bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abrupt Discontinuation Versus Taper of Hydrocortisone in Patients With Septic Shock
Authors: Carabetta Shannon , Allen Bryan , Cannon Chad , Johnson Totty 
Published: August 2022

Background: Although not mentioned in the most recent guidelines, the 2016 Surviving Sepsis Campaign guidelines recommend to taper corticosteroids once vasopressors are no longer needed; however, at the time of publication, there were no studies comparing taper versus abrupt discontinuation of corticosteroids. Objectives: The purpose of this study was to further evaluate the impact of abrupt versus taper discontinuation of corticosteroids in septic shock. Methods: This was a retrospective cohort study that included patients who received an initial dose of 200 to 300 mg of hydrocortisone for septic shock. Participants were then divided into “abrupt” and “taper” groups. The primary outcome assessed was hemodynamic instability during taper or within 72 hours of the last corticosteroid dose. Secondary outcomes included intensive care unit (ICU) and hospital length of stay, incidence of hyperglycemia or hypernatremia, and in-hospital mortality. Results: The primary outcome of reinitiation of vasopressor therapy occurred in a larger proportion of patients in the taper group compared with the abrupt group (21.9% vs 10.7%). The ICU length of stay (7.6 days abrupt vs 9 days taper) and hospital length of stay (14.9 vs 15.3 days) were similar between groups. There was a statistically significant increase in patients who experienced hyperglycemia within 24 hours of the last corticosteroid dose in the abrupt group. All other secondary outcomes were similar between groups. Conclusions: The abrupt discontinuation of hydrocortisone in the treatment of septic shock was associated with a nonstatistically significant 50% absolute reduction in the need for vasopressor reinitiation.
Assessment of cisplatin-induced nephrotoxicity and its associated factors among cervical cancer patients in the leading tertiary hospital in Kenya
Authors: Isaaka Joshua , Degu Amsalu , Kimani Lawrence M 
Published: August 2022

Introduction Cisplatin is the widely used antineoplastic agent in managing cervical cancer despite nephrotoxicity being a major concern. In addition, there was a paucity of data about the degree of nephrotoxicity due to cisplatin in the study setting. Therefore, this study aimed to investigate the prevalence of cisplatin nephrotoxicity among cervical patients. Methods A retrospective cross-sectional study was conducted at the Cancer Treatment Centre of Kenyatta National Hospital among 100 cervical cancer patients treated with a cisplatin regimen. Simple random sampling was employed to the recruit medical record of patients. This study used a data abstraction tool to extract the patients' relevant socio-demographic and clinical characteristics. The data were analysed using Statistical Package for Social Sciences version 25.0 software. Frequency tables and figures were used to present the findings of the study. Binary logistic regression analysis was used to determine factors associated with cisplatin nephrotoxicity. Results The study showed a mean age of 52.09 ± 10.44 years. The prevalence rate of cisplatin-induced nephrotoxicity in cervical cancer patients was 45%. Of these patients, 36% and 9% patients had grade 1 and 2 nephrotoxicities, respectively. Comorbidities (crude odd's ratio (COR) = 3.05, 95% confidence interval [CI] = 1.3–7.02, p = 0.011), hypertension (COR = 3.0, 95% CI = 1.1–7.8, p = 0.03), and more than three cycles of cisplatin treatment (adjusted odd's ratio = 4.5, 95% CI = 1.19–17.0, p = 0.027) were significant factors of nephrotoxicity. Conclusion The prevalence of cisplatin-induced nephrotoxicity among cervical cancer patients was high in the study setting. Comorbidities, number of cycles and types of comorbidities were significant factors associated with cisplatin nephrotoxicity.
Treatment of ruptured intracranial aneurysms using the novel generation of flow-diverters with surface modification: A systematic review and meta-analysis
Authors: Monteiro Andre , Khan Asham , Donnelly Brianna M , Kuo Cathleen C , Burke Samantha M , Waqas Muhammad , Housley Steven B , Cappuzzo Justin M , Davies Jason M , Snyder Kenneth V , Levy Elad I , Siddiqui Adnan H 
Published: August 2022

Background Surface modification of flow diverters (FDs) has been explored as a solution for reducing thrombotic risk of these devices, without necessarily using dual antiplatelet therapy (DAPT). If effective, this could pose a promising alternative for treatment of ruptured aneurysms not amenable to other modalities. Methods We performed a comprehensive search of PubMed, MEDLINE, and Embase databases following Preferred Reporting Items for Systematic reviews and Meta-analyzes guidelines. We included articles reporting use of surface-modified FDs for treatment of ruptured aneurysms. Demographics, subarachnoid hemorrhage (SAH) severity, aneurysm characteristics, devices used, periprocedural complications, angiographic outcomes, and mortality were extracted for sample size-based weighted analysis. Results Six studies comprising 59 patients with 64 aneurysms were included. Mean patient age was 56.6 ± 6.3 years and 60.6% (95% confidence interval [CI], 46.7–72.9%) were women. The anterior circulation was the location in 60.4% (95%CI, 45.5–73.5%) of aneurysms; 41.8% of the aneurysms were saccular (95%CI, 29.3–55.4%), 16.7% were fusiform (95%CI, 8.3–30.8%), 29.9% were dissecting (95%CI, 12.8–55.4%), 24.4% were blood-blister (95%CI, 15.2–36.7%), and 5.7% were mycotic (95%CI, 2–15.1%). Poor SAH grade was reported in 46.9% (95%CI, 33.3–60.9%). Adjunctive coiling was used in 33.2% (95%CI, 12.4–63.6%). Periprocedural thromboembolic and hemorrhagic complications occurred in 20% (95%CI, 7.1–45.1%) and 8.8% (95%CI, 3.7–19.5%), respectively. Complete occlusion was achieved in 76.4% (95%CI, 58.1–88.3%); no retreatments during follow-up were reported. Overall mortality was 15.1% (95%CI, 7.7–27.6%). There were no differences between single antiplatelet therapy (SAPT) and DAPT regimens with respect to periprocedural thromboembolic complications ( P = 0.09), hemorrhagic ( P = 0.834) complications, and mortality ( P = 0.312). Conclusion Surface-modified FD treatment of ruptured aneurysms resulted in high rates of thromboembolic complications and acceptable rates of hemorrhagic complications. A considerable proportion of aneurysms were nonsaccular. Rates of complete occlusion were high and retreatment were low. Importantly, no statistically significant difference was found between SAPT and DAPT with respect to complications and mortality.
The impact of COVID-19 on the hot food takeaway planning regulatory environment: perspectives of local authority professionals in the North East of England
Authors: Moore HJ , Lake AA , O’Malley CL , Bradford C , Gray N , Chang M , Mathews C , Townshend TG 
Published: August 2022

Aims: Planning regulations have been used to prevent the over-proliferation of hot food takeaways, minimising the impact of local obesogenic environments. To help mitigate the effects of lockdown, the UK government introduced temporary changes in March 2020 to Planning Regulations for England, allowing food retailers to open for takeaway services beyond ‘ancillary’ level without needing to apply for planning permission through permitted development rights (PDR). Businesses are required to notify their local authority (LA) when they implement PDRs. To better understand the impact of regulations on the policy and practice of key professional groups, Public Health England commissioned Teesside University to undertake scoping research in the North East of England. Methods: A focus group and interviews were conducted with 15 professionals from 7 of 12 North East LAs. Professions included Planners, Public Health Leads, Environmental Health Officers and Town Centre Managers. Data were analysed using a codebook thematic analysis approach. An interpretation meeting with some participants was conducted. Results: LAs were not aware of most businesses notifying them of new regulation adherence despite taking up PDRs, but were considered low-priority with many lacking formal recording procedures. There were concerns about health consequences of the changes, and consensus relating to ongoing issues with capacity across all professional groups, largely due to the continuing pandemic and absence of a strategy out of temporary measures. Concerns existed around ensuring cessation of restaurants trading as takeaways, and hygiene inspections backlog. Many (personally) saw new takeaways as a lifeline, offering broader menus and preserving local economies. Conclusion: Lack of information around the number of restaurants/pubs using PDR to trade as takeaway services, ongoing capacity issues of LAs and, at the time, the absence of a strategy post regulation changes, meant there were high levels of uncertainty regarding the impacts of these temporary measures.
Incidence, causes, and predictors of unsuccessful decannulation following prolonged weaning
Authors: Ghiani Alessandro , Tsitouras Konstantinos , Paderewska Joanna , Milger Katrin , Walcher Swenja , Weiffenbach Mareike , Neurohr Claus , Kneidinger Nikolaus 
Published: August 2022

Background: Liberation from prolonged tracheostomy ventilation involves ventilator weaning and removal of the tracheal cannula (referred to as decannulation). This study evaluated the incidence, causes, and predictors of unsuccessful decannulation following prolonged weaning. Methods: Observational retrospective cohort study of 532 prolonged mechanically ventilated, tracheotomized patients treated at a specialized weaning center between June 2013 and January 2021. We summarized the causes for unsuccessful decannulations and used a binary logistic regression analysis to derive and validate associated predictors. Results: Failure to decannulate occurred in 216 patients (41%). The main causes were severe intensive care unit (ICU)-acquired dysphagia (64%), long-term ventilator dependence following weaning failure (41%), excessive respiratory secretions (12%), unconsciousness (4%), and airway obstruction (3%). Predictors of unsuccessful decannulation from any cause were age [odds ratio (OR) = 1.04 year−1; 95% confidence interval (CI), 1.02–1.06; p < 0.01], body mass index [0.96 kg/m2 (0.93–1.00); p = 0.027], Acute Physiology and Chronic Health Evaluation II (APACHE-II) score [1.05 (1.00–1.10); p = 0.036], pre-existing non-invasive home ventilation [3.57 (1.51–8.45); p < 0.01], percutaneous tracheostomies [0.49 (0.30–0.80); p < 0.01], neuromuscular diseases [4.28 (1.21–15.1); p = 0.024], and total mechanical ventilation duration [1.02 day−1 (1.01–1.02); p < 0.01]. Regression models examined in subsets of patients with severe dysphagia and long-term ventilator dependence as the main reason for failure revealed little overlapping among predictors, which even showed opposite effects on the outcome. The application of non-invasive ventilation as a weaning technique contributed to successful decannulation in 96 of 221 (43%) long-term ventilator-dependent patients following weaning failure. Conclusion: Failure to decannulate after prolonged weaning occurred in 41%, mainly resulting from persistent ICU-acquired dysphagia and long-term ventilator dependence following weaning failure, each associated with its own set of predictors.
Arthroscopic Extensor Carpi Radialis Brevis Tenotomy and Debridement Versus Debridement Alone for Refractory Lateral Epicondylitis: Clinical and MRI Evaluation
Authors: Li Hong , Yang Xiang Dong , Xue XiaoAo , Zhang Qingguo , Ye Lingchao , Hua Yinghui , Zhou Xiaobo 
Published: August 2022

Background: Arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon is a widely accepted procedure used in refractory lateral epicondylitis. However, residual pain occurs in some patients. Purpose: To investigate the clinical effectiveness of arthroscopic extended debridement (ECRB tenotomy and debridement) in the treatment of lateral epicondylitis. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with refractory lateral epicondylitis were consecutively recruited for this study. They underwent traditional ECRB debridement (control group) or extended ECRB debridement (ED group) under arthroscopy. The Disabilities of the Arm, Shoulder and Hand (DASH) score, visual analog scale (VAS) for pain, and Mayo Elbow Performance Score (MEPS) were used to compare elbow function between the groups at 3, 6, and 12 months postoperatively. Magnetic resonance imaging (MRI) was also performed to evaluate pathology at 12 months. Results: A total of 69 patients participated in the study (33 patients in the ED group and 36 in the control group). After surgery, all patients showed improvement on all 3 outcome scores. Compared with the control group, the ED group had significantly better postoperative MEPS and VAS scores at 3 months ( P ≤ .001 for both) and 6 months ( P ≤ .03 for both) but similar values at 12 months. DASH scores between groups were similar at all time periods. At the 12-month follow-up, no patients in the ED group reported pain with strenuous work. Return-to-work (RTW) times were also shorter in the ED group compared with the controls (8 ± 4 vs 18 ± 8 weeks; P < .001). Postoperative MRI assessments revealed no high signal intensities on the lateral epicondyle in the ED group, while there was an increased internal signal intensity on the lateral epicondyle in 83% of the controls. Conclusion: Collectively, the extended ECRB debridement technique resulted in enhanced pain relief in the early postoperative period as well as providing faster RTW times compared with the traditional debridement technique. At 1 year follow-up, there were no differences in outcome measures between groups, but residual abnormal MRI findings were more common in the traditional debridement group.
Construct validity of the school-implementation climate scale
Authors: Thayer Andrew J. , Cook Clayton R. , Davis Chayna , Brown Eric C. , Locke Jill , Ehrhart Mark G. , Aarons Gregory A. , Picozzi Elissa , Lyon Aaron R. 
Published: August 2022

Background Implementation climate is an organizational construct theorized to facilitate the adoption and delivery of evidence-based practices. Within schools, teachers often are tasked with implementing universal prevention programs. Therefore, they are ideal informants when assessing school implementation climate for initial and continuous implementation improvement efforts. The purpose of this study was to examine the construct validity (i.e., factor structure and convergent/divergent validity) of a school-adapted measure of strategic implementation climate called the School Implementation Climate Scale (SICS). Methods Confirmatory factor analyses of SICS data, collected from 441 teachers in 52 schools, were used to compare uncorrelated and correlated first-order factor models and a second-order hierarchical model. Correlations with other school measures were examined to assess SICS convergent and divergent validities. Results Results demonstrated acceptable internal consistency for each SICS subscale ( αs > 0.80 for all subscales) and construct validity of the hypothesized factor structure of the SICS with three new scales. The hierarchical second-order factor structure with eight first-order factors was found to best model the SICS data. Correlations with other school measures were in the expected direction and magnitude. Conclusions Results from this study provide psychometric evidence that supports the use of the SICS to inform the implementation research and practice in schools. Plain Language Summary Schools are busy trying to implement various universal programs and systems to help support kids in their growth. Beginning and sustaining these efforts is quite challenging, and there is need for tools and ideas to help those implementation efforts. One concept is implementation climate, which is broadly the school staff’s perception of the implementation support for a given practice. However, no measure currently exists to help schools assess their implementation climate. The goal of our study was to adapt a measure of implementation climate used in other settings to the school environment. We used feedback from educational experts to make changes and used various analyses to determine if the newly adapted measure was psychometrically sound. Findings suggest the new measure is usable to guide implementation efforts in schools.
Combined immunosuppression for acquired hemophilia A: CyDRi is a highly effective low-toxicity regimen
Authors: Simon Barbara , Ceglédi Andrea , Dolgos János , Farkas Péter , Gaddh Manila , Hankó László , Horváth Robert , Kaposi Ambrus , Magyar Lászlóné , Masszi Tamás , Szederjesi Attila , Wohner Nikolett , Bodó Imre 
Published: August 2022

Abstract
Acquired hemophilia A (AHA) is a rare severe autoimmune bleeding disorder with significant morbidity and mortality. Although critical for disease control, there is no consensus for the best immunosuppressive regimen. Most authors use steroids first line, followed by other agents for steroid failures. Upfront combined regimens offer the advantage of reduced steroid exposure and toxicity as well as increased efficacy. We retrospectively analyzed data from 32 patients with AHA treated on an identical such institutional protocol: cyclophosphamide 1000 mg on days 1 and 22, dexamethasone 40 mg on days 1, 8, 15, and 22, and rituximab 100 mg on days 1, 8, 15, and 22 (the regimen was termed CyDRi). All patients received at least 1 cycle of CyDRi. If necessary, CyDRi was repeated until remission, no sooner than day 43 of the previous cycle. Bleeding control was rapidly achieved. The median time for bleeding control was 15.5 days (range, 0-429 days; interquartile range, 2.5-29.5 days). Thirty-one (96.8%) of 32 patients achieved durable complete remission (CR); 29 (90.6%) of 32 patients were alive at last follow-up, all of them in CR. The median time to reach first CR was 77 days (range, 19-939 days; interquartile range, 31-115 days). Toxicity and side effects were acceptable and milder than those of commonly used, prolonged steroid therapies. In conclusion, the CyDRi regimen produced markedly higher CR rates and overall survival than currently used sequential regimens. Taken together, CyDRi proved to be an attractive option for the immunosuppression of elderly patients with AHA.
Real-world effectiveness of caplacizumab vs the standard of care in immune thrombotic thrombocytopenic purpura
Authors: Izquierdo Cristina Pascual , Mingot-Castellano María Eva , Fuentes Ana E. Kerguelen , García-Arroba Peinado José , Cid Joan , Jimenez Maria Moraima , Valcarcel David , Gómez-Seguí Inés , de la Rubia Javier , Martin Paz , Goterris Rosa , Hernández Luis , Tallón Inmaculada , Varea Sara , Fernández Marta , García-Muñoz Nadia , Vara Míriam , Zarzoso Miguel Fernández , García-Candel Faustino , Paciello María Liz , García-García Irene , Zalba Saioa , Campuzano Verónica , Gala José María , Estévez Julia Vidán , Jiménez Gemma Moreno , López Lorenzo José Luis , Arias Elena González , Freiría Carmen , Solé María , Ávila Idrovo Laura Francisca , Hernández Castellet José Carlos , Cruz Naylen , Lavilla Esperanza , Pérez-Montaña Albert , Atucha Jon Ander , Moreno Beltrán María Esperanza , Moreno Macías Juán Ramón , Salinas Ramón , del Rio-Garma Julio 
Published: August 2022

Abstract
Immune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by anti-ADAMTS13 antibodies. Caplacizumab is approved for adults with an acute episode of iTTP in conjunction with plasma exchange (PEX) and immunosuppression. The objective of this study was to analyze and compare the safety and efficacy of caplacizumab vs the standard of care and assess the effect of the concomitant use of rituximab. A retrospective study from the Spanish TTP Registry of patients treated with caplacizumab vs those who did not receive it was conducted. A total of 155 patients with iTTP (77 caplacizumab, 78 no caplacizumab) were included. Patients initially treated with caplacizumab had fewer exacerbations (4.5% vs 20.5%; P &lt; .05) and less refractoriness (4.5% vs 14.1%; P &lt; .05) than those who were not treated. Time to clinical response was shorter when caplacizumab was used as initial treatment vs caplacizumab used after refractoriness or exacerbation. The multivariate analysis showed that its use in the first 3 days after PEX was associated with a lower number of PEX (odds ratio, 7.5; CI, 2.3-12.7; P &lt; .05) and days of hospitalization (odds ratio, 11.2; CI, 5.6-16.9; P &lt; .001) compared with standard therapy. There was no difference in time to clinical remission in patients treated with caplacizumab compared with the use of rituximab. No severe adverse event was described in the caplacizumab group. In summary, caplacizumab reduced exacerbations and refractoriness compared with standard of care regimens. When administered within the first 3 days after PEX, it also provided a faster clinical response, reducing hospitalization time and the need for PEX.
Experimental study on the embedment strength of smooth dowels inserted in cross-laminated timber narrow side
Authors: Long Weiguo , Ou Jiajia , Sun Xiaofeng , Huang Xinyue , He Minjuan , Li Zheng 
Published: August 2022

AbstractThe embedment properties of the dowel-type fasteners is a fundamental parameter that can determine the shear resisting performance of the connections utilized in cross-laminated timber (CLT) structures. To investigate the embedment strength of the smooth dowels inserted in CLT narrow side, totally 504 CLT embedment specimens were tested to evaluate the effects of the influencing factors on the embedment strength, which included the loading angle, the embedment angle, the embedment position, the diameter of the dowels, and the gaps between the lumbers. The existing predictive equations of the embedment strength were validated based on the experimental results, and modified empirical equations were proposed for a more accurate prediction on the average embedment strength. It is found that when the loading direction with a loading angle of 90 degree is parallel to the adhesive layer, for the dowels embedded in the core layer and for those embedded between layers, the average embedment strength decreases by 27.89% and by 33.61% with an increase of the diameter from 8 to 24 mm, respectively. When the loading direction is perpendicular to the adhesive layer, the average embedment strength of the smooth dowels with an embedment angle of 90 degree is 85.25–218.96% higher than that of the dowels with an embedment angle of 0 degree. Furthermore, almost no drop can be identified for the embedment strength of the dowels with an embedment angle of 0 degree when the gap exists in their embedment position. A more accurate prediction on the average embedment strength can be achieved based on the modified empirical equations.