seeking behaviours of the villagers. In the qualitative part, focus group discussions were employed to explore health-seeking behaviours of the villagers and in-depth interviews were used to explore the perceptions of the healthcare workers. Descriptive statistics were computed and multiple logistic regressions were used to identify the factors associated with perceived severity and perceived susceptibility. Thematic analysis was used to analyse the qualitative data. Quantitative and qualitative results were integrated in joint displays.ResultsIn the quantitative part, data were collected from 313 villagers from both villages. For malaria, 96.0% and 98.2% of villagers from villages A and B, respectively, would first seek treatment at public health facilities. Villagers who have not experienced malaria before were more likely to perceive that the consequences of malaria were serious compared with those who have experienced malaria before (adjusted OR=1.69, 95% CI: 1.03 to 2.75). However, qualitative data showed that villagers faced problems such as lack of medicines and medical equipment. Healthcare workers also mentioned the lack of manpower and equipment in the in-depth interviews. Nevertheless, villagers still preferred to seek treatment at the health center as the National Health Insurance was introduced.ConclusionsPublic health facility usage was high but barriers existed. Effective policy and enabling environment such as the introduction of the National Health Insurance could help accelerate the progress towards the malaria elimination goal. Moreover, the benefits could go beyond the context of malaria.
Combinatorial immunotherapy induces tumor-infiltrating CD8+T cells with distinct functional, migratory, and stem-like properties
Authors: Van Braeckel-Budimir Natalija , Dolina Joseph Samuel , Wei Jie , Wang Xiao , Chen Shih-Hsun , Santiago Pamela , Tu Guanghuan , Micci Luca , Al-Khami Amir A , Pfister Sophia , Ram Sripad , Sundar Purnima , Thomas Graham , Long Hua , Yang Wenjing , Potluri Shobha , Salek-Ardakani Shahram 
Published: December 2021

BackgroundProgrammed death (ligand) 1 (PD-(L)1) blockade and OX40/4-1BB costimulation have been separately evaluated in the clinic to elicit potent antitumor T cell responses. The precise mechanisms underlying single agent activity are incompletely understood. It also remains unclear if combining individual therapies leads to synergism, elicits novel immune mechanisms, or invokes additive effects.MethodsWe performed high-dimensional flow cytometry and single-cell RNA sequencing-based immunoprofiling of murine tumor-infiltrating lymphocytes (TILs) isolated from hosts bearing B16 or MC38 syngeneic tumors. This baseline infiltrate was compared to TILs after treatment with either anti-PD-(L)1, anti-OX40, or anti-4-1BB as single agents or as double and triple combinatorial therapies. Fingolimod treatment and CXCR3 blockade were used to evaluate the contribution of intratumoral versus peripheral CD8+T cells to therapeutic efficacy.ResultsWe identified CD8+T cell subtypes with distinct functional and migratory signatures highly predictive of tumor rejection upon treatment with single agent versus combination therapies. Rather than reinvigorating terminally exhausted CD8+T cells, OX40/4-1BB agonism expanded a stem-like PD-1loKLRG-1+Ki-67+CD8+T cell subpopulation, which PD-(L)1 blockade alone did not. However, PD-(L)1 blockade synergized with OX40/4-1BB costimulation by dramatically enhancing stem-like TIL presence via a CXCR3-dependent mechanism.ConclusionsOur findings provide new mechanistic insights into the interplay between components of combinatorial immunotherapy, where agonism of select costimulatory pathways seeds a pool of stem-like CD8+T cells more responsive to immune checkpoint blockade (ICB).
Cardiometabolic risk, biological sex, and age do not share an interactive relationship with cognitive function: a cross-sectional analysis of the Canadian Longitudinal Study on Aging
Authors: Falck Ryan S. , Best John R. , Davis Jennifer C. , Barha Cindy K. , Khan Karim M. , Liu-Ambrose Teresa 
Published: December 2021

It is unclear whether cardiometabolic risk shares an interactive relationship with age-associated differences in cognition, and whether this relationship varies by biological sex. We conducted a cross-sectional analysis using baseline data from the Canadian Longitudinal Study on Aging (CLSA; 2010–2015) to examine whether 1) cardiometabolic risk has an interactive relationship with age-associated cognition; and 2) interactive effects are sex-dependent. We measured memory, executive function, and verbal fluency in the Comprehensive cohort (N = 25 830; 45–86 years). Each cognitive domain was modeled using restricted cubic splines for age and each cardiometabolic risk factor (HbA1c, HSCRP, TG, and LDL and HDL cholesterol). Sex was included as a predictor in all models. Wald χ2 statistics were used to determine the relative importance of age, cardiometabolic risk, sex, and their interactive effects on cognition. Age was the most important variable in each model (proportion χ2 = 34%–48%). Biological sex was the second most important variable for memory (proportion χ2 = 26%) but was unimportant for executive function and verbal fluency (proportion χ2 = 3%–5%). Cardiometabolic risk factors were unimportant predictors in each model (proportion χ2 = 1%–3%). Two- and 3-way interactions between cardiometabolic risk, age, and sex were also unimportant (proportion χ2 = 0%–2%). Thus, cardiometabolic risk factors did not meaningfully account for age-associated differences in cognition, and these associations (or lack thereof) did not vary by sex. Novelty: Males have poorer age-associated cognitive performance than females. Females and males differ in cardiometabolic risk across middle and older adulthood. Cardiometabolic risk has a small association with age-associated cognition, and there are no sex differences in this relationship.
Long-term effects of tillage and nitrogen fertilization on soil C and N fractions in a corn–soybean rotation
Authors: St. Luce Mervin , Ziadi Noura , Chantigny Martin H. , Braun Justin 
Published: December 2021

Tillage and nitrogen (N) fertilization can influence soil organic matter (SOM) dynamics, but their interactive effects remain contradictory. A long-term (25 yr) corn (Zea mays L.)-soybean (Glycine max L. Merr.) rotation was used to investigate the effect of tillage [moldboard plow (MP) and no-till (NT)] and N rates (0, 80, and 160 kg N·ha−1) on soil organic carbon (SOC), total N (STN), respiration, and SOM fractions [particulate organic matter (POMC, POMN), mineral-associated organic matter (MAOMC, MAOMN), and microbial biomass (MBC, MBN)]. Results indicate that NT had 27% higher SOC and 24% higher STN than MP in the 0–20 cm depth. Furthermore, SOC and STN stocks (0–20 cm) were 22% and 20% higher, respectively, under NT than MP. There was significant stratification under NT, with a rather uniform distribution under MP. The SOM fractions and soil respiration were 28%–275% and 20%–83% higher at the 0–5 and 5–10 cm depths, respectively, under NT than MP. Interestingly, N fertilizer rate or its interaction with tillage had no impact, except for respiration (tillage × N rate and N rate × depth). Hence, while N addition was required for adequate grain production and increased cumulative plant C and N inputs, our findings indicate that the vertical distribution of SOC, STN, and SOM fractions was affected by tillage, thereby influencing resource accessibility and subsequent dynamics of SOM fractions. Taken together, our results support the adoption of NT and judicious use of N fertilizers for enhancing topsoil SOM storage and fertility under humid temperate conditions.
Direct comparison of PEN and TPB wavelength shifters in a liquid argon detector
Authors: Boulay M. G. , Camillo V. , Canci N. , Choudhary S. , Consiglio L. , Flammini A. , Galbiati C. , Ghiano C. , Gola A. , Horikawa S. , Kachru P. , Kochanek I. , Kondo K. , Korga G. , Kuźniak M. , Kuźwa M. , Leonhardt A. , Łęcki T. , Mazzi A. , Moharana A. , Nieradka G. , Paternoster G. , Pollmann T. R. , Razeto A. , Sablone D. , Sworobowicz T. , Szelc A. M. , Türkoğlu C. , Wang H. 
Published: December 2021

AbstractA large number of particle detectors employ liquid argon as their target material owing to its high scintillation yield and its ability to drift ionization charge over large distances. Scintillation light from argon is peaked at 128 nm and a wavelength shifter is required for its efficient detection. In this work, we directly compare the light yield achieved in two identical liquid argon chambers, one of which is equipped with polyethylene naphthalate (PEN) and the other with tetraphenyl butadiene (TPB) wavelength shifter. Both chambers are lined with enhanced specular reflectors and instrumented with SiPMs with a coverage fraction of approximately 1%, which represents a geometry comparable to the future large scale detectors. We measured the light yield of the PEN chamber to be 39.4$$\,\pm \,$$

±

0.4(stat)$$\,\pm \,$$

±

1.9(syst)% of the yield of the TPB chamber. Using a Monte Carlo simulation this result is used to extract the wavelength shifting efficiency of PEN relative to TPB equal to 47.2$$\,\pm \,$$

±

5.7%. This result paves the way for the use of easily available PEN foils as a wavelength shifter, which can substantially simplify the construction of future liquid argon detectors.