bluuebunny/crossref_metadata_2025_split huggingface dataset:
A randomized study of a best practice alert for platelet transfusions
Authors: Murphy Colin , Mou Eric , Pang Emily , Shieh Lisa , Hom Jason , Shah Neil 
Published: June 2021

AbstractBackground and ObjectivesInappropriate platelet transfusions represent an opportunity for improvements in patient care. Use of a best practice alert (BPA) as clinical decision support (CDS) for red cell transfusions has successfully reduced unnecessary red blood cell (RBC) transfusions in prior studies. We studied the impact of a platelet transfusion BPA with visibility randomized by patient chart.Materials and MethodsA BPA was built to introduce CDS at the time of platelet ordering in the electronic health record. Alert visibility was randomized at the patient encounter level. BPA eligible platelet transfusions for patients with both visible and non‐visible alerts were recorded along with reasons given for override of the BPA. Focused interviews were performed with providers who interacted with the BPA to assess its impact on their decision making.ResultsOver a 9‐month study period, 446 patient charts were randomized. The visible alert group used 25.3% fewer BPA eligible platelets. Mean monthly usage of platelets eligible for BPA display was 65.7 for the control group and 49.1 for the visible alert group (p = 0.07). BPA‐eligible platelets used per inpatient day at risk per month were not significantly different between groups (2.4 vs. 2.1, p = 0.53).ConclusionIt is feasible to study CDS via chart‐based randomization. A platelet BPA reduced total platelets used over the study period and may have resulted in $151,069 in yearly savings, although there were no differences when adjusted for inpatient days at risk. During interviews, providers offered additional workflow insights allowing further improvement of CDS for platelet transfusions.
A story of fibers and stress: Matrix‐embedded signals for fibroblast activation in the skin
Authors: Sawant Mugdha , Hinz Boris , Schönborn Katrin , Zeinert Isabel , Eckes Beate , Krieg Thomas , Schuster Ronen 
Published: June 2021

AbstractOur skin is continuously exposed to mechanical challenge, including shear, stretch, and compression. The extracellular matrix of the dermis is perfectly suited to resist these challenges and maintain integrity of normal skin even upon large strains. Fibroblasts are the key cells that interpret mechanical and chemical cues in their environment to turnover matrix and maintain homeostasis in the skin of healthy adults. Upon tissue injury, fibroblasts and an exclusive selection of other cells become activated into myofibroblasts with the task to restore skin integrity by forming structurally imperfect but mechanically stable scar tissue. Failure of myofibroblasts to terminate their actions after successful repair or upon chronic inflammation results in dysregulated myofibroblast activities which can lead to hypertrophic scarring and/or skin fibrosis. After providing an overview on the major fibrillar matrix components in normal skin, we will interrogate the various origins of fibroblasts and myofibroblasts in the skin. We then examine the role of the matrix as signaling hub and how fibroblasts respond to mechanical matrix cues to restore order in the confusing environment of a healing wound.
An early Miocene extinction in pelagic sharks
Authors: Sibert Elizabeth C. , Rubin Leah D. 
Published: June 2021

Mysterious mass extinction
The term “shark” inspires predictable images of stealthy and streamlined marine predators that are key components of modern ecosystems. Studying shark teeth buried in deep sea sediment, Sibert and Rubin reveal that current shark diversity is a small remnant of a much larger array of forms that were decimated by a previously unidentified major ocean extinction event (see the Perspective by Pimiento and Pyenson). The extinction led to a reduction in shark diversity by more than 70% and an almost complete loss in total abundance. There is no known climatic and/or environmental driver of this extinction, and its cause remains a mystery. Modern shark forms began to diversify within 2 to 5 million years after the extinction, but they represent only a minor sliver of what sharks once were.

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The first 5 years of gravitational-wave astrophysics
Authors: Vitale Salvatore 
Published: June 2021

Doing astronomy with ripples in spacetime
General relativity predicts that moving massive objects generate gravitational waves, ripples in spacetime that propagate at the speed of light. Direct detection of gravitational waves was first announced in February of 2016. Vitale reviews the scientific results of gravitational wave astronomy over the subsequent 5 years. About 50 events have been detected, mostly the mergers of binary black holes. The mass distribution of those events is unlike previously known black holes and constrains the evolution of massive stars. A binary neutron star merger was detected in both gravitational waves and electromagnetic radiation, a form of multi-messenger astrophysics. Tests of general relativity and cosmological measurements have also been performed.

Science
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Out-of-phase Late Pleistocene glacial maxima in the Western Alps reflect past changes in North Atlantic atmospheric circulation
Authors: Gribenski Natacha , Valla Pierre G. , Preusser Frank , Roattino Thibault , Crouzet Christian , Buoncristiani Jean-François 
Published: June 2021

Abstract
Paleoglacier reconstructions in the northern and southern forelands of the European Alps indicate a synchronous Late Pleistocene glacial maximum during Marine Isotope Stage (MIS) 2, in phase with global ice volume records. However, strong controversy remains for the western foreland, where scarce and indirect dating as well as modeling studies suggest glacial maxima out of phase with the rest of the Alps. New luminescence dating brings the first direct Late Pleistocene glacial chronology for the western Alpine foreland and reveals two major glacier advances of similar maximum extent, at ca. 75–60 and ca. 40–30 ka, coinciding with MIS 4 and late MIS 3. We propose that asynchrony in glacial maxima between the western and the northern and southern Alpine forelands results from a progressive spatial reorganization of the atmospheric circulation over the North Atlantic in response to Northern Hemisphere ice-sheet fluctuations. While such a feedback mechanism has emerged from general circulation models, our Late Pleistocene paleoglacial reconstruction permits tracking of the spatiotemporal evolution of moisture advection patterns over Western Europe.
Raising the West: Mid-Cenozoic Colorado-plano related to subvolcanic batholith assembly in the Southern Rocky Mountains (USA)?
Authors: Lipman Peter W. 
Published: June 2021

Abstract
The Southern Rocky Mountains of Colorado, United States, have the highest regional elevation in North America, but present-day crustal thickness (∼42–47 km) is no greater than for the adjacent, topographically lower High Plains and Colorado Plateau. The chemistry of continental-arc rocks of the mid-Cenozoic Southern Rocky Mountain volcanic field, calibrated to compositions and Moho depths at young arcs, suggests that paleocrustal thickness may have been 20%–35% greater than at present and elevations accordingly higher. Thick mid-Cenozoic Rocky Mountain crust and high paleo-elevations, comparable to those inferred for the Nevadaplano farther west in the United States from analogous volcanic chemistry, could be consistent with otherwise-perplexing evidence for widespread rapid erosion during volcanism. Variable mid-Cenozoic crustal thickening and uplift could have resulted from composite batholith growth during volcanism, superimposed on prior crustal thickening during early Cenozoic (Laramide) compression. Alternatively, the arc–crustal thickness calibration may be inappropriate for high-potassium continental arcs, in which case other published interpretations using similar methods may also be unreliable.
Serpentinized peridotite versus thick mafic crust at the Romanche oceanic transform fault
Authors: Gregory Emma P.M. , Singh Satish C. , Marjanović Milena , Wang Zhikai 
Published: June 2021

AbstractThe crust beneath transform faults at slow-spreading ridges has been considered to be thin, comprising a thin mafic layer overlying serpentinized peridotite. Using wide-angle seismic data, we report the presence of a Moho at ∼6 km depth and a low-velocity anomaly extending down to 9 km beneath the 20-km-wide Romanche transform valley floor in the equatorial Atlantic Ocean. The low crustal velocities above the Moho could be due to either highly serpentinized mantle peridotite or fractured mafic rocks. The existence of clear Moho reflections and the occurrence of a large crustal-depth rupture during the 2016 magnitude 7.1 earthquake suggest that the crust likely consists of fractured mafic material. Furthermore, the presence of low velocities below the Moho advocates for extensive serpentinization of the mantle, indicating that the Moho reflection is unlikely to be produced by a serpentinization front. The crust to the north of the transform fault likely consists of mafic material, but that in the south appears to be more amagmatic, possibly containing serpentinized peridotite. Our results imply that the transform fault structure is complex and highly heterogeneous, and thus would have significant influence on earthquake rupture and alteration processes.
DIVE/DPV registries: benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitus
Authors: van Mark Gesine , Tittel Sascha R , Welp Reinhard , Gloyer Jörg , Sziegoleit Stefan , Barion Ralf , Jehle Peter M , Erath Dieter , Bramlage Peter , Lanzinger Stefanie 
Published: June 2021

IntroductionThe aims of this study were to characterize insulin-treated individuals aged ≥75 years with type 2 diabetes using basal insulin analogs (BIA) or regular insulins (human insulin (HI)/neutral protamine Hagedorn (NPH)) and to compare the benefits and risks.Research design and methodsThe analysis was based on data from the DPV (Diabetes-Patienten-Verlaufsdokumentation) and DIVE (DIabetes Versorgungs-Evaluation) registries. To balance for confounders, propensity score matching for age, sex, diabetes duration, body mass index and hemoglobin A1c (HbA1c) as covariates was performed.ResultsAmong 167 300 patients aged ≥75 years with type 2 diabetes (mean age, 80.3 years), 9601 subjects used insulin regimens with basal insulin (HI/NPH or BIA). Of these 8022 propensity score-matched subjects were identified. The mean diabetes duration was ~12 years and half of the patients were male. At the time of switch, patients provided with BIA experienced more dyslipidemia (89.3% vs 85.9%; p=0.002) and took a greater number of medications (4.3 vs 3.7; p<0.001) and depression was more prevalent (8.4% vs 6.5%; p=0.01). Aggregated to the most actual treatment year, BIA was associated with a higher percentage of patients using basal-supported oral therapy (42.6% vs 14.4%) and intensified conventional insulin therapy (44.3% vs 29.4%) and lower total daily insulin doses (0.24 IU/kg/day vs 0.30 IU/kg/day; p<0.001). The study did not reveal significant differences in efficacy (HbA1c 7.4% vs 7.3%; p=0.06), hospitalizations (0.7 vs 0.8 per patient-year (PY); p=0.15), length of stay (16.3 vs 16.1 days per PY; p=0.53), or rates of severe hypoglycemia (4.07 vs 4.40 per 100 PY; p=0.88), hypoglycemia with coma (3.64 vs 3.26 per 100 PY; p=0.88) and diabetic ketoacidosis (0.01 vs 0.03 per 100 PY; p=0.36).ConclusionBIA were used in more individually and patient-centered therapy regimens compared with HI/NPH in patients with a mean age of 80 years. Both groups were slightly overtreated with mean HbA1c <7.5%. The risk of severe hypoglycemia was low and independent of insulin type. Further analyses of elderly patients with type 2 diabetes are needed to provide evidence for best practice approaches in this age group.
Use of ColonFlag score for prioritisation of endoscopy in colorectal cancer
Authors: Ayling Ruth M , Wong A , Cotter Finbarr 
Published: June 2021

ObjectiveColorectal cancer (CRC) is the fourth most common cancer in UK. Symptomatic patients are referred via an urgent pathway and although most are investigated with colonoscopy <4% are diagnosed with cancer. There is therefore a need for a suitable triage tool to prioritise investigations. This study retrospectively examined performance of various triage tools in patients awaiting investigation on the urgent lower gastrointestinal cancer pathwayDesignAll patients over 40 years of age on the urgent pathway awaiting investigation for suspected CRC on 1 May were included. After 6 months, outcomes were evaluated and the performance of the faecal immunochemical test (FIT), faecal haemoglobin concentration, age and sex test (FAST) and the artificial intelligence algorithm ColonFlag were examined.Results532 completed investigations and received a diagnosis; 15 had CRC. 388 had a valid FIT result, of whom 11 had CRC; FAST Score ≥4.5 had sensitivity of 72.7%, specificity of 80.6% and would have failed to detect three tumours. Faecal haemoglobin (f-Hb) at cut-off of 10 µg/g and ColonFlag had equal sensitivity of 81.82%, ColonFlag had greater specificity 73.47%, compared with 64.99%. Both tests would have failed to detect two tumours but not in the same patients; when used in combination, sensitivity and specificity were 100% and 49.4%. When ColonFlag was applied to the cohort of 532, an additional four tumours would have been detected in patients without a valid FIT.ConclusionThis study showed ColonFlag to have equal sensitivity and greater specificity than f-Hb at a cut-off of 10 µg/g as a triage tool for CRC
Health systems factors impacting the integration of midwifery: an evidence-informed framework on strengthening midwifery associations
Authors: Mattison Cristina , Bourret Kirsty , Hebert Emmanuelle , Leshabari Sebalda , Kabeya Ambrocckha , Achiga Patrick , Robinson Jamie , Darling Elizabeth 
Published: June 2021

IntroductionMidwifery associations are organisations that represent midwives and the profession of midwifery. They support midwives to reduce maternal and newborn mortality and morbidity by promoting the overall integration of midwifery in health systems. Our objective was to generate a framework for evidence-informed midwifery association strengthening.MethodsA critical interpretive synthesis complemented by key informant interviews, focus groups, observations, and document review was used to inform the development of concepts and theory. Three electronic bibliographical databases (CINAHL, EMBASE and MEDLINE) were searched through to 2 September 2020. A coding structure was created to guide the synthesis across the five sources of evidence.ResultsA total of 1634 records were retrieved through electronic searches and 57 documents were included in the critical interpretive synthesis. Thirty-one (31) key informant interviews and five focus groups were completed including observations (255 pages) and audio recordings. Twenty-four (24) programme documents were reviewed. The resulting theoretical framework outlines the key factors by context, describes the system drivers that impact the sustainability of midwifery associations and identifies the key-enabling elements involved in designing programmes that strengthen midwifery associations.ConclusionMidwifery associations act as the web that holds the profession together and are key to the integration of the profession in health systems, supporting enabling environments and improving gender inequities. Our findings highlight that in order to strengthen midwifery (education, regulation and services), we have to lead with association strengthening. Building strong associations is the foundation necessary to create formal quality midwifery education systems and to support midwifery regulation and accreditation mechanisms.
A partisan pandemic: state government public health policies to combat COVID-19 in Brazil
Authors: Touchton Michael , Knaul Felicia Marie , Arreola-Ornelas Héctor , Porteny Thalia , Sánchez Mariano , Méndez Oscar , Faganello Marco , Edelson Vaugh , Gygi Benjamin , Hummel Calla , Otero Silvia , Insua Jorge , Undurraga Eduardo , Rosado Julio Antonio 
Published: June 2021

IntroductionTo present an analysis of the Brazilian health system and subnational (state) variation in response to the COVID-19 pandemic, based on 10 non-pharmaceutical interventions (NPIs).Materials and methodsWe collected daily information on implementation of 10 NPI designed to inform the public of health risks and promote distancing and mask use at the national level for eight countries across the Americas. We then analyse the adoption of the 10 policies across Brazil’s 27 states over time, individually and using a composite index. We draw on this index to assess the timeliness and rigour of NPI implementation across the country, from the date of the first case, 26 February 2020. We also compile Google data on population mobility by state to describe changes in mobility throughout the COVID-19 pandemic.ResultsBrazil’s national NPI response was the least stringent among countries analysed. In the absence of a unified federal response to the pandemic, Brazilian state policy implementation was neither homogenous nor synchronised. The median NPI was no stay-at-home order, a recommendation to wear masks in public space but not a requirement, a full school closure and partial restrictions on businesses, public transportation, intrastate travel, interstate travel and international travel. These restrictions were implemented 45 days after the first case in each state, on average. Rondônia implemented the earliest and most rigorous policies, with school closures, business closures, information campaigns and restrictions on movement 24 days after the first case; Mato Grosso do Sul had the fewest, least stringent restrictions on movement, business operations and no mask recommendation.ConclusionsThe study identifies wide variation in national-level NPI responses to the COVID-19 pandemic. Our focus on Brazil identifies subsequent variability in how and when states implemented NPI to contain COVID-19. States’ NPIs and their scores on the composite policy index both align with the governors’ political affiliations: opposition governors implemented earlier, more stringent sanitary measures than those supporting the Bolsonaro administration. A strong, unified national response to a pandemic is essential for keeping the population safe and disease-free, both at the outset of an outbreak and as communities begin to reopen. This national response should be aligned with state and municipal implementation of NPI, which we show is not the case in Brazil.
Comorbidities of deformational plagiocephaly in infancy: a scoping review protocol
Authors: Charalambous Lia , Hadders-Algra Mijna , N. Yamasaki Edna , Lampropoulou Sofia 
Published: June 2021

IntroductionDeformational plagiocephaly (DP) is one of the most common cranial shape disorders in infancy. It is characterised by unilateral flattening of the skull due to head preference to one side. The literature suggests that DP is associated with comorbidities such as developmental delay, but the nature and prevalence of the comorbid impairments are still unclear and controversial. Therefore, our scoping review (ScR) aims to explore systematically the extent and nature of literature by identifying, mapping and categorising the most relevant comorbidities of DP in children up to the age of 2 years.Methods and analysisThis protocol is based on the framework outlined by Arksey and O’Malley. A systematic search will be conducted to identify relevant full text studies from 1992 to 2021 using the databases of Cochrane, MEDLINE, Google Scholar, EMBASE, PubMed and University of Nicosia EBSCO. Two independent reviewers will screen abstracts and full articles in parallel, using specific inclusion and exclusion criteria. Specifically, this review will consider studies investigating DP and relevant comorbidities in children up to the age of 2 years of life without craniosynostosis, torticollis and any other diagnosed neurodevelopmental deficiency.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for ScR Checklist will be considered for results’ analysis and reporting. The results will be described in a narrative form in relation to the research question and in the context of the overall study purpose.Ethics and disseminationResearch ethics approval is not required for this ScR since data will be retrieved from publicly available studies. Dissemination activities will include research findings’ submission for publication in a relevant peer-reviewed journal and presentation of the results at relevant conferences.RegistrationOur protocol was registered prospectively with the Open Science Framework (https://osf.io/48am3/).
Heavy alcohol drinking and subclinical echocardiographic abnormalities of structure and function
Authors: Iakunchykova Olena , Schirmer Henrik , Leong Darryl , Malyutina Sofia , Ryabikov Andrew , Averina Maria , Kudryavtsev Alexander , Kornev Mikhail , Voronina Ekaterina , Paramonov Andrey , Wilsgaard Tom , Leon David 
Published: June 2021

ObjectiveThe aim of the study is to assess changes in heart structure and function associated with heavy alcohol use by comparing echocardiographic indices in a population-based sample to those in patients admitted to an inpatient facility with severe alcohol problems.Methods and resultsWe used data from the Know Your Heart study (2015–2017) which is a cross-sectional study that recruited 2479 participants aged 35–69 years from the general population of the city of Arkhangelsk in Northwest Russia and 278 patients from the Arkhangelsk Regional Psychiatric Hospital with a primary diagnosis related to chronic alcohol use (narcology clinic subsample). The drinking patterns of the population-based sample were characterised in detail. We used regression models controlling for age, sex, smoking, education and waist to hip ratio to evaluate the differences in echocardiographic indices in participants with different drinking patterns. The means of left ventricular end-diastolic diameter and indexed left atrial systolic diameter were increased among heavy drinkers (narcology clinic subsample), while mean left ventricular ejection fraction was decreased in this group compared with the population-based sample. In contrast, the harmful and hazardous drinkers in the population-based sample did not differ from non-problem drinkers with respect to echocardiographic indices of systolic and diastolic function.ConclusionsExtremely heavy drinking is associated with a specific set of structural and functional abnormalities of the heart that may be regarded as precursors of alcohol-related dilated cardiomyopathy.