bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of the COVID-19 pandemic on maternal and perinatal health service utilisation and outcomes in Mozambique: an interrupted time series analysis
Authors: Lydon Megan M , Vilanculos Joaquim , Martinez Andres , Barata Américo , Keyes Emily 
Published: November 2022

ObjectivesTo measure the effects of the COVID-19 pandemic on maternal and perinatal health services and outcomes in Mozambique.DesignThis is an observational study analysing routine service delivery data using interrupted time series analysis. We used 43 months of district-level panel data with April 2020 as the point of interruption, adjusting for seasonality and population growth to analyse service utilisation outcomes.SettingThe 222 public health facilities in Nampula Province, Mozambique, from January 2018 to July 2021.Outcome measuresThe change in the number of antenatal care (ANC) visits and facility deliveries, and the change in the rate of adverse birth outcomes at pandemic onset and over time compared with expected levels and trends, respectively.ResultsThere were no significant disruptions to ANC at pandemic onset. Following this, there was a significant monthly increase of 29.8 (18.2–41.4) first ANC visits and 11.3 (5.5–17.2) ANC visits within the first trimester per district above prepandemic trends. There was no significant change in the number of fourth ANC visits completed. At the onset of COVID-19, districts experienced a significant decrease of 71.1 (−110.5 to −31.7) facility deliveries, but the rate then increased significantly above prepandemic trends. There was no significant increase in any adverse birth outcomes during the pandemic. Conversely, districts observed a significant monthly decrease of 5.3 uterine rupture cases (−9.9 to −0.6) and 19.2 stillbirths (−33.83 to −4.58) per 100 000 facility deliveries below prepandemic trends. There was a significant drop of 23.5 cases of neonatal sepsis/100 000 facility deliveries per district at pandemic onset.ConclusionDespite pandemic interference, Nampula Province saw no disruptions to ANC, only temporary disruptions to facility deliveries and no increases in adverse birth outcomes. ANC visits surprisingly increased, and the rates of uterine rupture, stillbirth and neonatal sepsis decreased, suggesting that Nampula Province may offer insights about health system resilience.
Care coordination and unmet need for specialised health services among children with special healthcare needs in the USA: results from a cross-sectional analysis of the national survey of children with special healthcare needs
Authors: Graaf Genevieve , Gigli Kristin 
Published: November 2022

ObjectiveTo report rates of need and unmet need for specialised health services (occupational and speech therapies, durable medical equipment, home healthcare, and mobility and communication aids) from the National Survey of Children with Special Health Care Needs (CSHCN) (2009/2010) and assess the role of care coordination in having needs met. We distinguish between CSHCN with and without emotional, behavioural and developmental disorders (EBDPs) in the USA.DesignA cross sectional cohort study of a nationally representative sample of CSHCN from the National Survey of CSHCN for 2009/2010 used logistic regression to assess the relationship between EBDPs and need and unmet need for specialised services. It also estimates the association of care coordination with unmet need for all services, for CSHCN with and without EBDPs.SettingA nationally representative sample of CSHCN in the USA.ParticipantsChildren ages 0–17 years of age.ResultsAcross all specialised health services, rates of unmet need were at or below 25%. Need and unmet need for most services was higher among CSHCN with EBDPs than those without. For CSHCN with and without EBDPs, adequate care coordination was associated with greater probability of having needs for therapy, home health and communication aids met.ConclusionCare coordination is essential to reducing barriers to a wide range of healthcare services for CSCHN. Policies requiring adequate insurance coverage for care coordination may play a critical role in ensuring access to specialised health services.
Effects of hydromorphone-based intravenous patient-controlled analgesia with and without a low basal infusion on postoperative hypoxaemia: study protocol for a randomised controlled clinical trial
Authors: Ma Yumei , Deng Zhuomin , Feng Xiangying , Luo Jialin , Meng Yang , Lin Jingjing , Mu Xiaoxiao , Yang Xuan , Nie Huang 
Published: November 2022

IntroductionWhen patients receive patient-controlled intravenous analgesia (PCIA), no basal infusion is always recommended, as the addition of a basal infusion increases the occurrence of postoperative opioid-induced respiratory depression. However, few studies have investigated whether low basal infusions increase the incidence of postoperative hypoxaemia relative to no basal infusion. We intend to conduct a clinical trial to test the hypothesis that PCIA with a low basal infusion does not increase the occurrence of postoperative hypoxaemia relative to PCIA with no basal infusion.Methods and analysisThis single-centre parallel randomised controlled clinical trial will be conducted with 160 patients undergoing gastrointestinal tumour surgery. The assigned nurse will set analgesic pumps (low or no basal infusion PCIA) according to block-based randomisation sequence. Other investigators and all participants will be blinded to intervention allocation. All patients will be monitored continuously with the ep pod, a wireless wearable device, recording of oxygen saturation (SpO2) and daily ambulation duration for 48 hours postoperatively. Three follow-up evaluations will be conducted to assess the analgesic effect (Numeric Rating Scale (NRS) pain score) and opioid-related side effects (Overall Benefit of Analgesic Score (OBAS)). The primary outcome will be the area under the curve for hypoxaemia (defined as SpO2<95%) per hour. The secondary outcomes will be the areas under the curve for hypoxaemia defined as SpO2<90% and <85% per hour, hydromorphone consumption, OBASs at 24 and 48 hours postoperatively, NRS scores at 4, 24 and 48 hours postoperatively, and the ambulation time per hour over 48 hours.Ethics and disseminationThe study has been approved by the Xijing Hospital Ethics Committee (KY20212163-F-1). Written informed consent will be obtained from all patients or their authorised surrogates. All data will be managed with confidentiality. Findings will be disseminated at international conferences and in peer-reviewed journals.Trial registration numberChiCTR2100054317.
Cellular Cancer Immunotherapy Development and Manufacturing in the Clinic
Authors: Fenton Graeme A. , Mitchell Duane A. 
Published: November 2022

AbstractThe transfusion of naturally derived or modified cellular therapies, referred to as adoptive cell therapy (ACT), has demonstrated clinical efficacy in the treatment of hematologic malignancies and metastatic melanoma. In addition, cellular vaccination, such as dendritic cell–based cancer vaccines, continues to be actively explored. The manufacturing of these therapies presents a considerable challenge to expanding the use of ACT as a viable treatment modality, particularly at academic production facilities. Furthermore, the expanding commercial interest in ACT presents new opportunities as well as strategic challenges for the future vision of cellular manufacturing in academic centers. Current trends in the production of ACT at tertiary care centers and prospects for improved manufacturing practices that will foster further clinical benefit are reviewed herein.
Monocytes: A Promising New TRAIL in Ovarian Cancer Cell Therapy
Authors: Chow Stephanie , Dorigo Oliver 
Published: November 2022

Summary
Adoptive cell transfer of IFN-activated monocytes administered intraperitoneally to patients with platinum-resistant ovarian cancer demonstrated antitumor effects and acceptable tolerability. The exposure of monocytes to IFNα and IFNγ upregulated TRAIL, which triggered caspase 8 and direct cell-to-cell contact-dependent apoptosis of ovarian cancer cells.
See related article by Green et al., p. 349
Endothelial Extracellular Signal‐Regulated Kinase/Thromboxane A2/Prostanoid Receptor Pathway Aggravates Endothelial Dysfunction and Insulin Resistance in a Mouse Model of Metabolic Syndrome
Authors: Sato Atsushi , Yumita Yusuke , Kagami Kazuki , Ishinoda Yuki , Kimura Toyokazu , Osaki Ayumu , Toya Takumi , Namba Takayuki , Endo Shogo , Ido Yasuo , Nagatomo Yuji , Satoh Yasushi , Adachi Takeshi 
Published: November 2022

Background
Metabolic syndrome is characterized by insulin resistance, which impairs intracellular signaling pathways and endothelial NO bioactivity, leading to cardiovascular complications. Extracellular signal‐regulated kinase (ERK) is a major component of insulin signaling cascades that can be activated by many vasoactive peptides, hormones, and cytokines that are elevated in metabolic syndrome. The aim of this study was to clarify the role of endothelial ERK2 in vivo on NO bioactivity and insulin resistance in a mouse model of metabolic syndrome.

Methods and Results
Control and endothelial‐specific ERK2 knockout mice were fed a high‐fat/high‐sucrose diet (HFHSD) for 24 weeks. Systolic blood pressure, endothelial function, and glucose metabolism were investigated. Systolic blood pressure was lowered with increased NO products and decreased thromboxane A2/prostanoid (TP) products in HFHSD‐fed ERK2 knockout mice, and Nω‐nitro‐l‐arginine methyl ester (L‐NAME) increased it to the levels observed in HFHSD‐fed controls. Acetylcholine‐induced relaxation of aortic rings was increased, and aortic superoxide level was lowered in HFHSD‐fed ERK2 knockout mice. S18886, an antagonist of the TP receptor, improved endothelial function and decreased superoxide level only in the rings from HFHSD‐fed controls. Glucose intolerance and the impaired insulin sensitivity were blunted in HFHSD‐fed ERK2 knockout mice without changes in body weight. In vivo, S18886 improved endothelial dysfunction, systolic blood pressure, fasting serum glucose and insulin levels, and suppressed nonalcoholic fatty liver disease scores only in HFHSD‐fed controls.

Conclusions
Endothelial ERK2 increased superoxide level and decreased NO bioactivity, resulting in the deterioration of endothelial function, insulin resistance, and steatohepatitis, which were improved by a TP receptor antagonist, in a mouse model of metabolic syndrome.
Trust in Medicine, the Health System & Public Health
Authors: Blendon Robert J. , Benson John M. 
Published: November 2022

Abstract
This essay reviews more than forty years of public opinion polling to look at trust in medicine, the health system, and public health. We use polling data to explore the reasons for the decline and current level of public trust in leaders of medicine and public health, including underlying forces such as the decline in trust in other institutions. Except for the military, none of the efforts to improve public trust in various institutions have been very successful to date. Given the uncertainty about how to restore trust, this essay makes a number of recommendations that might improve public trust in medicine and public health in the future.
A Comparison between 2D and 3D Rescaling Masks of Initial Condition Perturbation in a 3-km Storm-Scale Ensemble Prediction System
Authors: Deng Guo , Du Jun , Zhou Yushu , Yan Ling , Chen Jing , Chen Fajing , Li Hongqi , Wang Jingzhou 
Published: November 2022

Abstract
Using a 3-km regional ensemble prediction system (EPS), this study tested a three-dimensional (3D) rescaling mask for initial condition (IC) perturbation. Whether the 3D mask-based EPS improves ensemble forecasts over current two-dimensional (2D) mask-based EPS has been evaluated in three aspects: ensemble mean, spread, and probability. The forecasts of wind, temperature, geopotential height, sea level pressure, and precipitation were examined for a summer month (1–28 July 2018) and a winter month (1–27 February 2019) over a region in North China. The EPS was run twice per day (initiated at 0000 and 1200 UTC) to 36 h in forecast length, providing 56 warm-season forecast cases and 54 cold-season cases for verification. The warm and cold seasons are verified separately for comparison. The study found the following: 1) The vertical profile of IC perturbation becomes closer to that of analysis uncertainty with the 3D rescaling mask. 2) Ensemble performance is significantly improved in all three aspects. The biggest improvement is in the ensemble spread, followed by the probabilistic forecast, and the least improvement is in the ensemble mean forecast. Larger improvements are seen in the warm season than in the cold season. 3) More improvement is in the shorter time range (<24 h) than in the longer range. 4) Surface and lower-level variables are improved more than upper-level ones. 5) The underlying mechanism for the improvement has been investigated. Convective instability is found to be responsible for the spread increment and, thus, overall ensemble forecast improvement. Therefore, using a 3D rescaling mask is recommended for an EPS to increase its utility especially for shorter time range and surface weather elements.

Significant Statement
A weather prediction model is a complex system that consists of nonlinear differential equations. Small errors in either its inputs or model itself will grow with time during model integration, which will contaminate a forecast. To quantify such contamination (“uncertainty”) of a forecast, the ensemble forecasting technique is used. An ensemble of forecasts is a multiple of model runs at the same time but with slightly “perturbed” inputs or model versions. These small perturbations are supposed to represent true “uncertainty” in inputs or model representation. This study proposed a technique that makes a perturbation’s vertical structure more resemble real uncertainty (intrinsic error) in input data and confirmed that it can significantly improve ensemble forecast quality especially for a shorter time range and lower-level weather elements. It is found that convective instability is responsible for the improvement.
Comparison of anal pre-cancer screening strategies among men who have sex with men
Authors: Sun Jing , Wiley Dorothy , Barrett Benjamin W , Hsu Hilary , Palella Frank J , Kwait Jennafer , Martinson Jeremy , D’Souza Gypsyamber 
Published: November 2022

Purpose Comparison of anal pre-cancer screening strategies in men who have sex with men (MSM). Methods MSM in the Multicenter AIDS Cohort Study underwent repeated anal cytology (aCyt), oncogenic human papillomavirus (oncHPV) testing. A subset received High-Resolution Anoscopy (HRA). We evaluated three screening strategies for their ability to predict anal histological High-Grade Squamous Intraepithelial lesion (HSIL): single aCyt, sequential aCyt, and oncHPV co-testing. Multivariable logistic regression models evaluated risk of HSIL among participants undergoing HRA within 5 years of screening. Sensitivity and specificity were estimated among participants with HRA, and results corrected for verification bias using weighted generalized estimating equations. Results There were 1426 MSM with aCyt screening (48% people with HIV [PWH]) and 428 that underwent HRA. Median age was 57 years, 14% of PWH had CD4< 350 cells/mm3. HSIL probability was higher in MSM with one (39%, p < 0.01) or two abnormal aCyt results (46%, p < 0.01), versus those with normal aCyt (23–24%). Among men with abnormal aCyt, men with oncHPV+ had significantly higher risk than those who were oncHPV- (47% vs. 16%, p < 0.01). Specificity was modest with single aCyt+ (50%) but increased with sequential aCyt+ (79%) or oncHPV+ (67%). Sensitivity was high with single oncHPV+ (88%), moderate with single aCyt+ (66%) and oncHPV+ co-testing (61%), and low with sequential aCyt+ (39%). After correcting for potential verification bias, specificity increased and sensitivity decreased, but inferences were similar. Conclusion None of the screening strategies evaluated had both sufficient specificity and sensitivity to warrant routine widespread use.
Long Term Recidivism Rates Among Individuals at High Risk to Sexually Reoffend
Authors: Hanson R. Karl , Lee Seung C. , Thornton David 
Published: November 2022

Preventive detention provisions in the US and Canada assume we can identify, in advance, individuals at high risk for sexual recidivism. To test this assumption, 377 adult males with a history of sexual offending were followed for 20 years using Canadian national criminal history records and Internet searches. Using previously collected information, a high risk/high need (HRHN) subgroup was identified based on an unusually high levels of criminogenic needs ( n = 190, average age of 38 years; 83% White, 13% Indigenous, 4% other). A well above average subgroup of 99 individuals was then identified based on high Static-99R (6+) and Static-2002R (7+) scores. In the HRHN group, 40% reoffended sexually. STATIC HRHN norms overestimated sexual recidivism at 5 years (Static-99R, E/O = 1.44; Static-2002R, E/O = 1.72) but were well calibrated for longer follow-up periods (20 years: Static-99R, E/0 = 1.00; Static-2002R, E/O = 1.16). The overall sexual recidivism rate for the well above average subgroup was 52.1% after 20 years, and 74.3% for any violent recidivism. The highest risk individuals (top 1%) had rates in the 60%–70% range. We conclude that some individuals present a high risk for sexual recidivism, and can be identified using currently available methods.
Impact of Antimicrobial-Resistant Bacterial and Polymicrobial Infection on Wound Healing After Minor Forefoot Amputation in Chronic Limb-Threatening Ischemia With Infection
Authors: Kato Taku , Yanagiuchi Takashi , Hirano Keita , Imura Haruki , Matsubara Kunihiko , Hanabusa Katsuyuki , Ota Yutaro , Yamazaki Shinya , Ushimaru Shunpei , Yokoi Hirokazu 
Published: November 2022

Objectives: This study aimed to evaluate the relationship between bacteriological findings and wound healing after minor amputation in the treatment of chronic limb-threatening ischemia (CLTI) with infection. Methods: This single-center retrospective study analyzed 135 consecutive limbs with tissue loss and infection from 120 patients who underwent endovascular therapy (EVT) and minor forefoot amputation for CLTI with wound infection between November 2017 and August 2021. The Kaplan-Meier method was used to assess the rate of wound healing after the procedure. The Cox proportional-hazards model was used to examine the impact of bacteriological findings and baseline characteristics on wound healing. Results: The wound healing rate at 6 months was 72.6%. In a multivariate analysis, in addition to hemodialysis (hazard ratio [HR]=1.73; p=0.009) and amputation above the metatarsophalangeal (MP) joint (HR=1.81; p=0.006), antimicrobial-resistant bacterial infection (HR=1.80, p=0.004) and polymicrobial infection (H=1.51; p=0.049) were predictors of delayed wound healing. Conclusion: Antimicrobial-resistant bacterial infection, polymicrobial infection, hemodialysis, and amputation above the MP joint were independent predictors of delayed wound healing after EVT and minor forefoot amputation in patients with CLTI and bacterial wound infection. Clinical Impact In this single-center retrospective study, we analyzed 136 consecutive limbs with tissue loss and infection from 120 patients who underwent endovascular therapy and minor forefoot amputation for chronic limb-threatening ischemia (CLTI) with wound infection between November 2017 and August 2021. Our main findings were that antimicrobial-resistant bacterial infection, polymicrobial infection, hemodialysis, and amputation above the metatarsophalangeal joint were independent predictors of delayed wound healing after minor amputation. This is the first report of the association between bacteriological studies and wound healing in CLTI with infection, and will be of great help in the future clinical practice.
Satisfaction with alemtuzumab in relapsing multiple sclerosis patients: Results from the real-world PRO-ACT study
Authors: Wray Sibyl , Jacques Francois , Miller Tamara A , Nicholas Jacqueline A , Arroyo Rafael , Travis Lori , Khatri Bhupendra , Chirieac Magdalena , Gandhi Roopali , Roesch Nora , Rodrigues Amelie , Melas-Melt Lydie , Rawlings Andreea M , Hunter Samuel F 
Published: November 2022

Background Patient-reported outcomes are increasingly used in the management of patients with multiple sclerosis to understand the patient's perspective of disease and treatment. These measures provide insights into important factors including treatment satisfaction, physical and psychological function, and quality of life. Objective To present results from the real-world PRO-ACT study in patients with multiple sclerosis who switched to alemtuzumab from another disease-modifying therapy. Methods This 24-month, prospective, multicenter, observational study had a primary endpoint of change in overall satisfaction, measured using the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4. Secondary endpoints included the Multiple Sclerosis Impact Scale-29 (MSIS-29), Modified Fatigue Impact Scale-5 (MFIS-5), and the Patient-Determined Disease Steps (PDDS). Safety was monitored with adverse events (AEs). Results Of 199 enrolled patients, improvements were observed in mean TSQM scores for overall satisfaction (baseline, 50.3; year 2, + 13.2; p  < 0.0001), effectiveness (49.3 and + 12.2; p  < 0.0001), and side effects (77.6 and + 4.5; p  = 0.04). Improvements were also observed in MSIS-29 physical (52.4 and −6.0; p  < 0.0001), MSIS-29 psychological (53.4 and −7.0; p  = 0.0003), and MFIS-5 (12.8 and −1.7; p  < 0.0001). Most (95.0%) patients experienced ≥ 1 AE (88.4% mild, 67.8% moderate). Conclusions The primary endpoint was met; the safety of alemtuzumab was consistent with pivotal studies.
Pattern of Injury in Polytrauma Compared to Single Limb Related Midfoot Fractures
Authors: Mason Lyndon W. , Mangwani Jitendra , Tanaka Hiro , Airey Grace L. , Chapman James , Kyaw Htin , Boksh Khalis , Elbannan Mamdouh M. 
Published: November 2022

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Midfoot fractures in polytrauma patients are often an under appreciated injury relative to their other major injuries sustained. In this study, our aim was to explore the mechanisms and patterns of injury in a polytrauma related midfoot fractures as compared to single limb injuries. Methods: Setting: Multicentre observational study Methods: Data was retrospectively collected from three centres on surgically treated midfoot fracture dislocations between 2011 and 2021. Radiographs were analysed using departmental PACS. All statistics was performed using SPSS 26. Results: A total of 212 cases were included in the study. Almost all polytrauma cases had occurred as the result of a fall from height or road traffic collision (RTC) (19/20). In single limb injuries, 32% (61/192) had also occurred as the result of fall from height or RTC. The most common mechanism for single limb midfoot fracture was a trip (79/192). Crush injuries only occurred in the single limb injury group in our cohort (n=21). Regarding patterns of injury, there was no significant difference in prevalence of medial column injury (p=.260), or central column injury (p=.704). There were significantly more lateral column injuries in the polytrauma group (75% vs 44%, p=.008), and the polytrauma group was exclusively fracture related compared to 17% of single limb injury having purely ligamentous injury (p=.047). Conclusion: Polytrauma related midfoot injuries have a higher prevalence of lateral column injury than the single limb injuries. Single limb injuries can however, have an equally significant force involved as polytrauma patients with over 50% occurring as the result of high velocity injury. A high index of suspicion should be maintained for midfoot injuries in high velocity mechanisms, regardless of other injuries sustained.