bluuebunny/crossref_metadata_2025_split huggingface dataset:
Limitations to current methods to estimate cause of death: a validation study of a verbal autopsy model
Authors: Menéndez Clara , Quintó Llorenç , Castillo Paola , Carrilho Carla , Ismail Mamudo R. , Lorenzoni Cesaltina , Fernandes Fabiola , Hurtado Juan Carlos , Rakislova Natalia , Munguambe Khátia , Maixenchs Maria , Macete Eusebio , Mandomando Inacio , Martínez Miguel J , Bassat Quique , Alonso Pedro L , Ordi Jaume 
Published: May 2021

Background: Accurate information on causes of death (CoD) is essential to estimate burden of disease, track global progress, prioritize cost-effective interventions, and inform policies to reduce mortality. In low-income settings, where a significant proportion of deaths take place at home or in poorly-resourced peripheral health facilities, data on CoD often relies on verbal autopsies (VAs). Validations of VAs have been performed against clinical diagnosis, but never before against an acceptable gold standard: the complete diagnostic autopsy (CDA). Methods: We have validated a computer-coded verbal autopsy method –the InterVA- using individual and population metrics to determine CoD against the CDA, in 316 deceased patients of different age groups who died in a tertiary-level hospital in Maputo, Mozambique between 2013 and 2015. Results: We found a low agreement of the model across all age groups at the individual (kappa statistic ranging from -0.030 to 0.232, lowest in stillbirths and highest in adults) and population levels (chance-corrected cause-specific mortality fraction accuracy ranging from -1.00 to 0.62, lowest in stillbirths, highest in children). The sensitivity in identifying infectious diseases was low (0% for tuberculosis, diarrhea, and disseminated infections, 32% for HIV-related infections, 33% for malaria and 36% for pneumonia). Of maternal deaths, 26 were assigned to eclampsia but only four patients actually died of eclampsia. Conclusions: These findings do not lead to building confidence in current estimates of CoD. They also call to the need to implement autopsy methods where they may be feasible, and to improve the quality and performance of current VA techniques.
COVID-19 and vaccines in Africa: a descriptive and thematic analysis of Twitter content
Authors: Mwendwa Purity , Githui Simon , Marete Eunice , Kroll Thilo 
Published: May 2021

Introduction: As coronavirus disease 2019 (COVID-19) vaccines become available, it becomes important to understand public perceptions of the vaccines and implementation plans. The social media platform TwitterTM, which publicly shares information, serves as an important source of content related to COVID-19 vaccines. This study employed a qualitative descriptive design to examine content related to COVID-19 vaccines posted by Twitter users located in Africa. Methods: Data were collected from Twitter between the 11th and the 16th of December 2020 using the NCapture tool. We searched Twitter using the terms 'coronavirus', 'COVID-19 vaccine' and 'Africa' to identify the nature and content of tweets related to COVID-19 and vaccines shared by Twitter users from the African region. Descriptive statistics were used to describe the characteristics of Twitter accounts and thematic analysis helped determine, analyse, and clarify patterns of meaning (themes) emerging from the tweets. Results: The study found n=208 Twitter accounts, the majority (n=69; 33%) from South Africa and most (42%; n=87) from news agencies. The final dataset included n=212 tweets. The most used hashtag was #Covid19vaccine(s). Four themes were identified: i) capacity for vaccine production, ii) vaccine procurement, iii) vaccine logistics, and iv) perceived safety and efficacy of vaccines. The capacity of countries in Africa to manufacture a COVID-19 vaccine was deemed minimal and most tweets questioned Africa’s ability to procure vaccines based on the costs. Tweets also centred around the distribution of vaccines, storage and roll-out and the need to leverage existing solar-powered technologies to enhance the cold supply chain in Africa's remote locations. Questions about the safety and efficacy of vaccines developed in under one year were also raised. Conclusions: Concerns about vaccine procurement and readiness for distribution were dominant topics. These public concerns can be important in informing policymakers in preparation for the roll-out of vaccines in these contexts.
ИНКЛЮЗИВНЫЙ ПОДХОД В РАБОТЕ С ПОЖИЛЫМИ ЛЮДЬМИ. МОДЕЛИ ПРЕОДОЛЕНИЯ ГЕРОНТОЛОГИЧЕСКОГО ЭЙДЖИЗМА
Authors: Furiaeva Tatiana V. , Klimatckaia Liudmila G. , Furyaev Evgeny A. , Shpakou Andrei I. 
Published: May 2021

Цель. Выявить и проанализировать особенности инклюзивного подхода в интегрированной медико-социальной помощи пожилым людям в рамках концептуальных моделей преодоления геронтологического эйджизма в разных странах.
Результаты. Проанализированы результаты актуальных отечественных и зарубежных исследований по проблеме преодоления возрастной дискриминаци, выявлены пять концептуальных моделей социальной инклюзии (социально-экологическая, интеракционистская, ресурсно-потенциальная, модели социального пространства и социального участия), раскрыто их сущностное содержание и возможности применения в реальной социальной практике работы с пожилыми людьми.
Заключение. Инклюзивный подход при решении проблемы преодоления геронтологического эйджизма в работе с пожилыми людьми в разных странах находит свое отражение в наличии разнообразных концептуальных интегрированных моделей. Их выявление и анализ содержания свидетельствует об актуализации социально-политических и организационных задач по раскрытию, усилению личностного потенциала пожилых людей, по обеспечению доступности социальной и пространственной среды проживания. Полученные результаты компаративистского анализа свидетельствует о необходимости и возможности применения инклюзивного подхода в интегрированной медико-социальной помощи пожилым людям для улучшения качества их жизни.
Anatomical pelvic loading of a monoblock polyethylene acetabular component
Authors: Young Peter S. , Macarico Daniela T. , Silverwood Robert K. , Farhan-Alanie Omer M. , Mohammed Aslam , Periasamy Kumar , Nicol Alice , Meek R. M. Dominic 
Published: May 2021

Aims Uncemented metal acetabular components show good osseointegration, but material stiffness causes stress shielding and retroacetabular bone loss. Cemented monoblock polyethylene components load more physiologically; however, the cement bone interface can suffer fibrous encapsulation and loosening. It was hypothesized that an uncemented titanium-sintered monoblock polyethylene component may offer the optimum combination of osseointegration and anatomical loading. Methods A total of 38 patients were prospectively enrolled and received an uncemented monoblock polyethylene acetabular (pressfit) component. This single cohort was then retrospectively compared with previously reported randomized cohorts of cemented monoblock (cemented) and trabecular metal (trabecular) acetabular implants. The primary outcome measure was periprosthetic bone density using dual-energy x-ray absorptiometry over two years. Secondary outcomes included radiological and clinical analysis. Results Although there were differences in the number of males and females in each group, no significant sex bias was noted (p = 0.080). Furthermore, there was no significant difference in age (p = 0.910) or baseline lumbar bone mineral density (BMD) (p = 0.998) found between any of the groups (pressfit, cemented, or trabecular). The pressfit implant initially behaved like the trabecular component with an immediate fall in BMD in the inferior and medial regions, with preserved BMD laterally, suggesting lateral rim loading. However, the pressfit component subsequently showed a reversal in BMD medially with recovery back towards baseline, and a continued rise in lateral BMD. This would suggest that the pressfit component begins to reload the medial bone over time, more akin to the cemented component. Analysis of postoperative radiographs revealed no pressfit component subsidence or movement up to two years postoperatively (100% interobserver reliability). Medial defects seen immediately postoperatively in five cases had completely resolved by two years in four patients. Conclusion Initially, the uncemented monoblock component behaved similarly to the rigid trabecular metal component with lateral rim loading; however, over two years this changed to more closely resemble the loading pattern of a cemented polyethylene component with increasing medial pelvic loading. This indicates that the uncemented monoblock acetabular component may result in optimized fixation and preservation of retroacetabular bone stock. Cite this article: Bone Joint J 2021;103-B(5):872–880.
The impact of Charlson and Elixhauser comorbidities on patient outcomes following shoulder arthroplasty
Authors: Ling Daphne I. , Schneider Brandon , Ode Gabriella , Lai Emily Y. , Gulotta Lawrence V. 
Published: May 2021

Aims To investigate the impact of the Charlson and Elixhauser comorbidity indices on patient-reported outcomes measures (PROMs) following shoulder arthroplasty. Methods Patients undergoing total shoulder arthroplasty (TSA), reverse shoulder arthroplasty (RSA), or hemiarthroplasty (HA) from 2016 to 2018 were identified, along with the Charlson and Elixhauser comorbidities listed as their secondary diagnoses in the electronic medical records. Patients were matched to our institution’s registry to obtain their PROMs, including shoulder-specific (American Shoulder and Elbow Society (ASES) and Shoulder Activity Scale (SAS)) and general health scales (12-Item Short Form Survey (SF-12) and Patient-Reported Outcomes Measurement Information System-Pain Interference). Linear regression models adjusting for age and sex were used to evaluate the association between increasing number of comorbidities and PROM scores. A total of 1,817 shoulder arthroplasties were performed: 1,017 (56%) TSA, 726 (40%) RSA, and 74 (4%) HA. The mean age was 67 years (SD 10), and 936 (52%) of the patients were female. Results The most common comorbidities were obesity (1,256, 69%) and hypertension (990, 55%). Patients with more comorbidities had lower ASES and SAS scores at baseline (p < 0.001). Elixhauser comorbidities continued to negatively impact ASES and SAS scores at one year (p = 0.002) and two-year follow-up (p = 0.002). Patients with more comorbidities reported greater pain interference on PROMIS at baseline (p = 0.007), but not at two years. Higher number of Charlson comorbidities were associated with lower scores on the SF-12 mental component at baseline (p < 0.001) and two years (p = 0.020). Higher number of Elixhauser comorbidities were associated with lower SF-12 physical component scores at baseline (p < 0.001) and two years (p = 0.004). Conclusion Higher number of comorbidities was associated with lower baseline scores and worse outcomes on both shoulder-specific and general health PROMs. The presence of specific comorbidities may be used during shared decision-making to manage expectations for patients undergoing shoulder arthroplasty. Cite this article: Bone Joint J 2021;103-B(5):964–970.
Tübingen hip flexion splint more successful than Pavlik harness for decentred hips after the age of three months
Authors: Lyu XueMin , Chen Tao , Yang Zheng , Fu Gang , Feng Chao , Zhang Tao , Lu Ming 
Published: May 2021

Aims The objective of this study was to evaluate the clinical and radiological outcomes of patients younger than six months of age with developmental dysplasia of the hip (DDH) managed by either a Pavlik harness or Tübingen hip flexion splint. Methods Records of 251 consecutive infants with a mean age of 89 days (SD 47), diagnosed with DDH between January 2015 and December 2018, were retrospectively reviewed. Inclusion criteria for patients with DDH were: younger than 180 days at the time of diagnosis; ultrasound Graf classification of IIc or greater; treatment by Pavlik harness or Tübingen splint; and no prior treatment history. All patients underwent hip ultrasound every seven days during the first three weeks of treatment and subsequently every three to four weeks until completion of treatment. If no signs of improvement were found after three weeks, the Pavlik harness or Tübingen splint was discontinued. Statistical analysis was performed. Results The study included 251 patients with Graf grades IIc to IV in 18 males and 233 females with DDH. Mean follow-up time was 22 months (SD 10). A total of 116 hips were graded as Graf IIc (39.1%), nine as grade D (3.0%), 100 as grade III (33.7%), and 72 as grade IV (24.2%). There were 109 patients (128 hips) in the Pavlik group and 142 patients (169 hips) in the Tübingen group (p = 0.227). The Tübingen group showed a 69.8% success rate in Graf III and Graf IV hips while the success rate was significantly lower in the Pavlik group, 53.9% (p = 0.033). For infants older than three months of age, the Tübingen group showed a 71.4% success rate, and the Pavlik group a 54.4% success rate (p = 0.047). Conclusion The Tübingen splint should be the preferred treatment option for children older than three months, and for those with severe forms of DDH such as Graf grade III and IV, who are younger than six months at time of diagnosis. The Tübingen hip flexion splint is a valid alternative to the Pavlik harness for older infants and those with more severe DDH. Cite this article: Bone Joint J 2021;103-B(5):991–998.
Spectrum allocation scheme considering spectrum slicing in elastic optical networks
Authors: Kitsuwan Nattapong , Akaki Kaito , Pavarangkoon Praphan , Nag Avishek 
Published: May 2021

Recent advances in physical layer optics have made slicing of optical bands into multiple subbands with different bandwidths possible. Due to this development, spectrum allocation has become easier in elastic optical networks (EONs). More specifically, owing to the slicing technology, the defragmentation problem in EONs can be addressed easily, i.e., more demands can be fit into empty spectrum slots by breaking the demands as needed using the slicing technology. This paper proposes a spectrum allocation scheme considering the slicing process at any nodes, e.g., source node and intermediate nodes, in EONs. Slicing-and-stitching technology is applied to break the contiguous-spectrum constraint in an EON so that spectrum fragmentation is reduced. While slicing a demand from one node to another, the following questions must be answered: (1) Which parts of the spectrum band should be sliced? (2) In which node(s) along the path of a demand should the slicings be done to reduce the bandwidth blocking rate? To answer the above questions, we formulate a mixed-integer linear programming (MILP) model that jointly addresses the above questions as well as minimizes the total number of slicers in a network. To measure the performance of the MILP, we used the bandwidth blocking ratio (BBR) of the network as a performance metric. Our results from the MILP show that introducing slicing at every node in the network improves the BBR by as much as 68% compared to a conventional case where slicing a demand is allowed only at the source node.
Widely tunable silicon Raman laser
Authors: Ahmadi Mohammad , Shi Wei , LaRochelle Sophie 
Published: May 2021

Stimulated Raman scattering is an effective means of wavelength conversion and can largely extend the operating spectral range of an optical source. We demonstrate a high-performance tunable Raman laser on a sub-micrometer-thick silicon on insulator wafer using a standard foundry process. The key feature to this laser is the use of a tunable coupling mechanism to adjust both pump and signal coupling coefficients in the ring cavity, allowing demonstration of laser emission over a large wavelength tuning range of 83 nm. This Raman laser demonstrates efficient (slope of up to 26% and a maximum pump-to-signal power conversion efficiency of 10%) on-chip nonlinear wavelength conversion. Our results indicate great promise for substantially increasing the optical spectral resources available on a silicon chip.
Assessing selection procedures and roles of Community Health Volunteers and Community Health Management Committees in Ghana’s Community-based Health Planning and Services program
Authors: Sakeah Evelyn , Aborigo Raymond Akawire , Debpuur Cornelius , Nonterah Engelbert A. , Oduro Abraham Rexford , Awoonor-Williams John Koku 
Published: May 2021

Background
Community participation in health care delivery will ensure service availability and accessibility and guarantee community ownership of the program. Community-based strategies such as the involvement of Community Health Volunteers (CHVs) and Community Health Management Committees (CHMCs) are likely to advance primary healthcare in general, but the criteria for selecting CHVs, CHMCs and efforts to sustain these roles are not clear 20 years after implementing the Community-based Health Planning Services program. We examined the process of selecting these cadres of community health workers and their current role within Ghana’s flagship program for primary care–the Community-based Health Planning and Services program.

Methods
This was an exploratory study design using qualitative methods to appraise the health system and stakeholder participation in Community-based Health Planning and Services program implementation in the Upper East region of Ghana. We conducted 51 in-depth interviews and 33 focus group discussions with health professionals and community members.

Results
Community Health Volunteers and Community Health Management Committees are the representatives of the community in the routine implementation of the Community-based Health Planning and Services program. They are selected, appointed, or nominated by their communities. Some inherit the position through apprenticeship and others are recruited through advertisement. The selection is mostly initiated by the health providers and carried out by community members. Community Health Volunteers lead community mobilization efforts, support health providers in health promotion activities, manage minor illnesses, and encourage pregnant women to use maternal health services. Community Health Volunteers also translate health messages delivered by health providers to the people in their local languages. Community Health Management Committees mobilize resources for the development of Community-based Health Planning and Services program compounds. They play a mediatory role between health providers in the health compounds and the community members. Volunteers are sometimes given non-financial incentives but there are suggestions to include financial incentives.

Conclusion
Community Health Volunteers and Community Health Management Committees play a critical role in primary health care. The criteria for selecting Community Health Volunteers and Community Health Management Committees vary but need to be standardized to ensure that only self-motivated individuals are selected. Thus, CHVs and CHMCs should contest for their positions and be endorsed by their community members and assigned roles by health professionals in the CHPS zones. Efforts to sustain them within the health system should include the provision of financial incentives.
Mobile-phone-based e-diary derived patient reported outcomes: Association with clinical disease activity, psychological status and quality of life of patients with multiple sclerosis
Authors: Golan Daniel , Sagiv Smadar , Glass-Marmor Lea , Miller Ariel 
Published: May 2021

Background
The applicability of mobile digital technology to promote clinical care of people with multiple sclerosis (pwMS) is gaining increased interest as part of the implementation of patient-centered approaches. We aimed at assessing adherence to a smartphone-based e-diary, which was designed to collect patient-reported outcomes (PROs). Secondary objectives were to evaluate the construct and predictive validity of e-diary derived PROs and to explore the various factors that were associated with changes in PROs over time.

Materials and methods
In this observational cohort study patients downloaded an MS tailored e-diary into their personal smartphones. Report of PROs was enquired once monthly for a period of one year through a smartphone-based application, using previously validated tools. An e-diary derived bodily function summary score (eBF) was defined as the sum of scores depicting vision, limbs function, pain, bowl/ bladder dysfunction, pseudobulbar affect and spasticity. Multiple linear regression and analysis of covariance were used to determine the association between PROs, clinician-reported outcomes (ClinROs) of disease activity and quality of life (QoL). Regression coefficient analysis was used to compare the slope of change in eBF before and after a relapse.

Results
97 pwMS downloaded the e-diary [Female: 64 (66%), EDSS 3.4±2.1]. 76 patients (78%) completed the 12-month study period. 53 patients (55%) submitted ≥75% of requested surveys. Anxiety was negatively associated with adherence to periodic PROs assessments by the e-diary. E-diary derived PROs were significantly correlated with corresponding functional system scores (0.38< r <0.8, P<0.001). eBF score significantly predicted QoL (β = -0.36, P = 0.001) while EDSS did not. Change in eBF score over time was independently associated with the occurrence of an MS relapse (F = 4.4, P = 0.04), anxiety (F = 6.4, P = 0.01) and depression (F = 5.1, P = 0.03). Individual regression slopes of eBF scores were significantly higher pre-relapse than post-relapse (3.0±3.3 vs. -0.8±2.0, P = 0.007).

Conclusion
Adherence of pwMS to recording in an e-diary collecting PROs was high. Changes in e-diary derived PROs over time predict clinical MS relapses on the group level and thus carry the potential of usage in clinical research as well as for improved MS care in real world setting.
How does reorganisation in child and adolescent mental health services affect access to services? An observational study of two services in England
Authors: Fazel Mina , Rocks Stephen , Glogowska Margaret , Stepney Melissa , Tsiachristas Apostolos 
Published: May 2021

Background
Child and Adolescent Mental Health Services (CAMHS) in England are making significant changes to improve access and effectiveness. This ‘transformation’ variously involves easier access to services through a Single Point of Access (SPA), more integrated services within CAMHS and enhanced co-provision across education and third sector or non-profit organisations.

Methods
A mixed-methods observational study was conducted to explore the process and impact of transformation over four years in two services. Ethnographic observations and in-depth interviews were conducted and Electronic Patient Records with over one million contacts analysed. Difference-in-differences analysis with propensity score matching to estimate the causal impact of the transformation on patient access was utilised.

Outcomes
Spend and staffing increased across both CAMHS. The SPA had growing rates of self-referral and new care pathways were seeing patients according to expected degree of psychopathology. Third sector partners were providing increasing numbers of low-intensity interventions. Although the majority of staff were supportive of the changes, the process of transformation led to service tensions.
In the first year after transformation there was no change in the rate of new patients accessing services or new spells (episodes of care) in the services. However, by year three, the number of new patients accessing CAMHS was 19% higher (Incidence Rate Ratio: 1·19, CI: 1·16, 1·21) and the rate of new spells was 12% higher (Incidence Rate Ratio: 1·12, CI: 1·05, 1·20).

Interpretation
Transformation investment, both financial and intellectual, can help to increase access to CAMHS in England, but time is needed to realise the benefits of reorganisation.