bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health care seeking behaviour for common menstrual problems and their determinants in Adolescent girls at rural setting in Central India: A mix-method study
Authors: Patel S , Patel B , Pushpalatha K , Halder A , Modi JN , Singh B 
Published: August 2023

AbstractIntroductionMenstrual problems among adolescent females are common and a significant source of morbidity in this population.This study was to collect data on the different health seeking behaviours used by adolescents and their determinants for common menstrual illness in rural population in central India. Collected information may be vital for the development of appropriate adolescent healthcare system.Aims & ObjectivesTo assess the health care seeking behaviour and factors determinants in adolescent girl/ their parents for menstrual problems in rural areas ofBhopal.Material & MethodsThis cross sectional study was done in nearby (within 30km radius of AIIMS Bhopal) schools villages on adolescent girls (12-19 years) after excluding the chronic illnesses. By using multistage cluster sampling 10 village schools were selected randomly. After taking informed consent from the head of the school 40 girls from each school were enrolled. The information were collected using a pre tested, semi structured questionnaire from all 400 participants. Statistical analysis was done by using IBM-SPSS version 22 software.ResultsThe mean age of the girls in the study was 17±1.4 years. In our study 27% of adolescent girls suffered from menstrual problems with dysmenorrhoea (48%) was the most frequent complaint out of which nearly one-third of adolescent girls sought treatment. Majority (67%) girls didn’t know about menstruation prior to menarche. Social barriers/ restrictions, shame and misconceptions with the menstruations were commonly reported in these girls.ConclusionAdolescent girls are reluctant to seek medical advice and with little knowledge on adolescent’s health-seeking behavior towards the menstrual problems leading to delay in the diagnosis and treatment. Adolescent health educational programmes in the society and in the schools help the girls toimprove the treatment-seeking for menstrual problems, specifically in rural areas.
Toward adoption of health risk assessment in population-based and clinical scenarios
Authors: Gonzalez-Colom Ruben , Monterde David , Papa Roberta , Kull Mart , Anier Andres , Balducci Francesco , Cano Isaac , Coca Marc , De Marco Marco , Franceschini Giulia , Hinno Saima , Pompili Marco , Vela Emili , Piera-Jiménez Jordi , Pérez Pol , Roca Josep 
Published: August 2023

ABSTRACTIntroductionHealth risk assessment (HRA) strategies are cornerstone for health systems transformation toward value-based patient-centred care. However, steps for HRA adoption are undefined. This report analyses the process of transference of the Adjusted Morbidity Groups (AMG) algorithm from the Catalan Good Practice to the Marche region (IT) and to Viljandi Hospital (EE), within the JADECARE initiative (2020–2023).DescriptionThe implementation research approach involved a twelve-month pre-implementation period to assess feasibility and define the local action plans, followed by a sixteen-month implementation phase. During the two periods, a well-defined combination of experience-based co-design and quality improvement methodologies were applied.DiscussionThe evolution of the Catalan HRA strategy (2010–2023) illustrates its potential for health systems transformation, as well as its transferability. The main barriers and facilitators for HRA adoption were identified. The report proposes a set of key steps to facilitate site customized deployment of HRA contributing to define a roadmap to foster large-scale adoption across Europe.ConclusionsSuccessful adoption of the AMG algorithm was achieved in the two sites confirming transferability. Marche identified the key requirements for a population-based HRA strategy, whereas Viljandi Hospital proved its potential for clinical use paving the way toward value-based healthcare strategies.
Universal PCR for Bacteria, Mycobacteria, and Fungi: A 10-year Retrospective Review of Clinical Indications and Patient Outcomes
Authors: Kubiak Jeffrey , Morgan Alexandra , Kirmaier Andrea , Arnaout Ramy , Riedel Stefan 
Published: August 2023

AbstractUniversal PCR for bacteria, mycobacteria, and fungi can aid in the diagnosis of occult infections, especially in the case of fastidious organisms or when prior antimicrobial treatment compromises culture growth. However, the limitations of this technology, including lack of specificity, high cost, long turnaround time, and lack of susceptibility data, may limit its effect on clinical outcomes. We performed a retrospective analysis of all specimens sent for universal PCR over a 10-year period from 2013-2022, focusing on clinical indications for test utilization and patient outcomes. A total of 708 specimens were sent from 638 patients. Of those specimens, 163 were positive, for an overall positivity rate of 23%. Pre-analytic factors associated with a positive universal PCR result were the presence of organisms on Gram stain or histology, the presence of neutrophils on Gram stain, and growth on culture. Positivity rates varied significantly by specimen type. 20% of all organisms detected were deemed contaminants by the clinical services. A positive universal PCR led to a change in antibiotic management in 29% of cases. Positive fungal universal PCR results sent from hospitalized patients were associated with worse outcomes, including increased hospital mortality. Our findings suggest that factors such as the presence of organisms or neutrophils on Gram stain, specimen source/clinical context, and anticipated changes in management based on results should be strongly considered when making stewardship decisions regarding the appropriateness of this testing modality.
Integrating Genome-wide information and Wearable Device Data to Explore the Link of Anxiety and Antidepressants with Heart Rate Variability
Authors: Friligkou Eleni , Koller Dora , Pathak Gita A. , Miller Edward J. , Lampert Rachel , Stein Murray B. , Polimanti Renato 
Published: August 2023

ABSTRACTBackgroundAnxiety disorders are associated with decreased heart rate variability (HRV), but the underlying mechanisms remain elusive.MethodsWe selected individuals with whole-genome sequencing, Fitbit, and electronic health record data (N=920; 61,333 data points) from the All of Us Research Program. Anxiety PRS were derived with PRS-CS after meta-analyzing anxiety genome-wide association studies from three major cohorts-UK Biobank, FinnGen, and the Million Veterans Program (N Total =364,550). The standard deviation of average RR intervals (SDANN) was calculated using five-minute average RR intervals over full 24-hour heart rate measurements. Antidepressant exposure was defined as an active antidepressant prescription at the time of the HRV measurement in the EHR. The associations of daily SDANN measurements with the anxiety PRS, antidepressant classes, and antidepressant substances were tested. Participants with lifetime diagnoses of cardiovascular disorders, diabetes mellitus, and major depression were excluded in sensitivity analyses. One-sample Mendelian randomization (MR) was employed to assess potential causal effect of anxiety on SDANN.ResultsAnxiety PRS was independently associated with reduced SDANN (beta=-0.08; p=0.003). Of the eight antidepressant medications and four classes tested, venlafaxine (beta=-0.12, p=0.002) and bupropion (beta=-0.071, p=0.01), tricyclic antidepressants (beta=-0.177, p=0.0008), selective serotonin reuptake inhibitors (beta=-0.069; p=0.0008) and serotonin and norepinephrine reuptake inhibitors (beta=-0.16; p=2×10−6) were associated with decreased SDANN. One-sample MR indicated an inverse effect of anxiety on SDANN (beta=-2.22, p=0.03).ConclusionsAnxiety and antidepressants are independently associated with decreased HRV, and anxiety appears to exert a causal effect on HRV. Our observational findings provide novel insights into the impact of anxiety on HRV.
Genomic investigation of multi-species and multi-variant blaNDM outbreak reveals key role of horizontal IncN and IncX3 plasmid transfer
Authors: Macesic Nenad , Dennis Adelaide , Hawkey Jane , Vezina Ben , Wisniewski Jessica A. , Cottingham Hugh , Blakeway Luke V. , Harshegyi Taylor , Pragastis Katherine , Badoordeen Gnei Zweena , Bass Pauline , Stewardson Andrew J. , Dennison Amanda , Spelman Denis W. , Jenney Adam W.J. , Peleg Anton Y. 
Published: August 2023

AbstractObjectivesNew Delhi metallo-beta-lactamases (NDMs) are major contributors to the spread of carbapenem resistance globally. In Australia, NDMs were previously associated with international travel but from 2019 we noted increasing NDM episodes. We conducted an investigation to determine the clinical and genomic epidemiology of NDM-carriage at a tertiary Australian hospital from 2016-2021.MethodsWe identified 49 patients with 84 NDM-carrying isolates in an institutional database and collected clinical data from electronic medical records. Short- and long-read whole genome sequencing was performed on all isolates. Completed genome assemblies were used to assess the genetic setting ofblaNDMgenes and compare NDM plasmids.ResultsOf 49 patients, 38 (78%) were identified in 2019-2021 and only 11/38 (29%) reported prior travel compared with 9/11 (82%) in 2016-2018 (P=0.037). In patients with NDM infection, crude 7-day mortality was 0% and 30-day mortality was 14% (2/14 patients). NDMs were noted in 41 bacterial strains (i.e. species/sequence type combinations). Four NDM variants (blaNDM-1,blaNDM-4,blaNDM-5,blaNDM-7) were detected across 13 plasmid groups. We noted a change from a diverse NDM plasmid repertoire in 2016-2018 to the emergence of conservedblaNDM-1IncN andblaNDM-7IncX3 epidemic plasmids with inter-strain spread in 2019-2021. These plasmids were noted in 19/38 (50%) patients and 35/68 (51%) genomes in 2019-2021.ConclusionsIncreased NDM case numbers were due to local circulation of two epidemic plasmids with extensive inter-strain transfer. Our study underscores the challenges of outbreak detection when horizontal transmission of plasmids is the primary mode of spread.
Facilitating youth diabetes studies with the most comprehensive epidemiological dataset available through a public web portal
Authors: McDonough Catherine , Li Yan Chak , Vangeepuram Nita , Liu Bian , Pandey Gaurav 
Published: August 2023

AbstractThe prevalence of type 2 diabetes mellitus (DM) and prediabetes (preDM) is rapidly increasing among youth, posing significant health and economic consequences. To address this growing concern, we created the most comprehensive youth-focused diabetes dataset to date derived from National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. The dataset, consisting of 15,149 youth aged 12 to 19 years, encompasses preDM/DM relevant variables from sociodemographic, health status, diet, and other lifestyle behavior domains. An interactive web portal, POND (Prediabetes/diabetes in youth ONline Dashboard), was developed to provide public access to the dataset, allowing users to explore variables potentially associated with youth preDM/DM. Leveraging statistical and machine learning methods, we conducted two case studies, revealing established and lesser-known variables linked to youth preDM/DM. This dataset and portal can facilitate future studies to inform prevention and management strategies for youth prediabetes and diabetes.
Real-time epidemiological modelling during the COVID-19 emergency in Wales
Authors: Gravenor Mike B , Dawson Mark , Bennett Ed , Thorpe Ben , White Carla , Rahat Alma , Archambault Daniel , Picco Noemi , Powathil Gibin , Lucini Biagio 
Published: August 2023

AbstractThe sudden outbreak of the COVID-19 pandemic presented governments, policy makers and health services with an unprecedented challenge of taking real-time decisions that could keep the disease under control with non-pharmaceutical interventions, while at the same time limit as much as possible severe consequences of a very strict lockdown. Mathematical modelling has proved to be a crucial element for informing those decisions. Here we report on the rapid development and application of the Swansea Model, a mathematical model of disease spread in real time, to inform policy decisions during the COVID-19 pandemic in Wales.
Strong protective effect of theAPOL1p.N264K variant against G2-associated focal segmental glomerulosclerosis and kidney disease
Authors: Gupta Yask , Friedman David J. , McNulty Michelle , Khan Atlas , Lane Brandon , Wang Chen , Ke Juntao , Jin Gina , Wooden Benjamin , Knob Andrea L. , Lim Tze Y. , Appel Gerald B. , Huggins Kinsie , Liu Lili , Mitrotti Adele , Stangl Megan C. , Bomback Andrew , Westland Rik , Bodria Monica , Marasa Maddalena , Shang Ning , Cohen David J. , Crew Russell J. , Morello William , Canetta Pietro , Radhakrishnan Jai , Martino Jeremiah , Liu Qingxue , Chung Wendy K. , Espinoza Angelica , Luo Yuan , Wei Wei-Qi , Feng Qiping , Weng Chunhua , Fang Yilu , Kullo Iftikhar J. , Naderian Mohammadreza , Limdi Nita , Irvin Marguerite R. , Tiwari Hemant , Mohan Sumit , Rao Maya , Dube Geoffrey , Chaudhary Ninad S. , Gutiérrez Orlando M. , Judd Suzanne E. , Cushman Mary , Lange Leslie A. , Lange Ethan M. , Bivona Daniel L. , Verbitsky Miguel , Winkler Cheryl A. , Kopp Jeffrey B. , Santoriello Dominick , Batal Ibrahim , Brant Pinheiro Sérgio Veloso , Araújo Oliveira Eduardo , e Silva Ana Cristina Simoes , Pisani Isabella , Fiaccadori Enrico , Lin Fangming , Gesualdo Loreto , Amoroso Antonio , Ghiggeri Gian Marco , D’Agati Vivette D. , Magistroni Riccardo , Kenny Eimear E. , Loos Ruth J.F. , Montini Giovanni , Hildebrandt Friedhelm , Paul Dirk S. , Petrovski Slavé , Goldstein David B. , Kretzler Matthias , Gbadegesin Rasheed , Gharavi Ali G. , Kiryluk Krzysztof , Sampson Matthew G. , Pollak Martin R. , Sanna-Cherchi Simone 
Published: August 2023

ABSTRACTBlack Americans have a significantly higher risk of developing chronic kidney disease (CKD), especially focal segmental glomerulosclerosis (FSGS), than European Americans. Two coding variants (G1 and G2) in theAPOL1gene play a major role in this disparity. While 13% of Black Americans carry the high-risk recessive genotypes, only a fraction of these individuals develops FSGS or kidney failure, indicating the involvement of additional disease modifiers.Here, we show that the presence of theAPOL1p.N264K missense variant, when co-inherited with the G2APOL1risk allele, substantially reduces the penetrance of the G1G2 and G2G2 high-risk genotypes by rendering these genotypes low-risk. These results align with prior functional evidence showing that the p.N264K variant reduces the toxicity of theAPOL1high-risk alleles. These findings have important implications for our understanding of the mechanisms ofAPOL1-associated nephropathy, as well as for the clinical management of individuals with high-risk genotypes that include the G2 allele.
The Lancet peer reviewers and the COVID-19 pandemic
Authors: Masukume Gwinyai , Grech Victor 
Published: August 2023

AbstractIntroductionPeer review is paramount to the scholarly article paradigm, helping to ensure the integrity and credibility of research.The Lancetplayed a crucial role in disseminating key information on the COVID-19 pandemic, publishing early clinical descriptions, risk factors for death, and effectiveness of measures like physical distancing and masks. Notably,The Lancetwas the world’s most cited journal for COVID-19 research, emphasising its significant impact on disseminating critical findings during the pandemic.MethodsGeographic data forThe Lancet’speer reviewers in 2019 (pre-pandemic) and 2020 (pandemic) were analysed at the country level, ranking reviewer countries. A test of proportions compared reviewer numbers between the years.ResultsIn 2020, China emerged as one of the top ten reviewer countries for the first time, with a significant increase from 1% (25 of 1843) in 2019 to 3% (54 of 1850), p=0.001. Italy also entered the top five reviewer countries, rising from 4% (67) to 5% (90), p=0.065. Reviewers from Africa 43 (2%) and South America 31 (2%) represented their continents in 2020. The top ten reviewer nations forThe Lancetin 2020 largely mirrored the top ten countries in global COVID-19 research output.ConclusionDuring the COVID-19 pandemic’s acute phase in 2020,The Lancet, the world’s most cited journal for COVID-19 research, featured peer reviewers who were largely representative of global COVID-19 research output. Notably, reviewers from China, the first country affected by COVID-19, increased significantly. However, underrepresentation of some continents persisted. To foster global idea exchange and enhance pandemic preparedness, research capacity worldwide must expand, broadening the reviewer pool—a vital step given uncertainties in future pandemic geographic origin.
Benchmarking clinical risk prediction algorithms with ensemble machine learning: An illustration of the superlearner algorithm for the non-invasive diagnosis of liver fibrosis in non-alcoholic fatty liver disease
Authors: Charu Vivek , Liang Jane W. , Mannalithara Ajitha , Kwong Allison , Tian Lu , Kim W. Ray 
Published: August 2023

AbstractBackground and AimsEnsemble machine learning (ML) methods can combine many individual models into a single ‘super’ model using an optimal weighted combination. Here we demonstrate how an underutilized ensemble model, the superlearner, can be used as a benchmark for model performance in clinical risk prediction. We illustrate this by implementing a superlearner to predict liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).MethodsWe trained a superlearner based on 23 demographic and clinical variables, with the goal of predicting stage 2 or higher liver fibrosis. The superlearner was trained on data from the Non-alcoholic steatohepatitis – clinical research network observational study (NASH-CRN, n=648), and validated using data from participants in a randomized trial for NASH (‘FLINT’ trial, n=270) and data from examinees with NAFLD who participated in the National Health and Nutrition Examination Survey (NHANES, n=1244). We compared the performance of the superlearner with existing models, including FIB-4, NFS, Forns, APRI, BARD and SAFE.ResultsIn the FLINT and NHANES validation sets, the superlearner (derived from 12 base models) discriminates patients with significant fibrosis from those without well, with AUCs of 0.79 (95% CI: 0.73-0.84) and 0.74 (95% CI: 0.68-0.79). Among the existing scores considered, the SAFE score performed similarly to the superlearner, and the superlearner and SAFE scores outperformed FIB-4, APRI, Forns, and BARD scores in the validation datasets. A superlearner model derived from 12 base models performed as well as one derived from 90 base models.ConclusionsThe superlearner, thought of as the “best-in-class” ML prediction, performed better than most existing models commonly used in practice in detecting fibrotic NASH. The superlearner can be used to benchmark the performance of conventional clinical risk prediction models.
Impact of social vulnerability on cardiac arrest mortality in the United States, 2016-2020
Authors: Gonuguntla Karthik , Chobufo Muchi Ditah , Shaik Ayesha , Patel Neel , Penmetsa Mouna , Sattar Yasar , Thyagaturu Harshith , Chan Paul S. , Balla Sudarshan 
Published: August 2023

AbstractImportanceCardiac arrest is one of the leading causes of morbidity and mortality, with an estimated 340,000 out-of-hospital and 292,000 in-hospital cardiac arrest events per year in the U.S. Survival rates are lower in certain racial and socioeconomic groups.ObjectiveTo examine the impact of social determinants on cardiac arrest mortality among adults stratified by age, race, and sex in the U.S.DesignA county-level cross-sectional longitudinal study using death data between 2016 and 2020 from the Centers for Disease Control and Prevention’s (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database.SettingUsing the multiple causes of death dataset from the CDC’s WONDER database, cardiac arrests were identified using the International Classification of Diseases (ICD), tenth revision, clinical modification codes.ParticipantsIndividuals aged 15 years or more whose death was attributed to cardiac arrest.ExposuresSocial vulnerability index (SVI), reported by the CDC, is a composite measure that includes socioeconomic vulnerability, household composition, disability, minority status and language, and housing and transportation domains.Main outcomes and measuresCardiac arrest mortality per 100,000 adults.ResultsOverall age-adjusted cardiac arrest mortality (AAMR) during the study period was 95.6 per 100,000 persons. The AAMR was higher for men as compared with women (119.6 vs. 89.9 per 100,000) and for Black, as compared with White, adults (150.4 vs. 92.3 per 100,000). The AAMR increased from 64.8 per 100,000 persons in counties in Quintile 1 (Q1) of SVI to 141 per 100,000 persons in Quintile 5, with an average increase of 13% (95% CI: 9.8-16.9) in AAMR per quintile increase.Conclusion and relevanceMortality from cardiac arrest varies widely, with a more than 2-fold difference between the counties with the highest and lowest social vulnerability, highlighting the differential burden of cardiac arrest deaths throughout the U.S. based on social determinants of health.Key PointsQuestionWhat is the impact of social determinants of health on cardiac arrest mortality in the United States (U.S.)?FindingsIn this national cross-sectional study spanning 5 years, we found that counties in higher quintiles of the social vulnerability index had higher rates of mortality from cardiac arrest, which was consistent across all subgroups.MeaningOur data suggests that sizable disparities in cardiac arrest remain in the U.S. A multi- dimensional approach to address gaps, with emphasis on social determinants of health, is needed for vulnerable populations to impact outcomes.
Methylprednisolone as Adjunctive Therapy for Large Vessel Occlusion (MARVEL): a Randomized Double-blind, Placebo-controlled Trial in Patients undergoing Endovascular therapy: Study Rationale and Design
Authors: Yang Qing-Wu , Guo Changwei , Yue Chengsong , Yang Jie , Li Linyu , Peng Zhouzhou , Hu Jinrong , Huang Jiandi , Song Jiaxing , Huang Jiacheng , Kong Weilin , Yu Nizhen , Yang Dahong , Liu Xiang , Wang Duolao , Nogueira Raul G. , Li Fengli , Nguyen Thanh N. , Zi Wenjie 
Published: August 2023

AbstractBackgroundSteroids have pleiotropic neuroprotective actions including the regulation of inflammation and apoptosis which may influence the effects of ischemia on neurons, glial cells, and blood vessels. The effect of low-dose methylprednisolone in acute ischemic stroke (AIS) patients in the endovascular treatment (EVT) era remains unknown.ObjectiveThis trial investigates the efficacy and safety of low-dose methylprednisolone (2 mg/kg intravenous for 3 days) as adjunctive therapy for AIS patients undergoing mechanical thrombectomy (MT) within 24 hours from symptom onset.Methods and designMethylprednisolone as Adjunctive Therapy for Acute Large Vessel Occlusion (MARVEL) Trial is an investigator-initiated, prospective, randomized, double-blind, placebo-controlled multicenter clinical trial. Up to 1672 eligible patients with anterior circulation large vessel occlusion (LVO) stroke presenting within 24 hours from symptom onset are planned to be consecutively randomized to receive methylprednisolone or placebo in a 1:1 ratio across 82 stroke centers in China.OutcomesThe primary outcome is the ordinal shift in the modified Rankin scale (mRS) score at 90 days. Secondary outcomes include 90-day functional independence (mRS 0-2). The primary safety endpoints include mortality at 90 days and symptomatic intracerebral hemorrhage within 48 hours of MT.ConclusionThe MARVEL trial will provide evidence of the efficacy and safety of low-dose methylprednisolone as adjunctive therapy to anterior circulation LVO stroke patients undergoing endovascular treatment.Trial registry numberChiCTR2100051729 (www.chictr.org.cn).