bluuebunny/crossref_metadata_2025_split huggingface dataset:
A qualitative study of factors resulting in care delays for adults with meningitis in Zambia
Authors: Elafros Melissa A , Bwalya Chiti , Muchanga Godfrey , Mwale Mwangala , Namukanga Nachizya , Birbeck Gretchen L , Chomba Mashina , Mugala-Mulenga Anchindika , Kvalsund Michelle P , Sikazwe Izukanji , Saylor Deanna R , Winch Peter J 
Published: June 2022

Abstract

Background
Meningitis causes significant mortality in regions with high comorbid HIV and TB. Improved outcomes are hindered by limited understanding of factors that delay adequate care.

Methods
In-depth interviews of patients admitted to the University Teaching Hospital with suspected meningitis, their caregivers, doctors and nurses were conducted. Patient/caregiver interviews explored meningitis understanding, treatment prior to admission and experiences since admission. Provider interviews addressed current and prior experiences with meningitis patients and hospital barriers to care. A conceptual framework based on the Three Delays Model identified factors that delayed care.

Results
Twenty-six patient/caregiver, eight doctor and eight nurse interviews occurred. Four delays were identified: in-home care; transportation to a health facility; clinic/first-level hospital care; and third-level hospital. Overcrowding and costly diagnostic testing delayed outpatient care; 23% of patients began with treatment inside the home due to prior negative experiences with biomedical care. Admission occurred after multiple clinic visits, where subsequent delays occurred during testing and treatment.

Conclusions
Delays in care from home to hospital impair quality meningitis care in Zambia. Interventions to improve outcomes must address patient, community and health systems factors. Patient/caregiver education regarding signs of meningitis and indications for care-seeking are warranted to reduce treatment delays.
Machine identification method of subway service quality based on smart card data
Authors: Li Maosheng , Tu Ci , Wang Pu 
Published: June 2022

Abstract

A new automatic evaluation method of subway service quality based on metro smart card data is proposed suitable for three different levels: station pair, railway line and subway network, which has merits of overcoming the previous lagging and subjective evaluation in the system of ‘questionnaire survey plus evaluation method’. First, passengers' travel time distribution for different operating periods in station OD pairs are introduced initially for service evaluation purposes and are classified into different groups in order to infer the station's operating characteristics at the different periods. Second, the classification is verified by K-means cluster analysis and K-S tests. Third, the service quality weight indicator is proposed to identify the service quality of the entire metro network from the dual perspectives of passengers and companies. Finally, the feasibility and rationality of the proposed method are verified by Shenzhen metro smart card data as an example. The new automated evaluation method of subway service quality is suitable for online and offline application.

Highlights
• A new machine identification method based on travel time distribution is proposed for estimating the service quality.
• The proposed model employs the K-means clustering method to distinguish passenger's travel time distribution into different modes.
• Characteristics of the different modes of passenger travel time distribution reflect different service levels of the urban subway system.
• The method provides automatically identification of service levels for urban subway operations.
Competition law as a catalyst for collective market governance: gauging the discursive benefits of intensified administrative action
Authors: Kuenzler Adrian 
Published: June 2022

Abstract
This article offers a novel perspective on competition law’s role in concentrated markets. While progressive views arguably flout just about anything that traditional legal doctrine esteems—advocating that competition law should be reconfigured to address a broader set of values beyond the welfare of consumers— established viewpoints hold that the subject of these attacks is the sheer size of digital platforms, although this overlooks their character as networked industries that overwhelmingly generate consumer benefits. Both views miss a crucial issue: they blur the vital role that competition law’s emphasis on consumers plays in producing welfare and prosperity when competition- and non-competition-related problems of market power are entwined. In particular, an intensified extent of administrative action helps to put in place the discursive benefits gained by advancing a proper dialogue between leading actors and consumers, and encourages a greater extent of integration of consumers’ views into the market.
Pharmacotherapies for Adults With Alcohol Use Disorders: A Systematic Review and Network Meta-analysis
Authors: Bahji Anees , Bach Paxton , Danilewitz Marlon , Crockford David , Devoe Daniel J. , el-Guebaly Nady , Saitz Richard 
Published: June 2022

Background
We aimed to determine medications’ comparative efficacy and safety for adults with alcohol use disorders.

Methods
We searched eleven electronic data sources for randomized clinical trials with at least 4 weeks of treatment reporting on alcohol consumption (total abstinence and reduced heavy drinking), dropouts, and dropouts due to adverse events. We conducted network meta-analyses using random-effects, frequentist models, and calculated summary rate ratios (RRs) with 95% confidence intervals (CIs).

Results
We included 156 trials (N = 27,334). Nefazodone (RR = 2.11; 95% CI, 1.42–3.13), aripiprazole (RR = 1.97; 95% CI, 1.36–2.88), carbamazepine (RR = 1.85; 95% CI, 1.03–3.32), and nalmefene (RR = 1.17; 95% CI, 1.01–1.35) were associated with the most dropouts. Baclofen (RR = 0.83; 95% CI, 0.70–0.97) and pregabalin (RR = 0.63; 95% CI, 0.43–0.94) caused fewer dropouts than placebo. Nalmefene (RR = 3.26; 95% CI, 2.34–4.55), fluvoxamine (RR = 3.08; 95% CI, 1.59–5.94), and topiramate (RR=2.18; 95% CI, 1.36–3.51) caused more dropouts from adverse events over placebo. Gamma-hydroxy-butyrate (RR = 1.90; 95% CI, 1.03–3.53), baclofen (RR = 1.80; 95% CI, 1.39–2.34), disulfiram (RR = 1.71; 95% CI, 1.39–2.10), gabapentin (RR = 1.66; 95% CI, 1.04–2.67), acamprosate (RR = 1.33; 95% CI, 1.15–1.54), and oral naltrexone (RR = 1.15; 95% CI, 1.01–1.32) improved total abstinence over placebo (Fig. 3C). For reduced heavy drinking, disulfiram (RR = 0.19; 95% CI, 0.10–0.35), baclofen (RR = 0.72; 95% CI, 0.57–0.91), acamprosate (RR = 0.78; 95% CI, 0.70–0.86), and oral naltrexone (RR = 0.81; 95% CI, 0.73–0.90) were efficacious against placebo.

Conclusions
The current meta-analyses provide evidence that several medications for AUDs are effective and safe and encourage the expanded use of these medications in the clinical setting. Our review found that acamprosate (2–3 g/d), disulfiram (250–500 mg/d), baclofen (30 mg/d), and oral naltrexone (50 mg/d) had the best evidence for improving abstinence and heavy drinking for patients with AUD.

PROSPERO
CRD42020208946.
Comprehension of an Over-the-Counter Drug Facts Label Prototype for a Mifepristone and Misoprostol Medication Abortion Product
Authors: Biggs M. Antonia , Ehrenreich Katherine , Morris Natalie , Blanchard Kelly , Bustamante Claudie Kiti , Choimorrow Sung Yeon , Hauser Debra , Hernandez Yamani , Kapp Nathalie , Kromenaker Tammi , Moayedi Ghazaleh , Perritt Jamila B. , Ralph Lauren , Raymond Elizabeth G. , Valladares Ena Suseth , White Kari , Grossman Daniel 
Published: June 2022

OBJECTIVE:
To develop a drug facts label prototype for a combination mifepristone and misoprostol product and to conduct a label-comprehension study to assess understanding of key label concepts.

METHODS:
We followed U.S. Food and Drug Administration guidance, engaged a multidisciplinary group of experts, and conducted cognitive interviews to develop a drug facts label prototype for medication abortion. To assess label comprehension, we developed 11 primary and 13 secondary communication objectives related to indications for use, eligibility, dosing regimen, contraindications, warning signs, side effects, and recognizing the risk of treatment failure, with corresponding target performance thresholds (80–90% accuracy). We conducted individual structured video interviews with people with a uterus aged 12–49 years, recruited through social media. Participants reviewed the drug facts label and responded to questions to assess their understanding of each communication objective. After transcribing and coding interviews, we estimated the proportion of correct responses and exact binomial 95% CIs by age and literacy group.

RESULTS:
We interviewed 851 people (of 1,507 people scheduled); responses from 844 were eligible for analysis, and 35.7% (n=301) of participants were aged 12–17 years. The overall sample met performance criteria for 10 of the 11 primary communication objectives (93–99% correct) related to indications for use, eligibility for use, the dosing regimen, and contraindications; young people met nine and people with limited literacy met eight of the 11 performance criteria. Only 79% (95% CI 0.76–0.82) of the overall sample understood to contact a health care professional if little or no bleeding occurred soon after taking misoprostol, not meeting the prespecified threshold of 85.0%.

CONCLUSION:
Overall, high levels of comprehension suggest that people can understand most key drug facts label concepts for a medication abortion product without clinical supervision and recommend minor modifications.
Single-Dose, Bioadhesive Clindamycin 2% Gel for Bacterial Vaginosis
Authors: Mauck Christine , Hillier Sharon L. , Gendreau Judy , Dart Clint , Chavoustie Steven , Sorkin-Wells Valerie , Nicholson-Uhl Clifton , Perez Brandon , Jacobs Mark , Zack Nadene , Friend David 
Published: June 2022

OBJECTIVE:
To assess efficacy and safety of a single-dose vaginal clindamycin gel for bacterial vaginosis treatment.

METHODS:
We conducted a double-blind, placebo-controlled, randomized study comparing clindamycin gel with placebo (2:1 ratio). Entry required clinical diagnosis of bacterial vaginosis, that is, all four Amsel's criteria, without other genital infections. Nugent scores of 7–10 were required for efficacy assessment, per updated 2019 U.S. Food and Drug Administration guidance. Patients were evaluated at screening, day 7–14, and day 21–30 (test of cure). Clinical cure was defined as resolution of three of four Amsel's criteria. Bacteriologic cure was defined as Nugent score lower than 4. Therapeutic cure was both clinical and bacteriologic cure. Primary outcome was clinical cure at the test-of-cure visit. Secondary endpoints were clinical cure at day 7–14, and bacteriologic and therapeutic cures at day 7–14 and test of cure. A sample size of 188 patients in the clindamycin group compared with 94 patients in the placebo group had 90% power to detect statistically significant difference (P=.05, 2-tailed).

RESULTS:
Participants were seen between July 9, 2020, and November 12, 2020. Of 307 randomized women, 56.0% were Black and 88.3% reported one or more previous bacterial vaginosis episodes. In the modified intention-to-treat population, 70.5% of patients in the clindamycin group and 35.6% in the placebo group achieved clinical cure at test of cure (primary outcome) (difference of 34.9, 95% CI 19.0–50.8), as did 77.5% of patients in the clindamycin group and 42.6% of patients in the placebo group in the per-protocol population (difference of 34.9, 95% CI 17.0–52.7). Statistically significant differences between groups were seen for all secondary endpoints. Clinical cure rate in patients in the clindamycin group with more than three bacterial vaginosis episodes in the prior year was 70.0%. Approximately 15% (15.3%) of patients in the clindamycin group experienced one or more treatment-emergent adverse events related to study treatment, as did 9.7% of patients in the placebo group. The most frequent treatment-related, treatment-emergent adverse event was vulvovaginal candidiasis.

CONCLUSION:
A new, single-dose clindamycin vaginal gel was highly effective, with excellent safety, in women disproportionately affected by bacterial vaginosis, with Nugent scores of 7–10 at study entry.

FUNDING SOURCE:
The study was funded by Daré Bioscience, Inc.

CLINICAL TRIALS REGISTRATION:

ClinicalTrials.gov, NCT04370548.
Distinguishing High-Performing From Low-Performing Hospitals for Severe Maternal Morbidity
Authors: Howell Elizabeth A. , Sofaer Shoshanna , Balbierz Amy , Kheyfets Anna , Glazer Kimberly B. , Zeitlin Jennifer 
Published: June 2022

OBJECTIVE:
To investigate which organizational factors, policies, and practices distinguish hospitals with high compared with low risk-adjusted rates of severe maternal morbidity (SMM).

METHODS:
Using a positive deviance approach, this qualitative study included 50 semistructured interviews with health care professionals (obstetrics and gynecology chairs, labor and delivery medical directors, nurse managers, frontline nurses, physicians or nurses responsible for quality and safety, and chief medical officers) in four low-performing and four high-performing hospitals in New York City. Hospital performance was based on risk-adjusted morbidity metrics from previous research. Major topics explored were structural characteristics (eg, staffing, credentialing), organizational characteristics (eg, culture, leadership, communication, use of data), labor and delivery practices (eg, use of standardized, evidence-based practices, teamwork), and racial and ethnic disparities in SMM. All interviews were audiotaped, professionally transcribed, and coded using NVivo software. Researchers blinded to group assignment conducted qualitative content analysis. Researchers wrote analytic memos to identify key themes and patterns emerging from the interviews, highlight illustrative quotes, and draw qualitative comparisons between the two hospital clusters with different (but unrevealed) performance levels.

RESULTS:
Six themes distinguished high-performing from low-performing hospitals. High-performing hospitals were more likely to have: 1) senior leadership involved in day-to-day quality activities and dedicated to quality improvement, 2) a strong focus on standards and standardized care, 3) strong nurse–physician communication and teamwork, 4) adequate physician and nurse staffing and supervision, 5) sharing of performance data with nurses and other frontline clinicians, and 6) explicit awareness that racial and ethnic disparities exist and that racism and bias in the hospital can lead to differential treatment.

CONCLUSION:
Organizational factors, policies, and practices at multiple levels distinguish high-performing from low-performing hospitals for SMM. Findings illustrate the potential for targeted quality initiatives to improve maternal health and reduce obstetric disparities arising from delivery in low-performing hospitals.
Patterns of Sexual Activity and the Development of Sexual Pain Across the Menopausal Transition
Authors: Waetjen L. Elaine , Johnson Wesley O. , Xing Guibo , Hess Rachel , Avis Nancy E. , Reed Barbara D. , Dugan Sheila A. , Neal-Perry Genevieve , Gold Ellen B. ,   for the Study of Women's Health Across the Nation (SWAN)
Published: June 2022

OBJECTIVE:
To examine whether patterns of sexual intercourse frequency and demographic, menopausal status, genitourinary, health, and psychosocial factors are associated with developing sexual pain across the menopausal transition.

METHODS:
These were longitudinal analyses of questionnaire data from the multicenter, multiracial and ethnic prospective cohort SWAN (Study of Women's Health Across the Nation) (1995–2008). We used multivariable discrete-time proportional hazards models to examine whether incident sexual pain was associated with preceding long-term (up to 10 visits) or short-term (two and three visits) sexual intercourse frequency patterns or other factors (eg, menopause status, genitourinary symptoms, lifestyle factors, and mental health).

RESULTS:
Of the 2,247 women with no sexual pain at baseline, 1,087 (48.4%) developed sexual pain at least “sometimes” up to 10 follow-up visits over 13 years. We found no consistent association between prior patterns of sexual intercourse frequency and development of sexual pain. For example, neither decreases in intercourse frequency from baseline (adjusted hazard ratio [aHR] 0.93, 95% CI 0.73–1.19) nor decreases in frequency over three prior visits (aHR 1.00, 95% CI 0.72–1.41) were associated with incident pain. Reasons for interruptions in intercourse activity at the prior visit, including lack of interest (aHR 1.64, 95% CI 0.74–3.65) and relationship issues (aHR 0.36, 95% CI 0.04–2.88), were not associated with developing pain. Being postmenopausal using hormone therapy (aHR 3.16, 95% CI 1.46–6.85), and reported vaginal dryness (aHR 3.73, 95% CI 2.88–4.83) were most strongly associated with incident sexual pain.

CONCLUSION:
Long-term and short-term declines in sexual intercourse frequency across the menopausal transition were not associated with increased hazard of developing pain with intercourse. This empirical evidence does not support the common belief that a reduction in women's sexual frequency is responsible for their symptoms of sexual pain.
Effect of Postoperative Hormonal Suppression on Fertility in Patients With Endometriosis After Conservative Surgery
Authors: Richard Evelyne , Morin Jessica , Murji Ally , Lemyre Madeleine , Laberge Philippe Y. , Maheux-Lacroix Sarah 
Published: June 2022

OBJECTIVE:
To evaluate the effect of hormonal suppression on fertility when administered to infertile patients or patient wishing to conceive after surgery for endometriosis.

DATA SOURCES:
A systematic search of MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov was performed by two independent reviewers from the databases' inception until December 2020.

METHODS OF STUDY SELECTION:
We included randomized controlled trials comparing any suppressive hormonal therapy to an inactive control (placebo or absence of treatment) after conservative surgery for endometriosis. Studies that did not report fertility outcomes after surgery were excluded.

TABULATION, INTEGRATION AND RESULTS:
This systematic review and meta-analysis was registered in PROSPERO. Two reviewers extracted data and assessed the risk of bias as well as the strength of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed. Relative risks (RRs) were pooled by quantitative random effect meta-analysis. From 3,138 citations, 19 trials (2,028 patients) were included. Overall, no difference was observed between the treatment and the control group for pregnancy (RR 1.15; 95% CI 1.00–1.32) and live births (RR 1.05; 95% CI 0.84–1.32). When pooling all hormonal therapies, the duration of administration of postoperative therapy was identified as a substantial source of heterogeneity between studies (I2 difference=74%) with increased chances of pregnancy compared with control when administered for at least 3 months (RR 1.22; 95% CI 1.04–1.43). Gonadotropin-releasing hormone (GnRH) agonists (14 trials, 1,721 patients) were associated with increased chances of pregnancy compared with placebo or no treatment (RR 1.20; 95% CI 1.03–1.41; I2=25%). Data were limited for other hormonal treatments with no significant difference between groups. Subgroup analyses taking into account the use of fertility treatments (insemination or in vitro fertilization), stages of the disease and risk of bias of included trials did not modify the results.

CONCLUSION:
Postoperative hormonal suppression should be considered on a case-by-case basis to enhance fertility while balancing this benefit with the risks of delaying conception. If chosen, GnRH agonists would be the treatment of choice, and a duration of at least 3 months should be favored.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42021224424.
Intermittent Soft-Tissue Tumor Enlargement in Episodic Angioedema With Eosinophilia Syndrome
Authors: Fernández Lucía T. , Ocampo-Candiani Jorge , Watts-Santos Anabella , Guerrero-Putz María D. , González-Díaz Sandra Nora , Zárate-Hernández María Del Carmen , Cantú-Rodríguez Olga G. , Herz-Ruelas Maira E. 
Published: June 2022

Abstract:
Episodic hypereosinophilia and angioedema syndrome, also known as Gleich syndrome, is a rare entity characterized by recurrent episodes of eosinophilia, angioedema, urticaria, fever and weight gain with spontaneous resolution. It is classified as an idiopathic hypereosinophilic syndrome. Unlike other hypereosinophilic syndromes, it has a low risk for internal organ damage. We report the case of a 42-year-old male with a 28-year history of recurrent erythematous wheals and plaques and persistent hypereosinophilia. Physical examination revealed a well-defined subcutaneous nodule on his right lower limb that increased in size with each episode of angioedema. Histopathology evidenced a lipoma with intense eosinophil infiltration within the mature adipose tissue, while the specimen of the wheal revealed scarce perivascular and interstitial eosinophilic inflammatory infiltrate. Diagnosis of episodic angioedema with eosinophilia syndrome was made based on clinical and laboratory findings.
Is Developmental Regression in Down Syndrome Linked to Life Stressors?
Authors: Sargado Sabrina , Milliken Anna L. , Hojlo Margaret A. , Pawlowski Katherine G. , Deister Diana , Soccorso Cara N. , Baumer Nicole T. 
Published: June 2022

ABSTRACT:

Objective:
Unexplained regression in Down syndrome (URDS) involves a loss of acquired skills resulting in functional deterioration. Despite extensive workup and treatment, few individuals regain baseline function. This study aimed to understand the role of psychosocial stressors in URDS.

Methods:
We describe psychosocial stressors in 14 cases of URDS. Specifically, we examined psychosocial stressors in the context of presentation and clinical symptoms. We also examined co-occurring neurodevelopmental disorders and medical and mental health conditions.

Results:
All individuals experienced psychosocial stressors within one year of diagnosis of URDS. The most common psychosocial stressors were moving to a new home or school.

Conclusion:
Psychosocial stressors are commonly reported preceding URDS. Knowledge about psychosocial stressors' impact may lead to preventive interventions, improved monitoring, and earlier diagnosis. Future research should focus on understanding psychosocial stressors to help identify individuals at risk for URDS and contribute to treatment.