bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of major congenital malformations following first‐trimester exposure to vaginal azoles used for treating vulvovaginal candidiasis: a population‐based retrospective cohort study
Authors: Rotem R , Fishman B , Daniel S , Koren G , Lunenfeld E , Levy A 
Published: May 2018

ObjectiveTo evaluate the risk for major malformations following first‐trimester exposure to vaginal azoles.DesignA population‐based retrospective cohort study of women exposed to vaginal azoles from the first day of the last menstrual period until the 90th gestational day.SettingA combination of four computerised databases: medications, birth, infant hospitalizations, and pregnancy terminations.PopulationAll women who gave birth or underwent a pregnancy termination at Soroka Medical Center, Beer‐Sheva, Israel, between 1999 and 2009.MethodsCrude and adjusted relative risks for major congenital malformations and for specific malformations according to organ systems were calculated using a multivariate negative binomial regression. Potential confounders were assessed and controlled for included parity, maternal age, ethnicity, maternal diabetes, smoking, and year of birth or pregnancy termination. Additional analysis using propensity score matching was performed for selected malformations.Main outcome measuresMajor malformations as well as specific malformations according to organ systems.ResultsOf 101 615 pregnancies, 1993 (1.96%) were exposed to clotrimazole vaginal tablets and 313 (0.31%) to miconazole vaginal tablets during the first trimester of pregnancy. No association was found between first‐trimester exposure to clotrimazole and major or specific malformations. An association was found between miconazole exposure and musculoskeletal malformation in general and other congenital musculoskeletal anomalies in particular. However, no association was detected when propensity score matching was used.ConclusionsIntrauterine exposure to vaginal azoles during the first trimester of pregnancy was not associated with either major or specific malformations according to organ systems.Tweetable abstractFirst‐trimester exposure to vaginal azoles is not associated with either major or specific malformations.
Two‐step tier three interventions for children in grade three with low reading fluency
Authors: Svensson Idor , Fälth Linda , Tjus Tomas , Heimann Mikael , Gustafson Stefan 
Published: May 2018

The main aim of this study was to investigate the effect of a tier three intervention, response‐to‐intervention design, on children with low reading ability in grade three. Twenty‐eight children (12 females and 16 males) participated in this study. The participants were given out a battery of reading tests including decoding and reading comprehension tests, and in total, the children received 20 reading intervention sessions in two waves, during 4 weeks. The results showed substantial gains with large effect sizes (d 0.78–2.95) on all the reading tests after the intervention period. A short, intensive and individualised intervention has a substantially positive effect on children's reading ability. For a majority of the children, the increased ability sustains even 4 years after the end of the interventions. However, as boys seem to have the greatest problem to sustain their increased ability, the authors claim that it is important to continue the intervention even after the research interventions have ended.
Building a Workforce for Future Health Systems: Reflections from Health Policy and Systems Research
Authors: Javadi Dena , Tran Nhan , Ghaffar Abdul 
Published: May 2018

IntroductionThe era of the Sustainable Development Goals calls for multidisciplinary research and intersectoral approaches to addressing health challenges. This presents a unique opportunity for multidisciplinary fields concerned with complex systems. Those working in system‐oriented fields such as health policy and systems research (HPSR) and health services research must be forward‐thinking in optimizing their collective ability to address these global challenges.ObjectivesThe objective of this commentary was to share reflections on challenges and strategies in managing the HPSR workforce in order to stimulate dialogue and cross‐learning across similar fields.Strategies/FindingsThe following strategies are discussed here: definitional clarity of expected competencies and coordination across HPS researchers, national investment in HPSR, institutional capacity for coproduction of knowledge across different types of actors, and participatory leadership.ConclusionsCreative approaches in training, financing, developing, and leading the diverse workforce required to strengthen health systems can pave the way for its full‐time and part‐time members to work together.
Caring for older patients in the emergency department: Health professionals’ perspectives from Australia – The Safe Elderly Emergency Discharge project
Authors: Lennox Alyse , Braaf Sandra , Smit De Villiers , Cameron Peter , Lowthian Judy A 
Published: May 2018

AbstractObjectiveTo explore health professionals’ perspectives about caring for community‐dwelling older patients in the ED.MethodsThis exploratory qualitative study was undertaken with emergency nursing, medical and allied health staff from the ED of a large metropolitan public hospital in Melbourne. Nine focus groups (n = 54) and seven interviews were conducted between 2013 and 2014. Data were thematically analysed.ResultsHealth professionals described tailoring their approach when caring for older patients, including adopting a specific communication approach (i.e. increased voice volume, slower rate of speech). Caring for older patients was perceived as challenging given the need to balance the expectations of family members to deal with associated complex needs and limited time for transitional care planning in the ED. The environment and equipment were perceived as unsuitable, alongside a lack of geriatric‐specific knowledge; contributing to what health professionals described as a poor fit between the ED system and older patients’ needs.ConclusionThe growing number of older patients presents numerous challenges for emergency health professionals and necessitates a tailored approach to care. Understanding health professionals’ perspectives about caring for older patients can inform strategies that may improve the quality of care. Creating older person‐friendly areas, improving transitional care and providing staff with specific education would foster an environment that promotes person‐centred care, safety, independence and functional wellbeing.
Analysis of preventable deaths and errors in trauma care in a Scandinavian trauma level‐I centre
Authors: Ghorbani P. , Strömmer L. 
Published: May 2018

BackgroundThe wide disparity in the methodology of preventable death analysis has created a lack of comparability among previous studies. The guidelines for the peer review (PR) procedure suggest the inclusion of risk‐adjustment methods to identify patients to review, that is, exclude non‐preventable deaths (probability of survival [Ps] < 25%) or focus on preventable deaths (Ps > 50%). We aimed to, through PR process, (1) identify preventable death and errors committed in a level‐I trauma centre, and (2) explore the use of different risk‐adjustment methods as a complement.MethodsA multidisciplinary committee reviewed all trauma patients, which died a trauma‐related death, within 30 days of admission to Karolinska University Hospital, Stockholm, in the period of 2012‐2016. Ps was calculated according to TRISS and NORMIT and their accuracy where compared.ResultsTwo hundred and ninety‐eight deaths were identified and 252 were reviewed. The majority of deaths occurred between 1 and 7 days. Ten deaths (4.0%) were classified as preventable. Sixty‐seven errors were identified in 53 (21.0%) deaths. The most common error was inappropriate treatment in all deaths (21 of 67) and in preventable deaths (5 of 13). Median Ps in non‐preventable deaths was higher than the cut‐off (<25%) and Ps‐TRISS was almost twice as high as Ps‐NORMIT (65% vs 33%, P < .001). Two clinically judged preventable deaths with Ps <25% would have been missed with both models. Median Ps in preventable deaths was above the cut‐off (>50%) and higher with Ps‐TRISS vs Ps‐NORMIT (75% vs 58%, P < .001). Three and 4 clinically judged preventable deaths would have been missed, respectively, for TRISS and NORMIT, if using this cut‐off.ConclusionPreventable deaths were commonly caused by clinical judgment errors in the early phases but death occurred late. Ps calculated with NORMIT was more accurate than TRISS in predicting mortality, but both perform poorly in identifying preventable and non‐preventable deaths when applying the cut‐offs. PR of all trauma death is still the golden standard in preventability analysis.
Corticosteroids and risk of gastrointestinal bleeding in critically ill adults: Protocol for a systematic review
Authors: Butler E. , Møller M. H. , Cook O. , Granholm A. , Penketh J. , Rygård S. L. , Aneman A. , Perner A. 
Published: May 2018

BackgroundCorticosteroids are frequently prescribed to critically ill patients. However, their use may increase the risk of gastrointestinal (GI) bleeding, which is associated with morbidity and mortality. Accordingly, we aim to assess whether continued administration of corticosteroids for >24 hours increases the rate of GI bleeding in adult critically ill patients compared to placebo or no treatment.Methods/DesignWe will conduct a systematic review of randomized clinical trials with meta‐analysis and trial sequential analysis. The participants will be adult (as defined in the included trials) critically ill patients. The intervention will be any corticosteroid administered systematically for >24 hours and the comparator will be placebo or no treatment. The primary outcome will be rate of clinically important GI bleeding. We will systematically search EMBASE, MEDLINE, Medline In‐Process, Cochrane Library, Epistemonikos and trial registries for relevant literature, as well as perform a hand search. We will follow the recommendations by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Review and Meta‐Analysis (PRISMA) statement. The risk of systematic errors (bias) and random errors will be assessed and the overall quality of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.DiscussionThe risk of GI bleeding in adult critically ill patients treated with corticosteroids is unknown. Hence, there is need for a robust systematic review to assess this risk and provide clinicians with a clearer understanding of the strength and limitations of existing data.
Characteristics of jugular bulb oxygen saturation in patients after cardiac arrest: A prospective study
Authors: Wallin E. , Larsson I.‐M. , Nordmark‐Grass J. , Rosenqvist I. , Kristofferzon M.‐L. , Rubertsson S. 
Published: May 2018

BackgroundUsing cerebral oxygen venous saturation post‐cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post‐ CA in cases where TTM 33°C was applied.MethodProspective observational study in patients over 18 years, comatose immediately after resuscitation from CA. Patients were treated with TTM 33°C M and received a jugular bulb catheter within the first 26 hours post‐CA. Neurological outcome was assessed at 6 months using the Cerebral Performance Categories (CPC) and dichotomized into good (CPC 1‐2) and poor outcome (CPC 3‐5).ResultsSeventy‐five patients were included and 37 (49%) patients survived with a good outcome at 6 months post‐CA. No differences were found between patients with good outcome and poor outcome in jugular bulb oxygen saturation. Higher values were seen in differences in oxygen content between central venous oxygen saturation and jugular bulb oxygen saturation in patients with good outcome compared to patients with poor outcome at 6 hours (12 [8‐21] vs 5 [−0.3 to 11]% P = .001) post‐CA. Oxygen extraction fraction from the brain illustrated lower values in patients with poor outcome compared to patients with good outcome at 96 hours (14 [9‐23] vs 31 [25‐34]% P = .008).ConclusionsOxygen delivery and extraction differed in patients with a good outcome compared to those with a poor outcome at single time points. Based on the present findings, the usefulness of jugular bulb oxygen saturation for prognostic purposes is uncertain in patients treated with TTM 33°C post‐CA.
Alcohol Consumption and Trait Anger Strengthen the Association Between Perceived Quarrelsomeness and Quarrelsome Behavior via Feeling Angry
Authors: Sadikaj Gentiana , Moskowitz D. S. 
Published: May 2018

BackgroundAlcohol intoxication facilitates interpersonal aggression, but this effect depends on person and situation characteristics. Using the Alcohol Myopia Model, we examined the joint influence of alcohol, trait anger, and state anger on the association between perceived quarrelsomeness in an interaction partner and quarrelsome behavior in naturally occurring interpersonal interactions.MethodsUsing an event‐contingent recording method over a 20‐day period, community adults reported their perception of an interaction partner's quarrelsome behavior, their own anger and quarrelsome behavior, and the number of alcohol drinks consumed up to 3 hours prior to an interpersonal interaction.ResultsResults revealed that alcohol consumption and trait anger jointly moderated the association between perceived quarrelsomeness and quarrelsome behavior indirectly via state anger. Heightened anger experience accounted for increased quarrelsome behavior in response to perceived quarrelsomeness among higher trait anger individuals who reported increased alcohol consumption. When no alcohol was consumed, no such difference in quarrelsome behavioral response was found between low and high trait anger individuals.ConclusionsFindings suggest that alcohol consumption may strengthen the influence of perceived quarrelsomeness on a person's own quarrelsome behavior among individuals with a readiness to experience anger. Intense anger experience may undermine these individuals' ability to inhibit aggressive behaviors when under the influence of alcohol.
Initial experience with robotic pancreatic surgery in Singapore: single institution experience with 30 consecutive cases
Authors: Goh Brian K. P. , Low Tze‐Yi , Lee Ser‐Yee , Chan Chung‐Yip , Chung Alexander Y. F. , Ooi London L. P. J. 
Published: May 2018

BackgroundPresently, the worldwide experience with robotic pancreatic surgery (RPS) is increasing although widespread adoption remains limited. In this study, we report our initial experience with RPS.MethodsThis is a retrospective review of a single institution prospective database of 72 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2017. Of these, 30 patients who underwent RPS were included in this study of which 25 were performed by a single surgeon.ResultsThe most common procedure was robotic distal pancreatectomy (RDP) which was performed in 20 patients. This included eight subtotal pancreatectomies, two extended pancreatecto‐splenectomies (en bloc gastric resection) and 10 spleen‐saving‐RDP. Splenic preservation was successful in 10/11 attempted spleen‐saving‐RDP. Eight patients underwent pancreaticoduodenectomies (five hybrid with open reconstruction), one patient underwent a modified Puestow procedure and one enucleation of uncinate tumour. Four patients had extended resections including two RDP with gastric resection and two pancreaticoduodenectomies with vascular resection. There was one (3.3%) open conversion and seven (23.3%) major (>Grade II) morbidities. Overall, there were four (13.3%) clinically significant (Grade B) pancreatic fistulas of which three required percutaneous drainage. These occurred after three RDP and one robotic enucleation. There was one reoperation for port‐site hernia and no 30‐day/in‐hospital mortalities. The median post‐operative stay was 6.5 (range: 3–36) days and there were six (20%) 30‐day readmissions.ConclusionOur initial experience showed that RPS can be adopted safely with a low open conversion rate for a wide variety of procedures including pancreaticoduodenectomy.
Cervical cancer staging, pretreatment planning, and surgical treatment in the Nordic countries—Survey from the Surgical Subcommittee of the Nordic Society of Gynecological Oncology
Authors: Fuglsang Katrine , Haldorsen Ingfrid S , Avall‐Lundqvist Elisabeth , Lindahl Gabriel , Roed Henrik , Woie Kathrine , Pakarinen Päivi , Thoroddsen Asgeir , Anttila Maarit , Blaakær Jan 
Published: May 2018

AbstractIntroductionWomen with cervical cancer in the Nordic countries are increasingly undergoing pretreatment imaging by ultrasound, magnetic resonance imaging (MRI), positron emission tomography‐computed tomography (PET‐CT) or computed tomography, or sentinel lymph node procedure. The present survey reports the influence of pretreatment imaging findings on the recorded clinical International Federation of Gynecology and Obstetrics (FIGO) stage in Nordic countries and its impact on treatment planning and preferred surgical approach in cervical cancer.Material and methodsThe Nordic Society of Gynecological Oncology Surgical Subcommittee developed a questionnaire‐based survey that was conducted from 1 January to 31 March 2017. All the 22 Nordic Gynecological Oncology Centers (Denmark 5, Finland 5, Iceland 1, Norway 4, and Sweden 7) were invited to participate.ResultsThe questionnaires were returned by 19 of 22 (86.3%) centers. The median number (range) of women with cervical cancer treated at each center annually was 32 (15‐120). In 58% (11/19) of the centers, imaging findings were reported to influence the clinical staging. MRI in combination with PET‐CT was the preferred imaging method and the results influenced treatment planning. Robotic‐assisted radical hysterectomy was the preferred surgical method in 72% (13/18) of the centers. Sentinel lymph node procedure was not routinely implemented in the majority of the Nordic centers.ConclusionMore than half of the Nordic Gynecological Oncology Centers already report a clinical FIGO stage influenced by pretreatment imaging findings. The trend in preferred treatment is robotic‐assisted radical hysterectomy and the sentinel lymph node procedure is gradually being introduced.
Restored topography of the Po Plain‐Northern Adriatic region during the Messinian base‐level drop—Implications for the physiography and compartmentalization of the palaeo‐Mediterranean basin
Authors: Amadori Chiara , Garcia‐Castellanos Daniel , Toscani Giovanni , Sternai Pietro , Fantoni Roberto , Ghielmi Manlio , Di Giulio Andrea 
Published: May 2018

AbstractThe Messinian Salinity Crisis (MSC) involved the progressive isolation of the Mediterranean Sea from the Atlantic between 5.97 and 5.33 Ma, and a sea‐level fall whose timing, modalities, and magnitude remain actively debated. At that time, the central Mediterranean was undergoing strong tectonic activity due to the rollback of the Adria slab and eastward migration of the Apenninic belt. The combined effects of the post‐evaporiticMSCsea‐level drop and morphostructural changes (due to the Intra‐Messinian phase) resulted in a regional unconformity, which shows erosive markers and conformable relationships with the Messinian and Mio–Pliocene boundary in the Po Plain and Northern Adriatic Foreland. Here, we produce a palaeotopographic reconstruction of the Po Plain‐Northern Adriatic region (PPNA) during the Messinian peak desiccation event based on such regional unconformity. We mapped this surface through wells and 2D seismic data form Eni's private dataset. The unconformity shows V‐shaped incisions matching the present‐day southern Alpine valleys and filled with Messinian post‐evaporitic and Pliocene deposits, suggesting that the modern drainage network is at least of late Messinian age. The Messinian unconformity has been restored to its original state through flexural‐backstripping numerical modelling. The resulting landscape suggests a maximum sea‐level drop of 800–900 m during theMSCpeak, and is consistent with stratigraphic and sedimentologic data provided by previous works. The modelled shoreline separates the subaerially eroded land from an elongated basin composed by twoca. 400 and 1,000 m deep depocentres during the maximum sea‐level drop. These results suggest that the Mediterranean was split in at least three sub‐basins subject to independent base levels, fresh‐water budgets, and flexural responses during the maximum lowstand.
Clustered miRNAs and their role in biological functions and diseases
Authors: Kabekkodu Shama P. , Shukla Vaibhav , Varghese Vinay K. , D' Souza Jeevitha , Chakrabarty Sanjiban , Satyamoorthy Kapaettu 
Published: May 2018

ABSTRACTMicroRNAs (miRNAs) are endogenous, small non‐coding RNAs known to regulate expression of protein‐coding genes. A large proportion of miRNAs are highly conserved, localized as clusters in the genome, transcribed together from physically adjacent miRNAs and show similar expression profiles. Since a single miRNA can target multiple genes and miRNA clusters contain multiple miRNAs, it is important to understand their regulation, effects and various biological functions. Like protein‐coding genes, miRNA clusters are also regulated by genetic and epigenetic events. These clusters can potentially regulate every aspect of cellular function including growth, proliferation, differentiation, development, metabolism, infection, immunity, cell death, organellar biogenesis, messenger signalling, DNA repair and self‐renewal, among others. Dysregulation of miRNA clusters leading to altered biological functions is key to the pathogenesis of many diseases including carcinogenesis. Here, we review recent advances in miRNA cluster research and discuss their regulation and biological functions in pathological conditions.