bluuebunny/crossref_metadata_2025_split huggingface dataset:
EmPHasis-10 as a measure of health-related quality of life in pulmonary arterial hypertension: data from PHAR
Authors: Borgese Marissa , Badesch David , Bull Todd , Chakinala Murali , DeMarco Teresa , Feldman Jeremy , Ford H. James , Grinnan Dan , Klinger James R. , Bolivar Lena , Shlobin Oksana A. , Frantz Robert P. , Sager Jeffery S. , Mathai Stephen C. , Kawut Steven , Leary Peter J. , Gray Michael P. , Popat Rita A. , Zamanian Roham T. 
Published: November 2020

IntroductionWhile the performance of the emPHasis-10 (e10) score has been evaluated against limited patient characteristics within the United Kingdom, there is an unmet need for exploring the performance of the e10 score among pulmonary arterial hypertension (PAH) patients in the United States.MethodsUsing the Pulmonary Hypertension Association Registry, we evaluated relationships between the e10 score and demographic, functional, haemodynamic and additional clinical characteristics at baseline and over time. Furthermore, we derived a minimally important difference (MID) estimate for the e10 score.ResultsWe analysed data from 565 PAH (75% female) adults aged mean±sd55.6±16.0 years. At baseline, the e10 score had notable correlation with factors expected to impact quality of life in the general population, including age, education level, income, smoking status and body mass index. Clinically important parameters including 6-min walk distance and B-type natriuretic peptide (BNP)/N-terminal proBNP were also significantly associated with e10 score at baseline and over time. We generated a MID estimate for the e10 score of −6.0 points (range −5.0–−7.6 points).ConclusionsThe e10 score was associated with demographic and clinical patient characteristics, suggesting that health-related quality of life in PAH is influenced by both social factors and indicators of disease severity. Future studies are needed to demonstrate the impact of the e10 score on clinical decision-making and its potential utility for assessing clinically important interventions.
World Health Organization recommendations on the treatment of drug-resistant tuberculosis, 2020 update
Authors: Mirzayev Fuad , Viney Kerri , Linh Nguyen Nhat , Gonzalez-Angulo Licé , Gegia Medea , Jaramillo Ernesto , Zignol Matteo , Kasaeva Tereza 
Published: November 2020

Antimicrobial resistance is a major public health problem globally. Likewise, forms of tuberculosis (TB) resistant to first- and second-line TB medicines present a major challenge for patients, healthcare workers and healthcare services. In November 2019, the World Health Organization (WHO) convened an independent international expert panel to review new evidence on the treatment of multidrug- (MDR) and rifampicin-resistant (RR) TB, using the Grading of Recommendations Assessment, Development and Evaluation approach.Updated WHO guidelines emerging from this review, published in June 2020, recommend a shorter treatment regimen for patients with MDR/RR-TB not resistant to fluoroquinolones (of 9–11 months), with the inclusion of bedaquiline instead of an injectable agent, making the regimen all oral. For patients with MDR-TB and additional fluoroquinolone resistance, a regimen composed of bedaquiline, pretomanid and linezolid may be used under operational research conditions (6–9 months). Depending on the drug-resistance profile, extent of TB disease or disease severity, a longer (18–20 months) all-oral, individualised treatment regimen may be used. In addition, the review of new data in 2019 allowed the WHO to conclude that there are no major safety concerns on the use of bedaquiline for >6 months’ duration, the use of delamanid and bedaquiline together and the use of bedaquiline during pregnancy, although formal recommendations were not made on these topics.The 2020 revision has highlighted the ongoing need for high-quality evidence and has reiterated the need for clinical trials and other research studies to contribute to the development of evidence-based policy.
Identification of recent exacerbations in COPD patients by electronic nose
Authors: van Bragt Job J.M.H. , Brinkman Paul , de Vries Rianne , Vijverberg Susanne J.H. , Weersink Els J.M. , Haarman Eric G. , de Jongh Frans H.C. , Kester Sigrid , Lucas Annelies , in 't Veen Johannes C.C.M. , Sterk Peter J. , Bel Elisabeth H.D. , Maitland-van der Zee Anke H. 
Published: November 2020

Molecular profiling of exhaled breath by electronic nose (eNose) might be suitable as a noninvasive tool that can help in monitoring of clinically unstable COPD patients. However, supporting data are still lacking. Therefore, as a first step, this study aimed to determine the accuracy of exhaled breath analysis by eNose to identify COPD patients who recently exacerbated, defined as an exacerbation in the previous 3 months.Data for this exploratory, cross-sectional study were extracted from the multicentre BreathCloud cohort. Patients with a physician-reported diagnosis of COPD (n=364) on maintenance treatment were included in the analysis. Exacerbations were defined as a worsening of respiratory symptoms requiring treatment with oral corticosteroids, antibiotics or both. Data analysis involved eNose signal processing, ambient air correction and statistics based on principal component (PC) analysis followed by linear discriminant analysis (LDA).Before analysis, patients were randomly divided into a training (n=254) and validation (n=110) set. In the training set, LDA based on PCs 1–4 discriminated between patients with a recent exacerbation or no exacerbation with high accuracy (receiver operating characteristic (ROC)–area under the curve (AUC)=0.98, 95% CI 0.97–1.00). This high accuracy was confirmed in the validation set (AUC=0.98, 95% CI 0.94–1.00). Smoking, health status score, use of inhaled corticosteroids or vital capacity did not influence these results.Exhaled breath analysis by eNose can discriminate with high accuracy between COPD patients who experienced an exacerbation within 3 months prior to measurement and those who did not. This suggests that COPD patients who recently exacerbated have their own exhaled molecular fingerprint that could be valuable for monitoring purposes.
Patients' experiences of asthma exacerbation and management: a qualitative study of severe asthma
Authors: Song Woo-Jung , Won Ha-Kyeong , Lee Suh Young , Park Han-Ki , Cho You Sook , Chung Kian Fan , Heaney Liam G. , Joung Woo Joung 
Published: November 2020

Exacerbation is a defining feature of severe asthma, and oral corticosteroids (OCSs) are frequently prescribed to manage exacerbations. This qualitative study was conducted to examine the experience of patients with severe asthma, with a focus on asthma exacerbation and OCS treatment.Adults with severe asthma were recruited from three tertiary hospitals in South Korea. Data were collected through in-depth qualitative interviews. Verbatim transcripts were analysed using Colaizzi's phenomenological method to uncover the meaning of the participants’ experience. Recruitment of participants continued until thematic saturation.14 patients with severe asthma were recruited. Four theme clusters emerged: 1) experience of asthma exacerbation; 2) impact on life; 3) OCS treatments; and 4) disease perception. The patients experienced severe physical and psychosocial distress from asthma exacerbations, felt helpless due to failed efforts to prevent exacerbation and were living a restricted life due to fear of exacerbation. They feared OCS side-effects but had no other choice than to rely on OCSs because other interventions were ineffective. Most had poor knowledge and understanding of severe asthma and the long-term health consequences.Asthma exacerbation affects wide aspects of life in patients with severe asthma. Several components may underlie reliance on OCSs, including experience of distress during exacerbation, fear of future exacerbation and lack of proper knowledge about the long-term health consequences of severe asthma and OCS treatments. A multi-disciplinary approach is warranted to support the patients and to provide systematic education about the long-term health implications of severe asthma.
Improving spirometry testing by understanding patient preferences
Authors: Johnson Barbara , Steenbruggen Irene , Graham Brian L. , Coleman Courtney 
Published: November 2020

The American Thoracic Society and European Respiratory Society commissioned a task force to update the technical standards for spirometry testing with the aim of increasing the accuracy, precision and quality of spirometry measurements and improving the patient experience.To inform the task force with patient experiences, the European Lung Foundation, in collaboration with the task force, conducted an online survey in 10 languages between August and September 2018.There were 1760 respondents from 52 countries. The majority were adults (97.1%); the most common reasons for spirometry referral were diagnosis (35.0%) and management of an ongoing condition (60.1%). 53.2% reported regularly using inhalers. Respondents were very experienced with spirometry: 89.9% completed more than one test; 48% completed 10 or more tests. However, most reported not knowing what forced expiratory volume in 1 s (FEV1) means (59.4%) and only 39.6% knew their most recent FEV1; the exception was respondents with cystic fibrosis who reported much greater knowledge. Respondents rated as moderately or seriously problematic: being told to keep blowing when they felt nothing is coming out (31.4%), coughing (30.4%), tiredness (26.3%) and concern about shortness of breath (20.1%).Overall, respondents found spirometry to be acceptable; however, an important minority (17%) found it difficult. Patients want clear information before, during and after the test, including information on stopping medications. Operators have an important role in increasing the ease of patients and changes to the testing environment can increase patient comfort. Patients want access to their results and want to understand how they relate to their individual health.
Identifying the key purchase factors for organic food among Chinese consumers
Authors: Li Shimiao , Jaharuddin Nor Siah 
Published: November 2020

AbstractThe current study primarily aims to identify the critical purchase factors that affect Chinese consumer purchase intention and purchase decision with regard to organic food consumption, in accordance with a modified theory of planned behavior and the alphabet theory. Specifically, this study builds a conceptual research framework by which to delve into the relationships between purchase factors and purchase intention, and elucidate the mediating roles of purchase factors in the relationships between purchase intention and purchase decision. Moreover, by leveraging a modified theory of planned behavior and the alphabet theory, the current study also determines the critical roles of subjective norms and reveals the information and knowledge that impact consumer attitude toward the purchase of organic food. The current study leverages the purposive sampling method and captures 310 records within Beijing, China. The results indicate that purchase attitude correlates positively with subjective norms and knowledge, while purchase intention correlates positively with purchase attitude, perceived behavior control, and food therapy culture. Furthermore, purchase intention can significantly mediate relationships between each of purchase attitude, perceived behavior control, food therapy culture, and purchase decision. Finally, we discuss the theoretical and practical significance of the framework, and propose subsequent research directions regarding organic food purchase behavior.
Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa
Authors: M Kabongo Eveline , Mukumbang Ferdinand C. , Delobelle Peter , Nicol Edward 
Published: November 2020

AbstractBackgroundOne of the Sustainable Development Goals is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. In South Africa, the flagship National Department of Health MomConnect program was launched in 2014 to strengthen the quality of maternal and child health (MCH) services and improve mortality outcomes. MomConnect was rapidly rolled out with a limited understanding of how and why the program was expected to work even though studies had shown the effectiveness of the MomConnect program in improving the uptake of MCH services. This study aimed to unearth the initial program theory of the MomConnect program based on explicit and implicit assumptions of how the program was organized and expected to work.MethodsWe conducted a document analysis using design- and implementation-related documents of the MomConnect program guided by the principles of Theory of Change (ToC) and Realist Evaluation (RE). Content and thematic analysis approaches were deductively applied to analyze the documents toward constructing ToC and RE-informed models. Abductive thinking and retroduction were further applied to the realist-informed approach to link program context, mechanisms, and outcomes to construct the initial program theory.ResultsToC and RE-informed models illustrated how the MomConnect program was organized and expected to work. The process of constructing the ToC provided the platform for the development of the initial program theory, which identified three critical elements: (1) the central modalities of the MomConnect program; (2) the intended outcomes; and (3) the tentative causal links indicating, in a stepwise manner of, how the outcomes were intended to be achieved. The RE approach ‘enhanced’ the causal links by identifying relevant programmatic contexts and linking the postulated mechanisms of action (empowerment, encouragement, motivation, and knowledge acquisition) to program outcomes.ConclusionThe application of ToC and RE provided an explicitly cumulative approach to knowledge generation in unveiling the initial program theory of MomConnect rather than delivering answers to questions of program effectiveness.
Gestational weight gain and offspring’s cognitive skills: a systematic review and meta-analysis
Authors: Martínez-Hortelano Jose Alberto , Álvarez-Bueno Celia , Cavero-Redondo Iván , Herráiz-Adillo Ángel , Berlanga-Macías Carlos , Martínez-Vizcaíno Vicente 
Published: November 2020

Abstract
Background
Gestational weight gain has been associated with some adverse perinatal outcomes, but few studies have examined the association between gestational weight gain and offspring’s cognition and their conclusions are inconsistent. Our systematic review and meta-analysis aimed to synthesize the evidence regarding the association between gestational weight gain and offspring’s cognitive skills.

Methods
In this systematic review and meta-analysis (PROSPERO number, CRD42017073266), we systematically searched MEDLINE, EMBASE, Web of Science and the Cochrane Library for studies examining association between gestational weight gain and offspring’s cognitive skills, without restriction in study design or language. Two reviewers extracted in an independent way the data. The Quality of Reporting of Observational Longitudinal Research scale was used to assess the quality of included studies. Effect size (ES) for adjusted models and their corresponding 95% confidence intervals were calculated for (i) intelligence quotient, (ii) language related skills and (iii) mathematic related skills comparing offspring’s cognitive skills when gestational weight gain was within recommendations (as reference) with those from mothers whose gestational weight gain was above or below the recommendations.

Results
Thirteen studies were included. There was a positive trend that associated gestational weight gain above recommendations with better offspring’s intelligence quotient, although not statistically significant (ES 0.02, 95% CI -0.00, 0.05; I2 = 0.00%).

Conclusions
There is a not significant positive association between gestational weight gain above recommendations and intelligence quotient and some studies reported associations between gestational weight gain and offspring’s cognitive skills. Our analyses confirm a wide variability in the results of studies published so far and highlights the need for conducting studies including specific samples of pregnant women by pre-pregnancy body mass index and trimester of pregnancy.
Clinical trials and drug cost savings for Italian health service
Authors: D’Ambrosio Francesca , De Feo Gianfranco , Botti Gerardo , Capasso Arturo , Pignata Sandro , Maiolino Piera , Triassi Maria , Nardone Antonio , Perrone Franco , Piezzo Michela , Grimaldi Antonio Maria , Palazzo Ida , De Stasio Immacolata , D’Aniello Roberta , Morabito Alessandro , Pascarella Giacomo 
Published: November 2020

Abstract
Background
The cost of anticancer drugs is constantly growing. The aim of this study was determine the impact in terms of cost reduction for anticancer drug in the Italian Health Service due to patient participation in clinical trials.

Methods
We evaluated the cost of drugs administered to patients treated in clinical trials at the National Cancer Institute of Naples in a four-week time period. Patients with a diagnosis of different cancers were considered, including adjuvant therapy and treatment for advanced disease, pharma sponsored and investigator initiated phase I, II and III clinical studies. We defined the expected standard treatment for each patient and we calculated the cost of the standard antineoplastic drugs that should be administered in clinical practice outside clinical trials. We used the market price of drugs to determine the cost savings value. Costs other than drugs were not included in the cost saving calculation.

Results
From 23.10.2017 to 17.11.2017, 126 patients were treated in 34 pharma sponsored and investigator initiated clinical trials, using experimental drugs provided free of charge by the sponsors, for an overall number of 152 cycles of therapy. If these patients were treated with conventional therapies in clinical practice the cost of antineoplastic drugs would account for 517,658 Euros, with an average of 5487 Euros saved per patients for a period of 4 weeks.

Conclusions
Clinical trials with investigational antineoplastic drugs provided free of charge by Sponsors render considerable cost savings, with a tangible benefit in clinical and administrative strategies to reduce drug expenditures.
The differences of clinical characteristics and outcomes between imported and local patients of COVID-19 in Hunan: a two-center retrospective study
Authors: Wang Chang , Zhou Lizhi , Chen Juan , Yang Yong , Huang Tianlong , Fu Min , Li Ya , George Daniel M. , Chen Xiangyu 
Published: November 2020

Abstract
Background
The clinical characteristics and outcomes of the 2019 novel coronavirus (COVID-19) pneumonia are different in Hubei compared to other regions in China. But there are few comparative studies on the differences between imported and local patients which may provide information of the different courses of the virus after transmission.

Methods
We investigated 169 cases of COVID-19 pneumonia in two centers in Hunan Province, and divided them into two groups according to epidemiological history, "imported patients" refers to patient with a clear history of travel in Wuhan within 14 days before onset, and " local patients” refers to local resident without a recent history of travel in Wuhan, aiming to analyze the difference in clinical characteristics and outcomes between the two groups. All the epidemiological, clinical, imaging, and laboratory data were analyzed and contrasted.

Results
The incidence of fever on admission in imported patients was significantly higher than local patients. There was a significantly higher proportion of abnormal pulmonary signs, hypokalemia, hyponatremia, prolonged PT, elevated D-dimer and elevated blood glucose in imported patients. Compared with local patients, the proportion using antibiotics, glucocorticoids and gamma globulin were significantly higher in imported patients. The moderate type was more common in local patients, and the severe type were more frequent in imported patients. In addition, the median duration of viral clearance was longer in imported patients.

Conclusions
In summary, we found that imported cases were more likely to develop into severe cases, compared with local patients and required more powerful treatments.
Trial registration Registered 21st March 2020, and this study has been approved by the Medical Ethics Committee (Approved Number. 2020017).
Cross-cultural adaptation and validity of the Chinese version of the Oxford elbow score
Authors: Ngwayi James Reeves Mbori , Tan Jie , Liang Ning , Sita Emmanuel Gildas Eric , Porter Daniel Edward 
Published: November 2020

Abstract
Background
The Oxford Elbow score (OES) is a patient-reported outcome measure designed to evaluate patients before and after elbow surgery. Although various translated versions of the score are available, there is no Chinese mandarin version. The aim of this study was to develop a Chinese language version of the OES and evaluate its psychometric properties for clinical use.

Methods
The English version of the OES was forward translated into Chinese, followed by a backward translation into English. Then a final Chinese version was produced following expert committee discussions and pilot study of 11 patients. A smart device compatible electronic version of the OES was designed and completed by 70 patients with elbow pathology alongside the Quick-Dash and the SF-36. Reliability was assessed by measuring intraclass correlation coefficient (ICC) for test-retest reliability and Cronbach’s alpha for internal consistency. Spearman’s correlation coefficient was used to test the construct validity. Confirmatory factor analysis (CFA) was performed to evaluate the 3-factor structure of the OES.

Results
The overall Cronbach’s α coefficient was 0.906 and for the 3 different domains Function, Pain, and Social-psychological was 0.806, 0.796, and 0.776 respectively. The overall intraclass correlation coefficient was 0.764 and for the three different domains Function, Pain, and Social-psychological was 0.764, 0.624, and 0.590 respectively. The Spearman’s coefficient for correlation, between the QuickDASH and OES domains Function, Pain, and Social-psychological, was − 0.824, − 0.734, and − 0.622 respectively, showing strong correlation (r > 0.5; p < 0.01). There were moderate correlations between OES domains and the physical functioning, role physical, and strong correlations with bodily pain subscales of the PCS domain of the SF-36; results were insignificant for all other subscales.

Conclusion
Our translated Chinese mandarin OES version (mainland) was reliable and valid, suitable for evaluating elbow disorders in the Chinese population. Reliability was measured using both the Cronbach’s α for internal consistency and the intraclass correlation. Results were classified as “excellent” and were similar to results from the original OES. Electronic PROMs were used instead of the traditional paper-based PROMs for collection of data which was well tolerated by patients.