bluuebunny/crossref_metadata_2025_split huggingface dataset:
A beginner’s view of end of life care on German intensive care units
Authors: Sellmann Timur , Alneaj Muhammad Abu , Wetzchewald Dietmar , Schwager Heidrun , Burisch Christian , Thal Serge C. , Rassaf Tienush , Weiss Manfred , Marsch Stephan , Breuckmann Frank 
Published: May 2022

Abstract
Background
Little is known about importance and implementation of end-of-life care (EOLC) in German intensive care units (ICU). This survey analyses preferences and differences in training between “medical” (internal medicine, neurology) and “surgical” (surgery, anaesthesiology) residents during intensive care rotation.

Methods
This is a point-prevalence study, in which intensive care medicine course participants of one educational course were surveyed. Physicians from multiple ICU and university as well as non-university hospitals and all care levels were asked to participate. The questionnaire was composed of a paper and an electronic part. Demographic and structural data were prompted and EOLC data (48 questions) were grouped into six categories considering importance and implementation: category 1 (important, always implemented), 2 (important, sometimes implemented), 3 (important, never implemented) and 4–6 (unimportant, implementation always, sometimes, never). The trial is registered at the “Deutsches Register für klinische Studien (DRKS)”, Study number DRKS00026619, registered on September 10th 2021, www.drks.de.

Results
Overall, 194/ 220 (88%) participants responded. Mean age was 29.7 years, 55% were female and 60% had scant ICU working experience. There were 64% medical and 35% surgical residents. Level of care and size of ICU differed significantly between medical and surgical (both p < 0.001). Sufficient implementation was stated for 66% of EOLC questions, room for improvement (category 2 and 3) was seen in 25, and 8% were classified as irrelevant (category 6). Areas with the most potential for improvement included prognosis and outcome and patient autonomy. There were no significant differences between medical and surgical residents.

Conclusions
Even though EOLC is predominantly regarded as sufficiently implemented in German ICU of all specialties, our survey unveiled still 25% room for improvement for medical as well as surgical ICU residents. This is important, as areas of improvement potential may be addressed with reasonable effort, like individualizing EOLC procedures or setting up EOLC teams. Health care providers as well as medical societies should emphasize EOLC training in their curricula.
Prevalence of major electrocardiographic abnormalities in patients with hypertension in a primary care clinic in Hong Kong
Authors: Tin Yuen Ying , Chan Lit Ping , Sung Jonathan Gabriel , Leung Shuk Yun , Hui Eric Ming Tung , Leung Maria Kwan Wa 
Published: May 2022

Abstract
Background
Hypertension is strongly associated with cardiovascular events. Studies have shown that electrocardiographic (ECG) abnormalities were associated with increased risks for cardiovascular events. However local data is limited. The objectives of this study were: (1) to determine the prevalence of major electrocardiographic abnormalities in patients with hypertension in primary care in Hong Kong, and (2) to determine the association of major electrocardiographic abnormalities with patients’ socio-economical background, cardiovascular disease and cardiovascular risk factors.

Methods
This was a cross-sectional study. Subjects were hypertensive patients aged between 18 and 80 who were enrolled in the Risk Assessment and Management Programme (RAMP) in a general outpatient clinic in Hong Kong. Outcome measures were prevalence of probable ischaemic heart disease (IHD), complete left bundle branch block (LBBB), left ventricular hypertrophy (LVH) and atrial fibrillation (AF) in patients with hypertension. The Pearson Chi-square test, independent t-test and Mantel–Haenszel test were used to measure the association between socioeconomic characteristics and cardiovascular risk factors, and ECG abnormalities.

Results
504 hypertensive patients aged 18–80 were recruited in a general outpatient clinic. 6.3% had probable IHD, 0.4% had complete LBBB, 4.0% had LVH and 1.0% had AF. Probable IHD was associated with smoking (P = 0.032), hypercholesterolaemia (P = 0.037) and higher 10-year CV risk (P = 0.04). Complete LBBB was associated with smoking (P = 0.021) and hypercholesterolaemia (P = 0.022). LVH was associated with male gender (P = 0.001) and longer duration of hypertension (P = 0.035). AF was not significantly associated with any of the clinical or sociodemographic parameters.

Conclusions
This study showed that a significant proportion of patients with hypertension at the primary care setting in Hong Kong had probable ischaemic heart disease, left ventricular hypertrophy and atrial fibrillation. This finding is consistent with both overseas data and historic data in Hong Kong. The detection of electrocardiographic abnormalities is helpful in hypertension management by improving risk stratification.
The quality of primary care performance in private sector facilities in Nairobi, Kenya: a cross-sectional descriptive survey
Authors: Mohamoud Gulnaz , Mash Robert 
Published: May 2022

Abstract
Background
Integrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is paucity of information on the performance of these key elements and such information is needed to improve service delivery. Therefore, the study aimed to evaluate the quality of primary care performance in private sector facilities in Nairobi, Kenya.

Methods
A cross-sectional descriptive study using an adapted Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data were analysed to measure 11 domains of primary care performance and two aggregated primary care scores using the Statistical Package for Social Sciences.

Results
Mean primary care score was 2.64 (SD=0.23) and the mean expanded primary care score was 2.68 (SD=0.19), implying an overall low performance. The domains of first contact-utilisation, coordination (information system), family-centredness and cultural competence had mean scores of >3.0 (acceptable to good performance). The domains of first contact-access, coordination, comprehensiveness (provided and available), ongoing care and community-orientation had mean scores of < 3.0 (poor performance). Older respondents (p=0.05) and those with higher affiliation to the clinics (p=0.01) were more likely to rate primary care as acceptable to good.

Conclusion
These primary care clinics in Nairobi showed gaps in performance. Performance was rated as acceptable-to-good for first-contact utilisation, the information systems, family-centredness and cultural competence. However, patients rated low performance related to first-contact access, ongoing care, coordination of care, comprehensiveness of services, community orientation and availability of a complete primary health care team. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, incentivising use of these PC clinics rather than the tertiary hospital, improving access after-hours and marketing the use of the clinics to the practice population.
Comparison of fully coated anti-reflux metal stenting and per-oral endoscopic myotomy in patients with achalasia: a propensity score-matched retrospective study
Authors: Tang Yu-fen , Jin Peng , Tao Yu-rong , Xie Hui , Wang Xin , Yu Dongliang , Tang Shan , Sheng Jian-qiu 
Published: May 2022

Abstract
Background
Achalasia is a rare primary esophageal motility disorder disease. It is reported that the long-term effect of fully coated anti-reflux metal stent (FCARMS) implantation is satisfactory. Operated by a skilled and experienced endoscopist, the effect of per-oral endoscopic myotomy (POEM) treatment is equivalent to that of surgical myotomy. So far, there is still few evidence to prove FCARMS implantation or POEM which is better for achalasia. The choice of treatment for achalasia is still controversial. The aim of this study is to find a more suitable therapy for achalasia by comparing the efficacy of FCARMS implantation and POEM.

Methods
A propensity score (PS) matching (1:2) was used in this retrospective cohort study. Data collected from consecutive patients of Achalasia, receiving FCARMS implantation or POEM therapy at the department of gastroenterology, the Seventh Medical Center of the Chinese People’s Liberation Army General Hospital from May 2007 to May 2018. According to their previous treatment, they are divided into two groups, FCARMS group and POEM group. Clinical efficacy and complications were compared between the two groups.

Results
A total of 166 cases were collected, including 113 cases of FCARMS and 53 cases of POEM. By PS matching, 150 patients were enrolled (100 cases of FCARMS and 50 cases of POEM). By comparison, the FCARMS group has shorter operation time, shorter fasting time and lower hospitalization costs than the POEM group (p < 0.05). Common complications in the FCARMS group are nausea, vomiting, and stent shift. Repetitions of gastroscopy in the FCARMS group was more often, which were 3.8 ± 2.4 (vs 2.1 ± 1.8 of POEM) (p = 0.00 < 0.05) The 6-month remission rates of the FCARMS combination POEM group were 89% and 94%, respectively (p = 0.39), and the 2-year remission rates were 61% and 90%, respectively (p = 0.00).

Conclusions
Stent placement is a cost-effective and safe treatment option for achalasia. The short-term effect (less than 6 months) of FCARMS is similar to that of POEM, the long-term effect (more than 2 years), POEM is better than FCARMS. HRMIIis most suitable for POEM treatment. It indicate that Patients can choose treatment methods according to their own conditions.
Exploratory pilot study on resource allocation along the dementia continuum under constrained and unconstrained budget scenarios
Authors: Pierse Tom , Keogh Fiona , Challis David , O’Shea Eamon 
Published: May 2022

Abstract
Background
People with dementia and their carers have a wide range of health and social care needs which vary along the dementia continuum. The government response to events and transitions at various stages of the continuum can have a substantial impact on the lived experience of dementia and to resource allocation decision-making. Hearing what practitioners have to say about need at various points of transition along the dementia continuum is very important, especially for the resource allocation process.

Methods
The paper uses an innovative longitudinal balance of care (BoC) methodology to identify the impact of changes along the dementia care continuum for care recipients and practitioners throughout the course of the condition. Participatory workshops were held with five Health and Social Care Professionals (HSCPs) to pilot a mixed methods approach to resource allocation decision-making along the dementia continuum. In these workshops, these practitioner participants were asked to generate a set of services and supports for a person with dementia with changing and evolving needs over a five year period under two budget scenarios: no budget constraint (NBC); and a budget constraint (BC). Participants were asked to recommend services for short, post event, transition periods and for longer steady state periods.

Results
Participants were able to allocate different packages of services and supports for different stages of dementia under different budgetary conditions. The total cost for the five year period under the NBC scenario is €200,000 on average, reducing to €133,000 under the BC scenario. Under the BC (NBC) scenarios, participants spent on average 85% (90%) of their budget on community services and 15% (10%) on nursing home services.

Conclusion
The methodology used in this paper is a valuable complement to cross-sectional BoC studies through its identification of the importance of events, transitions and staging along the dementia care continuum. The desire of participants to keep people with dementia living in their own home is strong, even in the later stages of dementia, as evident by their recommendation to spend €400 per week more on home care provision compared to the alternative residential care, albeit in the absence of any budget constraints.
Do functional status and Medicare claims data improve the predictive accuracy of an electronic health record mortality index? Findings from a national Veterans Affairs cohort
Authors: Deardorff William James , Jing Bocheng , Jeon Sun Y. , Boscardin W. John , Lee Alexandra K. , Fung Kathy Z. , Lee Sei J. 
Published: May 2022

Abstract
Background
Electronic health record (EHR) prediction models may be easier to use in busy clinical settings since EHR data can be auto-populated into models. This study assessed whether adding functional status and/or Medicare claims data (which are often not available in EHRs) improves the accuracy of a previously developed Veterans Affairs (VA) EHR-based mortality index.

Methods
This was a retrospective cohort study of veterans aged 75 years and older enrolled in VA primary care clinics followed from January 2014 to April 2020 (n = 62,014). We randomly split participants into development (n = 49,612) and validation (n = 12,402) cohorts. The primary outcome was all-cause mortality. We performed logistic regression with backward stepwise selection to develop a 100-predictor base model using 854 EHR candidate variables, including demographics, laboratory values, medications, healthcare utilization, diagnosis codes, and vitals. We incorporated functional measures in a base + function model by adding activities of daily living (range 0-5) and instrumental activities of daily living (range 0-7) scores. Medicare data, including healthcare utilization (e.g., emergency department visits, hospitalizations) and diagnosis codes, were incorporated in a base + Medicare model. A base + function + Medicare model included all data elements. We assessed model performance with the c-statistic, reclassification metrics, fraction of new information provided, and calibration plots.

Results
In the overall cohort, mean age was 82.6 years and 98.6% were male. At the end of follow-up, 30,263 participants (48.8%) had died. The base model c-statistic was 0.809 (95% CI 0.805-0.812) in the development cohort and 0.804 (95% CI 0.796-0.812) in the validation cohort. Validation cohort c-statistics for the base + function, base + Medicare, and base + function + Medicare models were 0.809 (95% CI 0.801-0.816), 0.811 (95% CI 0.803-0.818), and 0.814 (95% CI 0.807-0.822), respectively. Adding functional status and Medicare data resulted in similarly small improvements among other model performance measures. All models showed excellent calibration.

Conclusions
Incorporation of functional status and Medicare data into a VA EHR-based mortality index led to small but likely clinically insignificant improvements in model performance.
Response to three doses of the Pfizer/BioNTech BNT162b2 COVID-19 vaccine: a retrospective study of a cohort of haemodialysis patients in France
Authors: Verdier Jean-François , Boyer Sonia , Chalmin Florence , Jeribi Ahmed , Egasse Caroline , Maggi Marie France , Auvray Philippe , Yalaoui Tarik 
Published: May 2022

Abstract
Background
The mortality rate associated with coronavirus disease 2019 (COVID-19) is high among haemodialyzed patients. We sought to describe the serological status of haemodialysis patients having received up to three doses of BNT162b2 mRNA vaccine, and to identify factors associated with a poor humoral response.

Methods
We performed a retrospective, observational study of patients attending a dialysis centre in Antibes, France. One or two of each patient’s monthly venous blood samples were assayed for anti–spike (S1) immunoglobulin G (IgG).

Results
We included 142 patients, of whom 124 remained COVID-19-negative throughout the study. Among these COVID-19-negative patients, the humoral immune response rate (defined as an anti-S1 IgG titre ≥1.2 U/ml) was 82.9% after two injections and 95.8% after three injections, and the median [interquartile range] titre increased significantly from 7.09 [2.21; 19.94] U/ml with two injections to 93.26 [34.25; 176.06] U/ml with three. Among patients with two injections, the mean body mass index and serum albumin levels were significantly higher in responders than in non-responders (26.5 kg/m2 vs. 23.2 kg/m2, p = 0.0392; and 41.9 g/l vs. 39.0 g/l, p = 0.0042, respectively). For the study population as a whole at the end of the study, a history of COVID-19, at least two vaccine doses, and being on the French national waiting list for kidney transplantation were the only factors independently associated with the anti-S1 IgG titre.

Conclusions
Dialysis patients vaccinated with two doses of BNT162b2 might not be sufficiently protected against SARS-CoV-2 and so should receive a third (booster) dose.

Trial registration
The present retrospective study of clinical practice was not interventional and so was not registered.
Laminin-integrin a6b4 interaction activates notch signaling to facilitate bladder cancer development
Authors: Hao Nan , Yang Daming , Liu Tianpei , Liu Shucheng , Lu Xinsheng , Chen Libo 
Published: May 2022

Abstract
Background
Laminins are high-molecular weight (400 ~ 900 kDa) proteins in extracellular matrix, which serve as major component of the basal lamina, and play a crucial role in promoting tumor cell migration. This study aimed at characterizing the role of laminin in promoting cancer development, and elucidating the mechanism of tumor progression driven by laminin-Notch signaling in bladder cancer.

Methods
2D collagen/laminin culture system was established and CCK-8/transwell assay was conducted to evaluate the proliferation/migration ability of Biu-87 and MB49 cells cultured on 2D gels. Activation of integrins-Notch1 signaling was determined by western blotting. Orthotopic bladder cancer mice model was established to assess the therapeutic effects of Notch inhibitor.

Results
Our study demonstrated that extracellular laminin can trigger tumor cell proliferation/migration through integrin α6β4/Notch1 signaling in bladder cancer. Inhibition of Telomere repeat-binding factor 3 (TRB3)/Jagged Canonical Notch Ligand 1 (JAG1) signaling suppressed Notch signals activation induced by laminin-integrin axis. In MB49 orthotopic bladder cancer mice model, Notch inhibitor SAHM1 efficiently improved tumor suppressive effects of chemotherapy and prolonged survival time of tumor-bearing mice.

Conclusion
In conclusion, we show that, in bladder cancer, extracellular laminin induced the activation of Notch pathway through integrin α6β4/TRB3/JAG3, and disclosed a novel role of laminin in bladder cancer cells proliferation or migration.
Better than my neighbor? Testing for overconfidence in COVID-19 preventive behaviors in Latin America
Authors: Boruchowicz Cynthia , Lopez Boo Florencia 
Published: May 2022

Abstract
Background
Procrastination and lack of attention may often hinder the implementation of preemptive actions necessary to mitigate the spread of COVID-19 like washing hands, covering nose and mouth with a mask, and keeping social distance. It is in such “easy” tasks that people (mistakenly) believe that they are better than others. In this paper we test for overconfidence bias in COVID-19 preventive behaviors in Latin America.

Methods
Using a phone survey in nationally representative samples from 10 Latin American countries where randomly, half of the sample in each country was asked about self-reported compliance to COVID-19 guidelines, and half about preventive behavior of fellow citizens compared to them; we tested: if the proportion of individuals claiming that others comply with a certain measure “Always more frequent than me” is higher than those stating that they “Never” or “Sometimes” comply with the same measure (i.e. people believe they are better at doing something than what they actually are).

Results
Over 90% of Latin-Americans claim to always wear a mask and sanitize their hands and more than 80% state to always keep social distance. We also find evidence of overconfidence in every behavior – except for keeping distance in public transportation. Moreover, the magnitude of such overconfidence is higher for behaviors such as wearing masks in public or washing hands than for those regarding keeping the 2-m distance.

Conclusions
To our knowledge, this is the first study to measure overconfidence in COVID-19 preventive behaviors in Latin America. Results show that more effort is needed to encourage people to comply with the regulation when it does not only depend on them: a better organization of closed stores and public transportation are, for instance, crucial to allow social distancing. It also suggests that a reinforcement of basic measures is essential, as individuals report to be performing them more frequently than when they have to think about such behaviors compared to others.
Shifting educational gradients in body mass index trajectories of Indonesians: an age period cohort analysis
Authors: Liwin Lilipramawanty Kewok 
Published: May 2022

Abstract
Background
Globally, the number of obese adults has increased rapidly in many developing countries. The links between increased educational attainment and lower risks of overweight/obesity have been studied in a number of high-income contexts. However, educational attainment can have a different association with obesity at different levels of economic development and different stages of the nutritional transition, and these associations may vary by period and cohort. This study aims to provide evidence on the shifting of educational gradients in overweight/obesity in Indonesia, a low middle income country.

Methods
Using five waves of Indonesian Family Life Survey (IFLS), this study examines the Body Mass Index (BMI) trajectories of 14,810 individuals from 1993 to 2014. This study analyses how educational gradients in BMI have shifted over time and across cohorts using a hierarchical age-period-cohort (HAPC) model to account for the effects of age and the changes in historical periods (social and environmental contexts).

Results
In older generations, higher educational attainment is associated with higher BMI, but the gap between educational groups shrinks in more recently-born cohorts. The BMI of lower educational groups is catching up with that of the tertiary educated, leading to an increased risk of overweight/obesity among low educated individuals. Having tertiary education lowers the risk of weight gain (-0.04 point) among recently-born cohort of women, but it still increases the risk (+ 0.04 point) for men.

Conclusion
Changes in access to education and the ongoing nutritional transition in Indonesia are leading to a shifting of educational gradients in overweight/obesity over time. The rising trends in BMI among low-educated and younger individuals are of substantial concern for Indonesian public health due to their implications for the risk of communicable and non-communicable diseases in the future.