bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Axial Impact Response and Plantar Load Distribution of the Hybrid III and Military Lower Extremity Under Altered Ankle Postures
Authors: de Lange Julia E. , Quenneville Cheryl E. 
Published: July 2021

AbstractFoot injuries as a result of automotive collisions are frequent and impactful. Anthropomorphic test devices (ATDs), used to assess injury risk during impact scenarios such as motor vehicle collisions, typically assess risk of foot/ankle injuries by analyzing data in tibia load cells. The peak axial force and the tibia index are metrics commonly used to evaluate risk of injury to the lower extremity but do not directly account for injury risk to the foot, or the risk of injury associated with out-of-position loading. Two ATDs, the Hybrid III lower leg and the Military Lower Extremity, were exposed to axial impacts at seven different ankle postures. An array of piezoresistive sensors located on the insole of a boot was employed during these tests to assess the load distribution variations among postures and between ATD models on the plantar surface of the foot. Both posture and ATD model affected the load distribution on the foot, highlighting the need for regional injury risk assessments in this vulnerable anatomical region. The increase in forefoot loading during plantarflexion was not reflected in the standard industry metrics of peak axial force or tibia index, suggesting that increased fracture risk to the forefoot would not be detected. The variations in load distribution between the models could also alter injury risk assessment in frontal collisions based on differences in attenuation. These data could be used for regional foot injury assessment and to inform the design of an improved ATD foot.
Respiratory-associated deaths in people with intellectual disabilities: a systematic review and meta-analysis
Authors: Truesdale Maria , Melville Craig , Barlow Fiona , Dunn Kirsty , Henderson Angela , Hughes-McCormack Laura Anne , McGarty Arlene , Rydzewska Ewelina , Smith Gillian S , Symonds Joseph , Jani Bhautesh , Kinnear Deborah 
Published: July 2021

ObjectiveTo review and synthesise evidence on rates of respiratory-associated deaths and associated risk factors in the intellectual disability population.DesignSystematic review and meta-analysis.Data sourcesEmbase, CINAHL, ISI Web of Science (all databases including Medline) and PsychINFO were searched for studies published between 1st January 1985 and 27th April 2020 and examined study and outcome quality. Reference lists and Google Scholar were also hand searched.ResultsWe identified 2295 studies, 17 were included in the narrative synthesis and 10 studies (11 cohorts) in the meta-analysis. Data from 90 302 people with intellectual disabilities and 13 808 deaths from all causes in people with intellectual disabilities were extracted. Significantly higher rates of respiratory-associated deaths were found among people with intellectual disabilities (standardised mortality ratio(SMR): 10.86 (95% CI: 5.32 to 22.18, p<0.001) compared with those in the general population, lesser rates for adults with ID (SMR: 6.53 (95% CI: 4.29 to 9.96, p<0.001); and relatively high rates from pneumonia 26.65 (95% CI: 5.63 to 126.24, p<0.001). The overall statistical heterogeneity was I2=99.0%.ConclusionPremature deaths due to respiratory disorders are potentially avoidable with improved public health initiatives and equitable access to quality healthcare. Further research should focus on developing prognostic guidance and validated tools for clinical practice to mitigate risks of respiratory-associated deaths.PROSPERO registration numberCRD42020180479.
Qualitative analysis of disposition decision making for patients referred for admission from the emergency department without definite medical acuity
Authors: Trinh Tina , Elfergani Amira , Bann Maralyssa 
Published: July 2021

ObjectiveTo map the physician approach when determining disposition for a patient who presents without the level of definite medical acuity that would generally warrant hospitalisation.Data sources/study settingSince 2018, our US academic county hospital/trauma centre has maintained a database in which hospitalists (‘triage physicians’) document the rationale and outcomes of requests for admission to the acute care medical ward during each shift.Study designNarrative text from the database was analysed using a grounded theory approach to identify major themes and subthemes, and a conceptual model of the admission decision-making process was constructed.ParticipantsDatabase entries were included (n=300) if the admission call originated from the emergency department and if the triage physician characterised the request as potentially inappropriate because the patient did not have definite medical acuity.ResultsAdmission decision making occurs in three main phases: evaluation of unmet needs, assessment of risk and re-evaluation. Importantly, admission decision making is not solely based on medical acuity or clinical algorithms, and patients without a definite medical need for admission are hospitalised when physicians believe a potential issue exists if discharged. In this way, factors such as homelessness, substance use disorder, frailty, etc, contribute to admission because they raise concern about patient safety and/or barriers to appropriate treatment. Physician decision making can be altered by activities such as care coordination, advocacy by the patient or surrogate, interactions with other physicians or a change in clinical trajectory.ConclusionsThe decision to admit ultimately remains a clinical determination constructed between physician and patient. Physicians use a holistic process that incorporates broad consideration of the patient’s medical and social needs with emphasis on risk assessment; thus, any analysis of hospitalisation trends or efforts to impact such should seek to understand this individual-level decision making.
Potentially inappropriate medications (PIMs): frequency and extent of GP-related variation in PIMs: a register-based cohort study
Authors: Ribe Anette Riisgaard , Christensen Line Due , Vestergaard Claus Høstrup , Prior Anders , Brynningsen Peter Krogh , Bro Flemming , Sandbæk Annelli , Vedsted Peter , Witte Daniel R , Fenger-Grøn Morten 
Published: July 2021

ObjectivesPotentially inappropriate medications (PIMs) pose an increasing challenge in the ageing population. We aimed to assess the extent of PIMs and the prescriber-related variation in PIM prevalence.DesignNationwide register-based cohort study.SettingGeneral practice.ParticipantsThe 4.2 million adults listed with general practitioner (GP) clinics in Denmark (n=1906) in 2016.Main outcome measuresWe estimated the patients’ time with PIMs by using 29 register-operationalised STOPP criteria linking GP clinics and redeemed prescriptions. For each criterion and each GP clinic, we calculated ratios between the observed PIM time and that predicted by multivariate Poisson regressions on the patients. The observed variation was measured as the 90th/10th percentile ratios of these ratios. The extent of expectable random variation was assessed as the 90th/10th percentile ratios in randomly sampled GP populations (ie, the sampled variation). The GP-related excess variation was calculated as the ratio between the observed variation and sampled variation. The linear correlation between the observed/expected ratio for each of the criteria and the observed/expected ratio of total PIM time (for each clinic) was measured by Pearson’s rho.ResultsOverall, 294 542 individuals were exposed to 1 44 117 years of PIMs. The two most prevalent PIMs were long-term use (>3 months) of non-steroidal anti-inflammatory drugs (51 074 years of PIMs) or benzodiazepines (48 723 years of PIMs). These two criteria showed considerable excess variation of 2.33 and 3.05, respectively; for total PIMs, this figure was 1.65. For more than half of the criteria, we observed a positive correlation between the specific PIM and the sum of remaining PIMs.ConclusionsThis study documents considerable variations in the prescribing practice of GPs for certain PIMs. These findings highlight a need for exploring the causal explanations for such variations, which could be markers of suboptimal GP-prescribing strategies.
Long-term weight loss success and the health behaviours of adults in the USA: findings from a nationally representative cross-sectional study
Authors: Shuval Kerem , Marroquin Elisa Morales , Li Qing , Knell Gregory , Pettee Gabriel Kelley , Drope Jeffrey , Yaroch Amy L , Chartier Karen G , Fennis Bob M , Qadan Mahmoud 
Published: July 2021

ObjectiveTo describe the relationship between long-term weight loss (LTWL) success and lifestyle behaviours among US adults.DesignSerial cross-sectional data from National Health and Nutrition Examination Survey cycles 2007–2014.Setting and participantsPopulation-based nationally representative sample. The analytic sample included 3040 adults aged 20–64 years who tried to lose weight in the past year.MeasuresParticipants were grouped into five LTWL categories (<5%, 5%–9.9%, 10%–14.9%, 15%–19.9% and ≥20%). Lifestyle-related behaviours included the following: alcohol intake, physical activity, smoking, fast-food consumption, dietary quality (Healthy Eating Index (HEI)) and caloric intake. Multivariable regression was employed adjusting for age, sex, race/ethnicity, marital status, education, household income and size, current body mass index and self-reported health status.ResultsIndividuals in the 15%–19.9% LTWL group differed significantly from the reference group (<5% LTWL) in their physical activity and dietary quality (HEI) but not caloric intake. Specifically, they had a higher HEI score (β=3.19; 95% CI 0.39 to 5.99) and were more likely to meet physical activity guidelines (OR=1.99; 95% CI 1.11 to 3.55). In comparison, the ≥20% LTWL group was significantly more likely to smoke (OR=1.63; 95% CI 1.03 to 2.57) and to consume lower daily calories (β=−202.91; 95% CI –345.57 to –60.25) than the reference group; however, dietary quality and physical activity did not significantly differ.ConclusionAmong a national sample of adults, a higher level of LTWL success does not necessarily equate to healthy weight loss behaviours. Future research should attempt to design interventions aimed at facilitating weight loss success while encouraging healthy lifestyle behaviours.
Social isolation and its psychosocial factors in mild lockdown for the COVID-19 pandemic: a cross-sectional survey of the Japanese population
Authors: Sugaya Nagisa , Yamamoto Tetsuya , Suzuki Naho , Uchiumi Chigusa 
Published: July 2021

ObjectiveThis study investigated the sociodemographic, behavioural and psychological characteristics of socially isolated individuals during the ‘mild lockdown’ period of COVID-19 in Japan.DesignA cross-sectional study.SettingThe seven prefectures where the emergency declaration was first applied in Japan.ParticipantsWe collected data on 11 333 individuals (52.4% women, 46.3±14.6 years) living in the seven prefectures where the emergency declaration was first applied. The online survey was performed between 11 May and 12 May 2020, in the final phase of the state of emergency.Primary outcome measuresLubben Social Network Scale (LSNS-6)ResultsWe found that male sex (95% CI 1.60 to 1.98), middle age (95% CI 1.55 to 1.93) and lower income (eg, annual household income <2.0 million: 95% CI 2.29 to 3.54) predicted social isolation; being a student was a protective factor against social isolation (95% CI 0.26 to 0.62). In the comparisons of each item of the LSNS-6 by sociodemographic characteristics, men were more likely to have fewer people to talk to about their personal problems (95% CI −0.37 to −0.28) and to seek help from (95% CI −0.39 to −0.30), and the middle-aged group had a lower social network of friends. Additionally, social isolation was associated with decreased online interaction with familiar people (95% CI −1.28 to −1.13) and decreased optimistic thinking under mild lockdown (95% CI −0.97 to −0.86).ConclusionsWe identified the sociodemographic and psychological characteristics associated with social isolation under mild lockdown. These results are expected to be a useful resource for identifying which groups may require intervention to improve their social interactions in order to preserve their mental health during the pandemic.
Opening up the black box of a Gateway to Medicine programme: a realist evaluation
Authors: Gibson Smith Kathrine , Alexander Kirsty , Cleland Jennifer 
Published: July 2021

ObjectivesA Gateway to Medicine programme, developed in partnership between a further and higher education setting and implemented to increase the socioeconomic diversity of medicine, was examined to identify precisely what works within the programme and why.DesignThis study employed realist evaluation principles and was undertaken in three phases: document analysis and qualitative focus groups with widening access (WA) programme architects; focus groups and interviews with staff and students; generation of an idea of what works.SettingParticipants were recruited from a further/higher education setting and were either enrolled or involved in the delivery of a Gateway to Medicine programme.ParticipantsTwelve staff were interviewed either individually (n=3) or in one of three group interviews. Nine focus groups (ranging from 5 to 18 participants in each focus group) were carried out with Gateway students from three consecutive cohorts at 2–3 points in their Gateway programme year.ResultsData were generated to determine what ‘works’ in the Gateway programme. Turning a realist lens on the data identified six inter-relating mechanisms which helped students see medicine as attainable and achievable and prepared them for the transition to medical school. These were academic confidence (M1); developing professional identity (M2); financial support/security (M3); supportive relationships with staff (M4) and peers (M5); and establishing a sense of belonging as a university student (M6).ConclusionsBy unpacking the ‘black box’ of a Gateway programme through realist evaluation, we have shown that such programmes are not solely about providing knowledge and skills but are rather much more complex in respect to how they work. Further work is needed to further test the mechanisms identified in our study in other contexts for theory development and to identify predictors of effectiveness in terms of students’ preparedness to transition.
Gender disparity between authors in leading medical journals during the COVID-19 pandemic: a cross-sectional review
Authors: Misra Vaidehi , Safi Frozan , Brewerton Kathryn A , Wu Wei , Mason Robin , Chan An-Wen , Rochon Paula A , Lega Iliana C , Abdel-Qadir Husam 
Published: July 2021

ObjectivesEvaluate gender differences in authorship of COVID-19 articles in high-impact medical journals compared with other topics.DesignCross-sectional review.Data sourcesMedline database.Eligibility criteriaArticles published from 1 January to 31 December 2020 in the seven leading general medical journals by impact factor. Article types included primary research, reviews, editorials and commentaries.Data extractionKey data elements were whether the study topic was related to COVID-19 and names of the principal and the senior authors. A hierarchical approach was used to determine the likely gender of authors. Logistic regression assessed the association of study characteristics, including COVID-19 status, with authors’ likely gender; this was quantified using adjusted ORs (aORs).ResultsWe included 2252 articles, of which 748 (33.2%) were COVID-19-related and 1504 (66.8%) covered other topics. A likely gender was determined for 2138 (94.9%) principal authors and 1890 (83.9%) senior authors. Men were significantly more likely to be both principal (1364 men; 63.8%) and senior (1332 men; 70.5%) authors. COVID-19-related articles were not associated with the odds of men being principal (aOR 0.99; 95% CI 0.81 to 1.21; p=0.89) or senior authors (aOR 0.96; 95% CI 0.78 to 1.19; p=0.71) relative to other topics. Articles with men as senior authors were more likely to have men as principal authors (aOR 1.49; 95% CI 1.21 to 1.83; p<0.001). Men were more likely to author articles reporting original research and those with corresponding authors based outside the USA and Europe.ConclusionsWomen were substantially under-represented as authors among articles in leading medical journals; this was not significantly different for COVID-19-related articles. Study limitations include potential for misclassification bias due to the name-based analysis. Results suggest that barriers to women’s authorship in high-impact journals during COVID-19 are not significantly larger than barriers that preceded the pandemic and that are likely to continue beyond it.PROSPERO registration numberCRD42020186702.
Heart failure medication dosage and survival in women and men seen at outpatient clinics
Authors: Bots Sophie Heleen , Onland-Moret N Charlotte , Tulevski Igor I , van der Harst Pim , Cramer Maarten J M , Asselbergs Folkert W , Somsen G Aernout , den Ruijter Hester M 
Published: July 2021

ObjectiveWomen with heart failure with reduced ejection fraction (HFrEF) may reach optimal treatment effect at half of the guideline-recommended medication dose. This study investigates prescription practice and its relation with survival of patients with HF in daily care.MethodsElectronic health record data from 13 Dutch outpatient cardiology clinics were extracted for HF receiving at least one guideline-recommended HF medication. Dose changes over consecutive prescriptions were modelled using natural cubic splines. Inverse probability-weighted Cox regression was used to assess the relationship between dose (reference≥50% target dose) and all-cause mortality.ResultsThe study population comprised 561 women (29% HFrEF (ejection fraction (EF)<40%), 49% heart failure with preserved ejection fraction (EF≥50%); HFpEF and 615 men (47% and 25%, respectively). During a median follow-up of 3.7 years, 252 patients died (48% women; 167 HFrEF, 84 HFpEF). Nine hundred thirty-four patients (46% women) received ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 795 (48% women) beta blockers and 178 (42% women) mineralocorticoid receptor antagonists (MRAs). In both sexes, the mean target dose across prescriptions was 50% for ACEI/ARBs and beta blockers, and 100% for MRAs. ACEI/ARB dose of <50% was associated with lower mortality in women but not in men with HFrEF. This was not seen in patients with HFpEF. Beta-blocker dose was not associated with all-cause mortality.ConclusionPatients with HF seen in outpatient cardiology clinics receive half of the guideline-recommended medication dose. Lower ACEI/ARB dose was associated with improved survival in women with HFrEF. These results underscore the importance of (re)defining optimal medical therapy for women with HFrEF.
Aspirin versus P2Y12inhibitors with anticoagulation therapy for atrial fibrillation
Authors: Fukaya Hidehira , Ako Junya , Yasuda Satoshi , Kaikita Koichi , Akao Masaharu , Matoba Tetsuya , Nakamra Masato , Miyauchi Katsumi , Hagiwara Nobuhisa , Kimura Kazuo , Hirayama Atsushi , Matsui Kunihiko , Ogawa Hisao 
Published: July 2021

ObjectivePatients with coronary artery disease (CAD) and atrial fibrillation (AF) can be treated with multiple antithrombotic therapies including antiplatelet and anticoagulant therapies; however, this has the potential to increase bleeding risk. Here, we aimed to evaluate the efficacy and safety of P2Y12inhibitors and aspirin in patients also receiving anticoagulant therapy.MethodsWe evaluated patients from the Atrial Fibrillation and Ischaemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial who received rivaroxaban plus an antiplatelet agent; the choice of antiplatelet agent was left to the physician’s discretion. The primary efficacy and safety end points, consistent with those of the AFIRE trial, were compared between P2Y12inhibitors and aspirin groups. The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularisation or death from any cause. The primary safety end point was major bleeding according to the International Society on Thrombosis and Haemostasis criteria.ResultsA total of 1075 patients were included (P2Y12inhibitor group, n=297; aspirin group, n=778). Approximately 60% of patients were administered proton pump inhibitors (PPIs) and there was no significant difference in PPI use in the groups. There were no significant differences in the primary end points between the groups (efficacy: HR 1.31; 95% CI 0.88 to 1.94; p=0.178; safety: HR 0.79; 95% CI 0.43 to 1.47; p=0.456).ConclusionsThere were no significant differences in cardiovascular and bleeding events in patients with AF and stable CAD taking rivaroxaban with P2Y12inhibitors or aspirin in the chronic phase.Trial registration numberUMIN000016612;NCT02642419.
The Vertex-Edge Resolvability of Some Wheel-Related Graphs
Authors: Xing Bao-Hua , Sharma Sunny Kumar , Bhat Vijay Kumar , Raza Hassan , Liu Jia-Bao 
Published: July 2021

A vertex

w
∈
V

H

distinguishes (or resolves) two elements (edges or vertices)

a
,
z
∈
V

H

∪
E

H

if

d

w
,
a

≠
d

w
,
z

. A set

W

m

of vertices in a nontrivial connected graph

H

is said to be a mixed resolving set for

H

if every two different elements (edges and vertices) of

H

are distinguished by at least one vertex of

W

m

. The mixed resolving set with minimum cardinality in

H

is called the mixed metric dimension (vertex-edge resolvability) of

H

and denoted by

m
dim

H

. The aim of this research is to determine the mixed metric dimension of some wheel graph subdivisions. We specifically analyze and compare the mixed metric, edge metric, and metric dimensions of the graphs obtained after the wheel graphs’ spoke, cycle, and barycentric subdivisions. We also prove that the mixed resolving sets for some of these graphs are independent.
Association of Major Adverse Cardiovascular Events in Patients With Stroke and Cardiac Wall Motion Abnormalities
Authors: Kamran Saadat , Akhtar Naveed , Singh Rajvir , Imam Yahya , Haroon Khawaja H. , Amir Noman , Hussain Suhail , Al Jerdi Salman , Ojha Laxmi , Own Ahmed , Muhammad Ahmad , Perkins Jonathan D. 
Published: July 2021

Background
The association of cardiac wall motion abnormalities (CWMAs) in patients with stroke who have major adverse cardiovascular events (MACE) remains unclear. The purpose of this study was to estimate the 50‐month risk of MACE, including stroke recurrence, acute coronary events, and vascular death in patients with stroke who have CWMAs.

Methods and Results

We performed a retrospective analysis of prospectively collected acute stroke data (acute stroke and transient ischemic attack) over 50 months by electronic medical records. Data included demographic and clinical information, vascular imaging, and echocardiography data including CWMAs and MACE. Of a total of 2653 patients with acute stroke/transient ischemic attack, CWMA was observed in 355 (13.4%). In patients with CWMAs, the embolic stroke of undetermined source (50.7%) was the most frequent index stroke subtype and stroke recurrences (
P
=0.001). In multivariate Cox regression after adjustment for demographics, traditional risk, and confounding factors, CWMA was independently associated with a higher risk of MACE (adjusted hazard ratio [HR], 1.74; 95% CI, 1.37–2.21 [
P
=0.001]). Similarly, CWMA independently conferred an increased risk for ischemic stroke recurrence (adjusted HR, 1.50; 95% CI, 1.01–2.17 [
P
=0.04]), risk of acute coronary events (aHR, 2.50; 95% CI, 1.83–3.40 [
P
=0.001]) and vascular death (adjusted HR, 1.57; 95% CI, 1.04–2.40 [
P
=0.03]), in comparison to the patients with stroke without CWMA.

Conclusions
In a multiethnic cohort of ischemic stroke with CWMA, CWMA was associated with 1.7‐fold higher risks of MACE independent of established risk factors. Embolic stroke of undetermined source was the most common stroke association with CWMA. Patients with stroke should be screened for CWMA to identify those at higher risk of MACE.