bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of seven different paediatric early warning scores to predict critical care admission in febrile children presenting to the emergency department: a retrospective cohort study
Authors: Romaine Sam T , Sefton Gerri , Lim Emma , Nijman Ruud G , Bernatoniene Jolanta , Clark Simon , Schlapbach Luregn J , Pallmann Philip , Carrol Enitan D 
Published: May 2021

ObjectivePaediatric Early Warning Scores (PEWS) are widely used in the UK, but the heterogeneity across tools and the limited data on their predictive performance represent obstacles to improving best practice. The standardisation of practice through the proposed National PEWS will rely on robust validation. Therefore, we compared the performance of the National PEWS with six other PEWS currently used in NHS hospitals, for their ability to predict critical care (CC) admission in febrile children attending the emergency department (ED).DesignRetrospective single-centre cohort study.SettingTertiary hospital paediatric ED.ParticipantsA total of 11 449 eligible febrile ED attendances were identified from the electronic patient record over a 2-year period. Seven PEWS scores were calculated (Alder Hey, Bedside, Bristol, National, Newcastle and Scotland PEWS, and the Paediatric Observation Priority Score, using the worst observations recorded during their ED stay.OutcomesThe primary outcome was CC admission within 48 hours, the secondary outcomes were hospital length of stay (LOS) >48 hours and sepsis-related mortality.ResultsOf 11 449 febrile children, 134 (1.2%) were admitted to CC within 48 hours of ED presentation, 606 (5.3%) had a hospital LOS >48 hours. 10 (0.09%) children died, 5 (0.04%) were sepsis-related. All seven PEWS demonstrated excellent discrimination for CC admission (range area under the receiver operating characteristic curves (AUC) 0.91–0.95) and sepsis-related mortality (range AUC 0.95–0.99), most demonstrated moderate discrimination for hospital LOS (range AUC 0.69–0.75). In CC admission threshold analyses, bedside PEWS (AUC 0.90; 95% CI 0.86 to 0.93) and National PEWS (AUC 0.90; 0.87–0.93) were the most discriminative, both at a threshold of ≥6.ConclusionsOur results support the use of the proposed National PEWS in the paediatric ED for the recognition of suspected sepsis to improve outcomes, but further validation is required in other settings and presentations.
Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore: a qualitative study
Authors: Foo Chuan De , Surendran Shilpa , Tam Chen Hee , Ho Elaine , Matchar David Bruce , Car Josip , Koh Gerald Choon Huat 
Published: May 2021

ObjectiveThe increasing chronic disease burden has placed tremendous strain on tertiary healthcare resources in most countries, necessitating a shift in chronic disease management from tertiary to primary care providers. The Primary Care Network (PCN) policy was promulgated as a model of care to organise private general practitioners (GPs) into groups to provide GPs with resources to anchor patients with chronic conditions with them in the community. As PCN is still in its embryonic stages, there is a void in research regarding its ability to empower GPs to manage patients with chronic conditions effectively. This qualitative study aims to explore the facilitators and barriers for the management of patients with chronic conditions by GPs enrolled in PCN.DesignWe conducted 30 semistructured interviews with GPs enrolled in a PCN followed by a thematic analysis of audio transcripts until data saturation was achieved.SettingSingapore.ResultsOur results suggest that PCNs facilitated GPs to more effectively manage patients through (1) provision of ancillary services such as diabetic foot screening, diabetic retinal photography and nurse counselling to permit a ‘one-stop-shop’, (2) systematic monitoring of process and clinical outcome indicators through a chronic disease registry (CDR) to promote accountability for patients’ health outcomes and (3) funding streams for PCNs to hire additional manpower to oversee operations and to reimburse GPs for extended consultations. Barriers include high administrative load in maintaining the CDR due to the lack of a smart electronic clinic management system and financial gradient faced by patients seeking services from private GPs which incur higher out-of-pocket expenses than public primary healthcare institutions.ConclusionPCNs demonstrate great promise in empowering enrolled GPs to manage patients with chronic conditions. However, barriers will need to be addressed to ensure the viability of PCNs in managing more patients in the face of an ageing population.
Effects of non-pharmacological and non-surgical interventions on health outcomes in systemic sclerosis: protocol for a living systematic review
Authors: Discepola Marie-Nicole , Carboni-Jiménez Andrea , Kwakkenbos Linda , Henry Richard S , Boruff Jill , Krishnan Ankur , Boström Carina , Culos-Reed S Nicole , Hudson Marie , Leader David M , Mattsson Malin , Mouthon Luc , Wojeck Robyn , Yakes Jimenez Elizabeth , Sauve Maureen , Welling Joep , Guillot Geneviève , Benedetti Andrea , Thombs Brett D 
Published: May 2021

IntroductionSystemic sclerosis (SSc; scleroderma) is a rare, chronic, autoimmune disease with a high level of burden, a significant impact on the ability to carry out daily activities, and a considerable negative impact on health-related quality of life. Non-pharmacological interventions could be provided to potentially improve mental and physical health outcomes. However, the effectiveness of non-pharmacological interventions on health and well-being among individuals with SSc has not been well established. The proposed living systematic review aims to identify and evaluate randomised controlled trial (RCT) evidence on the effectiveness of non-pharmacological and non-surgical interventions on mental and physical health outcomes and on the delivery of such services in SSc.Methods and analysisEligible studies will be RCTs that examine non-pharmacological and non-surgical interventions aimed at improving health outcomes among individuals with SSc or the delivery of services intended to improve healthcare or support of people with SSc (eg, support groups). All RCTs included in a previous systematic review that sought studies published between 1990 and March 2014 will be evaluated for inclusion. Additional trials will be sought from January 2014 onwards using a similar, augmented search strategy developed by a health sciences librarian. We will search the MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library and Web of Science databases and will not restrict by language. Two independent reviewers will determine the eligibility of identified RCTs and will extract data using a prespecified standardised form in DistillerSR. Meta-analyses will be considered if ≥2 eligible RCTs report similar non-pharmacological interventions and comparable health outcomes. We will conduct a qualitative synthesis for interventions that cannot be synthesised via meta-analysis.Ethics and disseminationWe will post initial and ongoing results via a website, publish results periodically via peer-reviewed journal publication, and present results at patient-oriented events.PROSPERO registration numberCRD42020219914.
Cervical ripening at home or in-hospital—prospective cohort study and process evaluation (CHOICE) study: a protocol
Authors: Stock Sarah Jane , Bhide Amarnath , Richardson Heather , Black Mairead , Yuill Cassandra , Harkness Mairi , Reid Maggie , Wee Fiona , Cheyne Helen , McCourt Christine , Rana Dikshyanta , Boyd Kathleen Anne , Sanders Julia , Heera Neelam , Huddleston Jane , Denison Fiona , Pasupathy Dharmintra , Modi Neena , Smith Gordon , Norrie John 
Published: May 2021

IntroductionThe aim of the cervical ripening at home or in-hospital—prospective cohort study and process evaluation (CHOICE) study is to compare home versus in-hospital cervical ripening to determine whether home cervical ripening is safe (for the primary outcome of neonatal unit (NNU) admission), acceptable to women and cost-effective from the perspective of both women and the National Health Service (NHS).Methods and analysisWe will perform a prospective multicentre observational cohort study with an internal pilot phase. We will obtain data from electronic health records from at least 14 maternity units offering only in-hospital cervical ripening and 12 offering dinoprostone home cervical ripening. We will also conduct a cost-effectiveness analysis and a mixed methods study to evaluate processes and women/partner experiences. Our primary sample size is 8533 women with singleton pregnancies undergoing induction of labour (IOL) at 39+0 weeks’ gestation or more. To achieve this and contextualise our findings, we will collect data relating to a cohort of approximately 41 000 women undergoing IOL after 37 weeks. We will use mixed effects logistic regression for the non-inferiority comparison of NNU admission and propensity score matched adjustment to control for treatment indication bias. The economic analysis will be undertaken from the perspective of the NHS and Personal Social Services (PSS) and the pregnant woman. It will include a within-study cost-effectiveness analysis and a lifetime cost–utility analysis to account for any long-term impacts of the cervical ripening strategies. Outcomes will be reported as incremental cost per NNU admission avoided and incremental cost per quality adjusted life year gained.Research ethics approval and disseminationCHOICE has been funded and approved by the National Institute of Healthcare Research Health Technology and Assessment, and the results will be disseminated via publication in peer-reviewed journals.Trial registration numberISRCTN32652461.
Experience of emergency department patients after a visit for hyperglycaemia: implications for communication and factors affecting adherence postdischarge
Authors: Yan Justin , Azzam Dimah , Columbus Melanie , Van Aarsen Kristine , Liu Selina , Spaic Tamara , Shepherd Lisa 
Published: May 2021

BackgroundWhile studies have reported factors affecting adherence to diabetic care plans from a chronic disease perspective, no studies have addressed issues with post-discharge adherence facing patients with diabetes after an emergency department (ED) presentation for hyperglycaemia. This study’s objectives were to describe patient perspectives on their experience during and after an ED visit for hyperglycaemia and to identify factors that influence postdischarge adherence.MethodsWe conducted a qualitative description (QD) study of adult patients who had visited a Canadian ED for hyperglycaemia. Consistent with QD, purposive sampling was utilised, seeking diversity across age, gender and diabetes type. Participants took part in semistructured interviews and thematic analysis was used to identify and describe core themes. Frequent team meetings were held to review the analysis and to develop the final list of themes used to recode the data set. Analytic insights were tracked using reflective memos and an audit trail documented all steps and decisions.Results22 patients with type 1 and 2 diabetes were interviewed from June to October 2019. Participants identified several factors that impacted their ability to adhere to discharge plans: communication of instructions, psychosocial factors (financial considerations, shame and guilt, stigma and mental health), access to follow-up care and paediatric to adult care transitions.ConclusionsThis study describes the patient experience with the communication of discharge instructions, as well as factors affecting adherence post-ED discharge for hyperglycaemia. Our findings suggest four strategies that could improve the patient experience, improve adherence to discharge plans and potentially decrease the frequency of recurrent ED visits for hyperglycaemia.
Management and outcome of patients with acute ischemic stroke and tandem carotid occlusion in the ESCAPE-NA1 trial
Authors: Marko Martha , Cimflova Petra , Poppe Alexandre Y , Kashani Nima , Singh Nishita , Ospel Johanna , Mayank Arnuv , van Adel Brian , McTaggart Ryan A , Nogueira Raul G , Demchuk Andrew M , Rempel Jeremy L , Joshi Manish , Zerna Charlotte , Menon Bijoy K , Tymianski Michael , Hill Michael D , Goyal Mayank , Almekhlafi Mohammed A 
Published: May 2021

BackgroundThe optimal treatment and prognosis for stroke patients with tandem cervical carotid occlusion are unclear. We analyzed outcomes and treatment strategies of tandem occlusion patients in the ESCAPE-NA1 trial.MethodsESCAPE-NA1 was a multicenter international randomized trial of nerinetide versus placebo in 1105 patients with acute ischemic stroke who underwent endovascular treatment. We defined tandem occlusions as complete occlusion of the cervical internal carotid artery (ICA) on catheter angiography, in addition to a proximal ipsilateral intracranial large vessel occlusion. Baseline characteristics and outcome parameters were compared between patients with tandem occlusions versus those without, and between patients with tandem occlusion who underwent ICA stenting versus those who did not. The influence of tandem occlusions on functional outcome was analyzed using multivariable regression modeling.ResultsAmong 115/1105 patients (10.4%) with tandem occlusions, 62 (53.9%) received stenting for the cervical ICA occlusion. Of these, 46 (74.2%) were stented after and 16 (25.8%) before the intracranial thrombectomy. A modified Rankin Score (mRS) of 0–2 at 90 days was achieved in 82/115 patients (71.3%) with tandem occlusions compared with 579/981 (59.5%) patients without tandem occlusions. Tandem occlusion did not impact functional outcome in the adjusted analysis (OR 1.5, 95% CI 0.95 to 2.4). Among the subgroup of patients with tandem occlusion, cervical carotid stenting was not associated with different outcomes compared with no stenting (mRS 0–2: 75.8% vs 66.0%, adjusted OR 2.0, 95% CI 0.8 to 5.1).ConclusionsTandem cervical carotid occlusion in patients with acute large vessel stroke did not lower the odds of good functional outcome in our study. Functional outcomes were similar irrespective of the management of the cervical ICA occlusion (stenting vs not stenting).
In vivo public monitoring in emergency exposure scenarios
Authors: Ciciani Luca , Vilardi Ignazio , Rizzo Alessandro , Antonacci Giuseppe , Battisti Paolo , Castellani Carlo-Maria , Sperandio Luciano 
Published: May 2021

AbstractIn a nuclear or radiological accident scenario, where members of the public can potentially take up anthropogenic radionuclides released in atmosphere, verified methods to fast screen for internal contamination a large number of individuals directly on the field can play a major role to adopt appropriate countermeasures. At the ENEA Casaccia Research Centre (Rome, Italy), a spectrometric monitoring method, based on a portable HpGe detector Trans-Spec-DX-100, has been developed. In this work, the results of the 2019 measurement campaign, where the method sensitivity was tested, in terms of detection limits (DL) for common fission and (some) activation products by acquiring gamma spectra on 102 uncontaminated volunteers (57 adults, 45 children between 7 and 12 years of age) are presented. The spectra, collected with acquisition time of 180 s, have been analysed according to the Standard ISO 28218 for the activity detection limit (Bq) calculations and according to ICRP Publications 134, 137, and 141 for the related minimum measurable committed effective dose. The measurements were taken in open field on a paved surface, in the presence of an environmental radiation background, given in term of ambient dose equivalent rate, $$\dot{H}$$

H
˙

*(10), equal to 0.230 ± 0.020 μSv/h, in order to study both the potentiality and the limitation of the technique with a significant statistic. The results are presented and discussed particularly focusing on the specific characteristics of the technique, in respect to features reported by the European Council Directive 2013/59/Euratom and the International Atomic Energy Agency (IAEA) document STI/PUB/1708 (2015), and to techniques described in the current literature.
Carboniferous tetrapod biostratigraphy, biochronology and evolutionary events
Authors: Lucas Spencer G. 
Published: May 2021

Abstract

Tetrapod (amphibian and amniote) fossils of Carboniferous age are known almost exclusively from the southern part of a palaeoequatorial Euramerican province. The stratigraphic distribution of Carboniferous tetrapod fossils is used to identify five land-vertebrate faunachrons: (1) Hortonbluffian (Givetian–early Visean), the time between the first appearance datum (FAD) of tetrapods to the beginning of the Doran; (2) Doran (late Visean–early Bashkirian), the time between the FAD of the baphetid
Loxomma
and the beginning of the Nyranyan; (3) Nyranyan (late Bashkirian–Moscovian), the time between the FAD of the eureptile
Hylonomus
and the beginning of the Cobrean; (4) Cobrean (Kasimovian–late Gzhelian), the time between the FAD of the eupelycosaur
Ianthasaurus
and the beginning of the Coyotean; and (5) Coyotean (late Gzhelian–early Permian), the time between the FAD of the eupelycosaur
Sphenacodon
and the beginning of the Seymouran. This biochronology provides insight into some important evolutionary events in Carboniferous tetrapod evolution.
Methods for Host-based Intrusion Detection with Deep Learning
Authors: Ring John H. , Van Oort Colin M. , Durst Samson , White Vanessa , Near Joseph P. , Skalka Christian 
Published: May 2021

Host-based Intrusion Detection Systems
(HIDS) automatically detect events that indicate compromise by adversarial applications. HIDS are generally formulated as analyses of sequences of system events such as bash commands or system calls.
Anomaly-based
approaches to HIDS leverage models of normal (a.k.a. baseline) system behavior to detect and report abnormal events and have the advantage of being able to detect novel attacks. In this article, we develop a new method for anomaly-based HIDS using deep learning predictions of sequence-to-sequence behavior in system calls. Our proposed method, called the

ALAD

algorithm, aggregates predictions at the
application
level to detect anomalies. We investigate the use of several deep learning architectures, including WaveNet and several recurrent networks. We show that

ALAD

empowered with deep learning significantly outperforms previous approaches. We train and evaluate our models using an existing dataset, ADFA-LD, and a new dataset of our own construction, PLAID. As deep learning models are black box in nature, we use an alternate approach, allotaxonographs, to characterize and understand differences in baseline vs. attack sequences in HIDS datasets such as PLAID.
Effect of Topical Brimonidine 0.15% on Conjunctival Injection after Strabismus Surgery in Children
Authors: Kim Dong Hyun , Yang Hee Kyung , Han Sang Beom , Hwang Jeong-Min 
Published: May 2021

Purpose. To investigate the effects of topical brimonidine 0.15% instillation on conjunctival injection after strabismus surgery in children. Methods. We retrospectively analyzed 63 Korean children who underwent strabismus surgery for intermittent exotropia. Patients received topical brimonidine 0.15% after surgery for up to 4 weeks. Conjunctival injection was objectively assessed using a software that automatically scored the region of interest from the image of the bulbar conjunctiva. Conjunctival injection scores were compared with those of the control group who were not prescribed topical brimonidine. Results. The mean scores of conjunctival injection after rectus muscle recession and resection were significantly lower in the brimonidine group than the controls at 4 weeks after surgery (

P
=
0.008
and

0.046

, respectively). There was no significant difference in intraocular pressure between the two groups. No adverse effects, such as dry mouth, fatigue/drowsiness, headache, sedation, hypotension, or bradycardia, were reported. Conclusions. Administration of topical brimonidine 0.15% after strabismus surgery is efficacious and safe in reducing postoperative conjunctival injection.
Theoretical Study of Electronic Structure of Charged Fullerenes
Authors: Vasiliev Alexander , Matveev Leonid , Mikhaylov Alexander , Mitrofanov Artem , Obukhov Yuri , Orekhov Nikita , Osadchy Alexander , Stegailov Vladimir 
Published: May 2021

The properties of excited short-living electron quantum levels of positively charged

C

60

+
Z

fullerenes are numerically investigated with the help of the density functional theory (DFT) packages Quantum Espresso, ORCA, and VASP. Earlier, the existence of the volume-localized electron states for neutral and charged fullerenes was demonstrated analytically by making use of the model potential approach based on the unique quasispherical geometrical shape of C60. Here, we revisit this issue by verifying numerically the existence of volume-localized states and by calculating physical parameters of all electronic states with a special focus on highly charged fullerene ions. The ionization potentials of

C

60

+
Z

are calculated and compared with available experimental data. The photoionization cross-sections for neutral fullerene using wave functions are obtained by making use of DFT codes. We demonstrate that lifetimes of excited states vary in the range

10

−
11

÷

10

−
4

s, and for the volume-localized levels, lifetimes are longer than those for the surface-localized states.
Associations of Household Income with Health-Related Quality of Life Following a Colorectal Cancer Diagnosis Varies With Neighborhood Socioeconomic Status
Authors: Robinson Jamaica R.M. , Phipps Amanda I. , Barrington Wendy E. , Hurvitz Philip M. , Sheppard Lianne , Malen Rachel C. , Newcomb Polly A. 
Published: May 2021

Abstract

Background:
Existing evidence indicates household income as a predictor of health-related quality of life (HRQoL) following a colorectal cancer diagnosis. This association likely varies with neighborhood socioeconomic status (nSES), but evidence is limited.

Methods:
We included data from 1,355 colorectal cancer survivors participating in the population-based Puget Sound Colorectal Cancer Cohort (PSCCC). Survivors reported current annual household income; we measured HRQoL via the Functional Assessment of Cancer Therapy - Colorectal (FACT-C) tool. Using neighborhood data summarized within a 1-km radial buffer of Census block group centroids, we constructed a multidimensional nSES index measure. We employed survivors' geocoded residential addresses to append nSES score for Census block group of residence. With linear generalized estimating equations clustered on survivor location, we evaluated associations of household income with differences in FACT-C mean score, overall and stratified by nSES. We used separate models to explore relationships for wellbeing subscales.

Results:
We found lower household income to be associated with clinically meaningful differences in overall FACT-C scores [&lt;$30K: −13.6; 95% confidence interval (CI): −16.8 to −10.4] and subscale wellbeing after a recent colorectal cancer diagnosis. Relationships were slightly greater in magnitude for survivors living in lower SES neighborhoods.

Conclusions:
Our findings suggest that recently diagnosed lower income colorectal cancer survivors are likely to report lower HRQoL, and modestly more so in lower SES neighborhoods.

Impact:
The findings from this work will aid future investigators' ability to further consider the contexts in which the income of survivors can be leveraged as a means of improving HRQoL