bluuebunny/crossref_metadata_2025_split huggingface dataset:
Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study
Authors: Ponmani Caroline , Nijman Ruud G , Roland Damian , Barrett Michael , Hulse Tony , Whittle Victoria , Lyttle Mark D 
Published: May 2023

ObjectivesTo describe the incidence of new onset paediatric diabetes mellitus, clinical characteristics and patterns of presentation to emergency departments (ED) during the COVID-19 pandemic, and to assess whether this increase was associated with SARS-CoV-2 infection.DesignRetrospective medical record review.SettingForty nine paediatric EDs across the UK and Ireland.PatientsAll children aged 6 months to 16 years presenting to EDs with (1) new onset diabetes or (2) pre-existing diabetes with diabetic ketoacidosis (DKA), during the COVID-19 pandemic (1 March 2020–28 February 2021) and the preceding year (1 March 2019–28 February 2020).ResultsThere were increases in new onset diabetes (1015 to 1183, 17%), compared with background incidence of 3%–5% in the UK over the past 5 years. There were increases in children presenting with new onset diabetes in DKA (395 to 566, 43%), severe DKA (141 to 252, 79%) and admissions to intensive care (38 to 72, 89%). Increased severity was reflected in biochemical and physiological parameters and administration of fluid boluses. Time to presentation from symptom onset for children presenting with new onset diabetes and DKA were similar across both years; healthcare seeking delay did not appear to be the sole contributing factor to DKA during the pandemic. Patterns of presentation changed in the pandemic year and seasonal variation was lost. Children with pre-existing diabetes presented with fewer episodes of decompensation.ConclusionsThere were increases in new onset diabetes in children and a higher risk of DKA in the first COVID pandemic year.
Experiences of healthcare personnel with death in the neonatal intensive care unit: a systematic review of qualitative studies
Authors: Wong Jessica Qing Hui , Charles Judith Sharon , Mok Hao Ting , Tan Teresa Shu Zhen , Amin Zubair , Ng Yvonne Peng Mei 
Published: May 2023

ObjectiveTo synthesise evidence from qualitative studies on the experiences of healthcare personnel (HCP) in the neonatal intensive care unit (NICU) caring for dying neonates.MethodsWe conducted a systematic search, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO: CRD42021250015), of four databases (PubMed, Embase, PsycINFO and CINAHL) from date of inception of the databases to 31 December 2021 using MeSH terms and related keywords. Data were analysed using three-step inductive thematic synthesis. Quality assessment of included studies was performed.ResultsThirty-two articles were included. There were 775 participants, majority (92.6%) of whom were nurses and doctors. Quality of studies was variable. The narratives of HCP coalesced into three themes: sources of distress, coping methods and the way forward. Sources of distress encompassed HCP’s discomfort with neonatal deaths; poor communication among HCP and with patient’s family; lack of support (from organisations, peers and HCP’s family) and emotional responses (guilt, helplessness and compassion fatigue). Methods of coping included setting emotional boundaries, support from colleagues, clear communication and compassionate care and well-designed end-of-life workflows. Steps taken by HCP to move forward and overcome the emotionally turbulent effects of NICU deaths included finding meaning in death, building deeper relationship with patients’ families and the NICU team and embracing purpose and pride in work.ConclusionHCP face several challenges when a death occurs in the NICU. HCP can provide better end-of-life care if their undesirable experiences with death are mitigated by better understanding and overcoming factors causing distress.
Leisure-time physical activity and mortality from influenza and pneumonia: a cohort study of 577 909 US adults
Authors: Webber Bryant J , Yun Heather C , Whitfield Geoffrey P 
Published: May 2023

ObjectiveTo examine the association of leisure-time physical activity with mortality from influenza and pneumonia.MethodsA nationally representative sample of US adults (aged ≥18 years) who participated in the National Health Interview Survey from 1998 to 2018 were followed for mortality through 2019. Participants were classified as meeting both physical activity guidelines if they reported ≥150 min/week of moderate-intensity equivalent aerobic physical activity and ≥2 episodes/week of muscle-strengthening activity. Participants were also classified into five volume-based categories of self-reported aerobic and muscle-strengthening activity. Influenza and pneumonia mortality was defined as having an underlying cause of death with an International Classification of Diseases, 10th Revision code of J09–J18 recorded in the National Death Index. Mortality risk was assessed using Cox proportional hazards, adjusting for sociodemographic and lifestyle factors, health conditions and influenza and pneumococcal vaccination status. Data were analysed in 2022.ResultsAmong 577 909 participants followed for a median of 9.23 years, 1516 influenza and pneumonia deaths were recorded. Compared with participants meeting neither guideline, those meeting both guidelines had 48% lower adjusted risk of influenza and pneumonia mortality. Relative to no aerobic activity, 10–149, 150–300, 301–600 and >600 min/week were associated with lower risk (by 21%, 41%, 50% and 41%). Relative to <2 episodes/week of muscle-strengthening activity, 2 episodes/week was associated with 47% lower risk and ≥7 episodes/week with 41% higher risk.ConclusionsAerobic physical activity, even at quantities below the recommended level, may be associated with lower influenza and pneumonia mortality while muscle-strengthening activity demonstrated a J-shaped relationship.
Staffing levels and hospital mortality in England: a national panel study using routinely collected data
Authors: Rubbo Bruna , Saville Christina , Dall'Ora Chiara , Turner Lesley , Jones Jeremy , Ball Jane , Culliford David , Griffiths Peter 
Published: May 2023

ObjectivesExamine the association between multiple clinical staff levels and case-mix adjusted patient mortality in English hospitals. Most studies investigating the association between hospital staffing levels and mortality have focused on single professional groups, in particular nursing. However, single staff group studies might overestimate effects or neglect important contributions to patient safety from other staff groups.DesignRetrospective observational study of routinely available data.Setting and participants138 National Health Service hospital trusts that provided general acute adult services in England between 2015 and 2019.Outcome measureStandardised mortality rates were derived from the Summary Hospital level Mortality Indicator data set, with observed deaths as outcome in our models and expected deaths as offset. Staffing levels were calculated as the ratio of occupied beds per staff group. We developed negative binomial random-effects models with trust as random effects.ResultsHospitals with lower levels of medical and allied healthcare professional (AHP) staff (e.g, occupational therapy, physiotherapy, radiography, speech and language therapy) had significantly higher mortality rates (rate ratio: 1.04, 95% CI 1.02 to 1.06, and 1.04, 95% CI 1.02 to 1.06, respectively), while those with lower support staff had lower mortality rates (0.85, 95% CI 0.79 to 0.91 for nurse support, and 1.00, 95% CI 0.99 to 1.00 for AHP support). Estimates of the association between staffing levels and mortality were stronger between-hospitals than within-hospitals, which were not statistically significant in a within–between random effects model.ConclusionsIn additional to medicine and nursing, AHP staffing levels may influence hospital mortality rates. Considering multiple staff groups simultaneously when examining the association between hospital mortality and clinical staffing levels is crucial.Trial registration numberNCT04374812.
Efficacy of focal high-dose-rate brachytherapy in the treatment of patients diagnosed with low or favourable intermediate-risk prostate cancer—a protocol for a randomised controlled trial
Authors: Jonušas Justinas , Patasius Ausvydas , Trakymas Mantas , Venius Jonas , Janulionis Ernestas , Smailyte Giedre , Kincius Marius 
Published: May 2023

IntroductionProstate cancer (PCa) is men’s second most predominant cancer worldwide. Because the prostate-specific antigen test is used in diagnostics, PCa is more often diagnosed in the early stages, making radical treatment of the disease possible. However, it is estimated that over a million men worldwide suffer from radical treatment-related complications. Thus, focal treatment has been proposed as a solution, which aims to destroy the predominant lesson that determines the progression of the disease. The main objective of our study is to compare the quality of life and efficacy of patients diagnosed with PCa before and after the treatment with focal high-dose-rate brachytherapy and to compare results with focal low-dose-rate brachytherapy and active surveillance.Methods and analysis150 patients diagnosed with low-risk or favourable intermediate-risk PCa who meet the inclusion criteria will be enrolled in the study. Patients are going to be randomly assigned to the study groups: focal high-dose-rate brachytherapy (group 1), focal low-dose-rate brachytherapy (group 2) and active surveillance (group 3). The study’s primary outcomes are quality of life after the procedure and time without biochemical disease recurrence. The secondary outcomes are early and late genitourinary and gastrointestinal reactions after the focal high-dose and low-dose-rate brachytherapies and evaluation of the importance and significance of in vivo dosimetry used for high-dose-rate brachytherapy.Ethics and disseminationBioethics committee approval was obtained before this study. The trial results will be published in peer-reviewed journals and at conferences.Trial registration numberVilnius regional bioethics committee; approval ID 2022/6-1438-911.
Efficacy and safety of carbon dioxide insufflation for brain protection for patients undergoing planned left-sided open heart valve surgery: protocol for a multicentre, placebo-controlled, blinded, randomised controlled trial (the CO2 Study)
Authors: Todd Rachel , Rogers Chris A , Pufulete Maria , Culliford Lucy , Pretorius Pieter , Voets Natalie , Akowuah Enoch , Sayeed Rana , Lazaroo Michelle , Kaur Surinder , Angelini Gianni D , Gibbison Ben 
Published: May 2023

IntroductionBrain injury is common following open heart valve surgery. Carbon dioxide insufflation (CDI) has been proposed to reduce the incidence of brain injury by reducing the number of air microemboli entering the bloodstream in surgery. The CO2 Study will evaluate the efficacy and safety of CDI in patients undergoing planned left-sided open heart valve surgery.Methods and analysisThe CO2 Study is a multicentre, blinded, placebo-controlled, randomised controlled trial. Seven-hundred and four patients aged 50 years and over undergoing planned left-sided heart valve surgery will be recruited to the study, from at least eight UK National Health Service hospitals, and randomised in a 1:1 ratio to receive CDI or medical air insufflation (placebo) in addition to standard de-airing. Insufflation will be delivered at a flow rate of 5 L/min from before the initiation of cardiopulmonary bypass until 10 min after cardiopulmonary bypass weaning. Participants will be followed up until 3 months post-surgery. The primary outcome is acute ischaemic brain injury within 10 days post-surgery based on new brain lesions identified with diffusion-weighted MRI or clinical evidence of permanent brain injury according to the current definition of stroke.Ethics and disseminationThe study was approved by the East Midlands–Nottingham 2 Research Ethics Committee in June 2020 and the Medicines and Healthcare products Regulatory Agency in May 2020. All participants will provide written informed consent prior to undertaking any study assessments. Consent will be obtained by the principal investigator or a delegated member of the research team who has been trained in the study and undergone Good Clinical Practice training. Results will be disseminated through peer-reviewed publications and presentations at national and international meetings. Study participants will be informed of results through study notifications and patient organisations.Trial registration numberISRCTN30671536.
Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context
Authors: Njagi Lilian Nkirote , Nduba Videlis , Mureithi Marianne Wanjiru , Mecha Jared Ongechi 
Published: May 2023

BackgroundTuberculosis (TB) disease is the leading cause of mortality among people living with HIV (PLHIV). Interferon-gamma release assays (IGRAs) are approved for TB infection ascertainment. However, current IGRA data on the prevalence of TB infection in the context of near-universal access to antiretroviral therapy (ART) and TB preventive therapy (TPT) are lacking. We estimated the prevalence and determinants of TB infection among PLHIV within a high TB and HIV burden context.MethodsThis cross-sectional study included data from adult PLHIV age ≥18 years in whom QuantiFERON-TB Gold Plus (QFT-Plus) assay, an IGRA, was performed. TB infection was defined as a positive or indeterminate QFT-Plus test. Participants with TB and those who had previously used TPT were excluded. Regression analysis was performed to identify independent predictors of TB infection.ResultsOf 121 PLHIV with QFT-Plus test results, females were 74.4% (90/121), and the mean age was 38.4 (SD 10.8) years. Overall, 47.9% (58/121) were classified as TB infection (QFT-Plus test positive and indeterminate results were 39.7% (48/121) and 8.3% (10/121), respectively). Being obese/overweight (body mass index ≥25 kg/m2; p=0.013, adjusted OR (aOR) 2.90, 95% CI 1.25 to 6.74) and ART usage for >3 years (p=0.013, aOR 3.99, 95% CI 1.55 to 10.28) were independently associated with TB infection.ConclusionThere was a high TB infection prevalence among PLHIV. A longer period of ART and obesity were independently associated with TB infection. The relationship between obesity/overweight and TB infection may be related to ART use and immune reconstitution and requires further investigation. Given the known benefit of test-directed TPT among PLHIV never exposed to TPT, its clinical and cost implications for low and middle-income countries should be explored further.
EradicatingHelicobacter pylorivia13C-urea breath screening to prevent gastric cancer in indigenous communities: a population-based study and development of a family index-case method
Authors: Lei Wei-Yi , Lee Jian-Yu , Chuang Shu-Ling , Bair Ming-Jong , Chen Chien-Lin , Wu Jeng-Yih , Wu Deng-Chyang , Tien O’Donnell Felice , Tien Hui-Wen , Chen Yi-Ru , Chiang Tsung-Hsien , Hsu Yu-Hsin , Hsu Tsui-Hsia , Hsieh Pei-Chun , Lin Li-Ju , Chia Shu-Li , Wu Chao-Chun , Subeq Yi-Maun , Wen Shu-Hui , Chang Hsiu-Chun , Lin Yu-Wen , Sun Kuo-Ping , Chu Chia-Hsiang , Wu Ming-Shiang , Graham David Y , Chen Hsiu-Hsi , Lee Yi-Chia 
Published: May 2023

ObjectiveScreening and eradication ofHelicobacter pylorihelp reduce disparities in the incidence of gastric cancer. We aimed to evaluate its acceptability and feasibility in the indigenous communities and develop a family index-case method to roll out this programme.DesignWe enrolled residents aged 20–60 years from Taiwanese indigenous communities to receive a course of test, treat, retest and re-treat initial treatment failures with the13C-urea breath tests and four-drug antibiotic treatments. We also invited the family members of a participant (constituting an index case) to join the programme and evaluated whether the infection rate would be higher in the positive index cases.ResultsBetween 24 September 2018 and 31 December 2021, 15 057 participants (8852 indigenous and 6205 non-indigenous) were enrolled, with a participation rate of 80.0% (15 057 of 18 821 invitees). The positivity rate was 44.1% (95% CI 43.3% to 44.9%). In the proof-of-concept study with 72 indigenous families (258 participants), family members of a positive index case had 1.98 times (95% CI 1.03 to 3.80) higher prevalence ofH. pylorithan those of a negative index case. The results were replicated in the mass screening setting (1.95 times, 95% CI 1.61 to 2.36) when 1115 indigenous and 555 non-indigenous families were included (4157 participants). Of the 6643 testing positive, 5493 (82.6%) received treatment. According to intention-to-treat and per-protocol analyses, the eradication rates were 91.7% (89.1% to 94.3%) and 92.1% (89.2% to 95.0%), respectively, after one to two courses of treatment. The rate of adverse effects leading to treatment discontinuation was low at 1.2% (0.9% to 1.5%).ConclusionA high participation rate, a high eradication rate ofH. pyloriand an efficient rollout method indicate that a primary prevention strategy is acceptable and feasible in indigenous communities.Trial registration numberNCT03900910.
Technical performance and diagnostic yield of motorised spiral enteroscopy compared with single-balloon enteroscopy in suspected Crohn’s disease: a randomised controlled, open-label study (the MOTOR-CD trial)
Authors: Pal Partha , Ramchandani Mohan , Banerjee Rupa , Viswakarma Piyush , Singh Aniruddha Pratap , Reddy Manohar , Rughwani Hardik , Patel Rajendra , Sekaran Anuradha , Kanaganti Swathi , Darisetty Santosh , Nabi Zaheer , Singh Jagadish , Gupta Rajesh , Lakhtakia Sundeep , Pradeep Rebala , Venkat Rao G , Tandan Manu , Reddy D Nageshwar 
Published: May 2023

ObjectiveRecent studies have shown that motorised spiral enteroscopy (MSE) enables deeper and total small bowel evaluation compared with single-balloon enteroscopy (SBE) in suspected Crohn’s disease (CD) when analysed per procedure. However, no randomised controlled study has compared bidirectional MSE with bidirectional SBE in suspected CD.DesignPatients with suspected CD requiring small bowel enteroscopy were randomly assigned to either SBE or MSE between May 2022 and September 2022 in a high volume tertiary centre. Bidirectional enteroscopy was done if intended lesion could not be reached on unidirectional study. Comparison was made with regard to technical success (ability to reach lesion), diagnostic yield, depth of maximal insertion (DMI), procedure time and total enteroscopy rates. Depth:time ratio was calculated to avoid confounding for the location of lesion.ResultsAmong 125 suspected patients with CD (28% female, 18–65 years, median 41 years), 62 and 63 underwent MSE and SBE, respectively. The overall technical success (98.4 %: MSE, 90.5 %: SBE; p=0.11), diagnostic yield (95.2%: MSE; 87.3%: SBE, p=0.2) and procedure time were not significantly different. However, MSE appeared to have higher technical success (96.8% vs 80.7%, p=0.08) in deeper small bowel (distal jejunum/proximal ileum) with higher DMI, higher depth:time ratio and total enteroscopy rates when attempted (77.8% vs 11.1%, p=0.0007). Both the modalities were safe although minor adverse events were more common with MSE.ConclusionMSE and SBE have comparable technical success and diagnostic yield for small bowel evaluation in suspected CD. MSE scores over SBE with regard to deeper small bowel evaluation with complete small bowel coverage and higher depth of insertion in a shorter time.Trial registration numberNCT05363930.
Impact of mental disorders during education on work participation: a register-based longitudinal study on young adults with 10 years follow-up
Authors: Porru Fabio , Schuring Merel , Hoogendijk Witte J G , Burdorf Alex , Robroek Suzan J W 
Published: May 2023

BackgroundMental disorders are a leading cause of disability and a major threat to work participation in young adults. This register-based longitudinal study aims to investigate the influence of mental disorders on entering and exiting paid employment among young graduates and to explore differences across socioeconomic groups.MethodsRegister information on sociodemographics (age, sex, migration background) and employment status of 2 346 393 young adults who graduated from secondary vocational (n=1 004 395) and higher vocational education or university (n=1 341 998) in the period 2010–2019 was provided by Statistics Netherlands. This information was enriched with register information on the prescription of nervous system medication for mental disorders in the year before graduation as a proxy for having a mental disorder. Cox proportional hazards regression models were used to estimate the influence of mental disorders on (A) entering paid employment among all graduates and (B) exiting from paid employment among graduates who had entered paid employment.ResultsIndividuals with mental disorders were less likely to enter (HR 0.69–0.70) and more likely to exit paid employment (HR 1.41–1.42). Individuals using antipsychotics were the least likely to enter (HR 0.44) and the most likely to exit paid employment (HR 1.82–1.91), followed by those using hypnotics and sedatives. The association between mental disorders and work participation was found across socioeconomic subgroups (ie, educational level, sex and migration background).DiscussionYoung adults with mental disorders are less likely to enter and maintain paid employment. These results ask for prevention of mental disorders and for a more inclusive labour market.
Craniofacial features of POLR3-related leukodystrophy caused by biallelic variants inPOLR3A,POLR3BandPOLR1C
Authors: Mirchi Amytice , Guay Simon-Pierre , Tran Luan T , Wolf Nicole I , Vanderver Adeline , Brais Bernard , Sylvain Michel , Pohl Daniela , Rossignol Elsa , Saito Michael , Moutton Sebastien , González-Gutiérrez-Solana Luis , Thiffault Isabelle , Kruer Michael C , Moron Dolores Gonzales , Kauffman Marcelo , Goizet Cyril , Sztriha László , Glamuzina Emma , Melançon Serge B , Naidu Sakkubai , Retrouvey Jean-Marc , Lacombe Suzanne , Bernardino-Cuesta Beatriz , De Bie Isabelle , Bernard Geneviève 
Published: May 2023

BackgroundRNA polymerase III-related or 4H leukodystrophy (POLR3-HLD) is an autosomal recessive hypomyelinating leukodystrophy characterized by neurological dysfunction, hypodontia and hypogonadotropic hypogonadism. The disease is caused by biallelic pathogenic variants inPOLR3A,POLR3B,POLR1CorPOLR3K. Craniofacial abnormalities reminiscent of Treacher Collins syndrome have been originally described in patients with POLR3-HLD caused by biallelic pathogenic variants inPOLR1C. To date, no published studies have appraised in detail the craniofacial features of patients with POLR3-HLD. In this work, the specific craniofacial characteristics of patients with POLR3-HLD associated with biallelic pathogenic variants inPOLR3A,POLR3BandPOLR1Care described.MethodsThe craniofacial features of 31 patients with POLR3-HLD were evaluated, and potential genotype–phenotype associations were evaluated.ResultsVarious craniofacial abnormalities were recognized in this patient cohort, with each individual presenting at least one craniofacial abnormality. The most frequently identified features included a flat midface (61.3%), a smooth philtrum (58.0%) and a pointed chin (51.6%). In patients withPOLR3Bbiallelic variants, a thin upper lip was frequent. Craniofacial anomalies involving the forehead were most commonly associated with biallelic variants inPOLR3AandPOLR3Bwhile a higher proportion of patients withPOLR1Cbiallelic variants demonstrated bitemporal narrowing.ConclusionThrough this study, we demonstrated that craniofacial abnormalities are common in patients with POLR3-HLD. This report describes in detail the dysmorphic features of POLR3-HLD associated with biallelic variants inPOLR3A,POLR3BandPOLR1C.