bluuebunny/crossref_metadata_2025_split huggingface dataset:
A qualitative study of anaesthetic trainee and trainer perspectives on regional teaching programmes
Authors: Lee A , Clementi R , Jackman S , Rakic M , Smyth S , Wight R 
Published: January 2024

AbstractSummaryBackgroundRegional teaching programmes are a common method of delivering postgraduate medical education in the United Kingdom. There is limited evidence available to guide the development of a successful regional teaching programme.MethodsIn this qualitative study, we interviewed stakeholders including trainers and trainee anaesthetists using a combination of purposive and convenience sampling. Semi- structured interviews were conducted on Microsoft Teams in a focus group format. Data was transcribed, anonymised, coded and analysed using thematic analysis.FindingsAll the college tutors and school board members for anaesthesia in the deanery, and five anaesthetic trainees at different training stages participated in the study in six focus groups. Analysis revealed concerns about the complicated nature of Stage 1 anaesthetic training and discussion about how the local training structure within the deanery could be further impeding the delivery of support and education to Stage 1 anaesthetic trainees. Despite the challenges identified, trainers and trainees were optimistic about implementing a regional teaching programme for Stage 1 anaesthetists within the deanery.ConclusionsThis study highlighted the challenges of delivering high-quality postgraduate education and training for Stage 1 anaesthetists in our deanery and considered possible solutions. The findings of this study informed the development of a quality improvement project to improve Stage 1 anaesthetic training in our deanery.
Escalating combinations of enhanced infectivity and immune escape define SARS-CoV-2 Omicron lineage replacement
Authors: Chen Nicholas F.G. , Pham Kien , Chaguza Chrispin , Lopes Rafael , Klaassen Fayette , Weinberger Daniel M. , Pitzer Virginia E. , Warren Joshua L. , Grubaugh Nathan D. , Hahn Anne M. 
Published: January 2024

AbstractIn 2022, consecutive sweeps of the highly transmissible SARS-CoV-2 Omicron-family maintained high viral transmission levels despite extensive antigen exposure on the population level resulting from both vaccinations and infections. To better understand variant fitness in the context of the highly dynamic immunity landscape of 2022, we aimed to dissect the interplay between immunity and fitness advantages of emerging SARS-CoV-2 Omicron lineages on the population-level. We evaluated the relative contribution of higher intrinsic transmissibility or immune escape on the fitness of emerging lineages by analyzing data collected through our local genomic surveillance program from Connecticut, USA. We compared growth rates, estimated infections, effective reproductive rates, average viral copy numbers, and likelihood for causing vaccine break-through infections. Using these population-level data, we find that newly emerging Omicron lineages reach dominance through a specific combination of enhanced intrinsic transmissibility and immune escape that varies over time depending on the state of the host-population. Using similar frameworks that integrate whole genome sequencing together with clinical, laboratory, and epidemiological data can advance our knowledge on host-pathogen dynamics in the post-emergence phase that can be applied to other communicable diseases beyond SARS-CoV-2.
SCIseg: Automatic Segmentation of T2-weighted Intramedullary Lesions in Spinal Cord Injury
Authors: Naga Karthik Enamundram , Valosek Jan , Smith Andrew C. , Pfyffer Dario , Schading-Sassenhausen Simon , Farner Lynn , Weber Kenneth A. , Freund Patrick , Cohen-Adad Julien 
Published: January 2024

AbstractPurposeTo develop a deep learning tool for the automatic segmentation of T2-weighted intramedullary lesions in spinal cord injury (SCI).Material and MethodsThis retrospective study included a cohort of SCI patients from three sites enrolled between July 2002 and February 2023. A deep learning model,SCIseg, was trained in a three-phase process involving active learning for the automatic segmentation of intramedullary SCI lesions and the spinal cord. The data consisted of T2-weighted MRI acquired using different scanner manufacturers with heterogeneous image resolutions (isotropic/anisotropic), orientations (axial/sagittal), lesion etiologies (traumatic/ischemic/hemorrhagic) and lesions spread across the cervical, thoracic and lumbar spine. The segmentations from the proposed model were visually and quantitatively compared with other open-source baselines. Wilcoxon signed-rank test was used to compare quantitative MRI biomarkers (lesion volume, lesion length, and maximal axial damage ratio) computed from manual lesion masks and those obtained automatically withSCIsegpredictions.ResultsMRI data from 191 SCI patients (mean age, 48.1 years ± 17.9 [SD]; 142 males) were used for model training and evaluation. SCIseg achieved the best segmentation performance for both the cord and lesions. There was no statistically significant difference between lesion length and maximal axial damage ratio computed from manually annotated lesions and those obtained usingSCIseg.ConclusionAutomatic segmentation of intramedullary lesions commonly seen in SCI replaces the tedious manual annotation process and enables the extraction of relevant lesion morphometrics in large cohorts. The proposed model segments lesions across different etiologies, scanner manufacturers, and heterogeneous image resolutions.SCIsegis open-source and accessible through the Spinal Cord Toolbox.SummaryAutomatic segmentation of the spinal cord and T2-weighted lesions in spinal cord injury on MRI scans across different treatment strategies, lesion etiologies, sites, scanner manufacturers, and heterogeneous image resolutions.Key ResultsAn open-source, automatic method,SCIseg, was trained and evaluated on a dataset of 191 spinal cord injury patients from three sites for the segmentation of the spinal cord and T2-weighted lesions.SCIseggeneralizes across traumatic and non-traumatic lesions, scanner manufacturers, and heterogeneous image resolutions, enabling the automatic extraction of lesion morphometrics in large multi-site cohorts.Quantitative MRI biomarkers, namely, lesion length and maximal axial damage ratio derived from the automatic predictions showed no statistically significant difference when compared with manual ground truth, implying reliability inSCIseg’spredictions.
Accuracy, Utility and Applicability of the WHOOP Wearable Monitoring Device in Health, Wellness and Performance - a systematic review
Authors: Khodr Riham , Kamal Latifah , Minerbi Amir , Gupta Gaurav 
Published: January 2024

AbstractIntroductionThe WHOOP wearable device is gaining popularity in clinical and performance applications with the ability to track sleep and heart rate parameters and provide feedback on recovery and strain. With the claims on potential benefits, a critical evaluation of the underlying scientific literature and the accuracy of these devices is imperative.MethodsAuthors systematically reviewed studies examining the accuracy and clinical applications of the WHOOP device.ResultsThe WHOOP appears to have acceptable accuracy for two-stage sleep and heart rate metrics, but depending on the study, room for improvement for four-stage sleep and heart rate variability identification. There are numerous preliminary studies looking at the WHOOP’s ability to track and/or influence sleep and exercise behaviours at the cohort and/or population level. The impact of athletic performance and/or objective sleep is limited based on existing studies.DiscussionThe clinical application for the WHOOP, given the acceptable accuracy levels, continues to expand. Uses have included impact on sports performance, correlation with medical conditions (i.e. cognitive dysfunction), sleep and health behaviours in various populations. Limitations of existing accuracy trials include variable design and reporting metrics, while results from non-accuracy trials require further clinical validation for response rate and effect size.ConclusionThe WHOOP wearable device has acceptable accuracy for sleep and cardiac variables to be used in clinical studies where a baseline can be established and, ideally, other clinical outcomes and gold standard tools can be employed.
Perspectives of young people, family carers and voluntary sector staff on help-seeking for mental health difficulties in a rural region of the United Kingdom - a qualitative study
Authors: Oduola Sheri , Coombes Emma , Hodgekins Jo , Jones Andy 
Published: January 2024

AbstractPurposeTo explore key stakeholders from rural communities’ perspectives of help-seeking for mental health difficulties.Methods/designSemi-structured interviews and a focus group were conducted with participants living in the East of England, UK. Thematic analysis was used to organise and analyse the data.ResultsNine participants were recruited. Participants described barriers and facilitators of help-seeking. Barriers included: lengthy waiting times, socioeconomic means, poor therapeutic relationships, insufficient treatment duration, poor transition between services, high staff turnover, and limited investment. Facilitators included: family involvement/support, school nurses, shorter delays in accessing specialist services such as eating disorder services, and the offer of family therapy. Suggestions for improving future help-seeking and pathways to care, included: peer-support for young people, enhanced support for carers, early intervention and raising awareness of mental health.OriginalityOur qualitative approach meant we were able to explore in detail the existence and mechanisms underlying varied barriers and facilitators of care pathways amongst our sample. This allowed us to report rich findings and recommendations for clinical practice and future research work.Practical implicationsTraining young people to support other young people, and identifying mental health champions in rural communities could reduce distress and ameliorate pressures on the health service.
A Healthcare Service Delivery and Epidemiological Model for Investigating Resource Allocation for Health: TheThanzi La OnseModel
Authors: Hallett Timothy B. , Mangal Tara D. , Tamuri Asif U. , Arinaminpathy Nimalan , Cambiano Valentina , Chalkley Martin , Collins Joseph H. , Cooper Jonathan , Gillman Matthew S. , Giordano Mosè , Graham Matthew M. , Graham William , Janoušková Eva , Jewell Britta L. , Lin Ines Li , Smith Robert Manning , Manthalu Gerald , Mnjowe Emmanuel , Mohan Sakshi , Molaro Margherita , Ng’ambi Wingston , Nkhoma Dominic , Piatek Stefan , Revill Paul , Rodger Alison , Salmanidou Dimitra , She Bingling , Smit Mikaela , Twea Pakwanja D. , Colbourn Tim , Mfutso-Bengo Joseph , Phillips Andrew N. 
Published: January 2024

AbstractBackgroundDecisions need to be made in all healthcare systems about the allocation of available resources with the aim of improving population health. Evidence is needed for these decisions, which can have enormous consequences for population health, especially in lower-income settings.MethodsWe address this need using an individual-based simulation model of healthcare need and service delivery that we have developed for Malawi, drawing on demographic, epidemiological and routine healthcare system data (on facilities, staff, and consumables). We compare the model’s simulated outputs with available data and estimate the impact that the healthcare system is having currently. We analyse the effects of improvements in healthcare access, clinician performance and consumables availability.FindingsMalawi’s healthcare system averted 40 million Disability-Adjusted Life-Years (DALYs) in the five-year period to end-2019, which is half of the total DALYS that the population (total size: 19 million in 2020) would otherwise incur. This impact is strongly focussed on young children (mediated largely by programmes addressing respiratory infections, HIV/AIDS and malaria) and also by the HIV/AIDS and TB programmes (among adults). More services seem to be delivered than would be expected based on the number of staff and expected time needed for services. Nevertheless, the additional services that are provided (through service times being reduced or additional HCW hours worked) account for half the impact of the healthcare system (i.e., ∼20 million DALYS averted). If system improvements gave ill persons immediate access to healthcare, led to optimal referral and diagnosis accuracy, and eliminated consumable stock-outs, the overall impact of the healthcare system could increase by up to ∼30% (12 million more DALYS averted).ConclusionsThe healthcare system in Malawi generates substantial health gains to the population with very limited resources. Strengthening interventions could potentially increase these gains considerably and so should be a priority for investigation and investment. A detailed individual-based simulation model of healthcare service delivery is a valuable tool for healthcare system planning and for evaluating proposals for healthcare system strengthening.
Lower probability of viral suppression in people living with HIV who are parents in Lima, Peru
Authors: Navarro-Galarza Valeria , González-Lagos Elsa , Robledo Jorge , Graña Ana , Gotuzzo Eduardo 
Published: January 2024

AbstractIntroductionParenting can be a detriment for selfcare among people living with HIV (PLWH) out of concern for their children’s futures and responsibilities that may limit attendance to health services. We explored the association between having children <20 years-old and viral suppression in PLWH.MethodsRetrospective cohort study from secondary data of PLWH enrolled at the largest HIV program in Lima between 2012-2018. We established parenthood by participant self-report children <20 years-old at enrollment, with additional data gathered for PLWH who reported a child born during the first year after enrollment. The main outcome was viral suppression (<400 copies/mL) by the end of follow-up. We conducted Cox regression analyses for repeated events, censoring at time of death or lost to follow-up. We built the final model by backward stepwise regression including potentially important variables and those with p-value ≤ 0.20 in bivariate analyses, presenting hazard ratios (HR), adjusted HR (aHR), and 95% confidence intervals (CIs).ResultsIn 3170 PLWH, median age at enrollment was 31.6 years (range 17.9-76.1), 79.8% were men and 27.2% reported having children <20 years-old (median=2). At end of follow-up (8766.6 person-years), 534 (62.0%) were virally suppressed. In our final multivariate model, having children <20 years-old (aHR 3.53; [95% CI] 1.88 - 6.62) and the birth of a child during the first year after enrollment in the program (HR 1.81; [95% CI] 1.30 – 2.50) were independently associated with lack of viral suppression by end of follow-up. Based on health status of the PLWH, we estimated 70% and 69% of children to be at risk of maternal and paternal orphanhood, respectively.ConclusionIn our setting, being a parent was associated with lower probability of viral suppression, creating a risk of orphanhood for children of PLWH. Family support services may facilitate HIV care and help PLWH maximize viral suppression.
Interprofessional Care Team, Staffing, and Setting Characteristics that Impact Patient Outcomes: A Review of Reviews
Authors: Pletcher Alix , Woodward Kyla , Hoge Natalie , Blair-Stahn Nathaniel , Lindstedt Paulina , Gohari Zahra , Flaxman Abraham , Iribarren Sarah 
Published: January 2024

AbstractBackgroundThe purpose of this study was to identify research methods and evidence pertaining to the relationship of interprofessional acute care teams and hospital characteristics on patient outcomes in hospital-based acute care.MethodsA review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews guidelines. The search strategy was executed across PubMed, CINAHL, and Embase. The review included 12 systematic reviews from 2012 to 2023 that examine the impact of acute care staffing characteristics on patient outcomes.ResultsWorkforce characteristics primarily focused on nurse staffing, with a limited number of studies assessing the impact of interprofessional teams or non-clinical workers on care quality. There is limited data describing the context of care delivery via potential relationships between hospital characteristics, interprofessional team staffing levels, and patient outcomes.ConclusionsTo promote comparability across studies, future workforce research should include a comprehensive analytic approach that includes clearly defined variables representing interprofessional care teams, community factors, and staffing and patient characteristics.
Clarifying the anatomy of tetralogy of Fallot with S-shaped ascending aorta
Authors: Gupta Saurabh Kumar , Mukharjee Aprateem , Pandey Niraj Nirmal , Ramakrishnan Sivasubramanian , Kothari Shyam Sunder , Saxena Anita , Anderson Robert H 
Published: January 2024

AbstractBackgroundWe have recently encountered several cases of tetralogy of Fallot with an abnormally oriented S-shaped ascending aorta. In this retrospective study, we sought to clarify the morphology of this unusual under-recognized variant of tetralogy of Fallot.MethodsWe reviewed our databases to identify all patients with tetralogy of Fallot having an S-shaped ascending aorta. We then used computed tomographic angiography to make a detailed assessment of the cardiac morphology.ResultsOut of the 21 patients we identified, 18 (86%) had a right aortic arch, 2 (9%) had a left aortic arch, and the remaining patient (5%) had a double aortic arch. Patients with right aortic arch, compared to those with the normally oriented ascending aorta, had lesser aortic override (29.3±14% vs 54.8±13.2%; p=0.0001) and a wider ascending aorta (2.52±0.7 cm vs 1.80±0.32; p=0.0003). Overall, compared to normal cases, the ascending aorta was located posteriorly, with a higher sterno-aortic distance (2.55±0.8 cm vs 0.99±0.45 cm; p=0.0001). The ascending aorta was longer (4.12±1.7 vs 3.07±0.82, p=0.03) although the tortuosity index (1.22±0.19 vs 1.15±0.17, p=0.23) was not different. Of the cases with right aortic arch and S-shaped ascending aorta, 16 (89%) had extrinsic compression of the right pulmonary artery (p = 0.0001), while 7 (39%) had crossed pulmonaryarteries(p = 0.008), with no such findings in those with normally oriented ascending aorta or those with left aortic arch and S-shaped ascending aorta.ConclusionTetralogy of Fallot with an S-shaped ascending aorta is a variant with lesser aortic override and a more posterior location of the aorta. Compression of the right pulmonary artery and crossed pulmonary arteries are frequent when the arrangement is associated with a right-sided aortic arch. These findings may have important implications for surgical management.
The genetics and epidemiology ofN-andO-IgA glycomics
Authors: Visconti Alessia , Rossi Niccolò , Bondt Albert , Hipgrave Ederveen Agnes , Thareja Gaurav , Koeleman Carolien A. M. , Stephan Nisha , Halama Anna , Lomax-Browne Hannah J. , Pickering Matthew C. , Zhou Xu-jie , Wuhrer Manfred , Suhre Karsten , Falchi Mario 
Published: January 2024

AbstractImmunoglobulin (Ig) glycosylation modulates the immune response, and plays a critical role in ageing and diseases. Studies have mainly focused on IgG glycosylation, and little is known about the genetics and epidemiology of IgA glycosylation. Here, we generated, using a novel LC-MS method, the first large-scale IgA glycomics dataset in serum from 2,423 twins, encompassing 71N-andO-glycan species. We showed that, despite the lack of a direct genetic template, glycosylation is highly heritable, and that glycopeptide structures are sex-specific, and undergo substantial changes with ageing. We observe extensive correlations between the IgA and IgG glycomes, and, exploiting the twin design, show that they are predominantly influenced by shared genetic factors. A genome-wide association study identified eight loci associated with both the IgA and IgG glycomes (ST6GAL1,ELL2,B4GALT1,ABCF2,TMEM121,SLC38A10,SMARCB1,MGAT3), and two novel loci specifically modulating IgAO-glycosylation (C1GALT1andST3GAL1). Validation of our findings in an independent cohort of 320 individuals from Qatar showed that the underlying genetic architecture is conserved across ethnicities. Our study delineates the genetic landscape of IgA glycosylation and provides novel potential functional links with the aetiology of complex immune diseases, including genetic factors involved in IgA nephropathy risk.
Exploring athlete pain assessment experiences and priorities; A two-part qualitative series of athlete and physiotherapist interactions. Part One. “Gauging and discerning” - Athlete & physiotherapist pain assessment experiences and interactions
Authors: Purcell Ciarán , Walsh Caoimhe Barry , Van Oirschot Garett , Fullen Brona M , Ward Tomás , Caulfield Brian M 
Published: January 2024

AbstractObjectivesTo explore the content (subjective questions, objective tools and outcome measures) and discuss the nature (qualitative elements and wider considerations) of the athlete pain assessment by facilitating shared understandings of athlete and sports physiotherapists.DesignQualitative Research using a hermeneutic phenomenological approach.MethodsWe carried out focus groups comprising a deliberate criterion sample using a constructivist perspective. We developed a topic guide and used reflexive thematic analysis. We developed codes, candidate themes and finalised themes iteratively, and employed a critical friend to add depth to our analysis. Our paper follows the consolidated criteria for reporting qualitative research (COREQ) guidelines.ResultsWe completed five focus groups comprising twelve athletes (five female, seven male) and four sports physiotherapists (four male). Three final themes (and eight subthemes) were created; (i) Measures, Scales and Dimensions (value and limitations of tools and scales, multidimensional methods, making sense and interpreting), (ii) Connect, Listen and Learn (the pain interview and athlete’s story, forging the athlete-clinician connection), (iii) Lighthouse in the Storm: providing direction for athletes in pain. (information overload and indecision, a beacon of direction; the role of the physiotherapist, the burden of expectation; challenges for physiotherapists)ConclusionWe described and explored the phenomena of pain assessment in sport including current pain assessment strategies. Comprehensive multidimensional assessment methods that preserve the athlete-clinician therapeutic relationship and facilitate optimal communication are priorities for future research and practice.