bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Dutch highly pathogenic H5N6 avian influenza virus showed remarkable tropism for extra-respiratory organs and caused severe disease but was not transmissible via air in the ferret model
Authors: Herfst Sander , Begeman Lineke , Spronken Monique I. , Poen Marjolein J. , Eggink Dirk , de Meulder Dennis , Lexmond Pascal , Bestebroer Theo M. , Koopmans Marion P. G. , Kuiken Thijs , Richard Mathilde , Fouchier Ron A. M. 
Published: July 2023

ABSTRACT

Continued circulation of A/H5N1 influenza viruses of the A/goose/Guangdong/1/96 lineage in poultry has resulted in the diversification in multiple genetic and antigenic clades. Since 2009, clade 2.3.4.4 hemagglutinin (HA) containing viruses harboring the internal and neuraminidase (NA) genes of other avian influenza A viruses have been detected. As a result, various HA-NA combinations, such as A/H5N1, A/H5N2, A/H5N3, A/H5N5, A/H5N6, and A/H5N8 have been identified. As of January 2023, 83 humans have been infected with A/H5N6 viruses, thereby posing an apparent risk for public health. Here, as part of a risk assessment, the
in vitro
and
in vivo
characterization of A/H5N6 A/black-headed gull/Netherlands/29/2017 is described. This A/H5N6 virus was not transmitted between ferrets via the air but was of unexpectedly high pathogenicity compared to other described A/H5N6 viruses. The virus replicated and caused severe lesions not only in respiratory tissues but also in multiple extra-respiratory tissues, including brain, liver, pancreas, spleen, lymph nodes, and adrenal gland. Sequence analyses demonstrated that the well-known mammalian adaptation substitution D701N was positively selected in almost all ferrets. In the
in vitro
experiments, no other known viral phenotypic properties associated with mammalian adaptation or increased pathogenicity were identified. The lack of transmission via the air and the absence of mammalian adaptation markers suggest that the public health risk of this virus is low. The high pathogenicity of this virus in ferrets could not be explained by the known mammalian pathogenicity factors and should be further studied.

IMPORTANCE

Avian influenza A/H5 viruses can cross the species barrier and infect humans. These infections can have a fatal outcome, but fortunately these influenza A/H5 viruses do not spread between humans. However, the extensive circulation and reassortment of A/H5N6 viruses in poultry and wild birds warrant risk assessments of circulating strains. Here an in-depth characterization of the properties of an avian A/H5N6 influenza virus isolated from a black-headed gull in the Netherlands was performed
in vitro
and
in vivo
, in ferrets. The virus was not transmissible via the air but caused severe disease and spread to extra-respiratory organs. Apart from the detection in ferrets of a mutation that increased virus replication, no other mammalian adaptation phenotypes were identified. Our results suggest that the risk of this avian A/H5N6 virus for public health is low. The underlying reasons for the high pathogenicity of this virus are unexplained and should be further studied.
Expression of antenatal symptoms of common mental disorders in The Gambia and the UK: a cross-sectional comparison study
Authors: Sanfilippo Katie Rose M , Glover Vivette , Cornelius Victoria , Amiel Castro Rita T , McConnell Bonnie , Darboe Buba , Huma Hajara B , Ceesay Hassoum , Ramchandani Paul , Cross Ian , Stewart Lauren 
Published: July 2023

ObjectivesIt is important to be able to detect symptoms of common mental disorders (CMDs) in pregnant women. However, the expression of these disorders can differ across cultures and depend on the specific scale used. This study aimed to (a) compare Gambian pregnant women’s responses to the Edinburgh Postnatal Depression Scale (EPDS) and Self-reporting Questionnaire (SRQ-20) and (b) compare responses to the EPDS in pregnant women in The Gambia and UK.DesignThis cross-sectional comparison study investigates Gambian EPDS and SRQ-20 scores through correlation between the two scales, score distributions, proportion of women with high levels of symptoms, and descriptive item analysis. Comparisons between the UK and Gambian EPDS scores were made by investigating score distributions, proportion of women with high levels of symptoms, and descriptive item analysis.SettingThis study took place in The Gambia, West Africa and London, UK.Participants221 pregnant women from The Gambia completed both the SRQ-20 and the EPDS; 368 pregnant women from the UK completed the EPDS.ResultsGambian participants’ EPDS and SRQ-20 scores were significantly moderately correlated (rs=0.6, p<0.001), had different distributions, 54% overall agreement, and different proportions of women identified as having high levels of symptoms (SRQ-20=42% vs EPDS=5% using highest cut-off score). UK participants had higher EPDS scores (M=6.5, 95% CI (6.1 to 6.9)) than Gambian participants (M=4.4, 95% CI (3.9 to 4.9)) (p<0.001, 95% CIs (−3.0 to –1.0), Cliff’s delta = −0.3).ConclusionsThe differences in scores from Gambian pregnant women to the EPDS and SRQ-20 and the different EPDS responses between pregnant women in the UK and The Gambia further emphasise how methods and understanding around measuring perinatal mental health symptoms developed in Western countries need to be applied with care in other cultures.Cite Now
Comparison of COVID-19 with influenza A in the ICU: a territory-wide, retrospective, propensity matched cohort on mortality and length of stay
Authors: Chu Raymond Bak Hei , Zhao Shi , Zhang Jack Zhenhe , Chan King Chung Kenny , Ng Pauline Yeung , Chan Carol , Fong Ka Man , Au Shek Yin , Yeung Alwin Wai Tak , Chan Jacky Ka Hing , Tsang Hin Hung , Law Kin Ip , Chow Fu Loi , Lam Koon Ngai , Chan Kai Man , Dharmangadan Manimala , Wong Wai Tat , Joynt Gavin Matthew , Wang Maggie Haitian , Ling Lowell 
Published: July 2023

ObjectivesDirect comparisons between COVID-19 and influenza A in the critical care setting are limited. The objective of this study was to compare their outcomes and identify risk factors for hospital mortality.Design and settingThis was a territory-wide, retrospective study on all adult (≥18 years old) patients admitted to public hospital intensive care units in Hong Kong. We compared COVID-19 patients admitted between 27 January 2020 and 26 January 2021 with a propensity-matched historical cohort of influenza A patients admitted between 27 January 2015 and 26 January 2020. We reported outcomes of hospital mortality and time to death or discharge. Multivariate analysis using Poisson regression and relative risk (RR) was used to identify risk factors for hospital mortality.ResultsAfter propensity matching, 373 COVID-19 and 373 influenza A patients were evenly matched for baseline characteristics. COVID-19 patients had higher unadjusted hospital mortality than influenza A patients (17.5% vs 7.5%, p<0.001). The Acute Physiology and Chronic Health Evaluation IV (APACHE IV) adjusted standardised mortality ratio was also higher for COVID-19 than influenza A patients ((0.79 (95% CI 0.61 to 1.00) vs 0.42 (95% CI 0.28 to 0.60)), p<0.001). Adjusting for age, PaO2/FiO2, Charlson Comorbidity Index and APACHE IV, COVID-19 (adjusted RR 2.26 (95% CI 1.52 to 3.36)) and early bacterial-viral coinfection (adjusted RR 1.66 (95% CI 1.17 to 2.37)) were directly associated with hospital mortality.ConclusionsCritically ill patients with COVID-19 had substantially higher hospital mortality when compared with propensity-matched patients with influenza A.
Association between homocysteine level and length of stay in patients with lower extremity atherosclerotic disease: a retrospective cohort study
Authors: Wang Xue , Yang Yu , Xu Li , Yu Ling , Zang Shuang , Li Xuan 
Published: July 2023

ObjectivesHomocysteine (Hcy) level has been widely identified as a risk factor associated with adverse outcomes in patients with lower extremity atherosclerotic disease (LEAD). However, there are still some knowledge gaps in research on the association between Hcy level and downstream adverse outcomes, such as length of stay (LOS). This study aims to explore whether and to what extent Hcy level is associated with LOS in patients with LEAD.DesignRetrospective cohort study.SettingChina.Participants, primary and secondary outcomesWe conducted a retrospective cohort study of 748 patients from inpatients with LEAD between January 2014 and November 2021 at the First Hospital of China Medical University in China. We used a slew of generalised linear models to evaluate the association between Hcy level and LOS.ResultsThe patients’ median age was 68 years and 631 (84.36%) were males. A dose–response curve with an inflection point at 22.63 µmol/L was observed between Hcy level and LOS after the adjustment of potential confounders. LOS increased before Hcy level reached the inflection point (β: 0.36; 95% CI: 0.18 to 0.55; p<0.001).ConclusionOur results show that an Hcy level <22.63 µmol/L is associated with increased LOS in patients with LEAD, which was independent of some other risk factors. This might shed light on how Hcy can be used as a key marker in the comprehensive management of patients with LEAD during hospitalisation.
Protocol for the mixed methods, Managing young people (aged 16–25) with Attention deficit hyperactivity disorder in Primary care (MAP) study: mapping current practice and co-producing guidance to improve healthcare in an underserved population
Authors: Price Anna , Smith Jane R , Mughal Faraz , Salimi Anita , Melendez-Torres G J , Newlove-Delgado Tamsin 
Published: July 2023

IntroductionAttention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents, with an average worldwide prevalence of 5%. Up to 40% of young people continue to experience symptoms into adulthood. Young people with ADHD experience poorer outcomes than their peers across multiple domains, with treatment shown to reduce these risks. Primary care practitioners play an important role in healthcare provision for this group in the UK. However, many feel unsure about how best to provide support, reporting prescribing concerns and need for more evidence-based guidance. A lack of national data on primary care provision hinders efforts to improve access to care and optimise outcomes. This mixed-methods study aims to provide evidence that may be used to improve primary care services for young people aged 16–25 years with ADHD.Methods and analysisThere are three interlinked work packages: (a) a mapping study including a survey of stakeholders (healthcare professionals, people with ADHD and commissioners) will map ADHD prescribing practice, shared-care arrangements, available support and practitioner roles by geographic locations across England for different respondent groups; (b) a qualitative study involving semi-structured interviews with stakeholders (10–15 healthcare professionals and 10–15 people with ADHD) will explore experiences of ‘what works’ and ‘what is needed’ in terms of service provision and synthesise findings; (c) workshops will integrate findings from (a) and (b) and work with stakeholders to use this evidence to codevelop key messages and guidance to improve care.Ethics and disseminationThe protocol has been approved by Yorkshire and the Humber—Bradford Leeds Research Ethics Committee. Recruitment commenced in September 2022. Findings will be disseminated via research articles in peer-reviewed journals, conference presentations, public involvement events, patient groups and media releases. A summary of study findings will be shared with participants at the end of the study.Trial registration numberNCT05518435.
Bridging that gap: a qualitative study of perceptions of equality, diversity and inclusivity in colorectal surgery in the UK and Ireland
Authors: Harji Deena , Sarmah Panchali , Gwyther Bethany , Lyons M K , Boereboom Catherine Louise , Siddiqi S , Arnott R , Harikrishnan Athur , Maxwell-Armstrong Charles , Cuming Tamzin 
Published: July 2023

BackgroundThere is a growing recognition on the importance of equality, diversity and inclusion (EDI) within surgery and the need to diversify the surgical community and its various organisations, in a bidto reflect the diverse populations they serve. To create, sustain and encourage a diverse surgical workforce requires an in-depth understanding of the current makeup of key surgical institutions, relevant issues pertaining to EDI and appropriate solutions and strategies to ensure tangible change.ObjectivesFollowing on from the recent Kennedy Review into Diversity and Inclusion commissioned by the Royal College of Surgeons of England, the aim of this qualitative study was to understand the EDI issues which affected the membership of the Association of Coloproctology of Great Britain and Ireland, while seeking appropriate solutions to address them.DesignDedicated, online and qualitative focus groups.ParticipantsColorectal surgeons, trainees and nurse specialists were recruited using a volunteer sampling strategy.MethodsA series of online, dedicated, qualitative focus groups across the 20 chapter regions were held. Each focus group was run informed by a structured topic guide. All participants who were given the opportunity to remain anonymous were offered a debriefing at the end. This study has been reported in keeping with the Standards for Reporting Qualitative Research.ResultsBetween April and May 2021, a total number of 20 focus groups were conducted, with a total of 260 participants across 19 chapter regions. Seven themes and one standalone code pertaining to EDI were identified: support, unconscious behaviours, psychological consequences, bystander behaviour, preconceptions, inclusivity and meritocracy and the one standalone code was institutional accountability. Five themes were identified pertaining to potential strategies and solutions: education, affirmative action, transparency, professional support and mentorship.ConclusionThe evidence presented here is of a range of EDI issues which affect the working lives of those within colorectal surgery in the UK and Ireland, and of potential strategies and solutions which can help build a more inclusive, equitable and diverse colorectal community.
Effects of different palliative care models on decedents with kidney failure receiving maintenance dialysis: a nationwide population-based retrospective observational study in Taiwan
Authors: Chu Wei-Min , Kuo Wen-Yu , Tung Yu-Chi 
Published: July 2023

ObjectivesPatients with kidney failure receiving maintenance dialysis are a particularly important population and carry a heavy disease burden. However, evidence related to palliative care for patients with kidney failure receiving maintenance dialysis remains scarce, especially in regard to palliative care consultation services and palliative home care. This study aimed to evaluate the effects of different palliative care models on aggressive treatment among patients with kidney failure receiving maintenance dialysis during the end of life.DesignA population-based retrospective observational study.SettingThis study used a population database maintained by Taiwan’s Ministry of Health and Welfare in combination with Taiwan’s National Health Research Insurance Database.ParticipantsWe enrolled all decedents who were patients with kidney failure receiving maintenance dialysis from the period 1 January 2017 to 31 December 2017 in Taiwan.Main exposure measureHospice care during the 1-year period before death.Main outcome measuresEight aggressive treatments within 30 days before death, more than one emergency department visit, more than one admission, a longer than 14-day admission, admission to an intensive care unit, death in hospital, endotracheal tube use, ventilator use and need for cardiopulmonary resuscitation.ResultsA total of 10 083 patients were enrolled, including 1786 (17.7%) patients with kidney failure who received palliative care 1 year before death. Compared with patients without palliative care, patients with palliative care had significantly less aggressive treatments within 30 days before death (Estimates: −0.09, CI: −0.10 to −0.08). Patients with inpatient palliative care, palliative home care or a mixed model experienced significantly lower treatment aggressiveness within 30 days before death.ConclusionsPalliative care, particularly use of a mixed care model, inpatient palliative care and palliative home care in patients with kidney failure receiving dialysis, could all significantly reduce the aggressiveness of treatment within 30 days before death.
Study protocol for assessment of the coagulation potential of concomitantly used factor VIII concentrates in patients with haemophilia A with emicizumab prophylaxis (CAGUYAMA Study): a multicentre open-label non-randomised clinical trial
Authors: Takeyama Masahiro , Ozu Naoki , Kasama Shu , Kasahara Masato , Matsumoto Masanori , Shima Midori , Nogami Keiji 
Published: July 2023

IntroductionEmicizumab prophylaxis substantially reduces bleeding episodes in patients with haemophilia A (HA). The haemostatic efficacy of emicizumab in patients with HA is estimated as approximately 15% based on mimic activity of factor (F) VIII. Although it has been proven effective in preventing bleeding, its haemostatic effect during breakthrough bleeding or surgery is considered insufficient. Therefore, haemostatic management of emicizumab-treated patients with HA without inhibitors frequently requires FVIII replacement therapy. In haemostatic management of emicizumab-treated patients with HA, conventional FVIII dosage calculations are used in clinical practice without considering the coagulant effects of emicizumab.Methods and analysisIn the CAGUYAMA study, 100 patients with HA without inhibitors will be enrolled for a maximum duration of 1 year, and samples of 30 events following the concomitant use of FVIII concentrates (30±5 U/kg) with emicizumab will be collected. An ‘event’ is defined as obtaining blood samples at preadministration and postadministration of FVIII concentrates during a breakthrough bleeding or a surgical procedure. Global coagulation assays will be used to measure the coagulation potential of the obtained samples. Clot waveform analysis (CWA) is used to identify the primary end-point, that is, the degree of improvement in the maximum coagulation rate at preadministration and post-administration of fixed-dose FVIII concentrations. The parameter obtained from CWA, which is triggered by an optimally diluted mixture of prothrombin time reagent and activated partial thromboplastin time reagent, is reported to be an excellent marker for assessing the degree of improvement of the coagulation potential in emicizumab-treated plasmas.Ethics and disseminationThe CAGUYAMA study was approved by the Japan-Certified Review Board of Nara Medical University (Approval ID; nara0031). The study results will be communicated through publication in international scientific journals and presentations at (inter)national conferences.Trial registration numberjRCTs051210137.
Protocol for virtual physical examination in an observational, longitudinal study evaluating virtual outcome measures in SLE
Authors: Askanase Anca D , Aranow Cynthia , Kim Mimi Y , Kamen Diane L , Arriens Cristina , Khalili Leila , Tang Wei , Barasch Julia , Dall'Era Maria , Mackay Meggan 
Published: July 2023

ObjectiveThere is a lack of data on the use of telemedicine (TM) in SLE. SLE outcome measures remain complex, and clinicians and clinical trialists have raised concerns about the accuracy of virtual disease activity measures. This study evaluates the level of agreement between virtual SLE outcome measures and face-to-face (F2F) encounter. Here, we describe the study design, virtual physical examination protocol and demographics for the first 50 patients evaluated.Methods and analysisThis is an observational, longitudinal study of 200 patients with SLE with varying levels of disease activity from 4 academic lupus centres serving diverse populations. Each study participant will be evaluated at a baseline and a follow-up visit. At each visit, participants are evaluated by the same physician first via a videoconference-based TM and then a F2F encounter. For this protocol, virtual physical examination guidelines relying on physician-directed patient self-examination were established. SLE disease activity measures will be completed immediately after the TM encounter and repeated after the F2F encounter for each visit. The degree of agreement between TM and F2F disease activity measures will be analysed using the Bland-Altman method. An interim analysis is planned after the enrolment of the first 50 participants.Ethics and disseminationThis study has been reviewed by the Columbia University Medical Center Institutional Review Board (IRB Protocol #: AAAT6574). The full results of this study will be published after the final data analysis of 200 patients. The abrupt shift to TM visits due to the COVID-19 pandemic disrupted clinical practice and clinical trials. Establishing a high level of agreement between SLE disease activity measures obtained with videoconference TM and F2F at the same time point, will allow for improved assessment of disease activity when F2F data cannot be acquired. This information may guide both medical decision-making and provide reliable outcome measures for clinical research.
Combined in situ XRF–LIBS analyses as a novel method to determine the provenance of central Mediterranean obsidians
Authors: Costantini Ilaria , Veneranda Marco , Prieto-Taboada Nagore , De Francesco Anna Maria , Castro Kepa , Madariaga Juan Manuel , Arana Gorka 
Published: July 2023

AbstractThis work presents a new calibration method for determining the provenance of obsidian artefacts based on the combined use of XRF and laser-induced breakdown spectroscopy (LIBS). At first, obsidian samples collected from the main Mediterranean sources were characterized using portable XRF and LIBS systems. After data treatment, elemental information was used to carry out principal component analysis (PCA) for each technique. Rb, Sr, Zr, Y and Fe elements, detected by using XRF, were found to be the key parameters enabling obsidians discrimination. Likewise, LIBS data helped differentiating the analysed patterns by the intensity of their main elemental components (Ca, Al, Mg and K). After selecting the key parameters detected by each technique, a new data matrix combining XRF and LIBS data was finally built. According to PCA results, the discrimination of Mediterranean sources based on combined XRF–LIBS data ensured a higher reliability over mono-analytical models, by increasing the Euclidean distance between sources projections over three-dimensional principal components plots. Knowing that the representativeness of elemental data could be compromised by the presence of superficial degradation products or deposition patinas, a shot-to-shot comparison of in-depth LIBS analyses is finally proposed as a method to disclose whether the spot under analysis was superficially contaminated or altered. Thus, the proposed strategy based on the combined use of portable XRF and LIBS spectrometers could be particularly useful for the in situ analysis of obsidian artefacts that underwent superficial alteration or could be covered by patina products.
Graphical abstract
Asymptotic UMVUE: Asymptotic Moments Matching the UMVUE under the Ewens Sampling Formula
Authors: Hirose Masayo Y. , Mano Shuhei 
Published: July 2023

The Ewens sampling formula is a distribution related to the random partition of a positive integer. In this study, we investigate the issue of non-existent solutions in parameter estimation under the distribution. We derive the first and second moments matching estimators to the uniformly minimum variance unbiased estimator (UMVUE) in the asymptotic sense (hereafter referred to as Asymptotic UMUVE) using the Ewens sampling formula. A Monte Carlo simulation study is performed to evaluate the efficiency of the resulting estimators. AMS Subject Classification: 62F12, 62P25