bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differing methodological quality but identical recommendations? - Assessment of methodological quality and content analysis of Clinical Practice Guidelines and Food-based Dietary Guidelines in early childhood allergy prevention
Authors: Sieferle Katharina , Bitzer Eva Maria 
Published: June 2023

AbstractObjectiveRecommendations on early childhood allergy prevention (ECAP) are found in clinical practice guidelines (CPG) and food-based dietary guidelines (FBDG). This study aims to compare the methodological quality and the content of recommendations in CPGs and FBDGs for ECAP.Study Design and SettingWe assessed methodological quality of a sample of 36 guidelines (23 CPGs, 13 FBDGs), retrieved through extensive searching, with the Appraisal of Guidelines for Research and Evaluation tool (AGREE) II. On a subset of recommendations, we performed an in-depth analysis by type of intervention for direction of and strength of recommendation and level of evidence. Descriptive analysis was conducted with SPSS 27.ResultsCPGs scored higher than FBDGs in most AGREE domains (3, 4, 5 and 6). The 36 guidelines contain 280 recommendations on ECAP, with 68 addressing the introduction of complementary foods and allergenic foods. We found only slight differences between those recommendations in CPGs and FBDGs.ConclusionFBDGs on ECAP are of lower quality than CPGs. This does not affect their recommendations on the introduction of complementary foods and allergenic foods but may compromise their trustworthiness.What is new?-Methodological quality of guidelines on ECAP is low, especially in FBDGs-Recommendations on introduction of complementary feeding rarely vary-Recommendations on introduction of potential allergenic foods show slight variation-More attention is needed on the slight differences and the underlying evidence
Association between food insecurity, ethnicity, and mental health in the UK: An analysis of the Family Resource Survey
Authors: Power Maddy , Yang Tiffany , Pybus Katie 
Published: June 2023

ABSTRACTBackgroundFood insecurity is associated with mental ill-health, but there is limited evidence on ethnicity despite indication that minority ethnic groups are at risk of food insecurity and worse mental health. We assess the relationship between UK food insecurity, ethnicity and mental health using a representative household survey.MethodsData from the 2019/20 Family Resource Survey provided information on ethnicity, subjective rating of anxiety (10-point scale), presence of long-standing illnesses affecting mental health, and food security assessed using 10-item Adult Food Security module. Linear and logistic regression was used to assess the relationship between food security status and degree of anxiety and presence of long-standing illness affecting mental health. Analyses were adjusted for covariates and stratified by ethnicity.Results19,210 participants were included. The majority were food secure (87%), identified as White (90.7%), reported a median and interquartile range of anxiety of 2 (0-5), and 22% reported a long-standing illness affecting mental health. Food insecurity was associated with increased levels of anxiety (adjusted β=1.51, 95% CI:(1.34, 1.68)) among all ethnic groups, with greatest increase among people identifying as Black/African/Caribbean/Black British (β=1.75 (1.05, 2.44)). Food insecurity was associated with longstanding illness affecting mental health (adjusted OR 2.01 (1.70, 2.39)) among all ethnic groups; Asian/Asian British respondents reported the highest odds of having a longstanding illness affecting their mental health (OR=2.63 (1.05, 6.56)).ConclusionThe impact of UK food insecurity on mental health affects all ethnic groups but is worse for ethnic minorities, necessitating a population-wide response to food insecurity alongside targeted interventions addressing ethnic inequalities.
Identifying potential effects of relative age in school year: an instrumental variable phenome-wide association study in the UK Biobank
Authors: de Lange Melanie A , Davies Neil M , Millard Louise AC , Tilling Kate 
Published: June 2023

AbstractBackgroundObservational research shows that a child’s relative age within their school year (‘relative age’) is associated with educational attainment and mental health. However, previous studies have only examined a small number of outcomes and evidence of the persistence of effects into adulthood is mixed. We conducted a hypothesis-free investigation of the effects of relative age.MethodWe used a regression discontinuity design and an instrumental variable (IV)-pheWAS in the UK Biobank (participants aged 40-69 years at baseline), using the PHESANT software package. We created two IVs for relative age: being born in September vs. August (n=64 075) and week of birth (n=383 309). Outcomes passing the Bonferroni-correctedPvalue threshold for either instrument were plotted to identify those displaying a discontinuity at the school year transition.ResultsWe found 21 traits associated with at least one of the instruments (Pvalue below the Bonferroni threshold). Of these, 13 showed a discontinuity at the school year transition. These included previously identified effects including those with a younger relative age being less likely to have educational qualifications and more likely to have started smoking at an earlier age. We also identified a novel potential effect of a younger relative age in school year causing a better lung function as adults.ConclusionEducational policy should address educational inequality due to relative age. Further research should seek to replicate our identified effect on lung function in different populations, and investigate the mechanisms through which this effect may act.Key MessagesChildren’s relative age within their school year has been associated with mental health in childhood and educational attainment.Our results supported previously identified effects, with those who were younger in their school year being less likely to have educational qualifications and more likely to report starting smoking at an earlier age.We also found a potential beneficial effect of a younger relative age in school year on lung function in adulthood.
The impact of a hybrid hospital at home program in reducing subacute rehabilitation referrals
Authors: Yadav Ravi R , Mahyoub Mohammed A , Capriotti Michael W , Berio-Dorta Raul L , Dougherty Kacie , Shukla Ajit 
Published: June 2023

AbstractPurposeThe purpose of this study was to validate Hospital at Home as an appropriate care option for patients of certain diagnostic-related groups and acuity levels.Patients and methodsWe compared outcomes for patients in a Hospital at Home program at Virtua Health in 2022 (N = 272) to traditional inpatients at Virtua hospitals during the same year who did not participate in the Hospital at Home program (N = 13879). We defined outcomes as recommendations for subacute rehabilitation (SAR) and final disposition upon inpatient discharge. Specifically, we searched electronic medical records for terms related to recommendation for SAR and discharge to SAR using text mining algorithms and a natural language processing (NLP) model to confirm these recommendations.ResultsWe observed that the proportion of patients in the Hospital at Home program that were recommended for SAR (0.147) was significantly different from the proportion of patients who remained in the hospital (0.361). Further, of those patients who received a recommendation, only 1 patient in the Hospital at Home group was discharged to SAR, while nearly half of those in the control group (proportion = 0.499) were transferred to SAR.ConclusionThe Hospital at Home program is a promising alternative to traditional inpatient care for patients with certain diagnoses and who meet certain clinical criteria.
CRISPR-based assays for point of need detection and subtyping of influenza
Authors: Zhang Yibin B. , Arizti-Sanz Jon , Bradley A’Doriann , Kosoko-Thoroddsen Tinna-Solveig F. , Sabeti Pardis C. , Myhrvold Cameron 
Published: June 2023

AbstractThe high disease burden of influenza virus poses a significant threat to human health and requires better methods to rapidly detect its many circulating species, subtypes, and variants. No current diagnostic technology meets the combined critical needs for a rapid, sensitive, specific, and cost-effective method for point-of-need (PON) influenza detection and discrimination with minimal equipment requirements. Here, we introduce such a method using SHINE (Streamlined Highlighting of Infections to Navigate Epidemics), a CRISPR-based RNA detection platform. We develop and validate four SHINE assays for the detection and differentiation of clinically relevant influenza species (A and B) and subtypes (H1N1 and H3N2). These optimized assays achieve 100% concordance with reverse-transcriptase real-time polymerase chain reaction (RT-qPCR) when tested on clinical samples. We also created duplex Cas12/Cas13 SHINE assays to simultaneously detect two targets and demonstrate its use in discriminating two alleles of an oseltamivir resistance (H275Y) mutation as well as to detect influenza A and human RNAse P, as a built-in internal control. Our assays have the potential to expand influenza detection outside of clinical laboratories in order to enhance influenza diagnosis and surveillance.
Newborn Care Practices in Health Facilities of Nepal: A Further Analysis from Nepal Health Facility Survey 2015 and 2021
Authors: Pandey Achyut Raj , Adhikari Bikram , Lamichhane Bipul , Dulal Bishnu , Saugat Pratap KC , Joshi Deepak , Baral Sushil Chandra 
Published: June 2023

AbstractIntroductionIncreased availability of Newborn care practices in health facilities (HFs) plays an important role in improving the survival and well-being of newborns. In this paper, we aimed to determine newborn care practices among HFs between 2015 and 2021, and associated factors among public and private HFs in Nepal.MethodsWe performed a secondary analysis of Nepal Health Facility Surveys 2015 and 2021. We summarized categorical variables with a weighted percent and 95% confidence interval (CI). We compared proportions using the z-test of proportion and reported differences in percentage points, 95% CI, and p-value. We applied univariate and multivariable logistic regression analysis to determine the association of the availability of seven newborn care practices.ResultsThe percentage of facilities with all seven newborn care practices was 50.5% (95% CI: 44.6, 56.3) in 2015 and 83.7% (95%CI: 79.8, 87.0) in 2021 with an overall increase of 34.2 percent points (95% CI: 27.9, 38.7). The availability of all seven newborn care practices significantly increased from 2015 to 2021 in each subcategory of the ecological region, all provinces except Madhesh, and all types of HFs except federal/provincial hospitals. In 2021, private hospitals had lower odds of having all seven newborn care practices compared to federal/provincial hospitals (AOR= 0.17, 95% CI: 0.07, 0.04). Similarly, in 2021, Sudurpaschim province had 2.87 (95% CI: 1.06, 8.31) higher odds of having all seven newborn care practices compared to Koshi province. In 2021, newborn care practices did not differ significantly based on ecological belt, quality assurance activities, external supervision, delivery service-related training and frequency of HF meeting.ConclusionThere was a significant increase in the availability of seven newborn care practices between 2015 and 2021 and in each category of ecological region, province, and type of facility. The type of facility and provinces were associated with the availability of newborn care practices among HFs in Nepal.
Personalized Tacrolimus Dosing After Liver Transplantation: A Randomized Clinical Trial
Authors: Khong Jeffrey , Lee Megan , Warren Curtis , Kim Un Bi , Duarte Sergio , Andreoni Kenneth A. , Shrestha Sunaina , Johnson Mark W. , Battula Narendra R. , McKimmy Danielle M. , Beduschi Thiago , Lee Ji-Hyun , Li Derek M. , Ho Chih-Ming , Zarrinpar Ali 
Published: June 2023

ABSTRACTBackgroundInter- and intra-individual variability in tacrolimus dose requirements mandates empirical clinician-titrated dosing that frequently results in deviation from a narrow target range. Improved methods to individually dose tacrolimus are needed. Our objective was to determine whether a quantitative, dynamically-customized, phenotypic-outcome-guided dosing method termed Phenotypic Personalized Medicine (PPM) would improve target drug trough maintenance.MethodsIn a single-center, randomized, pragmatic clinical trial (NCT03527238), 62 adults were screened, enrolled, and randomized prior to liver transplantation 1:1 to standard-of-care (SOC) clinician-determined or PPM-guided dosing of tacrolimus. The primary outcome measure was percent days with large (>2 ng/mL) deviation from target range from transplant to discharge. Secondary outcomes included percent days outside-of-target-range and mean area-under-the-curve (AUC) outside-of-target-range per day. Safety measures included rejection, graft failure, death, infection, nephrotoxicity, or neurotoxicity.Results56 (29 SOC, 27 PPM) patients completed the study. The primary outcome measure was found to be significantly different between the two groups. Patients in the SOC group had a mean of 38.4% of post-transplant days with large deviations from target range; the PPM group had 24.3% of post-transplant days with large deviations; (difference -14.1%, 95% CI: -26.7 to -1.5 %, P=0.029). No significant differences were found in the secondary outcomes. In post-hoc analysis, the SOC group had a 50% longer median length-of-stay than the PPM group [15 days (Q1-Q3: 11-20) versus 10 days (Q1-Q3: 8.5-12); difference 5 days, 95% CI: 2-8 days, P=0.0026].ConclusionsPPM guided tacrolimus dosing leads to better drug level maintenance than SOC. The PPM approach leads to actionable dosing recommendations on a day-to-day basis.Lay SummaryIn a study on 62 adults who underwent liver transplantation, researchers investigated whether a new dosing method called Phenotypic Personalized Medicine (PPM) would improve daily dosing of the immunosuppression drug tacrolimus. They found that PPM guided tacrolimus dosing leads to better drug level maintenance than the standard-of-care clinician-determined dosing. This means that the PPM approach leads to actionable dosing recommendations on a day-to-day basis and can help improve patient outcomes.
Plasma extracellular vesicle synaptic proteins as biomarkers of clinical progression in patients with Parkinson’s disease: A follow-up study
Authors: Hong Chien-Tai , Chung Chen-Chih , Yu Ruan-Ching , Chan Lung 
Published: June 2023

AbstractSynaptic dysfunction plays a key role in Parkinson’s disease (PD), and plasma extracellular vesicle (EV) synaptic proteins are emerging as biomarkers for neurodegenerative diseases. This study assessed the efficacy of plasma EV synaptic proteins as biomarkers in PD and their association with disease progression. In total, 144 participants were enrolled, including 101 people with PD (PwP) and 43 healthy controls (HCs). The changes in plasma EV synaptic protein levels between baseline and 1-year follow-up did not differ significantly in both PwP and HCs. In PwP, the changes in plasma EV synaptic protein levels were significantly associated with the changes in unified PD rating scale (UPDRS) part II and III scores. Moreover, PwP with elevated levels (first quartile) of any one plasma EV synaptic proteins (synaptosome-associated protein 25, growth-associated protein 43 or synaptotagmin-1) had significantly greater disease progression in UPDRS part II score and the postural instability and gait disturbance subscore in UPDRS part III than did the other PwP after adjustment for age, sex, and disease duration. These results indicate the promising potential of plasma EV synaptic proteins as clinical biomarkers of disease progression in PD. However, a longer follow-up period is warranted to confirm their role as prognostic biomarkers.
Burnout among labor and birth providers in northern Tanzania: A mixed-method study
Authors: Marchand Virginie , Watt Melissa H. , Minja Linda M. , Barabara Mariam L. , Mlay Janeth , Stephens Maya J. , Hanson Olivia , Mmbaga Blandina T. , Cohen Susanna R. 
Published: June 2023

ABSTRACTBurnout, characterized by emotional exhaustion, depersonalization, and a diminished sense of accomplishment, is a serious problem among healthcare workers. Burnout negatively impacts provider well-being, patient outcomes, and healthcare systems globally, and is especially worrisome in settings with a shortage of healthcare workers and resources. The goal of this study is to explore the experience of burnout in a population of labor and delivery (L&D) providers in Tanzania. We examined burnout using three data sources. A structured assessment of burnout was collected at four time points from a sample of 60 L&D providers in six clinics. The same providers participated in an interactive group activity from which we drew observational data on burnout prevalence. Finally, we conducted in-depth interviews (IDIs) with a subset of 15 providers to further explore their experience of burnout. At baseline, prior to any introduction to the concept, 18% of respondents met criteria for burnout. Immediately after a discussion and activity on burnout, 62% of providers met criteria. One- and three-months later, 29% and 33% of providers met criteria, respectively. In IDIs, participants saw the lack of understanding of burnout as the cause for low baseline rates and attributed the subsequent decrease in burnout to newly acquired coping strategies. The activity helped providers realize they were not alone in their experience of burnout. High patient load, low staffing, limited resources, and low pay emerged as contributing factors. Burnout was prevalent among a sample of L&D providers in northern Tanzania. However, a lack of exposure to the concept of burnout leads to providers being unaware of the issue as a collective burden. Therefore, burnout remains rarely discussed and not addressed, thus continuing to impact provider and patient health. Previously validated burnout measures cannot adequately assess burnout without a discussion of the context.
Pilot study of a ketogenic diet in bipolar disorder
Authors: Needham Nicole , Campbell Iain H , Grossi Helen , Kamenska Ivana , Rigby Benjamin P , Simpson Sharon A , McIntosh Emma , Bahuguna Pankaj , Meadowcroft Ben , Creasy Frances , Mitchell-Grigorjeva Maja , Norrie John , Gibbs Melissa C , McLellan Ailsa , Fisher Cheryl , Moses Tessa , Burgess Karl , Brown Rachel , Thrippleton Michael , Campbell Harry , Smith Daniel J 
Published: June 2023

AbstractBackgroundRecent evidence from case reports suggests that a ketogenic diet may be effective for bipolar disorder. To date, no clinical trials have been conducted.AimsTo assess the recruitment and feasibility of a ketogenic diet intervention in bipolar disorder.MethodsEuthymic individuals with bipolar disorder were recruited to a 6-8 week trial of a modified ketogenic diet and a range of clinical, economic and functional outcome measures were assessed.ResultsOf 27 recruited participants, 26 commenced and 20 completed the modified ketogenic diet at 6-8 weeks. The completeness of the outcomes dataset was 95% for daily ketone measures, 95% for daily glucose measures and 95% for daily Ecological Momentary Assessment of symptoms during the intervention period. Mean daily blood ketone readings were 1.3 mmol/L (SD= 0.77, Median = 1.1), and 91% of all readings indicated ketosis indicating a high degree of adherence to the diet. Over 91% of daily blood glucose readings were within normal range with 9% indicating mild hypoglycaemia. Eleven minor adverse events were recorded, including fatigue, constipation, drowsiness and hunger. One serious adverse event was reported (euglycemic ketoacidosis in a participant takingSGLT2-inhibitor medication).ConclusionsThe recruitment and retention of euthymic individuals with bipolar disorder to a 6-8 week ketogenic diet intervention was feasible, with high outcome measure completion rates. The majority of participants reached and maintained ketosis and adverse events were generally mild and modifiable. A future randomised controlled trial is now warranted.Study Registration NumberISRCTN61613198
Genetic inhibition of angiopoietin-like protein-3, lipoprotein-lipid levels and cardiometabolic diseases
Authors: Gobeil Émilie , Bourgault Jérôme , Mitchell Patricia L. , Houessou Ursula , Gagnon Eloi , Girard Arnaud , Paulin Audrey , Manikpurage Hasanga D. , Couture Christian , Marceau Simon , Bossé Yohan , Thériault Sébastien , Mathieu Patrick , Vohl Marie-Claude , Tchernof André , Arsenault Benoit J. 
Published: June 2023

AbstractBackgroundRNA-based, antibody-based and gene editing-based therapies are currently under investigation to determine if the inhibition of angiopoietin-like protein-3 (ANGPTL3) could reduce lipoprotein-lipid levels and atherosclerotic cardiovascular diseases (ASCVD) risk. We used Mendelian randomization (MR) to determine whether genetic variations influencing ANGPTL3 liver gene expression, blood levels and protein structure could causally influence triglyceride and apolipoprotein B (apoB) levels as well as coronary artery disease (CAD), ischemic stroke (IS) and other cardiometabolic diseases.MethodsWe performed RNA-sequencing of 246 explanted liver samples to identify single-nucleotide polymorphisms (SNPs) associated with liver expression ofANGPTL3. We used genome-wide summary statistics of plasma protein levels of ANGPTL3 from the deCODE study (n=35,359). We also identified 647 carriers ofANGPTL3protein-truncating variants (PTVs) associated with lower plasma triglyceride levels in the UK Biobank. We performed two-sample MR using SNPs that influenceANGPTPL3liver expression or ANGPTPL3 plasma protein levels as exposure and cardiometabolic diseases as outcomes (CAD, IS, heart failure, non-alcoholic fatty liver disease, acute pancreatitis and type 2 diabetes). The impact of rare PTVs influencing plasma triglyceride levels on apoB levels and CAD was also investigated in the UK Biobank.ResultsIn two-sample MR studies, common genetic variants influencingANGPTL3hepatic or blood expression levels of ANGPTL3 had a very strong effect on plasma triglyceride levels, a more modest effect on LDL cholesterol, a weaker effect on apoB levels and no effect on CAD or other cardiometabolic diseases. In the UK Biobank, carriers of rareANGPTL3PTVs providing lifelong reductions in median plasma triglyceride levels (-0.37 [interquartile range=0.41] mmol/L) had slightly lower apoB levels (-0.06±0.32] g/L) and similar CAD event rate compared to noncarriers (10.2% versus 10.9% in carriers versus noncarriers, p=0.60).ConclusionsPTVs influencing ANGPTL3 protein structure as well as common genetic variants influencingANGPTL3hepatic expression and/or blood protein levels exhibit a strong effect on circulating plasma triglyceride levels, a weak effect on circulating apoB levels and no effect on ASCVD. Near-complete inhibition of ANGPTL3 function in patients with very elevated apoB levels will likely be required to reduce ASCVD risk.