bluuebunny/crossref_metadata_2025_split huggingface dataset:
Methylene blue for vasodilatory shock in the intensive care unit: a retrospective, observational study
Authors: Naoum Emily E. , Dalia Adam A. , Roberts Russel J. , Devine Lauren T. , Ortoleva Jamel 
Published: June 2022

Abstract
Background
Refractory vasodilatory shock is a state of uncontrolled vasodilation associated with underlying inflammation and endothelial dysregulation. Rescue therapy for vasoplegia refractory to catecholamines includes methylene blue (MB) which restores vascular tone. We hypothesized that (1) at least 40% of critically ill patients would respond positively to MB administration and (2) that those who responded to MB would have a survival benefit.

Methods
This study was a retrospective review that included all adult patients admitted to an intensive care unit treated with MB for the indication of refractory vasodilatory shock. Responders to MB were identified as those with a ≥ 10% increase in mean arterial pressure (MAP) within the first 1-2 hours after administration. We examined the association of mortality to the groups of responders versus non-responders to MB. A subgroup analysis in patients undergoing continuous renal replacement therapy (CRRT) was also performed.
Statistical calculations were performed in Microsoft Excel® (Redmond, WA, USA). Where appropriate, the comparison of averages and standard deviations of demographics, dosing, MAP, and reductions in vasopressor dosing were performed via Chi squared, Fisher's exact test, or two-tailed t-test with a p-value < 0.05 being considered as statistically significant. After using the F-test to assess for differences in variance, the proper two tailed t-test was used to compare SOFA scores among responders versus non-responders.

Results
A total of 223 patients were included in the responder analysis; 88 (39.5%) had a ≥ 10% increase in MAP post-MB administration that was not associated with a significant change in norepinephrine requirements between responders versus non-responders (p=0.41). There was a non-statistically significant trend (21.6% vs 14.8%, p=0.19) toward improved survival to hospital discharge in the MB responder group compared to the non-responder group. In 70 patients undergoing CRRT, there were 33 responders who were more likely to survive than those who were not (p = 0.0111).

Conclusions
In patients with refractory shock receiving MB, there is a non-statistically significant trend toward improved outcomes in responders based on a MAP increase >10%. Patients supported with CRRT who were identified as responders had decreased ICU mortality compared to non-responders.
A progressive three-state model to estimate time to cancer: a likelihood-based approach
Authors: Akwiwu Eddymurphy U. , Klausch Thomas , Jodal Henriette C. , Carvalho Beatriz , Løberg Magnus , Kalager Mette , Berkhof Johannes , Coupé Veerle M.H. 
Published: June 2022

Abstract
Background
To optimize colorectal cancer (CRC) screening and surveillance, information regarding the time-dependent risk of advanced adenomas (AA) to develop into CRC is crucial. However, since AA are removed after diagnosis, the time from AA to CRC cannot be observed in an ethically acceptable manner. We propose a statistical method to indirectly infer this time in a progressive three-state disease model using surveillance data.

Methods
Sixteen models were specified, with and without covariates. Parameters of the parametric time-to-event distributions from the adenoma-free state (AF) to AA and from AA to CRC were estimated simultaneously, by maximizing the likelihood function. Model performance was assessed via simulation. The methodology was applied to a random sample of 878 individuals from a Norwegian adenoma cohort.

Results
Estimates of the parameters of the time distributions are consistent and the 95% confidence intervals (CIs) have good coverage. For the Norwegian sample (AF: 78%, AA: 20%, CRC: 2%), a Weibull model for both transition times was selected as the final model based on information criteria. The mean time among those who have made the transition to CRC since AA onset within 50 years was estimated to be 4.80 years (95% CI: 0; 7.61). The 5-year and 10-year cumulative incidence of CRC from AA was 13.8% (95% CI: 7.8%;23.8%) and 15.4% (95% CI: 8.2%;34.0%), respectively.

Conclusions
The time-dependent risk from AA to CRC is crucial to explain differences in the outcomes of microsimulation models used for the optimization of CRC prevention. Our method allows for improving models by the inclusion of data-driven time distributions.
Frailty in older people: Rehabilitation Treatment Research Examining Separate Settings (FORTRESS): protocol for a hybrid type II stepped wedge, cluster, randomised trial
Authors: Block Heather , Annesley Alexandra , Lockwood Keri , Xu Linda , Cameron Ian D. , Laver Kate , Crotty Maria , Sherrington Catherine , Kifley Annette , Howard Kirsten , Pond Dimity , Nguyen Tuan A. , Kurrle Susan E. 
Published: June 2022

Abstract
Background
Frailty in older people is associated with increased risk of falls, longer length of stay in hospital, increased risk of institutionalisation and death. Frailty can be measured using validated tools. Multi-component frailty interventions are recommended in clinical practice guidelines but are not routinely implemented in clinical practice.

Methods
The Frailty in Older people: Rehabilitation, Treatment, Research Examining Separate Settings (FORTRESS) trial is a multisite, hybrid type II, stepped wedge, cluster, randomised trial with blinded assessment and intention-to-treat analysis being conducted in Australia. The study aims to determine the effectiveness and cost-effectiveness of an embedded individualised multicomponent frailty intervention (commencing in hospital and continuing in the community) on readmissions, frailty and quality of life when compared with usual care. Frail older people admitted to study wards with no significant cognitive impairment, who are expected to return home after discharge, will be eligible to participate. Participants will receive extra sessions of physiotherapy, pharmacy, and dietetics during their admission. A Community Implementation Facilitator will coordinate implementation of the frailty management strategies and primary network liaison. The primary outcome is number of days of non-elective hospital readmissions during 12 month follow-up period. Secondary outcomes include frailty status measured using the FRAIL scale; quality of life measured using the EQ-5D-5L; and time-to-event for readmission and readmission rates. The total cost of delivering the intervention will be assessed, and cost-effectiveness analyses will be conducted. Economic evaluation will include analyses for health outcomes measured in terms of the main clinical outcomes. Implementation outcomes will be collected as part of a process evaluation. Recruitment commenced in 2020 and we are aiming to recruit 732 participants over the three-year duration of the study.

Discussion
This study will reveal whether intervening with frail older people to address factors contributing to frailty can reduce hospital readmissions and improve frailty status and quality of life. If the FORTRESS intervention provides a clinically significant and cost-effective result, it will demonstrate an improved approach to treating frail patients, both in hospital and when they return home.

Trial Registration
Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000760976p. ANZCTR registered 24 July 2020.
First-year mortality in incident dialysis patients: results of the Peridialysis study
Authors: Heaf James , Heiro Maija , Petersons Aivars , Vernere Baiba , Povlsen Johan V. , Sørensen Anette Bagger , Clyne Naomi , Bumblyte Inga , Zilinskiene Alanta , Randers Else , Løkkegaard Niels , Rosenberg Mai , Kjellevold Stig , Kampmann Jan Dominik , Rogland Björn , Lagreid Inger , Heimburger Olof , Qureshi Abdul Rashid , Lindholm Bengt 
Published: June 2022

Abstract
Background
Controversy surrounds which factors are important for predicting early mortality after dialysis initiation (DI). We investigated associations of predialysis course and circumstances affecting planning and execution of DI with mortality following DI.

Methods
Among 1580 patients participating in the Peridialysis study, a study of causes and timing of DI, we registered features of predialysis course, clinical and biochemical data at DI, incidence of unplanned suboptimal DI, contraindications to peritoneal dialysis (PD) or hemodialysis (HD), and modality preference, actual choice, and cause of modality choice. Patients were followed for 12 months or until transplantation. A flexible parametric model was used to identify independent factors associated with all-cause mortality.

Results
First-year mortality was 19.33%. Independent factors predicting death were high age, comorbidity, clinical contraindications to PD or HD, suboptimal DI, high eGFR, low serum albumin, hyperphosphatemia, high C-reactive protein, signs of overhydration and cerebral symptoms at DI. Among 1061 (67.2%) patients who could select dialysis modality based on personal choice, 654 (61.6%) chose PD, 368 (34.7%) center HD and 39 (3.7%) home HD. The 12-months survival did not differ significantly between patients receiving PD and in-center HD.

Conclusions
First-year mortality in incident dialysis patients was in addition to high age and comorbidity, associated with clinical contraindications to PD or HD, clinical symptoms, hyperphosphatemia, inflammation, and suboptimal DI. In patients with a “free” choice of dialysis modality based on their personal preferences, PD and in-center HD led to broadly similar short-term outcomes.
Outcomes of induction versus spontaneous onset of labour at 40 and 41 GW: findings from a prospective database, Sri Lanka
Authors: Senanayake Hemantha , Mariani Ilaria , Valente Emanuelle Pessa , Piccoli Monica , Armocida Benedetta , Businelli Caterina , Rishard Mohamed , Covi Benedetta , Lazzerini Marzia 
Published: June 2022

AbstractObjectivesThe World Health Organization recommends induction of labour (IOL) for low risk pregnancy from 41 + 0 gestational weeks (GW). Nevertheless, in Sri Lanka IOL at 40 GW is a common practice. This study compares maternal/newborn outcomes after IOL at 40 GW (IOL40) or 41 GW (IOL41) versus spontaneous onset of labour (SOL).MethodsData were extracted from the routine prospective individual patient database of the Soysa Teaching Hospital for Women, Colombo. IOL and SOL groups were compared using logistic regression.ResultsOf 13,670 deliveries, 2359 (17.4%) were singleton and low risk at 40 or 41 GW. Of these, 456 (19.3%) women underwent IOL40, 318 (13.5%) IOL41, and 1585 (67.2%) SOL. Both IOL40 and IOL41 were associated with an increased risk of any maternal/newborn negative outcomes (OR = 2.21, 95%CI = 1.75–2.77,p < 0.001 and OR = 1.91, 95%CI = 1.47–2.48,p < 0.001 respectively), maternal complications (OR = 2.18, 95%CI = 1.71–2.77,p < 0.001 and OR = 2.34, 95%CI = 1.78–3.07,p < 0.001 respectively) and caesarean section (OR = 2.75, 95%CI = 2.07–3.65,p < 0.001 and OR = 3.01, 95%CI = 2.21–4.12,p < 0.001 respectively). Results did not change in secondary and sensitivity analyses.ConclusionsBoth IOL groups were associated with higher risk of negative outcomes compared to SOL. Findings, potentially explained by selection bias, local IOL protocols and CS practices, are valuable for Sri Lanka, particularly given contradictory findings from other settings.
The implementation of a smoking cessation and alcohol abstinence intervention for people experiencing homelessness
Authors: Pratt Rebekah , Xiong Serena , Kmiecik Azul , Strobel-Ayres Cathy , Joseph Anne , Rose Susan A. Everson , Luo Xianghua , Cooney Ned , Thomas Janet , Specker Shelia , Okuyemi Kola 
Published: June 2022

Abstract
Background
In the United States, eighty percent of the adult homeless population smokes cigarettes compared to 15 percent of the general population. In 2017 Power to Quit 2 (PTQ2), a randomized clinical trial, was implemented in two urban homeless shelters in the Upper Midwest to address concurrent smoking cessation and alcohol treatment among people experiencing homelessness. A subset of this study population were interviewed to assess their experiences of study intervention. The objective of this study was to use participants’ experiences with the intervention to inform future implementation efforts of combined smoking cessation and alcohol abstinence interventions, guided by the Consolidated Framework for Implementation Research (CFIR).

Methods
Qualitative semi-structured interviews were conducted with 40 PTQ2 participants between 2016–2017 and analyzed in 2019. Interviews were audio-recorded, transcribed, and analyzed using a socially constructivist approach to grounded theory.

Results
Participants described the PTQ2 intervention in positive terms. Participants valued the opportunity to obtain both counseling and nicotine-replacement therapy products (intervention characteristics) and described forming a bond with the PTQ2 staff and reliance on them for emotional support and encouragement (characteristics of individuals). However, the culture of alcohol use and cigarette smoking around the shelter environment presented a serious challenge (outer setting). The study setting and the multiple competing needs of participants were reported as the most challenging barriers to implementation (implementation process).

Conclusion
There are unique challenges in addressing smoking cessation with people experiencing homelessness. For those in shelters there can be the difficulty of pro-smoking norms in and around the shelter itself. Considering pairing cessation with policy level interventions targeting smoke-free spaces, or pairing cessation with housing support efforts may be worthwhile.. Participants described a discord in their personal goals of reduction compared with the study goals of complete abstinence, which may pose a challenge to the ways in which success is defined for people experiencing homelessness.

Trial registration
Clinicaltrials.gov, NCT01932996, registered 08/30/2013.
SARS-CoV-2 antibody prevalence among homeless people and shelter workers in Denmark: a nationwide cross-sectional study
Authors: Eriksen Alexandra R Röthlin , Fogh Kamille , Hasselbalch Rasmus B. , Bundgaard Henning , Nielsen Susanne D. , Jørgensen Charlotte S. , Scharff Bibi F. S. S. , Erikstrup Christian , Sækmose Susanne G. , Holm Dorte K. , Aagaard Bitten , Kristensen Jonas H. , Bødker Cecilie A. , Norsk Jakob B. , Nielsen Pernille B. , Østergaard Lars , Ellermann-Eriksen Svend , Andersen Berit , Nielsen Henrik , Johansen Isik S. , Wiese Lothar , Simonsen Lone , K.Fischer Thea , Folke Fredrik , Lippert Freddy , Ostrowski Sisse R. , Ethelberg Steen , Koch Anders , Vangsted Anne-Marie , Krause Tyra , Fomsgaard Anders , Nielsen Claus , Ullum Henrik , Skov Robert , Iversen Kasper 
Published: June 2022

Abstract
Background
People experiencing homelessness (PEH) and associated shelter workers may be at higher risk of infection with “Severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2). The aim of this study was to determine the prevalence of SARS-CoV-2 among PEH and shelter workers in Denmark.

Design and methods
In November 2020, we conducted a nationwide cross-sectional seroprevalence study among PEH and shelter workers at 21 recruitment sites in Denmark. The assessment included a point-of-care test for antibodies against SARS-CoV-2, followed by a questionnaire. The seroprevalence was compared to that of geographically matched blood donors considered as a proxy for the background population, tested using a total Ig ELISA assay.

Results
We included 827 participants in the study, of whom 819 provided their SARS-CoV-2 antibody results. Of those, 628 were PEH (median age 50.8 (IQR 40.9–59.1) years, 35.5% female) and 191 were shelter workers (median age 46.6 (IQR 36.1–55.0) years and 74.5% female). The overall seroprevalence was 6.7% and was similar among PEH and shelter workers (6.8% vs 6.3%, p = 0.87); and 12.2% among all participants who engaged in sex work. The overall participant seroprevalence was significantly higher than that of the background population (2.9%, p < 0.001). When combining all participants who reported sex work or were recruited at designated safe havens, we found a significantly increased risk of seropositivity compared to other participants (OR 2.23, 95%CI 1.06–4.43, p = 0.02). Seropositive and seronegative participants reported a similar presence of at least one SARS-CoV-2 associated symptom (49% and 54%, respectively).

Interpretations
The prevalence of SARS-CoV-2 antibodies was more than twice as high among PEH and associated shelter workers, compared to the background population. These results could be taken into consideration when deciding in which phase PEH are eligible for a vaccine, as part of the Danish national SARS-CoV-2 vaccination program rollout.

Funding
TrygFonden and HelseFonden.
A parametric investigation on traditional and cortical bone trajectory screws for transpedicular fixation
Authors: Chung Tzu-Tsao , Chu Chen-Lun , Hueng Dueng-Yuan , Lin Shang-Chih 
Published: June 2022

Abstract
Background
Many studies have been conducted to compare traditional trajectory (TT) and cortical bone trajectory (CBT) screws; however, how screw parameters affect the biomechanical properties of TT and CBT screws, and so their efficacy remains to be investigated.

Methods
A finite element model was used to simulate screws with different trajectories, diameters, and lengths. Responses for implant and tissues at the adjacent and fixed segments were used as the comparison indices. The contact lengths and spanning areas of the inserted screws were defined and compared across the varieties.

Results
The trajectory and diameter had a greater impact on the responses from the implant and tissues than the length. The CBT has shorter length than the TT; however, the contact length and supporting area of the CBT within the cortical bone were 19.6%. and 14.5% higher than those of the TT, respectively. Overall, the TT and CBT were equally effective at stabilizing the instrumented segment, except for bending and rotation. The CBT experienced less adjacent segment compensations than the TT. With the same diameter and length, the TT was considerably less stressed than the CBT, especially for flexion and extension.

Conclusions
The CBT may provide less stress at adjacent segments compared with the TT. The CBT may provide more stiffer in osteoporotic segments than the TT due to greater contact with cortical bone and a wider supporting base between the paired screws. However, both entry point and insertion trajectory of the CBT should be carefully executed to avoid vertebral breach and ensure a stable cone-screw purchase.
Association between dietary total antioxidant capacity and hypertension in Iranian Kurdish women
Authors: Fateh Hawal Lateef , Mirzaei Narmin , Gubari Mohammed Ibrahim Mohialdeen , Darbandi Mitra , Najafi Farid , Pasdar Yahya 
Published: June 2022

Abstract
Background
Antioxidants intake from diet has been identified as one of the effective factors in the development of hypertension (HTN). The present study aimed to investigate the association between total antioxidant capacity (TAC) and HTN in women.

Methods
This cross-sectional study was performed using the baseline phase data of the ravansar non-communicable disease cohort study. The TAC was calculated using food items of the food frequency questionnaire. TAC scores were classified into four groups (quartile). The first and fourth quartiles had the lowest and highest TAC scores, respectively. Logistic regression analysis was utilized to estimate the odds ratio.

Results
A total of 5067 women were included in the study. Women with the highest socioeconomic status (SES) had a significantly higher TAC intake compared to those with the lowest SES (P < 0.001). The participants in the third and fourth quartiles of the TAC had significantly lower odds of HTN, respectively by 21% (OR = 0.79; 95% CI: 0.64, 0.972) and 26% (OR = 0.74; 95% CI: 0.60, 0.91), compared to the first quartile. After adjusting for confounding variables was found to significantly reduce the odds of developing HTN in the fourth quartile of TAC by 22% compared to the first quartile (OR = 0.78; 95% CI: 0.62, 0.97).

Conclusion
A high dietary TAC was associated to a decreased odd of HTN in women. We could suggest a diet rich in natural antioxidants as it may help prevent development of HTN.
Evaluating the impact of a polypharmacy Action Learning Sets tool on healthcare practitioners’ confidence, perceptions and experiences of stopping inappropriate medicines
Authors: Brooks Cindy Faith , Argyropoulos Anastasios , Matheson-Monnet Catherine Brigitte , Kryl David 
Published: June 2022

Abstract
Background
Issues of medication adherence, multimorbidity, increased hospitalisation risk and negative impact upon quality of life have led to the management of polypharmacy becoming a national priority. Clinical guidelines advise a patient-centred approach, involving shared decision-making and multidisciplinary team working. However, there have been limited educational initiatives to improve healthcare practitioners’ management of polypharmacy and stopping inappropriate medicines. This study aimed to evaluate the impact of a polypharmacy Action Learning Sets (ALS) tool across five areas: i. healthcare practitioners’ confidence and perceptions of stopping medicines; ii. knowledge and information sources around stopping medicines; iii. perception of patients and stopping medicines; iv. perception of colleagues and stopping medicines and v. perception of the role of institutional factors in stopping medicines.

Methods
The ALS tool was delivered to a multi-disciplinary group of healthcare practitioners: GPs [n = 24] and pharmacy professionals [n = 9]. A pre-post survey with 28 closed statements across five domains relating to the study aims [n = 32] and a post evaluation feedback survey with 4 open-ended questions [n = 33] were completed. Paired pre-post ALS responses [n = 32] were analysed using the Wilcoxon signed-rank test. Qualitative responses were analysed using a simplified version of the constant comparative method.

Results
The ALS tool showed significant improvement in 14 of 28 statements in the pre-post survey across the five domains. Qualitative themes (QT) from the post evaluation feedback survey include: i. awareness and management of polypharmacy; ii. opportunity to share experiences; iii. usefulness of ALS as a learning tool and iv. equipping with tools and information. Synthesised themes (ST) from analysis of pre-post survey data and post evaluation feedback survey data include: i. awareness, confidence and management of inappropriate polypharmacy, ii. equipping with knowledge, information, tools and resources and iii. decision-making and discussion about stopping medicines with colleagues in different settings.

Conclusions
This evaluation contributes to developing understanding of the role of educational initiatives in improving inappropriate polypharmacy, demonstrating the effectiveness of the ALS tool in improving healthcare practitioners’ awareness, confidence and perceptions in stopping inappropriate medicines. Further evaluation is required to examine impact of the ALS tool in different localities as well as longer-term impact.