bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme: a protocol of a cluster randomised control trial
Authors: Kaasalainen Sharon , Wickson-Griffiths Abigail , Hunter Paulette , Thompson Genevieve , Kruizinga Julia , McCleary Lynn , Sussman Tamara , Venturato Lorraine , Shaw Sally , Boamah Sheila A , Bourgeois-Guérin Valérie , Hadjistavropoulos Thomas , Macdonald Marilyn , Martin-Misener Ruth , McClement Susan , Parker Deborah , Penner Jamie , Ploeg Jenny , Sinclair Shane , Fisher Kathryn 
Published: October 2023

IntroductionDespite the high mortality rates in long-term care (LTC) homes, most do not have a formalised palliative programme. Hence, our research team has developed the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme. The goal of the proposed study is to examine the implementation and effectiveness of the SPA-LTC programme.Methods and analysisA cross-jurisdictional, effectiveness-implementation type II hybrid cluster randomised control trial design will be used to assess the SPA-LTC programme for 18 LTC homes (six homes within each of three provinces). Randomisation will occur at the level of the LTC home within each province, using a 1:1 ratio (three homes in the intervention and control groups). Baseline staff surveys will take place over a 3-month period at the beginning for both the intervention and control groups. The intervention group will then receive facilitated training and education for staff, and residents and their family members will participate in the SPA-LTC programme. Postintervention data collection will be conducted in a similar manner as in the baseline period for both groups. The overall target sample size will be 594 (297 per arm, 33 resident/family member participants per home, 18 homes). Data collection and analysis will involve organisational, staff, resident and family measures. The primary outcome will be a binary measure capturing any emergency department use in the last 6 months of life (resident); with secondary outcomes including location of death (resident), satisfaction and decisional conflict (family), knowledge and confidence implementing a palliative approach (staff), along with implementation outcomes (ie, feasibility, reach, fidelity and perceived sustainability of the SPA-LTC programme). The primary outcome will be analysed via multivariable logistic regression using generalised estimating equations. Intention-to-treat principles will be used in the analysis.Ethics and disseminationThe study has received ethical approval. Results will be disseminated at various presentations and feedback sessions; at provincial, national and international conferences, and in a series of manuscripts that will be submitted to peer-reviewed, open access journals.Trial registration numberNCT039359.
Association of serum magnesium levels with acute ischaemic stroke in patients with type 2 diabetes mellitus: a propensity score-matched case–control study
Authors: Ibrahim Anisha , Legha R , Ravi Renju , Raj Jeffrey Pradeep , Pushparajan Libby 
Published: October 2023

IntroductionMagnesium (Mg) deficiency has been found to be associated with many clinical conditions, such as type 2 diabetes mellitus (T2DM), cardiovascular diseases and likewise. Studies evaluating the association between serum Mg levels and ischaemic stroke in T2DM from India are limited, and this formed the aim of this study.MethodsWe conducted a case–control study among patients with T2DM where cases had a history of acute ischaemic stroke in the preceding 2 years and controls with no such history. Data regarding sociodemographic and clinical details and laboratory parameters, including serum Mg concentration, were collected using a semistructured questionnaire. Furthermore, propensity score matching (PSM) was done to match the controls with the cases.ResultsWe enrolled a total of 200 participants (cases: 75 and controls: 125), but after PSM, 149 participants (cases: 75 and control:74) were analysed. The serum Mg concentrations were significantly low (p<0.001) among the cases (mean (SD)=1.74 (0.22)) when compared with the controls (mean (SD)=1.95 (0.13)). For every 0.1 mg/dL decrease in serum Mg concentration, the odds of ischaemic stroke increase by approximately 1.918 times (95% CI 1.272 to 2.890; p=0.002).ConclusionsThe mean Mg level in the ischaemic stroke group was significantly low compared with the no stroke group in patients with T2DM. We recommend further controlled studies to evaluate the role of Mg supplementation in the management of acute ischaemic stroke.
Scabies in the Amhara region of northern Ethiopia: a cross-sectional study of prevalence, determinants, clinical presentation and community knowledge
Authors: Yirgu Robel , Middleton Jo , Fekadu Abebaw , Cassell Jackie A , Tesfaye Abraham , Jones Christopher Iain , Bremner Stephen , Enbiale Wendemagegn , Davey Gail 
Published: October 2023

BackgroundThe WHO aims to prevent, eliminate or control neglected tropical diseases, including scabies, by 2030. However, limited epidemiological data presented a challenge to control efforts, especially in high burden countries. There was a major scabies outbreak in northern Ethiopia starting in 2015 and prevalence has since increased across much of the country.ObjectiveTo estimate scabies prevalence, identify its predictors, and assess community perception of, and knowledge about, the infestation.DesignPopulation-based cross-sectional study.Study settingAyu Guagusa district, Amhara region, northern Ethiopia.Participants1437 people who were members of 381 randomly selected households participated in the study. Five trained mid-level health workers clinically diagnosed people with scabies.Outcome measuresClinically diagnosed scabies infestation.Data analysisMulti-level logistic regression models were fitted to adjust for individual and household-level confounding variables, and identify predictors of scabies infestation.ResultsScabies prevalence was 13.4% (95% CI 11.8 to 15.5). Households of more than five people (adjusted OR (aOR)=3.5, 95% CI 1.2 to 10.2) were associated with increased odds of developing scabies, however, females had lower odds (aOR=0.5 95% CI 0.3 to 0.8). Scabietic lesions most frequently involved the trunk (62.0%), and vesicles were the most common types of lesions (67.7%). Two-thirds of adult study participants had heard about scabies and most obtained scabies related information from informal sources. Only 32% of cases sought care for scabies from any source.ConclusionScabies prevalence was high, signifying the need for community-based control interventions. Host density and sex were important predictors of scabies. Despite the favourable attitude toward the effectiveness of scabies treatment, healthcare seeking was low.
Outer retinal corrugations in late-onset retinal degeneration: a diagnostic finding demonstrated with multimodal imaging
Authors: Duncan Holly Joan , McNally Thomas W , Ferrara Mariantonia , Kotagiri Ajay 
Published: October 2023

ObjectiveLate-onset retinal degeneration (L-ORD) is a rare autosomal dominant retinal degeneration that presents in the sixth decade and leads to severe visual loss. The objective of this paper is to describe outer retinal corrugations as a diagnostic feature of L-ORD.MethodsThis retrospective study reviewed consecutive patients diagnosed with L-ORD, confirmed through complete ophthalmic examination, multimodal imaging and genetic tests. Multimodal imaging investigations included spectral domain-optical coherence tomography (SD-OCT) and ultra-wide-field colour and autofluorescence fundus photographs.ResultsA total of 13 eyes of 9 patients with L-ORD had outer retinal corrugations identified on OCT scans.ConclusionOuter retinal corrugations may be a diagnostic finding for L-ORD. The detection of this sign may aid diagnosis and characterisation of this disease and help in the differential diagnosis with other acquired pathologies.
Alarm burden and the nursing care environment: a 213-hospital cross-sectional study
Authors: Ruppel Halley , Dougherty Maura , Bonafide Christopher P , Lasater Karen B 
Published: October 2023

BackgroundHigh rates of medical device alarms in hospitals are a well-documented threat to patient safety. Little is known about organisational features that may be associated with nurses’ experience of alarm burden.AimsTo evaluate the association between nurse-reported alarm burden, appraisals of patient safety, quality of care and hospital characteristics.MethodsSecondary analysis of cross-sectional survey data from 3986 hospital-based direct-care registered nurses in 213 acute care hospitals in New York and Illinois, USA. We evaluated associations of alarm burden with appraisals of patient safety and quality of care and hospital characteristics (work environment, staffing adequacy, size, teaching status) using χ2tests.ResultsThe majority of respondents reported feeling overwhelmed by alarms (83%), delaying their response to alarms because they were unable to step away from another patient/task (76%), and experiencing situations where a patient needed urgent attention but no one responded to an alarm (55%). Nurses on medical-surgical units reported these experiences at higher rates than nurses working in intensive care units (p<0.001). Alarm burden items were significantly associated with poorer nurse-reported patient safety, quality of care, staffing and work environment. Findings were most pronounced for situations where a patient needed urgent attention but no one responded to the alarm, which was frequently/occasionally experienced by 72% of those who rated their hospital’s safety as poor versus 38% good, p<0.001; 80% who rated overall quality of care poor/fair versus 46% good/excellent, p<0.001 and 65% from poor work environments versus 42% from good work environments, p<0.001.ConclusionMost nurses reported feeling overwhelmed by medical device alarms, and our findings suggest that alarm burden may be more pronounced in hospitals with unfavourable working conditions and suboptimal quality and safety. Because this was a cross-sectional study, further research is needed to explore causal relationships and the role of modifiable systems factors in reducing alarm burden.
PD-1-expressing macrophages and CD8 T cells are independent predictors of clinical benefit from PD-1 inhibition in advanced mesothelioma
Authors: Homicsko Krisztian , Zygoura Panagiota , Norkin Maxim , Tissot Stephanie , Shakarishvili Nicholas , Popat Sanjay , Curioni-Fontecedro Alessandra , O'Brien Mary , Pope Anthony , Shah Riyaz , Fisher Patricia , Spicer James , Roy Amy , Gilligan David , Rusakiewicz Sylvie , Fortis Ekaterina , Marti Nesa , Kammler Roswitha , Finn Stephen P , Coukos Georges , Dafni Urania , Peters Solange , Stahel Rolf A 
Published: October 2023

BackgroundFew tissue biomarkers exist to date that could enrich patient with cancer populations to benefit from immune checkpoint blockade by programmed cell death protein 1/ligand-1 (PD-/L-1) inhibitors. PD-L1 expression has value in this context in some tumor types but is an imperfect predictor of clinical benefit. In malignant pleural mesothelioma, PD-L1 expression is not predictive of the benefit from PD-1 blockade. We aimed to identify novel markers in malignant pleural mesothelioma to select patients better.MethodsWe performed a multiplex-immune histochemistry analysis of tumor samples from the phase III PROMISE-meso study, which randomized 144 pretreated patients to receive either pembrolizumab or standard second-line chemotherapy. Our panel focused on CD8+T cell, CD68+macrophages, and the expression of PD-1 and PD-L1 on these and cancer cells. We analyzed single and double positive cells within cancer tissues (infiltrating immune cells) and in the stroma. In addition, we performed cell neighborhood analysis. The cell counts were compared with clinical outcomes, including responses, progression-free and overall survivals.ResultsWe confirmed the absence of predictive value for PD-L1 in this cohort of patients. Furthermore, total CD8 T cells, CD68+macrophages, or inflammatory subtypes (desert, excluded, inflamed) did not predict outcomes. In contrast, PD-1-expressing CD8+T cells (exhausted T cells) and PD-1-expressing CD68+macrophages were both independent predictors of progression-free survival benefit from pembrolizumab. Patients with tumors simultaneously harboring PD1+T cells and PD-1+macrophages benefited the most from immune therapy.ConclusionWe analyzed a large cohort of patients within a phase III study and found that not only PD-1+CD8 T cells but also PD-1+CD68+ macrophages are predictive. This data provides evidence for the first time for the existence of PD-1+macrophages in mesothelioma and their clinical relevance for immune checkpoint blockade.
Construct validity and responsiveness of feasible composite disease activity measures for use in daily clinical practice in patients with psoriatic arthritis
Authors: Kasiem Fazira R. , Kok Marc R. , Luime Jolanda J. , Tchetverikov Ilja , Korswagen Lindy-Anne , Denissen Natasja H.A.M. , Goekoop-Ruiterman Yvonne P.M. , van Oosterhout Maikel , Fodili Faouzia , Hazes Johanna M.W. , Tillett William , Vis Marijn 
Published: October 2023

ObjectiveThere is a need for a widely accepted comprehensive disease activity measure for use in daily practice in patients with psoriatic arthritis (PsA). For this reason, the 3-item Visual Analogue Scale (3VAS) and 4-item Visual Analogue Scale (4VAS) were developed. This study aimed to test construct validity and responsiveness of the 3VAS and 4VAS in a population of patients with newly diagnosed PsA receiving usual care.MethodsComponents of the 3VAS (physician global, patient global, patient skin) and 4VAS (physician global, patient pain, patient joint, patient skin) were scored on 0–10 VAS scales. Agreement of low disease activity (LDA) state between 3VAS/4VAS and other composite measures was tested using Venn diagrams. Construct validity and responsiveness (3-month interval) were assessed using Spearman correlation coefficients and standardised response means (SRM) with effect sizes (ES), respectively, following hypothesis generation. Both 3VAS/4VAS were also compared with several patient-reported outcome measures.ResultsData from 629 patients were used. Both 3VAS (ES=0.48, SRM 0.52) and 4VAS (ES=0.48, SRM=0.50) showed responsiveness similar to Disease Activity in PSoriatic Arthritis (DAPSA) and Disease Activity Score-28 (DAS28). Both measures had a strong correlation with DAPSA (r=0.80–0.87), Psoriatic Arthritis Disease Activity Score (PASDAS) (r=0.89) and Routine Assessment of Patient Index Data 3 (RAPID3) (r=0.84–0.92). 3VAS and 4VAS had the highest agreement with PASDAS in categorising patients to LDA at 12 months.ConclusionThis is the first study assessing the performance of the 3VAS and 4VAS in an observational cohort of patients with early PsA. Both measures have promising performance characteristics, showing strong correlations and good discrimination with existing composite measures. The 4VAS may be the preferred version with better face validity.
Glucocorticoid trajectories over 2 years in patients with rheumatoid arthritis in a real-life setting
Authors: Delteil Alycia , Lambert Celine , Pereira Bruno , Couderc Marion , Malochet-Guinamand Sandrine , Pickering Marie Eva , Villedon Marc , Mathieu Sylvain , Soubrier Martin , Tournadre Anne 
Published: October 2023

ObjectivesTo analyse glucocorticoid (GC) use and trajectories in a real-life cohort of rheumatoid arthritis (RA).MethodsPatients with RA included in the longitudinal RCVRIC cohort for initiating or changing biological disease-modifying antirheumatic drugs, were compared for the use of GCs at baseline. Among the GC users, the GC dose was analysed over 2 years of follow-up by group-based trajectory models. Characteristics and outcomes were compared between the trajectories.ResultsAmong the 184 patients (RA duration 4.2 years (1.3; 12.6), Disease Activity Scores (DAS)28-C reactive protein (CRP) 4.24±2.14), 81 (44%) were on GCs. The GC users were significantly older, had higher CRP and Health Assessment Questionnaire (HAQ), more hypertension and lower lumbar T-score, but similar activity and erosive scores. Among the GC users, two trajectories were identified: trajectory 1 (n=20, 25%) with GC discontinuation in the first year and trajectory 2 (n=61, 75%) with maintenance of low-dose GCs at 2 years. Trajectory 2 was significantly associated with higher HAQ, a longer GC duration and a less frequent methotrexate association. After adjustment for HAQ, GC duration and MTX use, good EULAR responses were less frequent at 6 months and 1 year in the GC maintenance trajectory (38.3% vs 81.3%, p=0.03; 42.0% vs 82.4%, p=0.02). Diabetes, fractures and increased body mass index were noted in trajectory 2.ConclusionGCs were used in almost half of patients with established RA in real-world practice. For the majority of GC users, a long-term low dose of GCs is maintained over 2 years. These results highlight the difficulties with stopping GCs, the lack of consensus for the efficacy–safety balance of GCs, and the need to individualise the best GC tapering.
Risk of major adverse cardiovascular events in patients with rheumatoid arthritis treated with conventional synthetic, biologic and targeted synthetic disease-modifying antirheumatic drugs: observational data from the German RABBIT register
Authors: Meissner Yvette , Schäfer Martin , Albrecht Katinka , Kekow Joern , Zinke Silke , Tony Hans-Peter , Strangfeld Anja 
Published: October 2023

ObjectiveTo estimate the effects of Janus kinase inhibitors (JAKi), tumour necrosis factor inhibitors (TNFi), other biologic(b) or conventional synthetic(cs) disease-modifying antirheumatic drugs (DMARDs) on the risk of major adverse cardiovascular events (MACE) in patients with rheumatoid arthritis (RA).MethodsCohort study analysing episodes of DMARD-treatment initiated between January 2017 and April 2022 in the biologics register Rheumatoid Arthritis: Observation of Biologic Therapy. Incidence rates (IRs) per 100 patient-years with 95% CIs were calculated for overall patients and those with cardiovascular risk (age ≥50 years and ≥1 cardiovascular risk factor). MACE risk was estimated as HRs by inverse probability of treatment weight-adjusted Andersen-Gill models.ResultsA total of 154 MACE occurred among 14 203 treatment episodes (21 218 patient-years). IRs were 0.68 (0.47; 0.95), 0.62 (0.45; 0.83), 0.76 (0.53; 1.06) and 0.95 (0.68; 1.29) for JAKi, TNFi, bDMARDs and csDMARDs, respectively. IRs were higher in cardiovascular risk patients. Adjusted HRs (95% CI) comparing JAKi, bDMARDs and csDMARDs with TNFi were 0.89 (0.52 to 1.52), 0.76 (0.45; to1.27) and 1.36 (0.85 to 2.19) in overall, and 0.74 (0.41 to 1.31), 0.75 (0.45 to 1.27) and 1.21 (0.74 to 1.98) in cardiovascular risk patients. HRs were not increased in patients ≥65 years, with cardiovascular history or smokers, and also not when using csDMARD as reference instead of TNFi. IRs for baricitinib, tofacitinib and upadacitinib were 0.49 (0.25 to 0.85), 0.98 (0.58 to 1.55) and 0.53 (0.15 to 1.36), respectively.ConclusionIn this German observational cohort study, MACE did not occur more frequently with JAKi compared with other DMARDs. However, individual JAKis showed different unadjusted IRs.
Schwinger displacement of the quark–gluon vertex
Authors: Aguilar A. C. , Ferreira M. N. , Ibañez D. , Papavassiliou J. 
Published: October 2023

AbstractThe action of the Schwinger mechanism in pure Yang–Mills theories endows gluons with an effective mass, and, at the same time, induces a measurable displacement to the Ward identity satisfied by the three-gluon vertex. In the present work we turn to Quantum Chromodynamics with two light quark flavors, and explore the appearance of this characteristic displacement at the level of the quark–gluon vertex. When the Schwinger mechanism is activated, this vertex acquires massless poles, whose momentum-dependent residues are determined by a set of coupled integral equations. The main effect of these residues is to displace the Ward identity obeyed by the pole-free part of the vertex, causing modifications to its form factors, and especially the one associated with the tree-level tensor. The comparison between the available lattice data for this form factor and the Ward identity prediction reveals a marked deviation, which is completely compatible with the theoretical expectation for the attendant residue. This analysis corroborates further the self-consistency of this mass-generating scenario in the general context of real-world strong interactions.
Investigating and controlling the quantum resources of bipartite-qubit detectors of scalar fields in the process of spacetime expansion
Authors: Yang Huan , Xing Ling-Ling , Kong Min , Zhang Gang , Ye Liu 
Published: October 2023

AbstractQuantum resources construct new avenues to explore the cosmos. Considering bipartite-qubit detectors subjected to scalar fields in an expanding spacetime, quantum resources (including quantum coherence, quantum discord, Bell-nonlocality, and nonlocal advantage of quantum coherence) of the system are characterized. The influences of various cosmic parameters on these quantum resources are investigated. Besides, we use the filtering operation to propose a strategy that can be used to control these quantum resources. The results reveal that quantum coherence and quantum discord can not disappear at different expansion rapidity, expansion volumes, and particle masses of scalar field. Conversely, one can not capture Bell-nonlocality and nonlocal advantage of quantum coherence at higher expansion rapidity, larger expansion volume, and smaller particle mass. The dissipation of quantum resources can be resisted via the filtering operation. One can use the filtering operation to remarkably strengthen these quantum resources of the system.
Muscle Belly Repair: Biomechanical Assessment of the Anchor Suture and the Modified Kessler Techniques
Authors: JULIEN Terrill P. , LI Guoan , MUDGAL Chaitanya S. 
Published: October 2023

Background: Treatment of muscle belly lacerations remains a problem for surgeons. Inadequate repair of lacerations can cause functional disability. To date, there is no consensus on the method of repair for these injuries. We have previously described a technique of repairing mid-substance muscle belly lacerations. The aim of this study was to determine the ultimate strength of an intact muscle belly and to compare the anchor suture (AS) technique with the modified Kessler (MK) technique. Methods: Fifteen fresh frozen hind-legs from adolescent pigs were divided into three groups and used for the testing. Each group consisted of five specimens. Group one was the intact control group, group two was repaired with the MK technique and group three was repaired with the AS technique. Following repair, the muscles were secured in a custom-made fixation apparatus and underwent linear tensioning at a rate of 25 mm/min, generating a load-displacement curve for each specimen. The data regarding ultimate strength, modes of failure and number of intact suture/anchor constructs (for groups 2 and 3) was calculated. Results: The ultimate strength of the intact muscle group of was found to be 608.1 ± 107.9 N. This was significantly (p < 0.05) higher than the pull-out strength of the MK and AS groups. The pull-out strength of the AS group was 143.1 ± 36.7 N, nearly twice that of the MK group 69.8 ± 16.4 N (p = 0.11). Suture pull-out was the most common mode of failure. Conclusions: The AS technique was found to have both higher strain and nearly twice the ultimate pull-out strength compared to the MK repair group. We suggest the AS technique as a viable technique for mid-substance muscle belly repairs.