bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic review and meta-analysis assessing the diagnostic test accuracy of procalcitonin in the diagnosis of invasive bacterial infections in febrile infants: a study protocol
Authors: Norman-Bruce Hannah , Umana Etimbuk , Mills Clare , McFetridge Lisa , Mitchell Hannah , Waterfield Tom 
Published: August 2022

IntroductionYoung febrile infants are at higher risk of invasive bacterial infections (IBIs) compared with older children. The clinical features of IBI are subtle in this cohort mandating that clinicians take a cautious approach to their initial assessment and management. This includes the measurement of blood biomarkers of infection such as C reactive protein (CRP) and procalcitonin (PCT). In the UK, PCT is not widely available and not recommended for routine use in hospital. This is in contrast to Europe and the USA where PCT is regularly used to assist clinical decision-making. The objective of this review and meta-analysis is to report the diagnostic test accuracy of PCT in detecting IBI in febrile infants less than 91 days old, compare its accuracy with CRP and define optimal PCT cut-off values in this cohort.Methods and analysisA search strategy will include MEDLINE, EMBASE, Web of Science, The Cochrane Library and grey literature. There will be no language or date limitations. Diagnostic accuracy studies compliant with STARD criteria will be considered against eligibility criteria. Abstracts, then full texts, of potentially eligible studies will be independently screened for selection. Data extraction and quality assessment, using the QUADAS-2 tool, will be completed by two independent authors and a third author used for any inconsistencies. True positives, false positives, true negatives and false negatives will be pooled to collate specificity and sensitivity with 95% CIs. Results will be portrayed in forest plots, alongside their quality assessments.Ethics and disseminationThis review does not require ethical clearance. This review will be published in peer-reviewed journals and key messages will be disseminated through presentations at local and international conferences related to this field. The authors aim for this review to be completed and published in 2023.
Quality and safety indicators for home care recipients in Australia: development and cross-sectional analyses
Authors: Caughey Gillian Elizabeth , Lang Catherine E , Bray Sarah Catherine Elizabeth , Sluggett Janet K , Whitehead Craig , Visvanathan Renuka , Evans Keith , Corlis Megan , Cornell Victoria , Barker Anna L , Wesselingh Steve , Inacio Maria C 
Published: August 2022

ObjectivesTo develop and examine the prevalence of quality and safety indicators to monitor care of older Australians receiving home care packages (HCPs), a government-funded aged care programme to support individuals to live at home independently.DesignCross-sectional.SettingHome care recipients, Australia.Participants90 650 older individuals (aged ≥65 years old and ≥50 years old for people of Aboriginal or Torres Strait Islander descent) who received a HCP between 1 January 2016 and 31 December 2016 nationally were included.Primary and secondary outcome measuresThe Registry of Senior Australians developed 15 quality and safety indicators: antipsychotic use, high sedative load, chronic opioid use, antimicrobial use, premature mortality, home medicines reviews, chronic disease management plan, wait-time for HCP, falls, fractures, medication-related adverse events, weight loss/malnutrition, delirium/dementia-related hospitalisations, emergency department (ED) presentations and pressure injuries. Risk adjusted prevalence (%, 95% CI) and geographical area (statistical level 3) variation during 2016 were examined.ResultsIn 2016, a total of 102 590 HCP episodes were included for 90 650 individuals, with 66.9% (n=68 598) level 1–2 HCP episodes (ie, for basic care needs) and 33.1% (n=33 992) level 3–4 HCP (ie, higher care needs). The most prevalent indicators included: antibiotic use (52.4%, 95% CI 52.0 to 52.7), chronic disease management plans (38.1%, 95% CI 37.8 to 38.4), high sedative load (29.1%, 95% CI 28.8 to 29.4) and ED presentations (26.4%, 95% CI 25.9 to 26.9). HCP median wait time was 134 days (IQR 41–406). Geographical variation was highest in chronic disease management plans and ED presentations (20.7% of areas outside expected range).ConclusionA comprehensive outcome monitoring system to monitor the quality and safety of care and variation for HCP recipients was developed. It provides a pragmatic, efficient and low burden tool to support evidence-based quality and safety improvement initiatives for the aged care sector.
Exploring changes in maternal and congenital syphilis epidemiology to identify factors contributing to increases in congenital syphilis in Florida: a two time-period observational study (2013–2014 vs 2018–2019)
Authors: Matthias James , Spencer Emma C , Bowen Virginia B , Peterman Thomas A 
Published: August 2022

ObjectivesAs, cases of congenital syphilis (CS) and infectious syphilis among women more than doubled in Florida and across the nation during 2013–2019, we sought to understand what may be contributing to these increases in Florida.DesignA two time-period observational study.SettingPregnant women with reported syphilis infections and their pregnancy outcomes (2013–2014 and 2018–2019) in Florida.Participants1213 pregnant women with reported syphilis infections living in Florida and 341 infants meeting the CS case definition.Outcome measuresWe assessed what proportion of the increase in CS was from increases in maternal syphilis infections. We examined maternal demographics, infection characteristics and timing of diagnoses that could explain the increase in CS. Finally, we reviewed if changes in presentation or severity of CS cases occurred.ResultsDuring 2013–2014, 83 (21%) of 404 pregnant women with syphilis delivered babies with CS. During 2018–2019, 258 (32%) of 809 pregnant women with syphilis delivered babies with CS. Comparing CS prevention rates, it was determined that 65% of the increase in CS was due to the increases in maternal syphilis infections. The proportion of maternal cases staged as primary or secondary increased over time (7%–13%) (p<0.01) and reports of drug use became slightly more common (6%–10%) (p=0.02). During 2018–2019, women delivering CS infants were more likely to be reinfected during the same pregnancy (27 (10%) vs 5 (6%) p=0.23) and more had negative third trimester screening tests (43 (17%) vs 7 (8% p=0.07)). The percentage of infants with CS who had ≥1 sign or symptom increased from 35% to 40%, and the combined total of stillbirths and infant deaths increased from 5 to 26.ConclusionsRecently, more pregnant women are being infected with syphilis and a higher per cent are not being treated to prevent CS. The reasons for this finding are unclear.
Coproduced resources to support parents caring for children with gastrostomies
Authors: Page Bethan , Harrop Emily , Beale Tania , Boyce Katherine , Smith Colette , Butler Siobhan , Sharrard Alison , Vincent Charles , Lee Alex CH 
Published: August 2022

ObjectiveTo describe and disseminate a package of support for parents who care for children with gastrostomies, consisting of a library of videos and resources to support families from referral for gastrostomy surgery, to long-term support at home.MethodsThe resources were systematically developed and evaluated by parents, hospital and community-based nurses, paediatricians, a surgeon and researchers.ResultsThe videos empower families, reduce their anxiety and increase their confidence, providing support throughout the families’ journey. Surveys and feedback from parents and clinicians show that the video library is seen as providing clear and comprehensive guidance and is suitable for integration into routine practice. To effectively disseminate these resources across a region, the videos need to be shared widely with relevant community and hospital-based teams, and shared through parent networks. The videos should be viewed as one part of a wider package of training and support, in combination with hands-on-practice and clinical support.ConclusionsThe resources described have been developed with and for families. Critically the videos are founded in the lived-experience of families, as well as the expertise of clinicians from community and hospital services. Similar resources are needed to support families performing other types of specialist care. The resources are freely available to any parent or clinical team.
Exploring the phenotype of Italian patients with ALS with intermediateATXN2polyQ repeats
Authors: Chio Adriano , Moglia Cristina , Canosa Antonio , Manera Umberto , Grassano Maurizio , Vasta Rosario , Palumbo Francesca , Gallone Salvatore , Brunetti Maura , Barberis Marco , De Marchi Fabiola , Dalgard Clifton , Chia Ruth , Mora Gabriele , Iazzolino Barbara , Peotta Laura , Traynor Bryan , Corrado Lucia , D'Alfonso Sandra , Mazzini Letizia , Calvo Andrea 
Published: August 2022

ObjectiveTo detect the clinical characteristics of patients with amyotrophic lateral sclerosis (ALS) carrying an intermediateATXN2polyQ number of repeats in a large population-based series of Italian patients with ALS.MethodsThe study population includes 1330 patients with ALS identified through the Piemonte and Valle d’Aosta Register for ALS, diagnosed between 2007 and 2019 and not carryingC9orf72, SOD1, TARDBPandFUSmutations. Controls were 1274 age, sex and geographically matched Italian subjects, identified through patients’ general practitioners.ResultsWe found 42 cases and 4 controls with≥31 polyQ repeats, corresponding to an estimated OR of 10.4 (95% CI 3.3 to 29.0). Patients with≥31 polyQ repeats (ATXN2+) compared with those without repeat expansion (ATXN2−) had more frequently a spinal onset (p=0.05), a shorter diagnostic delay (p=0.004), a faster rate of ALSFRS-R progression (p=0.004) and King’s progression (p=0.004), and comorbid frontotemporal dementia (7 (28.0%) vs 121 (13.4%), p=0.037). ATXN2+ patients had a 1-year shorter survival (ATXN2+ patients 1.82 years, 95% CI 1.08 to 2.51; ATXN2− 2.84 years, 95% CI 1.67 to 5.58, p=0.0001).ATXN2polyQ intermediate repeats was independently related to a worse outcome in Cox multivariable analysis (p=0.006).ConclusionsIn our population-based cohort, ATXN2+ patients with ALS have a distinctive phenotype, characterised by a more rapid disease course and a shorter survival. In addition, ATXN2+ patients have a more severe impairment of cognitive functions. These findings have relevant implications on clinical practice, including the possibility of refining the individual prognostic prediction and improving the design of ALS clinical trials, in particular as regards as those targeted explicitly toATXN2.
Alberta Stroke Program Early CT Score and collateral status predict target mismatch in large vessel occlusion with delayed time windows
Authors: Hang Yu , Wang Chen dong , Ni Heng , Cao Yuezhou , Zhao Lin Bo , Liu Sheng , Shi Hai-Bin , Jia Zhenyu 
Published: August 2022

BackgroundThe Alberta Stroke Program Early CT Score (ASPECTS) and collateral score (CS) are two readily available imaging metrics for the evaluation of acute ischemic stroke (AIS) with large vessel occlusion (LVO).ObjectiveTo investigate the predictive value of the ASPECTS combined with CS in detecting patients with CT perfusion (CTP) target mismatch in delayed time windows.MethodsOne hundred and sixty-four patients with LVO-AIS were included. ASPECTS was assessed on non-contrast CT (NCCT). CS was evaluated on single-phase CT angiography (sCTA). Target mismatch was defined as a CTP core volume ≤70 mL, mismatch ratio ≥1.8, and absolute mismatch volume ≥15 mL. Spearman correlation analysis and receiver operating characteristic curve analyses were performed.ResultsThe median NCCT ASPECTS of the 164 patients was 8 (IQR 6–9), median sCTA-CS was 2 (IQR 1–2), and median CTP core volume was 8 mL (IQR 0–29.5). There was a strong correlation between NCCT ASPECTS and CTP core volume (rs=−0.756, p<0.0001) and a moderate correlation between the sCTA-CS and CTP core volume (rs=−0.450, p<0.0001). Integrating NCCT ASPECTS and sCTA-CS provided a higher area under the curve (AUC) for predicting target mismatch (AUC=0.882; sensitivity, 89.1%; specificity, 77.8%; p<0.001).ConclusionsNCCT ASPECTS had a strong correlation with CTP core volumes in patients with LVO-AIS in delayed time windows. Combining NCCT ASPECTS with sCTA-CS resulted in a more accurate prediction of target mismatch. If a CTP scan is not available, NCCT ASPECTS combined with sCTA-CS may guide clinicians in making treatment decisions.
Safety of anticoagulation use for treatment of portal vein thrombosis in liver cirrhosis and its effect on hospital-based outcomes: an insight from a US nationwide database
Authors: Tarar Zahid Ijaz , Farooq Umer , Kamal Faisal , Nawaz Ahmad , Saleem Saad , Ghous Ghulam , Basar Omer , Chela Harleen Kaur , Tahan Veysel , Daglilar Ebubekir 
Published: August 2022

Abstract

Background and aim
Anticoagulation use for portal vein thrombosis (PVT) in patients with advanced liver disease is controversial. We investigated the effect of anticoagulation on outcomes in patients with PVT with cirrhosis.

Methods
We reviewed National Inpatient Sample data from 2016 to 2018 to identify patients with PVT. Our outcomes were in-hospital mortality, variceal bleeding, hepatic encephalopathy, acute kidney injury (AKI), hepatorenal syndrome (HRS), spontaneous bacterial peritonitis (SBP), sepsis and hospital resource utilisation.

Results
We included 60 505 patients with PVT, out of whom 6.63% (4015) were on anticoagulation. The overall mortality in the anticoagulation group was 2.12% compared with 9.72% in the no anticoagulation group. The adjusted odds of mortality were low in the anticoagulation group (adjusted OR (AOR) 0.27, 95% CI 0.15 to 0.46, p&lt;0.001). Patients on anticoagulation had 29% lower odds of variceal bleeding (AOR 0.71, 95% CI 0.53 to 0.96, p=0.03). Lower odds of HRS (AOR 0.56, 95% CI 0.37 to 0.85, p=0.01) and AKI (AOR 0.57, 95% CI 0.48 to 0.69, p&lt;0.001) were also seen in the anticoagulation group. Patients in the anticoagulation group also showed lower odds of SBP (AOR 0.62, 95% CI 0.43 to 0.89, p=0.01) and sepsis (AOR 0.57, 95% CI 0.35 to 0.93, p=0.03). Anticoagulation use resulted in shorter hospital stay by 1.15 days (adjusted length of stay −1.15, 95% CI −1.51 to –0.79, p&lt;0.001). The mean difference in total hospital charges between the anticoagulation and the no anticoagulation group was −$20 034 (95% CI −$27 077 to −$12 991, p&lt;0.001).

Conclusion
Our analysis found that anticoagulation use is safe and associated with better outcomes in patients with PVT with advanced liver disease.
Levels of nicotine and tobacco-specific nitrosamines in oral nicotine pouches
Authors: Mallock Nadja , Schulz Thomas , Malke Sebastian , Dreiack Nadine , Laux Peter , Luch Andreas 
Published: August 2022

BackgroundNicotine pouches without tobacco are new products that deliver nicotine into the body via the oral mucosa. There is a lack of independent research on the chemical composition and product characteristics of these products, contributing to uncertainties regarding product regulation. This study sought to address knowledge gaps by assessing levels of nicotine and screening for tobacco-specific nitrosamines (TSNAs) in a sample of these products.MethodsNicotine pouches (n=44) and nicotine-free pouches (n=2) from 20 different manufacturers were analysed regarding their contents of nicotine and TSNAs by gas chromatography with flame ionisation and liquid chromatography–tandem mass spectrometry, respectively. Product labelling and pH values of aqueous extracts were determined.ResultsNicotine contents of products ranged from 1.79 to 47.5 mg/pouch; median product weight, pH, and proportion of free-base nicotine were 0.643 g, 8.8, and 86%, respectively. A clear labelling of the nicotine content was missing on 29 products and nicotine strength descriptions were ambiguous. TSNAs were detected in 26 products, with a maximum of 13 ng N-nitrosonornicotine/pouch.ConclusionAlthough nicotine pouches may potentially be a reduced risk alternative for cigarette smokers or users of some other oral tobacco products, nicotine contents of some pouches were alarmingly high. Presence of carcinogenic TSNAs in the nicotine pouches is of serious concern. Better manufacturing processes and quality control standards should be implemented. Labels of nicotine strength on most products are misleading. A strict regulation regarding nicotine contents and its labelling would be advisable.
Cigarette excise tax structure and cigarette prices in nine sub-Saharan African countries: evidence from the Global Adult Tobacco Survey
Authors: Filby Samantha , Van Walbeek Corné , Pan Liping 
Published: August 2022

BackgroundEconomic theory predicts that the excise tax structure influences the distribution of cigarette prices. Evidence shows that uniform specific excise tax structures exhibit the least price variability relative to other tax structures. The distribution of cigarette prices under different excise tax structures has never been examined for a group of African countries.ObjectivesTo examine the distribution of cigarette prices under different tax structures in nine African countries and to critically evaluate the effectiveness of African regional tax directives in promoting public health.MethodsData from the Global Adult Tobacco Survey, conducted in eight African countries during 2012–2018, and data from the 2017 Gambia Tobacco Survey were used to construct survey-derived cigarette prices. The coefficients of variation and skewness of the price distribution were compared in the context of each country’s cigarette excise tax structure.ResultsThe least price variability is found in countries with a uniform specific tax, or a mixed system with a minimum specific floor. Cigarette price variability is largest in countries with uniform ad valorem tax structures. Three of the four countries with ad valorem tax structures are in regional blocs, where the tax directives specify that they should implement an ad valorem structure.ConclusionsRegional tax directives that require the adoption of uniform specific excise taxes, or high minimum specific floors, could be an efficient way to get multiple African countries to adopt a tax structure that reduces substitution possibilities in response to excise tax increases.
Culturally specific health-related features on cigarette packs sold in China
Authors: Cui Yuxian , Dai Zheng , Cohen Joanna E , Rosas Scott , Clegg Smith Katherine , Welding Kevin , Czaplicki Lauren 
Published: August 2022

BackgroundChina is the country with the highest burden of tobacco-caused disease. We characterised the extent to which cigarette pack marketing features (eg, imagery, text, pack color) could potentially mislead consumers by suggesting products are healthy.MethodsWe used two methods: group concept mapping and content analysis. First, we used a group concept mapping approach to generate and sort Chinese consumer responses to an open-ended prompt asking what marketing features suggest a product is ‘healthy’ or ‘good for you’. Second, based on the concept mapping results, we developed a codebook of health-related features on cigarette packs that were relevant to the unique cultural context of product marketing in China. Two trained coders who were native Chinese speakers double-coded a sample of 1023 cigarette packs purchased in 2013 (wave 1) and 2017 (wave 2). We examined differences in the presence of features overall and over time.ResultsOverall, 83.5% (n=854) of Chinese cigarette packs in our sample contained at least one ‘healthy’ or ‘good for you’ feature, and the presence of health-related features on packs remained constant between wave 1 (83.5%, n=354) and wave 2 (83.5%, n=500; p=1.00). Across both waves, the most common categories of culturally specific health features present related to recycling symbols, rare animal imagery, bright colours (eg, bright yellow) and botanical imagery (eg, bamboo, mint).ConclusionHealth-related features on cigarette packs sold in China are common. Enhanced policies to address tobacco packaging, labelling and branding could support and facilitate a reduction in the high tobacco burden in China.
MUC5B, telomere length and longitudinal quantitative interstitial lung changes: the MESA Lung Study
Authors: Kim John S , Manichaikul Ani W , Hoffman Eric A , Balte Pallavi , Anderson Michaela R , Bernstein Elana J , Madahar Purnema , Oelsner Elizabeth C , Kawut Steven M , Wysoczanski Artur , Laine Andrew F , Adegunsoye Ayodeji , Ma Jennie Z , Taub Margaret A , Mathias Rasika A , Rich Stephen S , Rotter Jerome I , Noth Imre , Garcia Christine Kim , Barr R Graham , Podolanczuk Anna J 
Published: August 2022

BackgroundTheMUC5Bpromoter variant (rs35705950) and telomere length are linked to pulmonary fibrosis and CT-based qualitative assessments of interstitial abnormalities, but their associations with longitudinal quantitative changes of the lung interstitium among community-dwelling adults are unknown.MethodsWe used data from participants in the Multi-Ethnic Study of Atherosclerosis with high-attenuation areas (HAAs, Examinations 1–6 (2000–2018)) andMUC5Bgenotype (n=4552) and telomere length (n=4488) assessments. HAA was defined as the per cent of imaged lung with attenuation of −600 to −250 Hounsfield units. We used linear mixed-effects models to examine associations ofMUC5Brisk allele (T) and telomere length with longitudinal changes in HAAs. Joint models were used to examine associations of longitudinal changes in HAAs with death and interstitial lung disease (ILD).ResultsTheMUC5Brisk allele (T) was associated with an absolute change in HAAs of 2.60% (95% CI 0.36% to 4.86%) per 10 years overall. This association was stronger among those with a telomere length below an age-adjusted percentile of 5% (p value for interaction=0.008). A 1% increase in HAAs per year was associated with 7% increase in mortality risk (rate ratio (RR)=1.07, 95% CI 1.02 to 1.12) for overall death and 34% increase in ILD (RR=1.34, 95% CI 1.20 to 1.50). Longer baseline telomere length was cross-sectionally associated with less HAAs from baseline scans, but not with longitudinal changes in HAAs.ConclusionsLongitudinal increases in HAAs were associated with theMUC5Brisk allele and a higher risk of death and ILD.
Efficacy and Safety of Coronary Intervention via Distal Transradial Access (dTRA) in Patients with Low Body Mass Index
Authors: Li La-Mei , Zhang Liu-Yan , Huang Hao-Min , Chen Tao , Li Feng , Shi Gan-Wei , Li Wen-Hua , Xiao Jian-Qiang , Gong Chun , Xue She-Liang , Xu Bo , Gu Jun , Song Yan-Bin , Shen Dan-Dan , Ji Rong-Rong , Cai Gao-Jun 
Published: August 2022

The study aimed to investigate the efficacy and safety of coronary intervention via distal transradial access (dTRA) in patients with low body mass index (BMI). A total of 67 patients with low BMI who underwent coronary intervention, comprising 29 patients via dTRA and 38 patients via conventional transradial access (cTRA), were retrospectively included. There was no significant difference in the puncture success rate between the two groups (dTRA 96.6%, cTRA 97.4%,

P
=
0.846

). Compared with the cTRA group, the success rate of one-needle puncture in the dTRA group was lower (51.7% vs. 81.6%,

P
=
0.020

). The compression haemostasis time in the dTRA group was shorter than that in the cTRA group (

P

<

0.001

). However, the incidence of radial artery occlusion was lower in the dTRA group than in the cTRA group (4.0% vs. 33.3%,

P
=
0.007

). In conclusion, coronary intervention via dTRA was safe and effective in patients with low BMI.