bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequent attendance at the emergency department shows typical features of complex systems: analysis of multicentre linked data
Authors: Burton Christopher , Stone Tony , Oliver Phillip , Dickson Jon M , Lewis Jen , Mason Suzanne M 
Published: May 2021

ObjectiveFrequent attendance at the ED is a worldwide problem. We hypothesised that frequent attendance could be understood as a feature of a complex system comprising patients, healthcare and society. Complex systems have characteristic statistical properties, with stable patterns at the level of the system emerging from unstable patterns at the level of individuals who make up the system.MethodsAnalysis of a linked dataset of routinely collected health records from all 13 hospital trusts providing ED care in the Yorkshire and Humber region of the UK (population 5.5 million). We analysed the distribution of attendances per person in each of 3 years and measured the transition of individual patients between frequent, infrequent and non-attendance. We fitted data to power law distributions typically seen in complex systems using maximum likelihood estimation.ResultsThe data included 3.6 million attendances at EDs in 13 hospital trusts. 29/39 (74.3%) analyses showed a statistical fit to a power law; 2 (5.1%) fitted an alternative distribution. All trusts’ data fitted a power law in at least 1 year. Differences over time and between hospital trusts were small and partly explained by demographics. In contrast, individual patients’ frequent attendance was unstable between years.ConclusionsED attendance patterns are stable at the level of the system, but unstable at the level of individual frequent attenders. Attendances follow a power law distribution typical of complex systems. Interventions to address ED frequent attendance need to consider the whole system and not just the individual frequent attenders.
Evaluating the utility of Rapid Response EEG in emergency care
Authors: Wright Norah M K , Madill Evan S , Isenberg Derek , Gururangan Kapil , McClellen Hannah , Snell Samuel , Jacobson Mercedes P , Gentile Nina T , Govindarajan Prasanthi 
Published: May 2021

BackgroundTimely management of non-convulsive status epilepticus (NCSE) is critical to improving patient outcomes. However, NCSE can only be confirmed using electroencephalography (EEG), which is either significantly delayed or entirely unavailable in emergency departments (EDs). We piloted the use of a new bedside EEG device, Rapid Response EEG (Rapid-EEG, Ceribell), in the ED and evaluated its impact on seizure management when used by emergency physicians.MethodsPatients who underwent Rapid-EEG to rule out NCSE were prospectively enrolled in a pilot project conducted at two ED sites (an academic hospital and a community hospital). Physicians were surveyed on the perceived impact of the device on seizure treatment and patient disposition, and we calculated physicians’ sensitivity and specificity (with 95% CI) for diagnosing NCSE using Rapid-EEG’sBrain Stethoscopefunction.ResultsOf the 38 patients enrolled, the one patient with NCSE was successfully diagnosed and treated within minutes of evaluation. Physicians reported that Rapid-EEG changed clinical management for 20 patients (53%, 95% CI 37% to 68%), primarily by ruling out seizures and avoiding antiseizure treatment escalation, and expedited disposition for 8 patients (21%, 95% CI 11% to 36%). At the community site, physicians diagnosed seizures by their sound usingBrain Stethoscopewith 100% sensitivity (95% CI 5% to 100%) and 92% specificity (95% CI 62% to 100%).ConclusionRapid-EEG was successfully deployed by emergency physicians at academic and community hospitals, and the device changed management in a majority of cases. Widespread adoption of Rapid-EEG may lead to earlier diagnosis of NCSE, reduced unnecessary treatment and expedited disposition of seizure mimics.
Molecular heterogeneity of pancreatic intraductal papillary mucinous neoplasms and implications for novel endoscopic tissue sampling strategies
Authors: Rift Charlotte Vestrup , Melchior Linea Cecilie , Scheie David , Hansen Carsten Palnæs , Lund Eva Løbner , Hasselby Jane Preuss 
Published: May 2021

AimsIntraductal papillary mucinous neoplasms (IPMNs) may be precursor lesions of pancreatic cancer. The path towards malignancy is associated with mutations in tumour suppressor—and oncogenes that may serve as biomarkers during diagnostic investigation. A novel micro forceps has made it possible to obtain biopsies from the cyst wall for analysis by next generation sequencing (NGS), providing an opportunity for early detection and intervention. However, the impact of spatial tumour heterogeneity on the representability of the biopsies has not been determined. The primary aim is to characterise the impact of molecular heterogeneity of the luminal cyst wall on tissue sampling strategies with small biopsies.MethodsWe performed NGS and immunohistochemical phenotyping on 18 resected IPMNs with varying degrees of dysplasia and for a subset, concomitant carcinoma, using a commercially available NGS-panel of 51 oncogenes. We simulated endoscopic biopsies by performing punch biopsies (PBs) of the cyst wall from resected specimens.ResultsIn total, 127 NGS analyses were performed. ConcomitantKRASandGNASwas a common feature of the IPMNs. Mutations inKRASandGNASwere associated with low-grade dysplasia whereas alterations inTP53, SMAD4,CDKN2AandPIK3CAwere associated with high-grade dysplasia and/or carcinoma. The mutational analysis of the PBs from the cyst wall was compared with the whole lesion. No difference was detected between PBs and whole lesions when the cumulated mutational profile in increasing order of randomly performed PBs was compared.ConclusionsSmall IPMN biopsies from the cyst wall are adequate to yield a molecular diagnosis.
Changes in the behavioural determinants of health during the COVID-19 pandemic: gender, socioeconomic and ethnic inequalities in five British cohort studies
Authors: Bann David , Villadsen Aase , Maddock Jane , Hughes Alun , Ploubidis George B. , Silverwood Richard , Patalay Praveetha 
Published: May 2021

Background
The COVID-19 pandemic is expected to have far-reaching consequences on population health. We investigated whether these consequences included changes in health-impacting behaviours which are important drivers of health inequalities.

Methods
Using data from five representative British cohorts (born 2000–2002, 1989–1990, 1970, 1958 and 1946), we investigated sleep, physical activity (exercise), diet and alcohol intake (N=14 297). We investigated change in each behaviour (pre/during the May 2020 lockdown), and differences by age/cohort, gender, ethnicity and socioeconomic position (childhood social class, education attainment and adult financial difficulties). Logistic regression models were used, accounting for study design and non-response weights, and meta-analysis used to pool and test cohort differences in association.

Results
Change occurred in both directions—shifts from the middle part of the distribution to both declines and increases in sleep, exercise and alcohol use. Older cohorts were less likely to report changes in behaviours while the youngest reported more frequent increases in sleep, exercise, and fruit and vegetable intake, yet lower alcohol consumption. Widening inequalities in sleep during lockdown were more frequent among women, socioeconomically disadvantaged groups and ethnic minorities. For other outcomes, inequalities were largely unchanged, yet ethnic minorities were at higher risk of undertaking less exercise and consuming lower amounts of fruit and vegetables.

Conclusions
Our findings provide new evidence on the multiple changes to behavioural outcomes linked to lockdown, and the differential impacts across generation, gender, socioeconomic circumstances across life, and ethnicity. Lockdown appeared to widen some (but not all) forms of health inequality.
Microstructural plasticity in nociceptive pathways after spinal cord injury
Authors: Kyathanahally Sreenath P , Azzarito Michela , Rosner Jan , Calhoun Vince D , Blaiotta Claudia , Ashburner John , Weiskopf Nikolaus , Wiech Katja , Friston Karl , Ziegler Gabriel , Freund Patrick 
Published: May 2021

ObjectiveTo track the interplay between (micro-) structural changes along the trajectories of nociceptive pathways and its relation to the presence and intensity of neuropathic pain (NP) after spinal cord injury (SCI).MethodsA quantitative neuroimaging approach employing a multiparametric mapping protocol was used, providing indirect measures of myelination (via contrasts such as magnetisation transfer (MT) saturation, longitudinal relaxation (R1)) and iron content (via effective transverse relaxation rate (R2*)) was used to track microstructural changes within nociceptive pathways. In order to characterise concurrent changes along the entire neuroaxis, a combined brain and spinal cord template embedded in the statistical parametric mapping framework was used. Multivariate source-based morphometry was performed to identify naturally grouped patterns of structural variation between individuals with and without NP after SCI.ResultsIn individuals with NP, lower R1 and MT values are evident in the primary motor cortex and dorsolateral prefrontal cortex, while increases in R2* are evident in the cervical cord, periaqueductal grey (PAG), thalamus and anterior cingulate cortex when compared with pain-free individuals. Lower R1 values in the PAG and greater R2* values in the cervical cord are associated with NP intensity.ConclusionsThe degree of microstructural changes across ascending and descending nociceptive pathways is critically implicated in the maintenance of NP. Tracking maladaptive plasticity unravels the intimate relationships between neurodegenerative and compensatory processes in NP states and may facilitate patient monitoring during therapeutic trials related to pain and neuroregeneration.
Circadian rhythm of ischaemic core progression in human stroke
Authors: Reidler Paul , Brehm Alex , Sporns Peter B. , Burbano Vanessa Granja , Stueckelschweiger Lena , Broocks Gabriel , Liebig Thomas , Psychogios Marios-Nikos , Ricke Jens , Dimitriadis Konstantinos , Dichgans Martin , Kunz Wolfgang G. , Tiedt Steffen 
Published: May 2021

IntroductionExperimental stroke studies suggest an influence of the time of day of stroke onset on infarct progression. Whether this holds true after human stroke is unknown, but would have implications for the design of randomised controlled trials, especially those on neuroprotection.MethodsWe pooled data from 583 patients with anterior large-vessel occlusion stroke from three prospectively recruited cohorts. Ischaemic core and penumbra volumes were determined with CT perfusion using automated thresholds. Core growth was calculated as the ratio of core volume and onset-to-imaging time. To determine circadian rhythmicity, we applied multivariable linear and sinusoidal regression analysis adjusting for potential baseline confounders.ResultsPatients with symptom onset at night showed larger ischaemic core volumes on admission compared with patients with onset during the day (median, 40.2 mL vs 33.8 mL), also in adjusted analyses (p=0.008). Sinusoidal analysis indicated a peak of core volumes with onset at 11pm. Core growth was faster at night compared with day onset (adjusted p=0.01), especially for shorter onset-to-imaging times. In contrast, penumbra volumes did not change across the 24-hour cycle.DiscussionThese results suggest that human infarct progression varies across the 24-hour cycle with potential implications for the design and interpretation of neuroprotection trials.
Serological study of healthcare workers in four different hospitals in Madrid (Spain) with no previous history of COVID-19
Authors: Vázquez Rivas Fabián , Nieto Schwarz Sandra , Villarreal Carreño Jaime , Deschamps Perdomo Ámbar , Villanueva Ghino Patricio , Garrafa Mayra , del Campo M Teresa 
Published: May 2021

ObjectivesHealthcare workers (HCWs) have been one of the most severely affected groups during the COVID-19 pandemic, though few studies have sought to determine the rate of undiagnosed cases among this population. In this study, we aim to determine the rate of undetected infection in HCWs, a potential source of nosocomial infection.MethodsSerological screening for IgG and IgM antibodies against SARS-CoV-2 was carried out among HCWs from four different hospitals in Madrid, Spain, from 6 April to 25 April 2020; HCWs with a previous diagnosis of infection based on real-time reverse transcriptase-PCR assay performed after presenting compatible symptoms were excluded. Prevalence of IgG and IgM antibodies was calculated among HCWs to obtain the rate of COVID-19 presence of antibodies in each hospital.ResultsOf the 7121 HCWs studied, 6344 (89.09%) had not been previously diagnosed with COVID-19. A total of 5995 HCWs finally participated in the study, resulting in a participation rate of 94.49%. A positive IgM or IgG test against COVID-19 was revealed in 16.21% of the HCWs studied (n=972).ConclusionThis study reveals the importance of early detection of SARS-CoV-2 infection among HCWs to prevent nosocomial infection and exposure of patients, visitors and workers and the spread of COVID-19 in the overall community.
Associations between workplace characteristics and ‘outness’ in LGBTI workers in Austria
Authors: Markovic Lovro , Schönherr Daniel , Zandonella Martina , Gil-Salmeron Alejandro , Smith Lee , McDermott Daragh , Yang Lin , Dorner Thomas E , Mües Hanna , Grabovac Igor 
Published: May 2021

ObjectivesLesbian, gay, bisexual, transgender and intersex (LGBTI) individuals are often subjected to negative attitudes in the workplace, which may lead to non-disclosure of their sexual orientation and/or gender identities. We aimed to determine the prevalence of workplace disclosure of sexual or gender identity (ie, ‘outness’; being ‘out’) and to examine its associations with workplace characteristics in LGBTI workers in Austria.MethodsThis cross-sectional study analysed sociodemographic, work-related and well-being-related data from self-identifying gender and/or sexual minority participants elicited by an online questionnaire between February and June 2017. From the initial 1268 respondents, 1177 (93%) provided complete data and were included in the subsequent analyses.ResultsThe largest proportion of the sample were 26–35 years old (39.1%), cisgender gay men (40.0%) in full-time employment (63.9%). Overall, 51.7% of the sample were ‘out’ at the workplace. Being bisexual (OR=0.46, 95% CI 0.27 to 0.81), the provision of antidiscrimination guidelines in the workplace (OR=0.53, 95% CI 0.32 to 0.90), living alone (OR=0.50, 95% CI 0.32 to 0.79) and in shared households (OR=0.49, 95% CI 0.25 to 0.96) were associated with a decreased likelihood of being ‘out’ at work.Factors associated with being ‘out’ at work were being middle aged (36–45 years old; OR=1.74, 95% CI 1.07 to 2.85), having been in employment for >10 years (OR=2.03, 95% CI 1.08 to 3.81), an LGBTI-friendly work environment (OR 1.61, 95% CI 1.36 to 1.91), labour-management antidiscrimination contract (OR=2.02, 95% CI 1.23 to 3.32) and work council protections (OR=1.56, 95% CI 1.04 to 2.36).ConclusionsInstating antidiscrimination protections might facilitate ‘outness’ of LGBTI workers and lead to a better promotion of diversity in the workplace.
Occupational radiation exposure and cancer incidence in a cohort of diagnostic medical radiation workers in South Korea
Authors: Lee Won Jin , Ko Seulki , Bang Ye Jin , Choe Seung-Ah , Choi Yeongchull , Preston Dale L 
Published: May 2021

ObjectivesWe investigated the association between protracted low-dose ionising radiation and the risk of cancer in medical radiation workers, the largest group of workers with occupational radiation exposures.MethodsData of all South Korean diagnostic medical radiation workers enrolled at the National Dose Registry during 1996–2011 were merged with the death and cancer incidence data until 31 December 2017. SIRs, relative risks and excess relative risks (ERRs) for cancer were calculated to quantify the radiation dose–response relationship using Poisson regression models.ResultsA total of 3392 first primary cancer cases were identified among 93 920 diagnostic medical radiation workers. The mean cumulative badge dose in the cohort was 7.20 mSv. The ERRs for solid cancer with a 5-year lag and haematopoietic cancers with a 2-year lag for all workers were 0.15 per 100 mGy (95% CI −0.20 to 0.51) and 0.09 per 100 mGy (95% CI −2.02 to 2.20), respectively. The ERRs for cancers did not significantly vary by job title, different lag years or after excluding thyroid and lung cancers. Sensitivity analyses restricted to workers employed for at least 1 year, or who were employed in or after 1996, or who had exposure to a cumulative badge dose of 1 mSv or more showed similar results.ConclusionsOccupational radiation doses were not significantly associated with cancer incidence among South Korean diagnostic medical radiation workers. However, cautious interpretation of ERRs is needed due to the limitations of short follow-up and low cumulative radiation doses.
Elevated Alu retroelement copy number among workers exposed to diesel engine exhaust
Authors: Wong Jason Y.Y. , Cawthon Richard , Dai Yufei , Vermeulen Roel , Bassig Bryan A. , Hu Wei , Duan Huawei , Niu Yong , Downward George S. , Leng Shuguang , Ji Bu-Tian , Fu Wei , Xu Jun , Meliefste Kees , Zhou Baosen , Yang Jufang , Ren Dianzhi , Ye Meng , Jia Xiaowei , Meng Tao , Bin Ping , Hosgood, III H. Dean , Silverman Debra T. , Rothman Nathaniel , Zheng Yuxin , Lan Qing 
Published: May 2021

BackgroundMillions of workers worldwide are exposed to diesel engine exhaust (DEE), a known genotoxic carcinogen. Alu retroelements are repetitive DNA sequences that can multiply and compromise genomic stability. There is some evidence linking altered Alu repeats to cancer and elevated mortality risks. However, whether Alu repeats are influenced by environmental pollutants is unexplored. In an occupational setting with high DEE exposure levels, we investigated associations with Alu repeat copy number.MethodsA cross-sectional study of 54 male DEE-exposed workers from an engine testing facility and a comparison group of 55 male unexposed controls was conducted in China. Personal air samples were assessed for elemental carbon, a DEE surrogate, using NIOSH Method 5040. Quantitative PCR (qPCR) was used to measure Alu repeat copy number relative to albumin (Alb) single-gene copy number in leucocyte DNA. The unitless Alu/Alb ratio reflects the average quantity of Alu repeats per cell. Linear regression models adjusted for age and smoking status were used to estimate relations between DEE-exposed workers versus unexposed controls, DEE tertiles (6.1–39.0, 39.1–54.5 and 54.6–107.7 µg/m3) and Alu/Alb ratio.ResultsDEE-exposed workers had a higher average Alu/Alb ratio than the unexposed controls (p=0.03). Further, we found a positive exposure–response relationship (p=0.02). The Alu/Alb ratio was highest among workers exposed to the top tertile of DEE versus the unexposed controls (1.12±0.08 SD vs 1.06±0.07 SD, p=0.01).ConclusionOur findings suggest that DEE exposure may contribute to genomic instability. Further investigations of environmental pollutants, Alu copy number and carcinogenesis are warranted.
How robust is the association between youth unemployment and later mental health? An analysis of longitudinal data from English schoolchildren
Authors: Wright Liam , Head Jenny A , Jivraj Stephen 
Published: May 2021

BackgroundSeveral studies show that youth unemployment is associated with worse mental health later in life. However, existing studies report results for only one model, or a few models, and use regression adjustment to support causal claims. We use two novel methods to address these gaps in the literature.MethodsWe use data from Next Steps, a cohort study of English schoolchildren who entered the labour market in the aftermath of the 2008–2009 global financial crisis, and measure mental health using the 12-item General Health Questionnaire (GHQ-12) at age 25. We use specification curve analysis and a negative control outcome design (a form of placebo test) to test whether associations between youth unemployment and later GHQ-12 scores are sensitive to model specification or are likely to be confounded by unobserved factors.ResultsWe find that the association between unemployment and later GHQ-12 is qualitatively similar across 99.96% of the 120 000 models we run. Statistically significant associations with two placebo outcomes, height and patience, are not present when regression adjustments are made.ConclusionsThere is clear evidence that youth unemployment is related to later mental health, and some evidence that this cannot be easily explained by unobserved confounding.
Foundation rotations in medical training: is it love at first sight?
Authors: Collins Hannah , Eley Catherine , Kohler George , Morgan Holly 
Published: May 2021

AbstractPurpose of studyFactors influencing physician specialty choice is a prominent topic given the recruitment challenges faced by various specialties. We aimed to assess whether specialty exposure in the first foundation year was a positive predictive factor for permanent career choice.Study designA questionnaire-based study was distributed online using a survey tool. Questions recorded the foundation rotations of participants as well as their chosen medical specialty.Results1181 responses were included in the analysis. 23% of respondents had undertaken a Foundation Year 1 (F1) rotation in their career specialty. Having undertaken a foundation rotation in anaesthetics, cardiology, emergency medicine, endocrinology, gastroenterology, genito-urinary medicine, intensive care, obstetrics and gynaecology, oncology, paediatrics, palliative care, psychiatry, radiology, respiratory and rheumatology was found to be statistically significantly linked to choosing that specialty as a career (p&lt;0.01). There was a significant correlation between the second foundation rotation and career choice (p=0.02).ConclusionsFor many specialties, direct experience within foundation training has a positive effect on later career choice.
2020 family medicine postgraduate examinations at The University of the West Indies: successes and challenges in the time of COVID-19 pandemic
Authors: Motilal Shastri , Paul-Charles Joanne , Asnani Monika , Khan Raveed , Ricketts-Roomes Tana , Pinder-Butler Sabriquet , Herbert Joseph , Farquharson Carnille , Conliffe Catherine , Standard-Goldson Aileen , Smith Kristen , Morris Euclid , Maharaj Rohan G 
Published: May 2021

ABSTRACTLittle has been published regarding postgraduate assessments during the COVID-19 pandemic. There is an urgent need to graduate well-trained specialists including family physicians who play a key role in patient care. The successes and challenges encountered in mounting qualifying 2020 Family Medicine examinations during the COVID-19 pandemic at the University of the West Indies are described in this paper. Human resource, planning, use of technology and virtual environments are discussed, which enabled successful examinations at this multicampus regional site.