bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment effects in randomised trials using routinely collected data for outcome assessment versus traditional trials: meta-research study
Authors: Mc Cord Kimberly A , Ewald Hannah , Agarwal Arnav , Glinz Dominik , Aghlmandi Soheila , Ioannidis John P A , Hemkens Lars G 
Published: March 2021

Abstract

Objective
To compare effect estimates of randomised clinical trials that use routinely collected data (RCD-RCT) for outcome ascertainment with traditional trials not using routinely collected data.

Design
Meta-research study.

Data source
Studies included in the same meta-analysis in a Cochrane review.

Eligibility criteria for study selection
Randomised clinical trials using any type of routinely collected data for outcome ascertainment, including from registries, electronic health records, and administrative databases, that were included in a meta-analysis of a Cochrane review on any clinical question and any health outcome together with traditional trials not using routinely collected data for outcome measurement.

Review methods
Effect estimates from trials using or not using routinely collected data were summarised in random effects meta-analyses. Agreement of (summary) treatment effect estimates from trials using routinely collected data and those not using such data was expressed as the ratio of odds ratios. Subgroup analyses explored effects in trials based on different types of routinely collected data. Two investigators independently assessed the quality of each data source.

Results

84 RCD-RCTs and 463 traditional trials on 22 clinical questions were included. Trials using routinely collected data for outcome ascertainment showed 20% less favourable treatment effect estimates than traditional trials (ratio of odds ratios 0.80, 95% confidence interval 0.70 to 0.91, I
2
=14%). Results were similar across various types of outcomes (mortality outcomes: 0.92, 0.74 to 1.15, I
2
=12%; non-mortality outcomes: 0.71, 0.60 to 0.84, I
2
=8%), data sources (electronic health records: 0.81, 0.59 to 1.11, I
2
=28%; registries: 0.86, 0.75 to 0.99, I
2
=20%; administrative data: 0.84, 0.72 to 0.99, I
2
=0%), and data quality (high data quality: 0.82, 0.72 to 0.93, I
2
=0%).

Conclusions
Randomised clinical trials using routinely collected data for outcome ascertainment show smaller treatment benefits than traditional trials not using routinely collected data. These differences could have implications for healthcare decision making and the application of real world evidence.
Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya
Authors: Kumar Meghan Bruce , Madan Jason J , Auguste Peter , Taegtmeyer Miriam , Otiso Lilian , Ochieng Christian B , Muturi Nelly , Mgamb Elizabeth , Barasa Edwine 
Published: March 2021

IntroductionImprovements in maternal and infant health outcomes are policy priorities in Kenya. Achieving these outcomes depends on early identification of pregnancy and quality of primary healthcare. Quality improvement interventions have been shown to contribute to increases in identification, referral and follow-up of pregnant women by community health workers. In this study, we evaluate the cost-effectiveness of using quality improvement at community level to reduce maternal and infant mortality in Kenya.MethodsWe estimated the cost-effectiveness of quality improvement compared with standard of care treatment for antenatal and delivering mothers using a decision tree model and taking a health system perspective. We used both process (antenatal initiation in first trimester and skilled delivery) and health outcomes (maternal and infant deaths averted, as well as disability-adjusted life years (DALYs)) as our effectiveness measures and actual implementation costs, discounting costs only. We conducted deterministic and probabilistic sensitivity analyses.ResultsWe found that the community quality improvement intervention was more cost-effective compared with standard community healthcare, with incremental cost per DALY averted of $249 under the deterministic analysis and 76% likelihood of cost-effectiveness under the probabilistic sensitivity analysis using a standard threshold. The deterministic estimate of incremental cost per additional skilled delivery was US$10, per additional early antenatal care presentation US$155, per maternal death averted US$5654 and per infant death averted US$37 536 (2017 dollars).ConclusionsThis analysis shows that the community quality improvement intervention was cost-effective compared with the standard community healthcare in Kenya due to improvements in antenatal care uptake and skilled delivery. It is likely that quality improvement interventions are a good investment and may also yield benefits in other health areas.
Early life antibiotics and childhood gastrointestinal disorders: a systematic review
Authors: Kamphorst Kim , Van Daele Emmy , Vlieger Arine M , Daams Joost G , Knol Jan , van Elburg Ruurd M 
Published: March 2021

BackgroundIn adults, there is increasing evidence for an association between antibiotic use and gastrointestinal (GI) disorders but in children, the evidence is scarce.ObjectiveAssess the association between exposure to antibiotics in the first 2 years of life in term born children and the presence of chronic GI disorders later in childhood.DesignFor this systematic review the MEDLINE, Embase, WHO trial register and Web of Science were systematically searched from inception to 8 June 2020. Title and abstract screening (n=12 219), full-text screening (n=132) as well as the quality assessment with the Newcastle-Ottawa Scale were independently performed by two researchers.Main outcome measuresThe association between antibiotics and inflammatory bowel disease (IBD) (n=6), eosinophilic oesophagitis (EoE) (n=5), coeliac disease (CeD) (n=6), infantile colics (n=3), functional constipation (n=2), recurrent abdominal pain, regurgitation, functional diarrhoea and infant dyschezia were examined.ResultsTwenty-two studies were included, 11 cohort and 11 case–control studies. A best evidence synthesis showed strong evidence for an association between antibiotic exposure in the first 2 years of life and the presence of IBD, and CeD during childhood. Moderate evidence was found for an association with EoE and no association with functional constipation in the first year of life. There was insufficient evidence for the other studied disorders.ConclusionsThe use of antibiotics in early life may increase the risk of GI disorders later in life. Further studies are necessary to unravel the underlying mechanisms and determine potential preventive measures. Meanwhile judicious use of antibiotics in early childhood is highly warranted.PROSPERO registration numberPROSPERO CRD42019132631.
Paramedic occupational violence mitigation: a comprehensive systematic review of emergency service worker prevention strategies and experiences for use in prehospital care
Authors: Drew Peter , Tippett Vivienne , Devenish Scott 
Published: March 2021

Occupational violence is a significant issue within the context of prehospital healthcare with the majority of paramedics reporting some form of abuse, intimidation, physical or sexual assault during their career. Though the paramedic literature acknowledges the severity of this issue, there is limited literature examining occupational violence mitigation strategies. Despite this, the operational and environmental similarities that exist between paramedics and other emergency service workers such as the police and firefighters, provide an opportunity to review relatable occupational violence mitigation strategies and experiences.This review used Joanna Briggs Institute guidance for systematic reviews of both qualitative evidence and effectiveness. Studies included in this review incorporated those published in English from 1990 to January 2020.Two qualitative studies met the criteria for review. From these, a total of 22 findings were extracted and combined to form four categories from which two syntheses were developed. Twenty-four quantitative studies, encompassing six unique fields, met the criteria for review.Mitigation strategies for emergency service worker occupational violence are not easily defined. They are dynamic, multilayered and encompass a variety of complex social, medical and psychological influences. In spite of this, there are clear benefits to their application in regard to the approaches and training of violence mitigation. The paramedic environment would benefit from strategies that are flexible to the ongoing needs of the workers and the specific cultural, environmental and social factors that encompass the paramedic organisation.
Diffractive deeply inelastic scattering in future electron-ion colliders
Authors: Bendova D. , Cepila J. , Contreras J. G. , Gonçalves V. P. , Matas M. 
Published: March 2021

AbstractThe impact of nonlinear effects in the diffractive observables that will be measured in future electron-ion collisions is investigated. We present, for the first time, the predictions for the diffractive structure function and reduced cross sections derived using the solution to the Balitsky–Kovchegov equation with the collinearly-improved kernel and including the impact-parameter dependence. We demonstrate that the contribution of the diffractive events is enhanced in nuclear collisions and that the study of the ratio between the nuclear and proton predictions will be useful to discriminate among different models of the dipole-target scattering amplitude and, consequently, will allow us to constrain the description of QCD dynamics in parton densities.
Giant Abdominal Lipoma in Adult
Authors: Cinar Ozcan Nihal , Edizsoy Akay , Colak Tahsin 
Published: March 2021

Lipomas arising from the omentum are extremely rare in adults. Omental lipomas are typically asymptomatic, but very large ones may cause nonspecific abdominal symptoms and discomfort. Rarely they can cause omental torsion and present with an acute abdomen. We report a 41-year-old female patient with a giant lipoma (

40
×
26
×
8

cm

and 11,520 g) who presented with mild abdominal discomfort. Workup included abdominal ultrasound (USG) and magnetic resonance imaging (MRI). Surgical resection was performed without complication. No recurrence was observed during 4-year follow-up.
Microbiome Analysis of More Than 2,000 NHS Bowel Cancer Screening Programme Samples Shows the Potential to Improve Screening Accuracy
Authors: Young Caroline , Wood Henry M. , Fuentes Balaguer Alba , Bottomley Daniel , Gallop Niall , Wilkinson Lyndsay , Benton Sally C. , Brealey Martin , John Cerin , Burtonwood Carole , Thompson Kelsey N. , Yan Yan , Barrett Jennifer H. , Morris Eva J.A. , Huttenhower Curtis , Quirke Philip 
Published: March 2021

Abstract

Purpose:
There is potential for fecal microbiome profiling to improve colorectal cancer screening. This has been demonstrated by research studies, but it has not been quantified at scale using samples collected and processed routinely by a national screening program.

Experimental Design:
Between 2016 and 2019, the largest of the NHS Bowel Cancer Screening Programme hubs prospectively collected processed guaiac fecal occult blood test (gFOBT) samples with subsequent colonoscopy outcomes: blood-negative [n = 491 (22%)]; colorectal cancer [n = 430 (19%)]; adenoma [n = 665 (30%)]; colonoscopy-normal [n = 300 (13%)]; nonneoplastic [n = 366 (16%)]. Samples were transported and stored at room temperature. DNA underwent 16S rRNA gene V4 amplicon sequencing. Taxonomic profiling was performed to provide features for classification via random forests (RF).

Results:
Samples provided 16S amplicon-based microbial profiles, which confirmed previously described colorectal cancer–microbiome associations. Microbiome-based RF models showed potential as a first-tier screen, distinguishing colorectal cancer or neoplasm (colorectal cancer or adenoma) from blood-negative with AUC 0.86 (0.82–0.89) and AUC 0.78 (0.74–0.82), respectively. Microbiome-based models also showed potential as a second-tier screen, distinguishing from among gFOBT blood-positive samples, colorectal cancer or neoplasm from colonoscopy-normal with AUC 0.79 (0.74–0.83) and AUC 0.73 (0.68–0.77), respectively. Models remained robust when restricted to 15 taxa, and performed similarly during external validation with metagenomic datasets.

Conclusions:
Microbiome features can be assessed using gFOBT samples collected and processed routinely by a national colorectal cancer screening program to improve accuracy as a first- or second-tier screen. The models required as few as 15 taxa, raising the potential of an inexpensive qPCR test. This could reduce the number of colonoscopies in countries that use fecal occult blood test screening.
Toward More Complete Prognostication for Patients with Clonal Hematopoiesis
Authors: Spitzer Barbara , Levine Ross L. 
Published: March 2021

Abstract

Summary:
The study of clonal hematopoiesis is rapidly evolving, with the highest prevalence in aging populations and wide-ranging implications for health and disease, including an increased risk of subsequent myeloid malignancies and cardiovascular disease. In their article, Feusier and colleagues report on an expanded driver mutation list for capture of higher-risk clonal hematopoiesis mutations implicated in leukemia transformation. They also describe the prevalence of clonal hematopoiesis in several additional large studies, including, most importantly, in the pediatric context, which has not yet been extensively studied with respect to clonal hematopoiesis and clonal hematopoiesis–related sequelae.
See related article by Feusier et al., p. 226.
Kynurenine Relaxes Arteries of Normotensive Women and Those With Preeclampsia
Authors: Worton Stephanie A. , Pritchard Harry A.T. , Greenwood Susan L. , Alakrawi Mariam , Heazell Alexander E.P. , Wareing Mark , Greenstein Adam , Myers Jenny E. 
Published: March 2021

Rationale:
Activation of the kynurenine pathway of tryptophan catabolism by infection and inflammation contributes to the development of systemic hypotension. Commercially-available kynurenine has direct vasorelaxant effects on arteries from several species and reduces systemic blood pressure when administered to normotensive or hypertensive rats.

Objectives:
To determine whether kynurenine promotes relaxation of human resistance arteries from normotensive and hypertensive pregnant women and to identify the vascular mechanism of its effects.

Methods and Results:

In isolated omental and myometrial resistance arteries from normotensive pregnant women, kynurenine (1 mmol/L) significantly reduced U46619-induced constriction (omentum N=14,
P
=2.4×10
−3
; myometrium N=21–25,
P
=2.6×10
−4
) and relaxed preconstricted arteries (N=53,
P
=1.0×10
−11
; N=20,
P
=8.8×10
−3
). Vasorelaxation persisted following endothelium removal (N=7,
P
=1.6×10
−4
) but was completely prevented by inhibition of large-conductance Ca
2+
-activated K
+
channels (BK
Ca
) channels with iberiotoxin (N=9,
P
=5.7×10
−4
) or paxilline (N=10,
P
=2.1×10
−17
). Accordingly, in isolated vascular smooth muscle cells from omental arteries, kynurenine increased the BK
Ca
current (n=5–8,
P
=0.022) and the amplitude of spontaneous transient outward currents (n=6,
P
=0.031) but did not affect spontaneous transient outward current frequency. Kynurenine also increased Ca
2+
spark frequency of pressurized omental arteries (n=8,
P
=0.031). Vasorelaxant effects of kynurenine persisted following inhibition of ryanodine receptors (N=7,
P
=0.48) but were moderately reduced by inhibition of adenylate cyclase (N=9,
P
=0.024). In arteries from women with preeclampsia, kynurenine similarly attenuated vasoconstriction (N=15,
P
=1.3×10
−5
) and induced BK
Ca
-mediated vasodilation (N=16,
P
=2.0×10
−4
). Vasorelaxation in response to kynurenine and a specific BK
Ca
activator, NS11021, was absent in fetal-derived placental resistance arteries in normal pregnancy and preeclampsia.

Conclusions:

Kynurenine dilates systemic arteries from multiple territories via BK
Ca
activation. Notably, the vasorelaxatory capacity of kynurenine is preserved in preeclampsia, suggesting this approach may have translational potential for the treatment of hypertension in pregnancy. The data warrant further investigation of the potential to exploit this endogenous vasorelaxant as a new treatment for hypertensive pathologies.
The Left Angular Gyrus Is Causally Involved in Context-dependent Integration and Associative Encoding during Narrative Reading
Authors: Branzi Francesca M. , Pobric Gorana , Jung JeYoung , Lambon Ralph Matthew A. 
Published: March 2021

AbstractThe role of the left angular gyrus (AG) in language processing remains unclear. In this study, we used TMS to test the hypothesis that the left AG causally supports the processes necessary for context-dependent integration and encoding of information during language processing. We applied on-line TMS over the left AG to disrupt the on-line context-dependent integration during a language reading task, specifically while human participants integrated information between two sequentially presented paragraphs of text (“context” and “target” paragraphs). We assessed the effect of TMS on the left AG by asking participants to retrieve integrated contextual information when given the target condition as cue in a successive memory task. Results from the memory task showed that TMS applied over the left AG during reading impaired the formation of integrated context-target representation. These results provide the first evidence of a causal link between the left AG function, on-line information integration, and associative encoding during language processing.
Dopamine Precursor Depletion in Healthy Volunteers Impairs Processing of Duration but Not Temporal Order
Authors: Chassignolle Morgane , Jovanovic Ljubica , Schmidt-Mutter Catherine , Behr Guillaume , Giersch Anne , Coull Jennifer T. 
Published: March 2021

AbstractStudies in animals and humans have implicated the neurotransmitter dopamine in duration processing. However, very few studies have examined dopamine's involvement in other forms of temporal processing such as temporal order judgments. In a randomized within-subject placebo-controlled design, we used acute phenylalanine/tyrosine depletion (APTD) to reduce availability of the dopamine precursors tyrosine and phenylalanine in healthy human volunteers. As compared to a nutritionally balanced drink, APTD significantly impaired the ability to accurately reproduce interval duration in a temporal reproduction task. In addition, and confirming previous findings, the direction of error differed as a function of individual differences in underlying dopamine function. Specifically, APTD caused participants with low baseline dopamine precursor availability to overestimate the elapse of time, whereas those with high dopamine availability underestimated time. In contrast to these effects on duration processing, there were no significant effects of APTD on the accuracy of discriminating the temporal order of visual stimuli. This pattern of results does not simply represent an effect of APTD on motor, rather than perceptual, measures of timing because APTD had no effect on participants' ability to use temporal cues to speed RT. Our results demonstrate, for the first time in healthy volunteers, a dopaminergic dissociation in judging metrical (duration) versus ordinal (temporal order) aspects of time.
Jung’s and Groddeck’s Analytic Practice
Authors: Balenci Marco 
Published: March 2021

Abstract
This paper shows that Georg Groddeck and Carl Gustav Jung shared a common cultural background, in which Carl Gustav Carus’s theory of the psyche was preeminent. Accordingly, they emphasized symbolization and unconscious creativity. These aspects affected their clinical work, aimed at pioneering therapies: Jung with schizophrenics, Groddeck treating physical diseases. They overcame the limits of the psychoanalysis of their time and, going beyond neurosis, discovered the pre-Oedipal period and the fundamental role of mother-child relationship. While Freud’s technique was based on a one-person paradigm, both Jung and Groddeck considered analytic therapy as a dialectical process, ushering in a two-person paradigm. Therefore, they did not use the couch; a setting that is assessed in the light of recent research on mirror neurons. It is also highlighted that the analytic groups influenced by Groddeck and Jung have developed similar ideas in both theory and technique; a fact that may induce further studies on the history of depth psychology.
Sedative effects of alfaxalone and hydromorphone with or without midazolam in cats: a pilot study
Authors: Wheeler Emily P , Abelson Amanda L , Lindsey Jane C , Wetmore Lois A 
Published: March 2021

Objectives The aim of this pilot study was to compare the quality of sedation and ease of intravenous (IV) catheter placement following sedation using two intramuscular (IM) sedation protocols in cats: hydromorphone, alfaxalone and midazolam vs hydromorphone and alfaxalone. Methods This was a prospective, randomized and blinded study. Cats were randomly assigned to receive an IM injection of hydromorphone (0.1 mg/kg), alfaxalone (1.5 mg/kg) and midazolam (0.2 mg/kg; HAM group), or hydromorphone (0.1 mg/kg) and alfaxalone (1.5 mg/kg; HA group). Sedation scoring (0–9, where 9 indicated maximum sedation) was performed at 0, 5, 10, 15 and 20 mins from the time of injection. At 20 mins, an IV catheter placement score (0–10, where 10 indicated least resistance) was performed. Results Twenty-one client-owned adult cats were included in this study. Sedation and IV catheter placement scores were compared between groups using Wilcoxon rank sum tests. Peak sedation was significantly higher ( P = 0.002) in the HAM group (median 9; range 7–9) than in the HA group (median 7; range 3–9), and IV catheter placement scores were significantly higher ( P = 0.001) in the HAM group (median 9.5; range 7–10) compared with the HA group (median 7; range 4–9). Spearman correlations were calculated between IV catheter placement score and sedation scores. There was a significant positive correlation of average sedation over time (correlation 0.83; P <0.001) and sedation at 20 mins (correlation 0.76; P <0.001) with a higher, more favorable IV catheter placement score. Conclusions and relevance These preliminary results suggest that the addition of midazolam to IM alfaxalone and hydromorphone produced more profound sedation and greater ease of IV catheter placement than IM alfaxalone and hydromorphone alone.