bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 morbidity in Afghanistan: a nationwide, population-based seroepidemiological study
Authors: Saeedzai Sayed Ataullah , Sahak Mohammad Nadir , Arifi Fatima , Abdelkreem Aly Eman , Gurp Margo van , White Lisa J , Chen Siyu , Barakat Amal , Azim Giti , Rasoly Bahara , Safi Soraya , Flegg Jennifer A , Ahmed Nasar , Ahadi Mohmmad Jamaluddin , Achakzai Niaz M , AbouZeid Alaa 
Published: July 2022

ObjectiveThe primary objectives were to determine the magnitude of COVID-19 infections in the general population and age-specific cumulative incidence, as determined by seropositivity and clinical symptoms of COVID-19, and to determine the magnitude of asymptomatic or subclinical infections.Design, setting and participantsWe describe a population-based, cross-sectional, age-stratified seroepidemiological study conducted throughout Afghanistan during June/July 2020. Participants were interviewed to complete a questionnaire, and rapid diagnostic tests were used to test for SARS-CoV-2 antibodies. This national study was conducted in eight regions of Afghanistan plus Kabul province, considered a separate region. The total sample size was 9514, and the number of participants required in each region was estimated proportionally to the population size of each region. For each region, 31–44 enumeration areas (EAs) were randomly selected, and a total of 360 clusters and 16 households per EA were selected using random sampling. To adjust the seroprevalence for test sensitivity and specificity, and seroreversion, Bernoulli’s model methodology was used to infer the population exposure in Afghanistan.Outcome measuresThe main outcome was to determine the prevalence of current or past COVID-19 infection.ResultsThe survey revealed that, to July 2020, around 10 million people in Afghanistan (31.5% of the population) had either current or previous COVID-19 infection. By age group, COVID-19 seroprevalence was reported to be 35.1% and 25.3% among participants aged ≥18 and 5–17 years, respectively. This implies that most of the population remained at risk of infection. However, a large proportion of the population had been infected in some localities, for example, Kabul province, where more than half of the population had been infected with COVID-19.ConclusionAs most of the population remained at risk of infection at the time of the study, any lifting of public health and social measures needed to be considered gradually.
How can competencies in minor surgery in general practice be increased? Assessing the effect of a compact intervention in postgraduate training: a mixed-methodsstudy
Authors: Schwill Simon , Krug Katja , Poppleton Aaron , Reith Dorothee , Senft Jonas D , Szecsenyi Joachim , Stengel Sandra 
Published: July 2022

ObjectivesWe aimed to assess general practice (GP) trainees’ self-perception of surgical competencies and to explore longitudinal effects of a compact intervention.DesignWe performed a mixed-methods study including a before and after comparison in the intervention group (IG), a comparison of attendees and non-attendees (control group (CG)) and a qualitative evaluation of the intervention. Competencies were self-assessed through surveys. Semi-structured interviews were performed after 9 months.SettingIn 2019, a 2-day voluntary seminar focussing on minor surgery/injuries was offered on 13 occasions by educators from KWBW Verbundweiterbildungplus (Competence Centre for Postgraduate Medical Education Baden-Württemberg).ParticipantsAll enrolled GP trainees were offered participation. GP trainees who did not attend a seminar (non-attendees) were recruited for CG after the 13th intervention.InterventionAttendees took part in an interactive, GP-oriented short course incorporating 270 min of focused minor surgery/injuries training (compact intervention) on the second day of the 2-day seminar.Results326 GP trainees (IG: n=257; CG: n=69) participated in the study. 17 attendees were interviewed. CG had more often experienced a surgical rotation (p=0.03) and reported higher interest in performing minor surgery in future practice (p=0.03). GP trainees self-rated their all-round competency in minor surgery as average (IG: 3.0±1.0, CG: 3.2±0.9, IG:CG p=0.06). After the intervention, attendees felt that surgical skills should be a core component of GP vocational training (p=0.05). After 9 months, attendees remembered a variety of content and valued the interactive, case-oriented, peer-to-peer approach in a mixed learning group. Some attendees reported they had started to overcome competency gaps in minor surgery.ConclusionsA compact intervention in minor surgery provides an ‘intense’ stimulus which could foster positive attitudes towards minor surgery and promote longitudinal personal development of related competencies in GP trainees, including those with little interest in surgery. Such measures appear crucial to support individual progress of GP trainees to provide comprehensive primary care.
Interaction effect between overweight/obesity and alcohol consumption on hypertension risk in China: a longitudinal study
Authors: Sun Jiaru , Wang Xiaoqin , Terry Paul D , Ren Xiaohan , Hui Zhaozhao , Lei Shuangyan , Wang Caihua , Wang Mingxu 
Published: July 2022

ObjectiveTo explore the interaction effect between overweight/obesity and alcohol consumption on hypertension risk.DesignA longitudinal study of the independent and combined effects of hypertension risk factors.SettingTwelve provinces in China, including Beijing Liaoning, Heilongjiang, Shanghai, Jiangsu, Shandong, Henan, Hubei, Hunan, Guangxi, Guizhou and Chongqing.ParticipantsLongitudinal data of China Health and Nutrition Survey, collected between 2011 and 2015, were used in this study. A total of 13 121 residents from 12 provinces were included and completed physical examinations and questionnaires at baseline.OutcomeFirst incidence of hypertension.ResultsOver a mean follow-up of 4 years, 690 incident hypertension cases were reported. After adjusting for age, gender, education level, marital status, physical activity, diabetes and smoking, high body mass index (BMI) and light drinking (OR=5.07, 95% CI 3.06 to 8.41), high waist circumference (WC) and light drinking (OR=4.81, 95% CI 2.92 to 7.91), high waist hip ratio and light drinking (OR=2.85, 95% CI 1.84 to 4.42) were the highest risk of all participants in the three combinations. Multiplicative interaction measures were statistically significant in overweight/obesity and drinking/light drinking/heavy drinking categories in men (p<0.05). Additive interactions were observed between high BMI and drinking in men (relative excess risk due to interaction=1.75, 95% CI 0.85 to 2.65, attributable proportion due to interaction=0.56, 95% CI 0.36 to 0.76, synergy index=6.43, 95% CI 1.02 to 28.84).ConclusionsMeasures of body weight and size, particularly BMI and WC, appear to interact synergistically with alcohol consumption to increase the risk of hypertension in the Chinese population. Given that approximately 245 million people in China have hypertension, and that hypertension is a major cause of cardiovascular disease worldwide, our results may have implications for chronic disease prevention.
Frailty assessment tools for use by surgeons when evaluating older adults prior to surgery: a scoping review protocol
Authors: Chesney Tyler R , Wong Camilla , Tricco Andrea C , Wijeysundera Duminda N , Ladha Karim Shiraz , Kishibe Teruko , Dubé Samuel , Puts Martine T E , Alibhai Shabbir M H , Daza Julian F 
Published: July 2022

IntroductionDespite growing evidence, uncertainty persists about which frailty assessment tools are best suited for routine perioperative care. We aim to understand which frailty assessment tools perform well and are feasible to implement.Methods and analysisUsing a registered protocol following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA), we will conduct a scoping review informed by the Joanna Briggs Institute Guide for Scoping Reviews and reported using PRISMA extension for Scoping Reviews recommendations. We will develop a comprehensive search strategy with information specialists using the Peer Review of Electronic Search Strategies checklist, and implement this across relevant databases from 2005 to 13 October 2021 and updated prior to final review publication. We will include all studies evaluating a frailty assessment tool preoperatively in patients 65 years or older undergoing intracavitary, non-cardiac surgery. We will exclude tools not assessed in clinical practice, or using laboratory or radiologic values alone. After pilot testing, two reviewers will independently assess information sources for eligibility first by titles and abstracts, then by full-text review. Two reviewers will independently chart data from included full texts using a piloted standardised electronic data charting. In this scoping review process, we will (1) index frailty assessment tools evaluated in the preoperative clinical setting; (2) describe the level of investigation supporting each tool; (3) describe useability of each tool and (4) describe direct comparisons between tools. The results will inform ready application of frailty assessment tools in routine clinical practice by surgeons and other perioperative clinicians.Ethics and disseminationEthic approval is not required for this secondary data analysis. This scoping review will be published in a peer-review journal. Results will be used to inform an ongoing implementation study focused on geriatric surgery to overcome the current lack of uptake of older adult-oriented care recommendations and ensure broad impact of research findings.
Australian children’s foot, ankle and leg problems in primary care: a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) data
Authors: Williams Cylie M , Menz Hylton B , Lazzarini Peter A , Gordon Julie , Harrison Christopher 
Published: July 2022

ObjectivesTo explore children’s foot, ankle and leg consultation patterns and management practices in Australian primary care.DesignCross-sectional, retrospective study.SettingAustralia Bettering the Evaluation and Care of Health program dataset.ParticipantsData were extracted for general practitioners (GPs) and patients<18 years from April 2000 to March 2016 inclusive.Main outcome measuresDemographic characteristics: sex, GP age groups (ie, <45, 45–54, 55+ years), GP country of training, patient age grouping (0–4, 5–9, 10–14, 15–18 years), postcode, concession card status, indigenous status, up to three patient encounter reasons, up to four encounter problems/diagnoses and the clinical management actioned by the GP.ResultsChildren’s foot, ankle or leg problems were managed at a rate of 2.05 (95% CI 1.99 to 2.11) per 100 encounters during 229 137 GP encounters with children. There was a significant increase in the rate of foot, ankle and leg problems managed per 100 children in the population, from 6.1 (95% CI 5.3 to 6.8) in 2005–2006 to 9.0 (95% CI 7.9 to 10.1) in 2015–2016. Management of children’s foot, ankle and leg problems were independently associated with male patients (30% more than female), older children (15–18 years were 7.1 times more than <1 years), male GPs (13% more) and younger GPs (<45 years of age 13% more than 55+). The top four most frequently managed problems were injuries (755.9 per 100 000 encounters), infections (458.2), dermatological conditions (299.4) and unspecified pain (176.3). The most frequently managed problems differed according to age grouping.ConclusionsChildren commonly present to GPs for foot, ankle and leg problems. Presentation frequencies varied according to age. Unexpectedly, conditions presenting commonly in adults, but rarely in children, were also frequently recorded. This data highlights the importance of initiatives supporting contemporary primary care knowledge of diagnoses and management of paediatric lower limb problems to minimise childhood burden of disease.
Vitrectomy combined with lens capsule flap transplantation in the treatment of high myopia macular hole retinal detachment: study protocol for a prospective randomised controlled trial
Authors: Gong Qiaoyun , Ye Luyao , Wu Xia , Xue Lin , Zhou Hao , Fan Ying , Xu Xun , Wang Weijun , Qian Tianwei 
Published: July 2022

IntroductionVitrectomy combined with internal limiting membrane (ILM) peeling, flap or tamponade is widely used in the treatment of macular diseases, such as macular hole (MH) and high myopia macular hole retinal detachment (HMMHRD). However, movement of the ILM to a suitable position to prevent displacement is a difficult operation. Improving visual function after surgery remains controversial. Compared with ILM, the thicker and more flexible lens capsule is easy to obtain and operate. Previous studies have confirmed the effectiveness of lens capsule flap in the treatment of MH. This study aims to evaluate the efficacy and safety of vitrectomy combined with lens capsule flap transplantation in the treatment of HMMHRD.Methods and analysisThis single-centre, single-blind, prospective, randomised clinical trial will include 54 patients with HMMHRD who will first undergo phacoemulsification and intraocular lens implantation and then vitrectomy combined with lens capsule flap transplantation (experimental group) or ILM tamponade (control group). Study participants will be randomly allocated in a 1:1 ratio to experimental and control groups. Follow-up will be conducted 1, 3 and 7 days and 1, 3 and 6 months after surgery in both groups. Necessary examinations will be performed at each follow-up visit. Measurement outcomes include postoperative situation of macular hole closure, best-corrected visual acuity, macular retinal function and macular retinal sensitivity. The primary outcome is type I closure rate of MH 6 months after operation. Intergroup comparisons of the proportions of patients with type I closure of MH will be performed with Fisher’s exact test.Ethics and disseminationFull ethics approval for this study was obtained from the Ethics Committee of Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China. The outcomes of the trial will be disseminated through peer-reviewed journals and at scientific conferences.Trial registration numberChiCTR2200057836.
Helping healthcare teams to debrief effectively: associations of debriefers’ actions and participants’ reflections during team debriefings
Authors: Kolbe Michaela , Grande Bastian , Lehmann-Willenbrock Nale , Seelandt Julia Carolin 
Published: July 2022

BackgroundDebriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants’ reflection in debriefings.MethodsIn this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants’ verbalisation of a mental model as a particular form of reflection.ResultsThe 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers’ observation to debriefers’ opinion (z=9.85, p<0.001), from opinion to debriefers’ open-ended question (z=9.52, p<0.001) and from open-ended question to participants’ mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes.ConclusionWhen debriefers pair their observations and opinions with open-ended questions, paraphrase participants’ statements and ask specific questions, they help participants reflect during debriefings.
Predictors of longer-term depression trajectories during the COVID-19 pandemic: a longitudinal study in four UK cohorts
Authors: Rosa Lara , Godwin Hayward J , Cortese Samuele , Brandt Valerie 
Published: July 2022

BackgroundThe COVID-19 pandemic has caused an increase in mental ill health compared with prepandemic levels. Longer-term trajectories of depression in adults during the pandemic remain unclear.ObjectiveWe used latent growth curve modelling to examine individual trajectories of depression symptoms, and their predictors, beyond the early stage of the pandemic.MethodsData were collected in three waves in May 2020, September/October 2020 and February/March 2021 in four UK cohorts (Millennium Cohort Study, Next Steps cohort, British Cohort and National Child Development Study). We included n=16 978 participants (mean age at baseline: 20, 30, 50 and 62, respectively). Self-reported depressive symptoms were the study outcome.FindingsSymptoms of depression were higher in younger compared with older age groups (d=0.7) across all waves. While depressive symptoms remained stable from May 2020 to Autumn 2020 overall (standardized mean difference (SMD)=0.03, 95% CI 0.02 to 0.04), they increased in all age groups from May 2020 to Spring 2021 (SMD=0.12, 95% CI 0.11 to 0.13). Feelings of loneliness were the strongest predictor and concurrent correlate of increasing depressive symptoms across all cohorts, prepandemic mental health problems and having a long-term illness were also significantly associated with an increase in depression symptoms across all ages. By contrast, compliance with social distancing measures did not predict an increase in depression symptoms.ConclusionsFeeling lonely and isolated had a large effect on depression trajectories across all generations, while social distancing measures did not.Clinical implicationsThese findings highlight the importance of fostering the feeling of connectedness during COVID-19-related distancing measures.
Chimeric antigen receptor T cells engineered to recognize the P329G-mutated Fc part of effector-silenced tumor antigen-targeting human IgG1 antibodies enable modular targeting of solid tumors
Authors: Stock Sophia , Benmebarek Mohamed-Reda , Kluever Anna-Kristina , Darowski Diana , Jost Christian , Stubenrauch Kay-Gunnar , Benz Joerg , Freimoser-Grundschober Anne , Moessner Ekkehard , Umana Pablo , Subklewe Marion , Endres Stefan , Klein Christian , Kobold Sebastian 
Published: July 2022

BackgroundChimeric antigen receptor (CAR) T cell therapy has proven its clinical utility in hematological malignancies. Optimization is still required for its application in solid tumors. Here, the lack of cancer-specific structures along with tumor heterogeneity represent a critical barrier to safety and efficacy. Modular CAR T cells indirectly binding the tumor antigen through CAR-adaptor molecules have the potential to reduce adverse events and to overcome antigen heterogeneity. We hypothesized that a platform utilizing unique traits of clinical grade antibodies for selective CAR targeting would come with significant advantages. Thus, we developed a P329G-directed CAR targeting the P329G mutation in the Fc part of tumor-targeting human antibodies containing P329G L234A/L235A (LALA) mutations for Fc silencing.MethodsA single chain variable fragment-based second generation P329G-targeting CAR was retrovirally transduced into primary human T cells. These CAR T cells were combined with IgG1 antibodies carrying P329G LALA mutations in their Fc part targeting epidermal growth factor receptor (EGFR), mesothelin (MSLN) or HER2/neu. Mesothelioma, pancreatic and breast cancer cell lines expressing the respective antigens were used as target cell lines. Efficacy was evaluated in vitro and in vivo in xenograft mouse models.ResultsUnlike CD16-CAR T cells, which bind human IgG in a non-selective manner, P329G-targeting CAR T cells revealed specific effector functions only when combined with antibodies carrying P329G LALA mutations in their Fc part. P329G-targeting CAR T cells cannot be activated by an excess of human IgG. P329G-directed CAR T cells combined with a MSLN-targeting P329G-mutated antibody mediated pronounced in vitro and in vivo antitumor efficacy in mesothelioma and pancreatic cancer models. Combined with a HER2-targeting antibody, P329G-targeting CAR T cells showed substantial in vitro activation, proliferation, cytokine production and cytotoxicity against HER2-expressing breast cancer cell lines and induced complete tumor eradication in a breast cancer xenograft mouse model. The ability of the platform to target multiple antigens sequentially was shown in vitro and in vivo.ConclusionsP329G-targeting CAR T cells combined with antigen-binding human IgG1 antibodies containing the P329G Fc mutation mediate pronounced in vitro and in vivo effector functions in different solid tumor models, warranting further clinical translation of this concept.
Axenfeld-Rieger syndrome: more than meets the eye
Authors: Reis Linda M. , Maheshwari Mohit , Capasso Jenina , Atilla Huban , Dudakova Lubica , Thompson Samuel , Zitano Lia , Lay-Son Guillermo , Lowry R. Brian , Black Jennifer , Lee Joseph , Shue Ann , Kremlikova Pourova Radka , Vaneckova Manuela , Skalicka Pavlina , Jedlickova Jana , Trkova Marie , Williams Bradley , Richard Gabriele , Bachman Kristine , Seeley Andrea H. , Costakos Deborah , Glaser Thomas M , Levin Alex V. , Liskova Petra , Murray Jeffrey C. , Semina Elena V. 
Published: July 2022

BackgroundAxenfeld-Rieger syndrome (ARS) is characterised by typical anterior segment anomalies, with or without systemic features. The discovery of causative genes identified ARS subtypes with distinct phenotypes, but our understanding is incomplete, complicated by the rarity of the condition.MethodsGenetic and phenotypic characterisation of the largest reported ARS cohort through comprehensive genetic and clinical data analyses.Results128 individuals with causative variants inPITX2orFOXC1, including 81 new cases, were investigated. Ocular anomalies showed significant overlap but with broader variability and earlier onset of glaucoma forFOXC1-related ARS. Systemic anomalies were seen in all individuals withPITX2-related ARS and the majority of those withFOXC1-related ARS.PITX2-related ARS demonstrated typical umbilical anomalies and dental microdontia/hypodontia/oligodontia, along with a novel high rate of Meckel diverticulum.FOXC1-related ARS exhibited characteristic hearing loss and congenital heart defects as well as previously unrecognised phenotypes of dental enamel hypoplasia and/or crowding, a range of skeletal and joint anomalies, hypotonia/early delay and feeding disorders with structural oesophageal anomalies in some. Brain imaging revealed highly penetrant white matter hyperintensities, colpocephaly/ventriculomegaly and frequent arachnoid cysts. The expanded phenotype ofFOXC1-related ARS identified here was found to fully overlap features of De Hauwere syndrome. The results were used to generate gene-specific management plans for the two types of ARS.ConclusionSince clinical features of ARS vary significantly based on the affected gene, it is critical that families are provided with a gene-specific diagnosis,PITX2-related ARS orFOXC1-related ARS. De Hauwere syndrome is proposed to be a FOXC1opathy.