bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a comprehensive surveillance system for recording suicides and attempted suicides in rural India
Authors: Vijayakumar Lakshmi , Pathare Soumitra , Jain Nikhil , Nardodkar Renuka , Pandit Deepa , Krishnamoorthy Sadhvi , Kalha Jasmine , Shields-Zeeman Laura 
Published: November 2020

IntroductionWHO reports that 78 of the 140 low-income and middle-income countries (LMICs) do not have a registration system for suicides and attempted suicides. Absence of data on suicide and attempted suicide in LMICs, which account for 79% of suicides worldwide, is a major impediment in understanding the magnitude of the problem and formulating prevention strategies to reduce suicide and self-harm. A comprehensive surveillance system has the potential to address this data gap. The objective of this study is to describe the development of a comprehensive surveillance system in rural India by adding a community based component and reflect on its added value in obtaining data on suicide and attempted suicide compared with relying only on hospital and police records.MethodThe comprehensive system consists of three components. Community surveillance involved collecting information on suicides and attempted suicides from third party key informants such as village heads, teachers, priests, shopkeepers, private physicians, private hospitals and community health workers. The second component consisted of data from public health facilities. The final component consisted of suicide data from police records. Information was collected for a period of 12 months from August 2018 to July 2019 from 116 villages (population 377 276) in Gujarat, India.ResultsAn average of 710 community informants were interviewed each month (mean: 6.72 informants per village). The community surveillance system identified 67 cases of suicide compared with 30 cases by hospital and police records (Cochran’s Q test 67.9 p<0.01) and 70 attempted suicides compared with 51 from the hospital and police records (Cochran’s Q test 66.6 p<0.01).DiscussionThis is the first report of implementing a large-scale comprehensive surveillance system for suicide and attempted suicide in a LMIC. The combination of community surveillance system and official data from hospital and police records addresses the problem of under-reporting of suicide and suicide attempts in India and other LMIC.
The Copenhagen test and treat hepatitis C in a mobile clinic study: a protocol for an intervention study to enhance the HCV cascade of care for people who inject drugs (T’N’T HepC)
Authors: Lazarus Jeffrey Victor , Øvrehus Anne , Demant Jonas , Krohn-Dehli Louise , Weis Nina 
Published: November 2020

IntroductionInjecting drug use is the primary driver of hepatitis C virus (HCV) infection in Europe. Despite the need for more engagement with care, people who inject drugs (PWID) are hard to reach with HCV testing and treatment. We initiated a study to evaluate the efficacy for testing and linkage to care among PWID consulting peer-based testing at a mobile clinic in Copenhagen, Denmark.Methods and analysisIn this intervention study, we will recruit participants at a single community-based, peer-run mobile clinic. In a single visit, we will first offer participants a point-of-care HCV antibody test, and if they test positive, then they will receive an HCV RNA test. If they are HCV-RNA+, we will administer facilitated referrals to designated ‘fast-track’ clinics at a hospital or an addiction centre for treatment. The primary outcomes for this study are the number of tested and treated individuals. Secondary outcomes include individuals lost at each step in the care cascade.Ethics and disseminationThe results of this study could provide a model for targeting PWID for HCV testing and treatment in Demark and other settings, which could help achieve WHO HCV elimination targets. The Health Research Ethics Committee of Denmark and the Danish Data Protection Agency confirmed (December 2018/January 2019) that this study did not require their approval. Study findings will be disseminated through peer-reviewed publications, conference presentations and social media.
Dance for people with chronic breathlessness: a transdisciplinary approach to intervention development
Authors: Harrison Samantha , Bierski Krzysztof , Burn Naomi , Mclusky Sarah , McFaull Victoria , Russell Andrew , Williams Gaynor , Williams Siân , Macnaughton Jane 
Published: November 2020

ObjectivesA transdisciplinary research approach was used to develop a holistic understanding of the physical and psychosocial benefits of dance as an intervention for people living with chronic breathlessness.MethodsThe dance programme was developed in collaboration with British Lung Foundation Breathe Easy members in NE England (Darlington) and London (Haringey). Members of the Darlington group were invited to participate in the programme. An exercise instructor, trained and mentored by a dance facilitator delivered 60–90 min dance classes for 10 consecutive weeks. Exercise capacity, mobility, quadriceps strength, health status, mood and interoceptive awareness were assessed at baseline and after the 10-week programme. Second-to-second heart rate (HR) monitoring was conducted during one of the classes.ResultsTen individuals were enrolled (n=8 women). Mean (SD) age was 70 (24); Body Mass Index 29.7 (8.1) kg/m2; one participant used oxygen and one a walking aid. Seven completed the dance programme. Improvements in all outcome measures were detected, with the exception of the Multidimensional Assessment of Interoceptive Awareness, which individuals found hard to comprehend. Eight participants wore HR monitors during one dance class and spent on average 43.5 (21.8) min with HR corresponding to at least moderate intensity physical activity (≥64% HRmax). People found the dance classes enjoyable and those with relevant past experiences who are optimistic, committed to staying well and playful readily adopted the programme.ConclusionA dance programme bringing both physical and psychosocial benefits for people with chronic breathlessness is acceptable when coproduced and evaluated through a transdisciplinary approach.
Harmonising palliative care: a national survey to evaluate the knowledge and attitude of emergency physicians towards palliative care in Kuwait
Authors: Al-Ansari Ameena , Suroor Saleem , AboSerea Sobhi , Abd-El-Gawad Wafaa Mostafa 
Published: November 2020

Background and aimAlthough the challenges of integrating palliative care practices across care settings are real and well recognised, to date little is known about palliative care practices of emergency physicians (EPs) in Kuwait. Therefore, this study aims to explore the attitude and knowledge of EPs in providing palliative care in all general hospitals in Kuwait.MethodA cross-sectional survey was performed in the emergency rooms of all general hospitals in Kuwait using the Palliative Care Attitude and Knowledge Questionnaire.ResultsOf the total number of physicians working in emergency rooms (n=156), 104 (66.67%) had completed the survey. 76.9% (n=80) of the EPs had an uncertain attitude towards palliative care. Most of the EPs (n=73, 70.28%) did not discuss the patients’ need for palliative care either with the patients or with their families. Only 16 (15.4%) of the EPs responded correctly to most of the questions while nearly half of the EPs (n=51, 49%) had poor knowledge. Experience ≥11 years and better knowledge scores were independent predictors of positive attitude after adjustment of age, sex, qualifications, specialty, position and nationality (OR: 5.747 (CI 1.031 to 25.00), 1.458(CI 1.148 to 1.851); p values: 0.021, 0.002, respectively).ConclusionsDespite recognising palliative care as an important competence, the majority of the EPs in Kuwait had uncertain attitude and poor knowledge towards palliative care. Efforts should be made to enhance physician training and provide palliative care resources to improve the quality of care given to patients visiting emergency departments.
Using chatbots to screen for heritable cancer syndromes in patients undergoing routine colonoscopy
Authors: Heald Brandie , Keel Emma , Marquard Jessica , Burke Carol A , Kalady Matthew F , Church James M , Liska David , Mankaney Gautam , Hurley Karen , Eng Charis 
Published: November 2020

BackgroundHereditary colorectal cancer (HCRC) syndromes account for 10% of colorectal cancers but remain underdiagnosed. This feasibility project tested the utility of an artificial intelligence-based chatbot deployed to patients scheduled for colonoscopy to identify HCRC risk factors, educate participants about HCRC and obtain consent to genetic testing as an extension of genetic counselling of appropriate subjects. Genetic counsellor (GC) and genetic counselling assistant (GCA) time spent per subject was also measured.MethodsPatients scheduled for colonoscopy at Cleveland Clinic were invited via electronic medical record patient portal or letter prior to colonoscopy with a link to a chatbot administering the Colon Cancer Risk Assessment Tool (CCRAT) to screen for HCRC syndromes. Those with ≥1 positive response to a CCRAT question received chatbot-deployed genetic education and the option to receive genetic testing. An order for a 55-gene pan-cancer panel was placed for those consenting, and the subject had blood drawn on the day of colonoscopy. Results were disclosed by a GC or GCA by telephone. Subject demographics, progression through the chat, responses to CCRAT, personal and family history, genetic test results and communication with the subject were recorded. Descriptive statistics and two-tailed unpaired t-test and Fisher’s exact test were used.Results506/4254 (11.9%) initiated and 487 (96.2%) completed the chat with the chatbot. 215 (44.1%) answered ‘yes’ to ≥1 CCRAT question and all completed pretest education. 129/181 (71.3%) subjects who consented completed testing, and 12 (9.3%) were found to have a germline pathogenic variant. Per subject, the GC spent a mean of 14.3 (SD 7.3) and the GCA a mean of 19.2 (SD 9.8) minutes.ConclusionThe use of a chatbot in this setting was a novel and feasible method, with the potential of increasing genetic screening and testing in individuals at risk of HCRC syndromes.
Factors associated with delays in discharge for trauma patients at an urban county hospital
Authors: Cai Christopher , Lindquist Karla , Bongiovanni Tasce 
Published: November 2020

BackgroundDischarge delays for non-medical reasons put patients at unnecessary risk for hospital-acquired infections, lead to loss of revenue for hospitals and reduce hospital capacity to treat other patients. The objective of this study was to determine prevalence of, and patient characteristics associated with, delays in discharge at an urban county trauma service.MethodsWe performed a retrospective cohort study with data from Zuckerberg San Francisco General Hospital (ZSFGH), a level-1 trauma center and safety net hospital in San Francisco, California. The study included 1720 patients from the trauma surgery service at ZSFGH. A ‘delay in discharge’ was defined as days in the hospital, including an initial overnight stay, after all medical needs had been met. We used logistic and zero-inflated negative binomial regression models to test whether the following factors were associated with prolonged, non-medical length of stay: age, gender, race/ethnicity, housing, disposition location, type of insurance, having a primary care provider, primary language and zip code.ResultsOf the 1720 patients, 15% experienced a delay in discharge, for a total of 1147 days (median 1.5 days/patient). The following were statistically significant (p<0.05) predictors of delays in discharge in a multivariable logistic regression model: older age, unhoused status or disposition to home health or postacute care (compared with home discharge) were associated with increased likelihood of delays. Having private insurance or Medicare (compared with public insurance) and discharge against medical advice or absent without leave (compared with home discharge) were associated with reduced likelihood of delays in discharge after all medical needs were met.DiscussionThese results suggest that policymakers interested in reducing non-medical hospital stays should focus on addressing structural determinants of health, such as lack of housing, bottlenecks at postacute care disposition destinations and lack of adequate insurance.Level of evidenceEpidemiological, Level III
Cooperative Game with Agreements Implemented by a Third Party
Authors: Chen Jeanpantz 
Published: November 2020

In the literature of cooperative game theory, it is often assumed that there is only one coalition composed of all the players other than the dummies in a cooperative game of complete information, although the coalition formation is examined and the equilibrium process of coalition formation (EPCF) was defined in a repeated cooperative game of incomplete information. On the other hand, the blocking approach only provided several possible ranges of the distribution scheme of the cooperative payoff of a coalition in a cooperative game with agreements implemented by a third party, and the single point solutions provided are usually collectivistic. This paper examines the coalition formation in a cooperative game with agreements implemented by a third party, and provides the existence proof and an algorithm of the coalition equilibrium; moreover, this paper analyzes the equilibrium of the bargaining game on the distribution of the cooperative payoff of a coalition under the coalition equilibrium, and examines the distribution scheme of cooperative payoff of a coalition.
“So if Mr Blue Head here clicks the link...” Risk Thinking in Cyber Security Decision Making
Authors: Shreeve Benjamin , Hallett Joseph , Edwards Matthew , Anthonysamy Pauline , Frey Sylvain , Rashid Awais 
Published: November 2020

Cyber security decision making is inherently complicated, with nearly every decision having knock-on consequences for an organisation’s vulnerability and exposure. This is further compounded by the fact that decision-making actors are rarely security experts and may have an incomplete understanding of the security that the organisation currently has in place. They must contend with a multitude of possible security options that they may only partially understand. This challenge is met by decision makers’
risk thinking
—their strategies for identifying risks, assessing their severity, and prioritising responses. We study the risk thinking strategies employed by teams of participants in an existing dataset derived from a tabletop cyber-physical systems security game. Our analysis identifies four
structural patterns
of risk thinking and two
reasoning
strategies:
risk-first
and
opportunity-first
. Our work highlights that risk-first approaches (as prescribed by the likes of NIST-800-53 and ISO 27001) are followed neither substantially nor exclusively when it comes to decision making. Instead, our analysis finds that decision making is affected by the plasticity of teams—that is, the ability to readily switch between ideas and practising both risk-first and opportunity-first reasoning.
Abstract 331: Trajectories of Sequential Organ Failure Assessment (sofa) Scores After Cardiac Arrest
Authors: Flickinger Kate , Coppler Patrick J , Brown McKenzie , Elmer Jonathan 
Published: November 2020

Cardiac arrest (CA) often results in multi-system organ failure (MSOF). The Sequential Organ Failure Assessment (SOFA) Score is a tool based on the assessment of 6 physiological systems and can quantify severity of MSOF. Understanding the epidemiology, temporal dynamics and anticipated course of MSOF after CA is critical to both clinical care and prognostication. We included patients treated at a single center after CA from 2010-2019, regardless of arrest location or etiology. We electronically extracted all medication, laboratory, ventilator, intake and output data. We calculated SOFA scores daily for up to five days (or until death or discharge). We used group-based trajectory modeling (GBTM, also known as growth curve mixture modeling) to identify groups of patients with distinct trajectories of SOFA over time. We started by fitting trajectories with third order polynomials then sequentially eliminated higher order terms with non-significant coefficients. We used AIC and BIC to determine the number of groups.
We included 2,740 patients, of whom most (1,633; 59%) were male, with mean (SD) age of 59 (16) years. Most arrests (2,106; 76%) occurred out-of-hospital and 837 (30%) had a shockable initial rhythm. Overall survival to discharge was 38%. Bilirubin was infrequently checked in this cohort, so we excluded the liver subscale of SOFA from total SOFA calculation making maximum SOFA 20. Mean presenting SOFA was 6 (3), and mean SOFA on day 2 was 6 (4). We identified 5 groups of patients with unique trajectories of SOFA over time. Baseline demographics and survival differed across trajectory groups. Despite showing delayed MOSF onset with rapidly rising SOFA from baseline to day 2, 26% of Group 4 still survived to discharge, while Group 3, which had an initially severe but rapidly improving MSOF had a 32% survival rate. Unique patterns of MSOF after CA can be identified using GBTM. Delayed onset of severe MSOF is less prognostically ominous than commonly believed by clinicians.
Durable Mechanical Circulatory Support in Patients With Amyloid Cardiomyopathy
Authors: Michelis Katherine C. , Zhong Lin , Tang W.H. Wilson , Young James B. , Peltz Matthias , Drazner Mark H. , Pandey Ambarish , Griffin Jan , Maurer Mathew S. , Grodin Justin L. 
Published: November 2020

Background:
Many patients with amyloid cardiomyopathy (ACM) develop advanced heart failure, and durable mechanical circulatory support (MCS) may be a consideration. However, data describing clinical outcomes after MCS in this population are limited.

Methods:
Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support with dilated cardiomyopathy (DCM, n=19 921), nonamyloid restrictive cardiomyopathy (RCM, n=248), or ACM (n=46) between 2005 and 2017 were included. Patient and device characteristics were compared between cardiomyopathy groups. The primary end point was the cumulative incidence of death with heart transplantation as a competing risk.

Results:

Patients with ACM (n=46) were older (61 years [interquartile range, 55–69 years] versus 58 years [interquartile range, 49–66 years] for DCM and 55 years [interquartile range, 46–62 years] for nonamyloid RCM,
P
<0.001) and were more commonly Interagency Registry for Mechanically Assisted Circulatory Support profile 1 (30.4% versus 17.9% for DCM and 21.0% for nonamyloid RCM,
P
=0.04) at device implantation. Use of biventricular support (biventricular assist device or total artificial heart) was the highest for patients with ACM (41.3% versus 6.7% and 19.4% for patients with DCM and nonamyloid RCM, respectively,
P
=0.014). The cumulative incidence of death was highest for patients with ACM relative to those with DCM or nonamyloid RCM (
P
<0.001) but did not differ significantly between groups for those who required biventricular MCS.

Conclusions:
Compared with patients with DCM or nonamyloid RCM who received durable MCS, those with ACM experienced the highest use of biventricular support and the worst survival. These data highlight concerns with the use of durable MCS for patients with ACM.
Examining the Nocebo Effect of Statins Through Statin Adverse Events Reported in the Food and Drug Administration Adverse Event Reporting System
Authors: Moon Jungyeon , Cohen Sedgh Robert , Jackevicius Cynthia A. 
Published: November 2020

Background:
This study aimed to evaluate whether the high frequency of reported statin adverse effects (AEs) may be associated with the nocebo effect. We compared nocebo-related subjective AEs with objective AEs and investigated factors potentially associated with the nocebo effect.

Methods:

A retrospective cohort study was conducted using the Food and Drug Administration Adverse Event Reporting System between January 2010 and December 2019 for statins, including, atorvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. Subjective AEs included fatigue, subjective muscular, and nervous system AEs. Objective AEs were defined as hepatic and objective muscular AEs. We compared the number of subjective and objective AEs using the Mann-Whitney
U
test and examined trends in the frequency of subjective versus objective reports over time using linear regression with interaction terms. We evaluated the association between AEs and gender and country using linear regression. Quantitative detection of signals was estimated using proportional reporting ratio and reporting odds ratio for simvastatin.

Results:

Of 2 994 487 overall AE reports, more subjective than objective AEs were reported per quarter (mean±SD: 4777±1375.45 versus 999±276.95;
P
<0.0001), and over time during the study period (
P
<0.001). Women reported more subjective AEs than men per quarter (fatigue: 86.98 more per quarter,
P
=0.035; subjective muscular AE: 417.95,
P
<0.0001; nervous system AE: 273.60,
P
<0.0001), but fewer objective muscular AEs (−125.23 per quarter,
P
<0.0001). More subjective AEs and fewer objective AEs were reported per quarter in the United States relative to other countries. Simvastatin-associated reports showed signals for higher objective muscular AEs relative to all other statins (reporting odds ratio, 1.53 [95% CI, 1.49–1.58]).

Conclusions:
This study found that significantly more subjective than objective AEs are reported for statins. Subjective statin AEs, potentially related to the nocebo effect are reported more often by women than by men, and in the United States than in other countries.