bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and psychometric evaluation of the U.S. English Wound‐QoL questionnaire to assess health‐related quality of life in people with chronic wounds
Authors: Sommer Rachel , von Stülpnagel Catharina C. , Fife Caroline E. , Blasingame Mandy , Anders Melissa J. , Thompson Debi , Augustin Matthias , da Silva Neuza , Blome Christine 
Published: July 2020

AbstractPeople with chronic wounds perceive an impaired health‐related quality of life (HRQoL). For the assessment of HRQoL, valid instruments are needed. Therefore, the Wound‐QoL questionnaire was originally developed and psychometrically validated for use in Germany. As the Wound‐QoL is to be used in numerous countries, international versions are required. Therefore, this study aimed to psychometrically validate the U.S. English Wound‐QoL version. Upon translation into U.S. English, psychometric testing was performed based on cross‐sectional data deriving from the U.S. Wound Registry. Besides descriptive statistics, internal consistency and concurrent validity were tested. In addition, a graded response model was used. The sample consisted of 599 people with chronic wounds of different etiologies. Participants were between 18 and 95 years old, mean age was 63.7 (SD = 15.9) years. Gender was distributed almost equally, with 47.4% female patients. High internal consistency, low floor and ceiling effects of the subscales could be largely confirmed. The internal consistency of the global score was excellent, with α > .9. Concurrent validity between the Wound‐QoL and pain, the surface area of the largest wound, total surface area, and total number of active wounds could be confirmed. In contrast, item response theory (IRT) analyses could not fully confirm the factorial model underlying the Wound‐QoL subscales. Furthermore, the items regarding smell and discharge and the items on problems with hitting the wound against something, climbing stairs and feeling dependent on help from others showed a low item information in their belonging dimensions. In conclusion, the newly validated Wound‐QoL is available for HRQoL measurement in people with chronic wounds in the United States. It showed good psychometric properties, demonstrating its reliability and validity. Therefore, the instrument may be used to assess HRQoL in clinical practice. However, IRT analyses showed that the instrument may benefit from future refinement.
Study on Altitude Adaptability of a Turbocharged Off-Road Diesel Engine
Authors: Huang Fenlian , Lei Jilin , Xin Qianfan 
Published: July 2020

Abstract
This paper investigates the operating characteristics of an off-road diesel engine to enhance its power performance in plateau. First, the impacts of altitude on the power, fuel economy, and emissions characteristics were analyzed by a bench test. Second, the combustion and overall performance working at different altitudes were studied by three-dimensional numerical simulation, including the relationship between fuel injection parameters and engine performance. The results showed that altitude significantly affects the performance of the off-road diesel engine. As the altitude increased from 0 m to 2000 m, the engine power decreased as much as 4.3%, and the brake-specific fuel consumption (BSFC) increased as much as 6%. At the peak torque condition, the intake manifold boost pressure and the exhaust manifold pressure both reduced with a rise of altitude, while the intake and exhaust manifold temperatures both increased with a rise of altitude. Finally, after comparing the in-cylinder flow conditions and combustion characteristics given by six combustion chamber designs that have different shrinkage ratios, the engine performance at 4000 m altitude with five different fuel spray angles were further optimized. The engine rated power increased by 8.2% when the shrinkage ratio was 7.28% and the fuel spray angle was 150 deg at the 4000 m altitude.
Racial discrimination and socioemotional and sleep problems in a cross-sectional survey of Australian school students
Authors: Priest Naomi , Chong Shiau , Truong Mandy , Alam Oishee , Dunn Kevin , O'Connor Meredith , Paradies Yin , Ward Andrew , Kavanagh Anne 
Published: July 2020

ObjectiveTo determine the prevalence of direct and vicarious racial discrimination experiences from peer, school and societal sources, and examine associations between these experiences and socioemotional and sleep outcomes.MethodsData were analysed from a population representative cross-sectional study of n=4664 school students in years 5–9 (10–15 years of age) in Australia. Students reported direct experiences of racial discrimination from peers, school and societal sources; vicarious discrimination was measured according to the frequency of witnessing other students experiences of racial discrimination. Students self-reported on the Strengths and Difficulties Questionnaire, with the total difficulties, conduct, emotional and prosocial behaviour subscales examined. Sleep problems included duration, latency, and disruption.Results41.56% (95% CI 36.18 to 47.15) of students reported experiences of direct racial discrimination; Indigenous and ethnic minority students reported the highest levels. 70.15% (95% CI 63.83 to 75.78) of students reported vicarious racial discrimination. Direct and vicarious experiences of racial discrimination were associated with socioemotional adjustment (eg, for total difficulties, total direct racism: beta=3.77, 95% CI 3.11 to 4.44; vicarious racism: beta=2.51, 95% CI 2.00 to 3.03). Strong evidence was also found for an effect of direct and vicarious discrimination on sleep (eg, for sleep duration, total direct: beta=−21.04, 95% CI −37.67 to −4.40; vicarious: beta=−9.82, 95% CI −13.78 to −5.86).ConclusionsExperiences of direct and vicarious racial discrimination are common for students from Indigenous and ethnic minority backgrounds, and are associated with socioemotional and sleep problems in adolescence. Racism and racial discrimination are critically important to tackle as social determinants of health for children and adolescents.
Long-term BMI change trajectories in Chinese adults and its association with the hazard of type 2 diabetes: evidence from a 20-year China Health and Nutrition Survey
Authors: Mi Baibing , Wu Chenlu , Gao Xiangyu , Wu Wentao , Du Jiaoyang , Zhao Yaling , Wang Duolao , Dang Shaonong , Yan Hong 
Published: July 2020

IntroductionTo investigate the relationship between long-term change trajectory in body mass index (BMI) and the hazard of type 2 diabetes among Chinese adults.Research design and methodsData were obtained from the China Health and Nutrition Survey (CHNS). Type 2 diabetes was reported by participants themselves in each survey wave. The duration of follow-up was defined as the period from the first visit to the first time self-reported type 2 diabetes, death, or other loss to follow-up from CHNS. The patterns of change trajectories in BMI were derived by latent class trajectory analysis method. The Fine and Gray regression model was used to estimate HRs with corresponding 95% CIs for type 2 diabetes.ResultsFour patterns of the trajectories of change in BMI were identified among Chinese adults, 42.7% of participants had stable BMI change, 40.8% for moderate BMI gain, 8.9% for substantial BMI gain and 7.7% for weight loss. During the follow-up with mean 11.2 years (158 637 person-years contributed by 14 185 participants), 498 people with type 2 diabetes (3.7%) occurred. Risk of type 2 diabetes was increased by 47% among people who gained BMI more substantially and rapidly (HR: 1.47, 95% CI 1.08 to 2.02, p=0.016) and increased by 20% among those in people with the moderate BMI gain (HR: 1.20, 95% CI 0.98 to 1.48, p=0.078), compared with those with stable BMI change.ConclusionsLong-term substantial gain of BMI was significantly associated with an increased risk of type 2 diabetes in the Chinese adults.
HbA1c response and hospital admissions following commencement of flash glucose monitoring in adults with type 1 diabetes
Authors: Stimson Roland H , Dover Anna R , Ritchie Stuart A , Wright Rohana J , McKnight John A , Zammitt Nicola N , Gibb Fraser W 
Published: July 2020

IntroductionOur aim was to assess the effect of introducing flash monitoring in adults with type 1 diabetes with respect to change in hemoglobin A1c (HbA1c) and frequency of hospital admissions.Research design and methodsProspective observational study of adults with type 1 diabetes in our center, in whom a prescription for a flash monitoring sensor was collected. Primary outcome was change in HbA1c between 2016 and after flash monitoring. Rates of hospital admission were compared between the first year after flash monitoring and the corresponding 12-month period 2 years earlier.ResultsApproximately half of all adults with type 1 diabetes, attending our center, collected prescriptions for flash monitoring sensors (n=2216). Median fall in HbA1c was −1 (−0.1) mmol/mol (%) (p<0.001) and was greatest in those with baseline HbA1c >75 (9.0) mmol/mol (%): −10 (−0.9) mmol/mol (%), p<0.001. 43% of those with a baseline HbA1c >53 mmol/mol (7%) experienced a ≥5 mmol/mol (0.5%) fall in HbA1c. In addition to higher HbA1c, early commencement within 1 month of NHS-funded flash monitoring (p<0.001), and male gender (p=0.013) were associated with a fall in HbA1c of ≥5 (0.5) mmol/mol (%). Socioeconomic deprivation (p=0.009) and collecting fewer than 2 sensors per month (p=0.002) were associated with lack of response. Overall, hospital admissions did not change but an increase in admissions for hypoglycemia was observed (1.1% vs 0.3%, p=0.026).ConclusionsFlash monitoring is associated with reduction in HbA1c in individuals with HbA1c >58 mmol/mol. Numerous clinical features are independently associated with HbA1c response. An increase in hypoglycemia admissions occurred following flash monitoring.
Risk of lower gastrointestinal bleeding and colorectal neoplasms following initiation of low-dose aspirin: a Danish population-based cohort study
Authors: Troelsen Frederikke Schønfeldt , Farkas Dóra Körmendiné , Erichsen Rune , Sørensen Henrik Toft 
Published: July 2020

ObjectiveAspirin may increase the risk of lower gastrointestinal bleeding (LGIB) from precursors of colorectal cancer (CRC). We investigated whether use of low-dose aspirin, through initiation of LGIB, may lead patients to undergo colonoscopy and polypectomy before manifest CRC.DesignWe conducted a historical cohort study (2005–2013) of all Danish residents who initiated low-dose aspirin treatment (n=412 202) in a setting without screening for CRC. Each new aspirin user was matched with three non-users (n=1 236 560) by age, sex and region of residence on the date of their matched new user’s first-time aspirin prescription (index date). We computed absolute risks (ARs), risk differences and relative risks (RRs) of LGIB, lower gastrointestinal endoscopy, colorectal polyps and CRC, comparing aspirin users with non-users.ResultsThe ARs were higher for new users than non-users for LGIB, lower gastrointestinal endoscopy, colorectal polyps and CRC within 3 months after index. Comparing new users with non-users, the RRs were 2.79 (95% CI 2.40 to 3.24) for LGIB, 1.73 (95% CI 1.63 to 1.84) for lower gastrointestinal endoscopy, 1.56 (95% CI 1.42 to 1.72) for colorectal polyps and 1.73 (95% CI 1.51 to 1.98) for CRC. The RRs remained elevated for more than 12 months after the index date, with the exception of CRC where the RRs were slightly decreased during the 3–5 years (RR 0.90, 95% CI 0.83 to 0.98) and more than 5 years (RR 0.91, 95% CI 0.82 to 1.00) following the index date.ConclusionThese findings indicate that aspirin may contribute to reduce CRC risk by causing premalignant polyps to bleed, thereby expediting colonoscopy and polypectomy before CRC development.
Impact of a free care policy on the utilisation of health services during an Ebola outbreak in the Democratic Republic of Congo: an interrupted time-series analysis
Authors: Hung Yuen W , Law Michael R , Cheng Lucy , Abramowitz Sharon , Alcayna-Stevens Lys , Lurton Grégoire , Mayaka Serge Manitu , Olekhnovitch Romain , Kyomba Gabriel , Ruton Hinda , Ramazani Sylvain Yuma , Grépin Karen A 
Published: July 2020

BackgroundDuring past outbreaks of Ebola virus disease (EVD) and other infectious diseases, health service utilisation declined among the general public, delaying health seeking behaviour and affecting population health. From May to July 2018, the Democratic Republic of Congo experienced an outbreak of EVD in Equateur province. The Ministry of Public Health introduced a free care policy (FCP) in both affected and neighbouring health zones. We evaluated the impact of this policy on health service utilisation.MethodsUsing monthly data from the national Health Management Information System from January 2017 to January 2019, we examined rates of the use of nine health services at primary health facilities: total visits; first and fourth antenatal care visits; institutional deliveries; postnatal care visits; diphtheria, pertussis and tetanus (DTP) vaccinations and visits for uncomplicated malaria, pneumonia and diarrhoea. We used controlled interrupted time series analysis with a mixed effects model to estimate changes in the rates of services use during the policy (June–September 2018) and afterwards.FindingsOverall, use of most services increased compared to control health zones, including EVD affected areas. Total visits and visits for pneumonia and diarrhoea initially increased more than two-fold relative to the control areas (p<0.001), while institutional deliveries and first antenatal care increased between 20% and 50% (p<0.01). Visits for DTP, fourth antenatal care visits and postnatal care visits were not significantly affected. During the FCP period, visit rates followed a downward trend. Most increases did not persist after the policy ended.InterpretationThe FCP was effective at rapidly increasing the use of some health services both EVD affected and not affected health zones, but this effect was not sustained post FCP. Such policies may mitigate the adverse impact of infectious disease outbreaks on population health.
Mobilising computable biomedical knowledge: challenges for clinical decision support from a medical knowledge provider
Authors: Walsh Kieran , Wroe Chris 
Published: July 2020

IntroductionThis paper summarises a talk given at the first UK workshop on mobilising computable biomedical knowledge on 29 October 2019 in London. It examines challenges in mobilising computable biomedical knowledge for clinical decision support from the perspective of a medical knowledge provider.MethodsWe developed the themes outlined below after personally reflecting on the challenges that we have encountered in this field and after considering the barriers that knowledge providers face in ensuring that their content is accessed and used by healthcare professionals. We further developed the themes after discussing them with delegates at the workshop and listening to their feedback.DiscussionThere are many challenges in mobilising computable knowledge for clinical decision support from the perspective of a medical knowledge provider. These include the size of the task at hand, the challenge of creating machine interpretable content, the issue of standards, the need to do better in tracing how computable medical knowledge that is part of clinical decision support impacts patient outcomes, the challenge of comorbidities, the problem of adhering to safety standards and finally the challenge of integrating knowledge with problem solving and procedural skills, healthy attitudes and professional behaviours. Partnership is likely to be essential if we are to make progress in this field. The problems are too complex and interrelated to be solved by any one institution alone.
OpenClinical.net: Artificial intelligence and knowledge engineering at the point of care
Authors: Fox John , South Matthew , Khan Omar , Kennedy Catriona , Ashby Peter , Bechtel John 
Published: July 2020

ObjectiveOpenClinical.net is a way of disseminating clinical guidelines to improve quality of care whose distinctive feature is to combine the benefits of clinical guidelines and other human-readable material with the power of artificial intelligence to give patient-specific recommendations. A key objective is to empower healthcare professionals to author, share, critique, trial and revise these ‘executable’ models of best practice.DesignOpenClinical.netAlpha(www.openclinical.net) is an operational publishing platform that uses a class of artificial intelligence techniques calledknowledge engineeringto capture human expertise in decision-making, care planning and other cognitive skills in an intuitive but formal language called PROforma.3 PROformamodels can be executed by a computer to yield patient-specific recommendations, explain the reasons and provide supporting evidence on demand.ResultsPROformahas been validated in a wide range of applications in diverse clinical settings and specialties, with trials published in high impact peer-reviewed journals. Trials have included patient workup and risk assessment; decision support (eg, diagnosis, test and treatment selection, prescribing); adaptive care pathways and care planning. The OpenClinical software platform presently supports authoring, testing, sharing and maintenance. OpenClinical’s open-access, open-source repositoryRepertoirecurrently carries approximately 50+ diverse examples (https://openclinical.net/index.php?id=69).ConclusionOpenClinical.net is a showcase for a PROforma-based approach to improving care quality, safety, efficiency and better patient experience in many kinds of routine clinical practice. This human-centred approach to artificial intelligence will help to ensure that it is developed and used responsibly and in ways that are consistent with professional priorities and public expectations.
Multimodality imaging assessment of mitral annular disjunction in mitral valve prolapse
Authors: Mantegazza Valentina , Volpato Valentina , Gripari Paola , Ghulam Ali Sarah , Fusini Laura , Italiano Gianpiero , Muratori Manuela , Pontone Gianluca , Tamborini Gloria , Pepi Mauro 
Published: July 2020

ObjectiveMitral annular disjunction (MAD) is an abnormality linked to mitral valve prolapse (MVP), possibly associated with malignant ventricular arrhythmias. We assessed the agreement among different imaging techniques for MAD identification and measurement.Methods131 patients with MVP and significant mitral regurgitation undergoing transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) were retrospectively enrolled. Transoesophageal echocardiography (TOE) was available in 106 patients. MAD was evaluated in standard long-axis views (four-chamber, two-chamber, three-chamber) by each technique.ResultsConsidering any-length MAD, MAD prevalence was 17.3%, 25.5%, 42.0% by TTE, TOE and CMR, respectively (p<0.05). The agreement on MAD identification was moderate between TTE and CMR (κ=0.54, 95% CI 0.49 to 0.59) and good between TOE and CMR (κ=0.79, 95% CI 0.74 to 0.84). Assuming CMR as reference and according to different cut-off values for MAD (≥2 mm, ≥4 mm, ≥6 mm), specificity (95% CI) of TTE and TOE was 99.6 (99.0 to 100.0)% and 98.7 (97.4 to 100.0)%; 99.3 (98.4 to 100.0)% and 97.6 (95.8 to 99.4)%; 97.8 (96.2 to 99.3)% and 93.2 (90.3 to 96.1)%, respectively; sensitivity (95% CI) was 43.1 (37.8 to 48.4)% and 74.5 (69.4 to 79.5)%; 54.0 (48.7 to 59.3)% and 88.9 (85.2 to 92.5)%; 88.0 (84.5 to 91.5)% and 100.0 (100.0 to 100.0)%, respectively. MAD length was 8.0 (7.0-10.0), 7.0 (5.0-8.0], 5.0 (4.0-7.0) mm, respectively by TTE, TOE and CMR. Agreement on MAD measurement was moderate between TTE and CMR (ρ=0.73) and strong between TOE and CMR (ρ=0.86).ConclusionsAn integrated imaging approach could be necessary for a comprehensive assessment of patients with MVP and symptoms suggestive for arrhythmias. If echocardiography is fundamental for the anatomic and haemodynamic characterisation of the MV disease, CMR may better identify small length MAD as well as myocardial fibrosis.
Prognostic value of novel immune-related genomic biomarkers identified in head and neck squamous cell carcinoma
Authors: Yao Yao , Yan Zhongyi , Lian Senlin , Wei Liangnian , Zhou Chao , Feng Dongju , Zhang Yuan , Yang Jianrong , Li Ming , Chen Yun 
Published: July 2020

BackgroundThe immune response within the tumor microenvironment plays a key role in tumorigenesis and determines the clinical outcomes of head and neck squamous cell carcinoma (HNSCC). However, to date, a paucity of robust, reliable immune-related biomarkers has been identified that are capable of estimating prognosis in HNSCC patients.MethodsHigh-throughput RNA sequencing was performed in tumors and matched adjacent tissues from five HNSCC patients, and the immune signatures expression of 730 immune-related transcripts selected from the nCounter PanCancer Immune Profiling Panel were assessed. Survival analyzes were performed in a training cohort, consisting of 416 HNSCC cases, retrieved from The Cancer Genome Atlas (TCGA) database. A prognostic signature was built, using elastic net-penalized Cox regression and backward, stepwise Cox regression analyzes. The outcomes were validated by an independent cohort of 115 HNSCC patients, using tissue microarrays and immunohistochemistry staining. Cell-type identification by estimating relative subsets of RNA transcripts (CIBERSORT) was also used to estimate the relative fractions of 22 immune-cell types and their correlations coefficients with prognostic biomarkers.ResultsCollectively, 248 immune-related genes were differentially expressed in paired tumors and normal tissues using RNA sequencing. After process screening in the training TCGA cohort, four immune-related genes (PVR, TNFRSF12A,IL21R, andSOCS1) were significantly associated with overall survival (OS). Integrating these genes with Path_N stage, a multiplex model was built and suggested better performance in determining 5 years OS (receiver operating characteristic (ROC) analysis, area under the curve (AUC)=0.709) than others. Further protein-based validation was conducted in 115 HNSCC patients. Similarly, high expression of PVR and TNFRSF12A were associated with poor OS (Kaplan-Meier p=0.017 and 0.0032), while high expression of IL21R and SOCS1 indicated favorable OS (Kaplan-Meier p<0.0001 and =0.0018). The integrated model with Path_N stage still demonstrated efficacy in OS evaluation (Kaplan-Meier p<0.0001, ROC AUC=0.893). Besides, the four prognostic genes were significantly correlated with activated CD8+T cells, CD4+T cells, follicular helper T cells and regulatory T cells, implying the possible involvement of these genes in the immunoregulation and development of HNSCC.ConclusionsThe well-established model encompassing both immune-related biomarkers and clinicopathological factor might serve as a promising tool for the prognostic prediction of HNSCC.