bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved glucometrics in people with type 1 diabetes 1 year into the COVID-19 pandemic
Authors: Ali Namam , El Hamdaoui Soumia , Nefs Giesje , Tack Cornelis J , De Galan Bastiaan E 
Published: May 2022

IntroductionVarious studies have shown a number of glycemic parameters to improve over several weeks in people with type 1 diabetes during the first surge of the COVID-19 pandemic. Whether and to what extent such improvement is sustained during following COVID-19 surges remains unknown. Therefore, the aim of this study was to investigate glycemic parameters during the first year of the COVID-19 pandemic in people with type 1 diabetes and to determine factors associated with glycemic improvement.Research design and methodsThis was an observational cohort study in people with type 1 diabetes, aged ≥16 years. We compared glycated hemoglobin (HbA1c) and flash glucose monitoring (FGM) downloads between the prelockdown period and approximately 1 year thereafter. Using logistic regression analysis, we assessed associations between an HbA1creduction of at least 0.5% (~5.5 mmol/mol) with baseline clinical characteristics and self-reported changes in psychological well-being and lifestyle behavior related to COVID-19.ResultsA total of 437 participants were included. As compared with prepandemic data, 1 year after the start of the COVID-19 pandemic and associated lockdowns, HbA1chad decreased from 7.9%±1.1% (63±12 mmol/mol) to 7.5%±1.0% (59±11 mmol/mol) (p<0.001), whereas time in range increased from 55.8%±16.7% to 58.6%±16.7% (p=0.004) and time below (<3.9 mmol/L) and above (>13.9 mmol/L) range and glucose variability all decreased (all p<0.05). FGM use, higher HbA1cat baseline and current smoking were independently associated with an HbA1cdecrease of at least 0.5%, whereas self-reported changes in psychological well-being and lifestyle behavior related to the first surge of the COVID-19 pandemic and associated lockdowns were not.ConclusionsThe COVID-19 pandemic and related lockdown measures were associated with improvement in glucometrics, including HbA1cand FGM data, in individuals with type 1 diabetes, particularly in FGM users, those with higher HbA1cat baseline or current smokers.
Lost microbes of COVID-19:Bifidobacterium,Faecalibacteriumdepletion and decreased microbiome diversity associated with SARS-CoV-2 infection severity
Authors: Hazan Sabine , Stollman Neil , Bozkurt Huseyin S , Dave Sonya , Papoutsis Andreas J , Daniels Jordan , Barrows Brad D , Quigley Eamonn MM , Borody Thomas J 
Published: May 2022

ObjectiveThe study objective was to compare gut microbiome diversity and composition in SARS-CoV-2 PCR-positive patients whose symptoms ranged from asymptomatic to severe versus PCR-negative exposed controls.DesignUsing a cross-sectional design, we performed shotgun next-generation sequencing on stool samples to evaluate gut microbiome composition and diversity in both patients with SARS-CoV-2 PCR-confirmed infections, which had presented to Ventura Clinical Trials for care from March 2020 through October 2021 and SARS-CoV-2 PCR-negative exposed controls. Patients were classified as being asymptomatic or having mild, moderate or severe symptoms based on National Institute of Health criteria. Exposed controls were individuals with prolonged or repeated close contact with patients with SARS-CoV-2 infection or their samples, for example, household members of patients or frontline healthcare workers. Microbiome diversity and composition were compared between patients and exposed controls at all taxonomic levels.ResultsCompared with controls (n=20), severely symptomatic SARS-CoV-2-infected patients (n=28) had significantly less bacterial diversity (Shannon Index, p=0.0499; Simpson Index, p=0.0581), and positive patients overall had lower relative abundances ofBifidobacterium(p<0.0001),Faecalibacterium(p=0.0077) andRoseburium(p=0.0327), while having increasedBacteroides(p=0.0075). Interestingly, there was an inverse association between disease severity and abundance of the same bacteria.ConclusionWe hypothesise that low bacterial diversity and depletion ofBifidobacteriumgenera either before or after infection led to reduced proimmune function, thereby allowing SARS-CoV-2 infection to become symptomatic. This particular dysbiosis pattern may be a susceptibility marker for symptomatic severity from SARS-CoV-2 infection and may be amenable to preinfection, intrainfection or postinfection intervention.Trial registration numberNCT04031469(PCR−) and 04359836 (PCR+).
Youth social innovation during the COVID-19 pandemic in the Philippines: a quantitative and qualitative descriptive analyses from a crowdsourcing open call and online hackathon
Authors: Ulitin Allan , Mier-Alpaño Jana Deborah , Labarda Meredith , Juban Noel , Mier Abigail Ruth , Tucker Joseph D , Tang Weiming , Auplish Mallika , Chan Po-lin 
Published: May 2022

IntroductionYoung people have played a pivotal role as part of the COVID-19 response, including developing health messages and social innovations. Social innovation in health engages multiple stakeholders in linking social change and health improvement. The study examined the feasibility of youth ideas and innovations to address the impacts of the COVID-19 pandemic using quantitative and qualitative descriptive analyses.MethodsIn partnership with the WHO, academic institutions, youth organisations and civil society groups, we conducted a crowdsourcing open call among Filipino youth (15–30 years old) using a structured Special Programme for Research and Training in Tropical Diseases/Social Innovation in Health Initiative process. The open call had three categories:youth voices to cocreate the post-COVID-19 world(entries were texts, images, videos and music),youth-led COVID-19 social innovations, andyouth-led social innovations not related to COVID-19. Each submission was evaluated by three independent judges. Finalists were selected in each of the categories alongside four grand winners. All finalists were invited to attend a 1 day online civic hackathon.ResultsWe received a total of 113 entries (youth voices to cocreate the post-COVID world=76;youth-led COVID-19 social innovations=17;youth-led social innovations not related to COVID-19=20). Twelve entries focused on youth mental health during the pandemic. The online hackathon provided the participants mentorship for further development of their ideas. Finalists were able to produce draft health communication campaigns and improved social innovations.ConclusionMany Filipino youth created exceptional entries in response to the open call. This suggests the feasibility of including youth voices in strategic planning processes. A global youth social innovation call is recommended.
‘We just have to make it work’: a qualitative study on assistant nurses’ experiences of patient safety performance in home care services using forum play scenarios
Authors: Ekstedt Mirjam , Schildmeijer Kristina , Backåberg Sofia , Ljungholm Linda , Fagerström Cecilia 
Published: May 2022

ObjectiveSafety is essential to support independent living among the rising number of people with long-term healthcare and social care needs. Safety performance in home care leans heavily on the capacity of unlicensed staff to respond to problems and changes in the older patients’ functioning and health. The aim of this study is to explore assistant nurses’ adaptive responses to everyday work to ensure safe care in the home care context.DesignA qualitative approach using the drama-based learning and reflection technique forum play with subsequent group interviews. The audio-recorded interviews were transcribed and analysed with thematic analysis.SettingHome care services organisations providing care to older people in their private homes in two municipalities in southern Sweden.ParticipantsPurposeful sampling of 24 assistant nurses and three managers from municipal home care services and a local geriatric hospital clinic.ResultsHome care workers’ adaptive responses to provide safe home care were driven by an ambition to ‘make it work in the best interests of the person’ by adjusting to and accommodating care recipient needs and making autonomous decisions that expanded the room for manoeuvrability, while weighing risks of a trade-off between care standards and the benefits for the community-dwelling older people’s independent living. Adaptations to ensure information transfer and knowledge acquisition across disciplines and borders required reciprocity.ConclusionsSafety performance in home care service is dependent on the staff closest to the older people, who deal with safety risks and ethical dilemmas on a day-to-day basis and their access to information, competence, and resources that fit the demands. A proactive leadership characterised by mutual trust and adequate support for decision making is suggested. Managers and decision-makers across healthcare and social care need to consider how they can develop interprofessional collaborations and adaptive routines supporting safety from a broader perspective.
Diagnostic accuracy of code-free deep learning for detection and evaluation of posterior capsule opacification
Authors: Huemer Josef , Kronschläger Martin , Ruiss Manuel , Sim Dawn , Keane Pearse A , Findl Oliver , Wagner Siegfried K 
Published: May 2022

ObjectiveTo train and validate a code-free deep learning system (CFDLS) on classifying high-resolution digital retroillumination images of posterior capsule opacification (PCO) and to discriminate between clinically significant and non-significant PCOs.Methods and analysisFor this retrospective registry study, three expert observers graded two independent datasets of 279 images three separate times with no PCO to severe PCO, providing binary labels for clinical significance. The CFDLS was trained and internally validated using 179 images of a training dataset and externally validated with 100 images. Model development was through Google Cloud AutoML Vision. Intraobserver and interobserver variabilities were assessed using Fleiss kappa (κ) coefficients and model performance through sensitivity, specificity and area under the curve (AUC).ResultsIntraobserver variability κ values for observers 1, 2 and 3 were 0.90 (95% CI 0.86 to 0.95), 0.94 (95% CI 0.90 to 0.97) and 0.88 (95% CI 0.82 to 0.93). Interobserver agreement was high, ranging from 0.85 (95% CI 0.79 to 0.90) between observers 1 and 2 to 0.90 (95% CI 0.85 to 0.94) for observers 1 and 3. On internal validation, the AUC of the CFDLS was 0.99 (95% CI 0.92 to 1.0); sensitivity was 0.89 at a specificity of 1. On external validation, the AUC was 0.97 (95% CI 0.93 to 0.99); sensitivity was 0.84 and specificity was 0.92.ConclusionThis CFDLS provides highly accurate discrimination between clinically significant and non-significant PCO equivalent to human expert graders. The clinical value as a potential decision support tool in different models of care warrants further research.
Remote exposure to secondhand tobacco smoke is associated with lower exercise capacity through effects on oxygen pulse, a proxy of cardiac stroke volume
Authors: Zeng Siyang , Dunn Michelle , Gold Warren M , Kizer Jorge R , Arjomandi Mehrdad 
Published: May 2022

BackgroundPast exposure to secondhand tobacco smoke (SHS) is associated with exercise limitation. Pulmonary factors including air trapping contribute to this limitation but the contribution of cardiovascular factors is unclear.ObjectiveTo determine the contribution of cardiovascular mechanisms to SHS-associated exercise limitation.MethodsWe examined the cardiovascular responses to maximum-effort exercise in 245 never-smokers with remote, prolonged occupational exposure to SHS and no known history of cardiovascular disease. We estimated the contribution of oxygen-pulse (proxy for cardiac stroke volume) and changes in systolic blood pressures (SBP), diastolic blood pressures and heart rate (HR) towards exercise capacity, and examined whether the association of SHS with exercise capacity was mediated through these variables.ResultsAt peak exercise (highest workload completed (WattsPeak)=156±46 watts (135±33 %predicted)), oxygen consumption and oxygen-pulse (O2-PulsePeak) were 1557±476 mL/min (100±24 %predicted) and 11.0±3.0 mL/beat (116±25 %predicted), respectively, with 29% and 3% participants not achieving their predicted normal range. Oxygen saturation at peak exercise was 98%±1% and remained >93% in all participants. Sixty-six per cent showed hypertensive response to exercise. In models adjusted for covariates, WattsPeakwas associated directly with O2-PulsePeak, HRPeakand SBPPeakand inversely with SHS, air trapping (residual volume/total lung capacity) and rise of SBP over workload (all p<0.01). Moreover, SHS exposure association with WattsPeakwas substantially (41%) mediated through its effect on O2-PulsePeak(p=0.038). Although not statistically significant, a considerable proportion (36%) of air trapping effect on WattsPeakseemed to be mediated through O2-PulsePeak(p=0.078). The likelihood of having baseline respiratory symptoms (modified Medical Research Council score ≥1) was associated with steeper rise in SBP over workload (p<0.01).ConclusionIn a never-smoker population with remote exposure to SHS, abnormal escalation of blood pressure and an SHS-associated reduction in cardiac output contributed to lower exercise capacity.
Reducing exacerbations in children and adults with primary ciliary dyskinesia using erdosteine and/or azithromycin therapy (REPEAT trial): study protocol for a multicentre, double-blind, double-dummy, 2×2 partial factorial, randomised controlled trial
Authors: Chang Anne B , Morgan Lucy C , Duncan Emma L , Chatfield Mark D , Schultz André , Leo Paul J , McCallum Gabrielle B , McInerney-Leo Aideen M , McPhail Steven M , Zhao Yuejen , Kruljac Catherine , Smith-Vaughan Heidi C , Morris Peter S , Marchant Julie M , Yerkovich Stephanie T , Cook Anne L , Wurzel Danielle , Versteegh Lesley , O’Farrell Hannah , McElrea Margaret S , Fletcher Sabine , D'Antoine Heather , Stroil-Salama Enna , Robinson Phil J , Grimwood Keith 
Published: May 2022

IntroductionPrimary ciliary dyskinesia (PCD) is a rare, progressive, inherited ciliopathic disorder, which is incurable and frequently complicated by the development of bronchiectasis. There are few randomised controlled trials (RCTs) involving children and adults with PCD and thus evidence of efficacy for interventions are usually extrapolated from people with cystic fibrosis. Our planned RCT seeks to address some of these unmet needs by employing a currently prescribed (but unapproved for long-term use in PCD) macrolide antibiotic (azithromycin) and a novel mucolytic agent (erdosteine). The primary aim of our RCT is to determine whether regular oral azithromycin and erdosteine over a 12-month period reduces acute respiratory exacerbations among children and adults with PCD. Our primary hypothesis is that: people with PCD who regularly use oral azithromycin and/or erdosteine will have fewer exacerbations than those receiving the corresponding placebo medications. Our secondary aims are to determine the effect of the trial medications on PCD-specific quality-of-life (QoL) and other clinical outcomes (lung function, time-to-next exacerbation, hospitalisations) and nasopharyngeal bacterial carriage and antimicrobial resistance.Methods and analysisWe are currently undertaking a multicentre, double-blind, double-dummy RCT to evaluate whether 12 months of azithromycin and/or erdosteine is beneficial for children and adults with PCD. We plan to recruit 104 children and adults with PCD to a parallel, 2×2 partial factorial superiority RCT at five sites across Australia. Our primary endpoint is the rate of exacerbations over 12 months. Our main secondary outcomes are QoL, lung function and nasopharyngeal carriage by respiratory bacterial pathogens and their associated azithromycin resistance.Ethics and disseminationOur RCT is conducted in accordance with Good Clinical Practice and the Australian legislation and National Health and Medical Research Council guidelines for ethical conduct of Research, including that for First Nations Australians.Trial registration numberACTRN12619000564156.
Predicting lying, sitting and walking at different intensities using smartphone accelerometers at three different wear locations: hands, pant pockets, backpack
Authors: Khataeipour Seyed Javad , Anaraki Javad Rahimipour , Bozorgi Arastoo , Rayner Machel , A Basset Fabien , Fuller Daniel 
Published: May 2022

ObjectiveThis study uses machine learning (ML) to develop methods for estimating activity type/intensity using smartphones, to evaluate the accuracy of these models for classifying activity, and to evaluate differences in accuracy between three different wear locations.MethodForty-eight participants were recruited to complete a series of activities while carrying Samsung phones in three different locations: backpack, right hand and right pocket. They were asked to sit, lie down, walk and run three Metabolic Equivalent Task (METs), five METs and at seven METs. Raw accelerometer data were collected. We used the R, activity counts package, to calculate activity counts and generated new features based on the raw accelerometer data. We evaluated and compared several ML algorithms; Random Forest (RF), Support Vector Machine, Naïve Bayes, Decision Tree, Linear Discriminant Analysis and k-Nearest Neighbours using the caret package (V.6.0–86). Using the combination of the raw accelerometer data and the computed features leads to high model accuracy.ResultsUsing raw accelerometer data, RF models achieved an accuracy of 92.90% for the right pocket location, 89% for the right hand location and 90.8% for the backpack location. Using activity counts, RF models achieved an accuracy of 51.4% for the right pocket location, 48.5% for the right hand location and 52.1% for the backpack location.ConclusionOur results suggest that using smartphones to measure physical activity is accurate for estimating activity type/intensity and ML methods, such as RF with feature engineering techniques can accurately classify physical activity intensity levels in laboratory settings.
Cross-sectional survey on researchers’ experience in using accelerometers in health-related studies
Authors: Albrecht Birte Marie , Flaßkamp Fabian Tristan , Koster Annemarie , Eskofier Bjoern M , Bammann Karin 
Published: May 2022

ObjectivesAccelerometers are widely applied in health studies, but lack of standardisation regarding device placement, sampling and data processing hampers comparability between studies. The objectives of this study were to assess how accelerometers are applied in health-related research and problems with accelerometer hardware and software encountered by researchers.MethodsResearchers applying accelerometry in a health context were invited to a cross-sectional web-based survey (August 2020–September 2020). The questionnaire included quantitative questions regarding the application of accelerometers and qualitative questions on encountered hardware and software problems. Descriptive statistics were calculated for quantitative data and content analysis was applied to qualitative data.ResultsIn total, 116 health researchers were included in the study (response: 13.7%). The most used brand was ActiGraph (67.2%). Independently of brand, the main reason for choosing a device was that it was the standard in the field (57.1%–83.3%). In children and adolescent populations, sampling frequency was higher (mean: 73.3 Hz ±29.9 Hz vs 47.6 Hz ±29.4 Hz) and epoch length (15.0s±15.6s vs 30.1s±25.9s) and non-wear time (42.9 min ±23.7 min vs 65.3 min ±35.4 min) were shorter compared with adult populations. Content analysis revealed eight categories of hardware problems (battery problems, compliance issues, data loss, mechanical problems, electronic problems, sensor problems, lacking waterproofness, other problems) and five categories of software problems (lack of user-friendliness, limited possibilities, bugs, high computational burden, black box character).ConclusionsThe study confirms heterogeneity regarding accelerometer use in health-related research. Moreover, several hardware and software problems were documented. Both aspects must be tackled to increase validity, practicability and comparability of research.
Risk assessment and implementation of risk reduction measures is not associated with increased transmission of SARS-CoV-2 compared with standard isolation at professional golf events
Authors: Robinson Patrick Gordon , Murray Andrew , Watson Matt , Close Graeme , Kinane Denis F 
Published: May 2022

ObjectivesThe purpose of this prospective study was to report incidence and transmission of SARS-CoV-2, among professional golfers and essential support staff undergoing risk assessment and enhanced risk reduction measures when considered a close contact as opposed to standard isolation while competing on the DP World Tour during the 2021 season.MethodsThis prospective cohort study included all players and essential support staff participating in 26 DP World Tour events from 18 April 2021 to 21 November 2021. High-risk contacts were isolated for 10 days. Moderate-risk contacts received education regarding enhanced medical surveillance, had daily rapid antigen testing for 5 days, with reverse transcriptase-polymerase chain reaction (RT-PCR) tesing on day 5, mandated mask use and access to outside space for work purposes only. Low-risk contacts typically received rapid antigen testing every 48 hours and RT-PCR testing on day 5.ResultsThe total study cohort compromised 13 394 person-weeks of exposure. There were a total of 30 positive cases over the study period. Eleven contacts were stratified as ‘high risk’. Two of these subsequently tested positive for SARS-CoV-2. There were 79 moderate-risk contact and 73 low-risk contacts. One moderate-risk contact subsequently tested positive for SARS-CoV-2 but did not transmit the virus. All other contacts, remained negative and asymptomatic to the end of the tournament week.ConclusionsA risk assessment and risk reduction-based approach to contact tracing was safe in this professional golf event setting when Alpha and Delta were the predominant variants. It enabled professional golfers and essential support staff to work.
Assisted dying and medical practice: questions and considerations for healthcare organisations
Authors: Worthington Ana , Finlay Ilora , Regnard Claud 
Published: May 2022

ObjectivesMost clinical teams and organisations have not openly or formally discussed how they would react if physician-assisted suicide were to be legalised. This paper aims to discuss some of the potential challenges of introducing ‘assisted dying’ into medical care and produces a table of questions and considerations in light of such evidence so as to promote necessary discussion.MethodsAn analysis of recent quantitative and qualitative studies from jurisdictions where ‘assisted dying’ is practised was conducted, with particular attention paid to studies which focus on the impact of legalising ‘assisted dying’ on clinical care.Results‘Assisted dying’ can have a significant impact on clinical practice by complicating patient care and increasing clinician workload, potentially causing stress on patient care.ConclusionsIf physician-assisted suicide was to be legalised as part of existing healthcare, there are many questions that healthcare organisations must consider. Such considerations are tabulated in order to encourage awareness and discussion on the topic.