bluuebunny/crossref_metadata_2025_split huggingface dataset:
Process evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (T3 trial): a qualitative study
Authors: McInnes Elizabeth , Dale Simeon , Craig Louise , Phillips Rosemary , Fasugba Oyebola , Schadewaldt Verena , Cheung N. Wah , Cadilhac Dominique A. , Grimshaw Jeremy M. , Levi Chris , Considine Julie , McElduff Patrick , Gerraty Richard , Fitzgerald Mark , Ward Jeanette , D’Este Catherine , Middleton Sandy 
Published: November 2020

Abstract

Background
The implementation of evidence-based protocols for stroke management in the emergency department (ED) for the appropriate triage, administration of tissue plasminogen activator to eligible patients, management of fever, hyperglycaemia and swallowing, and prompt transfer to a stroke unit were evaluated in an Australian cluster-randomised trial (T3 trial) conducted at 26 emergency departments. There was no reduction in 90-day death or dependency nor improved processes of ED care. We conducted an a priori planned process influential factors that impacted upon protocol uptake.

Methods
Qualitative face-to-face interviews were conducted with purposively selected ED and stroke clinicians from two high- and two low-performing intervention sites about their views on factors that influenced protocol uptake. All Trial State Co-ordinators (n = 3) who supported the implementation at the 13 intervention sites were also interviewed. Data were analysed thematically using normalisation process theory as a sensitising framework to understand key findings, and compared and contrasted between interviewee groups.

Results
Twenty-five ED and stroke clinicians, and three Trial State Co-ordinators were interviewed. Three major themes represented key influences on evidence uptake: (i) Readiness to change: reflected strategies to mobilise and engage clinical teams to foster cognitive participation and collective action; (ii) Fidelity to the protocols: reflected that beliefs about the evidence underpinning the protocols impeded the development of a shared understanding about the applicability of the protocols in the ED context (coherence); and (iii) Boundaries of care: reflected that appraisal (reflexive monitoring) by ED and stroke teams about their respective boundaries of clinical practice impeded uptake of the protocols.

Conclusions
Despite initial high ‘buy-in’ from clinicians, a theoretically informed and comprehensive implementation strategy was unable to overcome system and clinician level barriers. Initiatives to drive change and integrate protocols rested largely with senior nurses who had to overcome contextual factors that fell outside their control, including low medical engagement, beliefs about the supporting evidence and perceptions of professional boundaries. To maximise uptake of evidence and adherence to intervention fidelity in complex clinical settings such as ED cost-effective strategies are needed to overcome these barriers.

Trial registration
Australian New Zealand Clinical Trials Registry (ACTRN12614000939695).
Reprogramming the tumour microenvironment by radiotherapy: implications for radiotherapy and immunotherapy combinations
Authors: Colton Madyson , Cheadle Eleanor J. , Honeychurch Jamie , Illidge Tim M. 
Published: November 2020

AbstractRadiotherapy (RT) is a highly effective anti-cancer therapy delivered to around 50–60% of patients. It is part of therapy for around 40% of cancer patients who are cured of their disease. Until recently, the focus of this anti-tumour efficacy has been on the direct tumour cytotoxicity and RT-induced DNA damage. Recently, the immunomodulatory effects of RT on the tumour microenvironment have increasingly been recognized. There is now intense interest in potentially using RT to induce an anti-tumour immune response, which has led to rethinking into how the efficacy of RT could be further enhanced. Following the breakthrough of immune check point inhibitors (ICIs), a new era of immuno-oncology (IO) agents has emerged and established immunotherapy as a routine part of cancer treatment. Despite ICI improving outcomes in many cancer types, overall durable responses occur in only a minority of patients. The immunostimulatory effects of RT make combinations with ICI attractive to potentially amplify anti-tumour immunity resulting in increased tumour responses and improved outcomes. In contrast, tumours with profoundly immunosuppressive tumour microenvironments, dominated by myeloid-derived cell populations, remain a greater clinical challenge and RT may potentially further enhance the immunosuppression. To harness the full potential of RT and IO agent combinations, further insights are required to enhance our understanding of the role these immunosuppressive myeloid populations play, how RT influences these populations and how they may be therapeutically manipulated in combination with RT to improve outcomes further. These are exciting times with increasing numbers of IO targets being discovered and IO agents undergoing clinical evaluation. Multidisciplinary research collaborations will be required to establish the optimal parameters for delivering RT (target volume, dose and fractionation) in combination with IO agents, including scheduling to achieve maximal therapeutic efficacy.
Preparing humanitarians to address ethical problems
Authors: McGowan Catherine R. , Baxter Louisa , DuBois Marc , Sheather Julian , Khondaker Ruma , Cummings Rachael , Watkins Kevin 
Published: November 2020

AbstractInfectious disease outbreaks represent potentially catastrophic threats to those affected by humanitarian crises. High transmissibility, crowded living conditions, widespread co-morbidities, and a lack of intensive care capacity may amplify the effects of the outbreak on already vulnerable populations and present humanitarian actors with intense ethical problems. We argue that there are significant and troubling gaps in ethical awareness at the level of humanitarian praxis. Though some ethical guidance does exist most of it is directed at public health experts and fails to speak to the day-to-day ethical challenges confronted by frontline humanitarians. In responding to infectious disease outbreaks humanitarian workers are likely to grapple with complex dilemmas opening the door to moral distress and burnout.
Comparison of the 2018 and 2003 International Society of Nephrology/Renal Pathology Society classification in terms of renal prognosis in patients of lupus nephritis: a retrospective cohort study
Authors: Umeda Ryosuke , Ogata Soshiro , Hara Shigeo , Takahashi Kazuo , Inaguma Daijo , Hasegawa Midori , Yasuoka Hidetaka , Yuzawa Yukio , Hayashi Hiroki , Tsuboi Naotake 
Published: November 2020

Abstract

Background
Although the 2018 revised International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification was proposed recently, until now, no reports have been made comparing the association of renal prognosis between the 2018 revised ISN/RPS classification and the 2003 ISN/RPS classification. The present study aimed to assess the usefulness, especially of activity and chronicity assessment, of the 2018 revised ISN/RPS classification for lupus nephritis (LN) in terms of renal prognosis compared to the classification in 2003.

Methods
We retrospectively collected medical records of 170 LN patients from the database of renal biopsy at Fujita Health University from January 2003 to April 2019. Each renal biopsy specimen was reevaluated according to both the 2003 ISN/RPS classification and the 2018 revised ISN/RPS classification. Renal endpoint was defined as a 30% decline of estimated glomerular filtration rate (eGFR).

Results
A total of 129 patients were class III/IV±V (class III, 44 patients; class IV, 35 patients; class III/IV+V, 50 patients). The mean age was 42 years, 88% were female, and the median observation period was 50.5 months. Renal prognosis was significantly different among the classes and significantly poor in the patients with higher modified National Institute of Health (mNIH) chronicity index (C index, ≥ 4) by a log-rank test (p = 0.05 and p = 0.02, respectively). By Cox proportional hazard models, only the C index was significantly associated with renal outcome (hazard ratio 1.32, 95% CI 1.11–1.56, p ≤ 0.01), while the classes, the 2003 activity and chronicity subdivision, and the mNIH activity index had no significant association with renal outcome. Each component of the C index was significantly associated with renal outcome in different models.

Conclusion
This study demonstrates that the 2018 revised ISN/RPS classification was more useful in terms of association with renal prognosis compared to the 2003 ISN/RPS classification.
Can pre-trained convolutional neural networks be directly used as a feature extractor for video-based neonatal sleep and wake classification?
Authors: Awais Muhammad , Long Xi , Yin Bin , Chen Chen , Akbarzadeh Saeed , Abbasi Saadullah Farooq , Irfan Muhammad , Lu Chunmei , Wang Xinhua , Wang Laishuan , Chen Wei 
Published: November 2020

Abstract

Objective
In this paper, we propose to evaluate the use of pre-trained convolutional neural networks (CNNs) as a features extractor followed by the Principal Component Analysis (PCA) to find the best discriminant features to perform classification using support vector machine (SVM) algorithm for neonatal sleep and wake states using Fluke® facial video frames. Using pre-trained CNNs as a feature extractor would hugely reduce the effort of collecting new neonatal data for training a neural network which could be computationally expensive. The features are extracted after fully connected layers (FCL’s), where we compare several pre-trained CNNs, e.g., VGG16, VGG19, InceptionV3, GoogLeNet, ResNet, and AlexNet.

Results
From around 2-h Fluke® video recording of seven neonates, we achieved a modest classification performance with an accuracy, sensitivity, and specificity of 65.3%, 69.8%, 61.0%, respectively with AlexNet using Fluke® (RGB) video frames. This indicates that using a pre-trained model as a feature extractor could not fully suffice for highly reliable sleep and wake classification in neonates. Therefore, in future work a dedicated neural network trained on neonatal data or a transfer learning approach is required.
A PUF-based cryptographic security solution for IoT systems on chip
Authors: Balan Alexandra , Balan Titus , Cirstea Marcian , Sandu Florin 
Published: November 2020

Abstract
The integration of multicore processors and peripherals from multiple intellectual property core providers as hardware components of IoT multiprocessor systems-on-chip (SoC) represents a source of security vulnerabilities for the in-chip communication.
This paper describes the concept and the practical results of a SoC security implementation that is illustrative for IoT applications. The mechanism employed in this approach uses physically unclonable functions (PUF) and symmetric cryptography in order to encrypt the transferred messages within the SoC between the microprocessor and its peripherals. The mechanism is experimentally validated at FPGA level, the paper describing also an implementation scenario for an IoT ARM based device.
Porcine hemothropic mycoplasmas infection associated with productive impact in intensive pig production
Authors: Petri Fernando Antônio Moreira , Sonalio Karina , de Souza Almeida Henrique Meiroz , Ferraz Maria Eugênia Silveira , Storino Gabriel Yuri , de Souza Mauro Rodrigo , André Marcos Rogério , de Oliveira Luis Guilherme 
Published: November 2020

Abstract

Background
So far, three porcine hemoplasmas (PH) have been identified, namely Mycoplasma suis, Mycoplasma parvum, and Mycoplasma haemosuis. The first one is the main agent associated with porcine hemoplasmosis, a possible cause of economic losses in pig production. Thus, this work aimed to detect and quantify PH 16S rRNA in finishing pigs and to associate its load estimate with average daily weight gain (ADWG). For this purpose, whole blood samples from 318 pigs were collected at an age of 75 days (d0) when the pigs entered the finishing phase and 105 days later (d105). To calculate ADWG, the animals were weighed at the abovementioned dates. Then, DNA from blood samples were submitted to a qPCR targeting the 16S rRNA gene for PH. Spearman correlation test was performed to investigate potential associations between ADWG and the quantification values. Lastly, the molecular characterization of PH was done by sequencing the 23S rDNA gene.

Results
Out of the 318 samples, 190 (59.74%) were positive on d0, and 304 (95.6%) were positive on d105. A significant correlation was observed (p < 0.05), albeit with a low coefficient value (0.18), when comparing ADWG with quantification values on d105. The phylogenetic analysis based on the 23S rDNA gene showed that four sequences were closely related to M. parvum, and one sequence was positioned in the M. suis cluster.

Conclusion
Two PH, M. suis and M. parvum, were detected in a Brazilian pig farm. Moreover, increasing occurrence through time was observed, which may have affected the productive performance of positive animals, mainly at the end of the finishing phase, when antimicrobials are removed.
Machine learning approach for predicting under-five mortality determinants in Ethiopia: evidence from the 2016 Ethiopian Demographic and Health Survey
Authors: Bitew Fikrewold H. , Nyarko Samuel H. , Potter Lloyd , Sparks Corey S. 
Published: November 2020

AbstractThere is a dearth of literature on the use of machine learning models to predict important under-five mortality risks in Ethiopia. In this study, we showed spatial variations of under-five mortality and used machine learning models to predict its important sociodemographic determinants in Ethiopia. The study data were drawn from the 2016 Ethiopian Demographic and Health Survey. We used three machine learning models such as random forests, logistic regression, and K-nearest neighbors as well as one traditional logistic regression model to predict under-five mortality determinants. For each machine learning model, measures of model accuracy and receiver operating characteristic curves were used to evaluate the predictive power of each model. The descriptive results show that there are considerable regional variations in under-five mortality rates in Ethiopia. The under-five mortality prediction ability was found to be between 46.3 and 67.2% for the models considered, with the random forest model (67.2%) showing the best performance. The best predictive model shows that household size, time to the source of water, breastfeeding status, number of births in the preceding 5 years, sex of a child, birth intervals, antenatal care, birth order, type of water source, and mother’s body mass index play an important role in under-five mortality levels in Ethiopia. The random forest machine learning model produces a better predictive power for estimating under-five mortality risk factors and may help to improve policy decision-making in this regard. Childhood survival chances can be improved considerably by using these important factors to inform relevant policies.
Identifying and characterizing students suspected of academic dishonesty in SPOCs for credit through learning analytics
Authors: Jaramillo-Morillo Daniel , Ruipérez-Valiente José , Sarasty Mario F. , Ramírez-Gonzalez Gustavo 
Published: November 2020

Abstract
Massive Open Online Massive Open Online Courses (MOOCs) have been transitioning slowly from being completely open and without clear recognition in universities or industry, to private settings through the emergence of Small and Massive Private Online Courses (SPOCs and MPOCs). Courses in these new formats are often for credit and have clear market value through the acquisition of competencies and skills. However, the endemic issue of academic dishonesty remains lingering and generating untrustworthiness regarding what students did to complete these courses. In this case study, we focus on SPOCs with academic recognition developed at the University of Cauca in Colombia and hosted in their Open edX instance called Selene Unicauca. We have developed a learning analytics algorithm to detect dishonest students based on submission time and exam responses providing as output a number of indicators that can be easily used to identify students. Our results in two SPOCs suggest that 17% of the students that interacted enough with the courses have performed academic dishonest actions, and that 100% of the students that were dishonest passed the courses, compared to 62% for the rest of students. Contrary to what other studies have found, in this study, dishonest students were similarly or even more active with the courseware than the rest, and we hypothesize that these might be working groups taking the course seriously and solving exams together to achieve a higher grade. With MOOC-based degrees and SPOCs for credit becoming the norm in distance learning, we believe that if this issue is not tackled properly, it might endanger the future of the reliability and value of online learning credentials.
Tracking inflation on a daily basis
Authors: Alvarez Santiago E. , Lein Sarah M. 
Published: November 2020

AbstractUsing online data for prices and real-time debit card transaction data on changes in expenditures for Switzerland allows us to track inflation on a daily basis. While the daily price index fluctuates around the official price index in normal times, it drops immediately after the lockdown related to the COVID19 pandemic. Official statistics reflect this drop only with a lag, specifically because data collection takes time and is impeded by lockdown conditions. Such daily real-time information can be useful to gauge the relative importance of demand and supply shocks and thus inform policymakers who need to determine appropriate policy measures.
Gabapentin as an adjuvant therapy to splinting in carpal tunnel syndrome (CTS): a systematic review and meta-analysis of randomized controlled trials
Authors: Ahmed Ahmed M. , Hassan Osama G. , Khalifa Ahmed A. 
Published: November 2020

Abstract

Background
Carpal tunnel syndrome (CTS) is a common upper limb entrapment neuropathy; severe cases are treated surgically and mild to moderate can be managed conservatively. The purpose of this systematic review and meta-analysis was to define the efficacy of gabapentin as an adjuvant to splinting in the treatment of mild to moderate CTS.

Methods
A systematic search through 13 databases, randomized clinical trials (RCTs) reporting the use of gabapentin with splinting in CTS were included and analyzed.

Results
Three RCTs including 170 patients were eligible. There was no significant difference between gabapentin plus splinting and splinting alone in 5 measured parameters: (1) Symptom Severity Scale (SSS) [MD (95% CI) = − 0.76 (− 2.46–0.93), p = 0.378], (2) Functional Status Scale (FSS) [MD (95% CI) = − 0.23 (− 1.40–0.94), p = 0.701], (3) visual analogue scale (VAS) to assess pain [MD (95% CI) = − 0.6 (− 1.47–0.27), p = 0.174], (4) Grip strength [MD (95% CI) = − 0.11 (− 0.70–0.48), p = 0.718], and (5) pinch strength [MD (95% CI) = 0.72 (− 0.10–1.54), p = 0.083].

Conclusion
This review provides low-quality evidence that gabapentin plus nocturnal splinting is not superior to splinting alone. More high-quality trials are needed to determine the role of this drug as an adjuvant in the management of CTS.
GIS-based assessment of groundwater quality and suitability for drinking and irrigation purposes in the outlet and central parts of Wadi El-Assiuti, Assiut Governorate, Egypt
Authors: Megahed Hanaa A. 
Published: November 2020

Abstract

Background
The limited water resources in arid environments in addition to the effect of agricultural and anthropogenic activities on groundwater quantity and quality necessitate paying more attention to the quality assessment of these resources. The present studies assess the quality of groundwater resources in Wadi El-Assiuti, south Egypt, and evaluate their suitability for drinking and irrigation purposes. To achieve this goal, 159 groundwater samples were collected from the outlet and central parts of the Wadi El-Assiuti during the autumn season (October–November) of 2019 and were analyzed for major ions, trace elements and heavy metals.

Results
The results indicate that the TDS values range between 1972 and 6217 ppm, while the concentration of trace elements (Fe++, Mn++ and Ni+) ranges between 0.05 and 0.46, 0.11 and 0.221 and 0.01 and 0.6 ppm, respectively. These results show that all groundwater samples are clearly unacceptable and inappropriate for human drinking due to their high content of total dissolved solids, trace elements and heavy metals, particularly in the majority of samples according to World Health Organization (WHO) guidelines and the Egyptian standards (Eg. St. 2007) for drinking water quality. Spatial analysis of the TDS values in geographic information system environment indicates that the salinity is higher in the northeast and gradually decreases southward. Sodium adsorption ratio, US Salinity Laboratory classification (1954), residual sodium carbonate, soluble sodium percentage and permeability index show that most groundwater samples are suitable for irrigation purposes.

Conclusions
The integrated approach provided in this study highlights the spatially distributed suitability of groundwater resources in Wadi El-Assiuti and can be applied in similar basins worldwide.
Printed by Parkinson’s: a neurological art project linking patient stories and biosignals
Authors: Feldmann Lucia K. , Kühn Andrea A. 
Published: November 2020

Abstract
“Printed by Parkinson’s” is an innovative project with the main aim to raise awareness for the many aspects of Parkinson’s disease and their implication for everyday life. In a cooperation of Innocean Worldwide GmbH and the Movement Disorder and Neuromodulation Section, Charité Universitätsmedizin Berlin, design and medical and neuroscientific expertise were combined to create unique artworks: Bronze sculptures were created when combining personal objects selected by each patient, and their neurophysiological individual health data. As a core element, patient interviews in an accompanying film shed light on the personal stories behind the art objects. Public presentations raised interest in the topic and very positive reactions by patients and relatives, and we think that the possibility to use art for improved communication in the field of medicine holds promise for the future.