bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ursodeoxycholic acid is associated with a reduction in SARS‐CoV‐2 infection and reduced severity of COVID‐19 in patients with cirrhosis
Authors: John Binu V. , Bastaich Dustin , Webb Gwilym , Brevini Teresa , Moon Andrew , Ferreira Raphaella D. , Chin Allison M. , Kaplan David E. , Taddei Tamar H. , Serper Marina , Mahmud Nadim , Deng Yangyang , Chao Hann‐Hsiang , Sampaziotis Fotios , Dahman Bassam 
Published: April 2023

AbstractBackground and aimsStudies have demonstrated that reducing farnesoid X receptor activity with ursodeoxycholic acid (UDCA) downregulates angiotensin‐converting enzyme in human lung, intestinal and cholangiocytes organoids in vitro, in human lungs and livers perfused ex situ, reducing internalization of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) into the host cell. This offers a potential novel target against coronavirus disease 2019 (COVID‐19). The objective of our study was to compare the association between UDCA exposure and SARS‐CoV‐2 infection, as well as varying severities of COVID‐19, in a large national cohort of participants with cirrhosis.MethodsIn this retrospective cohort study among participants with cirrhosis in the Veterans Outcomes and Costs Associated with Liver cohort, we compared participants with exposure to UDCA, with a propensity score (PS) matched group of participants without UDCA exposure, matched for clinical characteristics, and vaccination status. The outcomes included SARS‐CoV‐2 infection, symptomatic, at least moderate, severe, or critical COVID‐19, and COVID‐19‐related death.ResultsWe compared 1607 participants with cirrhosis who were on UDCA, with 1607 PS‐matched controls. On multivariable logistic regression, UDCA exposure was associated with reduced odds of developing SARS‐CoV‐2 infection (adjusted odds ratio [aOR] 0.54, 95% confidence interval [CI] 0.41–0.71, p < 0.0001). Among patients who developed COVID‐19, UDCA use was associated with reduced disease severity, including symptomatic COVID‐19 (aOR 0.54, 95% CI 0.39–0.73, p < 0.0001), at least moderate COVID‐19 (aOR 0.51, 95% CI 0.32–0.81, p = 0.005), and severe or critical COVID‐19 (aOR 0.48, 95% CI 0.25–0.94, p = 0.03).ConclusionsIn participants with cirrhosis, UDCA exposure was associated with both a decrease in SARS‐CoV‐2 infection, and reduction in symptomatic, at least moderate, and severe/critical COVID‐19.
Effects of Leader Group Prototypicality on Leadership Outcomes through Leader Identity Threat: The Moderating Effects of Leader Perceptions of Organizational Support
Authors: Rodgers Matthew S. , Kim Tae‐Yeol , Chen Tingting , David Emily 
Published: April 2023

AbstractWe theorized and tested how both team‐assessed leader group prototypicality (i.e., followers' collective perceptions of the extent to which a leader is viewed as being representative of the group prototype) and leader‐team congruence on this factor relate to leader identity threat. We also proposed that leader identity threat, subsequently, negatively affects both leadership effectiveness and team performance, and that leader perceptions of organizational support mitigate the relationships. Using a multi‐source and time‐lagged survey design to collect data at the leader (team) level from 402 group members and their 90 group leaders, the results generally support our research hypotheses. For example, both team‐assessed leader group prototypicality and leader‐team congruence on leader group prototypicality negatively relate to leader identity threat. In addition, the effects of leader identity threat on leadership effectiveness and team performance were weaker when leader perceptions of organizational support were higher rather than lower.
Factors associated with thrombotic and hemorrhagic complications in pediatric liver transplant: A multi‐center analysis from the Starzl Network for Excellence in Pediatric Transplantation
Authors: Soltys Kyle , Lemoine Caroline , Zhang Xingyu , Bhat Rukhmi , Bucuvalas John , Rasmussen Sara , Romero Rene , Batsis Irini , Sayed Blayne , Tunno John , Confair Cassandra , Vargas Sarah , Superina Riccardo , Mazariegos George 
Published: April 2023

AbstractBackgroundSurvival after pediatric liver transplantation (PLT) is negatively impacted by thrombotic and hemorrhagic complications. Limited data exists regarding factors associated with these complications and utilization of anticoagulation.MethodsRetrospective review of donor, recipient variables and outcomes from four centers participating in the Starzl Network for Excellence in Pediatric Transplantation.Results76 PLT included 39 (51%) technical variant transplants, with mean follow‐up 628 ± 193.6 days. Median age/weight at transplant were 59.3 ± 53.8 months and 19.6 ± 17.2 kg. Seven (9.2%) transplants experienced intraoperative hepatic artery thrombosis (iHAT), all successfully corrected. Four HAT recurred postoperatively on POD 1,7,8 and 616. All three portal vein thromboses (PVT) occurred on POD1. Anticoagulation protocols were initiated intraoperatively in 50 and postoperatively in 66 and were active for all thrombotic and hemorrhagic events. Two patients were re‐transplanted for HAT. Two patients died without having thrombotic or hemorrhagic complications. iHAT and post‐operative HAT were associated with lower hepatic arterial flows. iHAT was associated with donor variant anatomy, reduced allografts and intraoperative blood loss. Intraoperative ultrasound could not predict post‐operative HAT nor PVT. Surgeon pre‐operative concern regarding the native portal vein correlated with postoperative PVT. Lower hepatic arterial and portal flows, higher estimated blood losses, higher prothrombin time and use of arterial interposition grafts were associated with postoperative hemorrhagic complications.ConclusionsThrombotic and hemorrhagic complications after pediatric liver transplant remain rare but significant events. Their occurrence can be predicted with pre‐operative assessment of donor and recipient vascular anatomy and direct flow measurement but may not be predicted with ultrasound evaluation nor prevented with anticoagulation.
Dissecting the contributions of the peripheral chemoreflex and myocardial hypoxia to fetal heart rate decelerations in near‐term fetal sheep
Authors: Lear Christopher A. , Beacom Michael J. , Dhillon Simerdeep K. , Lear Benjamin A. , Mills Olivia J. , Gunning Mark I. , Westgate Jenny A. , Bennet Laura , Gunn Alistair J. 
Published: April 2023

AbstractBrief repeated fetal hypoxaemia during labour can trigger intrapartum decelerations of the fetal heart rate (FHR) via the peripheral chemoreflex or the direct effects of myocardial hypoxia, but the relative contribution of these two mechanisms and how this balance changes with evolving fetal compromise remain unknown. In the present study, chronically instrumented near‐term fetal sheep received surgical vagotomy (n = 8) or sham vagotomy (control, n = 11) to disable the peripheral chemoreflex and unmask myocardial hypoxia. One‐minute complete umbilical cord occlusions (UCOs) were performed every 2.5 min for 4 h or until arterial pressure fell below 20 mmHg. Hypotension and severe acidaemia developed progressively after 65.7 ± 7.2 UCOs in control fetuses and 49.5 ± 7.8 UCOs after vagotomy. Vagotomy was associated with faster development of metabolic acidaemia and faster impairment of arterial pressure during UCOs without impairing centralization of blood flow or neurophysiological adaptation to UCOs. During the first half of the UCO series, before severe hypotension developed, vagotomy was associated with a marked increase in FHR during UCOs. After the onset of evolving severe hypotension, FHR fell faster in control fetuses during the first 20 s of UCOs, but FHR during the final 40 s of UCOs became progressively more similar between groups, with no difference in the nadir of decelerations. In conclusion, FHR decelerations were initiated and sustained by the peripheral chemoreflex at a time when fetuses were able to maintain arterial pressure. After the onset of evolving hypotension and acidaemia, the peripheral chemoreflex continued to initiate decelerations, but myocardial hypoxia became progressively more important in sustaining and deepening decelerations.
imageKey points
Brief repeated hypoxaemia during labour can trigger fetal heart rate decelerations by either the peripheral chemoreflex or myocardial hypoxia, but how this balance changes with fetal compromise is unknown.
Reflex control of fetal heart rate was disabled by vagotomy to unmask the effects of myocardial hypoxia in chronically instrumented fetal sheep. Fetuses were then subjected to repeated brief hypoxaemia consistent with the rates of uterine contractions during labour.
We show that the peripheral chemoreflex controls brief decelerations in their entirety at a time when fetuses were able to maintain normal or increased arterial pressure.
The peripheral chemoreflex still initiated decelerations even after the onset of evolving hypotension and acidaemia, but myocardial hypoxia made an increasing contribution to sustain and deepen decelerations.
Geological records of transient fluid drainage into the shallow mantle wedge
Authors: Yoshida Kazuki , Oyanagi Ryosuke , Kimura Masao , Plümper Oliver , Fukuyama Mayuko , Okamoto Atsushi 
Published: April 2023

Pore fluid pressure on subduction zone megathrusts is lowered by fluid drainage into the overlying plate, affecting subduction zone seismicity. However, the spatial and temporal scales of fluid flow through suprasubduction zones are poorly understood. We constrain the duration and velocity of fluid flow through a shallow mantle wedge based on the analyses of vein networks consisting of high-temperature serpentine in hydrated ultramafic rocks from the Oman ophiolite. On the basis of a diffusion model and the time-integrated fluid flux, we show that the channelized fluid flow was short-lived (2.1 × 10
−1
to 1.1 × 10
1
years) and had a high fluid velocity (2.7 × 10
−3
to 4.9 × 10
−2
meters second
−1
), which is close to the propagation velocities of seismic events in present-day subduction zones. Our results suggest that the drainage of fluid into the overlying plate occurs as episodic pulses, which may influence the recurrence of megathrust earthquakes.
Cost-effectiveness of FreeO2in patients with chronic obstructive pulmonary disease hospitalised for acute exacerbations: analysis of a pilot study in Quebec
Authors: Poder Thomas G , Kouakou Christian R C , Bouchard Pierre-Alexandre , Tremblay Véronique , Blais Sébastien , Maltais François , Lellouche François 
Published: April 2023

ObjectiveConduct a cost-effectiveness analysis of FreeO2technology versus manual oxygen-titration technology for patients with chronic obstructive pulmonary disease (COPD) hospitalised for acute exacerbations.SettingTertiary acute care hospital in Quebec, Canada.Participants47 patients with COPD hospitalised for acute exacerbations.InterventionAn automated oxygen-titration and oxygen-weaning technology.Methods and outcomesThe costs for hospitalisation and follow-up for 180 days were calculated using a microcosting approach and included the cost of FreeO2technology. Incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap resampling with 5000 replications. The main effect variable was the percentage of time spent at the target oxygen saturation (SpO2). The other two effect variables were the time spent in hyperoxia (target SpO2+5%) and in severe hypoxaemia (SpO2<85%). The resamplings were based on data from a randomised controlled trial with 47 patients with COPD hospitalised for acute exacerbations.ResultsFreeO2generated savings of 20.7% of the per-patient costs at 180 days (ie, −$C2959.71). This decrease is nevertheless not significant at the 95% threshold (P=0.13), but the effect variables all improved (P<0.001). The improvement in the time spent at the target SpO2was 56.3%. The ICERs indicate that FreeO2technology is more cost-effective than manual oxygen titration with a savings of −$C96.91 per percentage point of time spent at the target SpO2(95% CI −301.26 to 116.96).ConclusionFreeO2technology could significantly enhance the efficiency of the health system by reducing per-patient costs at 180 days. A study with a larger patient sample needs to be carried out to confirm these preliminary results.Trial registration numberNCT01393015; Post-results.
Does dexmedetomidine given as a premedication or intraoperatively reduce post-hospitalisation behaviour change in children? A study protocol for a randomised controlled trial in a tertiary paediatric hospital
Authors: Lee-Archer Paul , McBride Craig , Paterson Rebecca , Reade Michael , Regli-von Ungern-Sternberg Britta , Long Deborah 
Published: April 2023

IntroductionIt has been reported that post-hospitalisation behaviour change (PHBC) occurs in over 50% of children undergoing a general anaesthetic and manifests as behaviours such as sleep and eating disorders, defiance of authority, nightmares, enuresis and temper tantrums. The effect is usually short-lived (2–4 weeks); however, in 5–10% of children, these behaviours can last up to 12 months. The risk factors for developing PHBC include underlying anxiety in the child or parent, a previous bad hospital experience, emergence delirium and preschool age. A recent meta-analysis of alpha-2 agonists (including dexmedetomidine) found that they effectively reduce the incidence of emergence delirium but none of the studies looked at longer term outcomes, such as PHBC.Methods and analysisTwo-year-old to seven-year-old children requiring general anaesthesia for common day-case procedures will be randomly assigned to one of three groups: a dexmedetomidine pre medication group, an intraoperative dexmedetomidine group and a control group. Baseline anxiety levels of the parent will be recorded and the anxiety of the child during induction of anaesthesia will also be recorded using validated tools. The primary outcome will be negative behaviours after hospitalisation and these will be measured using the Post Hospitalisation Behaviour Questionnaire for Ambulatory Surgery and the Strengths and Difficulties Questionnaire. These questionnaires will be administered by a blinded researcher at days 3, 14 and 28 post surgery.Ethics and disseminationEthics approval has been granted by the Children’s Health Queensland human research ethics committee (HREC/15/QRCH/248) and the University of Queensland human research ethics office (#2016001715). Any amendments to this protocol will be submitted to the ethics committees for approval.Trial registration numberNCT12616000096459.
Association between depressive symptoms and objectively measured daily step count in individuals at high risk of cardiovascular disease in South London, UK: a cross-sectional study
Authors: Ludwig Vera M , Bayley Adam , Cook Derek G , Stahl Daniel , Treasure Janet L , Asthworth Mark , Greenough Anne , Winkley Kirsty , Bornstein Stefan R , Ismail Khalida 
Published: April 2023

ObjectivesDepressive symptoms are common but rarely considered a risk factor for unhealthy lifestyles associated with cardiovascular disease (CVD). This study investigates whether depressive symptoms are associated with reduced physical activity (PA) in individuals at high risk of developing CVD.DesignSecondary analysis of the cross-sectional baseline data from a randomised controlled trial of an intensive lifestyle intervention.Setting135 primary care practices in South London, UK.Participants1742 adults, 49–74 years, 86% male at high (≥20%) risk of developing CVD in the next 10 years as defined via QRISK2 score.Outcome measuresThe main explanatory variable was depressive symptoms measured via the Patient Health Questionnaire-9 (PHQ-9). The main outcome was daily step count measured with an accelerometer (ActiGraph GT3X) stratified by weekdays and weekend days.ResultsThe median daily step count of the total sample was 6151 (IQR 3510) with significant differences (P<0.001) in mean daily step count between participants with low (PHQ-9 score: 0–4), mild (PHQ-9 score: 5–9) and moderate to severe depressive symptoms (PHQ-9 score: ≥10). Controlling for age, gender, ethnicity, education level, body mass index (BMI), smoking, consumption of alcohol, day of the week and season, individuals with mild depressive symptoms and those with moderate to severe depressive symptoms walked 13.3% (95% CI 18.8% to 7.9%) and 15.6% (95% CI 23.7% to 6.5%) less than non-depressed individuals, respectively. Furthermore, male gender, white ethnicity, higher education level, lower BMI, non-smoking, moderate alcohol intake, weekdays and summer season were independently associated with higher step count.ConclusionsPeople at high risk of CVD with depressive symptoms have lower levels of PA.Trial registrationNCT84864870.
Effects of high-intensity interval training on vascular function in breast cancer survivors undergoing anthracycline chemotherapy: design of a pilot study
Authors: Lee Kyuwan , Kang Irene , Mortimer Joanne E , Sattler Fred , Mack Wendy J , Fitzsimons Lindsey Avery , Salem George , Dieli-Conwright Christina M 
Published: April 2023

IntroductionCardiovascular disease (CVD) mortality is higher among breast cancer survivors (BCS) who receive chemotherapy compared with those not receiving chemotherapy. Anthracycline chemotherapy is of particular concern due to anthracycline-related impairment of vascular endothelial cells and dysregulation of the extracellular matrix. One strategy proven to offset these impairments is a form of exercise known as high-intensity interval training (HIIT). HIIT improves endothelial function in non-cancer populations by decreasing oxidative stress, the main contributor to anthracycline-induced vascular dysfunction. The purpose of this pilot study is to assess the feasibility of an 8-week HIIT, as well as the HIIT effects on endothelial function and extracellular matrix remodelling, in BCS undergoing anthracycline chemotherapy.Methods and analysisThirty BCS are randomised to either HIIT, an 8-week HIIT intervention occurring three times per week (seven alternating bouts of 90% of peak power output followed by 10% peak power output), or delayed group (DEL). Feasibility of HIIT is assessed by (1) the percentage of completed exercise sessions and (2) the number of minutes of exercise completed over the course of the study. Vascular function is assessed using brachial artery flow-mediated dilation and carotid intima media thickness. Extracellular matrix remodelling is assessed by the level of matrix metalloproteinases in the plasma. A repeated-measures analysis of covariance model will be performed with group (HIIT and DEL group) and time (pre/post assessment) as independent factors. We hypothesise that HIIT will be feasible in BCS undergoing anthracycline chemotherapy, and that HIIT will improve endothelial function and extracellular matrix remodelling, compared with the DEL group. Success of this study will provide evidence of feasibility and efficacy to support a larger definitive trial which will impact cancer survivorship by decreasing anthracycline-induced vascular dysfunction, thereby benefiting cardiovascular markers that are related to CVD risk.Ethics and disseminationThis trial was approved by the University of Southern California Institutional Review Board (HS-15–00227).Trial registration numberNCT02454777.
Intermittent versus continuous oxygen saturation monitoring for infants hospitalised with bronchiolitis: study protocol for a pragmatic randomised controlled trial
Authors: Mahant Sanjay , Wahi Gita , Giglia Lucy , Pound Catherine , Kanani Ronik , Bayliss Ann , Roy Madan , Sakran Mahmoud , Kozlowski Natascha , Breen-Reid Karen , Lavigne Mollie , Premji Laila , Moretti Myla E , Willan Andrew R , Schuh Suzanne , Parkin Patricia C 
Published: April 2023

IntroductionBronchiolitis is the most common reason for hospitalisation in infants in developed countries. The main focus of hospital care is on supportive care, such as monitoring for hypoxia and supplemental oxygen administration, as active therapies lack effectiveness. Pulse oximetry is used to monitor hypoxia in hospitalised infants and is used either intermittently or continuously. Observational studies have suggested that continuous pulse oximetry use leads to a longer length of hospital stay in stable infants. The use of continuous pulse oximetry may lead to unnecessary clinical intervention due to readings that are of little clinical significance, false-positive readings and less reliance on the clinical status. There is a lack of high-quality evidence to guide which pulse oximetry monitoring strategy, intermittent or continuous, is superior in infants hospitalised with bronchiolitis with respect to patient and policy-relevant outcomes.Methods and analysisThis is a multicentre, pragmatic randomised controlled trial comparing two strategies for pulse oximetry monitoring in infants hospitalised for bronchiolitis. Infants aged 1 month to 2 years presenting to Canadian tertiary and community hospitals will be randomised after stabilisation to receive either intermittent or continuous oxygen saturation monitoring on the inpatient unit until discharge. The primary outcome is length of hospital stay. Secondary outcomes include additional measures of effectiveness, acceptability, safety and cost. We will need to enrol 210 infants in order to detect a 12-hour difference in length of stay with a type 1 error rate of 5% and a power of 90%.Ethics and disseminationResearch ethics approval has been obtained for this trial. This trial will provide data to guide hospitals and clinicians on the optimal pulse oximetry monitoring strategy in infants hospitalised with bronchiolitis. We will disseminate the findings of this study through peer-reviewed publication, professional societies and meetings.Trial registration numberNCT02947204
Protocol for a randomised trial evaluating the comparative effectiveness of strategies to promote shared decision making for hip and knee osteoarthritis (DECIDE-OA study)
Authors: Mangla Mahima , Bedair Hany , Chang Yuchiao , Daggett Susannah , Dwyer Maureen K , Freiberg Andrew A , Mwangi Sheila , Talmo Carl , Vo Ha , Sepucha Karen 
Published: April 2023

IntroductionThere are several different interventions available to promote shared decision making (SDM); however, little is known about the comparative effectiveness of different approaches.ObjectiveTo examine the impact of patient-directed and physician-directed decision support strategies on the quality of treatment decisions for hip and knee osteoarthritis (OA).Trial designA 2×2 factorial randomised controlled trial.SettingOne academic medical centre, one community hospital and one orthopaedic specialty hospital.Participants and interventionsThe enrolment targets were 8 surgeons and 1120 patients diagnosed with hip or knee OA. Patients were randomly assigned to receive one of two different decision aids (DAs) stratified by site. The DAs varied in length, content and the level of detail regarding treatment options. Both DAs were available by paper or online.Surgeons were randomly assigned to receive a report detailing patients’ goals and treatment preferences at the time of the visit or not. Eligible patients received their assigned DA before their visit and completed three surveys: before the visit (timepoint (T)1), 1-week postvisit (T2) and 6 months from either the visit date or surgery date for patients who underwent surgery (T3). Study staff and participating surgeons were not blinded, but the statistician conducting the analyses was blinded to the arms.Main outcome measure and analysisThe primary study outcome was decision quality, the percentage of patients who were well informed and received their preferred treatment. Secondary outcomes included involvement in decision making, surgical rates, health outcomes, decision regret and satisfaction. A logistic regression model with the generalised estimating equations approach was used to compare rates of decision quality between the groups and account for the clustering of patients within providers.Ethics and disseminationEthics approval was obtained through the institutional review board at the main site. The findings will be published in peer-reviewed journals.Trial registration numberNCT02729831; Pre-results.