bluuebunny/crossref_metadata_2025_split huggingface dataset:
Temperature post out-of-hospital cardiac arrest: the TOPCAT study
Authors: Lyon Richard 
Published: October 2021

IntroductionOut-of-hospital cardiac arrest (OHCA) is a significant cause of death and severe neurological disability. The only postreturn of spontaneous circulation (ROSC) therapy shown to increase survival is mild therapeutic hypothermia (MTH). The relationship between body temperature post OHCA and outcome is still poorly defined.MethodsProspective observational study of all OHCA patients admitted to a single centre for a 14-month period. Oesophageal temperature was measured in the Emergency Department and Intensive Care Unit (ICU). Select patients had prehospital temperature monitoring.Results164 OHCA patients were included in the study. 105 (64.0%) were pronounced dead in the Emergency Department. 59 (36.0%) were admitted to ICU for cooling; 40 (24.4%) died in ICU and 19 (11.6%) survived to hospital discharge. Patients who achieved ROSC and had oesophageal temperature measured prehospital (n=29) had a mean prehospital temperature of 33.9°C (95% CI 33.2 to 34.5). All patients arriving in the ED post OHCA had a relatively low oesophageal temperature (34.3°C, 95% CI 34.1 to 34.6). Patients surviving to hospital discharge were warmer on admission to ICU than patients who died in hospital (35.7°C vs 34.3°C, p<0.05). Patients surviving to hospital discharge also took longer to reach target MTH temperature than non-survivors (2 h 48 min vs 1 h 32 min, p<0.05). There was no difference in mean arterial blood pressure on arrival in the ED between survivors and non-survivors.ConclusionsFollowing OHCA all patients have oesophageal temperatures below normal in the prehospital phase and on arrival in the Emergency Department. This questions the need for prehospital cooling post-OHCA patients. Patients who achieve ROSC following OHCA and survive to hospital discharge are warmer on arrival in ICU and take longer to reach target MTH temperatures compared to patients who die in hospital. The mechanisms of action underlying oesophageal temperature and survival from OHCA remain unclear and further research is warranted to clarify this relationship.
Current practice and opinion regarding the use of therapeutic hypothermia after cardiac arrest survival in children: a survey of UK Paediatric Emergency Medicine consultants to inform the cold-PACK study
Authors: Lyttle M 
Published: October 2021

Background and aimsTherapeutic hypothermia improves neurological outcome in adults after cardiac arrest and term neonates with hypoxic ischaemic encephalopathy. There is currently no evidence to support its use in the paediatric population following cardiac arrest. This survey of UK Paediatric Emergency Medicine (PEM) consultants aims to ascertain current practice in UK, and attitudes and opinions to guide the feasability of a multicentre randomised controlled trial (RCT) of therapeutic hypothermia after cardiac arrest in children (the Cold-PACK study).MethodsIn early 2010 UK PEM consultants were invited to complete a web based survey of current practice in therapeutic hypothermia and opinions regarding future research.ResultsFollowing return of spontaneous circulation after cardiac arrest in children 58 % of respondents never cool, 35.5% seldom cool and 3.2 % often cool. The most common reasons for not cooling are ‘not enough research evidence to support its use’ (31.8%) and ‘no equipment available to initiate cooling’ (31.8%). 87.1% of responders did not know if therapeutic hypothermia improved outcome. Only 12.9% have a specific protocol for cooling, and there is wide variation in practice with respect to the depth of cooling. In those who cool, a range of cooling methods is employed, the most common of which is ice packs applied to skin (22.6%). 86% of respondents would support an RCT in the UK investigating the use of hypothermia after cardiac arrest, and 87% of respondents would be willing to commence therapeutic hypothermia in the Emergency Department. 80% felt that deferred consent could be used.ConclusionsThere is wide variation in UK practice in the use of therapeutic hypothermia in PEM. This survey demonstrates clinical equipoise, and shows support for a future RCT of therapeutic hypothermia after cardiac arrest in children.
A lean, keen, kid-centred machine: change in children's ED
Authors: Crew Jamie 
Published: October 2021

IntroductionOur Children's Emergency Department, as part of a whole hospital improvement project has been piloting ‘Lean Thinking’ to develop and trial new ideas and processes within the department. Our initial project has been focusing on how we manage injuries in the department with the aim of ‘developing a system whereby children with injuries can be seen more efficiently and effectively by having combined medical and nursing staff assessment and treatment, coupled with the ability to prescribe and make appointments during the same consultation.’MethodsWe have used a series of lean processes and tools (Scope tools, KANO workshops, current state, process mapping, future state, ideas wall, Plan-Do-Study-Act (PDSA) cycle) to engage staff and facilitate them to generate ideas and develop projects for change and improvement. The initial priority for our Children's Emergency Department was the development of a multidisciplinary area in which to see and treat injuries. The idea was then developed into a clinical process and trialled, within the department, in real-time without any cessation of service. The findings are analysed, the processes refined, and further trials instituted to consolidate the process before full implementation.ResultsWe have completed three trials of the MDT injuries area with dramatic improvements in patient and staff satisfaction, as well as more objective outcomes one example being decreased patient journey. The average time from arrival to discharge in the trial was compared with baseline data for the same time over the preceeding 10 weeks:- Trial 1 (4 h) baseline 120 min, trial 30 min; Trial 2 (8 h) baseline 103 min, trial 54; Trial 3 (10 h) baseline 94 min, trial 49. We are now moving to implementation of this new area for 10 h a day, 7 days a week.ConclusionLean processes with real-time trials can facilitate successful, continuous, staff driven change within a Paediatric Emergency Department.
The Q**** Study – basic randomised evaluation of attendance at a children's emergency department
Authors: Johnson Graham 
Published: October 2021

IntroductionHealth Professionals are superstitious; be it a little ritual before sitting a cannula, or wearing a particular item of clothing while on-call, there are many things that we irrationally do day-to-day. One of the most well known superstitions is that uttering the word “quiet” (Q****) will immediately turn what has previously been a pleasant day into an extremely busy one. This belief is strongly at odds with modern Evidence Based Medicine, in fact a thorough literature review revealed no published research in this area. The aim of this study was to establish if there was any evidence that saying the word “Q****” influenced the number of attendances to a Children's Emergency Department.MethodWe measured attendance during three time periods per day for the study duration (A – 00:00 to 07:59; B – 08:00 to 15:59; C – 16:00 to 23:59). At the beginning of each time period a randomised envelope was opened that contained either the word “Q****”, “Busy” or was blank, this prompted the doctor and nurse in charge to utter a sentence containing the word from the envelope, which was also displayed for the rest of the 8 h.Results1454 patients were included in the intervention period and 2818 were included in the 4 week control period to measure typical attendance. Mean attendance for intervention and control were: A 7.29 and 7.71; B 40.86 and 40; C 55.57 and 52.86 respectively. “Q****” and Busy were uttered 12 times each. There was no statistically significant difference in attendance for either word.ConclusionThis study has shown that the long-held belief that saying the word ‘Quiet’ has dire consequences is unfounded. We would recommend further research to explore whether other words could be used to influence Emergency Department attendances.
Multicentre comparative analysis of long-term outcomes after aortic valve replacement in children
Authors: Knight Jessica H , Sarvestani Amber Leila , Ibezim Chizitam , Turk Elizabeth , McCracken Courtney E , Alsoufi Bahaaldin , St Louis James , Moller James H , Raghuveer Geetha , Kochilas Lazaros K 
Published: October 2021

ObjectiveThe ideal valve substitute for surgical intervention of congenital aortic valve disease in children remains unclear. Data on outcomes beyond 10–15 years after valve replacement are limited but important for evaluating substitute longevity. We aimed to describe up to 25-year death/cardiac transplant by type of valve substitute and assess the potential impact of treatment centre. Our hypothesis was that patients with pulmonic valve autograft would have better survival than mechanical prosthetic.MethodsThis is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a multi-institutional US-based registry of paediatric cardiac interventions, linked with the National Death Index and United Network for Organ Sharing through 2019. Children (0–20 years old) receiving aortic valve replacement (AVR) from 1982 to 2003 were identified. Kaplan-Meier transplant-free survival was calculated, and Cox proportional hazard models estimated hazard ratios for mechanical AVR (M-AVR) versus pulmonic valve autograft.ResultsAmong 911 children, the median age at AVR was 13.4 years (IQR=8.4–16.5) and 73% were male. There were 10 cardiac transplants and 153 deaths, 5 after transplant. The 25-year transplant-free survival post AVR was 87.1% for autograft vs 76.2% for M-AVR and 72.0% for tissue (bioprosthetic or homograft). After adjustment, M-AVR remained related to increased mortality/transplant versus autograft (HR=1.9, 95% CI=1.1 to 3.4). Surprisingly, survival for patients with M-AVR, but not autograft, was lower for those treated in centres with higher in-hospital mortality.ConclusionPulmonic valve autograft provides the best long-term outcomes for children with aortic valve disease, but AVR results may depend on a centre’s experience or patient selection.
Severity of anaemia and association with all-cause mortality in patients with medically managed left-sided endocarditis
Authors: Pries-Heje Mia Marie , Hasselbalch Rasmus Bo , Wiingaard Christoffer , Fosbøl Emil Loldrup , Glenthøj Andreas Birkedal , Ihlemann Nikolaj , Gill Sabine Ute Alice , Christiansen Ulrik , Elming Hanne , Bruun Niels Eske , Povlsen Jonas Agerlund , Helweg-Larsen Jannik , Schultz Martin , Østergaard Lauge , Fursted Kurt , Christensen Jens Jørgen , Rosenvinge Flemming , Køber Lars , Tønder Niels , Moser Claus , Iversen Kasper , Bundgaard Henning 
Published: October 2021

ObjectiveTo assess the prevalence and severity of anaemia in patients with left-sided infective endocarditis (IE) and association with mortality.MethodsIn the Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis trial, 400 patients with IE were randomised to conventional or partial oral antibiotic treatment after stabilisation of infection, showing non-inferiority. Haemoglobin (Hgb) levels were measured at randomisation. Primary outcomes were all-cause mortality after 6 months and 3 years. Patients who underwent valve surgery were excluded due to competing reasons for anaemia.ResultsOut of 400 patients with IE, 248 (mean age 70.6 years (SD 11.1), 62 women (25.0%)) were medically managed; 37 (14.9%) patients had no anaemia, 139 (56.1%) had mild anaemia (Hgb <8.1 mmol/L in men and Hgb <7.5 mmol/L in women and Hgb ≥6.2 mmol/L) and 72 (29.0%) had moderate to severe anaemia (Hgb <6.2 mmol/L). Mortality rates in patients with no anaemia, mild anaemia and moderate to severe anaemia were 2.7%, 3.6% and 15.3% at 6-month follow-up and 13.5%, 20.1% and 34.7% at 3-year follow-up, respectively. Moderate to severe anaemia was associated with higher mortality after 6 months (HR 4.81, 95% CI 1.78 to 13.0, p=0.002) and after 3 years (HR 2.14, 95% CI 1.27 to 3.60, p=0.004) and remained significant after multivariable adjustment.ConclusionModerate to severe anaemia was present in 29% of patients with medically treated IE after stabilisation of infection and was independently associated with higher mortality within the following 3 years. Further investigations are warranted to determine whether intensified treatment of anaemia in patients with IE might improve outcome.
Prediction of incident atrial fibrillation in community-based electronic health records: a systematic review with meta-analysis
Authors: Nadarajah Ramesh , Alsaeed Eman , Hurdus Ben , Aktaa Suleman , Hogg David , Bates Matthew G D , Cowan Campbel , Wu Jianhua , Gale Chris P 
Published: October 2021

ObjectiveAtrial fibrillation (AF) is common and is associated with an increased risk of stroke. We aimed to systematically review and meta-analyse multivariable prediction models derived and/or validated in electronic health records (EHRs) and/or administrative claims databases for the prediction of incident AF in the community.MethodsOvid Medline and Ovid Embase were searched for records from inception to 23 March 2021. Measures of discrimination were extracted and pooled by Bayesian meta-analysis, with heterogeneity assessed through a 95% prediction interval (PI). Risk of bias was assessed using Prediction model Risk Of Bias ASsessment Tool and certainty in effect estimates by Grading of Recommendations, Assessment, Development and Evaluation.ResultsEleven studies met inclusion criteria, describing nine prediction models, with four eligible for meta-analysis including 9 289 959 patients. The CHADS (Congestive heart failure, Hypertension, Age>75, Diabetes mellitus, prior Stroke or transient ischemic attack) (summary c-statistic 0.674; 95% CI 0.610 to 0.732; 95% PI 0.526–0.815), CHA2DS2-VASc (Congestive heart failure, Hypertension, Age>75 (2 points), Stroke/transient ischemic attack/thromboembolism (2 points), Vascular disease, Age 65–74, Sex category) (summary c-statistic 0.679; 95% CI 0.620 to 0.736; 95% PI 0.531–0.811) and HATCH (Hypertension, Age, stroke or Transient ischemic attack, Chronic obstructive pulmonary disease, Heart failure) (summary c-statistic 0.669; 95% CI 0.600 to 0.732; 95% PI 0.513–0.803) models resulted in a c-statistic with a statistically significant 95% PI and moderate discriminative performance. No model met eligibility for inclusion in meta-analysis if studies at high risk of bias were excluded and certainty of effect estimates was ‘low’. Models derived by machine learning demonstrated strong discriminative performance, but lacked rigorous external validation.ConclusionsModels externally validated for prediction of incident AF in community-based EHR demonstrate moderate predictive ability and high risk of bias. Novel methods may provide stronger discriminative performance.Systematic review registrationPROSPERO CRD42021245093.
Living in a block group with a higher eviction rate is associated with increased odds of preterm delivery
Authors: Freedman Alexa A , Smart Britney P , Keenan-Devlin Lauren S , Borders Ann , Ernst Linda M , Miller Gregory E 
Published: October 2021

BackgroundHousing instability is associated with adverse pregnancy outcomes. Recent studies indicate that eviction, which may affect a larger segment of the population than other forms of housing instability, is also associated with adverse pregnancy outcomes. However, these studies evaluate eviction across large areas, such as counties, so it remains unclear whether these patterns extend to individual-level pregnancy outcomes.MethodsWe used data on a cohort of all singleton live births at a single Chicago hospital between March 2008 and March 2018 to investigate the associations between block-group eviction rates and individual adverse pregnancy outcomes. Eviction data were obtained from the Eviction Lab at Princeton University. Generalised estimating equations were used to estimate associations and account for correlations among individuals living in the same block groups.ResultsIndividuals living in block groups in the highest quartile for eviction filing rate were 1.17 times as likely to deliver preterm (95% CI: 1.08 to 1.27) and 1.13 times as likely to deliver a small for gestational age infant (95% CI: 1.03 to 1.25) as compared with individuals living in block groups in the lowest quartile. Further, tests for linear trend indicated that for each quartile increase in eviction filing rate, there was a corresponding increase in odds of adverse outcomes (p<0.05). Results were strongest in magnitude for those with low neighbourhood and individual socioeconomic status, who are most likely to be renters and affected by local eviction policies.ConclusionOur results suggest that individuals living in block groups with higher eviction rates are more likely to deliver preterm. Future research should explore associations of individual experience with eviction on adverse pregnancy outcomes and examine whether policies to improve tenant protections also impact pregnancy outcomes.
ANA-positive primary immune thrombocytopaenia: a different clinical entity with increased risk of connective tissue diseases
Authors: Liu Yuan , Chen Shiju , Yang Guomei , Wang Bin , Lan Jinying , Dai Fan , Rao Peishi , Wu Puqi , Qian Hongyan , Shi Guixiu 
Published: October 2021

ObjectivePrimary immune thrombocytopaenia (ITP) is highly heterogeneous. ANA-positive primary ITP may resemble the preclinical stage of connective tissue diseases (CTDs), but is still considered primary ITP due to a controversial CTD risk assessment in this group. The objective of this study was to clarify the risk of CTD in ANA-positive patients with primary ITP.MethodsWe performed a retrospective cohort study and a meta-analysis. 586 patients with newly diagnosed primary ITP were followed up and Cox regression analyses were used to analyse the associations of ANA positivity and other immune parameters with CTD development.ResultsThe mean follow-up time was 37 (19–56) months. ANA was positive in 21.33% (125 of 586) of patients with primary ITP in our retrospective cohort, and the overall rate of ANA positivity in the meta-analysis was 17.06% (369 of 2163). The adjusted HR for CTD in ANA-positive primary ITP was 6.15 (95% CI 2.66 to 14.23, p<0.001). Five patients in the ANA-positive group developed SLE (5 of 125, 4.0%), significantly higher than in the ANA-negative group (0 of 461, 0%). A clinical model combining ANA, anti-Sjogren’s syndrome A antibody and C3 was successfully developed to predict the risk of CTD in patients with primary ITP. Increased risk of CTD (risk ratio=12.43, 95% CI 7.91 to 19.55, p<0.00001), especially SLE (risk ratio=30.41, 95% CI 13.23 to 69.86, p<0.00001), among ANA-positive patients with primary ITP was confirmed by a meta-analysis of previous studies and the present study.ConclusionsThe findings suggest that ANA-positive primary ITP is a clinical entity distinct from other primary ITPs and is associated with increased risk of developing CTDs, especially SLE.
Flavour capsule cigarette use and perceptions: a systematic review
Authors: Kyriakos Christina N , Zatoński Mateusz Zygmunt , Filippidis Filippos T 
Published: October 2021

ObjectiveThis systematic review on flavour capsule cigarettes aims to examine prevalence, correlates of use, behaviours and perceptions of these products globally.Data sourcesA search of original, peer-reviewed research without restrictions in publication year, population, study design or language, using a combination of cigarette and capsule terms was conducted across four databases (Medline, Embase, Web of Science and Scopus), indexed until 30 April 2021.Study selectionStudies were included if they presented original, human subjects research on flavour capsule cigarettes.Data extractionTwo authors independently extracted data on main outcome results and assessed risk of bias using a validated quality assessment tool (QATSDD).Data synthesisOf 842 unduplicated database records and four studies from citation searching screened, 20 studies were included in the review. Studies reported data from 2009 to 2019 across eight countries, the majority of which used cross-sectional or focus group study designs. Current capsule use among smokers was highest in Chile and Mexico (40%) and was associated with younger age, and in some countries, with being female. Capsule cigarettes are perceived as tasting better, being smoother on the throat, more fun to smoke, and more attractive compared with non-capsule cigarettes, particularly among susceptible non-smokers and non-daily smokers.ConclusionFindings call for the adoption of comprehensive tobacco control policies that account for flavour capsules and similar iterations, which can increase appeal through flavours and innovative features. Continued monitoring and research of these products is critical, with particular attention to low-income and middle-income countries, which make up a disproportionately larger share of the capsule market.
Thermodynamic properties of Bardeen black holes in dRGT massive gravity
Authors: Singh R.P. , Singh B.K. , Gupta B.R.K. , Sachan Shobhit 
Published: October 2021

The Bardeen black hole solution is the first spherically symmetric regular black hole based on the Sakharov and Gliner proposal which is a modification of the Schwarzschild black hole. We present the Bardeen black hole solution in the presence of the de Rham, Gabadaadze, and Tolly (dRGT) massive gravity, which is regular everywhere in the presence of a nonlinear source. The obtained solution reduces to the Bardeen black hole in the absence of a massive gravity parameter, and the Schwarzschild black hole when magnetic charge g = 0. We investigated the thermodynamic quantities, that is, mass (M), temperature (T), entropy (S), and free energy (F), in terms of the horizon radius for both canonical and grand canonical ensembles. We checked the local and global stability of the obtained solution by studying the heat capacity and free energy. The heat capacity changes sign at r = rc. The black hole is thermodynamically stable with a positive heat capacity C > 0 (i.e., globally preferred with negative free energy F < 0). In addition, we studied the phase structure of the obtained solution in both ensembles.
Dark matter self-interactions from spin-2 mediators
Authors: Kang Yoo-Jin , Lee Hyun Min 
Published: October 2021

AbstractWe propose a new mechanism for rendering dark matter self-interacting in the presence of a massive spin-2 mediator. The derived Yukawa-type potential for dark matter is independent of the spins of dark matter in the leading order of the momentum expansion, so are the resulting non-perturbative effects for the dark matter self-scattering. We find that both the Born cross section and relatively mild resonance effects assist to make the self-scattering cross section velocity-dependent. We discuss how to evade the current indirect bounds on dark matter annihilations and show that the model is marginally compatible with perturbative unitarity in the ghost-free realization of the massive spin-2 particle.