bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implications of Competitor Representation for Profit-Maximizing Design
Authors: Yip Arthur H. C. , Michalek Jeremy J. , Whitefoot Kate S. 
Published: July 2021

Abstract
Design optimization studies that model competition with other products in the market often use a small set of products to represent all competitors. We investigate the effect of competitor product representation on profit-maximizing design solutions. Specifically, we study the implications of replacing a large set of disaggregated elemental competitor products with a subset of competitor products or composite products. We derive first-order optimality conditions and show that optimal design (but not price) is independent of competitors when using logit and nested logit models (where preferences are homogeneous). However, this relationship differs in the case of random-coefficients logit models (where preferences are heterogeneous), and we demonstrate that profit-maximizing design solutions using latent-class or mixed-logit models can (but need not always) depend on the representation of competing products. We discuss factors that affect the magnitude of the difference between models with elemental and composite representations of competitors, including preference heterogeneity, cost function curvature, and competitor set specification. We present correction factors that ensure models using subsets or composite representation of competitors have optimal design solutions that match those of disaggregated elemental models. While optimal designs using logit and nested logit models are not affected by ad hoc modeling decisions of competitor representation, the independence of optimal designs from competitors when using these models raises questions of when these models are appropriate to use.
A tale of ‘politics and stars aligning’: analysing the sustainability of scaled up digital tools for front-line health workers in India
Authors: Singh Neha S , Scott Kerry , George Asha , LeFevre Amnesty Elizabeth , Ved Rajani 
Published: July 2021

IntroductionIndia has become a lighthouse for large-scale digital innovation in the health sector, particularly for front-line health workers (FLHWs). However, among scaled digital health solutions, ensuring sustainability remains elusive. This study explores the factors underpinning scale-up of digital health solutions for FLHWs in India, and the potential implications of these factors for sustainability.MethodsWe assessed five FLHW digital tools scaled at the national and/or state level in India. We conducted in-depth interviews with implementers, technology and technical partners (n=11); senior government stakeholders (n=5); funders (n=1) and evaluators/academics (n=3). Emergent themes were grouped according to a broader framework that considered the (1) digital solution; (2) actors; (3) processes and (4) context.ResultsThe scale-up of digital solutions was facilitated by their perceived value, bounded adaptability, support from government champions, cultivation of networks, sustained leadership and formative research to support fit with the context and population. However, once scaled, embedding digital health solutions into the fabric of the health system was hampered by challenges related to transitioning management and ownership to government partners; overcoming government procurement hurdles; and establishing committed funding streams in government budgets. Strong data governance, continued engagement with FLHWs and building a robust evidence base, while identified in the literature as critical for sustainability, did not feature strongly among respondents. Sustainability may be less elusive once there is more consensus around the roles played between national and state government actors, implementing and technical partners and donors.ConclusionThe use of digital tools by FLHWs offers much promise for improving service delivery and health outcomes in India. However, the pathway to sustainability is bespoke to each programme and should be planned from the outset by investing in people, relationships and service delivery adjustments to navigate the challenges involved given the dynamic nature of digital tools in complex health systems.
Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India
Authors: Scott Kerry , Ummer Osama , Shinde Aashaka , Sharma Manjula , Yadav Shalini , Jairath Anushree , Purty Nikita , Shah Neha , Mohan Diwakar , Chamberlain Sara , LeFevre Amnesty Elizabeth 
Published: July 2021

IntroductionKilkari is one of the world’s largest mobile phone-based health messaging programmes. Developed by BBC Media Action, it provides weekly stage-based information to pregnant and postpartum women and their families, including on infant and young child feeding (IYCF) and family planning, to compliment the efforts of frontline health workers. The quantitative component of a randomised controlled trial (RCT) in the Indian state of Madhya Pradesh found that exposure to Kilkari increased modern contraceptive uptake but did not change IYCF practices. This qualitative research complements the RCT to explore why these findings may have emerged.MethodsWe used system generated data to identify households within the RCT with very high to medium Kilkari listenership. Mothers (n=29), as well as husbands and extended family members (n=25 interviews/family group discussions) were interviewed about IYCF and family planning, including their reactions to Kilkari’s calls on these topics. Analysis was informed by the theory of reciprocal determinism, which positions behaviour change within the interacting domains of individual attributes, social and environmental determinants, and existing practices.ResultsWhile women who owned and controlled their own phones were the Kilkari listeners, among women who did not own their own phones, it was often their husbands who listened. Spouses did not discuss Kilkari messages. Respondents retained and appreciated Kilkari messages that aligned with their pre-existing worldviews, social norms, and existing practices. However, they overlooked or de-emphasised content that did not. In this way, they reported agreeing with and trusting Kilkari while persisting with practices that went against Kilkari’s recommendations, particularly non-exclusive breastfeeding and inappropriate complementary feeding.ConclusionTo deepen impact, digital direct to beneficiary services need to be complimented by wider communication efforts (e.g., sustained face-to-face, media, community engagement) to change social norms, taking into account the role of socio-environmental, behavioural, and individual determinants.
Using variation between countries to estimate demand for Cochrane reviews when access is free: a cost–benefit analysis
Authors: Jacobs Perke , Gigerenzer Gerd 
Published: July 2021

ObjectivesCochrane reviews are currently of limited use as many healthcare professionals and patients have no access to them. Most member states of the Organisation for Economic Co-operation and Development (OECD) choose not to pay for nationwide access to the reviews, possibly uncertain whether there is enough demand to warrant the costs of a national subscription. This study estimates the demand for review downloads and summary views under free access across all OECD countries.DesignThe study employs a retrospective design in analysing observational data of web traffic to Cochrane websites in 2014. Specifically, we model for each country downloads of Cochrane reviews and views of online summaries as a function of free access status and alternative sources of variation across countries. The model is then used to estimate demand if a country with restricted access were to purchase free access. We use these estimates to perform a cost-benefit analysis.ResultsFor one group of eight OECD countries, the additional downloads under free access are estimated to cost between US$4 and more than US$20 each. Three countries are expected to save money under free access, as existing institutional subscriptions would no longer be needed. For the largest group of 17 member states, free access is estimated to cost US$0.05–US$2 per additional review download. On average, the increase in review downloads does not appear to be associated with a decrease in the number of summary views. Instead, translations of plain-language summaries into national languages can serve as an additional strategy for dissemination.ConclusionsWe estimate that free access would cost less than US$2 per additional download for 20 of the 28 OECD countries without national subscriptions, including Canada, Germany and Israel. These countries may be encouraged by our findings to provide free access to their citizens.
A prospective, phase II, single-centre, cross-sectional, randomised study investigating Dehydroepiandrosterone supplementation and its Profile in Trauma: ADaPT
Authors: Bentley Conor , Potter Claire , Yakoub Kamal Makram , Brock Kristian , Homer Victoria , Toman Emma , Taylor Angela E , Shaheen Fozia , Gilligan Lorna C , Athwal Amrita , Barton Darren , Carrera Ronald , Young Katie , Desai Amisha , McGee Kirsty , Ermogenous Christos , Sur Gurneet , Greig Carolyn A , Hazeldine Jon , Arlt Wiebke , Lord Janet M , Foster Mark A 
Published: July 2021

IntroductionThe improvements in short-term outcome after severe trauma achieved through early resuscitation and acute care can be offset over the following weeks by an acute systemic inflammatory response with immuneparesis leading to infection, multiorgan dysfunction/multiorgan failure (MOF) and death. Serum levels of the androgen precursor dehydroepiandrosterone (DHEA) and its sulfate ester DHEAS, steroids with immune-enhancing activity, are low after traumatic injury at a time when patients are catabolic and immunosuppressed. Addressing this deficit and restoring the DHEA(S) ratio to cortisol may provide a range of physiological benefits, including immune modulatory effects.ObjectiveOur primary objective is to establish a dose suitable for DHEA supplementation in patients after acute trauma to raise circulating DHEA levels to at least 15 nmol/L. Secondary objectives are to assess if DHEA supplementation has any effect on neutrophil function, metabolic and cytokine profiles and which route of administration (oral vs sublingual) is more effective in restoring circulating levels of DHEA, DHEAS and downstream androgens.Methods and analysisA prospective, phase II, single-centre, cross-sectional, randomised study investigating Dehydroepiandrosterone supplementation and its profile in trauma, with a planned recruitment between April 2019 and July 2021, that will investigate DHEA supplementation and its effect on serum DHEA, DHEAS and downstream androgens in trauma. A maximum of 270 patients will receive sublingual or oral DHEA at 50, 100 or 200 mg daily over 3 days. Females aged ≥50 years with neck of femur fracture and male and female major trauma patients, aged 16–50 years with an injury severity score ≥16, will be recruited.Ethics and disseminationThis protocol was approved by the West Midlands – Coventry and Warwickshire Research Ethics Committee (Reference 18/WM/0102) on 8 June 2018. Results will be disseminated via peer-reviewed publications and presented at national and international conferences.Trial registrationThis trial is registered with the European Medicines Agency (EudraCT: 2016-004250-15) and ISRCTN (12961998). It has also been adopted on the National Institute of Health Research portfolio (CPMS ID:38158).Trial progressionThe study recruited its first patient on 2 April 2019 and held its first data monitoring committee on 8 November 2019. DHEA dosing has increased to 100 mg in both male cohorts and remains on 50 mg in across all female groups.
Pooled analysis of the association between alcohol use and violence against women: evidence from four violence prevention studies in Africa
Authors: Ramsoomar Leane , Gibbs Andrew , Chirwa Esnat D , Dunkle Kristin , Jewkes Rachel 
Published: July 2021

ObjectivesTo test associations between men’s past year alcohol use and patterns of drinking, and their perpetration of intimate partner violence (IPV) and non-partner sexual violence (NPSV). To test the associations between women’s reports of partner alcohol use and their experience of IPV, in three countries in Africa.DesignPooled analysis of cross-sectional baseline data from men and women participating in four IPV prevention studies across Africa and Asia.SettingData from five data sets generated by four violence against women and girls prevention studies in three countries in sub-Saharan Africa, South Africa, Ghana and Rwanda.Participants8104 men 18+ years old and 5613 women 18+ years old from a mix of volunteer and randomly selected samples.Main outcome measuresStudies employed comparable measures of past year alcohol use, harmful alcohol use (Alcohol Use Disorder Identification Test scale) and items from modified WHO Women’s Health and Domestic Violence to measure physical IPV and NPSV perpetration among men and IPV experience among women.FindingsOverall harmful alcohol use among men was associated with a substantially increased odds of perpetrating physical IPV (adjusted OR (aOR)=3.45 (95% CI 2.56 to 4.64)) and NPSV (aOR=2.64 (95% CI 1.85 to 3.76)) compared with non-drinkers. Women who had seen their partner occasionally drunk (aOR=2.68 (95% CI 2.13 to 3.36)) or frequently drunk (aOR=5.94 (95% CI 4.19 to 8.41)) in the past 12 months had an increased odds of experiencing physical IPV.ConclusionsAlcohol use is associated with increased IPV and NPSV perpetration for men and (physical) IPV experience for women. Reported frequency of IPV and NPSV increase with increasing levels and frequency of alcohol use. Interventions aimed at reducing alcohol may also lead to reductions in IPV and NPSV perpetration and experience.
Comparative 4-year risk and type of hospital admission among homeless and housed emergency department attendees: longitudinal study of hospital records in England 2013–2018
Authors: Moss Charlie , Sutton Matt , Cheraghi-Sohi Sudeh , Sanders Caroline , Allen Thomas 
Published: July 2021

ObjectivesPeople experiencing homelessness are frequent users of secondary care. Currently, there is no study of potentially preventable admissions for homeless patients in England. We aim to estimate the number of potentially preventable hospital admissions for homeless patients and compare to housed patients with similar characteristics.DesignRetrospective matched cohort study.SettingHospitals in England.Participants16 161 homeless patients and 74 780 housed patients aged 16–75 years who attended an emergency department (ED) in England in 2013/2014, matched on the basis of age, sex, ED attended and primary diagnosis.Primary and secondary outcome measuresAnnual counts of admissions, emergency admissions, ambulatory care-sensitive (ACS) emergency admissions, acute ACS emergency admissions and chronic ACS emergency admissions over the following 4 years (2014/2015–2017/2018). We additionally compare the prevalence of specific ACS conditions for homeless and housed patients.ResultsMean admissions per 1000 patients per year were 470 for homeless patients and 230 for housed patients. Adjusted for confounders, annual admissions were 1.79 times higher (incident rate ratio (IRR)=1.79; 95% CI 1.69 to 1.90), emergency admissions 2.08 times higher (IRR=2.08; 95% CI 1.95 to 2.21) and ACS admissions 1.65 times higher (IRR=1.65; 95% CI 1.51 to 1.80), compared with housed patients. The effect was greater for acute (IRR=1.78; 95% CI 1.64 to 1.93) than chronic (IRR=1.45; 95% CI 1.27 to 1.66) ACS conditions. ACS conditions that were relatively more common for homeless patients were cellulitis, convulsions/epilepsy and chronic angina.ConclusionsHomeless patients use hospital services at higher rates than housed patients, particularly emergency admissions. ACS admissions of homeless patients are higher which suggests some admissions may be potentially preventable with improved access to primary care. However, these admissions comprise a small share of total admissions.
Proof-of-concept study of electrospun PLGA membrane in the treatment of limbal stem cell deficiency
Authors: Ramachandran Charanya , Deshpande Pallavi , Ortega Ilida , Sefat Farshid , McKean Rob , Srivastava Mala , MacNeil Sheila , Basu Sayan , Sangwan Virender Singh 
Published: July 2021

ObjectiveThe aim of this study was to assess the safety of poly-lactic co-glycolic acid (PLGA) electrospun membranes as carriers for limbal tissue explants for treatment of limbal stem cell deficiency (LSCD).Methods and analysisApproval was obtained for a first in-man study from the Drug Controller General of India. PLGA membranes were applied to the affected eye of five patients after removal of the vascular pannus. Simple limbal epithelial transplantation was performed and limbal explants were secured on the membrane using fibrin glue followed by a bandage contact lens. Patients were followed up for 1 year with ocular exams including slit lamp exam, corneal thickness measurements, intraocular pressure measurements and recording of corneal vascularisation and visual acuity. Systemic examinations included pain grading, clinical laboratory assessment, blood chemistry and urine analysis at baseline, 3 and 6 months after surgery.ResultsPLGA membranes completely degraded by 8 weeks post-transplantation without any infection or inflammation. In all five patients, the epithelium regenerated by 3 months. In two in five patients, there was a sustained two-line improvement in vision. In one in five patients, the vision improvement was limited due to an underlying stromal scarring. There was recurrence of pannus and LSCD in two in five patients 6 months after surgery which was not attributable to the membrane. The ocular surface remained clear with no epithelial defects in three in five subjects at 12 months.ConclusionPLGA electrospun membranes show promise as carrier for limbal epithelial cells in the treatment of LSCD.
Anxiety during the COVID-19 pandemic in hospital staff: systematic review plus meta-analysis
Authors: Raoofi Samira , Pashazadeh Kan Fatemeh , Rafiei Sima , Khani Saghar , Hosseinifard Hossein , Tajik Fatemeh , Masoumi Maryam , Raoofi Neda , Ahmadi Saba , Aghalou Sepideh , Torabi Fatemeh , Dehnad Afsaneh , Hoseinipalangi Zahra , Rezaei Sepide , Shabaninejad Hosein , Ghashghaee Ahmad 
Published: July 2021

BackgroundThis study was conducted to systematically review the existing literature examining the prevalence of anxiety among hospital staff and identifying the contributing factors to address the complications of this disorder and develop effective programmes for reducing the complications of this mental health problem.MethodsWe searched the electronic databases including PubMed, EMBASE, Scopus, Web of Science and Google Scholar from January 2020 to February 2021. To perform meta-analysis, the random effects model was used. To assess the statistical heterogeneity of the included studies, the I2index was used, and 95% CI was estimated. Data analysis was performed by R software.ResultsIn the final analysis, 46 articles with the total sample size of 61 551 hospital staff members were included. Accordingly, anxiety prevalence among healthcare workers (HCWs) was 26.1% (95% CI 19% to 34.6%). The prevalence rates of anxiety in health technicians and medical students were 39% (95% CI 13% to 73%) and 36% (95% CI 15% to 65%), respectively, indicating a much higher prevalence than other hospital staff members. Furthermore, a positive significant relationship between prevalence of anxiety among HCWs and their age was approved (p<0.001). The prevalence rate of anxiety was higher among women 37.7% (95% CI 25.4% to 51.8%) than men 27.2% (95% CI 18.2% to 38.6%).ConclusionThe findings show a moderately high prevalence rate of anxiety in hospital staff. Due to the high prevalence of this mental health problem in health technicians, medical students and frontline health workers, it is highly suggested that healthcare institutions offer mental health programmes for these working groups in order to appropriately manage anxiety during the COVID-19 pandemic.
Clinical manifestations and outcome of SARS-CoV-2 infections in children and adolescents with rheumatic musculoskeletal diseases: data from the National Paediatric Rheumatology Database in Germany
Authors: Sengler Claudia , Eulert Sascha , Minden Kirsten , Niewerth Martina , Horneff Gerd , Kuemmerle-Deschner Jasmin , Siemer Caroline , Berendes Rainer , Girschick Hermann , Hühn Regina , Borte Michael , Hospach Anton , Emminger Wolfgang , Armann Jakob , Klein Ariane , Kallinich Tilmann 
Published: July 2021

ObjectivesThis study aimed to investigate the clinical manifestations, course and outcome of SARS-CoV-2 infection among children and adolescents with rheumatic and musculoskeletal diseases (RMD). Due to their underlying disease as well due to therapeutic immunosuppression, these patients may be at risk for a severe course of COVID-19 or for a flare of the underlying disease triggered by SARS-CoV-2 infection.MethodsDemographic, clinical and treatment data from juvenile patients with RMD as well as data about SARS-CoV-2 infection like test date and method, clinical characteristics, disease course, outcome and impact on the disease activity of the RMD were documented on a specific SARS-CoV-2 questionnaire implemented in the National Paediatric Rheumatology Database (NPRD) in Germany. The survey data were analysed descriptively.ResultsFrom 17 April 2020 to 16 February 2021, data were collected from 76 patients (52% female) with RMD and laboratory-proven SARS-CoV-2 infection with median age of 14 years, diagnosed with juvenile idiopathic arthritis (58%), autoinflammatory (24%) and connective tissue disease (8%). Fifty-eight patients (76%) received disease-modifying antirheumatic drugs (DMARDs), 41% biological DMARDs and 11% systemic glucocorticoids. Fifty-eight (76%) had symptoms of COVID-19. Disease course of SARS-CoV-2 infection (classified as asymptomatic, mild, moderate, severe, life-threatening) was mild and outcome of COVID-19 (classified as recovered, not yet recovered, permanent damage or deceased) was good (recovered) in the majority of patients. Two patients were hospitalised, one of whom required intensive care and died of cardiorespiratory failure. In 84% of SARS-CoV-2-positive patients, no relevant increase in disease activity of the RMD was observed.ConclusionsIn our cohort, SARS-CoV-2 infection in juvenile patients with RMD under various medications was mild with good outcome in the majority of cases and does not appear to have a relevant impact on disease activity of the underlying condition.