bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and factors associated with missed hospital appointments: a retrospective review of multiple clinics at Royal Hospital, Sultanate of Oman
Authors: Alawadhi Ahmed , Palin Victoria , van Staa Tjeerd 
Published: August 2021

ObjectivesMissed hospital appointments pose a major challenge for healthcare systems. There is a lack of information about drivers of missed hospital appointments in non-Western countries and extent of variability between different types of clinics. The aim was to evaluate the rate and predictors of missed hospital appointments and variability in drivers between multiple outpatient clinics.SettingOutpatient clinics in the Royal hospital (tertiary referral hospital in Oman) between 2014 and 2018.ParticipantsAll patients with a scheduled outpatient clinic appointment (N=7 69 118).Study designRetrospective cross-sectional analysis.Primary and secondary outcome measuresA missed appointment was defined as a patient who did not show up for the scheduled hospital appointment without notifying or asking for the appointment to be cancelled or rescheduled. The outcomes were the rate and predictors of missed hospital appointments overall and variations by clinic. Conditional logistic regression compared patients who attended and those who missed their appointment.ResultsThe overall rate of missed hospital appointments was 22.3%, which varied between clinics (14.0% for Oncology and 30.3% for Urology). Important predictors were age, sex, service costs, patient’s residence distance from hospital, waiting time and appointment day and season. Substantive variability between clinics in ORs for a missed appointment was present for predictors such as service costs and waiting time. Patients aged 81–90 in the Diabetes and Endocrine clinic had an adjusted OR of 0.53 for missed appointments (95% CI 0.37 to 0.74) while those in Obstetrics and Gynaecology had OR of 1.70 (95% CI 1.11 to 2.59). Adjusted ORs for longer waiting times (>120 days) were 2.22 (95% CI 2.10 to 2.34) in Urology but 1.26 (95% CI 1.18 to 1.36) in Oncology.ConclusionPredictors of a missed appointment varied between clinics in their effects. Interventions to reduce the rate of missed appointments should consider these factors and be tailored to clinic.
Association of metabolic syndrome with risk of cardiovascular disease mortality and all-cause mortality among Malaysian adults: a retrospective cohort study
Authors: Chee Cheong Kee , Lim Kuang Hock , Ghazali Sumarni Mohd , Teh Chien Huey , Cheah Yong Kang , Baharudin Azli , Lim Hui Li , Abdul Hamid Abdul Muneer , Mustapha Feisul Idzwan , Omar Mohd Azahadi 
Published: August 2021

ObjectivesThis study is aimed at determining the association between metabolic syndrome and risk of cardiovascular disease (CVD) mortality and all-cause mortality among Malaysian adults.DesignRetrospective cohort study.SettingThe Malaysian Non-Communicable Disease Surveillance (MyNCDS-1) 2005/2006.ParticipantsA total of 2525 adults (1013 men and 1512 women), aged 24–64 years, who participated in the MyNCDS-1 2005/2006.MethodsParticipants’ anthropometric indices, blood pressure, fasting lipid profile and fasting blood glucose levels were evaluated to determine the prevalence of metabolic syndrome by the Harmonized criteria. Participants’ mortality status were followed up for 13 years from 2006 to 2018. Mortality data were obtained via record linkage with the Malaysian National Registration Department. The Cox proportional hazards regression model was applied to determine association between metabolic syndrome (MetS) and risk of CVD mortality and all-cause mortality with adjustment for selected sociodemographic and lifestyle behavioural factors.ResultsThe overall point prevalence of MetS was 30.6% (95% CI: 28.0 to 33.3). Total follow-up time was 31 668 person-years with 213 deaths (111 (11.3%) in MetS subjects and 102 (6.1%) in non-MetS subjects) from all-causes, and 50 deaths (33 (2.9%) in MetS group and 17 (1.2%) in non-MetS group) from CVD. Metabolic syndrome was associated with a significantly increased hazard of CVD mortality (adjusted HR: 2.18 (95% CI: 1.03 to 4.61), p=0.041) and all-cause mortality (adjusted HR: 1.47 (95% CI: 1.00 to 2.14), p=0.048). These associations remained significant after excluding mortalities in the first 2 years.ConclusionsOur study shows that individuals with MetS have a higher hazard of death from all-causes and CVD compared with those without MetS. It is thus imperative to prescribe individuals with MetS, a lifestyle intervention along with pharmacological intervention to improve the individual components of MetS and reduce this risk.
Effects of short birth interval on neonatal, infant and under-five child mortality in Ethiopia: a nationally representative observational study using inverse probability of treatment weighting
Authors: Shifti Desalegn Markos , Chojenta Catherine , Holliday Elizabeth , Loxton Deborah 
Published: August 2021

ObjectiveTo assess the effect of short birth interval (SBI) on neonatal, infant, and under-five mortality in Ethiopia.DesignA nationally representative cross-sectional survey.SettingThis study used data from the Ethiopia Demographic and Health Survey 2016.ParticipantsA total of 8448 women who had at least two live births during the 5 years preceding the survey were included in the analysis.Outcome measuresNeonatal mortality (death of the child within 28 days of birth), infant mortality (death between birth and 11 months) and under-five mortality (death between birth and 59 months) were the outcome variables.MethodsWeighted logistic regression analysis based on inverse probability of treatment weights was used to estimate exposure effects adjusted for potential confounders.ResultsThe adjusted ORs (AORs) of neonatal mortality were about 85% higher among women with SBI (AOR=1.85, 95% CI=1.19 to 2.89) than those without. The odds of infant mortality were twofold higher (AOR=2.16, 95% CI=1.49 to 3.11) among women with SBI. The odds of under-five child mortality were also about two times (AOR=2.26, 95% CI=1.60 to 3.17) higher among women with SBI.ConclusionSBI has a significant effect on neonatal, infant and under-five mortality in Ethiopia. Interventions targeting SBI are warranted to reduce neonatal, infant and under-five mortality.
Luteinising hormone-based protocol versus traditional flexible gonadotropin-releasing hormone antagonist protocol in women with normal ovarian response: study protocol for a non-inferiority trial
Authors: Lv Ya-su , Li Yuan , Liu Shan 
Published: August 2021

IntroductionMany patients demonstrate an insufficient endogenous luteinising hormone (LH) concentration during ovarian stimulation. With traditional fixed or flexible gonadotropin-releasing hormone (GnRH) antagonist protocols, antagonist administration may further reduce LH activity. Previously, we proved that LH can be used as an indicator for the timing and dosage of antagonist. Patients with a persistently low LH concentration during ovarian stimulation may not require antagonists, whereas antagonist administration can affect reproductive outcomes. To further explore this hypothesis, we designed a randomised clinical trial to compare the LH-based flexible GnRH antagonist protocol with traditional flexible GnRH antagonist protocol in women with normal ovarian response.Methods and analysisThis study was a multicentre, parallel, prospective, randomised, non-inferiority study. The primary efficacy endpoint was cumulative ongoing pregnancy rate per cycle. The study aimed to prove the non-inferiority of cumulative ongoing pregnancy rate per cycle with an LH-based flexible GnRH antagonist protocol versus traditional flexible GnRH antagonist protocol. Secondary endpoints were the high-quality embryo rate, clinical pregnancy rate and cancellation rate. Differences in cost-effectiveness and adverse events were evaluated. The cumulative ongoing pregnancy rate per cycle in women with normal ovarian response was 70%. Considering that a non-inferiority threshold should retain 80% of the clinical effect of a control treatment, a minimal clinical difference of 14% (one-sided: α, 2.5%; β, 20%) and a total of 338 patients were needed. Anticipating a 10% drop-out rate, the total number of patients required was 372.Ethics and disseminationThis trial has been approved by the Institutional Ethical Committee of Beijing Chao-Yang hospital. All participants in the trial will provide written informed consent. The study will be conducted according to the principles outlined in the Declaration of Helsinki and its amendments. Results of this study will be disseminated in peer-reviewed scientific journals.Trial registration numberChiCTR1800018077.
Tenofovir alafenamide fumarate therapy in subjects with positive HBV-DNA and normal levels of alanine transaminase: a study protocol for a randomised controlled trial
Authors: Wang Lu , Wu Lina , Li Xuejun , Zhang Ying , Lai Jing , Zhu Xiang , Xie Chan , Peng Liang 
Published: August 2021

IntroductionThe current clinical guidelines do not recommend antiviral therapy for subjects with positive hepatitis B virus (HBV)-DNA and normal alanine transaminase (ALT). In this study, we will assess the safety and efficacy of tenofovir alafenamide fumarate (TAF) in the treatment of adults with positive HBV-DNA and normal ALT, including long-term prognosis.Methods and analysisThis study is a non-double-blind randomised controlled trial. Study participants will be randomised into the treatment group and the control group. In the treatment group, subjects will receive TAF monotherapy, while those in the control group will receive no antiviral treatment. Subjects will be followed up at the beginning of the study and every 12 or 24 weeks thereafter for review of laboratory findings and to record adverse events. The primary endpoint is the proportion of patients with serum hepatitis B surface antigen loss.Ethics and disseminationThis study protocol was approved by the Ethics Committee of the Third Affiliated Hospital of Sun Yat-Sen University for Human Study (reference number [2019]02-599-01). The results of this study will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT04231565.
Status, use and impact of sharing individual participant data from clinical trials: a scoping review
Authors: Ohmann Christian , Moher David , Siebert Maximilian , Motschall Edith , Naudet Florian 
Published: August 2021

ObjectivesTo explore the impact of data-sharing initiatives on the intent to share data, on actual data sharing, on the use of shared data and on research output and impact of shared data.Eligibility criteriaAll studies investigating data-sharing practices for individual participant data (IPD) from clinical trials.Sources of evidenceWe searched the Medline database, the Cochrane Library, the Science Citation Index Expanded and the Social Sciences Citation Index via Web of Science, and preprints and proceedings of the International Congress on Peer Review and Scientific Publication. In addition, we inspected major clinical trial data-sharing platforms, contacted major journals/publishers, editorial groups and some funders.Charting methodsTwo reviewers independently extracted information on methods and results from resources identified using a standardised questionnaire. A map of the extracted data was constructed and accompanied by a narrative summary for each outcome domain.Results93 studies identified in the literature search (published between 2001 and 2020, median: 2018) and 5 from additional information sources were included in the scoping review. Most studies were descriptive and focused on early phases of the data-sharing process. While the willingness to share IPD from clinical trials is extremely high, actual data-sharing rates are suboptimal. A survey of journal data suggests poor to moderate enforcement of the policies by publishers. Metrics provided by platforms suggest that a large majority of data remains unrequested. When requested, the purpose of the reuse is more often secondary analyses and meta-analyses, rarely re-analyses. Finally, studies focused on the real impact of data-sharing were rare and used surrogates such as citation metrics.ConclusionsThere is currently a gap in the evidence base for the impact of IPD sharing, which entails uncertainties in the implementation of current data-sharing policies. High level evidence is needed to assess whether the value of medical research increases with data-sharing practices.
Solution Focused Brief Therapy in Post-Stroke Aphasia (SOFIA): feasibility and acceptability results of a feasibility randomised wait-list controlled trial
Authors: Northcott Sarah , Thomas Shirley , James Kirsty , Simpson Alan , Hirani Shashivadan , Barnard Rachel , Hilari Katerina 
Published: August 2021

ObjectivesThe Solution Focused Brief Therapy in Post-Stroke Aphasia feasibility trial had four primary aims: to assess (1) acceptability of the intervention to people with aphasia, including severe aphasia, (2) feasibility of recruitment and retention, (3) acceptability of research procedures and outcome measures, and (4) feasibility of delivering the intervention by speech and language therapists.DesignTwo-group randomised controlled feasibility trial with wait-list design, blinded outcome assessors and nested qualitative research.SettingParticipants identified via two community NHS Speech and Language Therapy London services and through community routes (eg, voluntary-sector stroke groups).ParticipantsPeople with aphasia at least 6 months post stroke.InterventionSolution-focused brief therapy, a psychological intervention, adapted to be linguistically accessible. Participants offered up to six sessions over 3 months, either immediately postrandomisation or after a delay of 6 months.Outcome measuresPrimary endpoints related to feasibility and acceptability. Clinical outcomes were collected at baseline, 3 and 6 months postrandomisation, and at 9 months (wait-list group only). The candidate primary outcome measure was the Warwick-Edinburgh Mental Well-being Scale. Participants and therapists also took part in in-depth interviews.ResultsThirty-two participants were recruited, including 43.8% with severe aphasia. Acceptability endpoints: therapy was perceived as valuable and acceptable by both participants (n=30 interviews) and therapists (n=3 interviews); 93.8% of participants had ≥2 therapy sessions (90.6% had 6/6 sessions). Feasibility endpoints: recruitment target was reached within the prespecified 13-month recruitment window; 82.1% of eligible participants consented; 96.9% were followed up at 6 months; missing data <0.01%. All five prespecified feasibility progression criteria were met.ConclusionThe high retention and adherence rates, alongside the qualitative data, suggest the study design was feasible and therapy approach acceptable even to people with severe aphasia. These results indicate a definitive randomised controlled trial of the intervention would be feasible.Trial registration numberNCT03245060.
Associations between state scope of practice laws and US physician assistant wages from 1997 to 2017: a longitudinal analysis
Authors: Valentin Virginia L , Najmabadi Shahpar , Honda Trenton J 
Published: August 2021

ObjectiveThe purpose of this study is to determine whether, and to what degree, variations in physician assistant (PA) state scope of practice (SOP) laws across states are associated with (1) PA median wage over time and (2) if a specific SOP key element has greater impact on PA median wage than others. We hypothesise that expanded SOP laws will be associated with higher PA wage.DesignLongitudinal analysis from 1997 to 2017.SettingFifty states and the District of Columbia (US capital region).ParticipantsEmployed PAs from 1997 to 2017.MethodsFour national data sets were combined to allow for longitudinal analysis of state-level annual PA wage and state SOP laws. We used linear regression models to explore the associations of SOP elements with PA wage in 5-year intervals and individual growth models to assess the change in PA annual wage over the study period.ResultsThere was a 220% increase in weighted PA annual wage over two decades. There was a positive linear correlation between annual wage and age in 2012 and 2017 (r=0.52, p<0.01; r=0.29, p=0.04, respectively). The adjusted R2for individual SOP elements in the selected years were all small (range: 0.0–0.29), with no appreciable pattern across time for any SOP element. In 1997, several SOP laws show association with median wage but this impact disappears over time.ConclusionsPA median wage has risen over twofold in the past two decades, with the rise in PA wage mainly explained by time and provider age. In 1997 some SOP elements were associated with increased average wage; however, the impact of this increase diminished over time in all such instances. As the PA profession moves towards Optimal Team Practice, future research should examine if this move towards greater autonomy impacts wage.
Interventions targeted at reducing diagnostic error: systematic review
Authors: Dave Neha , Bui Sandy , Morgan Corey , Hickey Simon , Paul Christine L 
Published: August 2021

BackgroundIncorrect, delayed and missed diagnoses can contribute to significant adverse health outcomes. Intervention options have proliferated in recent years necessitating an update to McDonaldet al’s 2013 systematic review of interventions to reduce diagnostic error.Objectives(1) To describe the types of published interventions for reducing diagnostic error that have been evaluated in terms of an objective patient outcome; (2) to assess the risk of bias in the included interventions and perform a sensitivity analysis of the findings; and (3) to determine the effectiveness of included interventions with respect to their intervention type.MethodsMEDLINE, CINAHL and the Cochrane Database of Systematic Reviews were searched from 1 January 2012 to 31 December 2019. Publications were included if they delivered patient-related outcomes relating to diagnostic accuracy, management outcomes and/or morbidity and mortality. The interventions in each included study were categorised and analysed using the six intervention types described by McDonaldet al(technique, technology-based system interventions, educational interventions, personnel changes, structured process changes and additional review methods).ResultsTwenty studies met the inclusion criteria. Eighteen of the 20 included studies (including three randomised controlled trials (RCTs)) demonstrated improvements in objective patient outcomes following the intervention. These three RCTs individually evaluated a technique-based intervention, a technology-based system intervention and a structured process change. The inclusion or exclusion of two higher risk of bias studies did not affect the results.ConclusionTechnique-based interventions, technology-based system interventions and structured process changes have been the most studied interventions over the time period of this review and hence are seen to be effective in reducing diagnostic error. However, more high-quality RCTs are required, particularly evaluating educational interventions and personnel changes, to demonstrate the value of these interventions in diverse settings.
Serum ammonia use: unnecessary, frequent and costly
Authors: Aby Elizabeth , Olson Andrew P J , Lim Nicholas 
Published: August 2021

Background/objectiveWhile ammonia plays a role in the complex pathophysiology of hepatic encephalopathy (HE), serum ammonia is unreliable for both diagnosis of, and correlation with, neurological symptoms in patients with cirrhosis. We aimed to quantify ordering, cost and appropriate use of serum ammonia in a major Midwestern healthcare system.Design/methodSerum ammonia ordering in adult patients presenting to a large Midwestern health system was evaluated from 1 January 2015 to 31 December 2019.ResultsSerum ammonia ordering was prevalent, with 20 338 tests ordered over 5 years. There were no differences in the number of inappropriate serum ammonia tests per 100 000 admissions for chronic liver disease over time (Pearson’s correlation coefficient=−0.24, p=0.70). As a proportion of total ammonia tests ordered, inappropriate tests increased over time (Pearson’s correlation coefficient=0.91, p=0.03). Inappropriate ordering was more common at community hospitals compared with the academic medical centre (99.3% vs 87.6%, p<0.001).ConclusionDespite evidence that serum ammonia levels are unreliable for the diagnosis of HE and are not associated with severity of HE in individuals with cirrhosis, ordering remains prevalent, contributing to waste and potential harm.
Heaps’ law and vocabulary richness in the history of classical music harmony
Authors: Serra-Peralta Marc , Serrà Joan , Corral Álvaro 
Published: August 2021

AbstractMusic is a fundamental human construct, and harmony provides the building blocks of musical language. Using theKunstderfugecorpus of classical music, we analyze the historical evolution of the richness of harmonic vocabulary of 76 classical composers, covering almost 6 centuries. Such corpus comprises about 9500 pieces, resulting in more than 5 million tokens of music codewords. The fulfilment of Heaps’ law for the relation between the size of the harmonic vocabulary of a composer (in codeword types) and the total length of his works (in codeword tokens), with an exponent around 0.35, allows us to define a relative measure of vocabulary richness that has a transparent interpretation. When coupled with the considered corpus, this measure allows us to quantify harmony richness across centuries, unveiling a clear increasing linear trend. In this way, we are able to rank the composers in terms of richness of vocabulary, in the same way as for other related metrics, such as entropy. We find that the latter is particularly highly correlated with our measure of richness. Our approach is not specific for music and can be applied to other systems built by tokens of different types, as for instance natural language.
Impact of effective mass changes with mole-fraction on the analog/radio frequency benchmarking parameters in junctionless GaxIn1−xAs/GaAs field-effect transistor
Authors: Vadizadeh Mahdi , Fallahnejad Mohammad 
Published: August 2021

In this paper, for the first time, changes in the effective mass (EM) of electron and hole with mole fraction are taken into account for extracting the benchmarking parameters of analog/radio frequency (RF) and high-frequency noise performance of junctionless (JL)-Ga[Formula: see text]In[Formula: see text]As/GaAs via simulation. In the JL-Ga[Formula: see text]In[Formula: see text]As/GaAs structure, considering changes in the effective mass with mole fraction is called a with-EM state, while the JL-Ga[Formula: see text]In[Formula: see text]As/GaAs structure without considering the changes in effective mass with mole fraction is called a without-EM state. The simulation results show that, per [Formula: see text], the maximum transconductance in the with-effective mass (EM) state is [Formula: see text] mS/[Formula: see text]m, which is reduced by 8% compared to the without-EM state. The JL-Ga[Formula: see text]In[Formula: see text]As/GaAs device in the with-EM state has the unity gain cutoff frequency of [Formula: see text] GHz, minimum noise figure of [Formula: see text] db, and available associated gain of [Formula: see text] db. The [Formula: see text] and [Formula: see text] parameters in the with-EM state decreased by 10% and 38%, respectively, compared to the without-EM state. Moreover, [Formula: see text] in the with-EM state increased by 65% compared to the without-EM state. Our simulation results indicated that an increase in electron effective mass with the increased [Formula: see text] can limit the analog/RF frequency and high-frequency noise performance of the JL-Ga[Formula: see text]In[Formula: see text]As/GaAs device.