bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of a multifactorial ecosustainable isocaloric diet on liver fat in patients with type 2 diabetes: randomized clinical trial
Authors: Della Pepa Giuseppe , Vetrani Claudia , Brancato Valentina , Vitale Marilena , Monti Serena , Annuzzi Giovanni , Lombardi Gianluca , Izzo Anna , Tommasone Marianna , Cipriano Paola , Clemente Gennaro , Mirabelli Peppino , Mancini Marcello , Salvatore Marco , Riccardi Gabriele , Rivellese Angela Albarosa , Bozzetto Lutgarda 
Published: May 2020

IntroductionTreatment options for non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes (T2D) are still a matter of debate. We compared the effects of a diet including different components versus a proven beneficial diet rich in monounsaturated fatty acids (MUFAs) on liver fat in T2D.Research design and methodsAccording to a parallel design, 49 individuals with T2D, overweight/obese, with high waist circumference, 35–75 years-old, in satisfactory blood glucose control with diet or drugs not affecting liver fat content, were randomly assigned to an 8-week isocaloric intervention with a MUFA diet (n=26) or a multifactorial diet rich in fiber, MUFA, n-6 and n-3 polyunsaturated fatty acids, polyphenols, and vitamins D, E, and C (n=23). Before and after the intervention, liver fat content was evaluated by proton magnetic resonance spectroscopy (1H-MRS).1H-MRS complete data were available for n=21 (MUFA diet) and n=18 (multifactorial diet) participants.ResultsAdherence to dietary interventions was optimal. No significant differences between groups in body weight reduction, plasma glycated hemoglobin, insulin, glucose, lipids and liver enzymes were observed. Liver fat significantly decreased after both the multifactorial diet (9.18%±7.78% vs 5.22%±4.80%, p=0.003) and the MUFA diet (9.47%±8.89% vs 8.07%±8.52%, p=0.027) with a statistically significant difference between changes either in absolute terms (−4.0%±4.5% vs −1.4%±2.7%, p=0.035) or percent (−40%±33% vs −19%±25%, p=0.030).ConclusionsAn isocaloric multifactorial diet including several beneficial dietary components induced a clinically relevant reduction of liver fat in patients with T2D, more pronounced than that induced by simply replacing saturated fat with MUFA. This suggests that the ‘optimal diet’ for NAFLD treatment in T2D should be based on synergic actions of different dietary components on multiple pathophysiological pathways.Trial registration numberNCT03380416.
Cardiovascular risk profiles and the uptake of the NHS Healthcheck programme in male prisoners in six UK prisons: an observational cross-sectional survey
Authors: Packham Christopher , Butcher Elizabeth , Williams Marie , Miksza Joanne , Morriss Richard , Khunti Kamlesh 
Published: May 2020

IntroductionHalf of all deaths in custody are due to natural causes, the most common being cardiovascular disease (CVD). National Health Service Healthchecks should be available to all eligible prisoners; it is not clear who receives them. Mental health issues are common in prisoners and may affect how healthcare interventions should be delivered. Current policy is to offer Healthchecks to those serving over 2 years in prison.Objectives, methods, setting and designAn observational cross-sectional survey in six male prisons in England between September 2017 and January 2019 in prisoners aged 35–74 to identify who was eligible for a Healthcheck and compare CVD risk data with those that were not, and factors associated with uptake.Outcome measuresCharacteristics of those accepting a Healthcheck were compared with those declining. Assessments of anxiety and depression were compared with CVD risk factors.Results1207 prisoners completed a Healthcheck. 21.8% of prisoners were ineligible due to existing comorbidities. 76.4% of those invited took up a Healthcheck, and of those, 12.1% were found to have new significant CVD comorbidity. CVD risk was similar to community levels but this population was 10 years younger. Definite case-level depression or anxiety was present in 20.7% and 18.0%, respectively, of participants. An association was found between ethnicity and those invited (p=0.023, φ=0.1) and accepting (p=0.008, φ=0.1) a Healthcheck. 9.7% of prisoners serving less than 2 years had CVD risk scores of 10% or more, and had similar CVD risk profiles but much higher levels of anxiety (p<0.001, φ=0.2) or depression (p=0.009, φ=0.2) than those serving 2 years or more.ConclusionCardiovascular risk was comparable with community rates and in some prisons, much higher. Rates of anxiety and depression were high. The national policy for selecting prisoners for Healthchecks may leave many high-risk prisoners without appropriate cardiovascular preventative assessments.
Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care
Authors: Peakman Georgia , Karunatilake Nishshanka , Seynaeve Mathieu , Perera Gayan , Aarsland Dag , Stewart Robert , Mueller Christoph 
Published: May 2020

ObjectivesDepression can be a prodromal feature or a risk factor for dementia. We aimed to investigate which clinical factors in patients with late-life depression are associated with a higher risk of developing dementia and a more rapid conversion.DesignRetrospective cohort study.SettingSouth London and Maudsley NHS Foundation Trust (SLaM) secondary mental healthcare services.ParticipantsThe SLaM Clinical Record Interactive Search was used to retrieve anonymised data on 3659 patients aged 65 years or older who had received a diagnosis of depression in mental health services and had been followed up for at least 3 months.Outcome measuresPredictors of development of incident dementia were investigated, including demographic factors, health status rated on the Health of the National Outcome scale for older people (HoNOS65+), depression recurrence and treatments including psychotropic drugs and cognitive behavioural therapy (CBT).ResultsIn total, 806 (22.0%) patients developed dementia over a mean follow-up time of 2.7 years. Significant predictors of receiving a dementia diagnosis in fully adjusted models and after accounting for multiple comparisons were older age (adjusted HR=1.04, 95% CI 1.03 to 1.06 per year difference from sample mean) and the HoNOS65+ subscale measuring cognitive problems (HR=4.72, 95% CI 3.67 to 6.06 for scores in the problematic range). Recurrent depressive disorder or past depression (HR=0.65, 95% CI 0.55 to 0.77) and the receipt of CBT (HR=0.73 95% CI 0.61 to 0.87) were associated with a lower dementia risk. Over time, hazards related to age increased and hazards related to cognitive problems decreased.ConclusionsIn older adults with depression, a higher risk of being subsequently diagnosed with dementia was predicted by higher age, new onset depression, severity of cognitive symptoms and not receiving CBT. Further exploration is needed to determine whether the latter risk factors are responsive to interventions.
A Qualitative study assessing organisational readiness to implement caregiver support programmes in Ontario, Canada
Authors: Tseung Victrine , Jaglal Susan , Salbach Nancy Margaret , Cameron Jill I 
Published: May 2020

ObjectiveTo qualitatively explore factors affecting implementation of caregiver support programmes in healthcare institutions in a regional stroke system.DesignA qualitative descriptive study with the Ontario Stroke System (OSS) was conducted. Data were collected through focus groups and in-depth interviews. Transcripts were coded and analysed using inductive thematic analysis.SettingRegional Stroke System, Ontario, Canada.ParticipantsOSS stakeholders including medical directors, executives, programme directors, education coordinators, rehabilitation and community and long-term care specialists, primary care leaders and healthcare professionals.InterventionNot applicable.Main outcome measuresData collection explored perceptions of the need for caregiver support programmes and factors that may affect their implementation.ResultsFour focus groups (n=43) and 29 interviews were completed. Analyses identified themes related to (1) evidence that a caregiver programme will improve health and health system outcomes, (2) personnel requirements, (3) barriers associated with current billing and referral processes and (4) integration with current practice and existing workflow processes.ConclusionsImplementation strategies to adopt caregiver programmes into clinical practice should incorporate evidence and consider personnel and existing workflow processes.
Predictors of non-fatal violence or assault among adolescents in rural Bangladesh: cross-sectional study
Authors: Osaghae Ikponmwosa , Bhuiyan Md Al-Amin , Alonge Olakunle 
Published: May 2020

ObjectiveTo determine the predictors of non-fatal violence or assault among adolescents in rural Bangladesh to inform evidence-based interventions.DesignCross-sectional study.SettingHousehold survey and national census in 51 unions of rural Bangladesh.Participants, methods and main outcome213 782 adolescents aged 11–19 years who reported violence during a population-based survey in 2013. We used logistic regression to determine the prevalence of factors that predict non-fatal forms of violence or assaults among adolescents. Assault or violence was defined as all injuries inflicted directly by another person or resulting from collateral impact over a 6-month recall period.Results457 (0.21%) cases of violence or assault were reported. The adjusted prevalence ratio (PR) of violence was lower among female adolescents compared with males (PR: 0.60, 95% CI 0.47 to 0.78, p<0.001). Compared with the lowest socioeconomic quintile, being in a higher quintile was associated with lower prevalence of violence, with a 39% decrease in the adjusted prevalence of violence among adolescents in highest compared with lowest socioeconomic index (PR: 0.61, 95% CI 0.44 to 0.84). The adjusted prevalence of violence in Chandpur and Comilla districts was 7.30 times and 7.27 times higher respectively than the prevalence of violence in Sirajganj (PR: 7.30, 95% CI 4.07 to 13.10 and PR: 7.27, 95% CI 3.56 to 14.84, respectively). There was no significant difference in the adjusted prevalence of violence occurring in school compared with home (PR: 1.19, 95% CI 0.85 to 1.69).ConclusionMale adolescents may be at an increased risk of suffering violence, and socioeconomic factors and place (districts) are strong predictors of adolescent violence among a selected population in rural Bangladesh. These findings are important in guiding interventions to address the burden of violence among adolescents in communities with similar demographics as our study population. Further research is needed to identify the actual burden of violence among adolescents at national level and to establish an effective violence prevention programme across Bangladesh.
Work effort, readability and quality of pharmacy transcription of patient directions from electronic prescriptions: a retrospective observational cohort analysis
Authors: Zheng Yifan , Jiang Yun , Dorsch Michael P , Ding Yuting , Vydiswaran V G Vinod , Lester Corey A 
Published: May 2020

BackgroundFree-text directions generated by prescribers in electronic prescriptions can be difficult for patients to understand due to their variability, complexity and ambiguity. Pharmacy staff are responsible for transcribing these directions so that patients can take their medication as prescribed. However, little is known about the quality of these transcribed directions received by patients.MethodsA retrospective observational analysis of 529 990 e-prescription directions processed at a mail-order pharmacy in the USA. We measured pharmacy staff editing of directions using string edit distance and execution time using the Keystroke-Level Model. Using the New Dale-Chall (NDC) readability formula, we calculated NDC cloze scores of the patient directions before and after transcription. We also evaluated the quality of directions (eg, included a dose, dose unit, frequency of administration) before and after transcription with a random sample of 966 patient directions.ResultsPharmacy staff edited 83.8% of all e-prescription directions received with a median edit distance of 18 per e-prescription. We estimated a median of 6.64 s of transcribing each e-prescription. The median NDC score increased by 68.6% after transcription (26.12 vs 44.03, p<0.001), which indicated a significant readability improvement. In our sample, 51.4% of patient directions on e-prescriptions contained at least one pre-defined direction quality issue. Pharmacy staff corrected 79.5% of the quality issues.ConclusionPharmacy staff put significant effort into transcribing e-prescription directions. Manual transcription removed the majority of quality issues; however, pharmacy staff still miss or introduce following their manual transcription processes. The development of tools and techniques such as a comprehensive set of structured direction components or machine learning–based natural language processing techniques may help produce clear directions.
Usability assessment of Versius, a new robot-assisted surgical device for use in minimal access surgery
Authors: Haig Fiona , Medeiros Ana Cristina Barbosa , Chitty Karen , Slack Mark 
Published: May 2020

ObjectivesVersius is a teleoperated surgical robotic system intended for use in minimal access surgery. This study aimed to validate the safety and effectiveness of the Versius user interface in the hands of trained users and identify and address the causes of any user errors.DesignSurgical teams completed a commercially representative training program over 3.5 days. After training was completed, the usability-related aspects of the system were assessed.SettingA simulated operating room using a cadaveric model.ParticipantsSurgical teams consisting of a lead surgeon, assistant surgeon, scrub nurse and circulating nurse.Main outcome measuresUsability-related aspects of the system were assessed through the completion of critical and non-critical tasks. A critical task was defined according to the Food and Drug Administration’s definition, as a user task which, if performed incorrectly or not performed at all, would or could cause serious harm to the patient or user, where harm is defined to include compromised medical care.ResultsIn total, 17 surgical teams participated in the study and all were experienced in laparoscopic surgery. The number of robotic surgeries performed by the participants per month ranged from 0 to 100. Surgical specialties were similarly represented from obstetrics and gynecology, colorectal, urology and upper gastrointestinal. No critical task failures were observed. Of all the tasks completed, 98% were recorded as a pass or a pass with difficulty.ConclusionsThese results demonstrate that in a simulated clinical setting, Versius can be safely used by both laparoscopically and robotically trained healthcare professionals. These results support the progression to assessment of Versius in preclinical studies.
Analytical validation of the Immunoscore and its associated prognostic value in patients with colon cancer
Authors: Marliot Florence , Chen Xiaoyi , Kirilovsky Amos , Sbarrato Thomas , El Sissy Carine , Batista Luciana , Van den Eynde Marc , Haicheur-Adjouri Nacilla , Anitei Maria-Gabriela , Musina Ana-Maria , Scripcariu Viorel , Lagorce-Pagès Christine , Hermitte Fabienne , Galon Jérôme , Fieschi Jacques , Pagès Franck 
Published: May 2020

BackgroundNew and fully validated tests need to be brought into clinical practice to improve the estimation of recurrence risk in patients with colon cancer. The aim of this study was to assess the analytical performances of the Immunoscore (IS) and show its contribution to prognosis prediction.MethodsImmunohistochemical staining of CD3+ and CD8+ T cells on adjacent sections of colon cancer tissues were quantified in the core of the tumor and its invasive margin with dedicated IS modules integrated into digital pathology software. Staining intensity across samples collected between 1989 and 2016 (n=595) was measured. The accuracy of the IS workflow was established by comparing optical and automatic counts. Analytical precision of the IS was evaluated within individual tumor block on distant sections and between eligible blocks. The IS interlaboratory reproducibility (n=100) and overall assay precision were assessed (n=3). Contribution of the IS to prediction of recurrence based on clinical and molecular parameters was determined (n=538).ResultsOptical and automatic counts for CD3+ or CD8+ were strongly correlated (r=0.94, p<0.001 and r=0.92, p<0.001, respectively). CD3 and CD8 staining intensities were not altered by the age of the tumor block over a period of 30 years. Neither the position of tested tissue sections within a tumor block nor the selection of the tissue blocks affected the IS. Reproducibility of the IS was not affected by multiple variables (eg, antibody lots, DAB revelation kits, immunohistochemistry automates and operators). Interassay repeatability of the IS was 100% and interlaboratory reproducibility between two testing centers was 93%. Finally, in a case series of patients with stage II–III colon cancer, the relative proportion of variance for time to recurrence was greatest for the IS (53% of prognostic variability) in a model that included IS, T-stage, microsatellite instability status and total number of lymph nodes.ConclusionIS is a robust and validated clinical assay leveraging immune scoring to predict recurrence risk of patient with localized colon cancer. The strong and independent prognostic value of IS should pave the way for it use in clinical practice.
Efficacy and safety of camrelizumab combined with apatinib in advanced triple-negative breast cancer: an open-label phase II trial
Authors: Liu Jieqiong , Liu Qiang , Li Ying , Li Qian , Su Fengxi , Yao Herui , Su Shicheng , Wang Quanren , Jin Liang , Wang Ying , Lau Wan Yee , Jiang Zefei , Song Erwei 
Published: May 2020

BackgroundPrevious trials showed that antiangiogenesis or anti-programmed death protein 1/programmed death ligand 1 (PD-1/PD-L1) monotherapy only showed marginal effect in triple-negative breast cancer (TNBC). Preclinical studies demonstrated that antiangiogenic therapy could sensitize breast cancer to PD-1/PD-L1 blockade via reprogramming tumor microenvironment. Combinational treatment of checkpoint blockade and antiangiogenesis for TNBC has not been reported.MethodsPatients with advanced TNBC with less than three lines of systemic therapy were enrolled in an open-label, non-comparative, two-arm, phase II trial at Sun Yat-sen Memorial Hospital. Camrelizumab (intravenously every 2 weeks) with apatinib orally at either continuous dosing (d1–d14) or intermittent dosing (d1–d7) was given until disease progression or unacceptable toxicities. Primary endpoint was objective response rate (ORR).ResultsFrom January 2018 to April 2019, 40 patients were enrolled, including 10 in the apatinib intermittent dosing cohort and 30 in the apatinib continuous dosing cohort. The ORR was 43.3% (13 of 30) in the continuous dosing cohort, while no objective response was observed in the intermittent dosing cohort. The disease control rate was 63.3% (19 of 30) in the apatinib continuous dosing cohort, and 40.0% (4 of 10) in the apatinib intermittent dosing cohort, respectively. The median progression-free survival (PFS) was 3.7 (95% CI 2.0 to 6.4) months and 1.9 (95% CI 1.8 to 3.7) months in the continuous dosing and intermittent dosing cohort, respectively. In the continuous dosing cohort, the median PFS of patients with partial response (8.3 months, 95% CI 5.9 to not reached) was significantly longer than that of patients with stable disease/progressive disease/not evaluable (2.0 months, 95% CI 1.7 to 3.0). The most common adverse events (AEs) included elevated aspartate aminotransferase/alanine aminotransferase and hand-foot syndrome. Overall, 26.7% and 20.0% of patients experienced grade ≥3 AEs in the continuous dosing and intermittent dosing cohort, respectively. In the continuous dosing cohort, a high percentage of baseline tumor-infiltrating lymphocytes (>10%) was associated with higher ORR and favorable PFS (p=0.029, 0.054, respectively).ConclusionsThe ORR by this chemo-free regimen was dramatically higher than previously reported ORR by anti-PD-1/PD-L1 antibody or apatinib monotherapy. Camrelizumab combined with apatinib demonstrated favorable therapeutic effects and a manageable safety profile in patients with advanced TNBC.Trial registration numberNCT03394287.
PepMusic: motivational qualities of songs for daily activities
Authors: Kim Yongsung , Aiello Luca Maria , Quercia Daniele 
Published: May 2020

AbstractMusic can motivate many daily activities as it can regulate mood, increase productivity and sports performance, and raise spirits. However, we know little about how to recommend songs that are motivational for people given their contexts and activities. As a first step towards dealing with this issue, we adopt a theory-driven approach and operationalize the Brunel Music Rating Inventory (BMRI) to identify motivational qualities of music from the audio signal. When we look at frequently listened songs for 14 common daily activities through the lens of motivational music qualities, we find that they are clustered into three high-level latent activity groups: calm, vibrant, and intense. We show that our BMRI features can accurately classify songs in the three classes, thus enabling tools to select and recommend activity-specific songs from existing music libraries without any input required from user. We present the results of a preliminary user evaluation of our song recommender (called PepMusic) and discuss the implications for recommending songs for daily activities.
Montgomery Multiplication for Public Key Cryptography on MSP430X
Authors: Seo Hwajeong , An Kyuhwang , Kwon Hyeokdong , Hu Zhi 
Published: May 2020

For traditional public key cryptography and post-quantum cryptography, such as elliptic curve cryptography and supersingular isogeny key encapsulation, modular multiplication is the most performance-critical operation among basic arithmetic of these cryptographic schemes. For this reason, the execution timing of such cryptographic schemes, which may highly determine that the service availability for low-end microprocessors (e.g., 8-bit AVR, 16-bit MSP430X, and 32-bit ARM Cortex-M), mainly relies on the efficiency of modular multiplication on target embedded processors.
In this article, we present new optimal modular multiplication techniques based on the interleaved Montgomery multiplication on 16-bit MSP430X microprocessors, where the multiplication part is performed in a hardware multiplier and the reduction part is performed in a basic arithmetic logic unit (ALU) with the optimal modular multiplication routine, respectively. This two-step approach is effective for the special modulus of NIST curves, SM2 curves, and supersingular isogeny key encapsulation. We further optimized the Montgomery reduction by using techniques for “Montgomery-friendly” prime. This technique significantly reduces the number of partial products. To demonstrate the superiority of the proposed implementation of Montgomery multiplication, we applied the proposed method to the NIST P-256 curve, of which the implementation improves the previous modular multiplication operation by 23.6% on 16-bit MSP430X microprocessors and to the SM2 curve as well (first implementation on 16-bit MSP430X microcontrollers).
Moreover, secure countermeasures against timing attack and simple power analysis are also applied to the scalar multiplication of NIST P-256 and SM2 curves, which achieve the 8,582,338 clock cycles (0.53 seconds@16 MHz) and 10,027,086 clock cycles (0.62 seconds@16 MHz), respectively. The proposed Montgomery multiplication is a generic method that can be applied to other cryptographic schemes and microprocessors with minor modifications.