bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are local public expenditure reductions associated with increases in inequality in emergency hospitalisation? Time-series analysis of English local authorities from 2010 to 2017
Authors: Castro-Ávila Ana Cristina , Cookson Richard , Doran Tim , Shaw Robert , Brittain John , Sowden Sarah 
Published: June 2024

BackgroundReductions in local government funding implemented in 2010 due to austerity policies have been associated with worsening socioeconomic inequalities in mortality. Less is known about the relationship of these reductions with healthcare inequalities; therefore, we investigated whether areas with greater reductions in local government funding had greater increases in socioeconomic inequalities in emergency admissions.MethodsWe examined inequalities between English local authority districts (LADs) using a fixed-effects linear regression to estimate the association between LAD expenditure reductions, their level of deprivation using the Index of Multiple Deprivation (IMD) and average rates of (all and avoidable) emergency admissions for the years 2010–2017. We also examined changes in inequalities in emergency admissions using the Absolute Gradient Index (AGI), which is the modelled gap between the most and least deprived neighbourhoods in an area.ResultsLADs within the most deprived IMD quintile had larger pounds per capita expenditure reductions, higher rates of all and avoidable emergency admissions, and greater between-neighbourhood inequalities in admissions. However, expenditure reductions were only associated with increasing average rates of all and avoidable emergency admissions and inequalities between neighbourhoods in local authorities in England’s three least deprived IMD quintiles. For a LAD in the least deprived IMD quintile, a yearly reduction of £100 per capita in total expenditure was associated with a yearly increase of 47 (95% CI 22 to 73) avoidable admissions, 142 (95% CI 70 to 213) all-cause emergency admissions and a yearly increase in inequalities between neighbourhoods of 48 (95% CI 14 to 81) avoidable and 140 (95% CI 60 to 220) all-cause emergency admissions. In 2017, a LAD average population was ~170 000.ConclusionAusterity policies implemented in 2010 impacted less deprived local authorities, where emergency admissions and inequalities between neighbourhoods increased, while in the most deprived areas, emergency admissions were unchanged, remaining high and persistent.
Evaluation of the prehospital administration of tranexamic acid for injured patients: a state-wide observational study with sex and age-disaggregated analysis
Authors: Girardello Camille , Carron Pierre-Nicolas , Dami Fabrice , Darioli Vincent , Pasquier Mathieu , Ageron François-Xavier 
Published: June 2024

Background
Tranexamic acid (TXA) decreases mortality in injured patients and should be administered as soon as possible. Despite international guidelines recommending TXA in the prehospital setting, its use remains low. The aim of this study was to assess the prehospital administration of TXA for injured patients in a Swiss region.

Methods
We conducted a retrospective observational study in Switzerland between 2018 and 2021. Inclusion criteria were injured patients ≥18 years for whom an ambulance or helicopter was dispatched. The exclusion criterion was minor injury defined by a National Advisory Committee for Aeronautics score <3. The primary outcome was the proportion of patients treated with TXA according to guidelines. The European guidelines were represented by the risk of death from bleeding (calculated retrospectively using the Bleeding Audit for Trauma and Triage (BATT) score). Factors impacting the likelihood of receiving TXA were assessed by multivariate analysis.

Results
Of 13 944 patients included in the study, 2401 (17.2%) were considered at risk of death from bleeding. Among these, 257 (11%) received prehospital TXA. This represented 38% of those meeting US guidelines. For European guidelines, the treatment rate increased with the risk of death from bleeding: 6% (95% CI 4.4% to 7.0%) for low risk (BATT score 3–4); 13% (95% CI 11.1% to 15.9%) for intermediate risk (BATT score 5–7); and 21% (95% CI 17.6% to 25.6%) for high risk (BATT score ≥8) (p<0.01). Women and the elderly were treated less often than men and younger patients, irrespective of the risk of death from bleeding and the mechanism of injury.

Conclusion
The proportion of injured patients receiving TXA in the prehospital setting of the State of Vaud in Switzerland was low, with even lower rates for women and older patients. The reasons for this undertreatment are probably multifactorial and would require specific studies to clarify and correct them.
Initiation of mechanical thrombectomy in an insular setting with helicopter transfer: a 2-year experience from the first, complete, tertiary stroke center in the Caribbean
Authors: Bourgeois-Beauvais Quentin , Sellin Doriane , Arnaud Isaure , Tuttle Celia , Landais Anne , Lannuzel Annie , Signate Aissatou , Berge Jerome , Iosif Christina 
Published: June 2024

BackgroundThis is the first cohort study of patients treated with mechanical thrombectomy (MT) for acute ischemic stroke in the French West Indies, with a mothership center and helicopter transfer.ObjectiveTo describe the population and to evaluate imaging, clinical, and time metric outcomes, in order to assess the feasibility and adjust the territorial organization.MethodsIn this observational study, we retrospectively analyzed our prospectively collected data of a population of consecutive patients treated with MT for anterior and posterior circulation large vessel occlusions. Primary outcome was 3-month functional independence (modified Rankin Scale score ≤2). Secondary outcomes included aerial and terrestrial times of arrival, in-hospital delays, demographics, imaging and clinical data at onset, discharge, and at 3 months. We compared the results of the mothership and drip-and-ship paradigms.ResultsBetween January 2020 and December 2021, 223 patients were included (74% mothership, 26% drip-and-ship). Mean National Institutes of Health Stroke Scale (NIHSS) score of the population was 16 before MT, with significant reduction (NIHSS score 6) at discharge (9 mothership, 12 drip-and-ship, P=0.025). There was significant difference in onset-to-operation room times among the two centers (335 min mothership, 500 min drip-and-ship, P=0.004). Successful recanalization (modified Thrombolysis in Cerebral Infarction score 2b–3) was 80.3%. Functional independence at 3 months was 35%, symptomatic intracranial hemorrhage was 11%, and the complication rate was 9.4%, all without statistically significant difference between the two groups.ConclusionThe population has distinct risk factors. MT with helicopter transfer is feasible in the French West Indies. Reduction of prehospital and in-hospital times is mandatory; evaluation of the territorial strategy is underway, to avoid over-selection of transferred patients.
Rectus sheath block added to parasternal block may improve postoperative pain control and respiratory performance after cardiac surgery: a superiority single-blinded randomized controlled clinical trial
Authors: Strumia Alessandro , Pascarella Giuseppe , Sarubbi Domenico , Di Pumpo Annalaura , Costa Fabio , Conti Maria Cristina , Rizzo Stefano , Stifano Mariapia , Mortini Lara , Cassibba Alessandra , Schiavoni Lorenzo , Mattei Alessia , Ruggiero Alessandro , Agrò Felice E , Carassiti Massimiliano , Cataldo Rita 
Published: June 2024

BackgroundThe population undergoing cardiac surgery confronts challenges from uncontrolled post-sternotomy pain, with possible adverse effects on outcome. While the parasternal block can improve analgesia, its coverage may be insufficient to cover epigastric area. In this non-blinded randomized controlled study, we evaluated the analgesic and respiratory effect of adding a rectus sheath block to a parasternal block.Methods58 patients undergoing cardiac surgery via median sternotomy were randomly assigned to receive parasternal block with rectus sheath block (experimental) or parasternal block with epigastric exit sites of chest drains receiving surgical infiltration of local anesthetic (control). The primary outcome of this study was pain at rest at extubation. We also assessed pain scores at rest and during respiratory exercises, opiate consumption and respiratory performance during the first 24 hours after extubation.ResultsThe median (IQR) maximum pain scores (on a 0–10 Numeric Rate Scale (NRS)) at extubation were 4 (4, 4) in the rectus sheath group and 5 (4, 5) in the control group (difference 1, p value=0.03). Rectus sheath block reduced opioid utilization by 2 mg over 24 hours (IC 95% 0.0 to 2.0; p<0.01), reduced NRS scores at other time points, and improved respiratory performance at 6, 12, and 24 hours after extubation.ConclusionThe addition of a rectus sheath block with a parasternal block improves analgesia for cardiac surgery requiring chest drains emerging in the epigastric area.Trial registration numberNCT05764616.
Radiofrequency ablation versus intra-articular mesenchymal stem cell injection for knee osteoarthritis: a systematic review and network meta-analysis
Authors: Park Sukhee , Park Soyoon , Jang Jae Ni , Choi Young-Soon , Kim Dong Seong , Sohn Jeong Eun , Park Ji-Hoon 
Published: June 2024

BackgroundKnee osteoarthritis (OA) is a prevalent degenerative disease and causes disability, pain and imposes a substantial burden on patients. Conventional treatments for knee OA show limited effectiveness. Consequently, innovative treatments, such as radiofrequency ablation (RFA) and intra-articular mesenchymal stem cells (IA MSC), have gained attention for addressing these limitations.ObjectiveWe compared the efficacy of RFA and IA MSC for knee OA through a network meta-analysis (NMA).Evidence reviewA literature search was conducted using PubMed, MEDLINE, Embase, Cochrane Library, Web of Science and handsearching. Randomized controlled trials (RCTs) comparing RFA or IA MSC to conventional treatments for knee OA were included. The primary outcomes comprised the pain score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The clinical outcomes were compared using a frequentist approach, and the treatments were ranked using the surface under the cumulative ranking curve (SUCRA) values.FindingsWe included 34 RCTs (n=2371). Our NMA revealed that RFA and IA MSC were significantly more effective than conventional treatments in managing pain at both 3 and 6 months with moderate certainty. Specifically, RFA demonstrated the highest SUCRA values, indicating its superior efficacy. For WOMAC scores, both RFA and MSC showed significant improvements at 3 months, with RFA maintaining its lead at 6 months, although MSC did not display significant superiority at this stage.ConclusionsThis analysis suggests that RFA and MSC are resilient treatment options in knee OA. Despite some study heterogeneity, these treatments consistently outperformed conventional treatments, particularly in the short to mid-term, although with varying levels of certainty in their efficacy.PROSPERO registration numberCRD42023492299.
Randomized Trial for Evaluation in Secondary Prevention Efficacy of Combination Therapy–Statin and Eicosapentaenoic Acid (RESPECT-EPA)
Authors: Miyauchi Katsumi , Iwata Hiroshi , Nishizaki Yuji , Inoue Teruo , Hirayama Atsushi , Kimura Kazuo , Ozaki Yukio , Murohara Toyoaki , Ueshima Kenji , Kuwabara Yoshihiro , Tanaka-Mizuno Sachiko , Yanagisawa Naotake , Sato Tosiya , Daida Hiroyuki ,   RESPECT-EPA Investigators
Published: June 2024

BACKGROUND:
Low plasma levels of eicosapentaenoic acid (EPA) are associated with cardiovascular events. This trial aimed to assess the clinical benefits of icosapent ethyl in patients with coronary artery disease, a low EPA/arachidonic acid (AA) ratio, and statin treatment.

METHODS:
In this prospective, multicenter, randomized, open-label, blinded end-point study, patients with stable coronary artery disease and a low EPA/AA ratio (<0.4) were randomized to EPA (1800 of icosapent ethyl administered daily) or control group. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, unstable angina pectoris, and coronary revascularization. The secondary composite end points of coronary events included sudden cardiac death, fatal and nonfatal myocardial infarction, unstable angina requiring emergency hospitalization and coronary revascularization, or coronary revascularization.

RESULTS:

Overall, 3884 patients were enrolled at 95 sites in Japan. Among them, 2506 patients had a low EPA/AA ratio, and 1249 and 1257 patients were randomized to the EPA and control group, respectively. The median EPA/AA ratio was 0.243 (interquartile range, 0.180–0.314) and 0.235 (interquartile range, 0.163–0.310) in the EPA and control group, respectively. Over a median period of 5 years, the primary end point occurred in 112 of 1225 patients (9.1%) and 155 of 1235 patients (12.6%) in the EPA and control group, respectively (hazard ratio, 0.79 [95% CI, 0.62–1.00];
P
=0.055). Meanwhile, the secondary composite end point of coronary events in the EPA group was significantly lower (81/1225 [6.6%] versus 120/1235 [9.7%] patients; hazard ratio, 0.73 [95% CI, 0.55–0.97]). Adverse events did not differ between the groups, but the rate of new-onset atrial fibrillation was significantly higher in the EPA group (3.1% versus 1.6%;
P
=0.017).

CONCLUSIONS:
Icosapent ethyl treatment resulted in a numerically lower risk of cardiovascular events that did not reach statistical significance in patients with chronic coronary artery disease, a low EPA/AA ratio, and statin treatment.

REGISTRATION:

URL:
https://www.umin.ac.jp/ctr/
; Unique identifier: UMIN000012069.
Prognostic Significance of Proteomics‐Discovered Circulating Inflammatory Biomarkers in Patients With Pulmonary Arterial Hypertension
Authors: Yokokawa Tetsuro , Boucherat Olivier , Martineau Sandra , Lemay Sarah‐Eve , Breuils‐Bonnet Sandra , Krishna Vinod , Kalyana‐Sundaram Shanker , Jeyaseelan Jey , Potus François , Bonnet Sébastien , Provencher Steeve 
Published: June 2024

Background
Pulmonary arterial hypertension (PAH) ultimately leads to right ventricular failure and premature death. The identification of circulating biomarkers with prognostic utility is considered a priority. As chronic inflammation is recognized as key pathogenic driver, we sought to identify inflammation‐related circulating proteins that add incremental value to current risk stratification models for long‐term survival in patients with PAH.

Methods and Results
Plasma levels of 384 inflammatory proteins were measured with the proximity extension assay technology in patients with PAH (n=60) and controls with normal hemodynamics (n=28). Among these, 51 analytes were significantly overexpressed in the plasma of patients with PAH compared with controls. Cox proportional hazard analyses and C‐statistics were performed to assess the prognostic value and the incremental prognostic value of differentially expressed proteins. A panel of 6 proteins (CRIM1 [cysteine rich transmembrane bone morphogenetic protein regulator 1], HGF [hepatocyte growth factor], FSTL3 [follistatin‐like 3], PLAUR [plasminogen activator, urokinase receptor], CLSTN2 [calsyntenin 2], SPON1 [spondin 1]) were independently associated with death/lung transplantation at the time of PAH diagnosis after adjustment for the 2015 European Society of Cardiology/European Respiratory Society guidelines, the REVEAL (Registry to Evaluate Early and Long‐Term PAH Disease Management) 2.0 risk scores, and the refined 4‐strata risk assessment. CRIM1, PLAUR, FSTL3, and SPON1 showed incremental prognostic value on top of the predictive models. As determined by Western blot, FSTL3 and SPON1 were significantly upregulated in the right ventricle of patients with PAH and animal models (monocrotaline‐injected and pulmonary artery banding‐subjected rats).

Conclusions
In addition to revealing new actors likely involved in cardiopulmonary remodeling in PAH, our screening identified promising circulating biomarkers to improve risk prediction in PAH, which should be externally confirmed.
CYP2C19
Genotype Is Associated With Adverse Cardiovascular Outcomes in Black Patients Treated With Clopidogrel Undergoing Percutaneous Coronary Intervention
Authors: Tunehag Kayla R. , Thomas Cameron D. , Franchi Francesco , Rossi Joseph S. , Keeley Ellen C. , Anderson R. David , Beitelshees Amber L. , Duarte Julio D. , Gong Yan , Kerensky Richard A. , McDonough Caitrin W. , Nguyen Anh B. , Ortega‐Paz Luis , Venkatesh Sanjay , Wang Yehua , Johnson Julie A. , Winterstein Almut G. , Stouffer George A. , Angiolillo Dominick J. , Cavallari Larisa H. , Lee Craig R. 
Published: June 2024

Background

Cytochrome P450 2C19 (CYP2C19) intermediate and poor metabolizer patients exhibit diminished clopidogrel clinical effectiveness after percutaneous coronary intervention (PCI). However, outcome studies to date have lacked racial diversity. Thus, the impact of
CYP2C19
genotype on cardiovascular outcomes in patients treated with clopidogrel who identify as Black or African American remains unclear.

Methods and Results

Adults among 5 institutions who self‐identified as Black or African American, underwent PCI and clinical
CYP2C19
genotyping, and were treated with clopidogrel were included. Data were abstracted from health records. Major atherothrombotic (composite of death, myocardial infarction, ischemic stroke, stent thrombosis, or revascularization for unstable angina) and bleeding event rates within 1 year after PCI were compared across CYP2C19 metabolizer groups using multivariable Cox regression adjusted for potential confounders and baseline variables meeting a threshold of
P
<0.10. The population included 567 Black patients treated with clopidogrel (median age, 62 years; 46% women; 70% with an acute coronary syndrome indication for PCI). Major atherothrombotic events rates were significantly higher among clopidogrel‐treated intermediate and poor metabolizers (24 of 125 [19.2%]) versus patients treated with clopidogrel without a no function allele (43 of 442 [9.7%]; 35.1 versus 15.9 events per 100 person‐years; adjusted hazard ratio, 2.00 [95% CI, 1.20–3.33],
P
=0.008). Bleeding event rates were low overall (23 of 567 [4.1%]) and did not differ among the metabolizer groups.

Conclusions
Black patients with CYP2C19 intermediate and poor metabolizer phenotypes who are treated with clopidogrel exhibit increased risk of adverse cardiovascular outcomes after PCI in a real‐world clinical setting. Bleeding outcomes should be interpreted cautiously. Prospective studies are needed to determine whether genotype‐guided use of prasugrel or ticagrelor in intermediate and poor metabolizers improves outcomes in Black patients undergoing PCI.
Child Rights and Realities
Authors: Bendo Daniella 
Published: June 2024

Abstract
This paper explores how children’s rights are operationalised in practice, specifically by Canadian child and youth advocate offices (all 12 offices across Canada), international children’s commissioners’ offices (in Northern Ireland, Australia, New Zealand, Belgium, Norway and Denmark), and their institutional structures. A total of 24 participants took part in the study, including 12 current child and youth advocates from the Canadian Council of Child and Youth Advocates (cccya), two former advocates from the cccya, three additional staff members of the cccya (collectively, representing all 12 jurisdictions across Canada), one children’s commissioner and six designates on behalf of various international children’s commissioners. This paper shifts the research focus of children’s rights and childhood studies from the narrow confines of the individual child to a focus on the broader relational and interdependent aspects inherent within institutions that protect and promote children’s rights.
Re-Thinking the “Invisible Child” Constitutions
Authors: Couzens Meda 
Published: June 2024

Abstract
Recent attempts to systematise the constitutional protection of children’s rights by creating constitutional typologies have been a useful first step in theorising this growing field. These efforts have focused on the wording of constitutions rather than their application, while forms of constitutional protection that are less textually explicit and more difficult to detect have received limited attention. By exploring the constitutional protection of children’s rights in France, this article demonstrates that some constitutions poor in explicit provisions on children’s rights can provide valuable protection through their general provisions. The article further argues that constitutional typologies of children’s rights protection should be expanded to encompass non-liberal constitutions.
Religious Women in Africa
Authors: Almeida João Miguel 
Published: June 2024

Abstract
This paper sets out not only to explain how the Servants of Our Lady of Fatima became a missionary congregation in Mozambique in the late Portuguese colonial period (1972–1975) but also to detail the impacts of their activities in the post-colonial period in Mozambique. This process highlights the pastoral and theological approaches of the Servants. The missionary women were empowered during the early years of independence. This historical context was marked by changes in the ecclesiastic structures and pastoral approaches as well as changes in church-state relation during the transition of Mozambique to independence and the “sixteen years war” (1977–1992).
The Founding of the Baikaryū
Authors: Mross Michaela 
Published: June 2024

Abstract
This article explores the founding of the Baikaryū, the Sōtō school’s lineage of goeika hymn chanting. In the 1920s, Buddhist reformers in other schools developed lineages of singing goeika and in this process standardized the performance practice. Seeing the great popularity of goeika hymn chanting, Sōtō clerics created their goeika lineage in the 1950s, strongly influenced by the Shingon goeika lineages. I examine the background that led to the founding of the Baikaryū. Why did Sōtō clerics decide to create a new goeika lineage? What were their models? And what steps did they take? Throughout this article, I demonstrate that music played a vital role in fostering lay engagement in Sōtō Zen, as well as in other traditional Buddhist schools, in the twentieth century as clerics felt the need to employ new hymns and songs that sound—and “feel”—fresh to lay people.