bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intervention design in cognitively impaired populations—Lessons learned from the OPTIMIZE deprescribing pragmatic trial
Authors: Sheehan Orla C. , Gleason Kathy S. , Bayliss Elizabeth A. , Green Ariel R. , Drace Melanie L. , Norton Jonathan , Reeve Emily , Shetterly Susan M. , Weffald Linda A. , Sawyer Jennifer K. , Maciejewski Matthew L. , Kraus Courtney , Maiyani Mahesh , Wolff Jennifer , Boyd Cynthia M. 
Published: December 2022

AbstractBackgroundPolypharmacy is common in older adults with cognitive impairment and multiple chronic conditions, increasing risks of adverse drug events, hospitalization, and death. Deprescribing, the process of reducing or stopping potentially inappropriate medications, may improve outcomes. The OPTIMIZE pragmatic trial examined whether educating and activating patients, family members and clinicians about deprescribing reduces number of chronic medications and potentially inappropriate medications. Acceptability and challenges of intervention delivery in cognitively impaired older adults are not well understood.MethodsWe explored mechanisms of intervention implementation through post hoc qualitative interviews and surveys with stakeholder groups of 15 patients, 7 caregivers, and 28 clinicians. We assessed the context in which the intervention was delivered, its implementation, and mechanisms of impact.ResultsAcceptance of the intervention was affected by contextual factors including cognition, prior knowledge of deprescribing, communication, and time constraints. All stakeholder groups endorsed the acceptability, importance, and delivery of the intervention. Positive mechanisms of impact included patients scheduling specific appointments to discuss deprescribing and providers being prompted to consider deprescribing. Recollection of intervention materials was inconsistent but most likely shortly after intervention delivery. Short visit times remained the largest provider barrier to deprescribing.ConclusionsOur work identifies key learnings in intervention delivery that can guide future scaling of deprescribing interventions in this population. We highlight the critical roles of timing and repetition in intervention delivery to cognitively impaired populations and the barrier posed by short consultation times. The acceptability of the intervention to patients and family members highlights the potential to incorporate deprescribing education into routine clinical practice and expand proven interventions to other vulnerable populations.
Paediatric rhabdomyolysis: A UK centre's 10‐year retrospective experience
Authors: Harmer Matthew J , Nijloveanu Veronica , Thodi Eftychia , Ding Wen Y , Longthorpe Catherine , Fenton‐Jones Mary , Hogg Kirstin , Day Andrew , Platt Caroline 
Published: December 2022

AimsTo describe the aetiologies of paediatric rhabdomyolysis and explore the medium‐term renal consequences.MethodsRetrospective, single‐centre review of children with rhabdomyolysis.ResultsTwo hundred and thirty‐two children met inclusion criteria for the analysis. Mean age at presentation was 8.4 (SD ± 5.5) years. The commonest aetiology was infection (28%), with viral myositis making up the clear majority (75%). Trauma was identified as a cause in 18% of children, seizures in 10% and immune‐mediated mechanisms in 8%. Acute kidney injury (AKI) was present in 32% of the cases overall. Children with AKI tended to be younger, with higher peak creatine kinase (CK) and active urinary sediment on urinalysis at presentation. AKI and the need for renal replacement therapy (RRT) were associated with a prolonged hospital stay (15 (interquartile range, IQR 6.5–33) vs. 2 (IQR 0–7) days). A total of 18 children and young people required RRT, with a mean duration of 7.1 ± 4.3 days. Those who received RRT were more likely to have abnormalities on urinalysis at presentation (46% vs. 5%). Over the period of the study, 9% of children died and 2% met criteria for a diagnosis of chronic kidney disease.ConclusionsThis large paediatric rhabdomyolysis case series provides new and unique insights into the condition. Our results highlight the common aetiologies and provide evidence of good renal recovery overall, even in the most severely affected cases. Abnormalities of urinalysis appear to be important in predicting the development of AKI and the need for RRT.
Perioperative management in chronically anticoagulated children undergoing tonsillectomy
Authors: Hazkani Inbal , Billings Kathleen R. , Edwards Evan , Stein Eli , Bhat Rukhmi , Lavin Jennifer 
Published: December 2022

AbstractBackgroundWhen undergoing tonsillectomy, patients at high risk of thrombosis who require chronic anticoagulation therapy pose a special challenge as bleeding may occur up to 2 weeks after surgery. Because of a lack of evidence‐based data, there is no consensus on the best management for such patients. The objective of our study was to review perioperative anticoagulation bridging strategies in children undergoing tonsillectomy.MethodsThe study group were a retrospective series of patients on chronic anticoagulation therapy at high risk of a thromboembolic event, who underwent tonsillectomy from 2010 to 2021. Patients whose anticoagulation treatment was discontinued because of a low risk of thromboembolic events were excluded.ResultsFour patients met the inclusion criteria (age range, 1.5–16.1 years). All patients were admitted prior to surgery for bridging therapy with intravenous unfractionated heparin (UFH), drip‐titrated to a therapeutic dose until 4–6 h prior to surgery. The estimated blood loss during surgery was minimal in all surgeries. Unfractionated heparin was readministered according to the hospital protocol on the night of surgery and titrated to a therapeutic dose. Warfarin was restarted within 2 days postsurgery for all patients. High‐risk patients were kept in hospital until postoperative day 6–8 because of concern for delayed bleeding. One patient was noticed to have blood‐tinged sputum requiring no intervention; none of the patients developed early or delayed hematemesis.ConclusionsOur data show that bridging therapy with UFH has been successful in chronically anticoagulated patients undergoing tonsillectomy. These patients require multidisciplinary care for the management of their pre‐ and postoperative course.
Mantellic degassing of helium in an extensional active tectonic setting at the front of a magmatic arc (central Mexico)
Authors: Billarent-Cedillo Andrea , Hernandez-Pérez Eliseo , Levresse Gilles , Inguaggiato Claudio , Ferrari Luca , Inguaggiato Salvatore , López-Alvis Jorge , Silva-Fragoso Argelia 
Published: December 2022

Abstract
The physicochemical and isotopic characteristics of groundwater and dissolved gas of central Mexico provide valuable information about the geologic and tectonic context of the area. Low–high-enthalpy manifestations (up to 98 °C in springs and more than 100 °C in geothermal wells) are distributed within the San Juan del Río, Querétaro, and Celaya hydrologic basins, located at the boundary between the current Mexican magmatic arc and an extensional continental area with intraplate volcanism called Mesa Central Province. Groundwaters in the study area represent a mixture between the cold water end-member with a Ca2+-Mg2+-HCO3-composition and a hydrothermal end-member enriched in Na+, K+, SO42−, and Cl-. Cold and hot groundwaters δ2H and δ18O plot along the same evaporation lines and do not exhibit a magmatic input. Dissolved and free gas do not show a typical volcanic composition signature. He and Ne isotope composition provide evidence of an important contribution of non-atmospheric noble gases. Although helium composition mainly has a crustal origin (21–83%), the mantellic contribution (1–39%) is higher than expected for an area lacking recent volcanism. A volatilerich magma aging at depth was discarded as the source of this mantellic helium signature but points out a recent mantellic contribution. Thus, we propose that mantellic helium comes from the sublithospheric mantle into the shallow crust through the highly permeable tectonic boundaries between the geologic provinces, namely the N−S Taxco−San Miguel de Allende and Chapala-Tula fault systems. Mantellic helium flow rates through these fault systems were estimated to have values ranging from 0.1 m/yr to 2.9 m/yr. This He flux range implies that aside from subduction, mantle volatile degassing enhanced by crustal fault systems is the main degassing process in the region studied.
Mixing age and risk groups for accessing COVID-19 vaccines: a modelling study
Authors: Wang Hongming , Ibuka Yoko , Nakamura Ryota 
Published: December 2022

ObjectiveTo characterise the optimal targeting of age and risk groups for COVID-19 vaccines.DesignMotivated by policies in Japan and elsewhere, we consider rollouts that target a mix of age and risk groups when distributing the vaccines. We identify the optimal group mix for three policy objectives: reducing deaths, reducing cases and reducing severe cases.SettingJapan, a country where the rollout occurred over multiple stages targeting a mix of age and risk groups in each stage.Primary outcomesWe use official statistics on COVID-19 deaths to quantify the virus transmission patterns in Japan. We then search over all possible group mix across rollout stages to identify the optimal strategies under different policy objectives and virus and vaccination conditions.ResultsLow-risk young adults can be targeted together with the high-risk population and the elderly to optimally reduce deaths, cases and severe cases under high virus transmissibility. Compared with targeting the elderly or the high-risk population only, applying optimal group mix can further reduce deaths and severe cases by over 60%. High-efficacy vaccines can mitigate the health loss under suboptimal targeting in the rollout.ConclusionsMixing age and risk groups outperforms targeting individual groups separately, and optimising the group mix can substantially increase the health benefits of vaccines. Additional policy measures boosting vaccine efficacy are necessary under outbreaks of transmissible variants.
Survey of quality and clarity of methods and results reporting in 1 year of intervention studies published in high-impact medical and psychiatric journals
Authors: Ravichandran Caitlin , Babb Suzann M , Ongur Dost , Harris Peter Q , Cohen Bruce M 
Published: December 2022

ObjectiveWe assessed how well articles in major medical and psychiatric journals followed best reporting practices in presenting results of intervention studies.MethodStandardised data collection was used to review studies in high-impact and widely read medical (JAMA,LancetandNew England Journal of Medicine) and psychiatric (American Journal of Psychiatry,JAMA Psychiatry,Journal of Clinical PsychiatryandLancet Psychiatry) journals, published between 1 September 2018 and 31 August 2019. Two team members independently reviewed each article.MeasuresThe primary outcome measure was proportion of papers reporting consensus elements required to understand and evaluate the results of the intervention. The secondary outcome measure was comparison of complete and accessible reporting in the major medical versus the major psychiatric journals.ResultsOne hundred twenty-seven articles were identified for inclusion. At least 90% of articles in both medical and psychiatric journals included sample size, statistical significance, randomisation method, elements of study flow, and age, sex, and illness severity by randomisation group. Selected elements less frequently reported by either journal type were confidence intervals in the abstract, reported in 93% (95% CI 84% to 97%) of medical journal articles and 58% (95% CI 45% to 69%) of psychiatric journal articles, and sample size method (93%, 95% CI 84% to 97% medical; 69%, 95% CI 57% to 80% psychiatric), race and ethnicity by randomisation group (51%, 95% CI 40% to 63% medical; 73%, 95% CI 60% to 83% psychiatric), and adverse events (94%; 95% CI 86% to 98% medical; 80%, 95% CI 68% to 88% psychiatric) in the main text. CIs were included less often in psychiatric than medical journals (p<0.004 abstract, p=0.04 main text, after multiple-testing correction).ConclusionsRecommendations include standard inclusion of a table specifying the outcome(s) designated as primary, and the sample size, effect size(s), CI(s) and p value(s) corresponding to the primary test(s) for efficacy.
Peer support and online cognitive behavioural therapy for substance use concerns: protocol for a randomised controlled trial
Authors: Quilty Lena C , Wardell Jeffrey D , Garner Gord , Elison-Davies Sarah , Davies Glyn , Klekovkina Elizaveta , Corman Michael , Alfonsi Jeffrey , Crawford Allison , de Oliveira Claire , Weekes John 
Published: December 2022

IntroductionHazardous alcohol and drug use is associated with substantial morbidity, mortality and societal cost worldwide. Yet, only a minority of those struggling with substance use concerns receive specialised services. Numerous barriers to care exist, highlighting the need for scalable and engaging treatment alternatives. Online interventions have exhibited promise in the reduction of substance use, although studies to date highlight the key importance of patient engagement to optimise clinical outcomes. Peer support may provide a way to engage patients using online interventions. The goal of this study is to evaluate the efficacy and cost-effectiveness of Breaking Free Online (BFO), an online cognitive-behavioural intervention for substance use, delivered with and without peer support.Methods and analysisA total of 225 outpatients receiving standard care will be randomised to receive clinical monitoring with group peer support, with BFO alone, or with BFO with individual peer support, in an 8-week trial with a 6-month follow-up. The primary outcome is substance use frequency; secondary outcomes include substance use problems, depression, anxiety, quality of life, treatment engagement and cost-effectiveness. Mixed effects models will be used to test hypotheses, and thematic analysis of qualitative data will be undertaken.Ethics and disseminationThe protocol has received approval by the Centre for Addiction and Mental Health Research Ethics Board. Results will help to optimise the effectiveness of structured online substance use interventions provided as an adjunct to standard care in hospital-based treatment programmes. Findings will be disseminated through presentations and publications to scholarly and knowledge user audiences.Trial registration numberNCT05127733
Improving the utilisation of medication-assisted treatment for alcohol use disorder at discharge
Authors: Arms Luther , Johl Hershan , DeMartini Jeremy 
Published: December 2022

Alcohol use disorder is a constellation of symptoms and behaviours related to dependence and abuse. It is present in 11.0% of US adults and is a leading cause of death and healthcare expenditures in the USA. Medication-assisted treatment (MAT) is medication to reduce cravings, decrease rewards or limit withdrawal symptoms in combination with behavioural therapy.A review of all patients with an alcohol-related condition admitted to internal medicine teams at an academic medical centre over a 7-month period (N=583) identified that only 1.4% (n=8) were discharged with an MAT prescription. Quality improvement methods were used to increase the proportion of patients discharged with an MAT prescription.Implementing educational interventions and embedding a recommendation for MAT into the order sets used to treat alcohol withdrawal increased the percentage of patients with an alcohol-related condition that were discharged with an MAT prescription to 11.2%.MAT remains an underused intervention for the treatment of alcohol use disorder. However, combining educational and structural interventions, including just-in-time teaching, can successfully increase the percentage of patients who receive an MAT prescription.
Transcription Factor–Forced Astrocytic Differentiation Impairs Human Glioblastoma Growth In Vitro and In Vivo
Authors: Trovato Francesco , Stefani Francesca Romana , Li Jiaxin , Zetterdahl Oskar G. , Canals Isaac , Ahlenius Henrik , Bengzon Johan 
Published: December 2022

Abstract
Direct cellular reprogramming has recently gained attention of cancer researchers for the possibility to convert undifferentiated cancer cells into more differentiated, postmitotic cell types. While a few studies have attempted reprogramming of glioblastoma (GBM) cells toward a neuronal fate, this approach has not yet been used to induce differentiation into other lineages and in vivo data on reduction in tumorigenicity are limited. Here, we employ cellular reprogramming to induce astrocytic differentiation as a therapeutic approach in GBM. To this end, we overexpressed key transcriptional regulators of astroglial development in human GBM and GBM stem cell lines. Treated cells undergo a remarkable shift in structure, acquiring an astrocyte-like morphology with star-shaped bodies and radial branched processes. Differentiated cells express typical glial markers and show a marked decrease in their proliferative state. In addition, forced differentiation induces astrocytic functions such as induced calcium transients and ability to respond to inflammatory stimuli. Most importantly, forced differentiation substantially reduces tumorigenicity of GBM cells in an in vivo xenotransplantation model.
The current study capitalizes on cellular plasticity with a novel application in cancer. We take advantage of the similarity between neural developmental processes and cancer hierarchy to mitigate, if not completely abolish, the malignant nature of tumor cells and pave the way for new intervention strategies.
Association Between Income and Risk of Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study
Authors: van Nieuwenhuizen Benjamin P. , Tan Hanno L. , Blom Marieke T. , Kunst Anton E. , van Valkengoed Irene G.M. 
Published: December 2022

Background:
Previous studies have observed a higher out-of-hospital cardiac arrest (OHCA) risk among lower socioeconomic groups. However, due to the cross-sectional and ecological designs used in these studies, the magnitude of these inequalities is uncertain. This study is the first to assess the individual-level association between income and OHCA using a large-scale longitudinal study.

Methods:
This retrospective cohort study followed 1 688 285 adults aged 25 and above, living in the catchment area of an OHCA registry in a Dutch province. OHCA cases (n=5493) were linked to demographic and income registries. Cox proportional hazard models were conducted to determine hazard ratios of OHCA for household and personal income quintiles, stratified by sex and age.

Results:
The total incidence of OHCA per 100 000 person years was 30.9 in women and 87.1 in men. A higher OHCA risk was observed with lower household and personal income. Compared with the highest household income quintile, the adjusted hazard ratios from the second highest to the lowest household income quintiles ranged from 1.24 (CI=1.01–1.51) to 1.75 (CI=1.46–2.10) in women and from 0.95 (CI=0.68–1.34) to 2.30 (CI=1.74–3.05) in men. For personal income, this ranged from 0.95 (CI=0.68–1.34) to 2.30 (CI=1.74–3.05) in women and between 1.28 (CI=1.16–1.42) and 1.68 (CI=1.48–1.89) in men. Comparable household and personal income gradients were found across age groups except in the highest (>84 years) age group. For example, household income in women aged 65 to 74 ranged from 1.25 (CI=1.02–1.52) to 1.65 (CI=1.36–2.00). Sensitivity analyses assessing the prevalence of comorbidities at baseline and different lengths of follow-up yielded similar estimates.

Conclusions:
This study provides new evidence for a substantial increase in OHCA risk with lower income in different age and sex groups. Low-income groups are likely to be a suitable target for intervention strategies to reduce OHCA risk.
Patterns of Unnatural Deaths Among Children and Adolescents: Autopsy Study (2011-2018)
Authors: Ben Abderrahim Sarra , Belhaj Azza , Bellali Mohamed , Hmandi Ons , Gharbaoui Meriem , Harzallah Hana , Naceur Yomn , Ben Khelil Mehdi , Allouche Mohamed 
Published: December 2022

Background and Aims: The problem of unnatural death in children is still relevant because of their vulnerability. This work aimed to describe the epidemiological profile and patterns of these medicolegal deaths in children and adolescents in northern Tunisia. Methods: We conducted a retrospective study from January 2011 to December 2018, within the Forensic Department of Charles Nicolle Hospital in Tunis. All children who died of unnatural causes were included (767 cases). Results: An overall male predominance was observed (sex ratio = 2.4). Accidental deaths represent the most common manner of death (81.4%) involving most frequently domestic accidents occurring in children aged between 1 and 4 years. In cases of suicide, the highest risk profile was a female child aged between 15 and 18 years. The suicide occurred most often in the victim’s home with hanging representing the common means of suicide. For the criminal form, the most common means in those cases were stabbing and blunt injuries. Conclusion: Our study delivered a broad picture of unnatural deaths among children in Tunisia. These deaths, largely absent from child survival initiatives presently on the global agenda, can be prevented if they are addressed strategically, as their injury prevention strategies differ from adults.
Stroke in Africa: A systematic review and meta-analysis of the incidence and case-fatality rates
Authors: Okekunle Akinkunmi Paul , Jones Stephanie , Adeniji Olaleye , Watkins Caroline , Hackett Maree , Di Tanna Gian Luca , Owolabi Mayowa , Akinyemi Rufus 
Published: December 2022

Background: The burden of stroke (a leading cause of disability and mortality) in Africa appears to be increasing, but a systematic review of the best available data to support or refute this observation is lacking. Aim: To determine the incidence and 1-month case-fatality rates from high-quality studies of stroke epidemiology among Africans. Summary of review: We searched and retrieved eligible articles on stroke epidemiology among indigenous Africans in bibliographic databases (MEDLINE, ScienceDirect, Google Scholar, and Cochrane library) using predefined search terms from the earliest records through January 2022. Methodological assessment of eligible studies was conducted using the Newcastle–Ottawa scale. Pooling of incidence and case-fatality rates was performed via generalized linear models (Poisson-Normal random-effects model). Of the 922 articles retrieved, 14 studies were eligible for inclusion. The total number of stroke cases was 2568, with a population denominator (total sample size included in population-based registries or those who agreed to participate in door-to-door community studies) of 3,384,102. The pooled crude incidence rate of stroke per 100,000 persons in Africa was 106.49 (95% confidence interval (CI) = 58.59–193.55), I2 = 99.6%. The point estimate of the crude incidence rate was higher among males, 111.33 (95% CI = 56.31–220.12), I2 = 99.2%, than females, 91.14 (95% CI = 47.09–176.37), I2 = 98.9%. One-month case-fatality rate was 24.45 (95% CI = 16.84–35.50), I2 = 96.8%, with lower estimates among males, 22.68 (95% CI = 18.62–27.63), I2 = 12.9%, than females, 27.57 (95% CI = 21.47–35.40), I2 = 51.6%. Conclusion: The burden of stroke in Africa remains very high. However, little is known about the dynamics of stroke epidemiology among Africans due to the dearth of high-quality evidence. Further continent-wide rigorous epidemiological studies and surveillance programs using the World Health Organization STEPwise approach to Surveillance (WHO STEPS) framework are needed.