bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early sepsis care with the National Early Warning Score 2-guided Sepsis Hour-1 Bundle in the emergency department: hybrid type 1 effectiveness-implementation pilot stepped wedge randomised controlled trial (NEWS-1 TRIPS) protocol
Authors: Lam Rex Pui Kin , Hung Kevin Kei Ching , Lui Chun Tat , Kwok Wai Shing , Lam Wendy Wing Tak , Lau Eric Ho Yin , Sridhar Siddharth , Ng Peter Yau Tak , Cheng Chi Hung , Tsang Tat Chi , Tsui Matthew Sik Hon , Graham Colin Alexander , Rainer Timothy Hudson 
Published: February 2024

IntroductionEarly sepsis treatment in the emergency department (ED) is crucial to improve patient survival. Despite international promulgation, the uptake of the Surviving Sepsis Campaign (SSC) Hour-1 Bundle (lactate measurement, blood culture, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension/lactate ≥4 mmol/L and vasopressors for hypotension during/after fluid resuscitation within 1 hour of sepsis recognition) is low across healthcare settings. Delays in sepsis recognition and a lack of high-quality evidence hinder its implementation. We propose a novel sepsis care model (National Early Warning Score, NEWS-1 care), in which the SSC Hour-1 Bundle is triggered objectively by a high NEWS-2 (≥5). This study aims to determine the feasibility of a full-scale type 1 hybrid effectiveness-implementation trial on the NEWS-1 care in multiple EDs.Methods and analysisWe will conduct a pilot type 1 hybrid trial and prospectively recruit 200 patients from 4 public EDs in Hong Kong cluster randomised in a stepped wedge design over 10 months. All study sites will start with an initial period of standard care and switch in random order at 2-month intervals to the NEWS-1 care unidirectionally. The implementation evaluation will employ mixed methods guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, which includes qualitative and quantitative data from focus group interviews, staff survey and clinical record reviews. We will analyse the 14 feasibility outcomes as progression criteria to a full-scale trial, including trial acceptability to patients and staff, patient and staff recruitment rates, accuracy of sepsis screening, protocol adherence, accessibility to follow-up data, safety and preliminary clinical impacts of the NEWS1 care, using descriptive statistics.Ethics and disseminationThe institutional review boards of all study sites approved this study. This study will establish the feasibility of a full-scale hybrid trial. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities.Trial registration numberNCT05731349.
Maintaining independence in individuals with dementia at home after a fall: a protocol for the UK pilot cluster randomised controlled trial MAINTAIN
Authors: Greene Leanne , Barber Robert , Bingham Alison , Connors James , Conroy Simon , Elkhafer Kamr , Fox Chris , Goodwin Victoria , Gordon Adam , Hall Abigail J , Harwood Rowan H , Hulme Claire , Jackson T , Litherland Rachael , Morgan-Trimmer Sarah , Pankiewicz Sophie , Parry Steve W , Sharma Ashima , Ukoumunne Obioha , Whale Bethany , Allan Louise 
Published: February 2024

IntroductionIndividuals with dementia face an increased risk of falls. Falls can cause a decline in the individual’s overall functionality. All types of falls, including those that do not result in injury, can lead to psychosocial consequences, such as diminished confidence and a fear of falling. Projections indicate a rising trend in dementia diagnoses, implying an increase in fall incidents. Yet, there is a lack of evidence to support interventions for people living with dementia who have fallen. Our objective is to test the feasibility of a falls intervention trial for people with dementia.Method and analysisThis is a UK-based two-arm pilot cluster randomised controlled trial. In this study, six collaborating sites, which form the clusters, will be randomly allocated to either the intervention arm or the control arm (receiving treatment as usual) at a 1:1 ratio. During the 6 month recruitment phase, each cluster will enrol 10 dyads, comprising 10 individuals with dementia and their respective carers, leading to a total sample size of 60 dyads. The primary outcomes are the feasibility parameters for a full trial (ie, percentage consented, follow-up rate and cost framework). Secondary outcomes include activities of daily living, quality of life, fall efficacy, mobility, goal attainment, cognitive status, occurrence of falls, carer burden and healthcare service utilisation. Outcome measures will be collected at baseline and 28 weeks, with an additional assessment scheduled at 12 weeks for the healthcare service utilisation questionnaire. An embedded process evaluation, consisting of interviews and observations with participants and healthcare professionals, will explore how the intervention operates and the fidelity of study processes.Ethics and disseminationThe study was approved by the NHS and local authority research governance and research ethics committees (NHS REC reference: 23/WA/0126). The results will be shared at meetings and conferences and will be published in peer-reviewed journals.Trial registration numberISRCTN16413728.
Match injuries in English schoolboy rugby union
Authors: Hancock Matthew V , Barden Craig , Roberts Simon P , McKay Carly D , Stokes Keith A 
Published: February 2024

ObjectiveThis study describes the incidence, severity and burden of match injuries in schoolboy rugby union in England, across three age groups: under-13 (U13), under-15 (U15) and under-18 (U18).MethodsData regarding 574 24-hour time-loss match injuries and 18 485 player-hours of match exposure were collected from a total of 35 schools (66 teams) in the 2017/18, 2018/19 and 2019/20 seasons. Injury incidence (injuries/1000 hours), severity (mean and median days lost) and burden (days lost/1000 hours) were calculated for each age group, injury region, event, playing position and match period and were compared using Z scores.ResultsThe U18 age group had a significantly higher injury incidence (34.6 injuries/1000 hours, 95% CI 31.5 to 38.1) and burden (941 days/1000 hours, 95% CI 856 to 1035) than both the U13 (incidence=20.7 injuries/1000 hours, 95% CI 14.1 to 30.3, p=0.03; burden=477 days lost/1000 hours, 95% CI 325 to 701, p<0.01) and U15 (incidence=24.6 injuries/1000 hours, 95% CI 20.6 to 29.5, p<0.01; burden=602 days lost/1000 hours, 95% CI 503 to 721, p<0.01) age groups, but no significant differences were found between the U13 and U15 age groups. Contact events accounted for 87% of known injury events, with the tackle responsible for 52% (U13), 48% (U15) and 62% (U18) of all injuries. Concussion was the most common injury type in all age groups (U13=4.8 injuries/1000 hours; U15=6.4 injuries/1000 hours; U18=9.2 injuries/1000 hours), but the incidence was not significantly different between age groups.ConclusionInjury incidence and burden was higher in U18 than U13 and U15 age groups. Concussions and the tackle are priority areas at all age groups and should be the focus of injury prevention strategies.
Exploring conservative management for cervical intraepithelial neoplasia grade 2 in organised cervical cancer screening programmes: a multicentre study in Italy
Authors: Gori Silvia , Frayle Helena , Pagan Alessio , Soldà Marika , Romagnolo Cesare , Insacco Egle , Laurino Licia , Matteucci Mario , Sordi Giuseppe , Busato Enrico , Zorzi Manuel , Maggino Tiziano , Del Mistro Annarosa 
Published: February 2024

Cervical intraepithelial neoplasia grade 2 (CIN2) lesions may regress spontaneously, offering an alternative to immediate treatment, especially for women of childbearing age (15–45 years).We conducted a prospective multicentre study on conservative CIN2 management, with semiannual follow-up visits over 24 months, biomarkers’ investigation and treatment for progression to CIN3+ or CIN2 persistence for more than 12 months. Here, we assess women’s willingness to participate and adherence to the study protocol.The study was set in population-based organised cervical cancer screening.From April 2019 to October 2021, 640 CIN2 cases were diagnosed in women aged 25–64 participating in the screening programmes.According to our predefined inclusion and exclusion criteria, 228 (35.6%) women were not eligible; 93 (22.6%) of the 412 eligible refused, and 319 (77.4%) were enrolled. Refusal for personal reasons (ie, desire to become pregnant, anxiety, difficulty in complying with the study protocol) and external barriers (ie, residence elsewhere and language problems) accounted for 71% and 17%, respectively. Only 9% expressed a preference for treatment. The primary ineligibility factor was the upper age limit of 45 years. After enrolment, 12 (4%) women without evidence of progression requested treatment, 125 (39%) were lost to follow-up (mostly after 6–12 months) and 182 (57%) remained compliant. Remarkably, 40% of enrolees did not fully adhere to the protocol, whereas only 5% (20/412) of the eligible women desired treatment.Our study demonstrates a good acceptance of conservative management for CIN2 lesions by the women, supporting its implementation within cervical screening programmes.
Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system
Authors: Dayao John Kevin Ong , Duffy Caroline E L , Cristiano Amalia M , Kallenberg Gene 'Rusty' , Linke Sarah E 
Published: February 2024

ObjectiveExercise is Medicine (EIM) is a global initiative encouraging healthcare providers to routinely assess and promote physical activity (PA) among patients. The objective of this study was to evaluate the feasibility, adoption, implementation and effectiveness of EIM from patient, clinician and healthcare staff perspectives using a combination of electronic health record (EHR), survey and interview data.DesignThis study used a combination of the Practical Robust Implementation and Sustainability Model (PRISM) and the Learning Evaluation model to implement EIM. Data captured from the EHR, including Physical Activity Vital Sign (PAVS) scores, and data collected from qualitative surveys and interviews were used to evaluate the programme’s Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM, which is embedded within PRISM) from provider, staff and patient perspectives.SettingFive primary care clinics within a large academic health system.ParticipantsA total of 24 443 patients from all participating clinics had at least one PAVS score during the study period. A total of 17 clinicians completed surveys, and 4 clinicians, 8 medical assistants and 9 patients completed interviews.ResultsImplementation fidelity metrics varied widely between components and across clinics but were generally consistent over time, indicating a high degree of programme maintenance. Fidelity was highest during the first 6 months of the COVID-19 pandemic when most visits were virtual. Mean PAVS scores increased from 57.7 (95% CI: 56 to 59.4) to 95.2 (95% CI: 91.6 to 98.8) min per week at 6 months for patients not meeting PA guidelines at baseline and decreased from 253.84 (95% CI: 252 to 255.7) to 208.3 (95% CI: 204.2 to 212.4) min per week at 6 months for patients meeting PA guidelines at baseline. After EIM implementation, clinician-estimated time spent discussing PA with patients increased for 35% of providers and stayed the same for 53%.ConclusionOverall, this study established EIM’s feasibility, adoption, implementation and maintenance in routine primary care practice within a large academic health system. From a population health perspective, EIM is a model to emulate to help primary care providers efficiently address healthy lifestyle behaviours in routine primary care visits.
Defining criteria for disease activity states in juvenile dermatomyositis based on the Juvenile Dermatomyositis Activity Index
Authors: Rosina Silvia , Consolaro Alessandro , Pistorio Angela , Rebollo-Giménez Ana , Bracaglia Claudia , Dolezalova Pavla , Guilaisne Bernard-Medina Ana , Herlin Troels , Trachana Maria , Vargová Veronika , Wouters Carine , Carenini Laura , Ruperto Nicolino , Ravelli Angelo 
Published: February 2024

ObjectivesTo develop and validate the cut-offs in the Juvenile DermatoMyositis Activity Index (JDMAI) to distinguish the states of inactive disease (ID), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) in children with juvenile dermatomyositis (JDM).MethodsFor cut-off definition, data from 139 patients included in a randomised clinical trial were used. Among the six versions of the JDMAI, JDMA1 (score range 0–40) and JDMAI2 (score range 0–39) were selected. Optimal cut-offs were determined against external criteria by calculating different percentiles of score distribution and through receiver operating characteristic curve analysis. External criteria included the modified Pediatric Rheumatology International Trials Organization (PRINTO) criteria for clinically ID in JDM (for ID) and PRINTO levels of improvement in the clinical trial (for LDA and HDA). MDA cut-offs were set at the score interval between LDA and HDA cut-offs. Cut-off validation was conducted by assessing construct and discriminative ability in two cohorts including a total of 488 JDM patients.ResultsThe calculated JDMAI1 cut-offs were ≤2.4 for ID, ≤6.6 for LDA, 6.7–11 for MDA and >11 for HDA. The calculated JDMAI2 cut-offs were ≤5.2 for ID, ≤8.5 for LDA, 8.6–11.3 for MDA and >11.3 for HDA. The cut-offs discriminated strongly among disease activity states defined subjectively by caring physicians and parents, parents’ satisfaction or non-satisfaction with illness outcome, levels of pain, fatigue, physical functional impairment and physical well-being.ConclusionsBoth JDMAI1 and JDMAI2 cut-offs revealed good metrologic properties in validation analyses and are, therefore, suited for application in clinical practice and research.
Estimated prevalence, incidence and healthcare costs of Sjögren’s syndrome in France: a national claims-based study
Authors: Seror Raphaele , Chiche Laurent , Beydon Maxime , Desjeux Guillaume , Zhuo Joe , Vannier-Moreau Virginie , Devauchelle-Pensec Valérie 
Published: February 2024

ObjectivesTo estimate prevalence, incidence and mortality rates, and annual healthcare costs of primary Sjögren’s syndrome (pSS) and SS associated with other autoimmune disorders (SS+AID) in France.MethodsFrench national healthcare claims-based study within the prospective Système National des Données de Santé database that includes the majority of the French population. An algorithm was developed to identify patients with SS and SS-related healthcare claims were analysed between 2011 and 2018.ResultsOverall, 23 848 patients with pSS and 14 809 with SS+AID were identified. From 2011 to 2018, the prevalence rate increased slightly for pSS (23–32 per 100000) and SS+AID (16–20 per 100 000), with females comprising 90%–91% and 92%–93% of cases, respectively. The incidence rate of SS per 100 000 persons decreased from 2012 (pSS: 4.3; SS+AID: 2.0) to 2017 (pSS: 0.7; SS+AID: 0.3). Mortality rates per 100 000 persons increased from 2012 to 2018 in patients with pSS (0.2–0.8) or SS+AID (0.1–0.5); mean age of death also increased. Artificial tears and hydroxychloroquine were the most common drug reimbursements. Less than half of patients received annual specialist care from a dentist or ophthalmologist. Healthcare costs associated with SS increased from 2011 to 2018 and exceeded the national estimate of expected costs for chronic diseases.ConclusionIn this large French population database study, the low prevalence of pSS confirms that it is an orphan disease. SS is clinically and economically burdensome; these findings may help clinicians better understand routine healthcare received by patients.
Cretaceous pterosaur history, diversity and extinction
Authors: Martill David M. , Smith Roy E. 
Published: February 2024

Abstract
Pterosaurs, the first vertebrates to evolve powered flight, dominated Mesozoic skies from the Late Triassic to the end Cretaceous, a span of around 154 Myr (∼220–66 Ma). They achieved their greatest diversity in the mid-Cretaceous and had become globally distributed, even occurring at high latitudes and in a wide range of habitats. The pterosaur record is dominated by occurrences in conservation Lagerstätten in just a handful of countries and a narrow range of temporal windows, most notably China, Germany and Brazil, and the Middle–Upper Jurassic and mid-Cretaceous.
During the Cretaceous, two major pterosaur clades evolved edentulism, such that by the end of the Cretaceous, no toothed pterosaurs survived, having become extinct by the mid-Cenomanian.
A distinctive aspect of pterosaur evolution during the mid-Cretaceous was the achievement of gigantic wingspans, perhaps in excess of 10 m, hyper-elongation of the neck vertebrae in Azhdarchidae, and the evolution of highly elaborate cranial crests. For many years, pterosaur diversity in the terminal stage of the Late Cretaceous was regarded as low, but discoveries in the last few decades have indicated pterosaur taxic diversity remained high until the end Maastrichtian, although morphological diversity may have been low. The demise of the Pterosauria at the K/Pg boundary was most likely due to the same causes as the coeval dinosaur extinction associated with the Chicxulub bolide impact and its environmental repercussions. Faunal replacement by avians is no longer considered a significant factor in pterosaur extinction.
mGPT: Few-Shot Learners Go Multilingual
Authors: Shliazhko Oleh , Fenogenova Alena , Tikhonova Maria , Kozlova Anastasia , Mikhailov Vladislav , Shavrina Tatiana 
Published: February 2024

Abstract
This paper introduces mGPT, a multilingual variant of GPT-3, pretrained on 61 languages from 25 linguistically diverse language families using Wikipedia and the C4 Corpus. We detail the design and pretraining procedure. The models undergo an intrinsic and extrinsic evaluation: language modeling in all languages, downstream evaluation on cross-lingual NLU datasets and benchmarks in 33 languages, and world knowledge probing in 23 languages. The in-context learning abilities are on par with the contemporaneous language models while covering a larger number of languages, including underrepresented and low-resource languages of the Commonwealth of Independent States and the indigenous peoples in Russia. The source code and the language models are publicly available under the MIT license.
Tranexamic Acid Attenuates the Progression of Posttraumatic Osteoarthritis in Mice
Authors: Xie Weixin , Jiang Shan , Donat Antonia , Knapstein Paul Richard , Albertsen Lilly-Charlotte , Kokot Judith Luisa , Erdmann Cordula , Rolvien Tim , Frosch Karl-Heinz , Baranowsky Anke , Keller Johannes 
Published: February 2024

Background: Posttraumatic osteoarthritis (OA) is a common disorder associated with a high socioeconomic burden, particularly in young, physically active, and working patients. Tranexamic acid (TXA) is commonly used in orthopaedic trauma surgery as an antifibrinolytic agent to control excessive bleeding. Previous studies have reported that TXA modulates inflammation and bone cell function, both of which are dysregulated during posttraumatic OA disease progression. Purpose: To evaluate the therapeutic effects of systemic and topical TXA treatment on the progression of posttraumatic OA in the knee of mice. Study Design: Controlled laboratory study. Methods: OA was induced via anterior cruciate ligament (ACL) transection on the right knee of female mice. Mice were treated with TXA or vehicle intraperitoneally daily or intra-articularly weekly for 4 weeks, starting on the day of surgery. Articular cartilage degeneration, synovitis, bone erosion, and osteophyte formation were scored histologically. Micro−computed tomography evaluation was conducted to measure the subchondral bone microstructure and osteophyte volume. Cartilage thickness and bone remodeling were assessed histomorphometrically. Results: Both systemic and topical TXA treatment significantly reduced cartilage degeneration, synovitis, and bone erosion scores and increased the ratio of hyaline to calcified cartilage thickness in posttraumatic OA. Systemic TXA reversed ACL transection-induced subchondral bone loss and osteophyte formation, whereas topical treatment had no effect. Systemic TXA decreased the number and surface area of osteoclasts, whereas those of osteoblasts were not affected. No effect of topical TXA on osteoblast or osteoclast parameters was observed. Conclusion: Both systemic and topical TXA exerted protective effects on the progression of posttraumatic OA. Drug repurposing of TXA may, therefore, be useful for the prevention or treatment of posttraumatic OA, particularly after ACL surgery. Clinical Relevance: TXA might be beneficial in patients with posttraumatic OA of the knee.
Optimizing the Combination of Common Clinical Concussion Batteries to Predict Persistent Postconcussion Symptoms in a Prospective Cohort of Concussed Youth
Authors: Corwin Daniel J. , Mandel Francesca , McDonald Catherine C. , Barnett Ian , Arbogast Kristy B. , Master Christina L. 
Published: February 2024

Background: Studies have evaluated individual factors associated with persistent postconcussion symptoms (PPCS) in youth concussion, but no study has combined individual elements of common concussion batteries with patient characteristics, comorbidities, and visio-vestibular deficits in assessing an optimal model to predict PPCS. Purpose: To determine the combination of elements from 4 commonly used clinical concussion batteries and known patient characteristics and comorbid risk factors that maximize the ability to predict PPCS. Study Design: Cohort study; Level of evidence, 2. Methods: We enrolled 198 concussed participants—87 developed PPCS and 111 did not—aged 8 to 19 years assessed within 14 days of injury from a suburban high school and the concussion program of a tertiary care academic medical center. We defined PPCS as a Post-Concussion Symptom Inventory (PCSI) score at 28 days from injury of ≥3 points compared with the preinjury PCSI score—scaled for younger children. Predictors included the individual elements of the visio-vestibular examination (VVE), Sport Concussion Assessment Tool, 5th Edition (SCAT-5), King-Devick test, and PCSI, in addition to age, sex, concussion history, and migraine headache history. The individual elements of these tests were grouped into interpretable factors using sparse principal component analysis. The 12 resultant factors were combined into a logistic regression and ranked by frequency of inclusion into the combined optimal model, whose predictive performance was compared with the VVE, initial PCSI, and the current existing predictive model (the Predicting and Prevention Postconcussive Problems in Pediatrics (5P) prediction rule) using the area under the receiver operating characteristic curve (AUC). Results: A cluster of 2 factors (SCAT-5/PCSI symptoms and VVE near point of convergence/accommodation) emerged. A model fit with these factors had an AUC of 0.805 (95% CI, 0.661-0.929). This was a higher AUC point estimate, with overlapping 95% CIs, compared with the PCSI (AUC, 0.773 [95% CI, 0.617-0.912]), VVE (AUC, 0.736 [95% CI, 0.569-0.878]), and 5P Prediction Rule (AUC, 0.728 [95% CI, 0.554-0.870]). Conclusion: Among commonly used clinical assessments for youth concussion, a combination of symptom burden and the vision component of the VVE has the potential to augment predictive power for PPCS over either current risk models or individual batteries.