bluuebunny/crossref_metadata_2025_split huggingface dataset:
Added value of electrical impedance spectroscopy in adjunction of colposcopy: a prospective cohort study
Authors: Bergqvist Laura , Heinonen Annu , Carcopino Xavier , Redman Charles , Aro Karoliina , Kiviharju Mari , Virtanen Seppo , Omar Pirjo-Liisa , Kotaniemi-Talonen Laura , Louvanto Karolina , Nieminen Pekka , Kalliala Ilkka 
Published: October 2023

ObjectiveTo assess whether electrical impedance spectroscopy (EIS) as an adjunctive technology enhances the performance of colposcopy.DesignProspective cohort study.SettingUniversity Hospital colposcopy clinic.ParticipantsColposcopy with EIS for 647 women and conventional colposcopy for 962 women.InterventionsComparison of the performance of colposcopy by referral cervical cytology in two cohorts, with and without EIS as an adjunctive technology.Outcome measuresPrevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+), diagnostic testing accuracy to detect CIN2+ with and without EIS and their relative differences between cohorts.ResultsThe prevalence of CIN2+ varied between the cohorts according to referral cytology: 17.0% after abnormal squamous cells of unknown significance referral cytology in EIS cohort and 9.1% in the reference cohort, 16.5% and 18.9% after low-grade squamous intraepithelial lesion (LSIL), 44.3% and 58.2% after atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (HSIL) (atypical squamous cells that cannot exclude HSIL), and 81.9% and 77.0% after HSIL cytology, respectively. Sensitivity to detect CIN2+ was higher in the EIS cohort, varying from 1.79 (95% CI 1.30 to 2.45) after LSIL referral cytology to 1.16 (95% CI 1.09 to 1.23) after HSIL referral cytology, with correspondingly lower specificity after any referral cytology.ConclusionsColposcopy with EIS had overall higher sensitivity but lower specificity to detect CIN2+ than conventional colposcopy. CIN2+ prevalence rates were, however, not consistently higher in the EIS cohort, suggesting innate differences between the cohorts or truly lower detection rates of CIN2+ for EIS, highlighting the need for randomised controlled trials on the effectiveness of EIS.
Associations between spirometric impairments and microvascular complications in type 2 diabetes: a cross-sectional study
Authors: Hayfron-Benjamin Charles F , Agyemang Charles , van den Born Bert-Jan H , Amoah Albert G B , Amissah-Arthur Kwesi Nyan , Musah Latif , Abaidoo Benjamin , Awula Pelagia , Awuviri Henry Wedoi , Abbey Joseph Agyapong , Fummey Deladem A , Ackam Joana N , Asante Gloria Odom , Hashimoto Simone , Maitland-van der Zee Anke H 
Published: October 2023

ObjectiveEvidence shows that the conventional cardiometabolic risk factors do not fully explain the burden of microvascular complications in type 2 diabetes (T2D). One potential factor is the impact of pulmonary dysfunction on systemic microvascular injury. We assessed the associations between spirometric impairments and systemic microvascular complications in T2D.DesignCross-sectional study.SettingNational Diabetes Management and Research Centre in Ghana.ParticipantsThe study included 464 Ghanaians aged ≥35 years with established diagnosis of T2D without primary myocardial disease or previous/current heart failure. Participants were excluded if they had primary lung disease including asthma or chronic obstructive pulmonary disease.Primary and secondary outcome measuresThe associations of spirometric measures (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio) with microvascular complications (nephropathy (albumin-creatinine ratio ≥30 mg/g), neuropathy (vibration perception threshold ≥25 V and/or Diabetic Neuropathy Symptom score >1) and retinopathy (based on retinal photography)) were assessed using multivariable logistic regression models with adjustments for age, sex, diabetes duration, glycated haemoglobin concentration, suboptimal blood pressure control, smoking pack years and body mass index.ResultsIn age and sex-adjusted models, lower Z-score FEV1was associated with higher odds of nephropathy (OR 1.55, 95% CI 1.19–2.02, p=0.001) and neuropathy (1.27 (1.01–1.65), 0.038) but not retinopathy (1.22 (0.87–1.70), 0.246). Similar observations were made for the associations of lower Z-score FVC with nephropathy (1.54 (1.19–2.01), 0.001), neuropathy (1.25 (1.01–1.54), 0.037) and retinopathy (1.19 (0.85–1.68), 0.318). In the fully adjusted model, the associations remained significant for only lower Z-score FEV1with nephropathy (1.43 (1.09–1.87), 0.011) and neuropathy (1.34 (1.04–1.73), 0.024) and for lower Z-score FVC with nephropathy (1.45 (1.11–1.91), 0.007) and neuropathy (1.32 (1.03–1.69), 0.029). Lower Z-score FEV1/FVC ratio was not significantly associated with microvascular complications in age and sex and fully adjusted models.ConclusionOur study shows positive but varying strengths of associations between pulmonary dysfunction and microvascular complications in different circulations. Future studies could explore the mechanisms linking pulmonary dysfunction to microvascular complications in T2D.
‘Children awaken by playing’: a qualitative exploration of caregivers’ norms, beliefs and practices related to young children’s learning and early childhood development in rural Burkina Faso
Authors: Dumbaugh Mari , Belem Mireille , Kousse Sylvain , Ouoba Patricia , Sankoudouma Adama , Tchibozo Achille Mignondo , Fearon Pasco , Hollowell Jennifer , Hill Z 
Published: October 2023

IntroductionEvidence suggests that responsive caregiving and early learning activities positively impact developmental outcomes, with positive effects throughout the life course. Early childhood development interventions should align with local values, beliefs and resources but there has been little research of caregiver beliefs and perspectives on development and learning, especially in sub-Saharan Africa. This qualitative study explored norms, beliefs, practices and aspirations around child development of caregivers of young children in rural Burkina Faso.MethodsWe conducted 32 in-depth interviews with mothers and fathers of young children and 24 focus group discussions with mothers, fathers and grandmothers, which included trying behaviours and reporting on experiences. The research informed the development of Scaling Up Nurturing Care, a Radio Intervention to Stimulate Early Childhood Development (SUNRISE), an early child development radio intervention.ResultsCaregivers described a process of ‘awakening’, through which children become aware of themselves and the world around them.Perceptions of the timing of awakening varied, but the ability to learn was thought to increase as children became older and more awake. Consequently, talking and playing with babies and younger children were perceived to have little developmental impact. Caregivers said children’s interactions with them, alongside God-given intelligence, was believed to impact later behaviour and development. Caregivers felt their role in helping their children achieve later in life was to pay for education, save money, provide advice and be good role models. Interaction and learning activities were not specifically mentioned. Caregivers who trialled interaction and learning activities reported positive experiences for themselves and their child, but interactions were often caregiver led and directive and play was often physical. Key barriers to carrying out the behaviours were poverty and a lack of time.ConclusionsExploring early childhood beliefs and practices can reveal important sociocultural beliefs which, if incorporated into programme planning and implementation, could help achieve more impactful, acceptable and equitable programmes.Trial registration numberNCT05335395.
Exploring the relationship between simulation-based team training and sick leave among healthcare professionals: a cohort study across multiple hospital sites
Authors: Schram Anders , Jensen Hanne Irene , Gamborg Maria , Lindhard Morten , Rölfing Jan , Kjaergaard-Andersen Gunhild , Bie Magnus , Jensen Rune Dall 
Published: October 2023

ObjectiveBurnout and mental illness are frequent among healthcare professionals, leading to increased sick leave. Simulation-based team training has been shown to improve job satisfaction and mental health among healthcare professionals. This study seeks to investigate the relationship between simulation-based team training and sick leave.DesignCohort study.Setting and interventionFive Danish hospitals.ParticipantsA total of 15 751 individuals were screened for eligibility. To meet the eligibility criteria, individuals had to be employed in the same group (intervention or control) for the whole study period. A total of 14 872 individuals were eligible for analysis in the study.InterventionFrom 2017 to 2019, a simulation-based team training intervention was implemented at two hospital sites. Three hospital sites served as the control group.Outcome measuresData on sick leave from 2015 to 2020 covered five hospital sites. Using a difference-in-difference analysis, the rate of sick leave was compared across hospital sites (intervention vs control) and time periods (before vs after intervention).ResultsSignificant alterations in sick leave were evident when comparing the intervention and control groups. When comparing groups over time, the increase in sick leave was −0.3% (95% CI −0.6% to −0.0%) lower in the intervention group than in the control group. The difference-in-difference for the complete case analysis showed that this trend remained consistent, with analysis indicating a comparable lower increase in sick leave by −0.7% (95% CI −1.3% to −0.1%) in the intervention group.ConclusionThe increase in sick leave rate was statistically significantly lower in the intervention group, implying that simulation-based team training could serve as a protective factor against sick leave. However, when investigating this simulation intervention over 5 years, other potential factors may have influenced sick leave, so caution is required when interpreting the results.
Can video communication in the emergency medical communication centre improve dispatch precision? A before–after study in Norwegian helicopter emergency medical services
Authors: Ulvin Ole Erik , Skjærseth Eivinn Årdal , Krüger Andreas J , Thorsen Kjetil , Nordseth Trond , Haugland Helge 
Published: October 2023

ObjectivesDispatching helicopter emergency medical services (HEMS) to the patients with the greatest medical or logistical benefit remains challenging. The introduction of video calls (VC) in the emergency medical communication centres (EMCC) could provide additional information for EMCC operators and HEMS physicians when assessing the need for HEMS dispatch. The aim of this study was to evaluate the impact from VC in the EMCC on HEMS dispatch precision.DesignAn observational before–after study.SettingThe regional EMCC and one HEMS base in Mid-Norway.ParticipantsEMCC operators and HEMS physicians at the EMCC and HEMS base in Trondheim, Norway.InterventionIn January 2022, VC became available in emergency calls in Trondheim EMCC. Data were collected from 2020 2021 (pre-intervention) and 2022 (post-intervention).Primary and secondary outcome measuresThe primary outcome was the proportion of seriously ill or injured HEMS patients, defined as a National Advisory Committee for Aeronautics (NACA) score between 4 and 7. The secondary outcome was the proportion of inappropriate dispatches, defined as missions with neither provision of additional competence nor any logistical contribution based on quality indicators for physician-staffed emergency medical services.Results811 and 402 HEMS missions with patient contact were included in the pre- and post-intervention group, respectively. The proportion of missions with NACA 4–7 was not significantly changed after the intervention (OR 1.21, 95% CI 0.92 to 1.61, p=0.17). There was no significant change in HEMS alarm times between the pre- and post-intervention groups (7.6 min vs 6.4 min, p=0.15). The proportion of missions with neither medical nor logistical benefit was significantly lower in the post-intervention group (28.4% vs 40.3%, p=0.007).ConclusionThe results from this study indicate that VC is a promising, feasible and safe tool for EMCC operators in the complex HEMS dispatch process.
Long-term impact of the COVID-19 pandemic on self-management of chronic conditions among high-risk adults in the USA: protocol for the C3 observational cohort study
Authors: Lovett Rebecca , Filec Sarah , Bonham Morgan , Yoshino Benavente Julia , O'Conor Rachel , Russell Andrea , Zheng Pauline , Wismer Guisselle , Yoon Esther , Weiner-Light Sophia , Vogeley Abigail , Morrissey Kwasny Mary , Lowe Sarah , Curtis Laura M , Federman Alex , Bailey Stacy C , Wolf Michael 
Published: October 2023

IntroductionCOVID-19 is an unprecedented public health threat in modern times, especially for older adults or those with chronic illness. Beyond the threat of infection, the pandemic may also have longer-term impacts on mental and physical health. The COVID-19 & Chronic Conditions (‘C3’) study offers a unique opportunity to assess psychosocial and health/healthcare trajectories over 5 years among a diverse cohort of adults with comorbidities well-characterised from before the pandemic, at its onset, through multiple surges, vaccine rollouts and through the gradual easing of restrictions as society slowly returns to ‘normal’.Methods and analysisThe C3 study is an extension of an ongoing longitudinal cohort study of ‘high-risk’ adults (aged 23–88 at baseline) with one or more chronic medical conditions during the COVID-19 pandemic. Five active studies with uniform data collection prior to COVID-19 were leveraged to establish the C3 cohort; 673 adults in Chicago were interviewed during the first week of the outbreak. The C3 cohort has since expanded to include 1044 participants across eight survey waves (T1–T8). Four additional survey waves (T9–T12) will be conducted via telephone interviews spaced 1 year apart and supplemented by electronic health record and pharmacy fill data, for a total of 5 years of data post pandemic onset. Measurement will include COVID-19-related attitudes/behaviours, mental health, social behaviour, lifestyle/health behaviours, healthcare use, chronic disease self-management and health outcomes. Mental health trajectories and associations with health behaviours/outcomes will be examined in a series of latent group and mixed effects modelling, while also examining mediating and moderating factors.Ethics and disseminationThis study was approved by Northwestern University’s Feinberg School of Medicine Institutional Review Board (STU00215360). Results will be published in international peer-reviewed journals and summaries will be provided to the funders of the study.
Triple vasodilator therapy in pulmonary arterial hypertension associated with congenital heart disease
Authors: Luna-Lopez Raquel , Segura de la Cal Teresa , Sarnago Cebada Fernando , Martin de Miguel Irene , Hinojosa Williams , Cruz-Utrilla Alejandro , Velazquez Maria Teresa , Delgado Juan F , Mendoza Alberto , Arribas Ynsaurriaga Fernando , Escribano-Subías Pilar 
Published: October 2023

ObjectiveThis study assessed the long-term effects of triple therapy with prostanoids on patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD), as there is limited information on the safety and efficacy of this treatment approach.MethodsA retrospective cohort study was conducted on patients with PAH-CHD who were actively followed up at our centre. All patients were already receiving dual combination therapy at maximum doses. Clinical characteristics, including functional class (FC), 6-minute walking test distance (6MWTD) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, were documented before initiating triple therapy and annually for a 2-year follow-up period.ResultsA total of 60 patients were included in the study, with a median age of 41 years and 68% being women. Of these, 32 had Eisenmenger syndrome, 9 had coincidental shunts, 18 had postoperative PAH and 1 had a significant left-to-right shunt. After 1 year of triple combination initiation, a significant improvement in 6MWTD was observed (406 vs 450; p=0.0027), which was maintained at the 2-year follow-up. FC improved in 79% of patients at 1 year and remained stable in 76% at 2 years. NT-proBNP levels decreased significantly by 2 years, with an average reduction of 199 ng/L. Side effects were experienced by 33.3% of patients but were mostly mild and manageable. Subgroup analysis showed greater benefits in patients without Eisenmenger syndrome and those with pre-tricuspid defects.ConclusionsTriple therapy with prostanoids is safe and effective for patients with PAH-CHD, improving FC, 6MWTD and NT-proBNP levels over 2 years. The treatment is particularly beneficial for patients with pre-tricuspid defects and non-Eisenmenger PAH-CHD.
Computed tomography calcium scoring in aortic stenosis: bicuspid versus tricuspid morphology
Authors: Ye Zi , Clavel Marie-Annick , Foley Thomas A , Pibarot Philippe , Enriquez-Sarano Maurice , Michelena Hector I 
Published: October 2023

ObjectiveCT aortic valve calcium score (AVCscore) and density (AVCdensity) thresholds have been recommended for aortic stenosis (AS) severity assessment in tricuspid aortic valve (TAV). We aimed to compare AVCscoreand AVCdensityin bicuspid aortic valve (BAV) versus TAV.MethodsRetrospective single-centre study of patients with echocardiographic AS-severity and CT-AVC assessments within 6 months, and left ventricular ejection fraction ≥50%, all referred for clinical AS evaluation.Severe AS was defined as aortic valve area (AVA) ≤1 cm2or indexed AVA ≤0.6cm2/m2plus mean gradient ≥40 mm Hg or peak velocity ≥4 m/s. AVC was assessed by Agatston method.ResultsOf the 1957 patients, 328 had BAV and 1629 had TAV, age 65±11 vs 80±9 years (p<0.001), men 65% vs 56% (p=0.006), respectively. BAV morphology was associated with higher AVCscoreand AVCdensityindependent of age, comorbidities and AS severity (p<0.001) in men only (sex and BAV interaction p<0.001). In patients with severe AS, mean AVCscoreand AVCdensitywere higher in BAV-men than that in TAV-men (both p<0.001), but similar in BAV-women and TAV-women (both p≥0.4). Such patterns remained the same after adjustment for clinical covariates and AS severity. Best thresholds for severe AS diagnosis in BAV-men were 2916 AU by AVCscoreand 600 AU/cm2by AVCdensitywhich were higher than the guideline-recommended thresholds, while thresholds in BAV-women (1036 AU and 282 AU/cm2) were similar to guideline-recommended ones.ConclusionValve calcification in AS differs according to valve morphology and sex. BAV-men with severe AS exhibit greater AVCscoreand AVCdensitythan TAV-men. This presents a diagnostic challenge to the current guidelines, which needs confirmation in larger studies.
Effects of exercise during chemotherapy for breast cancer on long-term cardiovascular toxicity
Authors: Naaktgeboren Willeke R , Stuiver Martijn M , van Harten Wim H , Aaronson Neil K , Scott Jessica M , Sonke Gabe , van der Wall Elsken , Velthuis Miranda , Leiner Tim , Teske Arco J , May Anne M , Groen Wim G 
Published: October 2023

ObjectiveAnimal data suggest that exercise during chemotherapy is cardioprotective, but clinical evidence to support this is limited. This study evaluated the effect of exercise during chemotherapy for breast cancer on long-term cardiovascular toxicity.MethodsThis is a follow-up study of two previously performed randomised trials in patients with breast cancer allocated to exercise during chemotherapy or non-exercise controls. Cardiac imaging parameters, including T1 mapping (native T1, extracellular volume fraction (ECV)), left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), cardiorespiratory fitness, and physical activity levels, were acquired 8.5 years post-treatment.ResultsIn total, 185 breast cancer survivors were included (mean age 58.9±7.8 years), of whom 99% and 18% were treated with anthracyclines and trastuzumab, respectively. ECV and Native T1 were 25.3%±2.5% and 1026±51 ms in the control group, and 24.6%±2.8% and 1007±44 ms in the exercise group, respectively. LVEF was borderline normal in both groups, with an LVEF<50% prevalence of 22.5% (n=40/178) in all participants. Compared with control, native T1 was statistically significantly lower in the exercise group (β=−20.16, 95% CI −35.35 to −4.97). We found no effect of exercise on ECV (β=−0.69, 95% CI −1.62 to 0.25), LVEF (β=−1.36, 95% CI −3.45 to 0.73) or GLS (β=0.31, 95% CI −0.76 to 1.37). Higher self-reported physical activity levels during chemotherapy were significantly associated with better native T1 and ECV.ConclusionsIn long-term breast cancer survivors, exercise and being more physically active during chemotherapy were associated with better structural but not functional cardiac parameters. The high prevalence of cardiac dysfunction calls for additional research on cardioprotective measures, including alternative exercise regimens.Trial registration numberNTR7247.
Collisional Penrose process of extended test particles near an extremal Kerr black hole
Authors: Sang Aofei , Jiang Jie , Zhang Ming 
Published: October 2023

AbstractWe investigate the collisional Penrose process of extended test particles near an extremal Kerr black hole using the pole-dipole-quadrupole approximation. We analyze the motion of the test particles and examine the dynamics and maximal efficiency of energy extraction in this process. Our results demonstrate that the maximal extracted energy in the collisional Penrose process is influenced by the spin s and quadrupolar parameter C of the test particles. Specifically, we observe that, at a fixed collisional position, the energy extraction efficiency decreases as the spin increases for either the pole-dipole or the pole-dipole-quadrupole approximation case. Furthermore, for a fixed spin, the energy extraction efficiency is higher in the pole-dipole-quadrupole approximation compared to the pole-dipole approximation. These findings provide insight into the role of the internal structures of the test particles in the collisional Penrose process.