bluuebunny/crossref_metadata_2025 huggingface dataset:
Evacuation behavior of households facing compound hurricane‐pandemic threats
Authors: Yusuf Juita‐Elena (Wie) , Whytlaw Jennifer L. , Hutton Nicole , Olanrewaju‐Lasisi Taiwo , Giles Bridget , Lawsure Kaleen , Behr Joshua , Diaz Rafael , McLeod George
Published: April 2023

This study examines households' prospective evacuation behavior during a hurricane‐pandemic compound threat. Data from a 2020 survey of coastal Virginia households help answer two questions: (1) What factors associated with the threat and impacts of the COVID‐19 pandemic and hurricanes influence the prospective evacuation behavior of households during a compound hurricane‐pandemic event? (2) What are the equity implications for emergency management policies and practices to support evacuation and sheltering during a compound hurricane‐pandemic event? Households in the sample were split between those who stated they would evacuate away from the at‐risk region and those who would stay. Greater household vulnerability to hurricanes and COVID‐19 and having sufficient financial resources increase the likelihood of evacuation. Higher‐income households were more likely to have resources to evacuate and were less likely to suffer financial consequences from a hurricane or pandemic. Racial minorities are more vulnerable to the pandemic and face greater resource challenges when evacuating.
Bureaucratic response to performance information: how mandatory information disclosure affects environmental inspections
Authors: Li Zhengyan
Published: April 2023

Information disclosure has become a ubiquitous component of contemporary governance. This study examines how disclosure of information about the performance of regulated entities, which also implicates the performance of relevant government agencies, affects bureaucratic behaviors. In the context of the Clean Air Act (CAA)—the primary law that regulates air pollution in the United States—this study shows that regulators significantly increased CAA regulatory inspections on facilities that started to disclose relevant performance information to the public following the requirements of the Toxics Release Inventory (TRI), which is a major environmental information disclosure program in the United States. Additional analyses suggest the increase was because of the disclosure providing new information to regulators instead of mobilizing citizen actions. The findings suggest that performance information about regulated entities can alleviate information asymmetry between bureaucrats and regulated entities and increase the accountability of regulated entities as well as relevant government agencies.
Reputation management during a public health crisis: Overcompensating when all else fails
Authors: Varela Castro Samanta , Bustos Edgar O. , Saldivia Gonzatti Daniel
Published: April 2023

Although reactions to reputational threats have been studied before, there is still an opportunity to understand the dynamics of reputation management facing a crisis. This study seeks to understand how the legal‐procedural, moral, performative, and technical dimensions of reputation change during the management of an extended crisis in a public health organization. We explore the communication of the Mexican Health Secretariat by analyzing its press conferences and releases before and during the COVID‐19 pandemic. Building on the situational crisis communication theory and considering public interest, we conducted two exploratory examinations based on text‐as‐data methods to capture reputation‐related language. Our analysis suggests that factors influencing reputational threat, such as crisis severity, legitimacy, leaders' individual reputation, and coalition support, may be important for choosing between strategies. We argue that the Secretariat radically changed its reputation management strategy during the pandemic—they first stressed the technical and, as damage rose, the performative dimensions.
Reducing farmers' poverty vulnerability in China: The role of digital financial inclusion
Authors: Yang Bo , Wang Xiangnan , Wu Tong , Deng Weihua
Published: April 2023

This paper applies exogenous shocks to investigate the impact of digital financial inclusion (DFI) on farmers' poverty vulnerability in China. We find that farmers in highly developed DFI areas are less vulnerable to the poverty trap. The result is robust to various checks, including propensity score matching and difference‐in‐differences method and the instrumental variable approach. Moreover, we find that income diversification is the possible economic channel through which DFI affects farmers' poverty vulnerability. Further analyses show that DFI has a “targeting” effect on those who are poor and vulnerable, and a synergistic effect by working with medical insurance and informal finance in terms of reducing farmers' poverty vulnerability. Our research findings provide new theoretical insights and useful guidance in enhancing financial inclusiveness and sustainable development in the post‐COVID‐19 era.
The transcriptome of soybean reproductive tissues subjected to water deficit, heat stress, and a combination of water deficit and heat stress
Authors: Sinha Ranjita , Induri Sai Preethi , Peláez‐Vico María Ángeles , Tukuli Adama , Shostak Benjamin , Zandalinas Sara I. , Joshi Trupti , Fritschi Felix B. , Mittler Ron
Published: April 2023

Global warming and climate change are driving an alarming increase in the frequency and intensity of extreme climate events, such as droughts, heat waves, and their combination, inflicting heavy losses to agricultural production. Recent studies revealed that the transcriptomic responses of different crops to water deficit (WD) or heat stress (HS) are very different from that to a combination of WD + HS. In addition, it was found that the effects of WD, HS, and WD + HS are significantly more devastating when these stresses occur during the reproductive growth phase of crops, compared to vegetative growth. As the molecular responses of different reproductive and vegetative tissues of plants to WD, HS, or WD + HS could be different from each other and these differences could impact many current and future attempts to enhance the resilience of crops to climate change through breeding and/or engineering, we conducted a transcriptomic analysis of different soybean (Glycine max) tissues to WD, HS, and WD + HS. Here we present a reference transcriptomic dataset that includes the response of soybean leaf, pod, anther, stigma, ovary, and sepal to WD, HS, and WD + HS conditions. Mining this dataset for the expression pattern of different stress response transcripts revealed that each tissue had a unique transcriptomic response to each of the different stress conditions. This finding is important as it suggests that enhancing the overall resilience of crops to climate change could require a coordinated approach that simultaneously alters the expression of different groups of transcripts in different tissues in a stress‐specific manner.
Metabolic resistance to acetolactate synthase inhibitors in Beckmannia syzigachne: identification of CYP81Q32 and its transcription regulation
Authors: Wang Junzhi , Lian Lei , Qi Jiale , Fang Yuhang , Nyporko Alex , Yu Qin , Bai Lianyang , Pan Lang
Published: April 2023

Frequent herbicide use selects for herbicide resistance in weeds. Cytochrome P450s are important detoxification enzymes responsible for herbicide resistance in plants. We identified and characterized a candidate P450 gene (BsCYP81Q32) from the problematic weed Beckmannia syzigachne to test whether it conferred metabolic resistance to the acetolactate synthase‐inhibiting herbicides mesosulfuron‐methyl, bispyribac‐sodium, and pyriminobac‐methyl. Transgenic rice overexpressing BsCYP81Q32 was resistant to the three herbicides. Equally, rice overexpressing the rice ortholog gene OsCYP81Q32 was more resistant to mesosulfuron‐methyl. Conversely, an OsCYP81Q32 gene knockout generated using CRISPR/Cas9 enhanced mesosulfuron‐methyl sensitivity in rice. Overexpression of the BsCYP81Q32 gene resulted in enhanced mesosulfuron‐methyl metabolism in transgenic rice seedlings via O‐demethylation. The major metabolite, demethylated mesosulfuron‐methyl, was chemically synthesized and displayed reduced herbicidal effect in plants. Moreover, a transcription factor (BsTGAL6) was identified and shown to bind a key region in the BsCYP81Q32 promoter for gene activation. Inhibition of BsTGAL6 expression by salicylic acid treatment in B. syzigachne plants reduced BsCYP81Q32 expression and consequently changed the whole plant response to mesosulfuron‐methyl. Sequence polymorphisms in an important region of the BsTGAL6 promoter may explain the higher expression of BsTGAL6 in resistant versus susceptible B. syzigachne plants. Collectively, the present study reveals the evolution of an herbicide‐metabolizing and resistance‐endowing P450 and its transcription regulation in an economically important weedy plant species.
How do digital trade rules affect global value chain trade in services?—Analysis of preferential trade agreements
Authors: Wu Jie , Luo Zechu , Wood Jacob
Published: April 2023

As international trade practices continue to develop, more than half of all international service trade has been digitised, with digital trade rules becoming a key factor affecting the development of global value chain (GVC) service trade. This study constructs the depth and scope indicators of digital trade rules included within preferential trade agreements (PTAs). We then investigate the role that digital trade rules play in promoting service trade along GVC using a gravity model framework. From our analysis, we find that both the depth and the scope indicators of digital trade rules have a significant promotional effect on GVC service exports, with the impact on GVC forward service exports being greater than the impact that was felt on GVC backward service exports. We also find that the GVC trade promotion effect is affected by income level, types of PTAs and the differences in regulatory quality that exist between countries. Finally, by developing a dynamic model that includes a set of leads and lags for digital trade rules' variables, we find that the impact of digital trade rules on GVC trade in services has both an anticipation and phasing‐in effect.
Comparison of UV‐Cl and UV‐H2O2 advanced oxidation processes in the degradation of contaminants from water and wastewater: A review
Authors: Farzanehsa Mahshid , Vaughan Liam C. , Zamyadi Arash , Khan Stuart J.
Published: April 2023

Applications of advanced oxidation processes (AOPs) in water and wastewater treatment have been the subject of growing interest throughout the last decade. Although UV/hydrogen peroxide (UV‐H2O2) is the most established technology among the UV‐AOPs, UV‐chlorine (UV‐Cl) is emerging as a reliable and potentially more cost‐effective alternative. Recent studies have indicated that UV‐Cl processes may be more efficient and economically favourable for the degradation of some chemicals of emerging concern from contaminated water. Moreover, in terms of the formation of disinfection by‐products (DBPs), UV‐H2O2 seems to have no superiority over UV‐Cl. This said, more investigation in the assessment of genotoxicity and cytotoxicity of DBPs is required. Additionally, more pilot‐scale and full‐scale studies are required to establish UV‐Cl as a reliable alternative to UV‐ H2O2. This paper compares UV‐Cl and UV‐H2O2 AOPs for the degradation of intractable chemicals from water and wastewater based on the practical considerations of efficiency, cost, DBP formation, kinetics and sensitivity to water matrix variability. Finally, various modelling approaches to UV‐Cl have been reviewed. This review showed that UV‐Cl is superior to UV‐H2O2 in terms of degradation efficiency and cost effectiveness and can be a robust alternative in many UV‐AOPs applications.
Comparison of Fatigue Life of AA2050-T852 and AA7050-T7452 Alloy Forgings at Different Orientations
Authors: Fuhr N. , Zhou S. , Shen K. , Rajab A. , Es-Said S. , Thaung S. , Tan S. , Riebe R. , Santos N. , Thura Hein Y. , Toal R. , Li Y. , Timko M. , Es-Said O. S.
Published: April 2023

This study compares the fatigue performance between the AA2050-T852 alloy and AA7050-T7452 alloy traditionally used in aircraft structures. Rotating beam fatigue tests were performed on AA2050-T852 and AA7050-T7452 specimens cut from forged plates with different orientations and at different thickness levels. The samples were tested at 345 MPa (50 ksi), 276 MPa (40 ksi), 207 MPa (30 ksi), and 172 MPa (25 ksi). Scanning Electron Microscope (SEM) images showed mixed-mode failure in all samples. However, the equiaxed dimples were more abundant and finer in the AA2050-T852 alloy. The results indicated that AA2050-T852 alloy demonstrated better fatigue life performance compared to AA7050-T7452 alloy at almost all stresses. No significant difference in fatigue anisotropy was found in one alloy versus the other.
The interplay between psychoacoustic perception and L1-specific perception in evaluating the distinctiveness of sound pairs
Authors: Li Mingxing , Zhang Jie
Published: April 2023

A listener's judgement on the perceptual distance between two sounds usually draws on their psychoacoustic difference, but can also be subject to L1-specific perception. This study investigates the interplay between these two aspects when evaluating the perceptual distance of sound pairs. Mandarin and English listeners rated the perceptual distance of consonant-vowel pairs corresponding to sequences legal or illegal in their L1s. The results suggested that a similarity rating task can provide a finer assessment of distinctiveness between sound pairs as compared to a discrimination task. The results also showed how psychoacoustic perception may interact with L1-specific perception in this process.
“Legalize Safe Standing” in English Football: Complicating the Collective and Individual Dimensions of Social Movement Activism
Authors: Turner Mark
Published: April 2023

Over the past 25 years, a hermeneutic struggle has unfolded in English football between those spectators who wish to stand at matches and the risks associated with this practice in all-seated stadia. Amid this tension, fans have had to negotiate a neoliberal and authoritarian regime. However, the struggles of supporters against social control in football are characterized by the building of a long-term social movement against all-seating. In seeking to break down the state’s disciplinary power and its marketization of football, this movement, “Safe Standing,” has achieved several recent policy-based victories in the United Kingdom and Europe and is now firmly embedded within sports stadia developments and the demands of fans in North America and Australasia. Although these different contexts are temporally and culturally sensitive, they are interdependently linked through relational time frames and discursive practices that make up the modern consumption of football. This research applies relational sociology to analyze the fan networks that successfully built this movement across the U.K. fan activist scene, characterized by relational collective action, which complicates the individual and collective dimensions of activism.
Spectral imaging enables contrast agent–free real-time ischemia monitoring in laparoscopic surgery
Authors: Ayala Leonardo , Adler Tim J. , Seidlitz Silvia , Wirkert Sebastian , Engels Christina , Seitel Alexander , Sellner Jan , Aksenov Alexey , Bodenbach Matthias , Bader Pia , Baron Sebastian , Vemuri Anant , Wiesenfarth Manuel , Schreck Nicholas , Mindroc Diana , Tizabi Minu , Pirmann Sebastian , Everitt Brittaney , Kopp-Schneider Annette , Teber Dogu , Maier-Hein Lena
Published: April 2023

Laparoscopic surgery has evolved as a key technique for cancer diagnosis and therapy. While characterization of the tissue perfusion is crucial in various procedures, such as partial nephrectomy, doing so by means of visual inspection remains highly challenging. We developed a laparoscopic real-time multispectral imaging system featuring a compact and lightweight multispectral camera and the possibility to complement the conventional surgical view of the patient with functional information at a video rate of 25 Hz. To enable contrast agent–free ischemia monitoring during laparoscopic partial nephrectomy, we phrase the problem of ischemia detection as an out-of-distribution detection problem that does not rely on data from any other patient and uses an ensemble of invertible neural networks at its core. An in-human trial demonstrates the feasibility of our approach and highlights the potential of spectral imaging combined with advanced deep learning–based analysis tools for fast, efficient, reliable, and safe functional laparoscopic imaging.
Back to the Roots:
Agrobacterium
-Specific Phages Show Potential to Disinfect Nutrient Solution from Hydroponic Greenhouses
Authors: Fortuna K. J. , Holtappels D. , Venneman J. , Baeyen S. , Vallino M. , Verwilt P. , Rediers H. , De Coninck B. , Maes M. , Van Vaerenbergh J. , Lavigne R. , Wagemans J.
Published: April 2023

Hairy root disease, caused by rhizogenic
Agrobacterium
biovar 1 is a rapidly emerging bacterial disease worldwide. It affects tomatoes, cucumbers, eggplant, and bell pepper, causing high yield losses in hydroponic greenhouses.
Meddling with Metal Sensors: Fur-Family Proteins as Signaling Hubs
Authors: Steingard Caroline H. , Helmann John D.
Published: April 2023

The ferric uptake regulator (Fur) protein is the founding member of the FUR superfamily of metalloregulatory proteins that control metal homeostasis in bacteria. FUR proteins regulate metal homeostasis in response to the binding of iron (Fur), zinc (Zur), manganese (Mur), or nickel (Nur).
Rothia
from the Human Nose Inhibit
Moraxella catarrhalis
Colonization with a Secreted Peptidoglycan Endopeptidase
Authors: Stubbendieck Reed M. , Dissanayake Eishika , Burnham Peter M. , Zelasko Susan E. , Temkin Mia I. , Wisdorf Sydney S. , Vrtis Rose F. , Gern James E. , Currie Cameron R.
Published: April 2023

Moraxella catarrhalis
is a pathobiont of the respiratory tract, responsible for ear infections in children and wheezing illnesses in children and adults with chronic respiratory diseases. Detection of
M. catarrhalis
during wheezing episodes in early life is associated with the development of persistent asthma.
Genome Sequences of Bordetella pertussis Isolates from Outbreaks in Northeastern Mexico
Authors: Rodríguez-Medina Nadia , Gutiérrez-Ferman Jessica , Villarreal-Treviño Licet , Garza-Ramos Ulises , Maldonado-Garza Héctor Jesús , Bárcenas-Walls José , Ortiz-López Rocío , de-la-O-Cavazos Manuel , Treviño-Garza Consuelo , Ballesteros-Elizondo María Romelia , Garza-González Elvira
Published: April 2023

Here, we report the draft genome sequences of 4
Bordetella pertussis
isolates which correspond to major clones isolated between 2008 and 2014 from two outbreaks in northeastern Mexico. The
B. pertussis
clinical isolates belong to the
ptxP3
lineage, and they are grouped into two major clusters, defined by the
fimH
allele.
16S rRNA Gene Amplicon Sequencing of the Gut Microbiota of Chimaera phantasma (Silver Chimaera) Captured off Koshimoda in Suruga Bay, Japan
Authors: Ogita Tasuku
Published: April 2023

The intestinal microbiota of
Chimaera phantasma
(silver chimera) (two females and one male) collected off Koshimoda in Suruga Bay in April to May 2022 were comprehensively analyzed. Bacteria belonging to the phylum
Proteobacteria
were the dominant species. Occupancy rates of other bacterial phyla differed greatly among the samples.
Scurvy-induced pulmonary arterial hypertension
Authors: Azar Jehad , Ayyad Mohammed , Jaber Yasmin , Ayasa Laith Azzam
Published: April 2023

Pulmonary arterial hypertension (PAH) is a progressive disease of the pulmonary vasculature that results in precapillary pulmonary hypertension. PAH is caused by a group of clinical conditions involving multiple organ systems. Several cases have been reported in the literature demonstrating an association between vitamin C deficiency and PAH. Low endothelial nitric oxide levels in the pulmonary vasculature, combined with the inappropriate activation of hypoxia-inducible transcription factors, seen in patients with ascorbic acid deficiency, are believed to be the main contributors to the pathogenesis of pulmonary vasculopathy and the exaggerated pulmonary vasoconstrictive response seen in patients with scurvy-induced PAH. Vitamin C supplementation is considered the definitive treatment.
Protocol for a single-centre prospective observational study of postoperative delirium following total joint arthroplasties among South East Asians
Authors: Abdullah Hairil Rizal , Tan Sapphire RouXi , Lee Si Jia , Bin Abd Razak Hamid Rahmatullah , Seet Rachel Huiqi , Ying Hao , Sethi Ervin , Sim Eileen Yilin
Published: April 2023

Introduction

Postoperative delirium is a serious and common complication in older adults following total joint arthroplasties (TJA). It is associated with increased risk of postoperative complications, mortality, length of hospital stay and postdischarge institutionalisation. Thus, it has a negative impact on the health-related quality of life of the patient and poses a large economic burden. This study aims to characterise the incidence of postoperative delirium following TJA in the South East Asian population and investigate any risk factors or associated outcomes.

Methods and analysis

This is a single-centre prospective observational study recruiting patients between 65 and 90 years old undergoing elective total knee arthroplasty or total hip arthroplasty. Exclusion criteria included patients with clinically diagnosed dementia. Preoperative and intraoperative data will be obtained prospectively. The primary outcome will be the presence of postoperative delirium assessed using the Confusion Assessment Method on postoperative days 1, 2 and 3 and day of discharge. Other secondary outcomes assessed postoperatively will include hospital outcomes, pain at rest, knee and hip function, health-related quality of life and Postoperative Morbidity Survey-defined morbidity. Data will be analysed to calculate the incidence of postoperative delirium. Potential risk factors and any associated outcomes of postoperative delirium will also be determined.

Ethics and dissemination

This study has been approved by the Singapore General Hospital Institutional Review Board (SGH IRB) (CIRB Ref: 2017/2467) and is registered on the ClinicalTrials.gov registry (Identified:NCT03260218). An informed consent form will be signed by all participants before recruitment and translators will be made available to non-English-speaking participants. The results of this study will be presented at international conferences and submitted to a peer-reviewed journal. The data collected will also be made available in a public data repository.

Trial registration number

NCT03260218.
Reporting of methodological studies in health research: a protocol for the development of the MethodologIcal STudy reportIng Checklist (MISTIC)
Authors: Lawson Daeria O , Puljak Livia , Pieper Dawid , Schandelmaier Stefan , Collins Gary S , Brignardello-Petersen Romina , Moher David , Tugwell Peter , Welch Vivian A , Samaan Zainab , Thombs Brett D , Nørskov Anders K , Jakobsen Janus C , Allison David B , Mayo-Wilson Evan , Young Taryn , Chan An-Wen , Briel Matthias , Guyatt Gordon H , Thabane Lehana , Mbuagbaw Lawrence
Published: April 2023

Introduction

Methodological studies (ie, studies that evaluate the design, conduct, analysis or reporting of other studies in health research) address various facets of health research including, for instance, data collection techniques, differences in approaches to analyses, reporting quality, adherence to guidelines or publication bias. As a result, methodological studies can help to identify knowledge gaps in the methodology of health research and strategies for improvement in research practices. Differences in methodological study names and a lack of reporting guidance contribute to lack of comparability across studies and difficulties in identifying relevant previous methodological studies. This paper outlines the methods we will use to develop an evidence-based tool—the MethodologIcal STudy reportIng Checklist—to harmonise naming conventions and improve the reporting of methodological studies.

Methods and analysis

We will search for methodological studies in the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, MEDLINE, Web of Science, check reference lists and contact experts in the field. We will extract and summarise data on the study names, design and reporting features of the included methodological studies. Consensus on study terms and recommended reporting items will be achieved via video conference meetings with a panel of experts including researchers who have published methodological studies.

Ethics and dissemination

The consensus study has been exempt from ethics review by the Hamilton Integrated Research Ethics Board. The results of the review and the reporting guideline will be disseminated in stakeholder meetings, conferences, peer-reviewed publications, in requests to journal editors (to endorse or make the guideline a requirement for authors), and on the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network and reporting guideline websites.

Registration

We have registered the development of the reporting guideline with the EQUATOR Network and publicly posted this project on the Open Science Framework (www.osf.io/9hgbq).
ED to EPI: protocol for a pragmatic randomised controlled trial of an SMS (text) messaging intervention to improve the transition from the emergency department to early psychosis intervention for young people with psychosis
Authors: Polillo Alexia , Foussias George , Wong Albert H C , Ampofo Augustina , Stergiopoulos Vicky , Anderson Kelly K , Bromley Sarah , D'Arcey Jessica , de Oliveira Claire , Duda Lillian , Henderson Joanna , Kidd Sean , Kurdyak Paul , Wang Wei , Zaheer Juveria , Voineskos Aristotle N , Kozloff Nicole
Published: April 2023

Introduction

While nearly half of all new psychotic disorders are diagnosed in the emergency department (ED), most young people who present to the ED with psychosis do not receive timely follow-up with a psychiatrist, and even fewer with evidence-based early psychosis intervention (EPI) services. We aim to test an intervention delivered using short message service (SMS), a low-cost, low-complexity, youth-friendly approach, to improve transitions from the ED to EPI services.

Methods and analysis

This is a protocol for a pragmatic randomised, single blind, controlled trial with accompanying economic and qualitative evaluations conducted at the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. A consecutive series of 186 participants aged 16–29 referred by the ED to CAMH’s EPI programme will be recruited for a trial of a two-way intervention involving reminders, psychoeducation and check-ins delivered via SMS. The primary outcome will be attendance at the first consultation appointment within 30 days of study enrolment assessed through chart reviews in the electronic health record. We will also extract routine clinical measures, including the Brief Psychiatric Rating Scale, Clinical Global Impression and Service Engagement Scale, and link with provincial health administrative data to examine system-level outcomes, including ED visits and psychiatric hospitalisations, 6 months and up to 2 years after baseline. We will perform a cost-effectiveness analysis of the primary study outcome and costs incurred, calculating an incremental cost effectiveness ratio. Web-based surveys and qualitative interviews will explore intervention user experience. Patients and families with lived experience will be engaged in all aspects of the project.

Ethics and dissemination

Research Ethics Board approval has been obtained. Findings will be reported in scientific journal articles and shared with key stakeholders including youth, family members, knowledge users and decision makers.

Trial registration number

NCT04298450.
Factors associated with caregiver burden among family caregivers of children with cerebral palsy: a systematic review
Authors: Liu Fang , Shen Qiao , Huang Miao , Zhou Hengyu
Published: April 2023

Objectives

To identify caregiver and children factors associated with caregiver burden on primary caregivers of children with cerebral palsy (CP).

Design

Systematic review

Data sources

Seven electronic databases, including PubMed, Cochrane Library, Scopus, PsycINFO, Web of Science, CINAHL and Embase, were systematically searched up to 1 February 2023.

Eligibility criteria

Original observational studies reporting caregiver burden and related factors among caregivers of children with CP.

Data abstraction and synthesis

Two reviewers independently screened results and assessed the quality of studies. Title, abstract, full-text screening and data abstraction were done independently by two reviewers. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The quality of evidence for factors was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results

16 articles were included in the review. All studies were cross-sectional and examined caregiver-reported burden measures. The Zarit Burden Interview was the most commonly used questionnaire. Depression of caregiver and severity of illness in children with CP were moderate quality of evidence for factors contributing to caregiver burden.

Conclusions

Higher caregiver burden is associated with more depressive feelings and worse life quality of the caregiver, and with more severe physical disability of the children. Future studies should focus on high-quality longitudinal research and appropriate assistance to reduce caregiver burden and improve the quality of caregiving for children with CP.

PROSPERO registration number

CRD42021268284.
Prediction of preoperative in-hospital mortality rate in patients with acute aortic dissection by machine learning: a two-centre, retrospective cohort study
Authors: Wu Zhaoyu , Li Yixuan , Xu Zhijue , Liu Haichun , Liu Kai , Qiu Peng , Chen Tao , Lu Xinwu
Published: April 2023

Objectives

To conduct a comprehensive analysis of demographic information, medical history, and blood pressure (BP) and heart rate (HR) variability during hospitalisation so as to establish a predictive model for preoperative in-hospital mortality of patients with acute aortic dissection (AD) by using machine learning techniques.

Design

Retrospective cohort study.

Setting

Data were collected from the electronic records and the databases of Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the First Affiliated Hospital of Anhui Medical University between 2004 and 2018.

Participants

380 inpatients diagnosed with acute AD were included in the study.

Primary outcome

Preoperative in-hospital mortality rate.

Results

A total of 55 patients (14.47%) died in the hospital before surgery. The results of the areas under the receiver operating characteristic curves, decision curve analysis and calibration curves indicated that the eXtreme Gradient Boosting (XGBoost) model had the highest accuracy and robustness. According to the SHapley Additive exPlanations analysis of the XGBoost model, Stanford type A, maximum aortic diameter >5.5 cm, high variability in HR, high variability in diastolic BP and involvement of the aortic arch had the greatest impact on the occurrence of in-hospital deaths before surgery. Moreover, the predictive model can accurately predict the preoperative in-hospital mortality rate at the individual level.

Conclusion

In the current study, we successfully constructed machine learning models to predict the preoperative in-hospital mortality of patients with acute AD, which can help identify high-risk patients and optimise the clinical decision-making. Further applications in clinical practice require the validation of these models using a large-sample, prospective database.

Trial registration number

ChiCTR1900025818.
Artificial intelligence-based mining of electronic health record data to accelerate the digital transformation of the national cardiovascular ecosystem: design protocol of the CardioMining study
Authors: Samaras Athanasios , Bekiaridou Alexandra , Papazoglou Andreas S , Moysidis Dimitrios V , Tsoumakas Grigorios , Bamidis Panagiotis , Tsigkas Grigorios , Lazaros George , Kassimis George , Fragakis Nikolaos , Vassilikos Vassilios , Zarifis Ioannis , Tziakas Dimitrios N , Tsioufis Konstantinos , Davlouros Periklis , Giannakoulas George
Published: April 2023

Introduction

Mining of electronic health record (EHRs) data is increasingly being implemented all over the world but mainly focuses on structured data. The capabilities of artificial intelligence (AI) could reverse the underusage of unstructured EHR data and enhance the quality of medical research and clinical care. This study aims to develop an AI-based model to transform unstructured EHR data into an organised, interpretable dataset and form a national dataset of cardiac patients.

Methods and analysis

CardioMining is a retrospective, multicentre study based on large, longitudinal data obtained from unstructured EHRs of the largest tertiary hospitals in Greece. Demographics, hospital administrative data, medical history, medications, laboratory examinations, imaging reports, therapeutic interventions, in-hospital management and postdischarge instructions will be collected, coupled with structured prognostic data from the National Institute of Health. The target number of included patients is 100 000. Natural language processing techniques will facilitate data mining from the unstructured EHRs. The accuracy of the automated model will be compared with the manual data extraction by study investigators. Machine learning tools will provide data analytics. CardioMining aims to cultivate the digital transformation of the national cardiovascular system and fill the gap in medical recording and big data analysis using validated AI techniques.

Ethics and dissemination

This study will be conducted in keeping with the International Conference on Harmonisation Good Clinical Practice guidelines, the Declaration of Helsinki, the Data Protection Code of the European Data Protection Authority and the European General Data Protection Regulation. The Research Ethics Committee of the Aristotle University of Thessaloniki and Scientific and Ethics Council of the AHEPA University Hospital have approved this study. Study findings will be disseminated through peer-reviewed medical journals and international conferences. International collaborations with other cardiovascular registries will be attempted.

Trial registration number

NCT05176769.
Ea$ing into the USA: study protocol for adapting the Economic and Social Empowerment (EA$E) intervention for US-based, forcibly based populations
Authors: Gupta Jhumka , Dalpe Jessica , Kanselaar Samantha , Ramanadhan Shoba , Boa Patrice Comoe , Williams Michelle S , Wachter Karin
Published: April 2023

Introduction

Immigrant and forcibly displaced women and girls are disproportionately impacted by the harmful health consequences of intimate partner violence (IPV) in the USA. Economic and Social Empowerment (EA$E), a women’s protection and empowerment intervention, has shown promising reductions in IPV and gender inequities among forcibly displaced populations (FDPs) in low-income and middle-income countries. However, research on the integration of gender equity interventions into economic empowerment programming for FDPs within the USA is lacking. Additionally, there is growing interest in integrating gender equity programmes among US-based refugee resettlement organisations, including the International Rescue Committee (IRC). We describe our study protocol for examining the feasibility, acceptability and appropriateness of EA$E for use with US-based FDPs, and recommendations for adaptation.

Methods and analysis

This is a convergent parallel study to guide the adaptation of EA$E for use with US-based FDPs. Mixed methods (quantitative and qualitative) will be used for the adaptation research. Quantitative data will consist of brief surveys, and qualitative data will consist of focus group discussions (FGDs). Our research will be guided by the ‘administration’ phase of the ADAPT-ITT framework, which entails pretesting the intervention with the new target audience and implementation context to examine acceptability, appropriateness and feasibility to receive feedback to inform modifications of the original intervention. This is done via theatre testing, an innovative approach to pretesting that allows the new target audience to experience the intervention and provide feedback. We will conduct FGDs with IRC staff (n=4, total of 24 participants) and refugee clients (n=8, total of 48 participants, women and men, French and English speaking).

Ethics and dissemination

The study has received approval from the George Mason University Human Subjects Committee (#1686712–7) and IRC (via reliance agreement). Results will be made available to refugee resettlement organisations, policymakers, funders and other researchers. This study has been registered in Open Science Framework (https://doi.org/10.17605/OSF.IO/SZDVY)
Multicentre, randomised, double-blind, placebo-controlled phase II study of prophylactic olanzapine for patients with metastatic breast cancer receiving T-DXd treatment: protocol for the ERICA study (WJOG14320B)
Authors: Sakai Hitomi , Tsurutani Junji , Ozaki Yukinori , Ishiguro Hiroshi , Nozawa Kazuki , Watanabe Kenichi , Maeda Shigeto , Yokoe Takamichi , Imamura Chiyo K , Matsumoto Koji , Iwasa Tsutomu , Chiba Yasutaka , Takiguchi Daisuke , Takano Toshimi
Published: April 2023

Introduction

The antibody-drug conjugate trastuzumab deruxtecan (T-DXd) has led to a change in the clinical management of breast cancer. Nausea and vomiting are the most common adverse events of T-DXd, which cannot be completely alleviated by standard prophylactic regimens. Olanzapine is particularly effective in preventing delayed nausea caused by chemotherapy. In this study, we will evaluate the efficacy of olanzapine in managing persistent nausea and vomiting during T-DXd treatment.

Methods and analysis

The ERICA study is a multicentre, placebo-controlled, double-blind, randomised phase II study with the aim to evaluate the antiemetic effects of the prophylactic olanzapine (5 mg orally, on days 1–6) or placebo combined with a 1,5-hydroxytryptamine-3 (5-HT3)–receptor antagonist and dexamethasone in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer undergoing T-DXd treatment. For a period of 22 days from the day of T-DXd treatment, patients will document their experience in an electronic symptom diary daily during observational periods. The primary endpoint is the complete response rate, defined as no vomiting and no rescue medications during the ‘delayed phase’ of 24–120 hours post-T-DXd administration. In addition, we define 120–504 hour as the ‘persistent phase’ and 0–504 hours as the ‘overall phase’ for secondary endpoint analysis. We have estimated that a total sample size of at least 156 patients is needed to allow a power of 80% at a one-sided significance level of 20% in this study. The target sample size is set to 166 to account for possible case exclusions.

Ethics and dissemination

The study protocol is approved by the West Japan Oncology Group protocol review committee and the SHOWA University Clinical Research Review Board. The study results will be presented at international conferences and published in a peer-reviewed journal.

Trial registration number

jRCTs031210410.
Influence of contextual factors on strengthening key strategic and operational levers of primary healthcare to achieve universal health coverage: a protocol for a realist review
Authors: Erku Daniel , Khatri Resham , Endalamaw Aklilu , Wolka Eskinder , Nigatu Frehiwot , Zewdie Anteneh , Assefa Yibeltal
Published: April 2023

Introduction

Existing scoping reviews on the link between primary healthcare (PHC) and universal health coverage (UHC) have not sufficiently addressed the underlying causal mechanisms in which key strategic and operational PHC levers contribute to improved health system and realisation of UHC. This realist review aims to examine how key PHC levers work (independently and holistically) to achieve an improved health system and UHC, and the conditions and caveats that influence the outcome.

Methods and analysis

We will employ a four-step realist evaluation approach: (1) define the review scope and develop initial programme theory, (2) database search, (3) data extraction and appraisal, (4) synthesis of evidence. Electronic databases (PubMed/MEDLINE, Embase, CINAHL, SCOPUS, PsycINFO, Cochrane Library and Google Scholar) and grey literature will be searched to identify initial programme theories underlying the key strategic and operational levers of PHC and empirical evidence to test these matrices of programme theories. Evidence from each document will be abstracted, appraised and synthesised through a process of reasoning using a realistic logic of analysis (ie, theoretical, or conceptual frameworks). The extracted data will then be analysed using a realist context–mechanism–outcome configuration, including what caused an outcome, through which mechanism, and under which context.

Ethics and dissemination

Given the studies are scoping reviews of published articles, ethics approval is not required. Key dissemination strategies will include academic papers, policy briefs and conference presentations. By capturing the relationship between sociopolitical, cultural and economic contexts and the pathways in which PHC levers interact with each other and the broader health system, findings from this review will facilitate the design and development of evidence-based, context-sensitive strategies that will enhance effective and sustainable PHC implementation strategies.
Movement Foundations. The perceived impact of a digital rehabilitation tool for returning to fitness following a period of illness, including COVID-19 infection: a qualitative study
Authors: Salman David , Le Feuvre Peter , Hill Oliver , Conway Dean , Taylor Simon , Turner Shruti , Korgaonkar Jonathan , Hettiaratchy Shehan , McGregor Alison H
Published: April 2023

Digital interventions can increase physical activity (PA) levels in adults. However, the COVID-19 pandemic highlighted the complexities faced when guiding people to start or return to PA following illness or inactivity. A digital tool, Movement Foundations, was developed to provide remote guidance on building strength and capacity across functional movement patterns, with graduated progression based on user responses and input. This qualitative study aimed to explore the perceived impacts of using the tool. Nine participants aged over 35 years from the healthcare and academic healthcare sectors were recruited to use it and were subsequently interviewed. Thematic analysis identified three themes falling under the overarching concept of ‘Capability, Opportunity and Motivation—Behaviour (COM-B) Plus’, encompassing: skills and capacity for movement; opportunities, motivations and barriers for movement; and a personalised, safe space in which to develop. Participants felt that the digital tool increased their capacity and confidence in movement and positively impacted their daily activities. External factors such as illness and stress clouded perceptions of the impacts of PA. Time, work pressures and needing equipment were still considered significant barriers to PA. Still, participants appreciated the flexibility and non-prescriptive nature of the tool and felt that it helped movement to become opportunistic and habitual. Increased capacity for PA and feeling the subsequent physical and mental effects positively influenced motivation. Structure and guidance, with graduated progress, were seen as protective. Guided self-reflection helped participants understand their capacity and limitations with regard to movement and promoted motivation. Although acquiring technical skills to guide movement may be important for those recovering from illness, participants found that a structure promoting individualised guidance, graduated progression and guided self-reflection were important motivational factors for continuing use. Digital interventions should consider these aspects when seeking to promote habitual PA.
Prevalence of pulmonary hypertension in aortic regurgitation and its influence on outcomes
Authors: Ratwatte Seshika , Playford David , Stewart Simon , Strange Geoff , Celermajer David S
Published: April 2023

Objective

Aortic regurgitation (AR) can lead to pulmonary hypertension (PHT). There is a paucity of data on the prognostic importance of PHT in these patients. We therefore aimed to describe the prevalence and prognostic importance of PHT in such patients.

Methods

In this retrospective study, we analysed the National Echocardiography Database of Australia (data from 2000 to 2019). Adults with an estimated right ventricular systolic pressure (eRVSP), left ventricular ejection fraction (LVEF) >50% and with moderate or greater AR were included (n=8392). These subjects were then categorised according to their eRVSP. The relationship between PHT severity and mortality outcomes were evaluated (median follow-up of 3.1 years, IQR 1.5–5.7 years).

Results

Subjects were aged 74±14 years and 58.4% (4901) were female. Overall, 1417 (16.9%) had no PHT, and 3253 (38.8%), 2249 (26.9%), 893 (10.6%) and 580 (6.9%) patients had borderline, mild, moderate and severe PHT, respectively. Mean eRVSP was slightly higher in females than males (41±13 vs 39±12 mm Hg, p<0.0001) and increased with age in both sexes. After adjustment for age and sex, the risk of long-term mortality increased as eRVSP increased (adjusted HR (aHR) 1.20, 95% CI 1.06 to 1.36 in borderline PHT, to aHR 3.32, 95% CI 2.85 to 3.86 in severe PHT, p<0.0001). There was a mortality threshold seen from mild PHT onwards (eRVSP 41.36–44.15 mm Hg; aHR 1.41, 95%CI 1.17 to 1.68).

Conclusions

In this large cohort study, we characterise the relationship between AR and PHT in adults. In patients with ≥moderate AR, PHT is associated with a progressive risk of mortality, even at mildly elevated levels.