bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinician Perception of Risk As a Barrier to Implementation of a High-sensitivity Troponin Accelerated Diagnostic Protocol
Authors: Matuskowitz Andrew J. , Hall John P. , Gregoski Mathew J. , Saef Steven H. 
Published: May 2022

Background:
To assess emergency department (ED) clinician perception of patient risk, we measured willingness to discharge patients categorized as increased risk by traditional risk stratification modalities for acute coronary syndrome but low risk by a validated high-sensitivity troponin accelerated diagnostic protocol (HST-ADP).

Methods:
This was a cross-sectional descriptive survey study distributed to ED clinicians at an urban academic medical center. Four clinical vignettes classified hypothetical patients as low risk for 30-day acute coronary syndrome according to the 0-/1-hour HST-ADP. Vignettes additionally identified patients with History, Electrocardiogram, Age, Risk factors, and initial Troponin (HEART) scores of 4 or 6 (2 cases each). One patient in each subset had preexisting coronary artery disease (CAD). ED clinicians self-reported willingness to discharge patients from the ED on a 10-point Likert scale.

Results:
Among 66 eligible participants, 36 (55%) participated in the survey. ED clinicians reported a mean willingness to discharge patients of 6.07 (95% confidence interval, 5.34–6.80). They reported higher mean willingness to discharge patients with HEART scores of 4 compared with those with HEART scores of 6 (mean difference, 3.61; 95% confidence interval, 2.19–5.03). There were no differences in willingness to discharge regarding presence or absence of CAD or between clinician types (attending, resident, advanced practice provider).

Conclusions:
ED clinicians accustomed to the HEART Pathway demonstrated limited willingness to discharge patients from the ED categorized as moderate risk by the HEART score despite simultaneous classification as low risk by the 0-/1-hour HST-ADP. Willingness to discharge was higher with lower HEART scores but not affected by the presence of CAD and did not vary between clinician types.
Biopsychosocial influence on shoulder pain: results from a randomized preclinical trial of exercise-induced muscle injury
Authors: George Steven Z. , Bishop Mark D. , Wu Samuel S. , Staud Roland , Borsa Paul A. , Wallace Margaret R. , Greenfield Warren. H. , Dai Yunfeng , Fillingim Roger B. 
Published: May 2022

Abstract
Prior cohort studies validated that a subgroup defined by a specific COMT genotype and pain catastrophizing is at increased risk for heightened responses to exercise-induced or surgically induced shoulder pain. In this clinical trial, we used our preclinical model of exercise-induced muscle injury and pain to test the efficacy of interventions matched to characteristics of this high-risk subgroup (ie, personalized medicine approach). Potential participants provided informed consent to be screened for eligibility based on subgroup membership and then, as appropriate, were enrolled into the trial. Participants (n = 261) were randomized to 1 of 4 intervention groups comprised of pharmaceutical (propranolol or placebo) and informational (general education or psychologic intervention) combinations. After muscle injury was induced, participants received randomly assigned treatment and were followed for the primary outcome of shoulder pain intensity recovery over 4 consecutive days. Recovery rates were 56.4% (placebo and psychologic intervention), 55.4% (placebo and general education), 62.9% (propranolol and psychologic intervention), and 56.1% (propranolol and general education). No statistical differences were found between intervention groups in the primary analyses. Additional analyses found no differences between these intervention groups when shoulder pain duration was an outcome, and no differential treatment responses were detected based on sex, race, or level of pain catastrophizing. This trial indicates that these treatments were not efficacious for this high-risk subgroup when shoulder pain was induced by exercise-induced muscle injury. Accordingly, this phenotype should only be used for prognostic purposes until additional trials are completed in clinical populations.
Can early phase cardiac [123I]mIBG images be used to diagnose Lewy body disease?
Authors: Roberts Gemma , Kane Joseph P.M. , Lloyd Jim , Firbank Michael , Donaghy Paul Christopher , Petrides George S. , Taylor John-Paul , O’Brien John , Thomas Alan J. 
Published: May 2022

Purpose
Some studies have suggested that cardiac [123I]metaiodobenzylguanidine images obtained 15–20 min after tracer administration are as accurate for dementia with Lewy bodies (DLB) diagnosis as standard images acquired after a delay of 3–4 h; some suggest delayed imaging is preferable. We compare early and delayed heart-to-mediastinum ratios (HMR) in a well-characterised research dataset and make recommendations for clinical practice.

Methods
Images were acquired using a Siemens gamma camera with medium energy collimators. Early images were obtained at 20 min and delayed at 4 h (± 30) min. In total 167 pairs of images were reviewed: 30 controls, 39 people with dementia and 98 with mild cognitive impairment. HMR normal cutoff values derived from control data were ≥2.10 for early imaging and ≥1.85 for delayed.

Results
HMR tended to drop between early and delayed for abnormal images, but increase for normal images. Histograms of early and delayed HMR showed a slightly better separation of results into two groups for delayed imaging. Accuracy results were slightly higher for delayed imaging than early imaging (73 vs. 77%), sensitivity 63 vs. 65% and specificity 82 vs. 88%. However, this was not statistically significant – in total only 8/167 (5%) of scans changed designation between early and delayed imaging.

Conclusion
We suggest that a delayed image could be acquired only if the early result is borderline. This removes the need for delayed imaging in about 70% of patients. Adopting this protocol in clinical practice would reduce the time most patients have to wait and could free up scanner time.
The Relationship Among Anxiety Sensitivity, Psychache, and Suicidality in Patients With Generalized Anxiety Disorder
Authors: Demirkol Mehmet Emin , Tamam Lut , Namli Zeynep , Karaytuğ Mahmut Onur , Yeşiloğlu Caner 
Published: May 2022

Abstract
Although generalized anxiety disorder (GAD) is associated with suicide, not all dimensions of this relationship have been addressed. This study aimed to investigate the relationship between psychache and anxiety sensitivity with suicidality in patients with GAD. We included 80 patients with GAD (17 of whom had previous suicide attempts). The Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Scale (HAM-D), Beck Scale for Suicidal Ideation (BSIS), Psychache Scale (PS), and Anxiety Sensitivity Index-3 (ASI) were applied to the participants. The patients with previous suicide attempts had significantly higher scores on ASI total, ASI-physical and cognitive subdimensions, HAM-A total and psychic subscale, PS, and BSIS than those without (p < 0.05 for each). Mediation analyses revealed that psychache was a full mediator in the relationship between ASI-cognitive subdimension and suicidal ideation. Therapeutic interventions for anxiety sensitivity and psychache in patients with GAD will help reduce the risk of suicide.
Functional Alterations Due to COVID-19 Lung Lesions—Lessons From a Multicenter V/Q Scan-Based Registry
Authors: Bonnefoy Pierre-Benoît , Bahloul Achraf , Denizot Benoit , Barres Bertrand , Moreau-Triby Caroline , Girma Astrid , Pallardy Amandine , Ceyra Quentin , Sarda-Mantel Laure , Razzouk-Cadet Micheline , Zsigmond Reka , Cachin Florent , Karcher Gilles , Salaun Pierre-Yves , Le Roux Pierre-Yves 
Published: May 2022

Purpose
In coronavirus disease 2019 (COVID-19) patients, clinical manifestations as well as chest CT lesions are variable. Lung scintigraphy allows to assess and compare the regional distribution of ventilation and perfusion throughout the lungs. Our main objective was to describe ventilation and perfusion injury by type of chest CT lesions of COVID-19 infection using V/Q SPECT/CT imaging.

Patients and Methods
We explored a national registry including V/Q SPECT/CT performed during a proven acute SARS-CoV-2 infection. Chest CT findings of COVID-19 disease were classified in 3 elementary lesions: ground-glass opacities, crazy-paving (CP), and consolidation. For each type of chest CT lesions, a semiquantitative evaluation of ventilation and perfusion was visually performed using a 5-point scale score (0 = normal to 4 = absent function).

Results
V/Q SPECT/CT was performed in 145 patients recruited in 9 nuclear medicine departments. Parenchymal lesions were visible in 126 patients (86.9%). Ground-glass opacities were visible in 33 patients (22.8%) and were responsible for minimal perfusion impairment (perfusion score [mean ± SD], 0.9 ± 0.6) and moderate ventilation impairment (ventilation score, 1.7 ± 1); CP was visible in 43 patients (29.7%) and caused moderate perfusion impairment (2.1 ± 1.1) and moderate-to-severe ventilation impairment (2.5 ± 1.1); consolidation was visible in 89 patients (61.4%) and was associated with moderate perfusion impairment (2.1 ± 1) and severe ventilation impairment (3.0 ± 0.9).

Conclusions
In COVID-19 patients assessed with V/Q SPECT/CT, a large proportion demonstrated parenchymal lung lesions on CT, responsible for ventilation and perfusion injury. COVID-19–related pulmonary lesions were, in order of frequency and functional impairment, consolidations, CP, and ground-glass opacity, with typically a reverse mismatched or matched pattern.
68Ga-FAPI Versus 18F-FDG PET/CT in Recurrent Undifferentiated Pleomorphic Sarcoma of Colon Mesentery
Authors: Zhang Linqi , Liu Zhidong , Jiang Shuqin , He Qiao , Zhang Rusen 
Published: May 2022

Abstract
A 56-year-old woman presented with primary undifferentiated pleomorphic sarcoma of colon mesentery underwent complete surgical resection approximately 7 months ago. Abdominal contrast-enhanced CT showed a new mass in the descending colon, suggesting a high probability of tumor recurrence. Under a clinical trial, the patient underwent 68Ga-FAPI and 18F-FDG PET/CT to detect whether there are additional recurrent lesions. Compared with 18F-FDG PET/CT, the recurrent undifferentiated pleomorphic sarcoma of colon mesentery, peritoneum, pelvic lymph node, and lung metastases showed higher uptake in 68Ga-FAPI PET/CT. This case showed that 68Ga-FAPI might be a promising radiopharmaceutical in the evaluation of undifferentiated pleomorphic sarcoma.
Advanced Achalasia Mimicking Delayed Gastric Emptying During Standard Gastric Emptying Scintigraphy
Authors: Wu Chenxi , Hall Lance T. , Brandon David C. 
Published: May 2022

Abstract
An 82-year-old man underwent outpatient nuclear medicine gastric-emptying scintigraphy (GES) for dysphagia and regurgitation. Standard solid-meal GES showed significant elongated tracer retention with calculated 96% retention rate at 3 hours, with a presumed diagnosis of delayed gastric emptying. Subsequent CT of the chest and abdomen and upper gastrointestinal fluoroscopy instead showed normal size and function of the stomach but an enormously dilated esophagus with food debris, compatible with achalasia. Attention should be made on the location and shape of the visualized “stomach” and recognize that significantly dilated esophagus can mimic an elongated stomach during GES.
A research agenda for the study of social norm change
Authors: Andrighetto Giulia , Vriens Eva 
Published: May 2022

Social norms have been investigated across many disciplines for many years, but until recently, studies mainly provided indirect, implicit and correlational support for the role of social norms in driving behaviour. To understand how social norms, and in particular social norm change, can generate a large-scale behavioural change to deal with some of the most pressing challenges of our current societies, such as climate change and vaccine hesitancy, we discuss and review several recent advances in social norm research that enable a more precise underpinning of the role of social norms: how to identify their existence, how to establish their causal effect on behaviour and when norm change may pass tipping points. We advocate future research on social norms to study norm change through a mechanism-based approach that integrates experimental and computational methods in theory-driven, empirically calibrated agent-based models. As such, social norm research may move beyond unequivocal praising of social norms as the missing link between self-interested behaviour and observed cooperation or as the explanation for (the lack of) social tipping. It provides the toolkit to understand explicitly where, when and how social norms can be a solution to solve large-scale problems, but also to recognize their limits.
This article is part of the theme issue 'Emergent phenomena in complex physical and socio-technical systems: from cells to societies'.
Small-molecule autocatalytic networks are universal metabolic fossils
Authors: Xavier Joana C. , Kauffman Stuart 
Published: May 2022

Life and the genetic code are self-referential and so are autocatalytic networks made of simpler, small molecules. Several origins of life theories postulate autocatalytic chemical networks preceding the primordial genetic code, yet demonstration with biochemical systems is lacking. Here, small-molecule reflexively autocatalytic food-generated networks (RAFs) ranging in size from 3 to 619 reactions were found in all of 6683 prokaryotic metabolic networks searched. The average maximum RAF size is 275 reactions for a rich organic medium and 93 for a medium with a single organic cofactor, NAD. In the rich medium, all universally essential metabolites are produced with the exception of glycerol-1-p (archaeal lipid precursor), phenylalanine, histidine and arginine. The 300 most common reactions, present in at least 2732 RAFs, are mostly involved in amino acid biosynthesis and the metabolism of carbon, 2-oxocarboxylic acid and purines. ATP and NAD are central in generating network complexity, and because ATP is also one of the monomers of RNA, autocatalytic networks producing redox and energy currencies are a strong candidate niche of the origin of a primordial information-processing system. The wide distribution of small-molecule autocatalytic networks indicates that molecular reproduction may be much more prevalent in the Universe than hitherto predicted.This article is part of the theme issue 'Emergent phenomena in complex physical and socio-technical systems: from cells to societies'.
Comparison of tests done, and Tuberculosis cases detected by Xpert® MTB/RIF and Xpert® MTB/RIF-Ultra in Uganda
Authors: Kakinda Michael , Tugumisirize Didas , Nyombi Abdunoor , Mugisha Marvin , Turyahabwe Stavia , Walusimbi Simon , Matovu Joseph K. B 
Published: May 2022

AbstractBackgroundUganda introduced Xpert® MTB/RIF assay into its TB diagnostic algorithm in January 2012. In July 2018, this assay was replaced with Xpert® MTB/RIF Ultra assay. We set out to compare the tests done and tuberculosis cases detected by Xpert® MTB/RIF and Xpert® MTB/RIF Ultra assay in Uganda.MethodsThis was a before and after study, with the tests done and TB cases detected between Jan-June 2019 when using Xpert® MTB/RIF Ultra assay compared to those done between Jan-June 2018 while using Xpert® MTB/RIF assay. This data was analyzed using Stata version 13, it was summarized into measures of central tendency and the comparison between Xpert® MTB/RIF Ultra and Xpert® MTB/RIF was explored using a two-sided T-test which was considered significant if p <0.05.ResultsOne hundred and twelve (112) GeneXpert sites out of a possible 239 were included in the study. 128,476 (M: 1147.11, SD: 842.88) tests were performed with Xpert® MTB/RIF Ultra assay, with 9693 drug-susceptible TB (DS-TB) cases detected (M: 86.54, SD: 62.12) and 144 (M: 1.28, SD: 3.42) Rifampicin Resistant TB cases (RR-TB). Whilst 107, 890 (M: 963.30, SD: 842.88) tests were performed with Xpert® MTB/RIF assay between, 8807 (M: 78.63, SD: 53.29) DS-TB cases were detected, and 147 (M: 1.31, SD: 2.39) RR-TB cases. The Number Need to Test (NNT) to get one TB case was 12 for Xpert® MTB/RIF and 13 for Xpert ®MTB/RIF Ultra. On comparing the two assays in terms of test performance (p=0.75) and case detection both susceptible TB (p=0.31) and RR-TB (p=0.95) were not found statistically significant.ConclusionsThis study found no significant difference in test performance and overall detection of DS-TB and RR-TB when using Xpert® MTB/RIF Ultra and Xpert® MTB/RIF assays. The health systems approach should be used to elucidate all the probable potential of Xpert® MTB/RIF Ultra.
Japanese Encephalitis emergence in Australia: the potential population at risk
Authors: Yakob Laith , Hu Wenbiao , Frentiu Francesca D. , Gyawali Narayan , Hugo Leon E. , Johnson Brian , Lau Colleen , Kanamori Luis Furuya , Magalhaes Ricardo Soares , Devine Gregor 
Published: May 2022

AbstractIn Australia, Japanese Encephalitis virus circulated in tropical north Queensland between 1995 and 2005. In 2022, a dramatic range expansion across the southern states resulted in 24 confirmed human cases and three deaths. We discuss the outbreak drivers and estimate the potential size of the human population at risk.
Recent advances in efficacy of corticosteroids as adjunct therapy for the treatment of community-acquired pneumonia in children: a systematic review and meta-analysis
Authors: Mukanhaire Lydia , Wang Junyan , Zong Xiaoyu , Zhang Lingjian , Zhou Xiaohui , Gong Jian 
Published: May 2022

AbstractIt has been recently shown that the adjunct use of corticosteroids in the treatment of community-acquired pneumonia shorten the time taken to reach clinical stability (time to clinical stability) in patients with community-acquired pneumonia (CAP). Considering the hyperglycemic effects of corticosteroids, there are concerns about the efficacy and safety of this therapy for children with CAP. Our objective is to evaluate the influence of recent advances in adjunct corticosteroid use and/or aerosolized antibiotic administration on admission to hospital with our main outcome being duration of fever and hospital stay, and additional outcomes as the time to clinical stability therapeutic efficacy, C-reactive protein and defervescence at 24, 48, and 72 hours after starting treatment in a well-defined cohort of children with community-acquired pneumonia. Therapeutic efficacy is defined as the rate of achieving clinical recovery with no fever, improvement or disappearance of cough, and improved or normal laboratory values. Five academic literature databases will be searched using Boolean keyword searches. Articles eligible for inclusion are those that present original research with the study topic as CAP, the study was designed as a randomized controlled trial (RCT) or clinical trial (CT) or an observational study with controls. The review will result in a narrative synthesis that summarizes the effectiveness of corticosteroid use in children.
Aggressive Antipyretics in CNS Malaria: Study Protocol of a Randomized-Controlled Trial Assessing Antipyretic Efficacy and Parasite Clearance Effects (Malaria FEVER Study)
Authors: Chilombe Moses , McDermott Michael , Seydel Karl B. , Mathews Manoj , Mwenechanya Musaku , Birbeck Gretchen L. 
Published: May 2022

AbstractBackgroundDespite ongoing eradication efforts, malaria remains a major public health challenge in Africa where annually, ~250,000 children with malaria experience a neurologic injury with subsequent neurodisability. Evidence indicates that among children with CNS malaria, a higher temperature during the acute illness is a risk factor for post-infectious neurologic sequelae. As such, aggressive antipyretic therapy may be warranted, at least among children with complicated malaria who are at substantial risk of brain injury. Previous clinical trials conducted primarily in children with uncomplicated malaria and using only a single antipyretic medication have shown limited benefits in terms of fever reduction; however, no studies to date have examined malaria fever management using dual therapies. In this clinical trial of aggressive antipyretic therapy, children hospitalized with CNS malaria will be randomized to usual care (acetaminophen every 6 hours for a temperature ≥ 38.5°C) vs. prophylactic acetaminophen and ibuprofen every 6 hours for 72 hours. This proof-of-concept study will determine whether aggressive antipyretic therapy results in a lower mean maximum temperature relative to usual care.MethodsWe will enroll 284 participants from three settings at Queen Elizabeth Central Hospital in Blantyre, Malawi; at the University Teaching Hospitals Children’s Hospital in Lusaka, Zambia and at Chipata Central Hospital, Chipata, Zambia. Parents or guardians must provide written informed consent. Eligible participants are 2-11 years with evidence of P. falciparum malaria infection by peripheral blood smear or rapid diagnostic test with CNS symptoms associated with malaria. Eligible children will receive treatment allocation as determined by randomization and will be assigned to treatment groups with 1:1 allocation using blocked randomization.DiscussionThe clinical trial proposed here seeks to challenge the practice paradigm of limited fever treatment based upon hyperpyrexia by evaluating the fever-reduction efficacy of more aggressive antipyretic use involving two antipyretics and prophylactic administration while also taking advantage of a relatively new method for quantifying total parasite burden (HRP2 quantification) to further characterize malaria severity and elucidate the impact of antipyretics on parasite sequestration and clearance. If aggressive antipyretic therapy is shown to safely reduce the maximum temperature during CNS malaria, a clinical trial evaluating the neuroprotective effects of temperature reduction in CNS malaria is warranted.Trial registrationThis trial is registered withClinicalTrial.gov(NCT03399318) and with the Pan African Clinical Trials Registry (PACTR201804003255157)