bluuebunny/crossref_metadata_2025 huggingface dataset:
Change in urban and non-urban pattern of ED use during the COVID-19 pandemic in 28 Michigan hospitals: an observational study
Authors: Keyes Daniel , Hardin Blake , Sweeney Brian , Shedden Kerby
Published: February 2021

Objective

To assess the trends in visits, overall and by age, to urban and non-urban emergency departments (EDs), and visits resulting in admission to hospital before and during the COVID-19 pandemic using a large regional database.

Setting

A large regional database of 28 EDs during the COVID-19 pandemic in Michigan, with an index case of 11 March 2020 and peak in the first week of April.

Participants

ED visits during the first 5 months of the calendar year were included and compared with the previous year. Facilities where these participants were seen were classified as urban or non-urban, with comparisons of total visits, COVID-like cases, paediatric and trauma.

Outcome measures

Daily visits to EDs of patients presenting with COVID-like symptoms, trauma, age patterns and total cases, and stratified between urban and non-urban settings.

Results

There were 1 732 852 visits across the 2 years, 953 407 between study and comparison periods, and 457 130 visits defined as COVID-like (median age 44 years). Total ED visits decreased to 48% of the previous year, showing a delayed-inverse relationship with COVID-19. Trauma cases dropped but returned to the pre-COVID-19 rate by the end of May in Urban centres. Paediatric cases decreased to 20% of the previous year by the end of April. The oldest age groups showed the least change in ED visits in response to the pandemic.

Conclusions

This large US Midwestern state study describes a dramatic decrease in ED visits after the onset of the COVID-19 pandemic in Michigan, including stratification by varying ages and trauma, demonstrating the tangible impact of the COVID-19 pandemic on urban and non-urban EDs.
Effects of mechanical interventions in the management of knee osteoarthritis: protocol for an OA Trial Bank systematic review and individual participant data meta-analysis
Authors: Macri Erin M , Callaghan Michael , van Middelkoop Marienke , Hattle Miriam , Bierma-Zeinstra Sita M A
Published: February 2021

Introduction

Knee osteoarthritis (OA) is a prevalent and disabling musculoskeletal condition. Biomechanical factors may play a key role in the aetiology of knee OA, therefore, a broad class of interventions involves the application or wear of devices designed to mechanically support knees with OA. These include gait aids, bracing, taping, orthotics and footwear. The literature regarding efficacy of mechanical interventions has been conflicting or inconclusive, and this may be because certain subgroups with knee OA respond better to mechanical interventions. Our primary aim is to identify subgroups with knee OA who respond favourably to mechanical interventions.

Methods and analysis

We will conduct a systematic review to identify randomised clinical trials of any mechanical intervention for the treatment of knee OA. We will invite lead authors of eligible studies to share individual participant data (IPD). We will perform an IPD meta-analysis for each type of mechanical intervention to evaluate efficacy, with our main outcome being pain. Where IPD are not available, this will be achieved using aggregate data. We will then evaluate five potential treatment effect modifiers using a two-stage approach. If data permit, we will also evaluate whether biomechanics mediate the effects of mechanical interventions on pain in knee OA.

Ethics and dissemination

No new data will be collected in this study. We will adhere to institutional, national and international regulations regarding the secure and confidential sharing of IPD, addressing ethics as indicated. We will disseminate findings via international conferences, open-source publication in peer-reviewed journals and summaries posted on websites serving the public and clinicians.

PROSPERO registration number

CRD42020155466.
Cost–utility analysis of a multicomponent intervention for fibromyalgia syndrome in primary care versus usual clinical practice: study protocol for an economic evaluation of a randomised control trial
Authors: Arfuch Victoria Mailen , Aguilar Martín Carina , Berenguera Anna , Caballol Angelats Rosa , Carrasco-Querol Noèlia , González Serra Gemma , Sancho Sol Maria Cinta , Fusté Anguera Immaculada , Fernández Sáez José , Gonçalves Alessandra Queiroga , Casajuana Marc
Published: February 2021

Introduction

Fibromyalgia syndrome (FMS) imposes a high cost on society. The significant economic burden from the use of healthcare and, especially, social resources is a spur to revising the usual clinical care (UCC) and to improving treatment strategies. FMS has a deleterious effect on the quality of life (QOL) and productivity, which considerably increase the indirect costs to society. This study reports an economic evaluation comparing the cost and health benefits in a multicomponent intervention programme and UCC of patients with FMS who attend primary healthcare centres of the Gerència Territorial Terres de L’Ebre region of Catalonia, Spain. This article is linked to the pre-results of a randomised control trial study on the implementation of this intervention programme (ClinicalTrials.gov:NCT04049006).

Method and analysis

A cost–utility analysis will be conducted from a societal perspective. Quality-adjusted life years will be calculated from the results of the SF-36 questionnaire, a QOL measurement instrument. Direct and indirect healthcare costs will be obtained from official prices and reports published by the Spanish Public Health Administration and the National Statistics Institute. The incremental cost–utility ratio will be estimated to compare the two healthcare practices. Deterministic sensitivity analysis will also be used to compare different cost scenarios, modifying the items with the highest weight in the cost composition.

Ethics and dissemination

The Clinical Research Ethics Committee of the IDIAPJGol Institute approved this study on 25 April 2018 (code P18/068) in accordance with the Helsinki/Tokyo Declaration. Information will be provided orally and in writing to participants, and their informed consent will be required. Participant anonymity will be guaranteed. The dissemination strategy includes publications in scientific journals and presentations in local and national media and at academic conferences.

Trial registration number:NCT04049006; Pre-results.
Medication adherence in multiple sclerosis as a potential model for other chronic diseases: a population-based cohort study
Authors: Evans Charity , Marrie Ruth Ann , Yao Shenzhen , Zhu Feng , Walld Randy , Tremlett Helen , Blackburn David , Kingwell Elaine
Published: February 2021

Objective

To determine whether better medication adherence in multiple sclerosis (MS) might be due to specialised disease-modifying drug (DMD) support programmes by: (1) establishing higher adherence in MS than in other chronic diseases and (2) determining if higher adherence is associated with patient-specific or treatment-specific factors.

Design

Retrospective cohort study with data from 1 January 1996 to 31 December 2015.

Setting

Population-based health administrative data from three Canadian provinces.

Participants

Individual cohorts were created using validated case definitions for MS, epilepsy, Parkinson’s disease (PD) and rheumatoid arthritis (RA). Subjects were included if they received ≥1 dispensation for a disease-related drug between 1 January 1997 and 31 December 2014.

Main outcome measure(s)

Proportion of subjects with optimal adherence (≥80%) measured by the medication possession ratio 1 year after the index date (first dispensation of disease-related drug).

Results

126 478 subjects were included in the primary analysis (MS, n=6271; epilepsy, n=55 739; PD, n=21 304; RA, n=43 164). Subjects with epilepsy (adjusted OR, aOR 0.29; 95% CI 0.19 to 0.45), PD (aOR 0.42; 95% CI 0.29 to 0.63) or RA (aOR 0.26; 95% CI 0.19 to 0.35) were less likely to have optimal 1-year adherence compared with subjects with MS. Within the MS cohort, adherence was higher for DMD than for chronic-use non-MS medications, and no consistent patient-related predictors of adherence were observed across all four non-MS medication classes, including having optimal adherence to DMD.

Conclusions

Subjects with MS were significantly more likely to have optimal 1-year adherence than subjects with epilepsy, RA and PD, and optimal adherence appears related to treatment-specific factors rather than patient-related factors. This supports the hypothesis that higher adherence to the MS DMDs could be due to the specialised support programmes; these programmes may serve as a model for use in other chronic conditions.
Identifying patterns of health care utilisation among physical elder abuse victims using Medicare data and legally adjudicated cases: protocol for case–control study using data linkage and machine learning
Authors: Rosen Tony , Bao Yuhua , Zhang Yiye , Clark Sunday , Wen Katherine , Elman Alyssa , Jeng Philip , Bloemen Elizabeth , Lindberg Daniel , Krugman Richard , Campbell Jacquelyn , Bachman Ronet , Fulmer Terry , Pillemer Karl , Lachs Mark
Published: February 2021

Introduction

Physical elder abuse is common and has serious health consequences but is under-recognised and under-reported. As assessment by healthcare providers may represent the only contact outside family for many older adults, clinicians have a unique opportunity to identify suspected abuse and initiate intervention. Preliminary research suggests elder abuse victims may have different patterns of healthcare utilisation than other older adults, with increased rates of emergency department use, hospitalisation and nursing home placement. Little is known, however, about the patterns of this increased utilisation and associated costs. To help fill this gap, we describe here the protocol for a study exploring patterns of healthcare utilisation and associated costs for known physical elder abuse victims compared with non-victims.

Methods and analysis

We hypothesise that various aspects of healthcare utilisation are differentially affected by physical elder abuse victimisation, increasing ED/hospital utilisation and reducing outpatient/primary care utilisation. We will obtain Medicare claims data for a series of well-characterised, legally adjudicated cases of physical elder abuse to examine victims’ healthcare utilisation before and after the date of abuse detection. We will also compare these physical elder abuse victims to a matched comparison group of non-victimised older adults using Medicare claims. We will use machine learning approaches to extend our ability to identify patterns suggestive of potential physical elder abuse exposure. Describing unique patterns and associated costs of healthcare utilisation among elder abuse victims may improve the ability of healthcare providers to identify and, ultimately, intervene and prevent victimisation.

Ethics and dissemination

This project has been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #1807019417, with initial approval on 1 August 2018. We aim to disseminate our results in peer-reviewed journals at national and international conferences and among interested patient groups and the public.
Knowledge–attitude–practice and psychological status of college students during the early stage of COVID-19 outbreak in China: a cross-sectional study
Authors: Jia Yuehui , Qi Yanbo , Bai Li , Han Yunfeng , Xie Zhiping , Ge Jie
Published: February 2021

Objectives

This study aimed to investigate the knowledge–attitude–practice (KAP) of Chinese college students regarding COVID-19 and evaluate their psychological status against the background of the COVID-19 outbreak.

Design

This was a cross-sectional study.

Setting

This study covered 31 provinces, municipalities and autonomous regions of mainland China.

Participants

The participants, who were college students with ordinary full-time status, were surveyed anonymously on their KAP regarding COVID-19 by using self-made questionnaires. In addition, the Self-Rating Anxiety Scale was used to assess the psychological status of the students.

Methods

The online cross-sectional study among Chinese college students was conducted in February 2020. Logistic regression analysis was used to analyse the predictors of anxiety symptoms.

Primary outcome measures

The level of KAP and anxiety symptoms.

Results

A total of 740 college students from 31 provinces, municipalities and autonomous regions in China were recruited in the survey. Among them, 139 (18.78%) revealed having anxiety. Multivariable logistic regression analysis revealed that female gender was the risk factor for anxiety symptoms with an increased 2.164-fold risk than male gender (OR=2.164, 95% CI=1.279 to 3.662). The knowledge (OR=0.825, 95% CI=0.779 to 0.873) and attitude (OR=0.822, 95% CI=0.762 to 0.887) regarding COVID-19 were protective factors against anxiety symptoms.

Conclusions

The level of KAP regarding COVID-19 was significantly negatively correlated with anxiety symptoms. Thus, understanding the level of KAP among college students during the early stages of major public health emergencies, such as a pandemic, is important. Such understanding plays an important role in adopting targeted health education strategies and reducing the psychological damage caused by these emergencies.
Supporting self-care for eczema: protocol for two randomised controlled trials of ECO (Eczema Care Online) interventions for young people and parents/carers
Authors: Muller Ingrid , Stuart Beth , Sach Tracey , Hooper Julie , Wilczynska Sylvia , Steele Mary , Greenwell Kate , Sivyer Katy , Yardley Lucy , Williams Hywel C , Chalmers Joanne R , Leighton Paul , Howells Laura M , Ridd Matthew J , Lawton Sandra , Griffiths Gareth , Nuttall Jacqui , Langan Sinead M , Roberts Amanda , Ahmed Amina , Kirk Hayden , Becque Taeko , Little Paul , Thomas Kim S , Santer Miriam
Published: February 2021

Introduction

Eczema care requires management of triggers and various treatments. We developed two online behavioural interventions to support eczema care called ECO (Eczema Care Online) for young people and ECO for families. This protocol describes two randomised controlled trials (RCTs) aimed to evaluate clinical and cost-effectiveness of the two interventions.

Methods and analysis

Design: Two independent, pragmatic, unmasked, parallel group RCTs with internal pilots and nested health economic and process evaluation studies.Setting: Participants will be recruited from general practitioner practices in England.Participants: Young people aged 13–25 years with eczema and parents and carers of children aged 0–12 years with eczema, excluding inactive or very mild eczema (five or less on Patient-Oriented Eczema Measure (POEM)).Interventions: Participants will be randomised to online intervention plus usual care or to usual eczema care alone.Outcome measures: Primary outcome is eczema severity over 24 weeks measured by POEM. Secondary outcomes include POEM 4-weekly for 52 weeks, quality of life, eczema control, itch intensity (young people only), patient enablement, health service and treatment use. Process measures include treatment adherence, barriers to adherence and intervention usage. Our sample sizes of 303 participants per trial are powered to detect a group difference of 2.5 (SD 6.5) in monthly POEM scores over 24 weeks (significance 0.05, power 0.9), allowing for 20% loss to follow-up. Cost-effectiveness analysis will be from a National Health Service and personal social service perspective. Qualitative and quantitative process evaluation will help understand the mechanisms of action and participant experiences and inform implementation.

Ethics and dissemination

The study has been approved by South Central Oxford A Research Ethics Committee (19/SC/0351). Recruitment is ongoing, and follow-up will be completed by mid-2022. Findings will be disseminated to participants, the public, dermatology and primary care journals, and policy makers.

Trial registration number

ISRCTN79282252.
Influence of lifestyle risk factors on work ability and sick leave in a general working population in Norway: a 5-year longitudinal study
Authors: De Bortoli Marit Müller , Oellingrath Inger M. , Fell Anne Kristin Moeller , Burdorf Alex , Robroek Suzan J. W.
Published: February 2021

Objectives

The aim of this study is to assess (1) whether lifestyle risk factors are related to work ability and sick leave in a general working population over time, and (2) these associations within specific disease groups (ie, respiratory diseases, cardiovascular disease and diabetes, and mental illness).

Setting

Telemark county, in the south-eastern part of Norway.

Design

Longitudinal study with 5 years follow-up.

Participants

The Telemark study is a longitudinal study of the general working population in Telemark county, Norway, aged 16 to 50 years at baseline in 2013 (n=7952) and after 5-year follow-up.

Outcome measure

Self-reported information on work ability (moderate and poor) and sick leave (short-term and long-term) was assessed at baseline, and during a 5-year follow-up.

Results

Obesity (OR=1.64, 95% CI: 1.32 to 2.05) and smoking (OR=1.62, 95% CI: 1.35 to 1.96) were associated with long-term sick leave and, less strongly, with short-term sick leave. An unhealthy diet (OR=1.57, 95% CI: 1.01 to 2.43), and smoking (OR=1.67, 95% CI: 1.24 to 2.25) were associated with poor work ability and, to a smaller extent, with moderate work ability. A higher lifestyle risk score was associated with both sick leave and reduced work ability. Only few associations were found between unhealthy lifestyle factors and sick leave or reduced work ability within disease groups.

Conclusion

Lifestyle risk factors were associated with sick leave and reduced work ability. To evaluate these associations further, studies assessing the effect of lifestyle interventions on sick leave and work ability are needed.
Is there a sex difference in mortality rates for deaths occurring in paediatric intensive care units? Systematic literature review protocol
Authors: Almossawi Ofran , Friend Amanda , Palla Luigi , Feltbower Richard , De Stavola Bianca
Published: February 2021

Introduction

In the general population, female children have been reported to have a survival advantage. For children admitted to paediatric intensive care units (PICUs), mortality has been reported to be lower in males despite the higher admission rates for males into intensive care. This apparent sex reversal in PICU mortality is not well studied. To address this, we propose to conduct a systematic literature review to summarise the available evidence. Our review will study the reported differences in mortality between males and females aged 0–17, who died in a PICU, to examine if there is a difference between the two sexes in PICU mortality, and if so, to describe the magnitude and direction of this difference.

Methods and analysis

Studies that directly or indirectly addressed the association between sex and mortality in children admitted to intensive care will be eligible for inclusion. Studies that directly address the association will be eligible for data extraction. The search strings were based on terms related to the population (children in intensive care), the exposure (sex) and the outcome (mortality). We used the databases MEDLINE (1946–2020), Embase (1980–2020) and Web of Science (1985–2020) as these cover relevant clinical publications. We will assess the reliability of included studies using the risk of bias in observational studies of exposures tool. We will consider a pooled effect if we have at least three studies with similar periods of follow up and adjustment variables.

Ethics and dissemination

Ethical approval is not required for this review as it will synthesise data from existing studies. This manuscript is a part of a larger data linkage study, for which Ethical approval was granted. Dissemination will be via peer-reviewed journals and via public and patient groups.

PROSPERO registration number

CRD42020203009.
Qualitative exploration of the Medical Examiner role in identifying problems with the quality of patient care
Authors: O’Hara Rachel , Coster Joanne , Goodacre Steve
Published: February 2021

Objective

A national system of Medical Examiners (MEs) implemented in England and Wales from April 2019 was intended to ensure that every death receives scrutiny from an independent, senior doctor, resulting in early detection of problems in care. The aim of this study was to increase understanding of how the ME role operates to identify problems related to quality of patient care and to explore the potential for development to maximise learning opportunities.

Design

A qualitative approach involved the use of semi-structured interviews. Data analysis employed a framework approach.

Setting

Study participants were recruited from 11 acute hospitals in England, known to be operating an ME service.

Participants

A purposive sample of 20 MEs and one ME officer.

Results

MEs brought different perspectives to the role based on their medical background. The process for identifying and acting on quality of care concerns was broadly consistent, with a notable consensus regarding the value of speaking to bereaved relatives. Variation was identified within and between services in relation to how core components are carried out and the perceived salience of information, which appeared to reflect individual and service preferences as well as different organisational pathways. ME services required flexibility to accommodate fluctuating demand, but funding arrangements imposed restrictions. The majority of MEs highlighted limited opportunity for formal team contact and a lack of meaningful feedback as limiting scope for development.

Conclusion

Core components of the ME role were being conducted, although individual and systemic variations in practice were identified. The discussion with bereaved relatives is a unique feature of the ME role and was considered highly valuable, both for the organisation and relatives. Further development could consider the impact of the variation identified and address mechanisms for feedback and shared learning.
Added value of an open narrative in verbal autopsies: a mixed-methods evaluation from Malawi
Authors: Loh Patricia , Fottrell Edward , Beard James , Bar-Zeev Naor , Phiri Tambosi , Banda Masford , Makwenda Charles , Bird Jon , King Carina
Published: February 2021

Background

The WHO standardised verbal autopsy (VA) instrument includes closed questions, ascertaining signs and symptoms of illness preceding death, and an optional open narrative. As VA analyses increasingly use automated algorithms, inclusion of narratives should be justified. We evaluated the role of open narratives on VA processes, data quality and respondent’s emotional stress.

Methods

A mixed-methods analysis was conducted using VA data for child deaths (0–59 months), between April 2013 and November 2016 in Mchinji district, Malawi. Deaths were prospectively randomised to receive closed questions only or open narrative followed by closed questions. On concluding the VA, interviewers self-completed questions on respondents’ emotional stress. Logistic regression was used to determine associations with visible emotional distress during VAs. A group discussion with interviewers was conducted at the project end, to understand field experiences and explore future recommendations; data were coded using deductive themes.

Results

2509 VAs were included, with 49.8% (n=1341) randomised to open narratives. Narratives lasted a median of 7 minuntes (range: 1–113). Interviewers described improved rapport and felt narratives improved data quality, although there was no difference in the proportion of deaths with an indeterminate cause using an automated algorithm (5.3% vs 6.1%). The majority of respondents did not display visible emotional stress (81%). Those with a narrative had higher, but not statistically significant, odds of emotional distress (adjusted OR: 1.20; 95% CI: 0.98 to 1.47). Factors associated with emotional stress were: infant deaths versus neonates; deaths at a health centre or en-route to hospital versus home; and higher socioeconomic status. Non-parental respondents and increased time between death and interview were associated with lower odds of emotional distress.

Conclusion

Conducting an open narrative may help build rapport, something valued by the interviewers. However, additional time and emotional burdens should be further justified, with quality and utility of narratives promoted through standardised recommendations.
How can robot-assisted surgery provide value for money?
Authors: Patel Sejal , Rovers Maroeska M , Sedelaar Michiel J P , Zusterzeel Petra L M , Verhagen Ad F T M , Rosman Camiel , Grutters Janneke P C
Published: February 2021

Objectives

To develop an interactive tool that estimates what potential benefits are needed for the robot to provide value for money when compared with endoscopic or open surgical interventions.

Design

A generic online interactive tool was developed to analyze the (health) effects needed to compensate for the additional costs of using a surgical robotic system from a healthcare perspective. The application of the tool is illustrated with a hypothetical new surgical robotic platform. A synthesis of evidence from different sources was used combined with interviews with surgeons.

Setting

Flexible tool that can be adapted to flexible settings.

Participants

Any hospital patient group for which robotic, endoscopic or open surgical procedures may be considered as appropriate treatment alternatives (eg, urology, gynecology, and so on).

Intervention

Robotically assisted surgical interventions.

Comparator

Endoscopic or open surgical interventions.

Main outcome measures

Thresholds of how much (health) effect is needed for robot-assisted surgery to provide value for money and to become cost-effective.

Results

The utilization rate of the surgical robotic system and a reduction in complications appeared to be important aspects in determining the value for money. To become cost-effective, it was deemed important for new surgical robotic systems to have added clinical benefit and become less costly than the current system.

Conclusions

This paper and its assisting interactive tool can be used by clinicians, researchers, and policymakers to gain insight in the benefit needed to provide value for money when using a (new) surgical robotic system or, when the effects are known or can be estimated, to assess the value for money for a specific indication. For robotic surgery to provide most value for money, we recommend assessing for each indication whether the necessary effects seem achievable.
Discovery of predictors of sudden cardiac arrest in diabetes: rationale and outline of the RESCUED (REcognition of Sudden Cardiac arrest vUlnErability in Diabetes) project
Authors: van Dongen Laura H , Harms Peter P , Hoogendoorn Mark , Zimmerman Dominic S , Lodder Elisabeth M , 't Hart Leen M , Herings Ron , van Weert Henk C P M , Nijpels Giel , Swart Karin M A , van der Heijden Amber A , Blom Marieke T , Elders Petra J , Tan Hanno L
Published: February 2021

Introduction

Early recognition of individuals with increased risk of sudden cardiac arrest (SCA) remains challenging. SCA research so far has used data from cardiologist care, but missed most SCA victims, since they were only in general practitioner (GP) care prior to SCA. Studying individuals with type 2 diabetes (T2D) in GP care may help solve this problem, as they have increased risk for SCA, and rich clinical datasets, since they regularly visit their GP for check-up measurements. This information can be further enriched with extensive genetic and metabolic information.

Aim

To describe the study protocol of the REcognition of Sudden Cardiac arrest vUlnErability in Diabetes (RESCUED) project, which aims at identifying clinical, genetic and metabolic factors contributing to SCA risk in individuals with T2D, and to develop a prognostic model for the risk of SCA.

Methods

The RESCUED project combines data from dedicated SCA and T2D cohorts, and GP data, from the same region in the Netherlands. Clinical data, genetic data (common and rare variant analysis) and metabolic data (metabolomics) will be analysed (using classical analysis techniques and machine learning methods) and combined into a prognostic model for risk of SCA.

Conclusion

The RESCUED project is designed to increase our ability at early recognition of elevated SCA risk through an innovative strategy of focusing on GP data and a multidimensional methodology including clinical, genetic and metabolic analyses.
Description of multimorbidity clusters of admitted patients in medical departments of a general hospital
Authors: Matesanz-Fernández María , Seoane-Pillado Teresa , Iñiguez-Vázquez Iria , Suárez-Gil Roi , Pértega-Díaz Sonia , Casariego-Vales Emilio
Published: February 2021

Objective

We aim to identify patterns of disease clusters among inpatients of a general hospital and to describe the characteristics and evolution of each group.

Methods

We used two data sets from the CMBD (Conjunto mínimo básico de datos - Minimum Basic Hospital Data Set (MBDS)) of the Lucus Augusti Hospital (Spain), hospitalisations and patients, realising a retrospective cohort study among the 74 220 patients discharged from the Medic Area between 01 January 2000 and 31 December 2015. We created multimorbidity clusters using multiple correspondence analysis.

Results

We identified five clusters for both gender and age. Cluster 1: alcoholic liver disease, alcoholic dependency syndrome, lung and digestive tract malignant neoplasms (age under 50 years). Cluster 2: large intestine, prostate, breast and other malignant neoplasms, lymphoma and myeloma (age over 70, mostly males). Cluster 3: malnutrition, Parkinson disease and other mobility disorders, dementia and other mental health conditions (age over 80 years and mostly women). Cluster 4: atrial fibrillation/flutter, cardiac failure, chronic kidney failure and heart valve disease (age between 70–80 and mostly women). Cluster 5: hypertension/hypertensive heart disease, type 2 diabetes mellitus, ischaemic cardiomyopathy, dyslipidaemia, obesity and sleep apnea, including mostly men (age range 60–80). We assessed significant differences among the clusters when gender, age, number of chronic pathologies, number of rehospitalisations and mortality during the hospitalisation were assessed (p<0001 in all cases).

Conclusions

We identify for the first time in a hospital environment five clusters of disease combinations among the inpatients. These clusters contain several high-incidence diseases related to both age and gender that express their own evolution and clinical characteristics over time.
Effect of non-encapsulated and encapsulated active dried yeast on blood cell count, blood metabolites, and immune response of finishing beef heifers
Authors: Jiao Peixin , Beauchemin Karen A. , Ma Fengchun , AlZahal Ousama , Xie Xiaolai , Yang Wenzhu
Published: February 2021

A study was conducted to evaluate whether encapsulated active dried yeast (EDY), compared with non-protected active dried yeast (ADY) or antibiotics (ANT), improved immune response and blood metabolites of finishing beef heifers. Blood urea nitrogen was lower (P < 0.05) with supplemented ADY and mixture of ADY and EDY (MDY) compared with control. Supplementation of MDY also resulted in lower (P < 0.05) red blood cell distribution width than control. Lipopolysaccharide-binding protein was less (P < 0.05) for EDY than control, ANT, and ADY as well as cytokine concentration of interleukin-6 was less (P < 0.05) for MDY versus control.
Bias in hatchery-origin coho salmon survival estimates due to underestimated prerelease mortality
Authors: Irvine James R.
Published: February 2021

The widely accepted belief that hatchery-origin salmon survive less well than natural-origin or wild salmon can be, at least in part, an artifact of the way hatchery salmon survival is estimated. Hatchery salmon are often marked several months before release, while natural salmon are marked during their seaward migration. Underestimated prerelease mortalities result in biased low survival estimates. In British Columbia, although hatchery rearing practices have been modified to reduce unrecorded mortalities, experimental evidence indicates that coho salmon (Oncorhynchus kisutch) smolt survivals continue to be underestimated by ∼13%. Better reporting and incorporation of survival bias in data sets and analyses as well as additional work to evaluate bias for other regions and species over time is needed.
Electron-impact ionization of the Pb atom
Authors: Pindzola M. S. , Loch S. D. , Colgan J. P.
Published: February 2021

Electron-impact ionization cross sections are calculated for the ground configuration of the Pb atom. Time-dependent close-coupling cross sections for the direct ionization of the 6s and 6p subshells leading to single ionization are calculated with and without a polarization potential. Configuration-average distorted-wave cross sections for the direct ionization of the 6s and 6p subshells leading to single ionization are also calculated with and without a polarization potential. We find the time-dependent close-coupling cross sections using a polarization potential to be in good agreement with convergent-close-coupling cross sections using a polarization potential. The total direct ionization cross sections are compared to two sets of experimental measurements. The differences between the direct ionization cross sections and the experimental measurements are mainly due to indirect ionization cross sections coming from the $$6s^2 6p^2 \rightarrow 6s 6p^3$$

6

s
2

6

p
2

→
6
s
6

p
3

excitation followed by autoionization.

GraphicAbstract
Random Regular Expression Over Huge Alphabets
Authors: Nicaud Cyril , Rotondo Pablo
Published: February 2021

In this article, we study some properties of random regular expressions of size [Formula: see text], when the cardinality of the alphabet also depends on [Formula: see text]. For this, we revisit and improve the classical Transfer Theorem from the field of analytic combinatorics. This provides precise estimations for the number of regular expressions, the probability of recognizing the empty word and the expected number of Kleene stars in a random expression. For all these statistics, we show that there is a threshold when the size of the alphabet approaches [Formula: see text], at which point the leading term in the asymptotics starts oscillating.
EFFECT OF MACHINING PARAMETERS ON SURFACE ROUGHNESS FOR ALUMINIUM MATRIX COMPOSITE BY USING TAGUCHI METHOD WITH DECISION TREE ALGORITHM
Authors: RAVEENDRAN P. , ALAGARSAMY S. V. , RAVICHANDRAN M. , MEIGNANAMOORTHY M.
Published: February 2021

The intend of this research work is to explore the effect of various parameters in a CNC turning process like cutting speed ([Formula: see text]), feed ([Formula: see text]), and depth of cut ([Formula: see text]) on surface roughness (Ra) of turning AA7075 filled with 10[Formula: see text]wt.% of TiO2 composite fabricated through stir casting method. Taguchi method and decision tree (DT) algorithm were utilized to foresee the surface roughness (Ra) of the proposed composite. The microstructure of composite was ensured with the presence of TiO2 particles dispersed in a homogeneous manner within the matrix material. The machining of composite was carried out by using the CNC turning center and tungsten carbide insert as tool material. This experimental work was designed on L27 (33) orthogonal array using Taguchi’s design of experiments. From its signal-to-noise (S/N) ratio study, the minimum surface roughness (Ra) was obtained at the optimum level of parameters with the cutting speed at 1500[Formula: see text]rpm, feed at 0.15[Formula: see text]mm/rev and depth of cut at 0.3[Formula: see text]mm. Analysis of variance (ANOVA) and decision tree (DT) algorithm were used to identify the significant effect of parameters. The experimental result shows that depth of cut was the major significant parameter on surface roughness (Ra) when compared to cutting speed and feed.
Unified theories metrics and primordial magnetic fields in Riemann–Cartan spacetime
Authors: Garcia de Andrade L. C.
Published: February 2021

Several spacetime metrics in teleparallel geometry of Einstein like unified field theory (UFT) are presented. Cosmic magnetic fields are obtained in terms of the early universe torsion and other stages of the universe. For example, in one of the metrics, integration of the 2-form torsion 0-component is written in terms of magnetic flux, from Faraday’s induced equation. These ideas were obtained from a recent paper we published [Class. Quantum Grav. (2015)] on non-stationary teleparallel metrics, where at coherent length of [Formula: see text] a magnetic field of [Formula: see text] is obtained. At early universe, a torsion of [Formula: see text] leads us to a magnetic field of the order of [Formula: see text] which is weaker than the Bierman battery effect magnetic field of the order of [Formula: see text]. Hence this new metric indicates that unifield theory metrics a la Schrödinger may be used to obtain primordial magnetic fields. Other tests of this metric led to the nowadays magnetic field of [Formula: see text] from the torsion at present universe (at the laboratory using dual maser obtained by Kostelecky et al. [Phys. Rev. Lett.]) of [Formula: see text]. Cartan torsion has been frequently associated to topological defects in crystals or in pseudo-magnetic torsional fields. In this paper, we discuss how from teleparallel gravity one may obtain a theory of electromagnetism from metrics in spacetime. Topological defects given by Letelier [Class. Quantum Grav. 12 (1995) 1133] and Tod [Class. Quantum Grav. 11(5) (1994)] metrics can also be associated with pseudo-magnetic fields. Electromagnetism is geometrized via a bimetric theory of gravity where one metric is responsible for Ampere’s law and the other by the Faraday induction equation which gives rise to dynamo equation.
DIVERSITY OF PERCEPTION OF THE DYNAMICS BETWEEN COLLECTIVE IDENTITY AND INNOVATION IN COMMUNITIES OF PRACTICE
Authors: CARTON SABINE , CORBETT-ETCHEVERS ISABELLE , FARASTIER ARMELLE , FINE-FALCY SANDRINE
Published: February 2021

The paper explores how the collective identity of a community of practice contributes to the development of innovation capacity. Specifically, we question how members’ perception of collective identity influences their perception of individual and collective capacity to innovate, whether different dynamics are at work between collective identity and innovation capacity, and finally how individual factors can explain these different dynamics. Empirically, we studied the communities of practice at Schneider Electric, a world leading company in energy management and automation. We surveyed 672 members of communities of practice in order to understand their relationship to their community. Our findings highlight the relationship between the perception of CoP collective identity and innovation capacity and suggest that (1) the three dimensions of collective identity play a role on members’ perception of knowledge sharing and CoP contribution to innovation capacity and also that (2) this influence may act differently depending on members’ profiles.
Neural Networks Application on Human Skin Biophysical Impedance Characterizations
Authors: Ribar Srdjan , Mitic Vojislav V. , Lazovic Goran
Published: February 2021

Artificial neural networks (ANNs) are basically the structures that perform input–output mapping. This mapping mimics the signal processing in biological neural networks. The basic element of biological neural network is a neuron. Neurons receive input signals from other neurons or the environment, process them, and generate their output which represents the input to another neuron of the network. Neurons can change their sensitivity to input signals. Each neuron has a simple rule to process an input signal. Biological neural networks have the property that signals are processed through many parallel connections (massively parallel processing). The activity of all neurons in these parallel connections is summed and represents the output of the whole network. The main feature of biological neural networks is that changes in the sensitivity of the neurons lead to changes in the operation of the entire network. This is called adaptation and is correlated with the learning process of living organisms. In this paper, a set of artificial neural networks are used for classifying the human skin biophysical impedance data.
Antiviral optical techniques as a possible novel approach to COVID-19 treatment
Authors: Moshfegh Fereshteh , Khosraviani Farshad , Moghaddasi Negar , Limoodi Seyedeh Fatemeh Seyed Javadi , Boluki Ebrahim
Published: February 2021

The current pandemic SARS-CoV-2 (also known as 2019-nCoV and COVID-19) viral infection is growing globally and has created a disastrous situation all over the world. One of the biggest challenges is that no drugs are available to treat this life-threatening disease. As no drugs are available for definitive treatment of this disease and the mortality rate is very high, there is an utmost need to cure the infection using novel technologies. This study will point out some new antimicrobial technologies that have great potentials for eradicating and preventing emerging infections. They can be considered as treatments of choice for viral infections in the future.
On the Aα-spectrum of joined union of digraphs
Authors: Ganie Hilal A.
Published: February 2021

Let [Formula: see text] be a digraph of order [Formula: see text] and let [Formula: see text] be the adjacency matrix of [Formula: see text] Let Deg[Formula: see text] be the diagonal matrix of vertex out-degrees of [Formula: see text] For any real [Formula: see text] the generalized adjacency matrix [Formula: see text] of the digraph [Formula: see text] is defined as [Formula: see text] This matrix generalizes the spectral theories of the adjacency matrix and the signless Laplacian matrix of [Formula: see text]. In this paper, we find [Formula: see text]-spectrum of the joined union of digraphs in terms of spectrum of adjacency matrices of its components and the eigenvalues of an auxiliary matrix determined by the joined union. We determine the [Formula: see text]-spectrum of join of two regular digraphs and the join of a regular digraph with the union of two regular digraphs of distinct degrees. As applications, we obtain the [Formula: see text]-spectrum of various families of unsymmetric digraphs.
The Decomposition Analysis of Carbon Emissions: Theoretical Basis, Methods and Their Evaluations
Authors: QU Shenning
Published: February 2021

As an analytical framework for studying the characteristics of changes in things and their action mechanisms, the decomposition analysis of greenhouse gas emissions has been increasingly used in environmental economics research. The author introduces several decomposition methods commonly used at present and compares them. The index decomposition analysis (IDA) of carbon emissions usually uses energy identities to express carbon emissions as the product of several factor indexes, and decomposes them according to different weight-determining methods to clarify the incremental share of each index, in which way it is possible to decompose the models that contain less factors, process time series data, and conduct cross-country comparisons. It mainly includes the Laspeyres index decomposition and the Divisia index decomposition. Among them, the LMDI I method has been widely used for its advantages such as generating no residuals and easy to use. The structural decomposition analysis (SDA) can be used to conduct a more systematic analysis, decompose models with more influencing factors, and analyze the impacts of various factors on emissions, but this method has higher requirements for data collection. The biggest difference between the SDA method and the IDA methods of carbon emissions is that the former is based on an input–output system, while the latter only needs to use sectors’ aggregate data.
Review of Brownfield Redevelopment in China and a Comparison with that in OECD Countries
Authors: ORDERUD Geir Inge , SKOGHEIM Ragnhild , NORDAHL Berit Irene
Published: February 2021

Concomitantly with China’s rise as the manufacturing hub of the world as the 20th Century faded and the Western countries witnessed industrial restructuring, brownfields emerged as an urban problem in city regions, prompting research into how to achieve brownfield redevelopment. More recently, as the global economy diversified, brownfields, and demand for redevelopment have entered the scene of urban development in China, also becoming a research field. This paper reviews international peer reviewed scientific journals on brownfield redevelopment in China, with a focus on social science approaches. Utilizing a previous review of research on OECD countries, this paper indicates similarities and differences between China and Europe and North America in terms of brownfield redevelopment. The comparison shows that research on China is catching up with the international state-of-the-art literature, addressing topics related to pollution; land use and property development; land financing, property and economics; governance, state-market interactions and private–public partnerships; and decision-making systems. Especially, the focus on user rights versus property ownership appears important for international comparative research.
A New Method of Coding for Steganography Based on LSB Matching Revisited
Authors: Fateh Mansoor , Rezvani Mohsen , Irani Yasser
Published: February 2021

LSB matching revisited is an LSB-based approach for image steganography. This method is a type of coding to increase the capacity of steganography. In this method, two bits of the secret message are hidden in two pixels with only one change. But this method provides no idea for hiding a message with a large number of bits. In other words, this method works only for

n
=
2

, where

n

is the number of bits in a block of the secret message. In this paper, we propose an improved version of the LSB matching revisited approach, which works for

n
>
2

. The proposed scheme contains two phases including embedding and extracting the message. In the embedding phase, we first convert the secret message into a bit-stream, and then the bit-stream is divided into a set of blocks including

n

bits in each block. Then we choose

2

n
−
1

pixels for hiding such

n

bits of the secret message. In the next step, we choose the operations needed to generate such a message. Finally, we perform the obtained operations over the coefficients to hide the secret message. The proposed approach needs fewer changes than LSB MR when

n
>
2

. The capacity of the proposed approach is

2

n

−
1

/

2

n
−
1

−
1

×
100
%

higher than the F5 method where this value for

n
>
2

is bigger than 75%. For example, the capacity of our scheme is 75% higher than the capacity of F5 for

n
=
3

. The proposed method can be used in the first step of every steganography method to reduce the change in the stego image. Therefore, this method is a new coding method for steganography. Our experimental results using steganalysis show that using our method provides around 10% higher detection error for SRNet over two steganography schemes.