bluuebunny/crossref_metadata_2025_split huggingface dataset:
An evaluation of service user experience, clinical outcomes and service use associated with urgent care services that utilise telephone-based digital triage: a systematic review protocol
Authors: Sexton Vanashree , Dale Jeremy , Atherton Helen 
Published: January 2021

Abstract
Background
Telephone-based digital triage is widely used by services that provide urgent care. This involves a call handler or clinician using a digital triage tool to generate algorithm-based care advice, based on a patient’s symptoms. Advice typically takes the form of signposting within defined levels of urgency to specific services or self-care advice. Despite wide adoption, there is limited evaluation of its impact on service user experience, service use and clinical outcomes; no previous systematic reviews have focussed on services that utilise digital triage, and its impact on these outcome areas within urgent care. This review aims to address this need, particularly now that telephone-based digital triage is well established in healthcare delivery.

Methods
Studies assessing the impact of telephone-based digital triage on service user experience, health care service use and clinical outcomes will be identified through searches conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus. Search terms using words relating to digital triage and urgent care settings (excluding in-hours general practice) will be used. The review will include all original study types including qualitative, quantitative and mixed methods studies; studies published in the last 20 years and studies published in English. Quality assessment of studies will be conducted using the Mixed Methods Appraisal Tool (MMAT); a narrative synthesis approach will be used to analyse and summarise findings.

Discussion
This is the first systematic review to evaluate service user experience, service use and clinical outcomes related to the use of telephone-based digital triage in urgent care settings. It will evaluate evidence from studies of wide-ranging designs. The narrative synthesis approach will enable the integration of findings to provide new insights on service delivery. Models of urgent care continue to evolve rapidly, with the emergence of self-triage tools and national help lines. Findings from this review will be presented in a practical format that can feed into the design of digital triage tools, future service design and healthcare policy.

Systematic review registration
This systematic review is registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO 2020 CRD42020178500).
On zeros and growth of solutions of complex difference equations
Authors: Chen Min-Feng , Cui Ning 
Published: January 2021

AbstractLet f be an entire function of finite order, let $n\geq 1$
n
≥
1
, $m\geq 1$
m
≥
1
, $L(z,f)\not \equiv 0$
L
(
z
,
f
)
≢
0
be a linear difference polynomial of f with small meromorphic coefficients, and $P_{d}(z,f)\not \equiv 0$

P
d

(
z
,
f
)
≢
0
be a difference polynomial in f of degree $d\leq n-1$
d
≤
n
−
1
with small meromorphic coefficients. We consider the growth and zeros of $f^{n}(z)L^{m}(z,f)+P_{d}(z,f)$

f
n

(
z
)

L
m

(
z
,
f
)
+

P
d

(
z
,
f
)
. And some counterexamples are given to show that Theorem 3.1 proved by I. Laine (J. Math. Anal. Appl. 469:808–826, 2019) is not valid. In addition, we study meromorphic solutions to the difference equation of type $f^{n}(z)+P_{d}(z,f)=p_{1}e^{\alpha _{1}z}+p_{2}e^{\alpha _{2}z}$

f
n

(
z
)
+

P
d

(
z
,
f
)
=

p
1

e

α
1

z

+

p
2

e

α
2

z

, where $n\geq 2$
n
≥
2
, $P_{d}(z,f)\not \equiv 0$

P
d

(
z
,
f
)
≢
0
is a difference polynomial in f of degree $d\leq n-2$
d
≤
n
−
2
with small mromorphic coefficients, $p_{i}$

p
i

, $\alpha _{i}$

α
i

($i=1,2$
i
=
1
,
2
) are nonzero constants such that $\alpha _{1}\neq \alpha _{2}$

α
1

≠

α
2

. Our results are improvements and complements of Laine 2019, Latreuch 2017, Liu and Mao 2018.
Psychological distress, self-harm and attempted suicide in UK 17-year olds: prevalence and sociodemographic inequalities
Authors: Patalay Praveetha , Fitzsimons Emla 
Published: January 2021

SummaryIn a large (n = 10 103), nationally representative sample of 17-year-olds 16.1% had experienced high psychological distress in the past 30 days, 24.1% had self-harmed in the previous 12 months and 7.4% had ever attempted suicide. Females, White adolescents, sexual minorities and those from more socioeconomically disadvantaged families had worse mental health outcomes; with the exceptions of no detected differences in attempted suicide by ethnicity and in self-harm by socioeconomic position. Findings include a narrower gender gap in self-harm at age 17 (males 20.1%, females 28.2%) compared with at age 14 (males 8.5%; females 22.8%) and 2–4 times higher prevalence in sexual minority adolescents (39.3% high distress, 55.8% self-harmed, 21.7% attempted suicide compared with 13.4%, 20.5% and 5.8%, respectively, in heterosexual adolescents).
Artificial Intelligence Clinical Evidence Engine for Automatic Identification, Prioritization, and Extraction of Relevant Clinical Oncology Research
Authors: Saiz Fernando Suarez , Sanders Corey , Stevens Rick , Nielsen Robert , Britt Michael , Yuravlivker Leemor , Preininger Anita M. , Jackson Gretchen P. 
Published: January 2021

PURPOSE We developed a system to automate analysis of the clinical oncology scientific literature from bibliographic databases and match articles to specific patient cohorts to answer specific questions regarding the efficacy of a treatment. The approach attempts to replicate a clinician’s mental processes when reviewing published literature in the context of a patient case. We describe the system and evaluate its performance. METHODS We developed separate ground truth data sets for each of the tasks described in the paper. The first ground truth was used to measure the natural language processing (NLP) accuracy from approximately 1,300 papers covering approximately 3,100 statements and approximately 25 concepts; performance was evaluated using a standard F1 score. The ground truth for the expert classifier model was generated by dividing papers cited in clinical guidelines into a training set and a test set in an 80:20 ratio, and performance was evaluated for accuracy, sensitivity, and specificity. RESULTS The NLP models were able to identify individual attributes with a 0.7-0.9 F1 score, depending on the attribute of interest. The expert classifier machine learning model was able to classify the individual records with a 0.93 accuracy (95% CI, 0.9 to 0.96, P < .0001), and sensitivity and specificity of 0.95 and 0.91, respectively. Using a decision boundary of 0.5 for the positive (expert) label, the classifier demonstrated an F1 score of 0.92. CONCLUSION The system identified and extracted evidence from the oncology literature with a high degree of accuracy, sensitivity, and specificity. This tool enables timely access to the most relevant biomedical literature, providing critical support to evidence-based practice in areas of rapidly evolving science.
Characteristics of Advance Care Planning in Patients With Cancer Referred to Palliative Care
Authors: Berkowitz Callie M. , Wolf Steven P. , Troy Jesse , Kamal Arif H. 
Published: January 2021

PURPOSE: Advance care planning (ACP) is a process in which patients share their values, goals, and preferences regarding future medical care. ACP can improve care quality, yet may be challenging to address for patients with cancer. We sought to characterize key components of ACP in patients with cancer as compared with patients with noncancer serious illness referred to palliative care (PC). METHODS: We performed a retrospective cross-sectional analysis of initial outpatient PC visits from the Quality Data Collection Tool for PC database from 2015 to 2019. Quality Data Collection Tool is a web-based point-of-care specialty PC registry to track quality metrics. RESULTS: We analyzed 1,604 patients with cancer and 1,094 patients without cancer: 44% of patients were female, 87% were White, and 98% were non-Hispanic. The average age was 72.2 years (standard deviation [SD] 15.4). Patients with cancer were on average younger than patients without cancer (66.5 [SD: 13.9] v 80.5 [SD: 13.8]) and had a higher Palliative Performance Scale (PPS) (59.5 [SD: 22.4] v 33.4 [SD: 25.1]). In our unadjusted comparison, patients with cancer were less likely to be DNR/DNI (37% v 53%; P < .0001) and less likely to have an advance directive (53% v 73%; < .0001); rates of healthcare proxy identification were similar (92.8% v 94.5%; P = .10). These differences did not persist when we accounted for age, race, sex, and PPS, with age being the primary explanatory factor. CONCLUSION: Despite having serious illness meriting PC referral, many patients with cancer in our study lacked advance directives. This highlights both the important role of oncologists in facilitating ACP and the utility of PC playing a complementary role.
E2F1 regulates testicular descent and controls spermatogenesis by influencing WNT4 signaling
Authors: Jorgez Carolina J. , Seth Abhishek , Wilken Nathan , Bournat Juan C. , Chen Ching H. , Lamb Dolores J. 
Published: January 2021

ABSTRACT
Cryptorchidism is the most common urologic birth defect in men and is a predisposing factor of male infertility and testicular cancer, yet the etiology remains largely unknown. E2F1 microdeletions and microduplications contribute to cryptorchidism, infertility and testicular tumors. Although E2f1 deletion or overexpression in mice causes spermatogenic failure, the mechanism by which E2f1 influences testicular function is unknown. This investigation revealed that E2f1-null mice develop cryptorchidism with severe gubernacular defects and progressive loss of germ cells resulting in infertility and, in rare cases, testicular tumors. It was hypothesized that germ cell depletion resulted from an increase in WNT4 levels. To test this hypothesis, the phenotype of a double-null mouse model lacking both Wnt4 and E2f1 in germ cells was analyzed. Double-null mice are fertile. This finding indicates that germ cell maintenance is dependent on E2f1 repression of Wnt4, supporting a role for Wnt4 in germ cell survival. In the future, modulation of WNT4 expression in men with cryptorchidism and spermatogenic failure due to E2F1 copy number variations may provide a novel approach to improve their spermatogenesis and perhaps their fertility potential after orchidopexy.
Exercise Reduces Medication for Metabolic Syndrome Management: A 5-Year Follow-up Study
Authors: MORALES-PALOMO FELIX , MORENO-CABAÑAS ALFONSO , RAMIREZ-JIMENEZ MIGUEL , ALVAREZ-JIMENEZ LAURA , VALENZUELA PEDRO L. , LUCIA ALEJANDRO , ORTEGA JUAN F. , MORA-RODRIGUEZ RICARDO 
Published: January 2021

ABSTRACT

Purpose
This study aimed to determine the effects of a 5-yr exercise intervention on metabolic syndrome (MetS) and health-related variables and medication use for MetS management.

Methods
Participants were randomly assigned to an exercise intervention (n = 25, 54 ± 2 yr, 20% women) or control group (n = 26, 54 ± 2 yr, 38% women). The intervention lasted 4 months per year and consisted of high-intensity interval training on a cycloergometer thrice a week. Outcomes were MetS z-score and medication use score, MetS-related variables (including blood pressure, blood glucose homeostasis, and lipid profile), and cardiorespiratory fitness (CRF, as determined by maximal oxygen uptake).

Results
MetS z-score was similarly reduced over time in both groups (P = 0.244 for group–time interaction). A quasi-significant and significant group–time interaction was found for MetS number of factors (P = 0.004) and CRF (P < 0.001), respectively. Thus, MetS factors tended to decrease over time only in the exercise group with no change in the control group, whereas CRF increased from baseline to 5-yr assessment in the exercise group (by 1.1 MET, P < 0.001) but decreased in the control group (−0.5 MET, P = 0.025). Medicine use score increased twofold from baseline to 5-yr follow-up in the control group (P < 0.001) but did not significantly change (10%, P = 0.52) in the exercise group (P < 0.001 for group–time interaction). The proportion of medicated patients who had to increase antihypertensive (P < 0.001), glucose-lowering (P = 0.036), or total medication (P < 0.0001) over the 5-yr period was lower in the exercise than that in the control group.

Conclusions
Exercise training can attenuate the increase in medication that would be otherwise required to manage MetS over a 5-yr period.
Effects of Exercise Mode on Postprandial Metabolism in Humans with Chronic Paraplegia
Authors: MCMILLAN DAVID W. , MAHER JENNIFER L. , JACOBS KEVIN A. , MENDEZ ARMANDO J. , NASH MARK S. , BILZON JAMES L. J. 
Published: January 2021

ABSTRACT

Purpose
The purpose of this study was to assess the acute effects of exercise mode and intensity on postprandial macronutrient metabolism.

Methods
Ten healthy men age 39 ± 10 yr with chronic paraplegia (13.2 ± 8.8 yr, ASIA A–C) completed three isocaloric bouts of upper-body exercise and a resting control. After an overnight fast, participants completed circuit resistance exercise (CRE) first and the following conditions in a randomized order, separated by >48 h: i) control (CON), ~45-min seated rest; ii) moderate-intensity continuous exercise (MICE), ~40-min arm cranking at a resistance equivalent to ~30% peak power output (PPO); and iii) high-intensity interval exercise (HIIE), ~30 min arm cranking with resistance alternating every 2 min between 10% PPO and 70% PPO. After each condition, participants completed a mixed-meal tolerance test consisting of a 2510-kJ liquid meal (35% fat, 50% carbohydrate, 15% protein). Blood and expired gas samples were collected at baseline and regular intervals for 150 min after a meal.

Results
An interaction (P < 0.001) was observed, with rates of lipid oxidation elevated above CON in HIIE until 60 min after a meal and in CRE at all postprandial time points up to 150 min after a meal. Postprandial blood glycerol was greater in MICE (P = 0.020) and CRE (P = 0.001) compared with CON. Furthermore, nonesterified fatty acid area under the curve had a moderate-to-strong effect in CRE versus MICE and HIIE (Cohen’s d = −0.76 and −0.50, respectively).

Conclusions
In persons with paraplegia, high-intensity exercise increased postprandial energy expenditure independent of the energy cost of exercise. Furthermore, exercise combining resistance and endurance modes (CRE) showed the greater effect on postprandial lipid oxidation.
Evaluating the sensitivity, specificity and clinical utility of algorithms of spatial variation in sub-epidermal moisture (SEM) for the diagnosis of deep and early-stage pressure-induced tissue damage
Authors: Gershon Steve , Okonkwo Henry 
Published: January 2021

Background: Sub-epidermal moisture (SEM) is a measurable biomarker detecting early pressure damage in order to objectively support current ‘gold standard’ skin tissue assessments (STA) for the detection of deep and early-stage pressure-induced injuries or ulcers (PI/PUs). Objective: A multi-site, dual arm, cross sectional, retrospective study was conducted to evaluate the sensitivity, specificity and clinical utility of spatial variation in SEM readings between healthy and damaged skin tissue. Method: The study enrolled 175 subjects: 125 with confirmed PI/PUs or suspected deep tissue injury (sDTI), and 50 confirmed healthy subjects. Expert principal investigators and PI/PU healthcare practitioners (HCPs) evaluating all subjects were trained in SEM measurements but blinded to clinical interpretation of SEM readings. Sequential and spatial SEM readings of the sacrum and heels, subjects' demographic data, STAs, risk assessment tool scores (RATS), pain assessment and potential confounders were recorded. Independent statistical analyses were performed. Results: Mean spatial SEM measures within subjects with healthy tissue and within subjects with damaged tissue were statistically similar. Mean spatial SEM measures within anatomies of subjects with damaged tissue were significantly different (p<0.05). There was no significant difference between spatial readings in healthy subjects. Algorithms computing a range of SEM delta thresholds indicated a sensitivity of 82–87% and a specificity of 51–88% at an SEM delta ≥0.6. Receiver operating characteristic (ROC) curves computed areas under the curve (AUC) of 0.7809–0.9181 (95% CI: 0.7221–0.8817, 0.8397–0.9545, p<0.0001) exceeding clinical judgement. Conclusion: These SEM data augment clinical decision-making for developing intact skin PI/PUs including sDTIs and Stage I PI/PUs. Informing HCPs of this subclinical, non-visible skin and tissue damage and providing opportunities for alternative PI/PU care pathways is an exciting prospect.
Positron emission tomography study of effects of two pressure-relieving support surfaces on pressure ulcer development
Authors: Soppi Esa , Knuuti Juhani , Kalliokoski Kari 
Published: January 2021

Objective: To study the pathophysiological cascade of pressure ulcer (PU) development consisting of tissue deformation, inflammation and hypoxia. Method: In this crossover study, deformation was measured with computerised tomography (CT) linked with contact area reflecting immersion and envelopment. Inflammation and hypoxia were measured using subepidermal moisture (SEM), skin temperature and tissue perfusion with positron emission tomography. These variables were investigated under 90 minutes of pressure exposure caused by two functionally different support surfaces—a regular foam mattress and a minimum pressure air (MPA) mattress. Results: A total of eight healthy volunteers took part in the study. There was major tissue deformation when the participants lay on a foam mattress while the tissues retained their original shape on the MPA mattress (p<0.0001). During the pressure exposure, the skin temperature increased significantly on both support surfaces but the final temperature on the foam mattress was about 1oC higher than on the MPA mattress (p<0.0001). SEM increased on both support surfaces compared with an unexposed reference site, but the cause may be different between the two support surfaces. Tissue perfusion was lowest in the skin followed by subcutaneous tissues and highest in the muscles. The pressure exposure did not cause any substantial changes in perfusion. The results showed that tissue deformation was more pronounced, the support surface contact area (envelopment), was smaller and the skin temperature higher on the foam mattress than on the MPA mattress, without significant differences in tissue perfusion. Conclusion: In this study, the MPA mattress support surface had mechanobiological properties that counteracted tissue deformation and thereby may prevent PUs.
Numerical modelings of ultrashort pulse propagation and conical emission in multimode optical fibers
Authors: Tarnowski Karol , Majchrowska Sylwia , Béjot Pierre , Kibler Bertrand 
Published: January 2021

We make use of two well-known numerical approaches of nonlinear pulse propagation, namely, the unidirectional pulse propagation equation and the multimode generalized nonlinear Schrödinger equation, to provide a detailed comparison of ultrashort pulse propagation and possible conical emission in the context of multimode optical fibers. We confirm the strong impact of the frequency dispersion of the nonlinear response on pulse splitting and supercontinuum dynamics in the femtosecond regime for pumping powers around the critical self-focusing threshold. Our results also confirm that the modal distribution of optical fibers provides a discretization of conical emission of the corresponding bulk medium (i.e., here fused silica). This study also provides some criteria for the use of numerical models, and it paves the way for future nonlinear experiments in commercially available optical fibers.
An extended lidar-based cirrus cloud retrieval scheme: first application over an Arctic site
Authors: Nakoudi Konstantina , Stachlewska Iwona S. , Ritter Christoph 
Published: January 2021

Accurate and precise characterization of cirrus cloud geometrical and optical properties is essential for better constraining their radiative footprint. A lidar-based retrieval scheme is proposed here, with its performance assessed on fine spatio-temporal observations over the Arctic site of Ny-Ålesund, Svalbard. Two contributions related to cirrus geometrical (dynamic Wavelet Covariance Transform (WCT)) and optical properties (constrained Klett) are reported. The dynamic WCT rendered cirrus detection more robust, especially for thin cirrus layers that frequently remained undetected by the classical WCT method. Regarding optical characterization, we developed an iterative scheme for determining the cirrus lidar ratio (LR
ci
) that is a crucial parameter for aerosol - cloud discrimination. Building upon the Klett-Fernald method, the LR
ci
was constrained by an additional reference value. In established methods, such as the double-ended Klett, an aerosol-free reference value is applied. In the proposed constrained Klett, however, the reference value was approximated from cloud-free or low cloud optical depth (COD up to 0.2) profiles and proved to agree with independent Raman estimates. For optically thin cirrus, the constrained Klett inherent uncertainties reached 50% (60-74%) in terms of COD (LR
ci
). However, for opaque cirrus COD (LR
ci
) uncertainties were lower than 10% (15%). The detection method discrepancies (dynamic versus static WCT) had a higher impact on the optical properties of low COD layers (up to 90%) compared to optically thicker ones (less than 10%). The constrained Klett presented high agreement with two established retrievals. For an exemplary cirrus cloud, the constrained Klett estimated the COD355 (

L

R

c
i

355

) at 0.28 ± 0.17 (29 ± 4 sr), the double-ended Klett at 0.27 ± 0.15 (32 ± 4 sr) and the Raman retrievals at 0.22 ± 0.12 (26 ± 11 sr). Our approach to determine the necessary reference value can also be applied in established methods and increase their accuracy. In contrast, the classical aerosol-free assumption led to 44 sr LR
ci
overestimation in optically thin layers and 2-8 sr in thicker ones. The multiple scattering effect was corrected using Eloranta (1998) and accounted for 50-60% extinction underestimation near the cloud base and 20-30% within the cirrus layers.
µJ-level multi-cycle terahertz generation in a periodically poled Rb:KTP crystal
Authors: Tian Wenlong , Cirmi Giovanni , Olgun Halil T. , Mutter Patrick , Canalias Carlota , Zukauskas Andrius , Wang Lu , Kueny Elias , Ahr Frederike , Calendron Anne-Laure , Reichert Fabian , Hasse Kore , Hua Yi , Schimpf Damian N. , Çankaya Hüseyin , Pergament Mikhail , Hemmer Michael , Matlis Nicholas , Pasiskevicius Valdas , Laurell Fredrik , Kärtner Franz X. 
Published: January 2021

We demonstrate multi-cycle terahertz (MC-THz) generation in a 15.5 mm long periodically poled rubidium (Rb)-doped potassium titanyl phosphate (Rb:PPKTP) crystal with a poling period of 300 µm. By cryogenically cooling the crystal to 77 K, up to 0.72 µJ terahertz energy is obtained at a frequency of 0.5 THz with a 3 GHz bandwidth. A maximum internal optical-to-terahertz conversion efficiency of 0.16% is achieved, which is comparable with results achieved using periodically poled lithium niobate crystal. Neither photorefractive effects nor damage was observed with up to

900

m
J

/

c
m

2

, showing the great potential of Rb:PPKTP for multi-millijoule-level MC-THz generation.