bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic letters: A qualitative study exploring their influence on the hope of parents of children receiving pediatric palliative care in Portugal
Authors: Fonseca Ricardo , Carvalho Matilde , Querido Ana , Figueiredo Maria H. , Bally Jill , Charepe Zaida 
Published: January 2021

AbstractPurposeThe purpose of this qualitative descriptive study was to explore the hope experiences of parents of children diagnosed with complex chronic conditions (CCCs) who received therapeutic letters.Design and MethodsA purposive sample of 10 parents of inpatient children with CCCs was recruited from a pediatric palliative care unit in a Portuguese public hospital. A demographic form and audio‐recorded semi‐structured, face‐to‐face interviews were conducted with each participant to explore the experiences, processes, and meanings of hope, and to describe how parents of children receiving pediatric palliative care perceived the usefulness of receiving therapeutic letters. The interviews were transcribed verbatim, and using a thematic analysis, a systematic approach to data analysis was completed.FindingsData analysis resulted in three main themes including Trust in the Future; Strengthening Hope; and Moments of Hope. Findings highlight the positive influence of therapeutic letters including supporting parental hope, facilitating personal inner‐strengthening, recognition of parental skills, and promotion of self‐efficacy during hospitalization. The themes and related subthemes add value to the existing literature and highlight the need for supportive palliative nursing care aimed at promoting parental hope.Practice ImplicationsTo optimize the value of supporting parental hope, therapeutic letters can be delivered at the time of diagnosis, during times of celebration, and when learning the difficult tasks of daily childcare. Additional research can inform the development of a formal hope‐based intervention to provide an evidence base from which to enhance the well‐being of parental caregivers of children who have CCCs.
Anchor Regression: Heterogeneous Data Meet Causality
Authors: Rothenhäusler Dominik , Meinshausen Nicolai , Bühlmann Peter , Peters Jonas 
Published: January 2021

AbstractWe consider the problem of predicting a response variable from a set of covariates on a data set that differs in distribution from the training data. Causal parameters are optimal in terms of predictive accuracy if in the new distribution either many variables are affected by interventions or only some variables are affected, but the perturbations are strong. If the training and test distributions differ by a shift, causal parameters might be too conservative to perform well on the above task. This motivates anchor regression, a method that makes use of exogenous variables to solve a relaxation of the ‘causal’ minimax problem by considering a modification of the least-squares loss. The procedure naturally provides an interpolation between the solutions of ordinary least squares (OLS) and two-stage least squares. We prove that the estimator satisfies predictive guarantees in terms of distributional robustness against shifts in a linear class; these guarantees are valid even if the instrumental variable assumptions are violated. If anchor regression and least squares provide the same answer (‘anchor stability’), we establish that OLS parameters are invariant under certain distributional changes. Anchor regression is shown empirically to improve replicability and protect against distributional shifts.
Individual vs. World in Schopenhauer's Pessimism
Authors: Hassan Patrick 
Published: January 2021

AbstractThis article aims to elucidate and explore the significance of a distinction in Schopenhauer's pessimism which has not yet received detailed attention in the secondary literature. Schopenhauer is well known to have argued for the thesis that the fundamental feature of sentient life is pervasive suffering, and on these grounds held that individual lives are not worth living. However, he similarly claims with frequency that the nonexistence of the world “as a whole” is preferable to its existence. This is a distinct thesis, and it is unclear how Schopenhauer thinks it relates to the first. This investigation seeks to rectify this, arguing that the ambiguous concept of the world “as a whole” has at least two interpretations in Schopenhauer's texts. Moreover, that this “world‐pessimism”—once properly understood—may avoid certain objections that pessimism at the level of the individual is vulnerable to.
The risk to future pregnancies of transfusing Rh(D)‐negative females of childbearing potential with Rh(D)‐positive red blood cells during trauma resuscitation is dependent on their age at transfusion
Authors: Seheult Jansen N. , Stram Michelle N. , Pearce Thomas , Bub Carolina B. , Emery Stephen P. , Kutner Jose , Watanabe‐Okochi Naoko , Sperry Jason L. , Takanashi Minoko , Triulzi Darrell J. , Yazer Mark H. 
Published: January 2021

BackgroundA risk assessment model for predicting the risk of haemolytic disease of the fetus and newborn (HDFN) in future pregnancies following the transfusion of Rh(D)‐positive red blood cell (RBC)‐containing products to females of childbearing potential (FCP) was developed, accounting for the age that the FCP is transfused in various countries.MethodsThe HDFN risk prediction model included the following inputs: risk of FCP death in trauma, Rh(D) alloimmunization rate following Rh(D)‐positive RBC transfusion, expected number of live births following resuscitation, probability of carrying an Rh(D)‐positive fetus, the probability of HDFN in an Rh(D)‐positive fetus carried by an alloimmunized mother. The model was implemented in Microsoft R Open, and one million FCPs of each age between 18 and 49 years old were simulated. Published data from eight countries, including the United States, were utilized to generate country‐specific HDFN risk estimates.ResultsThe risk predictions showed similar characteristics for each country in that the overall risk of having a pregnancy affected by HDFN was higher if the FCP was younger when she received her Rh(D)‐positive transfusion than if she was older. In the United States, the overall risk of HDFN if the FCP was transfused at age 18 was 3·4% (mild: 1·20%, moderate: 0·45%; severe: 1·15%; IUFD: 0·57%); the risk was approximately 0% if the FCP was 43 years or older at the time of transfusion.ConclusionThis model can be used to predict HDFN outcomes when establishing transfusion policies as it relates to the administration of Rh(D)‐positive products for massively bleeding FCPs.
Calcium sulfate antibiotic‐impregnated bead implantation for deep surgical site infection associated with orthopedic surgery in small animals
Authors: Peterson Lindsay C. , Kim Stanley E. , Lewis Daniel D. , Johnson Matthew D. , Ferrigno Cassio R. A. 
Published: January 2021

AbstractObjectiveTo report the outcomes and complications associated with antibiotic‐impregnated calcium sulfate beads for prevention and treatment of orthopedic‐related surgical site infection (SSI) in companion animals.Study designRetrospective case series.AnimalsClient‐owned cats (n = 2) and dogs (n = 14).MethodsMedical records of 16 cases in which implantation of antibiotic‐impregnated calcium sulfate beads was performed for the prevention or treatment of SSI were reviewed. Information collected included signalment, prior surgery, reason for bead placement, antibiotics used, bacterial culture results, and clinical outcomes.ResultsSurgical site infection resolved in six of 10 animals treated therapeutically and did not occur in six of six animals treated prophylactically. Susceptibility of the causative bacteria to the antibiotic implanted was confirmed in five of six cases with resolved SSI treated therapeutically but in only one of four cases with unresolved SSI treated therapeutically. Complications directly related to bead placement were evident in only one case in which beads extruded from external skeletal fixator pin tracts 7 days after implantation. At final follow‐up, 11 of 12 animals without SSI had satisfactory limb use and no clinical, cytologic, or radiographic evidence of infection.ConclusionImplantation was well tolerated. Resolution of SSI was inconsistent; however, when bacteria were susceptible to the antibiotic implanted, SSI resolved in all but one case.Clinical significanceAntibiotic‐impregnated calcium sulfate beads could be considered for prevention or treatment of orthopedic SSI in small animals. A prospective clinical study is required to obtain additional information, including the value of preoperative bacterial culture.
The use of near infrared fluorescence imaging with indocyanine green for vascular visualization in caudal auricular flaps in two cats
Authors: Quinlan Adam S. F. , Wainberg Shannon H. , Phillips Erin , Oblak Michelle L. 
Published: January 2021

AbstractObjectivesTo describe the use of near infrared fluorescence (NIRF) imaging with indocyanine green (ICG) for vascular visualization in two caudal auricular axial pattern flaps (APF).AnimalsTwo client‐owned cats with upper eyelid masses.Study designClinical case report.MethodsWide surgical excision with enucleation was performed by using a caudal auricular APF for closure. Flap margins and perforating artery location were approximated with anatomical landmarks. The caudal auricular artery origin was then visualized percutaneously by using an exoscope with NIRF camera and light source after a single 2.5‐mg dose of IV ICG. Margins were adjusted as required. The flaps were routinely elevated with continued intraoperative visualization of the artery and rotated to complete closure.ResultsAfter IV ICG administration, fluorescence was initially visualized after 15 to 18 seconds and remained visible for up to 26 minutes. The achieved visualization led to flap margin adjustments in cat 1. Both cats recovered with minimal flap congestion, excellent hair regrowth, and no long‐term complications (>186 days). Cat 1 experienced 100% flap survival. Cat 2 experienced 10% partial thickness flap necrosis, but revision was not required, and the flap was healed at recheck 85 days postoperatively.ConclusionThe use of ICG for APF vessel visualization prior to and during flap elevation resulted in transcutaneous visualization of the perforating vessel and improved awareness of vessel location intraoperatively. These two cats experienced excellent flap survival without major complications. This report highlights the potential benefits of ICG NIRF in APF for animals undergoing reconstructive surgery.
Divergence of neuroimmune circuits activated by afferent and efferent vagal nerve stimulation in the regulation of inflammation
Authors: Murray Kaitlin , Rude Kavi M. , Sladek Jessica , Reardon Colin 
Published: January 2021

Key points
It has previously been shown that afferent and efferent vagal nerve stimulation potently inhibits lipopolysaccharide (LPS)‐induced inflammation
Our data show inhibition of inflammation by efferent but not afferent vagal nerve stimulation requires T‐cell derived acetylcholine
We show that afferent and efferent neuroimmune circuits require β2‐adrenergic receptor signalling
AbstractChronic inflammation due to inappropriate immune cell activation can have significant effects on a variety of organ systems, reducing lifespan and quality of life. As such, highly targeted control of immune cell activation is a major therapeutic goal. Vagus nerve stimulation (VNS) has emerged as a therapeutic modality that exploits neuroimmune communication to reduce immune cell activation and consequently inflammation. Although vagal efferent fibres were originally identified as the primary driver of anti‐inflammatory actions, the vagus nerve in most species of animals predominantly comprises afferent fibres. Stimulation of vagal afferent fibres can also reduce inflammation; it is, however, uncertain how these two neuroimmune circuits diverge. Here we show that afferent VNS induces a mechanism distinct from efferent VNS, ameliorating lipopolysaccharide (LPS)‐induced inflammation independently of T‐cell derived acetylcholine (ACh) which is required by efferent VNS. Using a β2‐adrenergic receptor antagonist (β2‐AR), we find that immune regulation induced by intact, afferent, or efferent VNS occurs in a β2‐AR‐dependent manner. Together, our findings indicate that intact VNS activates at least two distinct neuroimmune circuits each with unique mechanisms of action. Selective targeting of either the vagal efferent or afferent fibres may provide more personalized, robust and effective control over inappropriate immune responses.
Risk of dementia in adults with cerebral palsy: a matched cohort study using general practice data
Authors: Smith Kimberley J , Peterson Mark D , Victor Christina , Ryan Jennifer M 
Published: January 2021

ObjectivesDetermine the risk of incident dementia in adults with cerebral palsy (CP) compared with age, sex and general practice (GP) matched controls.DesignRetrospective cohort study.SettingUK GPs linked into the Clinical Practice Research Datalink (CPRD).ParticipantsCPRD data were used to identify adults aged 18 or older with a diagnosis of CP. Each adult with CP was matched to three controls who were matched for age, sex and GP. In total, 1703 adults with CP and 5109 matched controls were included in the analysis. The mean baseline age of participants was 33.30 years (SD: 15.48 years) and 46.8% of the sample were female.Primary outcomeNew diagnosis of dementia during the follow-up period (earliest date of 1987 to latest date of 2015).ResultsDuring the follow-up, 72 people were identified with a new diagnosis of dementia. The overall proportion of people with and without CP who developed dementia was similar (CP: n=19, 1.1%; matched controls n=54, 10.0%). The unadjusted HR suggested that people with CP had an increased hazard of being diagnosed with dementia when compared with matched controls (HR 2.69, 95% CI 1.44 to 5.00). This association was attenuated when CP comorbidities (sensory impairment, intellectual disability and epilepsy) were accounted for (HR 1.92, 95% CI 0.92 to 4.02).ConclusionsThere was no difference in the proportion of people with CP and matched controls who were diagnosed with dementia during the follow-up. Furthermore, while there was evidence for an increased hazard of dementia among people with CP, the fact that this association was attenuated after controlling for comorbidities indicates that this association may be explained by comorbidities rather than being a direct result of CP. Findings should be interpreted with caution due to the low number of incident cases of dementia.
Are there opportunities to improve care as patients transition through the cancer care continuum? A scoping review protocol
Authors: Sauro Khara , Maini Arjun , Machan Matthew , Lorenzetti Diane , Chandarana Shamir , Dort Joseph 
Published: January 2021

IntroductionTransitions in Care (TiC) are vulnerable periods in care delivery associated with adverse events, increased cost and decreased patient satisfaction. Patients with cancer encounter many transitions during their care journey due to improved survival rates and the complexity of treatment. Collectively, improving TiC is particularly important among patients with cancer. The objective of this scoping review is to synthesise and map the existing literature regarding TiC among patients with cancer in order to explore opportunities to improve TiC among patients with cancer.Methods and analysisThis scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review Extension and the Joanna Briggs Institute methodology. The PubMed cancer filter and underlying search strategy will be tailored to each database (Embase, Cochrane, CINAHL and PsycINFO) and combined with search terms for TiC. Grey literature and references of included studies will be searched. The search will include studies published from database inception until 9 February 2020. Quantitative and qualitative studies will be included if they describe transitions between any type of healthcare provider or institution among patients with cancer. Descriptive statistics will summarise study characteristics and quantitative data of included studies. Qualitative data will be synthesised using thematic analysis.Ethics and disseminationOur objective is to synthesise and map the existing evidence; therefore, ethical approval is not required. Evidence gaps around TiC will inform a programme of research aimed to improve high-risk transitions among patients with cancer. The findings of this scoping review will be published in a peer-reviewed journal and widely presented at academic conferences. More importantly, decision makers and patients will be provided a summary of the findings, along with data from a companion study, to prioritise TiC in need of interventions to improve continuity of care for patients with cancer.
Recruiting in intervention studies: challenges and solutions
Authors: Axén Iben , Björk Brämberg Elisabeth , Galaasen Bakken Anders , Kwak Lydia 
Published: January 2021

IntroductionIn order for study results to be relevant for practice, the study participants should represent the source population. A common problem is recruitment of sufficient and representative subjects, threatening the external validity of the study and, ultimately, evidence-based practice. The aim was to highlight common challenges and to present possible solutions to recruitment.MethodsUsing four recent randomised controlled trials as examples, common recruitment challenges were highlighted and solutions were proposed. The four studies represented some common and some specific challenges, but they investigated interventions for the prevention of the two major public health challenges of today: musculoskeletal pain and common mental disorders.ResultsIdentified challenges and suggested solutions were presented as a checklist to be used for future trials in order to aid recruitment and reporting thereof.
Prediction of disease severity in young children presenting with acute febrile illness in resource-limited settings: a protocol for a prospective observational study
Authors: Chandna Arjun , Aderie Endashaw M , Ahmad Riris , Arguni Eggi , Ashley Elizabeth A , Cope Tanya , Dat Vu Quoc , Day Nicholas P J , Dondorp Arjen M , Illanes Victor , De Jesus Joanne , Jimenez Carolina , Kain Kevin , Suy Keang , Koshiaris Constantinos , Lasry Estrella , Mayxay Mayfong , Mondal Dinesh , Perera Rafael , Pongvongsa Tiengkham , Rattanavong Sayaphet , Rekart Michael , Richard-Greenblatt Melissa , Shomik Mohammad , Souvannasing Phouthalavanh , Tallo Veronica , Turner Claudia , Turner Paul , Waithira Naomi , Watson James A , Yosia Mikhael , Burza Sakib , Lubell Yoel 
Published: January 2021

IntroductionIn rural and difficult-to-access settings, early and accurate recognition of febrile children at risk of progressing to serious illness could contribute to improved patient outcomes and better resource allocation. This study aims to develop a prognostic clinical prediction tool to assist community healthcare providers identify febrile children who might benefit from referral or admission for facility-based medical care.Methods and analysisThis prospective observational study will recruit at least 4900 paediatric inpatients and outpatients under the age of 5 years presenting with an acute febrile illness to seven hospitals in six countries across Asia. A venous blood sample and nasopharyngeal swab is collected from each participant and detailed clinical data recorded at presentation, and each day for the first 48 hours of admission for inpatients. Multianalyte assays are performed at reference laboratories to measure a panel of host biomarkers, as well as targeted aetiological investigations for common bacterial and viral pathogens. Clinical outcome is ascertained on day 2 and day 28.Presenting syndromes, clinical outcomes and aetiology of acute febrile illness will be described and compared across sites. Following the latest guidance in prediction model building, a prognostic clinical prediction model, combining simple clinical features and measurements of host biomarkers, will be derived and geographically externally validated. The performance of the model will be evaluated in specific presenting clinical syndromes and fever aetiologies.Ethics and disseminationThe study has received approval from all relevant international, national and institutional ethics committees. Written informed consent is provided by the caretaker of all participants. Results will be shared with local and national stakeholders, and disseminated via peer-reviewed open-access journals and scientific meetings.Trial registration numberNCT04285021.
Development and evaluation of an intervention on suPpoRting infOrmal cAregivers of older people with early CogniTIVe declinE (PROACTIVE): a study protocol based on the Medical Research Council framework
Authors: Wang Shanshan , de Almeida Mello Johanna , Declercq Anja 
Published: January 2021

IntroductionCaring for people with cognitive problems can have an impact on informal caregivers’ health and well-being, and especially increases pressure on healthcare systems due to an increasing ageing society. In response to a higher demand of informal care, evidence suggests that timely support for informal caregivers is essential. The New York University Caregiver Intervention (NYUCI) has proven consistent effectiveness and high adaptability over 30 years. This study has three main objectives: to develop and evaluate the Flemish adaptation of the NYUCI in the context of caregiving for older people with early cognitive decline; to explore the causal mechanism of changes in caregivers’ health and well-being and to evaluate the validity and feasibility of the interRAI Family Carer Needs Assessment in Flanders.Methods and analysisGuided by Medical Research Council framework, this study covers the development and evaluation phases of the adapted NYUCI, named PROACTIVE—suPpoRting infOrmal cAregivers of older people with early CogniTIVe declinE. In the development phase, we will identify the evidence base and prominent theory, and develop the PROACTIVE intervention in the Flemish context. In the evaluation phase, we will evaluate the PROACTIVE intervention with a pretest and posttest design in 1 year. Quantitative data will be collected with the BelRAI Screener, the BelRAI Social Supplement and the interRAI Family Carer Needs Assessment at baseline and follow-up points (at 4, 8 and 12 months). Qualitative data will be collected using counselling logs, evaluation forms and focus groups. Quantitative data and qualitative data will be analysed with SAS 9.4 software and NVivo software, respectively. Efficacy and process evaluation of the intervention will be performed.Ethics and disseminationThis study has been approved by the Ethics Committee of KU Leuven with a dossier number G-2020-1771-R2(MAR). Findings will be disseminated through community information sessions, peer-reviewed publications and national and international conference presentations.