bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exposure to baby-friendly hospital practices and mothers’ achievement of their planned duration of breastfeeding
Authors: Lok Kris Y. W. , Chow Charlotte L. Y. , Fan Heidi S. L. , Chan Vincci H. S. , Tarrant Marie 
Published: May 2020

Abstract
Background
Both breastfeeding intentions and exposure to baby-friendly hospital practices were found to be associated with a longer duration of breastfeeding. This study aims to examine the effect of exposure to baby-friendly hospital practices on mothers’ achievement of their planned duration of breastfeeding.

Methods
A total of 1011 mother-newborn pairs from the postnatal units of four public hospitals in Hong Kong were recruited. Sociodemographic data and breastfeeding intention data were collected via self-report questionnaires during the postnatal hospitalization and exposure to Baby-Friendly hospital practices were assessed through hospital records and maternal self-report. Breastfeeding status after hospital discharge was assessed through telephone follow-up for up to 12 months postnatal, or until participants were no longer breastfeeding.

Results
Only 55% (n = 552) of study participants achieved their intended duration of breastfeeding. Participants with higher socioeconomic status, previous breastfeeding experience, and those who had lived in Hong Kong for less than 5 years, were more likely to achieve their planned duration of breastfeeding. Among baby-friendly hospital practices, feeding only breast milk during the hospitalization and providing information about breastfeeding support on discharge were associated with participants’ achieving their individual breastfeeding intentions. After adjustment, when compared with women who experienced onebaby-friendly practice, participants who experienced six baby-friendly hospital practices were significantly more likely to achieve their planned duration of breastfeeding (adjusted odds ratio = 8.45, 95% confidence interval 3.03–23.6).

Conclusions
Nearly half of participants did not achieve their planned breastfeeding duration. Exposure to baby-friendly hospital practices, especially in-hospital exclusive breastfeeding and providing breastfeeding support information upon hospital discharge may help more mothers to achieve their individual breastfeeding goals.
Sensitive detection methods are key to identify secondary EGFR c.2369C>T p.(Thr790Met) in non-small cell lung cancer tissue samples
Authors: Keppens Cleo , Dequeker Elisabeth M. C. , Rouleau Etienne , ’t Hart Nils , Bubendorf Lukas , Dufraing Kelly , Garrec Céline , Guéguen Paul , Lamy Aude , Marchetti Antonio , Pauwels Patrick , Ryska Ales , Tack Véronique , Tornillo Luigi , Van Casteren Kaat , von der Thüsen Jan H. , Zwaenepoel Karen , Lissenberg-Witte Birgit , Thunnissen Erik , Schuuring Ed 
Published: May 2020

Abstract
Background
Correct identification of the EGFR c.2369C>T p.(Thr790Met) variant is key to decide on a targeted therapeutic strategy for patients with acquired EGFR TKI resistance in non-small cell lung cancer. The aim of this study was to evaluate the correct detection of this variant in 12 tumor tissue specimens tested by 324 laboratories participating in External Quality Assessment (EQA) schemes.

Methods
Data from EQA schemes were evaluated between 2013 and 2018 from cell lines (6) and resections (6) containing the EGFR c.2369C>T p.(Thr790Met) mutation. Adequate performance was defined as the percentage of tests for which an outcome was available and correct. Additional data on the used test method were collected from the participants. Chi-squared tests on contingency tables and a biserial rank correlation were applied by IBM SPSS Statistics version 25 (IBM, Armonk, NY, USA).

Results
In 26 of the 1190 tests (2.2%) a technical failure occurred. For the remaining 1164 results, 1008 (86.6%) were correct, 151 (12.9%) were false-negative and 5 (0.4%) included incorrect mutations. Correct p.(Thr790Met) detection improved over time and for repeated scheme participations. In-house non-next-generation sequencing (NGS) techniques performed worse (81.1%, n = 293) compared to non-NGS commercial kits (85.2%, n = 656) and NGS (97.0%, n = 239). Over time there was an increase in the users of NGS. Resection specimens performed worse (82.6%, n = 610 tests) compared to cell line material (90.9%, n = 578 tests), except for NGS (96.3%, n = 344 for resections and 98.6%, n = 312 for cell lines). Samples with multiple mutations were more difficult compared to samples with the single p.(Thr790Met) variant. A change of the test method was shown beneficial to reduce errors but introduced additional analysis failures.

Conclusions
A significant number of laboratories that offer p.(Thr790Met) testing did not detect this relevant mutation compared to the other EQA participants. However, correct identification of this variant is improving over time and was higher for NGS users. Revising the methodology might be useful to resolve errors, especially for resection specimens with low frequency or multiple variants. EQA providers should include challenging resections in the scheme.
A multivariate multilevel analysis of the risk factors associated with anthropometric indices in Iranian mid-adolescents
Authors: Alamolhoda Marzieh , Heydari Seyyed Taghi , Ayatollahi Seyyed Mohammad Taghi , Tabrizi Reza , Akbari Maryam , Ardalan Arash 
Published: May 2020

Abstract
Background
The present study was conducted to jointly assess some specific factors related to body fat measures using a multivariate multilevel analysis in a representative sample of Iranian mid-adolescents.

Methods
This study was conducted among 2538 students (1286 boys) aged 14–20 years old, who were randomly selected among 16 public high schools by multi-stage random sampling procedure from all education districts of Shiraz, Iran. Data on demographic characteristics, family history of obesity, physical activity, socio-economic (SES) variables and screen time were collected. Height, weight, triceps (TST), abdominal (AST), and subscapular (SST) skinfold thickness were measured and their body mass index (BMI) was calculated. A multivariate multilevel approach was used to analyze the factors associated with obesity measures of the TST, AST, SST at the child and district levels.

Results
In this study, the prevalence of overweight and obesity was estimated to be 10.2 and 5.1%, respectively. Overall, the major portion of the total variance in TST (97.1%), AST (97.7%), and SST (97.5%) was found at the child level. The results of multivariate multilevel method revealed that being girls, having a family history of obesity, and SES were significantly associated with increasing of three body fat measures (all the p-values were less than 0.05). There were significant positive associations between moderate to vigorous physical activities with AST and SST (for AST: β =2.54, SE = 1.40, p = 0.05; for SST: β =2.24, SE = 1.20, p = 0.05). Compared to children in 14–16 age group, children in age group 16–18 years had less TST (β = − 0.67, SE = 0.34, p = 0.04). Furthermore, other age groups and screen time did not play an important role in three outcome variables.

Conclusions
The results showed some factors that contribute to three body fat measures. Therefore, it is necessary to develop effective interventions to prevent the effects of individual and environmental undesirable factors on childhood obesity in both family and community levels.
Incorporating machine learning and social determinants of health indicators into prospective risk adjustment for health plan payments
Authors: Irvin Jeremy A. , Kondrich Andrew A. , Ko Michael , Rajpurkar Pranav , Haghgoo Behzad , Landon Bruce E. , Phillips Robert L. , Petterson Stephen , Ng Andrew Y. , Basu Sanjay 
Published: May 2020

Abstract
Background
Risk adjustment models are employed to prevent adverse selection, anticipate budgetary reserve needs, and offer care management services to high-risk individuals. We aimed to address two unknowns about risk adjustment: whether machine learning (ML) and inclusion of social determinants of health (SDH) indicators improve prospective risk adjustment for health plan payments.

Methods
We employed a 2-by-2 factorial design comparing: (i) linear regression versus ML (gradient boosting) and (ii) demographics and diagnostic codes alone, versus additional ZIP code-level SDH indicators. Healthcare claims from privately-insured US adults (2016–2017), and Census data were used for analysis. Data from 1.02 million adults were used for derivation, and data from 0.26 million to assess performance. Model performance was measured using coefficient of determination (R2), discrimination (C-statistic), and mean absolute error (MAE) for the overall population, and predictive ratio and net compensation for vulnerable subgroups. We provide 95% confidence intervals (CI) around each performance measure.

Results
Linear regression without SDH indicators achieved moderate determination (R2 0.327, 95% CI: 0.300, 0.353), error ($6992; 95% CI: $6889, $7094), and discrimination (C-statistic 0.703; 95% CI: 0.701, 0.705). ML without SDH indicators improved all metrics (R2 0.388; 95% CI: 0.357, 0.420; error $6637; 95% CI: $6539, $6735; C-statistic 0.717; 95% CI: 0.715, 0.718), reducing misestimation of cost by $3.5 M per 10,000 members. Among people living in areas with high poverty, high wealth inequality, or high prevalence of uninsured, SDH indicators reduced underestimation of cost, improving the predictive ratio by 3% (~$200/person/year).

Conclusions
ML improved risk adjustment models and the incorporation of SDH indicators reduced underpayment in several vulnerable populations.
Identifying facilitators and barriers for adolescents participating in a school-based HIIT intervention: the eXercise for asthma with commando Joe’s® (X4ACJ) programme
Authors: Sharp Catherine A. , McNarry Melitta A. , Eddolls William T. B. , Koorts Harriet , Winn Charles O. N. , Mackintosh Kelly A. 
Published: May 2020

Abstract
Background
High-intensity interval training (HIIT) elicits numerous health benefits, but little evidence is available regarding the feasibility of delivering school-based HIIT interventions. The aim of this study was to explore adolescents’ perceptions of a 6-month, 3 × 30-min sessions per week, HIIT intervention delivered either before or after school.

Method
Eighty adolescents allocated to the intervention group (13.3 ± 1.0 years; 45 boys) were invited to take part in semi-structured focus groups post-intervention. Participants were categorised as attendees (≥40% attendance) or non-attendees (< 5% attendance). Data were transcribed verbatim and thematically analysed deductively, with key emergent themes represented using pen profiles.

Results
Results showed that a school-based HIIT intervention can be an enjoyable form of exercise. Irrespective of attendance, similar facilitators and barriers to participating were highlighted, including benefits of participation, content of the exercise session and the intervention instructor.

Conclusion
This study provides support for the delivery of a HIIT intervention in a school setting but highlights the importance of a flexible design and delivery to accommodate competing interests. There is a need to educate adolescents on the possible benefits of participation and to make the sessions enjoyable in order to increase their extrinsic and intrinsic motivation to sustain participation.
Barriers and facilitators of sport and physical activity for Aboriginal and Torres Strait Islander children and adolescents: a mixed studies systematic review
Authors: May Tamara , Dudley Amanda , Charles James , Kennedy Kate , Mantilla Ana , McGillivray Jane , Wheeler Keane , Elston Hope , Rinehart Nicole J. 
Published: May 2020

Abstract
Background
Participation in sport and physical activity could minimise the inflated risk of poor physical health outcomes for Aboriginal and Torres Strait Islander children and adolescents. This review aimed to synthesise existing quantitative and qualitative literature regarding barriers and facilitators to physical activity and sports participation in Aboriginal and Torres Strait Islander children.

Methods
Literature was systematically searched to include studies reporting barriers or facilitators to physical activity and/or sports participation in Aboriginal and Torres Strait Islander children aged 0–18 years. Using a pre-established taxonomy based on the social-ecological model, a deductive analysis was performed. Quality appraisal was performed using the Mixed Methods Appraisal Tool.

Results
Of 3440 unique articles, nine studies were included with n = 10,061 total participants. Of the nine included studies one reported on participants from urban areas, two from regional and three from remote areas. Three were from representative samples of the Aboriginal and Torres Strait Islander population. Barriers were reported in all nine studies: 18 individual, 9 interpersonal, 27 community and 4 at the policy level (58 total); Facilitators were reported in five studies: 12 individual, 11 interpersonal, 11 community and 3 policy level (37 total).

Conclusions
Research in this area is lacking with some states in Australia not represented and small samples. Strategies for improving participation in sport and physical activity by Aboriginal and Torres Strait Islander children and adolescents need to integrate a comprehensive identification of barriers and facilitators with a social-ecological understanding of how community and cultural factors can impact individual participation.
Effects of reproductive resource allocation and pollen density on fertilization success in plants
Authors: Gillet Elizabeth M. , Gregorius Hans-Rolf 
Published: May 2020

Abstract
Background
Declining resources due to climate change may endanger the persistence of populations by reducing fecundity and thus population fitness via effects on gamete production. The optimal mode of generative reproduction allocates the limited resources to ovule and pollen production in proportions that maximize the number of fertilized ovules in the population. In order to locate this optimum and derive reproduction modes that compensate for declined resources to maintain reproductive success, a model of gamete production, pollen dispersal, and ovule fertilization is developed. Specification of opportunities for compensation is given priority over specification of physiological or evolutionary mechanisms of adaptation. Thus model parameters summarize gametic production resources, resource investment per gamete, resource allocation as proportion of resources invested in ovules, and pollen density as size of the pollen dispersal range and proportion of pollen retained within the range. Retained pollen disperses randomly, and an ovule is fertilized if at least one pollen settles on its surface. The outcome is the expected number of fertilized ovules.

Results
Maximization of fertilization success is found to require the investment of more gametic production resources in ovules than in pollen, irrespective of the parameter values. Resource decline can be compensated by adjusting the resource allocation if the maximum expected number of fertilized ovules after the decline is not less than the expected number the population experienced before the decline. Compensation is also possible under some conditions by increasing the pollen density, either by raising a low pollen retention or by shrinking the dispersal range.

Conclusion
Fertilization success in populations affected by resource decline may be maintainable by adjustment of the sexual allocation of gametic production resources or by increasing pollen density. The results have implications for insect pollination, sexual allocation bias, management measures, and metapopulation fragmentation.
Risks and perception of non-communicable diseases and health promotion behavior of middle-aged female immigrants in Japan: a qualitative exploratory study
Authors: Nagamatsu Yasuko , Barroga Edward , Sakyo Yumi , Igarashi Yukari , Hirano O Yuko 
Published: May 2020

Abstract
Background
Ensuring good health of immigrants is a serious issue across countries, including Japan. This study focused on the health of middle-aged female immigrants in Japan who experienced changes to their health as well as an increased risk of non-communicable diseases. Specifically, the study aimed to clarify the risks and perceptions of non-communicable diseases and health promotion behavior of middle-aged female immigrants in Japan.

Methods
This investigation used an exploratory design. The participants were a purposive sample of 35 middle-aged female immigrants (age ≥ 40 years) living in urban and rural areas of Japan. Data were generated using mixed methods. A quantitative approach provided data of their risks of non-communicable diseases. Focus group discussions provided insights to identify their health promotion perceptions.

Results
Blood pressure measurement revealed that 29% of the immigrants had hypertension, 29% had a body mass index of > 30, and 71% had an abdominal girth of > 80 cm. About 31% had a history of chronic disease and 34% had regular medication. There were 80% who received regular health check-up, 49% who received breast cancer screening, and 34% who received cervical cancer screening. The focus group discussions indicated that the middle-aged female immigrants recognized the threat of non-communicable diseases. However, they lacked knowledge about the prevention of non-communicable diseases, and they felt that non-communicable diseases were unavoidable. They also failed to understand the benefits of health promotion behavior. The study revealed that the monolingual Japanese health service prevented immigrant women from understanding their health check-up and cancer screening results, and how to utilize the health service system.

Conclusions
Middle-aged female immigrants in Japan had potential risks of non-communicable diseases, and recognized their threat. These settled immigrant women received health check-ups and cancer screenings with the support of their family, and consequently attained the same level of adherence as that of Japanese women. However, lack of knowledge about health promotion and its benefits and the absence of a culturally sensitive health service system for immigrants in Japan constrained their health-promotion behavior. Sociocultural multilingual-tailored interventions including interpretation services by care providers with cultural sensitivities must be developed.
Machine learning approaches to predict peak demand days of cardiovascular admissions considering environmental exposure
Authors: Qiu Hang , Luo Lin , Su Ziqi , Zhou Li , Wang Liya , Chen Yucheng 
Published: May 2020

Abstract
Background
Accumulating evidence has linked environmental exposure, such as ambient air pollution and meteorological factors, to the development and severity of cardiovascular diseases (CVDs), resulting in increased healthcare demand. Effective prediction of demand for healthcare services, particularly those associated with peak events of CVDs, can be useful in optimizing the allocation of medical resources. However, few studies have attempted to adopt machine learning approaches with excellent predictive abilities to forecast the healthcare demand for CVDs. This study aims to develop and compare several machine learning models in predicting the peak demand days of CVDs admissions using the hospital admissions data, air quality data and meteorological data in Chengdu, China from 2015 to 2017.

Methods
Six machine learning algorithms, including logistic regression (LR), support vector machine (SVM), artificial neural network (ANN), random forest (RF), extreme gradient boosting (XGBoost), and light gradient boosting machine (LightGBM) were applied to build the predictive models with a unique feature set. The area under a receiver operating characteristic curve (AUC), logarithmic loss function, accuracy, sensitivity, specificity, precision, and F1 score were used to evaluate the predictive performances of the six models.

Results
The LightGBM model exhibited the highest AUC (0.940, 95% CI: 0.900–0.980), which was significantly higher than that of LR (0.842, 95% CI: 0.783–0.901), SVM (0.834, 95% CI: 0.774–0.894) and ANN (0.890, 95% CI: 0.836–0.944), but did not differ significantly from that of RF (0.926, 95% CI: 0.879–0.974) and XGBoost (0.930, 95% CI: 0.878–0.982). In addition, the LightGBM has the optimal logarithmic loss function (0.218), accuracy (91.3%), specificity (94.1%), precision (0.695), and F1 score (0.725). Feature importance identification indicated that the contribution rate of meteorological conditions and air pollutants for the prediction was 32 and 43%, respectively.

Conclusion
This study suggests that ensemble learning models, especially the LightGBM model, can be used to effectively predict the peak events of CVDs admissions, and therefore could be a very useful decision-making tool for medical resource management.
Impact of the diabetes Canada guideline dissemination strategy on dispensed vascular protective medications for older patients in Ontario, Canada: a linked EMR and administrative data study
Authors: Greiver Michelle , Kalia Sumeet , Moineddin Rahim , Chen Simon , Duchen Raquel , Rigobon Alanna 
Published: May 2020

Abstract
Background
The 2013 Diabetes Canada guidelines recommended routinely using vascular protective medications for most patients with diabetes. These medications included statins and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). Antiplatelet agents were only recommended for secondary prevention of cardiovascular disease. Using Electronic Medical Record (EMR) data, we previously found that guideline dissemination efforts were not associated with an increase in the rate of primary care prescriptions of these medications. However, this needs confirmation: patients can receive prescriptions from different sources including specialists and they may not always fill these prescriptions. Using both EMR and administrative health data, we examined whether guideline dissemination impacted the dispensing of vascular protective medications to patients.

Methods
The study population included patients with diabetes aged 66 or over in Ontario, Canada. We created two cohorts using two different approaches: an Electronic Medical Record (EMR) algorithm for diabetes using linked EMR-administrative data and an administrative algorithm using population level administrative data. We examined data from January 2010 to December 2016. Patients with diabetes were deemed to be likely taking a medication (or covered) during a quarter if the daily amount for a dispensed medication would last for at least 75% of days in any given quarter. An interrupted time series analysis was used to assess the proportion of patients covered by each medication class. Proton pump inhibitors (PPIs) were used as a reference.

Results
There was no increase in the rate of change for medication coverage following guideline release in either the EMR or the administrative diabetes cohorts. For statins, the change in trend was − 0.03, p = 0.7 (EMR) and − 0.12, p = 0.04(administrative). For ACEI/ARBs, this was 0.03, p = 0.6 (EMR) and 0, p = 1(administrative). For antiplatelets, this was 0.001, P = .97 (EMR) and − 0.03, p = 0.03 (administrative). The comparator PPI was − 0.07, p = 0.4 (EMR) and − 0.11, p = 0.002 (administrative).

Conclusions
Using both EMR and administrative health data, we confirmed that the Diabetes Canada 2013 guideline dissemination strategy did not lead to an increased rate of coverage for vascular protective medications. Alternative strategies are needed to effect change in practice.