bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenges and opportunities in neonatal sepsis management: insights from a survey among clinicians in 25 Sub-Saharan African countries
Authors: Rosa-Mangeret Flavia , Dupuis Marc , Dewez Juan Emmanuel , Muhe Lulu M , Wagner Noemie , Pfister Riccardo E 
Published: June 2024

BackgroundNeonatal sepsis (NS) is a global health issue, particularly in Sub-Saharan Africa, where it accounts for a substantial portion of neonatal morbimortality. This multicountry survey aimed to elucidate current practices, challenges and case definitions in managing NS among clinicians in Sub-Saharan Africa.MethodsThe survey targeted physicians and medical practitioners working in neonatal care who participated in a Self-Administered Web Questionnaire. The main objective was to understand NS and infection case definitions and management from the clinician’s point of view and to identify challenges and opportunities in sepsis management. Participants were queried on demographics, definitions and diagnostic criteria, treatment approaches, and infection prevention and control (IPC) measures. A total of 136 participants from 86 healthcare structures responded, providing valuable insights into NS management practices.ResultsFrom May to July 2022 across 25 Sub-Saharan African countries, 136 neonatal clinicians with an average from 86 structures with on average 10-year experience took the survey. NS ranked highest among prevalent neonatal conditions. Diagnostic case definitions between sepsis and infection were attributed to clinical signs, anamnesis, C reactive protein, white blood cll count and blood cultures with no statistically significant differences. Early-onset sepsis was defined within 72 hours by 48%, while late-onset varied. Antibiotics were likely on admission (86.4%) and during the stay (82.2%). Treatment abandonment was reported unlikely. The preferred antibiotic regimen for early-onset sepsis was intravenous amoxicillin (or ampicillin), gentamycin and cefotaxime. Blood culture availability and IPC protocols were reported as limited, particularly concerning patient environment, pharmacy protocols and clean–dirty circuits.ConclusionsThis NS survey emphasises clinicians’ challenges due to limited access to diagnostic tools and raises concerns about antimicrobial overexposure. IPC also seem limited, according to participants. Addressing these challenges can enhance diagnostic practices, antibiotic stewardship and infection control in the region.
What did we learn about elite student-athlete mental health systems from the COVID-19 pandemic?
Authors: Simpson Kaitlin , Baker Graham , Cameron-Blake Emily , Palmer Debbie , Jarvie Grant , Kelly Paul 
Published: June 2024

Elite student-athletes (SAs) in higher education (HE) have distinct mental health (MH) risks. The COVID-19 pandemic put pressure on systems and increased elite SA vulnerability to adverse MH outcomes.The aim of this study was to explore the provision and management of MH in elite HE sports settings during the time of COVID-19 pandemic stress. The secondary aim was to identify lessons and opportunities to enhance future mental healthcare systems and services for elite SAs.A qualitative study design was used to investigate the views of three groups (athletic directors, coaches and sport healthcare providers). Ten key leaders were purposively recruited from HE institutions in Canada, the USA and the United Kingdom. They represented various universities from the National College Athletic Association, U SPORTS Canada and British Universities and Colleges Sport. Semistructured interviews were conducted, recorded, transcribed and thematically analysed.Five key themes were identified: (1) The pandemic disruption had salient impacts on motivation and how elite SAs engaged with sport (2) when student sport systems are under pressure, support staff perceive a change in duties and experience their own MH challenges, (3) the pandemic increased awareness about MH care provision and exposed systemic challenges, (4) digital transformation in MH is complex and has additional challenges for SAs and (5) there were some positive outcomes of the pandemic, lessons learnt and a resulting motivation for systems change. Participants highlighted future opportunities for MH provision in elite university sport settings. Four recommendations were generated from the results.
Seeking abortion accompaniment: experiences and self-managed abortion preferences of hotline callers after abortion legalisation in Argentina
Authors: Keefe-Oates Brianna , Filippa Sofia , Janiak Elizabeth , Zurbriggen Ruth , Grosso Belén , Chen Jarvis T , Gerdts Caitlin , Gottlieb Barbara 
Published: June 2024

BackgroundUntil the legalisation of abortion in Argentina in 2021, the Socorristas en Red, a network of feminist collectives, provided support and information (‘accompaniment’) to people self-managing their abortion with medications. Following legalisation, the Socorristas continued accompanying people self-managing or accessing abortion through the healthcare system. We conducted a cross-sectional study to understand preferences, experiences and choices about abortion when contacting a Socorristas hotline after legalisation of abortion in Argentina.MethodsWe surveyed callers to the Socorristas’ hotline in Neuquén, Argentina about their demographics, pregnancy history, reasons for calling, and experiences seeking abortion through the hotline and the healthcare system. We assessed overall prevalence of these experiences, and analysed differences between people who contacted the health system before calling the hotline and those who first called the hotline for services.ResultsOf the 755 callers in the study, the majority (63.3%) contacted the Socorristas because they trusted them, and 21.7% called because they both trusted the Socorristas and did not want to go to the healthcare system. At the end of the call, most people (95.4%) chose to self-manage their abortion with accompaniment outside the healthcare system. People who called the healthcare system prior to contacting the hotline frequently reported being referred to the Socorristas, as well as challenges scheduling appointments.ConclusionsAfter legalisation of abortion in Argentina there is continued demand for accompaniment. Globally, ensuring that accompaniment and self-management of abortion is legal and protected will provide individuals with the support and facilitated access to the abortion care they desire.
Exploring the predictive potential of programmed death ligand 1 expression in healthy organs and lymph nodes as measured by18F-BMS-986192 PET: pooled analysis of data from four solid tumor types
Authors: Miedema Iris H C , Pouw Johanna E. E. , Kwakman Anne , Zwezerijnen Gerben J C , Huisman Marc C , Timmer Florentine E F , van de Ven Rieneke , de Gruijl Tanja D , Hospers Geke A P , de Langen Adrianus J , Menke-van der Houven van Oordt C Willemien 
Published: June 2024

IntroductionImmune checkpoint inhibitors (ICIs) can elicit anticancer immune responses, but predictive biomarkers are needed. We measured programmed death ligand 1 (PD-L1) expression in organs and lymph nodes using18F-BMS-986192 positron emission tomography (PET)-imaging and looked for correlations with response and immune-related adverse events.MethodsFour18F-BMS-986192 PET studies in patients with melanoma, lung, pancreatic and oral cancer, receiving ICI treatment, were combined. Imaging data (organ standardized uptake value (SUV)mean, lymph node SUVmax) and clinical data (response to treatment and incidence of immune-related adverse events) were extracted.ResultsBaseline PD-L1 uptake in the spleen was on average higher in non-responding patients than in responders (spleen SUVmean16.1±4.4 vs 12.5±3.4, p=0.02). This effect was strongest in lung cancer, and not observed in oral cancer. In the oral cancer cohort, benign tumor-draining lymph nodes (TDLNs) had higher PD-L1 uptake (SUVmax3.3 IQR 2.5-3.9) compared with non-TDLNs (SUVmax1.8, IQR 1.4-2.8 p=0.04). Furthermore, in the same cohort non-responders showed an increase in PD-L1 uptake in benign TDLNs on-treatment with ICIs (+15%), while for responders the PD-L1 uptake decreased (−11%). PD-L1 uptake did not predict immune-related adverse events, though elevated thyroid uptake on-treatment correlated with pre-existing thyroid disease or toxicity.ConclusionPD-L1 PET uptake in the spleen is a potential negative predictor of response to ICIs. On-treatment with ICIs, PD-L1 uptake in benign TDLNs increases in non-responders, while it decreases in responders, potentially indicating a mechanism for resistance to ICIs in patients with oral cancer.
Predictive utility of ANCA positivity and antigen specificity in the assessment of kidney disease in paediatric-onset small vessel vasculitis
Authors: Mann Simranpreet K , Bone Jeffrey N , Bosman Else S , Cabral David A , Morishita Kimberly A , Brown Kelly L 
Published: June 2024

ObjectivesThe objective of this study is to evaluate whether anti-neutrophil cytoplasmic antibody (ANCA) seropositivity and antigen specificity at diagnosis have predictive utility in paediatric-onset small vessel vasculitis.MethodsChildren and adolescents with small vessel vasculitis (n=406) stratified according to the absence (n=41) or presence of ANCA for myeloperoxidase (MPO) (n=129) and proteinase-3 (PR3) (n=236) were compared for overall and kidney-specific disease activity at diagnosis and outcomes between 1 and 2 years using retrospective clinical data from the ARChiVe/Paediatric Vasculitis Initiative registry to fit generalised linear models.ResultsOverall disease activity at diagnosis was higher in PR3-ANCA and MPO-ANCA-seropositive individuals compared with ANCA-negative vasculitis. By 1 year, there were no significant differences, based on ANCA positivity or specificity, in the likelihood of achieving inactive disease (~68%), experiencing improvement (≥87%) or acquiring damage (~58%). Similarly, and in contrast to adult-onset ANCA-associated vasculitis, there were no significant differences in the likelihood of having a relapse (~11%) between 1 and 2 years after diagnosis. Relative to PR3-ANCA, MPO-ANCA seropositivity was associated with a higher likelihood of kidney involvement (OR 2.4, 95% CI 1.3 to 4.7, p=0.008) and severe kidney dysfunction (Kidney Disease Improving Global Outcomes (KDIGO) stages 4–5; OR 6.04, 95% CI 2.77 to 13.57, p<0.001) at onset. Nonetheless, MPO-ANCA seropositive individuals were more likely to demonstrate improvement in kidney function (improved KDIGO category) within 1 year of diagnosis than PR3-ANCA seropositive individuals with similarly severe kidney disease at onset (p<0.001).ConclusionsThe results of this study suggest important paediatric-specific differences in the predictive value of ANCA compared with adult patients that should be considered when making treatment decisions in this population.
Quantifying sustained health system benefits of primary care-based integrated disease management for COPD: a 6-year interrupted time series study
Authors: Licskai Christopher , Hussey Anna , Rowley Véronique , Ferrone Madonna , Lu Zihang , Zhang Kimball , Terebessy Emilie , Scarffe Andrew , Sibbald Shannon , Faulds Cathy , O'Callahan Tim , To Teresa 
Published: June 2024

BackgroundSevere exacerbation of chronic obstructive pulmonary disease (COPD) is a trajectory-changing life event for patients and a major contributor to health system costs. This study evaluates the real-world impact of a primary care, integrated disease management (IDM) programme on acute health service utilisation (HSU) in the Canadian health system.MethodsInterrupted time series analysis using retrospective health administrative data, comparing monthly HSU event rates 3 years prior to and 3 years following the implementation of COPD IDM. Primary outcomes were COPD-related hospitalisation and emergency department (ED) visits. Secondary outcomes included hospital bed days and all-cause HSU.ResultsThere were 2451 participants. COPD-related and all-cause HSU rates increased in the 3 years prior to IDM implementation. With implementation, there was an immediate decrease (month 1) in COPD-related hospitalisation and ED visit rates of −4.6 (95% CI: −7.76 to –1.39) and −6.2 (95% CI: –11.88, –0.48) per 1000 participants per month, respectively, compared with the counterfactual control group. After 12 months, COPD-related hospitalisation rates decreased: −9.1 events per 1000 participants per month (95% CI: –12.72, –5.44) and ED visits −19.0 (95% CI: –25.50, –12.46). This difference nearly doubled by 36 months. All-cause HSU also demonstrated rate reductions at 12 months, hospitalisation was −10.2 events per 1000 participants per month (95% CI: –15.79, –4.44) and ED visits were −30.4 (95% CI: –41.95, –18.78).ConclusionsImplementation of COPD IDM in a primary care setting was associated with a changed trajectory of COPD-related and all-cause HSU from an increasing year-on-year trend to sustained long-term reductions. This highlights a substantial real-world opportunity that may improve health system performance and patient outcomes.
SIGACT News Complexity Theory Column 121
Authors: Lee Volk Ben 
Published: June 2024

This month, Pranjal Dutta and Sumanta Ghosh contributed an in-depth survey on the Polynomial Identity Testing problem, and the efforts made towards obtaining deterministic algorithms for testing identities for various models of algebraic circuits. I wish to thank Pranjal and Sumanta for their thorough work. I hope you enjoy reading their article.
On the next issues of SIGACT News, you can expect columns by Dean Doron (probably on probably on binary codes and the GV bound, but stay tuned!), by Stacey Jeffrey (on Quantum Las Vegas Algorithms and Composition), by Igor Carboni Oliveira (on Complexity Theory in Bounded Arithmetic: Recent Results and Current Frontiers) and by Noam Mazor (topic TBA).
Identifying People at High Risk for Severe Aortic Stenosis: Aortic Valve Calcium Versus Lipoprotein(a) and Low-Density Lipoprotein Cholesterol
Authors: Marrero Natalie , Jha Kunal , Razavi Alexander C. , Boakye Ellen , Anchouche Khalil , Dzaye Omar , Budoff Matthew J. , Tsai Michael Y. , Shah Sanjiv J. , Rotter Jerome I. , Guo Xiuqing , Yao Jie , Blumenthal Roger S. , Thanassoulis George , Post Wendy S. , Blaha Michael J. , Whelton Seamus P. 
Published: June 2024

BACKGROUND:
Aortic valve calcification (AVC), Lp(a) [lipoprotein(a)], and low-density lipoprotein cholesterol (LDL-C) are associated with severe aortic stenosis (AS). We aimed to determine which of these risk factors were most strongly associated with the risk of incident severe AS.

METHODS:
A total of 6792 participants from the MESA study (Multi-Ethnic Study of Atherosclerosis) had computed tomography-quantified AVC, Lp(a), and LDL-C values at MESA visit 1 (2000–2002). We calculated the absolute event rate of incident adjudicated severe AS per 1000 person-years and performed multivariable adjusted Cox proportional hazards regression.

RESULTS:
The mean age was 62 years old, and 47% were women. Over a median 16.7-year follow-up, the rate of incident severe AS increased exponentially with higher AVC, regardless of Lp(a) or LDL-C values. Participants with AVC=0 had a very low rate of severe AS even with elevated Lp(a) ≥50 mg/dL (<0.1/1000 person-years) or LDL-C ≥130 mg/dL (0.1/1000 person-years). AVC >0 was strongly associated with severe AS when Lp(a) <50 mg/dL hazard ratio (HR) of 33.8 (95% CI, 16.4–70.0) or ≥50 mg/dL HR of 61.5 (95% CI, 7.7–494.2) and when LDL-C <130 mg/dL HR of 31.1 (95% CI, 14.4–67.1) or ≥130 mg/dL HR of 50.2 (95% CI, 13.2–191.9).

CONCLUSIONS:
AVC better identifies people at high risk for severe AS compared with Lp(a) or LDL-C, and people with AVC=0 have a very low long-term rate of severe AS regardless of Lp(a) or LDL-C level. These results suggest AVC should be the preferred prognostic risk marker to identify patients at high risk for severe AS, which may help inform participant selection for future trials testing novel strategies to prevent severe AS.
Individualised prediction of longitudinal change in multimodal brain imaging
Authors: Gong Weikang , Beckmann Christian F. , Smith Stephen M. 
Published: June 2024

Abstract
It remains largely unknown whether individualised longitudinal changes of brain imaging features can be predicted based only on the baseline brain images. This would be of great value, for example, for longitudinal data imputation, longitudinal brain-behaviour associations, and early prediction of brain-related diseases. We explore this possibility using longitudinal data of multiple modalities from UK Biobank brain imaging, with around 3,500 subjects. As baseline and follow-up images are generally similar in the case of short follow-up time intervals (e.g., 2 years), a simple copy of the baseline image may have a very good prediction performance. Therefore, for the first time, we propose a new mathematical framework for guiding the longitudinal prediction of brain images, providing answers to fundamental questions: (1) what is a suitable definition of longitudinal change; (2) how to detect the existence of changes; (3) what is the “null” prediction performance; and (4) can we distinguish longitudinal change prediction from simple data denoising. Building on these, we designed a deep U-Net based model for predicting longitudinal changes in multimodal brain images. Our results show that the proposed model can predict to a modest degree individualised longitudinal changes in almost all modalities, and outperforms other potential models. Furthermore, compared with the true longitudinal changes computed from real data, the predicted longitudinal changes have a similar or even improved accuracy in predicting subjects’ non-imaging phenotypes, and have a high between-subject discriminability. Our study contributes a new theoretical framework for longitudinal brain imaging studies, and our results show the potential for longitudinal data imputation, along with highlighting several caveats when performing longitudinal data analysis.
Making Austria German Again
Authors: Grube Eric 
Published: June 2024

Abstract
Years before the Second World War, there emerged an Austrofascist Ständestaat [Corporatist State] to the south of Nazi Germany. This Ständestaat would be subsumed into Germany during the Anschluss of 1938. Subsumption of Austrofascism into Nazism has also occurred in understandings of fascism. This article centers two paramilitary organizations—an Austrian Nazi Legion based in Bavaria and the Austrian-based Heimwehren [Home Guards]—to argue that German-speaking fascists functioned via internecine violence over Austria’s sovereignty. Fighting between the Heimwehren and Austrian Nazi Legionaries based in Bavaria culminated in a quasi-war across the Austro-Bavarian border, studied here from 1933 to 1934. This article showcases how fascist obsessions with total control came with an uncontrollable need for conflict over this contested borderland space. This tension undermined their claims of supremacy yet undergirded their supporters to fight harder against, ironically, other German-speaking fascists. As such, division was critical to their very formation. By taking this granular perspective, we acquire a better understanding of the convoluted history prior to the notorious Anschluss.
Rising Extreme Meltwater Trends in Greenland Ice Sheet (1950–2022): Surface Energy Balance and Large-Scale Circulation Changes
Authors: Bonsoms Josep , Oliva Marc , López-Moreno Juan I. , Fettweis Xavier 
Published: June 2024

Abstract
The Greenland Ice Sheet (GrIS) meltwater runoff has increased considerably since the 1990s, leading to implications for the ice sheet mass balance and ecosystem dynamics in ice-free areas. Extreme weather events will likely continue to occur in the coming decades. Therefore, a more thorough understanding of the spatiotemporal patterns of extreme melting events is of interest. This study aims to analyze the evolution of extreme melting events across the GrIS and determine the climatic factors that drive them. Specifically, we have analyzed extreme melting events (90th percentile) across the GrIS from 1950 to 2022 and examined their links to the surface energy balance (SEB) and large-scale atmospheric circulation. Extreme melting days account for approximately 35%–40% of the total accumulated melting per season. We found that extreme melting frequency, intensity, and contribution to the total accumulated June–August (summer) melting show a statistically significant upward trend at a 95% confidence level. The largest trends are detected across the northern GrIS. The trends are independent of the extreme melting percentile rank (90th, 97th, or 99th) analyzed and are consistent with average melting trends that exhibit an increase in similar magnitude and spatial configuration. Radiation plays a dominant role in controlling the SEB during extreme melting days. The increase in extreme melting frequency and intensity is driven by the increase in anticyclonic weather types during summer and more energy available for melting. Our results help to enhance the understanding of extreme events in the Arctic.
Influences of Large-Scale Circulation and Atmospheric Rivers on U.S. Winter Precipitation beyond ENSO
Authors: Ding Qinghua , Wang Hailan 
Published: June 2024

Abstract
This study aims to understand the underlying mechanism of large-scale circulation control on atmospheric rivers (ARs) and precipitation variability across the contiguous United States (CONUS) in winter. El Niño–Southern Oscillation (ENSO), known as a key driver of global circulation, has shown a modest impact on CONUS precipitation, prompting us to focus our attention on other climate drivers. Here, we find that barotropic instability over the exit region of the North Pacific subtropical jet stream plays a critical role in forming a downstream stationary Rossby wave train during winter (referred to as the West Mode). This wave pattern influences CONUS precipitation by affecting AR activity and explains approximately 50% of rainfall changes in the western United States, as well as numerous extreme wet and drought years along the West Coast, such as the wet winter in 2022/23. Over the past eight decades, the West Mode exhibited limited sensitivity to both sea surface temperature (SST) and increasing anthropogenic forcing and was more influential in shaping interannual and interdecadal CONUS precipitation variabilities than ENSO. This result may explain why ENSO alone can only account for a limited portion of CONUS precipitation variability, thereby imposing an inherent constraint on the precision of seasonal predictions of CONUS precipitation made by climate models. Due to the significance of the West Mode in governing precipitation variability over the western United States, winter precipitation in that region may possess some resilience to the effects of global warming in the coming decades, as supported by large ensemble simulations driven by projected radiative forcing.

Significance Statement
To better understand how large-scale circulation shapes precipitation within the contiguous United States (CONUS), we identify at least two leading circulation modes in winter that together explain almost 70% of CONUS precipitation in the western United States and 30% in the central and eastern United States. One of these modes is a well-known teleconnection modulated by El Niño–Southern Oscillation (ENSO), and the other reflects internal variability related to jet stream dynamics. However, this internal mode is more critical than the ENSO-driven one in regulating precipitation changes through mediating atmospheric rivers (ARs) over the CONUS, particularly in the West. This finding suggests that precipitation changes over the CONUS are partly governed by internal circulation dynamics and thus exhibit less susceptibility to global warming in the decades to come.