bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient and primary care direct provocation challenges for antibiotic allergy in children
Authors: Grewal Anjum , Jay Nicola 
Published: February 2024

ObjectiveTo evaluate the use of a questionnaire-based decision-making algorithm to triage children with reported antibiotic allergies to proceed directly to an oral provocation challenge.DesignCohort study.SettingChildren aged 2–16 years attending paediatric emergency department over 1 year (1 June 2018 till 31 May 2019) or identified from four primary care centres in Sheffield with a recorded antibiotic allergy and no previous testing.Participants313 children with 325 recorded antibiotic allergies.ExposureClinical decision-making algorithm used to either exclude, directly delabel or stratify children to oral antibiotic challenge in outpatient department or primary care practice.Main outcome measuresTo assess the safety of using the questionnaire-based algorithm for proceeding to a direct oral provocation challenge.The secondary outcomes were to look for associations and predictive factors in positive challenges and to assess parent/carer acceptability of the service by using Likert Scale.ResultsSuccessful contact was made with 200 children, of which 153 children could be evaluated based on inclusion criteria, engagement and availability of medical records.15 children were directly delabelled based on history and records. 138 children underwent challenges in outpatient and primary care. 6% of challenges were reactive with a mild, delayed reaction. Overall, a delabelling rate of 91% was achieved. There were no clear predictors for a positive challenge.ConclusionOur questionnaire-based algorithm for stratifying children with antibiotic allergies to proceed directly to an oral outpatient or primary care challenge was found to be safe, feasible and acceptable.
Effectiveness, barriers and facilitating factors of strategies for active delabelling of patients with penicillin allergy labels: a systematic review protocol
Authors: Nürnberg Hannah , Khatamzas Elham , Denkinger Claudia , Krause Tabea , Oetken Lars , Rauer Sophie , Rapp Amelie , Hoppe-Tichy Torsten , Morath Benedict 
Published: February 2024

IntroductionUp to 15% of adult patients in the clinical setting report to be allergic to penicillin. However, in most cases, penicillin allergy is not confirmed. Due to the negative aspects associated with erroneous penicillin allergy, the implementation of active delabelling processes for penicillin allergy is an important part of antibiotic stewardship programmes. Depending on the clinical setting, different factors need to be considered during implementation. This review examines the effectiveness of different delabelling interventions and summarises components and structures that facilitate, support or constrain structured penicillin allergy delabelling.Methods and analysisThis review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The databases MEDLINE (via PubMed), EMBASE and Cochrane Library were searched for studies reporting on any intervention to identify, assess or rule out uncertain penicillin allergy. To improve completeness, two further databases are also searched for grey literature. Study design, intervention type, professional groups involved, effectiveness, limitations, barriers, facilitating factors, clinical setting and associated regulatory factors will be extracted and analysed. In addition, exclusion criteria for participation in the delabelling intervention and criteria for not delabelling penicillin allergy will be summarised. In case of failed protocols, these are highlighted and quantitatively analysed if possible. Two independent reviewers will perform the screening process and data extraction. Discordant decisions will be resolved through review by a third reviewer. Bias assessment of the individual studies will be performed using the Newcastle Ottawa Scale.Ethics and disseminationBecause individual patient-related data are not analysed, an ethical approval is not required. The review will be published in a peer-reviewed scientific journal.
Immune regulation and blood–brain barrier permeability in cerebral small vessel disease: study protocol of the INflammation and Small Vessel Disease (INSVD) study – a multicentre prospective cohort study
Authors: Low Audrey , van Winden Sanne , Cai Lupei , Kessels Roy P C , Maas Marnix C , Morris Robin G , Nus Meritxell , Tozer Daniel J , Tuladhar Anil , van der Kolk Anja , Wolters Rowan , Mallat Ziad , Riksen Niels P , Markus Hugh , de Leeuw Frank‐Erik 
Published: February 2024

IntroductionThe INflammation and Small Vessel Disease (INSVD) study aims to investigate whether peripheral inflammation, immune (dys)regulation and blood–brain barrier (BBB) permeability relate to disease progression in cerebral small vessel disease (SVD). This research aims to pinpoint specific components of the immune response in SVD relating to disease progression. This could identify biomarkers of SVD progression, as well as potential therapeutic targets to inform the development and repurposing of drugs to reduce or prevent SVD, cognitive decline and vascular dementia.Methods and analysisINSVD is a prospective observational multicentre cohort study in individuals with symptomatic SVD. This longitudinal study combines comprehensive immunophenotyping of the peripheral blood immune compartment with advanced neuroimaging markers of SVD and BBB permeability. The main SVD marker of interest is white matter microstructure as determined by diffusion tensor imaging, a valuable marker of disease progression owing to its sensitivity to early alterations to white matter integrity. The research is being conducted in two sites—in the UK (Cambridge) and the Netherlands (Nijmegen)—with each site recruiting 100 participants (total n=200). Participants undergo clinical and cognitive assessments, blood draws, and brain MRI at baseline and 2-year follow-up.Ethics and disseminationThis study received ethical approval from the local ethics boards (UK: East of England—Cambridge Central Research Ethics Committee (REC) ref: 22/EE/00141, Integrated Research Application System (IRAS) ID: 312 747. Netherlands: Medical Research Ethics Committee (MREC) Oost-Nederland, ref: 2022-13623, NL-number: NL80258.091.22). Written informed consent was obtained from all subjects before the study. Any participant-derived benefits resulting from this research, such as new insights into disease mechanisms or possible novel therapies, will be disseminated to study participants, patient groups and members of the public.Trial registration numberNCT05746221.
Clinical manifestations and prognostic factors analysis of patients hospitalised with acute exacerbation of idiopathic pulmonary fibrosis and other interstitial lung diseases
Authors: Ba Cuirong , Wang Huijuan , Jiang Chunguo , Shi Xuhua , Jin Jiawei , Fang Qiuhong 
Published: February 2024

BackgroundAcute exacerbation (AE) is a life-threatening condition taking place not only in idiopathic pulmonary fibrosis (IPF) but also in interstitial lung diseases (ILD) other than IPF (non-IPF ILD). This study aims to compare the clinical manifestations between patients hospitalised with AE-IPF and AE-non-IPF ILD, and further analyse the risk factors related to in-hospital mortality.MethodsClinical data of 406 patients hospitalised with AE-IPF (93 cases) and AE-non-IPF ILD (313 cases) were retrospectively collected. Clinical features were compared between the two groups. Risk factors related to in-hospital mortality in patients with overall AE-ILD, AE-IPF and AE-non-IPF ILD were identified by multiple logistic regression analyses, respectively, and assessed by receiver operating characteristic curve.ResultsIn addition to having more smokers and males, the AE-IPF group also had more respiratory failure on admission, comorbidities of pulmonary hypertension (PAH) or coronary artery disease/heart failure, a longer history of pre-existing ILD. Comorbidity of coronary heart disease/heart failure, respiratory failure at admission, neutrophil (N)%, serum hydroxybutyrate dehydrogenase (HBDH), lactate dehydrogenase (LDH) and low cholesterol levels were independent risk factors for patients with AE-ILD, while respiratory failure on admission, N%, serum HBDH, urea nitrogen, LDH and low albumin levels were risk factors for the AE-non-IPF ILD group, and fever, N% and PAH were the AE-IPF group’s. Among them, HBDH 0.758 (sensitivity 85.5%, specificity 56%, cut-off 237.5 U/L) for patients with AE-ILD; N% 0.838 (sensitivity 62.5%, specificity 91.18%, cut-off 83.55%) for the AE-IPF group and HBDH 0.779 (sensitivity 86.4%, specificity 55.1%, cut-off 243.5 U/L) for the AE-non-IPF ILD group were the risk factors with the highest area under the curve.ConclusionsClinical characteristics differ between patients with AE-IPF and AE-non-IPF ILD. HBDH outperformed LDH in predicting the prognosis for patients with AE-ILD and AE-non-IPF ILD. N% was an independent predictor of death in-hospital in all three groups, especially in the AE-IPF group.
Navigating implementation barriers: a holistic approach to improving exertional heat stroke management
Authors: Hosokawa Yuri , Akama Takao 
Published: February 2024

ObjectivesTo assess the shift in medical volunteers’ perception and practice surrounding exertional heat stroke (EHS) prehospital management after the Tokyo 2020 Olympic Games.MethodsAn online survey was sent to medical volunteers assigned to work at high EHS risk events during the Tokyo 2020 Olympic Games. Surveys were sent at the time of initial training, immediately after the Games, and one year after the Games. The survey investigated medical volunteers’ perceptions and practices regarding the assessment of rectal temperature and the use of whole-body cold water immersion (CWI) as prehospital management of EHS. In addition, an open-ended question was prepared to examine barriers and facilitators of their chosen perception and/or behaviour.ResultsThe lack of knowledge about rectal temperature assessment improved over time, but the actual implementation did not. Meanwhile, increased utilisation of CWI was observed 1 year after the Games. The lack of equipment, apprehension towards rectal temperature assessment, the perception of difficulty getting patient consent, concerns for hypothermic overshoot and the number of required medical providers were raised as barriers to implementation.ConclusionSome improvements were observed in perception and practice; however, further organisational and financial support is warranted for a broader skill transfer and implementation.
Association between disease-modifying antirheumatic drugs for rheumatoid arthritis and risk of incident dementia: a systematic review with meta-analysis
Authors: Xie Wenhui , Hou Yue , Xiao Shiyu , Zhang Xiaolin , Zhang Zhuoli 
Published: February 2024

BackgroundDysregulation of several inflammatory cytokines including tumour necrosis factor (TNF) in dementia patients has also been identified as a key factor in the pathogenesis of rheumatoid arthritis (RA). We aimed to investigate the association of disease-modifying antirheumatic drugs (DMARDs) therapy for RA with risk of incident dementia.MethodsElectronic database searches of PubMed, EMBASE and Cochrane Library were performed. Observational studies that assessed the association of dementia with DMARDs in RA were included. Pooled risk ratios (RRs) with 95% CIs were used as summary statistic. The certainty of evidence was judged by using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsOverall, 14 studies involving 940 442 patients with RA were included. Pooled RR for developing dementia was 0.76 (95% CI 0.72 to 0.80) in patients taking biological DMARDs overall versus those taking conventional synthetic DMARDs, with 24% for TNF inhibitors (RR 0.76, 95% CI 0.71 to 0.82), 24% for non-TNF biologics (RR 0.76, 95% CI 0.70 to 0.83), separately. There was a significant subgroup effect among different types of TNF inhibitors (RR 0.58 [95%CI 0.53 to 0.65], 0.65 [95% CI 0.59 to 0.72], 0.80 [95% CI 0.72 to 0.88] for etanercept, adalimumab, infliximab, respectively; p value between groups=0.002). However, compared with non-users of DMARDs or investigative treatment, no significant effect on dementia incidence was observed in those receiving conventional synthetic DMARDs overall (RR 0.84, 95% CI 0.59 to 1.20), methotrexate (RR 0.78, 95% CI 0.54 to 1.12), hydroxychloroquine (RR 0.95, 95% CI 0.63 to 1.44), except for sulfasalazine (RR 1.27, 95% CI 1.06 to 1.50).ConclusionsBiological DMARDs for RA are associated with decreased dementia risk, while protective effect is not observed in conventional synthetic DMARDs. Controlled clinical trials on TNF inhibitors are necessary to test their neuroprotective potentials.
Implementation of a Multidimensional Strategy to Reduce Post-PCI Bleeding Risk
Authors: Price Andrea L. , Amin Amit P. , Rogers Susan , Messenger John C. , Moussa Issam D. , Miller Julie M. , Jennings Jonathan , Masoudi Frederick A. , Abbott J. Dawn , Young Rebecca , Wojdyla Daniel M. , Rao Sunil V. 
Published: February 2024

BACKGROUND:
The American College of Cardiology Reduce the Risk: PCI Bleed Campaign was a hospital-based quality improvement campaign designed to reduce post-percutaneous coronary intervention (PCI) bleeding events. The aim of the campaign was to provide actionable evidence-based tools for participants to review, adapt, and adopt, depending upon hospital resources and engagement.

METHODS:
We used data from 8 757 737 procedures in the National Cardiovascular Data Registry between 2015 and 2021 to compare patient and hospital characteristics and bleeding outcomes among campaign participants (n=195 hospitals) and noncampaign participants (n=1384). Post-PCI bleeding risk was compared before and after campaign participation. Multivariable hierarchical logistic regression was used to determine the adjusted association between campaign participation and post-PCI bleeding events. Prespecified subgroups were examined.

RESULTS:
Campaign hospitals were more often higher volume teaching facilities located in urban or suburban locations. After adjustment, campaign participation was associated with a significant reduction in the rate of bleeding (bleeding: adjusted odds ratio, 0.61 [95% CI, 0.53–0.71]). Campaign hospitals had a greater decrease in bleeding events than noncampaign hospitals. In a subgroup analysis, the reduction in bleeding was noted in non–ST-segment–elevation acute coronary syndrome and ST-segment–elevation myocardial infarction patients, but no significant reduction was seen in patients without acute coronary syndrome.

CONCLUSIONS:
Participation in the American College of Cardiology Reduce the Risk: PCI Bleed Campaign was associated with a significant reduction in post-PCI bleeding. Our results underscore that national quality improvement efforts can be associated with a significant impact on PCI outcomes.
Sex Differences in Receipt of Bystander Cardiopulmonary Resuscitation Considering Neighborhood Racial and Ethnic Composition
Authors: Blewer Audrey L. , Starks Monique A. , Malta‐Hansen Carolina , Sasson Comilla , Ong Marcus Eng Hock , Al‐Araji Rabab , McNally Bryan F. , Viera Anthony J. 
Published: February 2024

Background
Bystander cardiopulmonary resuscitation (B‐CPR) and defibrillation for out‐of‐hospital cardiac arrest (OHCA) vary by sex, with women being less likely to receive these interventions in public. It is unknown whether sex differences persist when considering neighborhood racial and ethnic composition. We examined the odds of receiving B‐CPR stratified by location and neighborhood. We hypothesized that women in predominantly Black neighborhoods will have a lower odds of receiving B‐CPR.

Methods and Results

We conducted a retrospective study using the Cardiac Arrest Registry to Enhance Survival (CARES). Neighborhoods were classified by census tract. We modeled the odds of receipt of B‐CPR (primary outcome), automatic external defibrillation application, and survival to hospital discharge (secondary outcomes) by sex. CARES collected 457 621 arrests (2013–2019); after appropriate exclusion, 309 662 were included. Women who had public OHCA had a 14% lower odds of receiving B‐CPR (odds ratio [OR], 0.86 [95% CI, 0.82–0.89]), but effect modification was not seen by neighborhood (
P
=not significant). In predominantly Black neighborhoods, women who had public OHCA had a 13% lower odds of receiving B‐CPR (adjusted OR, 0.87 [95% CI, 0.76–0.98]) and 12% lower odds of receiving automatic external defibrillation application (adjusted OR, 0.88 [95% CI, 0.78–0.99]). In predominantly Hispanic neighborhoods, women who had public OHCA were less likely to receive B‐CPR (adjusted OR, 0.83 [95% CI, 0.73–0.96]) and less likely to receive automatic external defibrillation application (adjusted OR, 0.74 [95% CI, 0.64–0.87]).

Conclusions
Women with public OHCA have a decreased likelihood of receiving B‐CPR and automatic external defibrillation application. Findings did not differ significantly according to neighborhood composition. Despite this, our work has implications for considering strategies to reduce disparities around bystander response.
Blood Pressure and Heart Rate Variability and the Impact on Pregnancy Outcomes: A Systematic Review
Authors: Wilson Milly G. , Bone Jeffrey N. , Mistry Hiten D. , Slade Laura J. , Singer Joel , von Dadelszen Peter , Magee Laura A. 
Published: February 2024

Background
Long‐term (visit‐to‐visit) blood pressure variability (BPV) and heart rate variability (HRV) outside pregnancy are associated with adverse cardiovascular outcomes. Given the limitations of relying solely on blood pressure level to identify pregnancies at risk, long‐term (visit‐to‐visit) BPV or HRV may provide additional diagnostic/prognostic counsel. To address this, we conducted a systematic review to examine the association between long‐term BPV and HRV in pregnancy and adverse maternal and perinatal outcomes.

Methods and Results
Databases were searched from inception to May 2023 for studies including pregnant women, with sufficient blood pressure or heart rate measurements to calculate any chosen measure of BPV or HRV. Studies were excluded that reported short‐term, not long‐term, variability. Adjusted odds ratios were extracted. Eight studies (138 949 pregnancies) reporting BPV met our inclusion criteria; no study reported HRV and its association with pregnancy outcomes. BPV appeared to be higher in women with hypertension and preeclampsia specifically, compared with unselected pregnancy cohorts. Greater BPV was associated with significantly more adverse pregnancy outcomes, particularly maternal (gestational hypertension [odds ratio range, 1.40–2.15], severe hypertension [1.40–2.20]), and fetal growth (small‐for‐gestational‐age infants [1.12–1.32] or low birth weight [1.18–1.39]). These associations were independent of mean blood pressure level. In women with hypertension, there were stronger associations with maternal outcomes but no consistent pattern for perinatal outcomes.

Conclusions
Future work should aim to confirm whether BPV could be useful for risk stratification prospectively in pregnancy, and should determine the optimal management path for those women identified at increased risk of adverse outcomes.
Influence of Time to Achieve Target Systolic Blood Pressure on Outcome After Intracerebral Hemorrhage: The Blood Pressure in Acute Stroke Collaboration
Authors: Wang Xia , Yang Jie , Moullaali Tom J. , Sandset Else Charlotte , Woodhouse Lisa J. , Law Zhe Kang , Arima Hisatomi , Butcher Kenneth S. , Delcourt Candice , Edwards Leon , Gupta Salil , Jiang Wen , Koch Sebastian , Potter John , Qureshi Adnan I. , Robinson Thompson G. , Al-Shahi Salman Rustam , Saver Jeffrey L. , Sprigg Nikola , Wardlaw Joanna , Anderson Craig S. , Sakamoto Yuki , Bath Philip M. , Chalmers John ,   The Blood Pressure in Acute Stroke (BASC) Investigators
Published: February 2024

OBJECTIVE:
To investigate whether an earlier time to achieving and maintaining systolic blood pressure (SBP) at 120 to 140 mm Hg is associated with favorable outcomes in a cohort of patients with acute intracerebral hemorrhage.

METHODS:
We pooled individual patient data from randomized controlled trials registered in the Blood Pressure in Acute Stroke Collaboration. Time was defined as time form symptom onset plus the time (hour) to first achieve and subsequently maintain SBP at 120 to 140 mm Hg over 24 hours. The primary outcome was functional status measured by the modified Rankin Scale at 90 to 180 days. A generalized linear mixed models was used, with adjustment for covariables and trial as a random effect.

RESULTS:
A total of 5761 patients (mean age, 64.0 [SD, 13.0], 2120 [36.8%] females) were included in analyses. Earlier SBP control was associated with better functional outcomes (modified Rankin Scale score, 3–6; odds ratio, 0.98 [95% CI, 0.97–0.99]) and a significant lower risk of hematoma expansion (0.98, 0.96–1.00). This association was stronger in patients with bigger baseline hematoma volume (>10 mL) compared with those with baseline hematoma volume ≤10 mL (0.006 for interaction). Earlier SBP control was not associated with cardiac or renal adverse events.

CONCLUSIONS:
Our study confirms a clear time relation between early versus later SBP control (120–140 mm Hg) and outcomes in the one-third of patients with intracerebral hemorrhage who attained sustained SBP levels within this range. These data provide further support for the value of early recognition, rapid transport, and prompt initiation of treatment of patients with intracerebral hemorrhage.
Developments in analytical techniques for mycotoxin determination: an update for 2022-23
Authors: Tittlemier S.A. , Cramer B. , DeRosa M.C. , Dzuman Z. , Malone R. , Maragos C. , Suman M. , Sumarah M.W. 
Published: February 2024

Abstract
This review summarises developments published in the period from mid-2022 to mid-2023 on the analysis of a variety of matrices for mycotoxins. Important developments in all aspects of mycotoxin determination, from sampling and quality assurance/quality control of analytical results, to the various detection and quantitation technologies ranging from single mycotoxin biosensors to comprehensive instrumental methods are presented and discussed. This non-exhaustive summary and associated discussion covers such technology as chromatography with targeted or non-targeted high resolution mass spectrometry, detection other than mass spectrometry such as fluorescence or diode array detection, biosensors, as well as assays using alternatives to antibodies. This collaborative critical review intends to guide readers to relevant research by briefly presenting the most important developments in mycotoxin determination published in the past year. This review also relays limitations of the presented methodologies, in order to provide a thorough assessment of the analytical developments.
Biased Knowers, Biased Reasons, and Biased Philosophers
Authors: Veber Michael 
Published: February 2024

Abstract
In Bias: A Philosophical Study, Thomas Kelly offers a response to epistemological skepticism grounded in his account of bias. According to Kelly, the classic argument for skepticism is best understood as an attempt to show that our commonsense beliefs are biased against the skeptic. Kelly grants that this is true but argues that biased beliefs can still be knowledge. I offer two objections. First, if we are applying Kelly’s theory of bias to skepticism, it is best to think of the skeptic’s challenge to be that our anti-skeptical beliefs are based on what we know to be biased reasons. Kelly has not shown that this sort of bias is compatible with knowledge. Second, Kelly’s approach to the problem of skepticism is an example of what I have called “unambitious epistemology.” And, for that reason, it is not a satisfactory answer to skepticism.