bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educational interventions delivered to prescribing advisers to influence primary care prescribing: a very low-cost pragmatic randomised trial using routine data from OpenPrescribing.net
Authors: Curtis Helen J , MacKenna Brian , Reddy Bhavana , Walker Alex J , Bacon Sebastian , Perera Rafael , Goldacre Ben 
Published: February 2025

Abstract

Background
NHS England issued commissioning guidance on 18 low-priority treatments which should not be routinely prescribed in primary care. We aimed to monitor the impact of an educational intervention delivered to regional prescribing advisors by senior pharmacists from NHS England on the primary care spend on low-priority items.

Methods
An opportunistic randomised, controlled parallel-group trial. Participants (clinical commissioning groups, CCGs) were randomised to intervention or control in a 1:1 ratio. The intervention group were invited to participate. The intervention was a one-off educational session. Our primary outcomes concerned the total prescribing of low-priority items in primary care. Secondary outcomes concerned the prescribing of specific low-priority items. We also measured the impact on information-seeking behaviour.

Results
40 CCGs were randomised, 20 allocated to intervention, with 11 receiving the intervention. There was no significant impact on any prescribing outcomes. There was some possible evidence of increased engagement with data, in the form of CCG email alert sign-ups (p = 0.077). No harms were detected.

Conclusions
A one-off intervention delivered to CCGs by NHS England did not significantly influence low-priority prescribing. This trial demonstrates how routine interventions planned to improve uptake or adherence to healthcare guidance can be delivered as low-cost randomised trials and how to robustly assess their effectiveness.

Trial registration
ISRCTN31218900, October 01 2018.
How can a community of practice support healthcare professionals navigating new roles? a case study of genetic counsellors employed to work in medical specialities
Authors: Do Trang Thu , McEwen Alison , Martyn Melissa , Gaff Clara , Dawson-McClaren Belinda 
Published: February 2025

Abstract

Background
Communities of Practice (CoPs) have been implemented in healthcare settings to enhance knowledge translation and facilitate the implementation of new practices. However, their role in supporting healthcare professionals transitioning to new environments remains under-researched. This study examines a CoP designed for genetic health professionals in Australia who were employed to support the integration of genomics in medical specialities. Informed by the i-PARIHS framework, we explore how the facilitation of a CoP external to the implementation setting can support health professionals implementing innovative practices.

Methods
Data was collected through qualitative interviews with 14 genetic counsellors participating in the CoP through different stages of their new roles, 35 discussion and reflection logs, and workshop and meeting notes. Thematic analyses were carried out to capture the patterns and process of facilitation performed by this CoP, resulting in five overarching themes.

Results
Participants highlighted the unique role of the CoP in forging peer connection and providing emotional support in new environments with a high degree of uncertainty and limited peer support. Through CoP sessions and associated professional development workshops, they benefited from ongoing knowledge acquisition about good practices and innovations. The CoP served as an effective space for identifying and solving problems collectively or escalating emergent issues. Additionally, the CoP helped participants build inter-personal skills to overcome relational challenges and improved communication with non-genetic colleagues about genomics. Critical reflection emerged as both a practice and an impact of the CoP, enabling participants to redefine their roles and adopt future-oriented thinking for the genetic counselling profession.

Conclusion
The collaborative environment fostered by the CoP offered significant benefits to genetic professionals, facilitating their transition to new practice settings and supporting essential knowledge and skill development crucial for their success in introducing genomics in speciality patient care.
Antidepressant use and cognitive decline in patients with dementia: a national cohort study
Authors: Mo Minjia , Abzhandadze Tamar , Hoang Minh Tuan , Sacuiu Simona , Jurado Pol Grau , Pereira Joana B. , Naia Luana , Kele Julianna , Maioli Silvia , Xu Hong , Eriksdotter Maria , Garcia-Ptacek Sara 
Published: February 2025

Abstract

Background
Dementia is associated with psychiatric symptoms but the effects of antidepressants on cognitive function in dementia are understudied. We aimed to investigate the association between antidepressants and cognitive decline in patients with dementia, and the risk of severe dementia, fractures and death, depending on antidepressant class, drug, and dose.

Methods
This is a national cohort study. Patients with dementia registered in the Swedish Registry for Cognitive/Dementia Disorders-SveDem from May 1, 2007, until October 16, 2018, with at least one follow-up after dementia diagnosis, and who were new users of antidepressants, were included. Antidepressant use as a time varying exposure defined during the 6 months leading up to dementia diagnosis or each subsequent follow-up. We used linear mixed models to examine the association between antidepressant use and cognitive trajectories assessed by Mini-Mental State Examination (MMSE) scores. We used Cox proportional hazards models to calculate the hazard ratios for severe dementia (MMSE score < 10), fracture, and death. We compared antidepressant classes and drugs, and analyzed dose–response.

Results
We included 18740 patients (10 205 women [54.5%]; mean [SD] age, 78.2[7.4] years), of which 4271 (22.8%) received at least one prescription for an antidepressant. During follow-up, a total of 11912 prescriptions for antidepressants were issued, with selective serotonin reuptake inhibitors (SSRI) being the most common (64.8%). Antidepressant use was associated with faster cognitive decline (β (95% CI) = − 0.30(− 0.39, − 0.21) points/year), in particular sertraline (− 0.25(− 0.43, − 0.06) points/year), citalopram (− 0.41(− 0.55, − 0.27) points/year), escitalopram (− 0.76(− 1.09, − 0.44) points/year), and mirtazapine (− 0.19(− 0.34, − 0.04) points/year) compared with non-use. The association was stronger in patients with severe dementia (initial MMSE scores 0–9). Escitalopram showed a greater decline rate than sertraline. Compared with non-use, dose response of SSRIs on greater cognitive decline and higher risks of severe dementia, all-cause mortality, and fracture were observed.

Conclusions
In this cohort study, current antidepressant use was associated with faster cognitive decline; furthermore, higher dispensed doses of SSRIs were associated with higher risk for severe dementia, fractures, and all-cause mortality. These findings highlight the significance of careful and regular monitoring to assess the risks and benefits of different antidepressants use in patients with dementia.
Effects of reductive soil disinfestation on microbiological and physicochemical properties of continuous cropping soils in karst areas of Guizhou Province
Authors: He Yi , Gong Bo , Liang Taibo , Luo Zhenbao , Yu Qiwei , Li Caibin , Peng Huawei , Cai Heqing , Dai Huaxin , Zhai Zhen , Shang Nianjie , Ding Mengjiao 
Published: February 2025

Abstract

Purpose
The soil-borne diseases have limited the development of agricultural production in Guizhou Province of southwest China which was caused by long-term continuous cropping of crops. To reduce the limit factors of continuous cropping of corps has become an urgent problem.

Methods
Reductive soil disinfestation (RSD) is an environmentally friendly soil amendment technology. In this study, high-throughput sequencing was used to investigate the mechanisms of RSD technology to improve long-term continuous cropping soil health. The examination focused on discerning how RSD influences the composition and structure of the rhizosphere microbial community.

Result
The results demonstrated that: (1) RSD treatment increased the content of soil organic matter (SOM), alkaline hydrolyzed nitrogen (AN), available phosphorus (AP), available potassium (AK) and pH; (2) RSD changed the fungal and bacterial community structure and the relative abundance of pathogenic microorganisms (e.g., Fusarium) was reduced, while the beneficial microorganisms (e.g., Trichoderma and Penicillium) was increased. (3) AN and pH had a greater impact on the bacterial community in the rhizosphere soil than on the fungal community. (4) RSD treatment improved the agronomic traits of tobacco and reduced the disease incidence of root rot disease.

Conclusion
Our results revealed that RSD treatment improved the physicochemical properties of continuous cropping tobacco soil and maintain the soil nutrient balance, resulting in the effective alleviation of continuous cropping barriers.
Preoperative prediction of the Lauren classification in gastric cancer using automated nnU-Net and radiomics: a multicenter study
Authors: Cao Bo , Hu Jun , Li Haige , Liu Xuebing , Rong Chang , Li Shuai , He Xue , Zheng Xiaomin , Liu Kaicai , Wang Chuanbin , Guo Wei , Wu Xingwang 
Published: February 2025

Abstract

Objectives
To develop and validate a deep learning model based on nnU-Net combined with radiomics to achieve autosegmentation of gastric cancer (GC) and preoperative prediction via the Lauren classification.

Methods
Patients with a pathological diagnosis of GC were retrospectively enrolled in three medical centers. The nnU-Net autosegmentation model was developed using manually segmented datasets and evaluated by the Dice similarity coefficient (DSC). The CT images were processed by the nnU-Net model to obtain autosegmentation results and extract radiomic features. The least absolute shrinkage and selection operator (LASSO) method selects optimal features for calculating the Radscore and constructing a radiomic model. Clinical characteristics and the Radscore were integrated to construct a combined model. Model performance was evaluated via the receiver operating characteristic (ROC) curve.

Results
A total of 433 GC patients were divided into the training set, internal validation set, external test set-1, and external test set-2. The nnU-Net model achieved a DSC of 0.79 in the test set. The areas under the curve (AUCs) of the internal validation set, external test set-1, and external test set-2 were 0.84, 0.83, and 0.81, respectively, for the radiomic model; and 0.81, 0.81, and 0.82, respectively, for the combined model. The AUCs of the radiomic and combined models showed no statistically significant difference (p > 0.05). The radiomic model was selected as the optimal model.

Conclusions
The nnU-Net model can efficiently and accurately achieve automatic segmentation of GCs. The radiomic model can preoperatively predict the Lauren classification of GC with high accuracy.

Critical relevance statement
This study highlights the potential of nnU-Net combined with radiomics to noninvasively predict the Lauren classification in gastric cancer patients, enhancing personalized treatment strategies and improving patient management.

Key Points

The Lauren classification influences gastric cancer treatment and prognosis.

The nnU-Net model reduces doctors’ manual segmentation errors and workload.

Radiomics models aid in preoperative Lauren classification prediction for patients with gastric cancer.

Graphical Abstract
Risk factors for detection of Pseudomonas aeruginosa in clinical samples upon hospital admission
Authors: Reyle Romeo , Schwab Frank , Saydan Selin , Behnke Michael , Leistner Rasmus , Gastmeier Petra , Geffers Christine , Kramer Tobias Siegfried 
Published: February 2025

Abstract

Background/introduction
Antipseudomonal antibiotics are frequently used in patients admitted to hospitals. Many of these substances are classified as a reserve or watch status by the WHO. Inappropriate risk assessment of invasive detection of P. aeruginosa (PAE) can be a reason for overuse of antipseudomonal antibiotics. Therefore it is important to define relevant and specific risk factors for invasive PAE detection.

Objective
The objective of this study was to identify risk factors for invasive detection of PAE in patients upon hospital admission.

Methods
All patients 18 years of age and older with a detection of PAE and/or Enterobacterales in clinical samples taken within 48 h of admission to one of the hospitals of Charité Universitätsmedizin Berlin between 2015 and 2020 were included into this retrospective cohort study.

Results
Overall, we included a total of 27,710 patients. In 3,764 (13.6%) patients PAE was detected in clinical samples taken within 48 h after admission. The most frequently detected Enterobacterales was E. coli in 14.142 (51%) patients followed by Klebsiella spp. in 4.432 (16%) patients. Multivariable regression analysis identified that prior colonisation with a multi drug resistant PAE or detection of a PAE in clinical samples during a previous hospitalisation increased the risk for invasive detection of PAE (OR 39.41; 95% CI 28.54–54.39) and OR 7.87 (95% CI 6.60–9.38) respectively. Admission to a specialised ward for patients with cystic fibrosis was associated with an increased risk (OR 26.99; 95% CI 20.48–35.54). Presence of chronic pulmonary disease (OR 2.05; 95% CI 1.85–2.26), hemiplegia (OR 2.16; 95% CI 1.90–2.45) and male gender (OR 1.60; 95% CI 1.46–1.75) were associated with a modest increase in risk for presence of PAE.

Conclusion
Patients with a prior detection of P. aeruginosa or admission to a cystic fibrosis ward had the highest risk for invasive detection of P. aeruginosa. Adherence to specific risk scores based on local risk factors could help to optimize prescription of anti-pseudomonal antibiotics that categorized as reserve and watch.
From plate to policy: segmenting consumers’ food behaviours to tailor nutritional recommendations in African cities
Authors: Marini Govigli Valentino , Alboni Fabrizio , Mulazzani Luca , Mwanri Akwilina , Suleiman Rashid , Chimoita Evans , Kogi-Makau Wambui , Setti Marco 
Published: February 2025

Abstract
Malnutrition poses significant challenges to African food systems. Addressing these challenges requires synergistic strategies informed by a comprehensive understanding of consumers' food preferences and characteristics, which necessitates the identification of more homogeneous consumer groups. To help reach this objective, this article presents a novel segmentation of African urban food consumers from nine cities across Kenya, Morocco, Tunisia, and Tanzania. The segmentation is based on diet quality indicators and behavioural traits, gathered through structured surveys combined with incentivized in-lab behavioural experiments. Subsequent cluster analyses identified four primary consumer groups characterized by shared behavioural patterns, diet quality, and propensity to food change. These groups serve as the basis for tailored nutritional recommendations aimed at providing policymakers with practical solutions to reinforce the nutritional capacity of local food systems.
Causal effects of education, intelligence, and income on COVID-19: evidence from a Mendelian randomization study
Authors: Song Yuqing , Baranova Ancha , Cao Hongbao , Yue Weihua , Zhang Fuquan 
Published: February 2025

Abstract

Background
The protective effects of higher educational attainment (EA) and intelligence on COVID-19 outcomes are not yet understood with regard to their dependency on income. The objective of our study was to examine the overall as well as independent effects of the three psychosocial factors on the susceptibility to and severity of COVID-19. To accomplish this, we utilized genetic correlation, Mendelian randomization (MR), and multivariable MR (MVMR) analyses to evaluate genetic associations between EA, intelligence, household income, and three specific COVID-19 outcomes: SARS-CoV-2 infection, hospitalized COVID-19, and critical COVID-19.

Results
The genetic correlation analysis revealed that COVID-19 outcomes were negatively correlated with the three psychosocial factors (rg: -0.19‒-0.36). The MR analysis indicated that genetic liability to EA, intelligence, and income exerted overall protective effects against SARS-CoV-2 infection (OR: 0.86‒0.92), hospitalized COVID-19 (OR: 0.70‒0.80), and critical COVID-19 (OR: 0.65‒0.85). MVMR analysis revealed that elevated levels of EA conferred independent protective effects against SARS-CoV-2 infection (OR: 0.85), hospitalization due to COVID-19 (OR: 0.79), and critical COVID-19 (OR: 0.63). Furthermore, intelligence exhibited a negative association with the risk of SARS-CoV-2 infection (OR: 0.91), whereas a higher income was linked to an elevated risk of SARS-CoV-2 infection (OR: 1.13).

Conclusions
Our findings indicated that EA could significantly reduce the risk and severity of COVID-19, regardless of intelligence and income. However, the impact of intelligence or income on COVID-19 severity was not supported by our research.
The EU global health strategy: from policy to implementation
Authors: Skordis Jolene , Froeschl Guenter , Baldi Sante Leandro , Berner-Rodoreda Astrid , Casamitjana Nuria , Cobelens Frank , Klipstein-Grobusch Kerstin , Raviglione Mario , Rocamora Alberto , Vandamme Anne-Mieke , Plasència Antoni 
Published: February 2025

Abstract
In November 2022, a draft of the next EU Global Health Strategy was published. The European Global Health Research Institutes Network (EGHRIN) of 22 leading European Universities has analysed the Strategy. In this commentary, EGHRIN notes the Strategy’s positive commitments to life-course wellbeing, strengthening health systems and combating health threats in an equitable and collaborative manner. We find the strategy is compatible with the sustainable development goals and addresses social, political and environmental determinants of health. However, our analyses also highlight a lack of critical assessment of the private sector’s role within health systems, insufficient attention to syndemics, and little emphasis on transdisciplinary education and the ethical training of a global health workforce. We conclude that, while its commitments are commendable, the greatest challenge for the next EU Strategy will be in its implementation. The trategy currently lacks a fully-resourced and clearly hypothecated funding mechanism and there is little evidence to date of the stated commitment that Global Health will be considered in all EU policy areas. In the present geopolitical climate, a speedy acceptance of both the policy and an implementation plan is needed more than ever.
Persistent epileptic spikes after recurrent posterior reversible encephalopathy syndrome in a patient with lupus nephritis: case report and literature review
Authors: Chen Yu , Chu Yu-Cheng , Chen Shih-Chi , Chang Ting-Hui , Wu Chien-Sheng 
Published: February 2025

Abstract

Background
Posterior reversible encephalopathy syndrome (PRES) is characterized by white matter lesions distributed mainly at the posterior brain, which may present with headache, visual disturbances, seizures, and disturbed consciousness in patients with systemic lupus erythematosus (SLE). Recurrent PRES is uncommon, but persistent seizures after PRES are even rarer.

Case presentation
Herein, we reported a 33-year-old Taiwanese female patient with SLE requiring long-term antiepileptics after two episodes of PRES within 5 months. The possible trigger factors were end-stage renal disease, hypertension, and immunosuppressant use. The brain magnetic resonance imaging showed hyperintense lesions in the bilateral parietal lobes, occipital lobes, and cerebellum, which was compatible with PRES. There are still unresolved clinical problems regarding the management of PRES in SLE. To investigate possible risk factors of recurrent attacks and persisted epileptic spikes, we also reviewed previous literature for recurrent PRES and antiepileptic use to provide insight into the clinical care of these patients. In our review, most patients have recent end-stage renal disease or immunosuppressant use, and the main trigger factor is severe hypertension which breaks down the blood–brain barrier, impairs cerebrovascular autoregulation, and results in the development of brain edema and therefore PRES.

Conclusion
Recurrent PRES may increase the risk of epilepsy. Long-term antiepileptic agents might be prescribed based on electroencephalogram findings.
Cancer brain metastasis: molecular mechanisms and therapeutic strategies
Authors: Lu Yu , Huang Yunhang , Zhu Chenyan , Li Zhidan , Zhang Bin , Sheng Hui , Li Haotai , Liu Xixi , Xu Zhongwen , Wen Yi , Zhang Jing , Zhang Liguo 
Published: February 2025

Abstract
Brain metastases (BMs) are the most common intracranial tumors in adults and the major cause of cancer-related morbidity and mortality. The occurrence of BMs varies according to the type of primary tumors with most frequence in lung cancer, melanoma and breast cancer. Among of them, lung cancer has been reported to have a higher risk of BMs than other types of cancers with 40 ~ 50% of such patients will develop BMs during the course of disease. BMs lead to many neurological complications and result in a poor quality of life and short life span. Although the treatment strategies were improved for brain tumors in the past decades, the prognosis of BMs patients is grim. Poorly understanding of the molecular and cellular characteristics of BMs and the complicated interaction with brain microenvironment are the major reasons for the dismal prognosis of BM patients. Recent studies have enhanced understanding of the mechanisms of BMs. The newly identified potential therapeutic targets and the advanced therapeutic strategies have brought light for a better cure of BMs. In this review, we summarized the mechanisms of BMs during the metastatic course, the molecular and cellular landscapes of BMs, and the advances of novel drug delivery systems for overcoming the obstruction of blood–brain barrier (BBB). We further discussed the challenges of the emerging therapeutic strategies, such as synergistic approach of combining targeted therapy with immunotherapy, which will provide vital clues for realizing the precise and personalized medicine for BM patients in the future.