bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paediatric primary care in Germany during the early COVID-19 pandemic: the calm before the storm
Authors: Kohns Vasconcelos Malte , Weil Katharina , Vesterling-Hörner Daniela , Klemm Mehrsad , el Scheich Tarik , Renk Hanna , Remke Katharina , Bosse Hans Martin 
Published: May 2021

ObjectivesGlobally, the COVID-19 pandemic has a major impact on healthcare provision. The effects in primary care are understudied. This study aimed to explore changes in consultation numbers and patient management during the COVID-19 pandemic, and to identify challenges for patient care.DesignSurvey of paediatric primary care practices on consultation numbers and patient management changes, and semistructured interviews to identify challenges for patient care. Surveys and interviews were partially linked in an explanatory sequential design to identify patient groups perceived to be at higher risk for worse care during the pandemic.SettingIn and around Düsseldorf, a densely populated area in Western Germany. The primary care facilities are spread over an area with approximately 2 million inhabitants.ParticipantsPrimary care in Germany is provided through practices run by self-employed specialist physicians that are contracted to offer services to patients under public health insurance which is compulsory to the majority of the population. The sample contained 44 paediatric primary care practices in the area, the response rate was 50%.ResultsNumbers of consultations for scheduled developmental examinations remained unchanged compared with the previous year while emergency visits were strongly reduced (mean 87.3 less/week in March–May 2020 compared with 2019, median reduction 55.0%). Children dependent on developmental therapy and with chronic health conditions were identified as patient groups receiving deteriorated care. High patient numbers, including of mildly symptomatic children presenting for health certificates, in combination with increased organisational demands and expected staff outages are priority concerns for the winter.ConclusionsPrimary care paediatricians offered stable service through the early pandemic but expected strained resources for the upcoming winter. Unambiguous guidance on which children should present to primary care and who should be tested would help to allocate resources appropriately, and this guidance needs to consider age group specific issues including high prevalence of respiratory symptoms, dependency on carers and high contact rates.
Association of inverted T wave during atrial fibrillation rhythm with subsequent cardiac events
Authors: Kawaji Tetsuma , Ogawa Hisashi , Hamatani Yasuhiro , Kato Masashi , Yokomatsu Takafumi , Miki Shinji , Abe Mitsuru , Akao Masaharu 
Published: May 2021

ObjectiveThe clinical significance of ECG abnormalities during atrial fibrillation (AF) rhythm is poorly understood. The aim of the current study was to explore the impact of inverted T wave on cardiac prognosis in patients with AF.MethodsThe current study enrolled 2709 patients with AF whose baseline ECG was available from a Japanese community-based prospective survey, the Fushimi AF Registry, and the impact of inverted T wave in baseline ECG at AF rhythm on the composite of cardiac death, myocardial infarction and hospitalisation due to heart failure was examined.ResultsIntraventricular conduction delay, ST segment depression and inverted T wave were observed in 15.8%, 24.7% and 41.4% of baseline ECG with a mean heart rate of 94.7 beats per minute. The median follow-up duration was 5.0 years. The incidence rate of the composite cardiac endpoint was significantly higher in patients with inverted T wave than those without (5.8% vs 3.3% per patient-year, log-rank p<0.01). The higher risk associated with inverted T wave was consistent even for individual components of the composite cardiac endpoint. By multivariable analysis, inverted T wave was an independent predictor of the composite cardiac endpoint (HR 1.53, 95% CI 1.26 to 1.85, p<0.01). Inverted T wave was detected in 15.7% at anterior leads, 19.8% at inferior leads and 26.6% at lateral leads. The location of inverted T wave was not associated with risk of composite cardiac endpoint.ConclusionsInverted T wave was commonly observed in patients with AF and its presence during AF rhythm was associated with subsequent cardiac events.
Audit of medical (non-targeted) liver biopsy specimen quality, pathology reporting and effect on patient management
Authors: Seth Sidhant , Forrest Ewan H , Morris Judith M , Heydtmann Mathis , Konanahalli Prakash , Kohnen Gabriele , Oien Karin A 
Published: May 2021

AimsTo evaluate our medical liver pathology practice and its influence on patient management, using audit templates published by the UK Royal College of Pathologists (RCPath).MethodsWe audited medical liver biopsies reported in our centre in 2019 using RCPath proformas. Data were collected from pathology reports and corresponding electronic patient record.Results60 cases were selected for audit from 135 eligible biopsies reported in 2019. 58/60 cases were core biopsies and 2/60 were laparoscopic wedge biopsies. 53/57 (93%) core biopsies with available data met RCPath adequacy criteria (length >15 mm and/or ≥6 portal tracts). Most reports (57/60; 95%) were judged to have helped patient management. 25/60 (42%) biopsy reports helped to clarify the clinical diagnosis and 48/60 (80%) led to altered management.ConclusionsWe demonstrate the utility of the RCPath audit templates, highlighting the clinical value of medical liver biopsies in the diagnostic work-up and management of patients with liver disease.
The intersectional role of social stress in fracture risk: results from the Women’s Health Initiative
Authors: Follis Shawna , Klimentidis Yann C , Bea Jennifer , Hu Chengcheng , Garcia David , Wactawski-Wende Jean , Kohler Lindsay , Shadyab Aladdin H , Flores Melissa , Tindle Hilary A , Chen Zhao 
Published: May 2021

Background
The biological consequences of stress from the social environment pattern health outcomes. This study investigated whether social stress is prospectively associated with fracture incidence among racially and ethnically diverse, postmenopausal women.

Methods
Data from 160 709 postmenopausal women in the Women’s Health Initiative was analysed using Cox proportional hazards regression models to examine prospective associations of social stress with time to total and hip fracture incidence. Self-reported questionnaires measuring social strain, social functioning and social support were used to assess social stress.

Results
Age and race/ethnicity modified associations between social stress and total and hip fractures. HRs for the associations between higher social support (indicating lower social stress) and total fractures among those age 50–59 years were 0.92 (95% CI: 0.90 to 0.94); HR=0.94 (95% CI: 0.93 to 0.95) for those age 60–69 years and HR=0.96 (95% CI: 0.95 to 0.98) for those age 70–79 years. Higher social strain was associated with greater hip fracture incidence among Native American women (HR=1.84, 95% CI: 1.10 to 3.10), Asian women (HR=1.37, 95% CI: 1.01 to 1.86) and white women (HR=1.04, 95% CI: 1.01 to 1.08).

Conclusion
Identifying population patterns of fracture incidence as biological expressions of social environments reveals how race/ethnic specific social environmental factors influence disparities in fractures.
Rates of adverse events in patients with ischemic stroke treated at thrombectomy capable hospitals
Authors: Chaudhry Saqib A , Sadaf Humaira , Laleka Ibrahim , Nasir Wahid , Witzel Catherine , Bahiru Zelalem , Fang Yun , Ishfaq Fawad , Altaweel Laith R , Qureshi Adnan I 
Published: May 2021

ObjectiveTo identify the beneficial effects of thrombectomy capable hospitals (TCHs), by comparing the incidence of in-hospital adverse events and discharge outcomes among patients with ischemic stroke treated at thrombectomy capable and non-thrombectomy capable hospitals in the United States.MethodsWe used the data from the Nationwide Inpatient Sample from January 2012 to December 2017. Thrombectomy capable hospitals were identified based on the number of thrombectomy procedures performed by a hospital each year among patients with ischemic stroke. If a hospital performed 10 or more thrombectomy procedures, it was labelled a TCH. The inclusion criteria were age ≥18 years, and ischemic stroke (International Classification of Diseases 433 .x1-434.x1 (ICD-9) or I63 (ICD-10)) as primary discharge diagnosis. A comparative analysis of propensity-matched patient groups was done to study the influence of TCH admissions on in-hospital outcomes.ResultsA total of 2 826 334 patients with primary ischemic stroke were identified. In a multivariate logistic regression model after adjusting for age, sex, race/ethnicity, hospital teaching status, comorbidities, and all patients refined diagnosis-related groups-based disease severity, patients admitted to a TCH were found to have low incidence of in-hospital adverse events: pneumonia (OR=0.86, 95% CI 0.78 to 0.93), urinary tract infection (OR=0.87, 95% CI 0.84 to 0.91), sepsis (OR=0.91, 95% CI 0.81 to 1.02), and pulmonary embolism (OR=0.89, 95% CI 0.77 to 1.03); in-hospital death (OR=0.82, 95% CI 0.78 to 0.88); and higher rate of home discharge (OR=1.09, 95% CI 1.06 to 1.12).ConclusionsA decrease in-hospital adverse events and improved discharge outcomes were observed among patients with ischemic stroke admitted to a TCH compared with a non-TCH.
Cancer incidence and mortality in the USA Astronaut Corps, 1959–2017
Authors: Reynolds Robert , Little Mark P , Day Steven , Charvat Jacqueline , Blattnig Steven , Huff Janice , Patel Zarana S 
Published: May 2021

ObjectivesCancer incidence and mortality are important outcomes in the surveillance of long-term astronaut health. We compare cancer incidence rates, cancer-specific mortality rates, and cancer case-fatality ratios in US astronauts with those in the US general population.MethodsWe use standardised incidence ratios (SIRs) and standardised mortality ratios (SMRs) to index the incidence and mortality of various cancers against rates in the US general population, from the US astronaut cohort inception in April 1959 through 31 December 2017. We compare the lethality of these cancers using the relative case-fatality ratio.ResultsOverall cancer incidence and mortality were slightly lower than expected from national rates with SIR 82 (95% CI 63 to 104) and SMR 72 (95% CI 44 to 111) with a modest 14% reduction in case-fatality ratio. Prostate cancer and melanoma skin cancer had significant increases in incidence, with SIR of 162 (95% CI 109 to 232) and 252 (95% CI 126 to 452), respectively, though only melanoma had a significant increase in mortality, with SMR 508 (95% CI 105 to 1485). Lung cancer had a significant deficit of both cases and deaths, while colon cancer had sizeable (but not significant) reductions in incidence and mortality.ConclusionsThe increase in incidence of melanoma is consistent with that observed in aircraft pilots, suggesting this may be associated with ultraviolet radiation or lifestyle factors rather than any astronaut-specific exposure. Reductions in lung cancer incidence and mortality, and trends towards such reductions in colon cancer, may be explained in part by healthy lifestyle, as well as differential screening among astronauts.
Occupational exposure to high-level disinfectants and risk of miscarriage among nurses
Authors: Ding Ming , Lawson Christina , Johnson Candice , Rich-Edwards Janet , Gaskins Audrey Jane , Boiano Jim , Henn Scott , Rocheleau Carissa , Chavarro Jorge E 
Published: May 2021

ObjectivesTo examine the association of occupational exposure to high-level disinfectants (HLDs) with risk of miscarriage among nurses.MethodsOur study included women who enrolled in the Nurses’ Health Study 3 (2010–2020) and had at least one pregnancy during follow-up. Occupational exposure to HLDs was self-reported at baseline. Every 6 months, a follow-up questionnaire was sent to participants asking for detailed information on pregnancies. We used a discrete-time Cox model to calculate the HRs and 95% CIs of miscarriage according to exposure to HLDs.ResultsOur study included 2579 nurses with a median of 5.6 years of follow-up (range: 1–9 years), and we documented 768 (19%) cases of miscarriage among 3974 pregnancies. Compared with women with no HLD exposure, the HRs of miscarriage were 1.08 (95% CI: 0.87 to 1.34) for past users and 0.84 (95% CI: 0.68 to 1.04) for HLD users. Compared with women with no HLD exposure, duration, frequency, and type of HLD and use of exposure controls were not associated with risk of miscarriage. When restricting to pregnancies that occurred within 12 months of HLD use, occupational exposure to unspecified types of HLD was significantly associated with higher risk of miscarriage (HR=1.78; 95% CI: 1.08 to 2.93).ConclusionsWe observed no associations between occupational use of HLDs and miscarriage, except when we restricted to pregnancies occurring within 12 months of assessed baseline exposure. Given the observational design and limited sample size, results should be interpreted cautiously.
Knowledge and practice of home blood pressure monitoring 6 months after the risk and assessment management programme: does health literacy matter?
Authors: FU Sau Nga , Dao Man Chi , Wong Carlos K H , Cheung Bernard M Y 
Published: May 2021

AbstractBackgroundLittle is known whether patients with lower health literacy could retain the practice and knowledge of home blood pressure monitoring (HBPM) after an educational programme.MethodsA cluster randomised controlled trial in five primary care clinics recruited participants with uncontrolled hypertension. Clinics were randomised either to a HBPM group education (Risk Assessment and Management Programme (RAMP-group), or individual counselling of self-management (RAMP-individual). Health literacy was assessed by the Chinese Health Literacy Scale for Chronic Care. Practice and knowledge of HBPM were surveyed by a 10-item HBPM knowledge checklist and patient record review 6 months after interventions. Predictors for regular HBPM and good HBPM knowledge were assessed by multivariate logistic regression models.Results287 participants (RAMP-group: 151; RAMP-individual: 136) were follow-up for 6 months. 272 participants completed the knowledge questionnaires (response rate 94.8%). 67.8% of the participants performed HBPM regularly, and there was no statistical difference between both interventions. Age more than 65 (adjusted odds ratios (aOR) 2.58, 95% CI 1.37 to 4.86, p=0.003), not working (aOR 2.34, 95% CI 1.10 to 4.97, p=0.027)and adequate health literacy (aOR 2.25, 95% CI 1.28 to 3.95, p=0.005) predicted regular HBPM. Participants in RAMP-group demonstrated a significant lower body weight than those in RAMP-individual (−0.3±2.0 kg vs +0.7 ±1.7 kg, p&lt;0.001).The RAMP-group participants were eight times more likely to have full HBPM knowledge score than the RAMP-individual participants (aOR 8.46, 95% CI 4.68 to 15.28, p&lt;0.001).ConclusionPatients could retain HBPM knowledge better after RAMP-group than RAMP-individual. Older, retired and patients with adequate health literacy were more likely to continue weekly HBPM 6 months after education.Trial registration numberNCT02551393.
Utility of nasal application of lignocaine gel using cotton tip swab versus squirting with slip-tip syringe for transnasal fibreoptic bronchoscopy: a pilot randomised controlled trial
Authors: Ray Animesh , Biswas Sagnik , Manjunath Mouna B , Meena Ved Prakash , Sethi Prayas , Sinha Sanjeev 
Published: May 2021

AbstractBackgroundDuring flexible fibreoptic bronchoscopy through the nasal route, anaesthesia of the nasal passage is achieved by lignocaine gel application by a slip-tip syringe or with the help of a cotton tip swab. No studies in existing literature have compared the two techniques in terms of efficacy.Methods137 consecutive patients undergoing bronchoalveolar lavage (BAL) were recruited over a 2-year period. The patients underwent BAL after nasal anaesthesia—either by slip-tip syringe or by cotton tip swab smeared with 2% lignocaine gel. Patients were monitored for intraprocedural epistaxis, discomfort and improvement in operator visibility of nasal passage.Results67 patients were randomised to cotton swab and 70 patients to the gel instillation group. There were no significant differences in terms of epistaxis, 29.9% in the cotton tip swab (95% CI 19.3% to 42.3%) versus 24.3% in the gel instillation group (95% CI 14.8% to 36%) or detection of nasal blocks, 7.5% in the cotton tip swab (95% CI 2.5% to 16.6%) versus 10% in the gel instillation group (95% CI 4.1% to 19.5%) in the two groups, although a significant difference was there in terms of visibility, 73.1% in the cotton tip swab (95% CI 60.9% to 83.2%) versus 42.9% in the gel instillation group (95% CI 31.1% to 55.3%). There was no difference in the mean pain score across the two groups either during the procedure or 1 hour after it. A short systematic review of existing literature on the topic has been provided for comparison.ConclusionApplication of 2% lignocaine gel by slip-tip syringe and cotton tip swab are equivalent in terms of observed and narrated pain experienced by patients, frequency of epistaxis and nasal blocks. Vision was better preserved in the cotton tip swab group.
Introduction to the development of complex interventions
Authors: Brewster Sarah , Holt Richard , Price Hermione 
Published: May 2021

AbstractHealthcare interventions are complex, but have the potential to deliver more efficient, cost-effective care and improved health outcomes. Careful attention must be paid to their early planning and development to minimise research waste or interventions that fail to deliver what they set out to achieve. The Medical Research Council provides guidance to help intervention developers, encouraging an explicit and iterative approach. This article describes the Medical Research Council's guidance and introduces two frequently used tools that further support the process of intervention design.
Review of the published literature to characterise clinical excellence in COVID-19 care
Authors: Garibaldi Brian T , Chisolm Margaret S , Berkenblit Gail V , Feller-Kopman David , Stephens R Scott , Stewart Rosalyn W , Wright Scott M 
Published: May 2021

AbstractCOVID-19 continues to be a major source of global morbidity and mortality. It abruptly stressed healthcare systems early in 2020 and the pressures continue. Devastating hardships have been endured by individuals, families and communities; the losses will be felt for years to come. As healthcare professionals and organisations stepped up to respond to the overwhelming number of cases, it is understandable that the focus has been primarily on coping with the quantity of the demand. During a pandemic, it is not surprising that few papers have drawn attention to the quality of the care delivered to those afflicted with illness. Despite the challenges, clinicians caring for patients with COVID-19 have risen to the occasion. This manuscript highlights aspirational examples from the published literature of thoughtful and superb care of patients with COVID-19 using an established framework for clinical excellence (formulated by the Miller-Coulson Academy of Clinical Excellence).
Gravitationally induced entanglement dynamics between two quantum walkers
Authors: Badhani Himanshu , Chandrashekar C. M. 
Published: May 2021

AbstractQuantum walk is a synonym for multi-path interference and faster spread of a particle in a superposition of position space. We study the effects of a quantum mechanical interaction modeled to mimic quantum mechanical gravitational interaction between the two states of the walkers. The study has been carried out to investigate the entanglement generation between the two quantum walkers that do not otherwise interact. We see that the states do in fact get entangled more and more as the quantum walks unfold, and there is an interesting dependence of entanglement generation on the mass of the two particles performing the walks. With the introduction of noise into the dynamics, we also show the sensitivity of entanglement between the two walkers on the noise introduced in one of the walks. The signature of quantum effects due to gravitational interactions highlights the potential role of quantum systems in probing the nature of gravity.
A low cost, short range quantum key distribution system
Authors: Lowndes David , Frick Stefan , Hart Andy , Rarity John 
Published: May 2021

AbstractWe present a miniaturized quantum key distribution system, designed to augment the more mature quantum key distribution systems currently commercially available. Our device is designed for the consumer market, and so size, weight and power are more important than raw performance. To achieve our form factor, the transmitter is handheld and the receiver is a larger fixed terminal. We envisage users would bring their transmitters to centrally located receivers and exchange keys which they could use at a later point. Transmitting qubits at 80 MHz, the peak key rate is in excess of 20 kbps. The transmitter device fits within an envelope of <150 ml, weighs 65 g and consumes 3.15 W of power.
High Response Rate and Durability Driven by HLA Genetic Diversity in Patients with Kidney Cancer Treated with Lenvatinib and Pembrolizumab
Authors: Lee Chung-Han , DiNatale Renzo G. , Chowell Diego , Krishna Chirag , Makarov Vladimir , Valero Cristina , Vuong Lynda , Lee Mark , Weiss Kate , Hoen Doug , Morris Luc , Reznik Ed , Murray Samuel , Kotecha Ritesh , Voss Martin H. , Carlo Maria I. , Feldman Darren , Sachdev Pallavi , Adachi Yusuke , Minoshima Yukinori , Matsui Junji , Funahashi Yasuhiro , Nomoto Kenichi , Hakimi A. Ari , Motzer Robert J. , Chan Timothy A. 
Published: May 2021

Abstract

Immune checkpoint blockade (ICB) therapy has substantially improved the outcomes of patients with many types of cancers, including renal cell carcinoma (RCC). Initially studied as monotherapy, immunotherapy-based combination regimens have improved the clinical benefit achieved by ICB monotherapy and have revolutionized RCC treatment. While biomarkers like PD-L1 and tumor mutational burden (TMB) are FDA approved as biomarkers for ICB monotherapy, there are no known biomarkers for combination immunotherapies. Here, we describe the clinical outcomes and genomic determinants of response from a phase Ib/II clinical trial on patients with advanced RCC evaluating the efficacy of lenvatinib, a multi-kinase inhibitor mainly targeting VEGFR and FGFR plus pembrolizumab, an anti-PD1 immunotherapy. Concurrent treatment with lenvatinib and pembrolizumab resulted in an objective response rate of 79% (19/24) and tumor shrinkage in 96% (23/24) of patients. While tumor mutational burden (TMB) did not predict for clinical benefit, germline HLA-I diversity strongly impacted treatment efficacy. Specifically, HLA-I evolutionary divergence (HED), which measures the breadth of a patient's immunopeptidome, was associated with both improved clinical benefit and durability of response. Our results identify lenvatinib plus pembrolizumab as a highly active treatment strategy in RCC and reveal HLA-I diversity as a critical determinant of efficacy for this combination. HED also predicted better survival in a separate cohort of patients with RCC following therapy with anti-PD-1–based combination therapy.

Implications:
These findings have substantial implications for RCC therapy and for understanding immunogenetic mechanisms of efficacy and warrants further investigation.