dataesr/scientific-paragraphs-categorization huggingface dataset:
Interview and focus group guides were created by the research team and the advisory committee to ensure that the questions would focus on the implementation process of PI and on the contextual factors that explain the differences between schools. Data analysis was conducted by two team members using the QDA miner software. Descriptive codes were inductively developed by a team member (MG) and verified by a second team member (AJB). Regular meetings among coders were held to review newly developed codes, deepen coders reflexivity, and make iterative modifications to the coding tree. A second cycle of coding was conducted via QDA Miner to refine codes and identify overarching categories. After coding each case, intra-and inter-case analyses were performed for the three schools  [27]. Finally, quantitative and qualitative data were integrated using the Conceptual Framework for ICC  [28]  to highlight strengths, limitations, and suggestions to further improve PI's implementation.
What You Need to Know Background: Skeletal muscle-derived cell therapy has been previously suggested for fecal incontinence treatment. However, placebo-controlled clinical trials are rare and are necessary to draw efficacy conclusions. Findings: Treatment of patients experiencing chronic fecal incontinence with skeletal musclederived cells led to significant reduction in incontinence symptoms compared with control treated patients. Implications for patient care: Subject to confirmatory phase 3 clinical trial(s), skeletal muscle-derived cell therapy could become a valuable treatment option for fecal incontinence. concomitant medication was registered. The study was overseen by an independent data safety monitoring board. For the definition of AEs, see the Supplementary Methods.
Secondary Endpoints IEF Time Course Up to 12 Months. Patients willing to participate beyond the V4 primary endpoint were included in 12-month posttreatment analysis up to V5. The 12-month (V5) data revealed a trend of difference between HCC-and CTR-treated patients in the ITT population and significant differences in TPP1 when comparing HCC vs CTR groups (P <. 015, d ¼ 0. 52) and LCC vs CTR (P ¼. 043, d ¼ 0. 39) and TPP2 when comparing HCC vs CTR groups (P ¼. 027, d ¼ 0. 48) (Figures 2A', 2B', 2C') Changes in IEF from baseline were also assessed at 1, 3, and 12 months postimplantation, to study treatment dynamics. In the ITT population and specified subgroups, the mean change in IEF of the CTR treatment diminished over time, whereas it remained constant or even increased in HCC-treated patients, most pronouncedly in the TPP2 subgroup.
A plot showing the entire time course of mean changes in IEF is demonstrated in Figure  3. Descriptive statistics are summarized in Supplementary Table  2. Responder Rates. In agreement with others,  18  we considered a reduction of IEF by !50% to be a clinically relevant improvement and classified patients showing at least this extent of reduction as responders. Accordingly, we evaluated our data regarding the proportion of responders in each treatment arm, including data from 1 and 3 months postinjection, and revisiting subgroups as specified previously. In all groups and subpopulations defined, the proportion of responders continuously increased up to the 6-month follow-up, with the cell groups exceeding the CTR group in all cases, and with HCC exceeding LCC in all cases (Figure  4 ). Between 6 and 12 months, the responder proportion of the CTR and LCC groups either plateaued or even declined, whereas it continued to increase up 54.
Diagnostic Procedures Anal endoscopy, ultrasound examination, and anorectal manometry measurement were performed according to standards set in each of the participating centers. Anal Endosonography. Anal endosonography was performed in all patients. Investigators were experienced and trained in the technique. A B-K Medical Scanner Type Flexfocus, fitted with an 8838 high resolution endoanal probe was used (B-K Medical, Herlev, Denmark). Patients were examined in the supine position using standard technique. A 3-dimensional dataset that encompassed the entire anal canal length was obtained and discussed among participating investigators. Anal Manometry. Parameters assessed included length of the anal canal, resting pressure, and maximal squeeze pressure. Balloon expulsion tests were used to measure the filling volume until the first sensation was reached, the volume for the desire to defecate, the volume of urgency for defecation, and the maximal tolerable volume.
Conclusions Vistacare ® is a new innovative device for wound management which is currently being assessed in patients with acute and chronic leg wounds in an open-label, prospective, multi-center study (NCT03790202). However, this is the first report concerning the use of this specific wound environment control system in the management of a patient with a severe diabetic foot ulcer, which allowed us to avoid major amputation. This device should be considered as complementary to usual treatment, notably for ischemic wounds, when standards of care are insufficient and when the use of a topical wound negative pressure device is painful and/or ineffective. Additional reports are needed to better define its use in diabetic foot management.
Background: There are significant cross-country differences in socio-economic gradients in later childhood and adulthood overweight/obesity; few studies assess whether this cross-national variation is evident from early childhood. Furthermore, the role of childcare in explaining overweight/obesity gradients might vary across countries, given differences in access, quality and heterogeneity within. Additionally, childcare is linked to parental characteristics such as maternal employment. The interplay between childcare and employment in producing early overweight/obesity gradients has received little attention, and might vary cross-nationally. Methods: Using harmonized data from six high-quality, large datasets, we explore the variation in gradients in early overweight/obesity (at age 3-4 years old) by parental education across several high-income countries (USA, UK, France, the Netherlands, Germany and Japan).
Data A key strength of this study is the use of large, high-quality longitudinal samples from six countries. This article draws on longitudinal birth cohort data, harmonized and analyzed through the project DICE (Development of Inequalities in Child Educational Achievement  26  ) The French Longitudinal Study of Children (Elfe) is a birth cohort of children born in France in 2011 at a nationallyrepresentative sample of 341 maternity wards;  27  the Millennium Cohort Study (MCS) is a nationally representative cohort of children born in 2000-2 and residing in the UK shortly after birth;  28  Generation R is a population-based birth cohort in the Netherlands. All pregnant women living in Rotterdam with expected delivery dates of April 2002 to January 2006 were invited to participate. 29 The Longitudinal Survey of Newborns in the 21st Century-2010 cohort (LSN21-2010) is a birth cohort of all children born in Japan in May 2010.
30 The Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) is a nationally representative sample of children born in the USA in 2001 (In accordance with the restricted-data requirements, all sample sizes for the ECLS are rounded to the nearest 50). 31 In Germany, the Newborn Cohort Study of the German National Educational Panel Study (NEPS-SC1),  32  a nationally representatively sample of about 3500 infants born in 2012 is followed from 7 months of age.
The latter two analyses are available upon request. All estimates from the USA, France and UK applied the recommended longitudinal weights and survey design variables to adjust estimates for complex sampling and attrition. For Germany and the Netherlands, longitudinal weights were constructed by the DICE team to account for attrition. 35 Weighting adjustments were made via the svy command. Multiple imputations were implemented to account for item nonresponse, imputing 20 datasets to ensure appropriate power. The results of the analyses with 20 imputed datasets were combined in accordance with Rubin's formulas, using mi estimate. Complete case analyses, run on the non-imputed sample, were conducted as a check (available upon request); substantive results were similar to analyses run on imputed datasets.
It is however important to note that the overall prevalence of overweight/obesity varied widely across our six countries, so that, e. g. while the USA exhibited smaller mean differences by parental education, they started from an overall much higher prevalence than Germany, France or the Netherlands. Because the birth cohorts used in this article span a 10-year period, with the USA, UK, Dutch data collected before the economic crisis, and the French, Germany and Japanese data collected just after, it is possible that our observed gradients are conservative in the UK, USA and the Netherlands compared with those observed for France, Germany and Japan. Furthermore, while in the Netherlands, France and Japan overall gradients are driven by the overweight group, with relatively muted differences in obesity rates across education groups, in Germany, the UK and the USA, the obese group also contribute to gradients.
Notes: Lagged variables are measured at 1. 5-2 years (Germany, France, the Netherlands, USA and Japan) or 9 months (UK) of child age, except for income, family structure in the Netherlands, which were measured at enrollment. Non-lagged variables are measured at age 3. 5 (France and Japan), 3 (the Netherlands, Germany and UK) and 4 (USA). a: In these datasets, estimation samples vary slightly across imputation sets because the stratification variable (maternal employment) originally had missing values and was imputed. The smallest sample is reported. *: Significant at 5% level; **: significant at 1% level; ***: significant at <1%. International differences in gradients in early childhood overweight and obesity 7 of 8.
Funding This research was undertaken as part of the  Development of Inequalities in Child Educational Achievement: A Six Country Study (DICE)  project, funded under the  Open Research Area (ORA) Round 5 Funding Scheme. We gratefully acknowledge funding support from the  Economic and Social Research Council  ( ESRC Grant   ES/S015191/1 , UK); the  Agence Nationale de la Recherche  ( ANR  grant  ANR-18-ORAR-0001 , France), the  Deutsche Forschungsgemeinschaft (DFG, Germany ,  SCHN 1116/1-1 ;  WE 1478/12-1 ), the  Nederlandse Organisatie voor Wetenschappelijk Onderzoek (NWO, Netherlands , grant number  464. 18. 102 ).
Via the RECONAI platform, it receives a government grant managed by the National Research Agency under SN-5795-5) conducted by the Centre for Longitudinal Studies. We would like to thank the MCS families for their time and cooperation as well as the MCS team at the Institute of Education, University College London. Japan: Japan's results are based on data from the Longitudinal Survey of Newborns in the 21st Century, 2010 birth cohort (LSN2010). The LSN2010 was collected and provided by the Japanese Ministry of Health, Labour and Welfare. M1 M2 M3 M4 M5 Notes: Lagged variables are measured at 1. 5-2 years (Germany, France, the Netherlands, USA and Japan) or 9 months (UK) of child age, except for income, family structure in the Netherlands, which were measured at enrollment. Non-lagged variables are measured at age 3.
5 (France and Japan), 3 (the Netherlands, Germany and UK) and 4 (USA). *: Significant at 5% level; **: significant at 1% level; ***: Significant at <1%. the "Investissements d'avenir" programme (ANR-11-EQPX-0038 and ANR-19-COHO-0001). Germany: This article uses data from the National Educational Panel Study (NEPS; see Blossfeld & Roßbach, 2019). The NEPS is carried out by the Leibniz Institute for Educational Trajectories (LIfBi, Germany) in cooperation with a nationwide network. The Netherlands: The Generation R Study is conducted by the Erasmus MC, University Medical Center Rotterdam in close collaboration with the Erasmus University Conflicts of interest: None declared.
Objectives: Monitoring the appropriateness of antibiotic prescriptions with indicators based on reimbursement data is required to guide antibiotic stewardship (AMS) interventions in nursing homes (NHs). Quantity metrics (QMs) monitor the volume of prescriptions while proxy indicators (PIs) reflect the appropriateness of antibiotic use. Our objectives were: (i) to provide a relevant consensual set of indicators to be used in French NHs; and (ii) to assess the feasibility of their implementation at the national and local scale. Methods: Nine French professional organizations implicated in AMS in NHs were asked to nominate at least one member to create a national expert panel of 20 physicians. Twenty-one recently published QMs and 11 PIs were assessed by the expert panel. Indicators were evaluated using a RAND-modified Delphi procedure comprising two online surveys and a videoconference meeting.
16 ntibiotic reimbursement data are easily available in national databases, giving information about the quantity of antibiotics dispensed by community pharmacies, but without the clinical context of prescription. Two types of indicators are currently used, quantity metrics (QMs) and proxy indicators (PIs). QMs measure the volume of antibiotic delivery and can be easily calculated, but they give poor indication about possible misuse of antibiotics. On the other hand, PIs can reflect the appropriateness of antibiotic prescriptions in the absence of medical data available, and provide concrete targets for improvement. The aim of the present study was to select relevant indicators, adapt the definition of the QMs and PIs if necessary, and select the targets for PIs using a Delphi process involving a national expert panel.
Initial set of indicators used As detailed previously,  16  in France, most NHs (>80%) are communitybased, without in-house pharmacies. In such settings, antibiotics are prescribed by GPs, dispensed by community pharmacies, and reimbursed by the National Health Insurance (NHI). Different residents accommodated in the same NH can have different GPs. The indicators used in the present study for AMS in NHs were based on the NHI reimbursement database (SNDS). This database includes the following information for all prescriptions: age and gender of the patient; identification of the prescriber; information on the antibiotic dispensed; and the facility identification in case of NH residency. Information on diagnoses and the duration of treatment in days is not available in the database. However, the number of packages dispensed is collected.
The NHI database does not include hospital-based NHs (with on-site antibiotic delivery), representing less than 20% of French NHs. For each indicator, individual prescriptions were aggregated at the NH level. QMs estimated the volume of antibiotic consumption per resident-days, using number of prescriptions and/or DDDs, with a numerator-denominator combination. PIs estimated the appropriateness of antibiotic prescriptions at the NH level and were associated with targets reflecting compliance with national guidelines.
Study design A four-step RAND-modified Delphi procedure  17, 18  was used to validate a set of indicators for AMS in NHs. Considering the lack of evidence-based medicine in the field of indicators for AMS, RAND studies can be useful to combine the best available scientific data with the collective statement of experts, in order to yield a consensual list of indicators. 17 Theses procedures have the advantage to provide: (i) iteration, permitting experts to change their opinion between the different rounds; (ii) controlled feedback, by communicating the results of previous rounds; and (iii) high-quality statistical data, assuring that perspectives of each expert are equally represented in the final set. 19 Our study comprised two online surveys separated by a videoconference meeting. For the first round of the consensus procedure, we used an initial list of 21 QMs and 11 PIs, recently published by Simon et al.
Overall relevance for each indicator was considered fair if the mean score was ≤3. 5, good if the mean score was 3. 5, good if the mean score was >3. 5 and ≤4, and excellent if the mean score was >4. Experts were encouraged to justify their rating, suggest modifications for each component of the indicators if needed (numerator, denominator and target) and, if necessary, suggest new indicators. Experts were not able to reject indicators during this first round. Data were analysed by two independent researchers (A. A. K. and G. B. ). For the second round, experts who participated in the online questionnaire were invited to take part in a 2 h videoconference. During the meeting, the results of the experts' first-round ratings, with median scores for each indicator and a detailed summary of individual replies, were presented to experts to initiate the discussion.
Practical use of selected indicators for the national and local monitoring of antibiotic prescriptions The final list of indicators was tested using the NHI database in two different French areas for the year 2019. We included all community-based Antibiotic stewardship in nursing homes NHs in the Pays de la Loire and Grand Est regions (respectively 3 787 000 and 2 338 000 inhabitants) that were active in 2019. The calculation of QMs and PIs was performed according to the method described elsewhere. 16 n an exploratory basis, experts were secondly asked to give their opinion regarding four possible uses of the indicators: (i) comparisons between NHs in a benchmarking process; (ii) design of AMS programmes at the facility level; (iii) feedback to NH prescribers; and (iv) public reporting of facility-level indicators.
Practical use of selected indicators for the national and local monitoring of antibiotic prescriptions The indicators were assessed using the NHI databases from two French administrative areas: the Grand Est and the Pays de la Loire regions. In 2019, there were 417 NHs in the Grand Est and 443 in the Pays de la Loire regions. The mean number (±SD) of residents per NH was 91. 1  and 2. Indicators were consistent across both areas. Wide variations were noted between NHs for all QMs. On an exploratory basis, the 20 experts were asked to give their opinion regarding possible uses of the indicators, and 11 completed the survey. Most of the experts who answered (91%) were in favour of sharing the indicators within the French regional AMS network for local programmes at the facility level (Figure  2 ).
Development of a relevant set of indicators for AMS in NHs This study provides a consensual list of 14 QMs and 10 PIs adapted to AMS in NHs, for estimating the volume and appropriateness of antimicrobial prescriptions, respectively, in NHs based on national reimbursement data. This list of indicators includes a wide range of frequent clinical situations in NHs, from overuse to misuse of antibiotics. The overuse of antibiotics was approached by 14 indicators, 11 QMs and 3 PIs. Monitoring the prescription of urine cultures is a way of addressing the treatment of asymptomatic bacteriuria. Regarding upper respiratory tract infections in primary care, 80% of treatment courses may exceed the recommended duration. 24 To overcome the unavailability of prescription durations in the NHI database, an estimation was performed using the quantity of packages dispensed.
The use of oral cephalosporins that may generate suboptimal concentrations, 28 repeated prescriptions of quinolones within a 6 month period 29 and the choice of drugs for first-line regimens have all been associated with an increased risk of AMR. An indicator related to flu vaccination falls outside the scope of antibiotic reimbursement, but is also available in SNDS database, and is indirectly correlated with antibiotic prescriptions, since flu vaccination might prevent one in 25 antibiotic prescriptions among acute respiratory infections during the influenza season. 30 Monitoring and benchmarking these practices may lead to improved use of antibiotics during winter.
Practical use of selected indicators for the national and local monitoring of antibiotic prescriptions This list of indicators developed and validated for French NHs is easy to generate from NHI databases and may be of use at the international scale for benchmarking purposes. These outputs will contribute to the national monitoring of antibiotic use in French NHs, in line with the 2022-25 national strategy for preventing antibiotic resistance. 31 The experts were asked to give their opinion about possible uses for the indicators. Unfortunately, only 11 of the 20 experts completed the survey, so the results have to be taken with caution. Regarding PIs, 91% of our experts supported transmitting them to regional AMS networks for local programmes at the facility level. Several stakeholders, such as the Regional and National Health Insurance organization and the regional antibiotic stewardship networks, might be able to use these data to help NHs develop personalized action plans, with concrete objectives and a monitoring plan.
Statistical analysis We adopted an outcome-wide approach that enables a comprehensive holistic assessment of the association of one given exposure with a wide range of outcomes; its methodological advantages include less susceptibility to P-hacking and publication bias. 26 We used linear (or modified Poisson 27 for the dichotomized outcomes, i. e. maternal depression, perceived physical and emotional health) regression models to regress each standardized outcome on any breastfeeding duration !6 months. All models were controlled for the covariates mentioned above (see 'Covariates' section). We performed multiple imputations by chained equations to impute missing data for all variables, with 20 imputed datasets created. More information is available in Supplementary material S1. To evaluate the robustness of the estimated associations with unmeasured confounding, we calculated E-values for each exposureoutcome association.
A recent study in the UK supports this hypothesis, at least in the short term. 37 In low-income settings, high rates of some degree of breastfeeding exist but comparisons between breastfed and nonbreastfed populations may have examined more homogeneous groups. 38 Moreover, other sources of confounding cannot entirely be ruled out. Breastfeeding duration data were self-reported retrospectively for most of the sample (as few mothers-12%-were still breastfeeding the child at the time of the survey), thus impairing precision and accuracy. Nonetheless, previous studies suggest that maternal recall is a valid and reliable measure of breastfeeding practices. 39 dditionally, we had no information about the type of breastfeeding; in particular, we cannot rule out the possibility that findings for exclusive breastfeeding might be different.
Funding This work was funded through both the  French National Research Agency  ( ANR-19-CE36-0006 ) and the  Paris-NUS  grant ( ANR-18-IDEX-0001 ). The ENFAMS survey was supported by:  Agence Regionale de Santed'Ile-de-France (ARS) ;  Caisse Nationale des Allocations Familiales (CNAF) ;  Canceropole Ile-de-France ;  Fondation de France ;  Fondation Macif ;  Fondation Sanofi Espoir ;  Institut de Recherche en SantePublique (IReSP) ;  Institut de Veille Sanitaire (InVS) ;  Institut National de Prevention et d'Education pour la Sante(INPES) ;  Ministere de l'Interieur ;  Observatoire National de l'Enfance en Danger (ONED) ;  Procter et Gamble ;  State Street.