bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying Safety Practices Perceived as Low Value: An Exploratory Survey of Healthcare Staff in the United Kingdom and Australia
Authors: Halligan Daisy , Janes Gillian , Conner Mark , Albutt Abigail , Debono Deborah , Carland Jane , Sheppard-Law Suzanne , Taylor Natalie , Middleton Sandy , McInnes Elizabeth , Ferguson Caleb , Lawton Rebecca 
Published: February 2023

Objectives
Up to 30% of healthcare spending is considered unnecessary and represents systematic waste. While much attention has been given to low-value clinical tests and treatments, much less has focused on identifying low-value safety practices in healthcare settings. With increasing recognition of the problem of “safety clutter” in organizations, it is important to consider deimplementing safety practices that do not benefit patients, to create the time needed to deliver effective, person-centered, and safe care. This study surveyed healthcare staff to identify safety practices perceived to be of low value.

Methods
Purposive and snowball sampling was used. Data collection was conducted from April 2018 to November 2019 (United Kingdom) and May 2020 to November 2020 (Australia). Participants completed the survey online or in hard copy to identify practices they perceived to not contribute to safe care. Responses were analyzed using content and thematic analysis.

Results
A total of 1394 responses from 1041 participants were analyzed. Six hundred sixty-three responses were collected from 526 UK participants and 515 Australian participants contributed 731 responses. Frequently identified categories of practices identified included “paperwork,” “duplication,” and “intentional rounding.” Five cross-cutting themes (e.g., covering ourselves) offered an underpinning rationale for why staff perceived the practices to be of low value.

Conclusions
Staff identified safety practices that they perceived to be low value. In healthcare systems under strain, removing existing low-value practices should be a priority. Careful evaluation of these identified safety practices is required to determine whether they are appropriate for deimplementation and, if not, to explore how to better support healthcare workers to perform them.
Economic evaluation of improving HIV self-testing among MSM in China using a crowdsourced intervention: a cost-effectiveness analysis
Authors: Ong Jason J. , Booton Ross D. , Tucker Joseph D. , Tang Weiming , Vickerman Peter , Zhang Lei , Mitchell Kate M. 
Published: February 2023

Objectives:
Crowdsourcing, which taps into the wisdom of crowds, has been successful in generating strategies to enhance HIV self-testing (HIVST) uptake. We determined the cost-effectiveness of a crowdsourced intervention (one-off or annual) compared with a control scenario (no crowdsourcing) among MSM living in China.

Design:
Economic evaluation.

Methods:
We used data from our cluster randomized controlled trial of MSM (NCT02796963). We used a micro-costing approach to measure direct health costs ($USD2017) from a health provider perspective. Using outputs from a dynamic transmission model over a 20-year time horizon, we estimated the incremental cost-effectiveness ratios using cost per disability-adjusted life years (DALYs) averted with 3% discounting. An intervention was considered highly cost-effective if it was less than one gross domestic product (GDP, $8823) per DALY averted.

Results:
Across all cities, the crowdsourced intervention was highly cost-effective compared with the control scenario (incremental cost-effectiveness ratios ranged from $2263 to 6152 per DALY averted for annual crowdsourcing; $171 to 204 per DALY averted for one-off crowdsourcing). The one-off intervention was cost-saving in Guangzhou and Qingdao. Sensitivity analyses confirmed the robustness of the findings; specifically, changes in discounting, costs of the crowdsourced intervention, costs of HIV testing and cost of antiretroviral therapy did not alter our conclusions.

Conclusion:
Scaling up a one-off or annual crowdsourced HIV prevention intervention in four cities in China was very likely to be cost-effective. Further research is warranted to evaluate the feasibility of scaling up crowdsourced HIV prevention interventions in other settings and populations.
Hypertension and one-year risk of all-cause mortality among women with treated HIV in the United States
Authors: Sadinski Leah M. , Westreich Daniel , Edmonds Andrew , Breger Tiffany L. , Cole Stephen R. , Ramirez Catalina , Brown Todd T. , Ofotokun Igho , Konkle-Parker Deborah , Kassaye Seble , Jones Deborah L. , D'Souza Gypsyamber , Cohen Mardge H. , Tien Phyllis C. , Taylor Tonya N. , Anastos Kathryn , Adimora Adaora A. 
Published: February 2023

Objective:
Hypertension is a critical cause of cardiovascular disease, and women with HIV have a higher prevalence of hypertension than women without HIV. The relationship between hypertension and mortality has not been well characterized in women with treated HIV. Here, we estimate the effect of hypertension on 1-year risk of all-cause mortality among women with HIV on antiretroviral therapy (ART) in the United States.

Design:
An analysis of multicenter, observational cohort data from the Women's Interagency HIV Study (WIHS) collected between 1995 and 2019.

Methods:
We included women with HIV who reported ever using ART. We used parametric g-computation to estimate the effect of hypertension (SBP ≥140  mmHg, DBP ≥90 mmHg, or use of hypertensive medication) on all-cause mortality within 1 year of a WIHS visit.

Results:
Among 2929 unique women, we included 57 034 visits with a median age of 45 (interquartile range: 39, 52) years. Women had hypertension at 34.5% of visits, and 641 deaths occurred within 1 year of a study visit. Comparing women at visits with hypertension to women at visits without hypertension, the standardized 1-year risk ratio for mortality was 1.16 [95% confidence interval (95% CI): 1.01–1.33]. The risk ratios were higher in Hispanic (risk ratio: 1.23, 95% CI: 0.86–1.77) and non-Hispanic black women (risk ratio: 1.19, 95% CI: 1.04–1.37) and lower in non-Hispanic white women (risk ratio: 0.93, 95% CI: 0.58–1.48).

Conclusion:
Among women with treated HIV, those with hypertension, compared with those without, had an increased 1-year risk of all-cause mortality.
Electronic Dose Monitoring Device Patterns in Youth Living With HIV Enrolled in an Adherence Intervention Clinical Trial
Authors: Lindsey Jane C. , Hudgens Michael , Gaur Aditya H. , Horvath Keith J. , Dallas Ronald , Heckman Barbara , Mueller Johnson Megan , Amico K. Rivet 
Published: February 2023

Introduction:
Youth living with HIV in the US have low rates of viral suppression, in part because of challenges with antiretroviral therapy adherence.

Methods:
Daily dosing in the Adolescent Medicine Trials Network for HIV/AIDS Interventions 152 study, a randomized controlled trial of a 12-week adherence intervention (triggered escalating real-time adherence intervention) for viremic youth, compared with standard of care (SOC), was measured by electronic dose monitoring (EDM) throughout 48 weeks of follow-up. EDM data collected over the first 24 weeks were used to characterize patterns of antiretroviral therapy adherence with group-based trajectory models.

Results:
Four trajectory groups were identified among the 85 participants included in the analysis during the intervention phase of the study: (Worst) no interaction with EDM, (Declining) initially moderate EDM-based adherence followed by steep declines, (Good) initially high EDM-based adherence with modest declines, and (Best) consistently high EDM-based adherence. Being in the SOC arm, not being in school, higher evasiveness and panic decision-making scores, and lower adherence motivation were associated with higher odds of being in a worse trajectory group (P < 0.05). A general decline in dosing was observed in the 12 weeks postintervention, when all participants were managed using SOC.

Conclusions:
Use of group-based trajectory models allowed a more nuanced understanding of EDM-based adherence over time compared with collapsed summary measures. In addition to the study intervention, other factors influencing EDM-based adherence included being in school, decision-making styles, and adherence-related motivation. This information can be used to design better intervention services for youth living with HIV.
Evaluation of the Revised Versus Original Ryan White Part A HIV Care Coordination Program in a Cluster-Randomized, Stepped-Wedge Trial
Authors: Irvine Mary K. , Levin Bruce , Abdelqader Faisal , Carmona Jennifer , Avoundjian Tigran , Thomas Jacinthe , Braunstein Sarah L. , Robertson McKaylee , Nash Denis 
Published: February 2023

Background:
To address challenges with delivery of an evidence-based HIV care coordination program (CCP), the New York City Health Department initiated a CCP redesign. We conducted a site-randomized stepped-wedge trial to evaluate effectiveness of the revised versus the original model.

Setting:
The CCP is delivered in New York City hospitals, community health centers, and community-based organizations to people experiencing or at risk for poor HIV outcomes.

Methods:
The outcome, timely viral suppression (TVS), was defined as achievement of viral load <200 copies/mL within 4 months among enrollees with unsuppressed viral load (≥200 copies/mL). Seventeen original-CCP provider agencies were randomized within matched pairs to early (August 2018) or delayed (May 2019) starts of revised-model implementation. Data from 3 periods were examined to compare revised versus original CCP effects on TVS. The primary analysis of the intervention effect applied fully conditional maximum likelihood estimation together with an exact, conditional P-value and an exact test-based 95% CI. We assigned each trial enrollee the implementation level of their site (based on a three-component measure) and tested for association with TVS, adjusting for period and study arm.

Results:
Over 3 nine-month periods, 960 individuals were eligible for trial inclusion (intention to treat). The odds ratio of TVS versus no TVS comparing revised with original CCP was 0.88 (95% CI: 0.45, 1.7). Thus, the revised program yielded slightly lower TVS, although the effect was statistically nonsignificant. TVS was not significantly associated with revised-CCP implementation level.

Conclusion:
Program revisions did not increase TVS, irrespective of the implementation level.
The role of the genital microbiota in the acquisition and pathogenesis of sexually transmitted infections
Authors: Waltmann Andreea , Thomas Cynthia , Duncan Joseph A. 
Published: February 2023

Purpose of review
There are an estimated 374 million new sexually transmitted infections (STIs) worldwide every year. Our review article examines the current evidence of how STI acquisition, transmission, and pathogenesis is impacted upon by the genital microbiota, with a focus on epidemiological, biochemical, and immunological features.

Recent findings
At least in women, a genital microbiota dominated by lactobacilli has long been considered optimal for reproductive health, while depletion of lactobacilli may lead to a genital microenvironment dominated by anaerobic pathogens, which can manifest clinically as bacterial vaginosis. Recent research efforts have characterized genital microbiota composition in greater resolution, sometimes at species-level, using proteomics, metabolomics, and deep sequencing. This has enhanced our understanding of how specific microbiota members influence acquisition or clinical manifestation of STI pathogen infection. Other advances include a steady, though still slow, increase in the number of studies that sought to determine the genital (penile or urethral) microbiota of males and how it may impact that of their female partners’ genital microbiota and risk of STI acquisition. Altogether, these data enabled us to explore the concept that genital microbiota may be sexually transmitted and influence pathogenesis and clinical presentation of other STI.

Summary
With STI infection rates increasing worldwide, it is important now more than ever to find novel STI prevention strategies. Understanding if and how the genital microbiota is a modifiable risk factor for STI transmission, acquisition, and clinical manifestation may prove to be an important strategy in our efforts to curb morbidity in at risk populations.
Impact of COVID-19 infection during pregnancy on maternal and fetal outcomes
Authors: Anter Mohamed Elsibai , Abd El-Aal Nasser Kamal , Rezk Mohamed Abd Allah , Moawad Hussein Fahmy , Abudakika Ahmed Tharwat 
Published: February 2023

Objectives:
The objective of this study is to assess the impact of coronavirus disease 2019 (COVID-19) infection during pregnancy on maternal and fetal outcome in relation to gestational age.

Methods:
This retrospective study was conducted between May 2020 and July 2021. Sixty-five women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and hospitalized at a quarantine hospital were included. Thirty-four women received prenatal care at the hospital until delivery, while 31 dropped out from the study due to COVID-19 recovery and discharge before delivery.

Results:
COVID-19 was found in 83% of the pregnant women after 20 weeks of pregnancy. The most common symptoms were cough and fever. Medical complications included severe pneumonia and thrombosis. The maternal mortality rate was 9.2%. Premature rupture of membranes and severe hypertension during labor affected nearly 9% of the pregnant women who completed prenatal care until delivery at the hospital. Preterm labor occurred at a rate of 38.2%. There were seven (20.8%) stillbirths and two cases of infant mortality.

Conclusion:
Hospitalized pregnant women who have coronavirus infection, lymphopenia, and a high C-reactive protein level were at a higher risk of developing severe illness, which can lead to maternal and neonatal complications.
Low Rates of Reproductive Counseling Documentation in Women With Interstitial Pneumonia With Autoimmune Features
Authors: Joerns Elena K. , Mills Brooke , Makris Una E. , Adams Traci N. , Bermas Bonnie 
Published: February 2023

Abstract

Background/Objective
Women with interstitial pneumonia with autoimmune features (IPAFs), a subset of interstitial lung disease (ILD), are at risk for pregnancy complications. Family planning discussions improve pregnancy outcomes in women with ILD. The objective of this study was to evaluate the documentation of reproductive counseling in IPAF female patients of childbearing age by pulmonary and rheumatology providers at an academic medical center.

Methods
We conducted a medical record review study of pulmonary and rheumatology encounters in reproductive-aged women with IPAF to evaluate documentation of family planning discussions and contraceptive use. We used nonparametric measures of association and logistic regression to evaluate the relationship between patient characteristics and the presence of reproductive counseling documentation by providers.

Results
Thirty-one women met IPAF classification and were ≤50 years at initial ILD clinic visit. Twenty-five (81%) of these women had risk factors for adverse pregnancy outcomes. Ten women (32%) had a record of reproductive counseling during any visit with their pulmonary provider. Of the 21 patients who also saw a rheumatology provider, 12 (57%) women had a record of reproductive counseling during any visit with their rheumatology provider. No baseline characteristics were associated with odds of reproductive counseling documentation.

Conclusions
Neither pulmonary nor rheumatology providers consistently discussed family planning/contraceptive use with reproductive-aged women with IPAF. There was a trend for rheumatology providers to discuss reproductive issues with IPAF patients more frequently than pulmonary providers. Efforts should focus on educating providers about the need for reproductive counseling in women with IPAF of childbearing age.
Skin Thickening of the Scalp and High Signal Intensity of Dentate Nucleus in Multiple Sclerosis
Authors: Quattrocchi Carlo C. , Parillo Marco , Spani Federica , Landi Doriana , Cola Gaia , Dianzani Caterina , Perrella Eleonora , Marfia Girolama A. , Mallio Carlo A. 
Published: February 2023

Objective
The aim of this study was to assess the presence of detectable changes of skin thickness on clinical brain magnetic resonance imaging (MRI) scans in patients with MS, history of multiple gadolinium-based contrast agents (GBCAs) administrations, and evidence of gadolinium deposition in the brain.

Materials and Methods
In this observational cross-sectional study, 71 patients with MS who underwent conventional brain MRI with an imaging protocol including enhanced 3D volumetric interpolated breath-hold examination (VIBE) T1-weighted with fat saturation were assessed. Patients with bilateral isointense dentate nucleus on unenhanced T1-weighted images were assigned to group A (controls without MRI evidence of gadolinium deposition), and patients with visually hyperintense dentate nuclei were assigned to group B. Qualitative and quantitative assessment of the skin thickness were performed.

Results
Group A included 27 patients (median age, 33 years [IQR, 27–46]; 20 women), and group B included 44 patients (median age, 42 years [IQR, 35–53]; 29 women). Qualitative and quantitative assessment of the skin revealed significant differences between group A and group B. The average skin–to–scalp thickness ratios was significantly higher in group B than in group A (mean ± standard deviation = 0.52 ± 0.02 in group B vs 0.41 ± 0.02 in group A, P < 0.0001) and showed a positive correlation with the total number of enhanced MRI scans (r = 0.39; 95% confidence interval, 0.17–0.57, P < 0.01).

Conclusions
Brain MRI detects increased skin thickness of the scalp in patients with MS and dentate nucleus high signal intensity on unenhanced T1-weighted images and shows positive association with previous exposures to linear GBCAs rather than macrocyclic GBCAs.
Longitudinal Assessment of Multiple Sclerosis Lesion Load With Synthetic Magnetic Resonance Imaging—A Multicenter Validation Study
Authors: Schlaeger Sarah , Li Hongwei Bran , Baum Thomas , Zimmer Claus , Moosbauer Julia , Byas Sebastian , Mühlau Mark , Wiestler Benedikt , Finck Tom 
Published: February 2023

Introduction
Double inversion recovery (DIR) has been validated as a sensitive magnetic resonance imaging (MRI) contrast in multiple sclerosis (MS). Deep learning techniques can use basic input data to generate synthetic DIR (synthDIR) images that are on par with their acquired counterparts. As assessment of longitudinal MRI data is paramount in MS diagnostics, our study's purpose is to evaluate the utility of synthDIR longitudinal subtraction imaging for detection of disease progression in a multicenter data set of MS patients.

Methods
We implemented a previously established generative adversarial network to synthesize DIR from input T1-weighted and fluid-attenuated inversion recovery (FLAIR) sequences for 214 MRI data sets from 74 patients and 5 different centers. One hundred and forty longitudinal subtraction maps of consecutive scans (follow-up scan—preceding scan) were generated for both acquired FLAIR and synthDIR. Two readers, blinded to the image origin, independently quantified newly formed lesions on the FLAIR and synthDIR subtraction maps, grouped into specific locations as outlined in the McDonald criteria.

Results
Both readers detected significantly more newly formed MS-specific lesions in the longitudinal subtractions of synthDIR compared with acquired FLAIR (R1: 3.27 ± 0.60 vs 2.50 ± 0.69 [P = 0.0016]; R2: 3.31 ± 0.81 vs 2.53 ± 0.72 [P < 0.0001]). Relative gains in detectability were most pronounced in juxtacortical lesions (36% relative gain in lesion counts—pooled for both readers). In 5% of the scans, synthDIR subtraction maps helped to identify a disease progression missed on FLAIR subtraction maps.

Conclusions
Generative adversarial networks can generate high-contrast DIR images that may improve the longitudinal follow-up assessment in MS patients compared with standard sequences. By detecting more newly formed MS lesions and increasing the rates of detected disease activity, our methodology promises to improve clinical decision-making.
18F-FMISO PET of an Intracranial Tuberculoma
Authors: Sakata Akihiko , Fushimi Yasutaka , Arakawa Yoshiki , Shimizu Yoichi , Nakamoto Yuji 
Published: February 2023

Abstract
Solitary intracranial tuberculomas are rare and frequently misdiagnosed as brain tumors. We report a case of intracranial tuberculous granuloma mimicking a high-grade glioma with avid uptake on 18F-fluoromisonidazole PET/CT. It has been believed that hypoxia exists within the tuberculosis granuloma, and that this hypoxic environment causes Mycobacterium tuberculosis to lie dormant and asymptomatic infection to occur. This hypoxic and necrotic condition inside tuberculous granuloma may lead to high accumulation of 18F-fluoromisonidazole in this case.
18F-Choline Versus 68Ga-PSMA-11 PET/CT Imaging Comparison in Incidental Clear Cell Renal Cell Carcinoma
Authors: Urso Luca , Rocca Giovanni Christian , Uccelli Licia , Ippolito Carmelo , Bartolomei Mirco 
Published: February 2023

Abstract
Few articles in literature describe the potential usefulness of 18F-choline PET/CT and particularly 68Ga-PSMA-11 PET/CT in imaging of clear cell renal cell carcinoma (ccRCC). We report a unique comparison in literature between the 2 radiotracers in a patient who underwent left nephrectomy with diagnosis of ccRCC, grade 3. 68Ga-PSMA-11 PET/CT confirmed its emerging role in imaging ccRCC, as the incidentally detected renal neoplasm showed a significant higher uptake in comparison to 18F-choline PET/CT, inducing surgical indication.
Novel Depiction of Collateral Flow in Chronic Thromboembolic Pulmonary Hypertension Using 4D Dynamic 82Rb PET/CT
Authors: Dixon James T. , DiFilippo Frank P. , Renapurkar Rahul D. , Huang Steve S. 
Published: February 2023

Abstract
CT pulmonary angiogram and ventilation-perfusion scintigraphy are the 2 primary imaging modalities for evaluating patients with CTEPH (chronic thromboembolic pulmonary hypertension). PET/CT and MRI currently have a limited role in the evaluation of acute or chronic pulmonary embolism. We present incidentally captured dynamic pulmonary perfusion images in a patient with history of CTEPH who underwent 82Rb myocardial perfusion PET/CT for evaluation of chest pain. Analysis of the PET data revealed delayed perfusion of the affected lobes suggesting collateralization, highlighting a potentially new imaging paradigm for assessment of pulmonary perfusion.