bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why do children under 5 years go to the GP in Lambeth: a cross-sectional study
Authors: Craven Eleanor May , Luck Gemma , Whitney David , Dodhia Hiten , Foster Shaneka , Stanke Carla , Seed Paul T , Crompton James , Brown Kerry Ann 
Published: May 2024

ObjectivesThis study identifies the most common recorded reason for attendance to primary care for children under 5 years old, including a breakdown via age, ethnicity, deprivation quintile and sex.DesignCross-sectional.Setting39 of 40 general practices in Lambeth, London, UK.Participants22 189 children under 5 years who had attended primary care between the 1 April 2017 and 31 March 2020 and had not opted out of anonymous data sharing within Lambeth DataNet.Outcome measureThe primary objective was to identify the most frequently recorded complaint in general practice for children under 5 years old. The secondary objective was to understand how presenting complaint differs by age, ethnicity, sex and deprivation level. The third objective was to create a multivariate logistic regression with frequent attendance as the outcome variable.ResultsNine conditions formed over 50% of all patient interactions: the most common reason was upper respiratory tract infections (14%), followed by eczema (8%) and cough (7%). While there was some variation by ethnicity and age, these nine conditions remained dominant. Children living in the most deprived area are more likely to be frequent attenders than children living in the least deprived area (adjusted OR (AOR) 1.27 (95% CI 1.14 to 1.41)). Children of Indian (AOR 1.47 (1.04 to 2.08)), Bangladeshi (AOR 2.70 (1.95 to 3.74)) and other white (AOR 1.18 (1.04 to 1.34)) ethnicities were more likely to be frequent attenders, compared with those of white British ethnicity.ConclusionsMost reasons for attendance for children under 5 years to primary care are for acute, self-limiting conditions. Some of these could potentially be managed by increasing access to community care services, such as pharmacies. By focusing on the influence of the broader determinants of health as to why particular groups are more likely to attend, health promotion efforts have the opportunity to reduce barriers to healthcare and improve outcomes.
Determinants of COVID-19 severity in Ethiopia: a multicentre case–control study
Authors: Tadie Manayesh Bantie , Yimer Yimer Seid , Taye Girma 
Published: May 2024

ObjectiveIt was necessary to understand the determinants of severe COVID-19 in order to deliver targeted healthcare services to prevent further complications and mortality. Identifying the factors associated with severe COVID-19 in Addis Ababa, Ethiopia, is the aim of this study.DesignA case–control study was conducted from October 2021 to March 2022.SettingThe study was conducted at three public COVID-19 treatment centres including Ekka Kotebe General, St. Peter Hospital and St. Paul’s Hospital.ParticipantsThe study participants were COVID-19 patients admitted to three COVID-19 treatment centres. Cases were patients admitted with severe COVID-19, and controls were patients with mild or moderate COVID-19. A total of 306 patients (153 cases and 153 controls) selected by simple random sampling technique participated in this study.Outcome measures and analysisData were collected by a face-to-face or telephone interviewer using a structured questionnaire. COVID-19 admission category, clinical and biomedical characteristics and comorbidity-related data were extracted from the participant’s medical record. Multivariable binary logistic regression analysis was used to identify predictors of COVID-19 severity.ResultsThe odds of being old were 4.54 times higher among severe COVID-19 cases (adjusted odds ratio (AOR)=4.54, 95% CI=2.499 to 8.24), the odds of being male were 2.72 times higher among severe COVID-19 cases (AOR=2.72, 95% CI=1.46 to 5.057), being vaccinated for COVID-19 decreases the severity by 55.1% (AOR=0.449, 95% CI=0.251 to 0.801), having good knowledge about COVID-19 decreases by 65% (AOR=0.35%, 95% CI=0.195 to 0.63) among patients with severe COVID-19, the odds of being diabetic were 10.2 times higher among severe COVID-19 cases (AOR=10.2, 95% CI=4.596 to 22.61) and the odds of being hypertensive were 2.3 times higher among severe COVID-19 cases (AOR=2.26, 95% CI=1.092 to 4.685).ConclusionMale, older age, diabetes or hypertension comorbidity, COVID-19 vaccination and having inadequate knowledge about COVID-19 were determinant factors of severe COVID-19.
Effects of flipped classroom teaching in anaesthesiology residents: a protocol for systematic review and meta-analysis
Authors: Zhang Donghang , Xiang Jiaxin , Wei Yiyong 
Published: May 2024

IntroductionThe flipped classroom teaching model is widely used in medical education and is indicated to be better than traditional lecture approaches in many medical specialties. Emerging studies have evaluated the effects of the flipped classroom teaching model on anaesthesiology residents. This protocol aims to perform a systematic review and meta-analysis to determine whether the flipped classroom teaching model is superior to traditional teaching methods for anaesthesiology residents.Methods and analysisSeven databases, including PubMed, Web of Science, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure, Wanfang Data and the VIP database, will be systematically searched from their inception to 1 June 2024. Randomised controlled trials that compared the effects of flipped classrooms versus traditional teaching methods in anaesthesiology residents will be included. The primary outcome will be the theoretical knowledge score. The secondary outcomes will include skill scores and the proportion of anaesthesiology residents who preferred the flipped classroom model. RevMan V.5.4 software will be used to perform the statistical analysis. The Grading of Recommendation, Assessment, Development and Evaluation approach will assess the quality of evidence.Ethics and disseminationEthical approval is not applicable to this protocol. The results of this study will be submitted to a peer-reviewed journal.PROSPERO registration numberCRD42024497935.
Evaluating the implementation of group empowerment and training (GREAT) for diabetes in South Africa: convergent mixed methods
Authors: Mash Robert James , Schouw Darcelle 
Published: May 2024

ObjectiveType 2 diabetes is a leading contributor to the burden of disease in South Africa. Primary care is struggling to support self-management and lifestyle change. Group empowerment and training (GREAT) for diabetes is a feasible and cost-effective intervention in our setting. This study aimed to evaluate the implementation of GREAT for diabetes.DesignA convergent mixed-methods study evaluated a range of implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, reach and cost.SettingTen primary care facilities from a district in all nine provinces of South Africa.ParticipantsDescriptive exploratory individual semistructured interviews were conducted with 34 key stakeholders from national policy-makers to primary care providers. Three focus group interviews were held with 35 patients.ResultsThe National Department of Health saw GREAT as an acceptable and appropriate intervention, but only five of the nine provinces adopted GREAT. District-level and facility-level managers also saw GREAT as an acceptable and appropriate intervention. Factors related to feasibility included physical space, sufficient staff numbers, availability of resource materials, the health information system, adaptation to the model of care (selection of facilities, patients, adjustment of patient flow and appointment systems, leadership from local managers and the whole clinical team) and inclusion in systems for quality improvement. No major changes were made to the design of GREAT and fidelity to the session content ranged from 66% to 94%. Incremental costs were US$494 per facility. Due to disruption from the COVID-19 pandemic, only 14 facilities implemented and reached 588 patients at the time of evaluation.ConclusionKey lessons were learnt on how to implement GREAT for diabetes in a middle-income country setting. The findings informed the design of a programme theory using a health system framework. The programme theory will guide further scale-up in each province and scale-out to provinces that have not yet implemented.QuestionThis study focused on evaluating how to implement GREAT for type 2 diabetes in primary care and to take it to scale in South Africa.FindingThe findings led to a programme theory on how to successfully implement GREAT for diabetes in the South African context.MeaningThe study demonstrates relevant contextual factors that need to be considered in the implementation of group diabetes education programme in a middle-income country.
Influencing factors of sedentary behaviour in people with chronic obstructive pulmonary disease: a systematic review
Authors: Harding Stefanie , Richardson Alan , Glynn Angela , Hodgson Luke 
Published: May 2024

BackgroundPeople with chronic obstructive pulmonary disease (COPD) are more likely to adopt a sedentary lifestyle. Increased sedentary behaviour is associated with adverse health consequences and reduced life expectancy.AimThis mixed-methods systematic review aimed to report the factors contributing to sedentary behaviour in people with COPD.MethodsA systematic search of electronic databases (Medline, CINAHL, PsycINFO and Cochrane Library) was conducted and supported by a clinician librarian in March 2023. Papers were identified and screened by two independent researchers against the inclusion and exclusion criteria, followed by data extraction and analysis of quality. Quantitative and qualitative data synthesis was performed.Results1037 records were identified, 29 studies were included (26 quantitative and 3 qualitative studies) and most studies were conducted in high-income countries. The most common influencers of sedentary behaviour were associated with disease severity, dyspnoea, comorbidities, exercise capacity, use of supplemental oxygen and walking aids, and environmental factors. In-depth findings from qualitative studies included a lack of knowledge, self-perception and motivation. However, sedentarism in some was also a conscious approach, enabling enjoyment when participating in hobbies or activities.ConclusionsInfluencers of sedentary behaviour in people living with COPD are multifactorial. Identifying and understanding these factors should inform the design of future interventions and guidelines. A tailored, multimodal approach could have the potential to address sedentary behaviour.PROSPERO registration numberCRD42023387335.
Child safety seat checks in Salt Lake County: protective and risk factors
Authors: Talbot Morgan , Miller Linsey , Hafoka Siosaia 
Published: May 2024

BackgroundOlder children are at an increased risk of injury due to less commonly being in an appropriate child safety seat (CSS). Proper installation and consistent use of CSSs can significantly reduce child and infant automobile injuries. While research exists around parent behaviours concerning CSS use (or lack), little research takes place at the county level to identify normative beliefs as they contribute to risk factors.MethodsThrough a mixed-methods approach, this evaluation retrospectively determines the Salt Lake County Health Department’s impact on CSS usage, as well as identify normative parent behaviours that impact CSS usage.ResultsResults indicated that parents’ level of education and being in the car with family/friends was significantly associated with overall CSS usage.DiscussionMore research is needed to specify parent normative beliefs around CSS use (or lack).
Prevalence of major adverse cardiovascular events among Saudi patients with systemic lupus erythematosus compared with the general population: updates from the national SLE and PURE cohorts
Authors: Almaghlouth Ibrahim , Bohuliga Kawther Ghassan , Alanazi Boshra , Alhawsa Bushra Khaled , Alabdulkareem Abdulaziz Mohammed , Alqarawi Wael , Asfina Kazi Nur , Khalil Najma , Ali Hebatallah Hamed , Bedaiwi Mohammed , Aboabat Aos , Su Jiandong , Alam Tariq Asef , Alanazi Fehaid Ghali , Omair Mohammed A , Alarfaj Abdurhman S , Almalag Haya M , Al Shamiri Mostafa , Alhabib Khalid F 
Published: May 2024

ObjectiveThis study examined the prevalence of major adverse cardiovascular events (MACE) among Saudi patients with SLE and the general population and considered factors associated with such outcomes were taken into consideration.MethodsThis is a cohort study evaluating the period prevalence of MACE from 2020 to 2023. The study used two datasets, namely the Saudi national prospective cohort for SLE patients and the Prospective Urban-Rural Epidemiology Study Saudi subcohort (PURE-Saudi) for the general population. Participants in both studies were monitored using a standardised protocol. MACE was defined as myocardial infarction (MI), stroke or angina. The analysis was adjusted for demographics, traditional cardiovascular risk factors and SLE diagnosis through logistic regression models.ResultsThe PURE and national SLE cohorts comprised 488 and 746 patients, respectively. Patients with SLE from the SLE cohort were younger (40.7±12.5 vs 49.5±8.6 years) and predominantly female (90.6% vs 41.6%). The prevalence of traditional risk factors was greater in the PURE cohort compared with the SLE cohort. These factors included dyslipidaemia (28.9% vs 49.4%), obesity (63% vs 85%) and diabetes (7.8% vs 27.2%), but not hypertension (19.3% vs 18.8%). MACE (defined as MI or stroke or venous thromboembolism or heart failure) occurred more frequently in patients with SLE (4.3% vs 1.6%, p=0.004). Older age and lupus diagnosis were independently associated with MACE after adjusting for conventional risk factors. The odds of MACE were significantly related to age and lupus diagnosis (p=0.00 and p=0.00, respectively), but not cardiovascular disease (CVD) risk factors (p=0.83).ConclusionPatients with SLE have a significantly higher risk of developing MACE than the general population. This risk is not well explained by traditional risk factors, which may explain the failure of CVD risk scores to stratify patients with SLE adequately. Further studies are needed to understand CVD risk’s pathogenesis in SLE and mitigate it.
Cognitive–behavioural therapy effectiveness for fear of cancer recurrence: systematic review and meta-analysis
Authors: Wei Fangxin , He Ruiyao , Yang Xin , Hu Ziqi , Wang Yu 
Published: May 2024

ObjectiveFear of cancer recurrence is one of the psychological distresses for patients with cancer and cancer survivors, which poses a physical and psychological threat. There is scant evidence on the effectiveness of cognitive–behavioural therapy in reducing fear of cancer recurrence. Therefore, we conducted a systematic review and meta-analysis to assess the effectiveness of cognitive–behavioural therapy for fear of cancer recurrence.MethodThe review was reported according to Preferred Reporting Items for Systematic Review and Meta-analyses statement. Seven databases were systematically searched from inception to 31 March 2023. Randomised controlled trials implementing cognitive–behavioural therapy interventions and studies reporting fear of cancer recurrence were included. The methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool 2.ResultsA total of 32 randomised controlled trials involving 1515 cancer survivors and 1845 patients with cancer undergoing treatment were included. The meta-analysis indicated a significant effect of cognitive–behavioural therapy on fear of cancer recurrence in patients with cancer and cancer survivors compared with controls (g=−0.65; 95% CI=−0.86, –0.44; p<0.001). The results of the overall risk of bias indicated some concerns in 4 studies and a high risk in 28 studies.ConclusionThe study indicated the effectiveness of cognitive–behavioural therapy intervention for fear of cancer recurrence in patients with cancer and cancer survivors, which should inform future clinical practice of interventions for the treatment of fear of cancer recurrence.PROSPERO registration numberCRD42023404948.
Proposing a physical mechanism to explain various observed sources of QPOs by simulating the dynamics of accretion disks around the black holes
Authors: Donmez Orhan 
Published: May 2024

AbstractWe propose a mechanism to explain the low-frequency QPOs observed in X-ray binary systems and AGNs. To achieve this, we perturbed stable accretion disks around Kerr and EGB black holes at different angular velocities, revealing characteristics of shock waves and oscillations on the disk. By applying this perturbation to scenarios with varying alpha values for EGB black holes and different spin parameters for Kerr black holes, we numerically observed changes in the disk dynamic structure and its oscillations. Through various numerical models, we found that the formation of one- and two-armed spiral shock waves on the disk serves as a mechanism for generating QPOs. We compared the QPOs obtained from numerical calculations with the low-frequency QPOs observed in X-ray binary systems and AGN sources, finding high consistency with observations. We observed that the shock mechanism, leading to QPOs, explains the X-ray binaries and AGNs studied in this article. Our numerical findings indicate that QPOs are more strongly dependent on the EGB constant than on the black hole spin parameter. However, we highlighted that the primary impact on oscillations and QPOs is driven by the perturbation angular velocity. The results from the models showed that the perturbation asymptotic speed at $$V_{\infty }=0.2$$

V
∞

=
0.2

independently generates QPO frequencies, regardless of the black hole spin parameter and the EGB coupling constant. Therefore, for the moderate value of $$V_{\infty }$$

V
∞

, a two-armed spiral shock wave formed around the black hole is suggested as a decisive mechanism in explaining low-frequency QPOs.
Targeting Acute Myeloid Leukemia Stem Cells through Perturbation of Mitochondrial Calcium
Authors: Sheth Anagha Inguva , Althoff Mark J. , Tolison Hunter , Engel Krysta , Amaya Maria L. , Krug Anna E. , Young Tracy N. , Minhajuddin Mohammad , Pei Shanshan , Patel Sweta B. , Winters Amanda , Miller Regan , Shelton Ian T. , St-Germain Jonathan , Ling Tianyi , Jones Courtney L. , Raught Brian , Gillen Austin E. , Ransom Monica , Staggs Sarah , Smith Clayton A. , Pollyea Daniel A. , Stevens Brett M. , Jordan Craig T. 
Published: May 2024

Abstract
Acute myeloid leukemia stem cells (LSCs) are uniquely reliant on oxidative phosphorylation (OXPHOS) for survival. Moreover, maintenance of OXPHOS is dependent on BCL-2, creating a therapeutic opportunity to target LSCs using the BCL-2 inhibitor venetoclax. Although venetoclax-based regimens have shown promising clinical activity, the emergence of drug resistance is prevalent. Thus, in the present study, we investigated how mitochondrial properties may influence venetoclax responsiveness. Our data show that utilization of mitochondrial calcium is fundamentally different between drug-responsive and nonresponsive LSCs. By comparison, venetoclax-resistant LSCs demonstrate an active metabolic (i.e., OXPHOS) status with relatively high levels of calcium. Consequently, we tested genetic and pharmacological approaches to target the mitochondrial calcium uniporter. We demonstrate that inhibition of calcium uptake reduces OXPHOS and leads to eradication of venetoclax-resistant LSCs. These findings demonstrate a central role for calcium signaling in LSCs and provide an avenue for clinical management of venetoclax resistance.
Significance: We identify increased utilization of mitochondrial calcium as a distinct metabolic requirement of venetoclax-resistant LSCs and demonstrate the potential of targeting mitochondrial calcium uptake as a therapeutic strategy.
Endovascular Versus Medical Management in Distal Medium Vessel Occlusion Stroke: The DUSK Study
Authors: Mohammaden Mahmoud H. , Souza Viana Lorena , Abdelhamid Hend , Olive-Gadea Marta , Rodrigo-Gisbert Marc , Requena Manuel , Martins Pedro N. , Matsoukas Stavros , Schuldt Braxton R. , Fifi Johanna T. , Farooqui Mudassir , Vivanco-Suarez Juan , Ortega-Gutierrez Santiago , Klein Piers , Abdalkader Mohamad , Vigilante Nicholas , Siegler James E. , Moreira Ferreira Felipe , Peng Sophia , Alaraj Ali , Haussen Diogo C. , Nguyen Thanh N. , Nogueira Raul G. 
Published: May 2024

BACKGROUND:
Endovascular treatment (EVT) is part of the usual care for proximal vessel occlusion strokes. However, the safety and effectiveness of EVT for distal medium vessel occlusions remain unclear. We sought to compare the clinical outcomes of EVT to medical management (MM) for isolated distal medium vessel occlusions.

METHODS:
This is a retrospective analysis of prospectively collected data from seven comprehensive stroke centers. Patients were included if they had isolated distal medium vessel occlusion strokes due to middle cerebral artery M3/M4, anterior cerebral artery A2/A3, or posterior cerebral artery P1/P2 segments. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included 90-day good (mRS score, 0–2) and excellent (mRS score, 0–1) outcomes. Safety measures included symptomatic intracranial hemorrhage and 90-day mortality.

RESULTS:

A total of 321 patients were included in the analysis (EVT, 179; MM, 142; 40.8% treated with intravenous thrombolysis). In the inverse probability of treatment weighting model, there were no significant differences between EVT and MM in terms of the overall degree of disability (mRS ordinal shift; adjusted odds ratio [aOR], 1.25 [95% CI, 0.95–1.64];
P
=0.110), rates of good (mRS score, 0–2; aOR, 1.32 [95% CI, 0.97–1.80];
P
=0.075) and excellent (aOR, 1.32 [95% CI, 0.94–1.85];
P
=0.098) outcomes, or mortality (aOR, 1.20 [95% CI, 0.78–1.85];
P
=0.395) at 90 days. The multivariable regression model showed similar findings. Moreover, there was no difference between EVT and MM in rates of symptomatic intracranial hemorrhage in the multivariable regression model (aOR, 0.57 [95% CI, 0.21–1.58];
P
=0.277), but the inverse probability of treatment weighting model showed a lower likelihood of symptomatic intracranial hemorrhage (aOR, 0.46 [95% CI, 0.24–0.85];
P
=0.013) in the EVT group.

CONCLUSIONS:
This multicenter study failed to demonstrate any significant outcome differences among patients with isolated distal medium vessel occlusions treated with EVT versus MM. These findings reinforce clinical equipoise. Randomized clinical trials are ongoing and will provide more definite evidence.