bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers and Motives for Complying With “Sexual Distancing” Among Men Who Have Sex With Men During the First COVID-19 Pandemic Lockdown in Amsterdam: A Qualitative Study
Authors: de Vries Dominique C. , Zimmermann Hanne M.L. , Drückler Susanne , Davidovich Udi , Hoornenborg Elske , de Vries Henry John C. 
Published: April 2022

Background
Between March 15 and May 31, 2020, the Dutch government imposed lockdown and health measures to curb the coronavirus disease 2019 (COVID-19) pandemic. As part of social distancing, sexual distancing was one of these measures. Sexual distancing implied refraining from sex with partners outside of one's household. We aimed to elucidate barriers and motives for complying with sexual distancing and related factors that could have led to (non)compliance among men who have sex with men.

Methods
In this exploratory qualitative study, we interviewed men who have sex with men who visited the center for sexual health in Amsterdam during the first COVID-19 lockdown using a semistructured interview guide from March to May 2020. We interviewed both men who complied and did not comply with sexual distancing. The interviews were transcribed verbatim and analyzed using an open-coding process in MAXQDA.

Results
We included 18 noncompliers and 4 compliers to COVID-19 sexual distancing. Barriers to compliance were the following: lack of information on, or understanding of, the need for sexual distancing; being single; having had an active sex life before COVID-19; a high perceived importance of the social aspect of sex; a strong urge for sex; using sex to cope with the negative impact of the pandemic; being under the influence of alcohol or drugs; and not perceiving COVID-19 as a serious health threat. Motives for compliance were the following: perceiving COVID-19 as a serious health threat, direct confrontation with critically ill COVID-19 patients, protecting someone dear from COVID-19, and being convinced of the importance of social and/or sexual distancing measures.

Conclusions
Information on sexual distancing needs to be made more explicit, accessible, understandable, inclusive, customized to individual barriers, and relatable to the key populations. This may improve the effectiveness of measures and health recommendations in both the current COVID-19 pandemic and future respiratory outbreaks.
Association Between Digoxin Use and Cardiac Function in Infants With Single-Ventricle Congenital Heart Disease During the Interstage Period
Authors: Kumar Karan R. , Flair Antonina , Thompson Elizabeth J. , Zimmerman Kanecia O. , Andersen Nicholas D. , Hill Kevin D. , Hornik Christoph P. 
Published: April 2022

OBJECTIVES:
To examine the association between digoxin use and cardiac function assessed by echocardiographic indices in infants with single-ventricle (SV) congenital heart disease (CHD) during the interstage period.

DESIGN
Retrospective cohort study.

SETTING:
Fifteen North American hospitals.

PATIENTS:
Infants discharged home following stage 1 palliation (S1P) and prior to stage 2 palliation (S2P). Infants with no post-S1P and pre-S2P echocardiograms were excluded.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Of 373 eligible infants who met inclusion criteria, 140 (37.5%) were discharged home on digoxin. In multivariable linear and logistic regressions, we found that compared with infants discharged home without digoxin, those discharged with digoxin had a smaller increase in end-systolic volume (β = –8.17 [95% CI, –15.59 to –0.74]; p = 0.03) and area (β = –1.27 [–2.45 to –0.09]; p = 0.04), as well as a smaller decrease in ejection fraction (β = 3.38 [0.47–6.29]; p = 0.02) and fractional area change (β = 2.27 [0.14–4.41]; p = 0.04) during the interstage period.

CONCLUSIONS:
Digoxin may partially mitigate the expected decrease in cardiac function during the interstage period through its positive inotropic effects. Prospective clinical trials are needed to establish the pharmacokinetics, safety, and efficacy of digoxin use in SV CHD.
Impact of Blood Sampling on Anemia in the PICU: A Prospective Cohort Study
Authors: François Tine , Sauthier Michaël , Charlier Julien , Dessureault Jessica , Tucci Marisa , Harrington Karen , Ducharme-Crevier Laurence , Al Omar Sally , Lacroix Jacques , Du Pont-Thibodeau Geneviève 
Published: April 2022

OBJECTIVES:
Fifty percent of children are anemic after a critical illness. Iatrogenic blood testing may be a contributor to this problem. The objectives of this study were to describe blood sampling practice in a PICU, determine patient factors associated with increased sampling, and examine the association among blood sampling volume, anemia at PICU discharge, and change in hemoglobin from PICU entry to PICU discharge.

DESIGN
Prospective observational cohort study.

SETTING:
PICU of Sainte-Justine University Hospital.

PATIENTS:
All children consecutively admitted during a 4-month period.

MEASUREMENTS AND MAIN RESULTS:
Four hundred twenty-three children were enrolled. Mean blood volume sampled was 3.9 (±19) mL/kg/stay, of which 26% was discarded volume. Children with central venous or arterial access were sampled more than those without access (p < 0.05). Children with sepsis, shock, or cardiac surgery were most sampled, those with a primary respiratory diagnosis; the least (p < 0.001). We detected a strong association between blood sample volume and mechanical ventilation (H, 81.35; p < 0.0001), but no association with severity of illness (Worst Pediatric Logistic Organ Dysfunction score) (R, –0.044; p = 0.43). Multivariate analysis (n = 314) showed a significant association between the volume of blood sampled (as continuous variable) and anemia at discharge (adjusted OR, 1.63; 95% CI, 1.18–2.45; p = 0.003). We lacked power to detect an association between blood sampling and change in hemoglobin from PICU admission to PICU discharge.

CONCLUSIONS:
Diagnostic blood sampling in PICU is associated with anemia at discharge. Twenty-five percent of blood losses from sampling is wasted. Volumes are highest for patients with sepsis, shock, or cardiac surgery, and in patients with vascular access or ventilatory support.
Trainee-led Engagement of the Care Team Improves Application of an Institutional Blood Culture Clinical Decision Algorithm to Pediatric Oncology Inpatients: A Single-institution Quality Improvement Project
Authors: Lemberg Kathryn M. , Koontz Danielle W. , Young David J. , DiDomizio P. Galen , King Anne , Chen Allen R. , Gamper Christopher J. , Colantuoni Elizabeth , Milstone Aaron M. , Cooper Stacy L. 
Published: April 2022

Introduction:
Meaningful engagement in quality improvement (QI) projects by trainees is often challenging. A fellow-led QI project aimed to improve adherence to a blood culture clinical decision algorithm and reduce unnecessary cultures in pediatric oncology inpatients.

Methods:
We visualized preintervention rates of blood cultures drawn on pediatric oncology inpatients using a control chart. Following the introduction of the algorithm to our division, an Ishikawa fishbone diagram of cause-and-effect identified two areas for improvement: prescriber education on the algorithm and targeted feedback on its use. We developed two interventions to support algorithm awareness and use: (1) bundled educational interventions and (2) targeted chart review and feedback. Fellows reviewed >750 blood culture episodes and adjudicated each as “adherent” or “nonadherent” to the algorithm. In addition, fellows provided direct feedback to prescribers regarding nonadherent episodes and discussed strategies for algorithm adherence.

Results:
Blood culture rates in preintervention, intervention, and follow-up periods were 33.35, 25.24, and 22.67 cultures/100 patient-days, respectively. The proportion of nonadherent culture episodes decreased from 47.14% to 11.11%. The use of the algorithm did not prolong the time to cultures drawn on patients with new fever. Seventy-five percent of fellows provided feedback to inpatient teams on algorithm use. Following this project, trainees reported feeling more qualified to apply QI principles to patient care.

Conclusions:
Implementation of a clinical decision algorithm reduced the rate of cultures drawn on pediatric oncology inpatients. Fellow-led education of the care team decreased the proportion of nonadherent culture episodes and provided active engagement in QI.
Disease Course of Primary Dupuytren Disease: 5-Year Results of a Prospective Cohort Study
Authors: Broekstra Dieuwke C. , Lanting Rosanne , Werker Paul M. N. , van den Heuvel Edwin R. 
Published: April 2022

Background:
Predicting progression of Dupuytren disease becomes relevant in an upcoming era with progression-preventing treatment. This study aimed to determine the course of Dupuytren disease and identify factors associated with progression.

Methods:
Two hundred fifty-eight patients with Dupuytren disease participated in this prospective cohort study, obtaining 17,645 observations in 5 years. Outcomes were disease extent (surface area) and contracture severity (total passive extension deficit). Demographics, lifestyle, health status, exposure to manual work, and genetic risk scores were gathered as potential predictors. Subject-specific, mixed-effects models were used to estimate disease course, and logistic regression with least absolute shrinkage and selection operator was used to evaluate factors associated with the presence of progression.

Results:
On average, Dupuytren disease was progressive in all finger rays with regard to area [yearly increase, 0.07 cm2 (95% CI, 0.02 to 0.13 cm2) to 0.25 cm2 (95% CI, 0.11 to 0.39 cm2)]. Progression in total passive extension deficit was only present on the small finger side [yearly increase, 1.75 degrees (95% CI, 0.30 to 3.20 degrees) to 6.25 degrees (95% CI, 2.81 to 9.69 degrees)]. Stability or regression in area and total passive extension deficit was observed in 11 and 13 percent and 16 and 15 percent (dominant and nondominant hands), respectively. Smoking, cancer, genetic risk score, and hand injury were univariate associated with progression in area, but after multivariate variable selection, none of these associations remained. No predictors for progression in total passive extension deficit were found.

Conclusions:
Dupuytren disease is progressive, especially with respect to disease extent. Progression in contracture severity is mainly present on the small finger side of the hand. None of the traditional risk and diathesis factors were associated with progression, indicating that new hypotheses about Dupuytren disease progression might be needed.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Can Posttransarterial Chemoembolization Volumetric Oil Deposition on Computed Tomography Predict Treatment Response on Magnetic Resonance Imaging in Leiomyosarcoma Metastases to the Liver?
Authors: Hazhirkarzar Bita , Shaghaghi Mohammadreza , Baghdadi Azarakhsh , Ghadimi Maryam , Ghasabeh Mounes Aliyari , Wu Qingxia , Tang Hao , Khoshpouri Pegah , Ameli Sanaz , Habibabadi Roya R. , Motaghi Mina , Meyer Christian F. , Kamel Ihab R. 
Published: April 2022

Objective
To predict early tumor response to transarterial chemoembolization (TACE) based on volumetric oil deposition on posttreatment computed tomography (CT) in patients with leiomyosarcoma liver metastases.

Methods
This retrospective lesion-by-lesion based study included 32 lesions. The volumetric percent enhancing tumor on pre-TACE and 1-month post-TACE venous phase magnetic resonance imaging (MRI), and the percent oil deposition on CT 1 day after TACE were calculated. The predicted post-TACE enhanced percentage was computed by subtracting percent oil deposition from baseline percent enhanced.

Results
Mean percentage of viable tumor on pre-TACE MRI was 90.6% ± 9.3%. Mean oil deposition was calculated as 51.4% ± 26.2%. Mean percentage of measured residual tumor enhancement 1 month after TACE was 58.3% ± 27%, which correlates with predicted enhancement percentage of 43.9% ± 25.1% (r = 0.72, P < 0.001). A threshold of 35.5% for enhancement reduction was determined to predict tumor response with an accuracy of 78.1%.

Conclusion
Volumetric oil deposition on CT can predict residual enhancement on post-TACE MRI.
A Modified Bowel Displacement Technique for Magnetic Resonance Imaging–Guided Focused Ultrasound Surgery in the Treatment of Uterine Fibroids and Adenomyosis
Authors: Lai Mao , Chen Ye , Li Haoxiong , Li Yajie , Wu Shiman , Li Zhanfeng , Zhang Qi 
Published: April 2022

Objective
The clinical application of magnetic resonance imaging–guided focused ultrasound (MRgFUS) surgery for treatment of symptomatic uterine fibroids is often limited because of the bowel between the abdominal wall and uterus. If bowels are in the pathway of sonication path, firstly filling the bladder, then filling the rectum, and emptying the bladder subsequently can be used to avoid them in recent research. The purpose of this study was to evaluate whether the modified bowel displacement technique (rectal filling first and then bladder filling, with or without subsequent bladder emptying) was feasible to create secure acoustic window.

Methods
A total of 78 patients who had undergone MRgFUS treatment for uterine fibroids and adenomyosis from January 2020 to November 2020 were included in this retrospective study. Of the 78 patients, 19 patients were treated using a modified bowel displacement technique, whereas the rest of the patients did not require intestinal displacement. High-intensity focused ultrasound was performed using GE Sightec HDXT 1.5 Tesla MR and ExAblate high-intensity focused ultrasound system.

Results
Of the 19 patients requiring bowel displacement techniques, 17 patients successfully completed MRgFUS surgery. Magnetic resonance imaging–guided focused ultrasound surgery was feasible in 4 patients after rectal filling, bladder filling, and subsequent bladder emptying. The others received ablation through the extended bladder because of bowel descending after emptying the bladder. The surgery caused no intestinal or uterine complications and no serious discomfort to the patient.

Conclusions
The modified bowel displacement technique was effective in displacing interposed bowels during MRgFUS treatment to create safe acoustic pathway for ablating uterine fibroids and adenomyosis.
Intensive Care Unit Critical Incident Analysis as an Objective Tool to Select Content for a Simulation Curriculum
Authors: Yartsev Alex , Yang Feibi 
Published: April 2022

Introduction
The intensive care unit (ICU) offers a unique environment where emergency events are frequent, high-stakes, and carefully documented, which makes it an ideal setting to research the specific technical skills, which are deployed during such events. This study aimed to describe a method of objectively identifying skills and scenarios, which should be prioritized for inclusion in a simulation curriculum.

Method
A retrospective audit of all available critical incident data (11 months) from a 36-bed tertiary ICU was performed. Code blue events were analyzed. Data were coded according to a rubric based on Le Guen and Costa-Pinto (Intern Med J. 2020;51(8):1298–1303) tallying the occurrence of common ICU scenarios and skills.
Documentation of each event was analyzed. The frequency with which a skill or scenario appeared in these events was considered as “high frequency” if it occurred in more than 20% of the events.
The trainees' confidence in a particular skill was assessed by means of a self-assessment survey questionnaire (based on an anchored 6-item rating scale).

Results
One hundred twenty-one incidents were analyzed. Sixteen were eliminated because of insufficient documentation. The most common skills during these emergency events were familiarity with the advanced life support trolley (34% of events), electrocardiogram (ECG) rhythm strip interpretation (32.4%), and the operation of an external defibrillator (29.5%).
Most trainees surveyed are preparing to undergo training in anesthesia (58%) or intensive care (28%). Specialized areas of expertise (troubleshooting an extra-corporeal membrane oxygenation (ECMO) circuit or intra-aortic balloon pump) had the lowest confidence scores (average scores of 0.81 and 0.72).

Conclusions
We highlighted a novel, reproducible, and objective methodology by which critical incident data can be integrated with trainee self-assessment to generate a targeted simulation curriculum.
Social Support during pregnancy: A phenomenological exploration of young women’s experiences of support networks on pregnancy care and wellbeing in Soweto, South Africa
Authors: Mabetha Khuthala , Soepnel Larske , Klingberg Sonja , Mabena Gugulethu , Motlhatlhedi Molebogeng , Norris Shane A , Draper Catherine E 
Published: April 2022

AbstractSocial support is deemed to have a crucial influence on maternal health and wellbeing during pregnancy. The objective of the study was to explore the experiences of pregnant young females and their receipt of social support in Soweto, South Africa. An interpretive phenomenological approach was employed to understand and interpret pregnant young women’s lived experiences of support networks on their pregnancy care and wellbeing. Data was collected conducting 18 indepth interviews with young pregnant women. Analysis of the data resulted in the development of two superordinate themes: (1) relationships during pregnancy and (2) network involvement. Each superordinate theme was linked to subthemes that helped explain whether young women had positive or negative experiences of social support during their pregnancy care, and their wellbeing. The sub-themes emanating from the superordinate theme ‘relationships during pregnancy’ were (a) behavioural response of partner following disclosure of pregnancy, (b) behavioural response of family following disclosure of pregnancy, and (c) sense of emotional security. Accompanying subthemes of the superordinate theme ‘network involvement’ were (a) emotional and instrumental support, and (b) information support. An interpretation of the young women’s experiences has revealed that young women’s satisfaction with existing support networks and involvement of the various social networks contributed greatly to the participants having a greater sense of potential parental efficacy and increased acceptance of their pregnancies. Pregnant women who receive sufficient social support from immediate networks have increased potential to embrace and give attention to pregnancy-related changes. This could, in turn, foster positive behavioural outcomes that encourage engaging in good pregnancy care practices and acceptance of motherhood.Focusing on previously unexamined factors that could improve maternal health, such as social support, could improve maternal mortality rates and help achieve reproductive health accessibility universally.
Functional response to a microbial synbiotic in the gastrointestinal system of constipated children
Authors: Tierney Braden T. , Versalovic James , Fasano Alessio , Petrosino Joseph F , Chumpitazi Bruno , Mayer Emeran A. , Boetes Jared , Smits Gerard , Parkar Shanthi G. , Voreades Noah , Kartal Ece , Bron Peter A. , Reid Gregor , Dhir Raja , Mason Christopher E. 
Published: April 2022

AbstractBackgroundOral microbial therapy has been studied as an intervention for a range of gastrointestinal and immunological disorders. Though emerging research suggests microbial exposure may intimately affect the gastrointestinal system, motility, and host immunity in a pediatric population, data has been inconsistent and variable, with the majority of prior studies conducted in neither a randomized nor placebo-controlled setting. The aim of this placebo-controlled study was to evaluate efficacy of a synbiotic (a prebiotic and rationally-defined microbial consortia) on increasing weekly bowel movement frequency in constipated children.MethodsSixty-four children (3-17 years of age) were randomized to receive a synbiotic composition (n=33) comprised of mixed-chain length, prebiotic oligosaccharides and nine microbial strains or placebo (n=31) for 84 days. Stool microbiota was analyzed using shotgun metagenomic sequencing on samples collected at baseline (T1) and completion (T2). The primary outcome was change from baseline of Weekly Bowel Movements (WBMs) in children compared to placebo.ResultsTreatment with a multi-strain synbiotic significantly (p < 0.05) increased the number of WBMs in children with low bowel movement frequency (< 4 WBMs and < 5 WBMs), irrespective of broadly distinctive microbiome signatures at baseline. Metagenomic shotgun sequencing revealed that low baseline microbial richness in the treatment group significantly anticipated improvements in constipation (p = 0.00074).ConclusionsThese findings suggest the potential for (i) multi-species synbiotic interventions to improve digestive health in a pediatric population and (ii) bioinformatics-based methods to predict response to microbial interventions in children.ImpactSynbiotic microbial treatment exerted functional improvements in the number of spontaneous Weekly Bowel Movements in children compared to placeboIntervention induced a significant bifidogenic effect in children compared to placeboAll administered probiotic species were enriched in the gut microbiome of the intervention group compared to placeboBaseline microbial richness demonstrated potential as a predictive biomarker for response to intervention
Impact of SARS-CoV-2 vaccination on systemic immune responses in people living with HIV
Authors: Bessen Clara , Plaza-Sirvent Carlos , Bhat Jaydeep , Marheinecke Corinna , Urlaub Doris , Bonowitz Petra , Busse Sandra , Schumann Sabrina , Vidal Blanco Elena , Skaletz-Rorowski Adriane , Brockmeyer Norbert H , Overheu Oliver , Reinacher-Schick Anke , Faissner Simon , Watzl Carsten , Pfaender Stephanie , Potthoff Anja , Schmitz Ingo 
Published: April 2022

AbstractThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) and an ongoing global pandemic. Despite the development of vaccines, which protect healthy people from severe and life-threatening COVID-19, the immunological responses of people with secondary immunodeficiencies to SARS-CoV-2 mRNA vaccines are currently not well understood. Human Immunodeficiency Virus (HIV), causing acquired immunodeficiency syndrome (AIDS), targets CD4+ T helper (Th) cells that orchestrate the immune response. Anti-retroviral therapy suppresses HIV burden and restores Th cell numbers. Here, we investigated the humoral and cellular immune responses elicited by the BTN162b2 vaccine in a cohort of people living with HIV (PLWH), who receive anti-retroviral therapy. While antibody responses in PLWH increased progressively after the first and second vaccination compared to baseline, they were reduced compared to HIV negative study participants (controls). CD8+ T cells exhibited a general activated phenotype and increased effector and effector memory compartments. In contrast, CD4+ Th cell responses exhibited a vaccination-dependent increase and were comparable between PLWH and controls. In line with their reduced humoral response, the correlation between neutralizing antibodies and the CD4+ T cell response was decreased in PLWH compared to healthy controls. Interestingly, CD4+ T cell activation negatively correlated with the CD4 to CD8 ratio, indicating that low CD4 T cell numbers do not necessarily interfere with cellular immune responses. Taken together, our data demonstrate that COVID-19 mRNA vaccination in PLWH results in potent cellular immune responses, but the reduced antibody responses suggest that booster vaccination might be required for preventing disease.