bluuebunny/crossref_metadata_2025_split huggingface dataset:
Protocol for the e-POWUS Project: multicentre blinded-randomised controlled trial of ultrasound speed choice to improve sonography quality in pregnant women with obesity
Authors: Delabaere Amélie , Chauveau Benoit , Lémery Didier , Ollier Amandine , Guiguet-Auclair Candy , Mourgues Charline , Legrand Anne 
Published: September 2021

IntroductionDuring pregnancy, maternal obesity increases the risk of fetal abnormalities. Despite advances in ultrasound imaging, the assessment of fetal anatomy is less thorough among these women. Currently, the construction of ultrasound images uses a conventional ultrasound propagation velocity (1540 m/s), which does not correspond to the slower speed of propagation in fat tissue.The main objective of this randomised study is to compare the completeness of fetal ultrasonography according to whether the operator could choose the ultrasound velocity (1420, 1480 or 1540 m/s) or was required to apply the 1540 m/s velocity.Methods and analysisThis randomised trial is an impact study to compare a diagnostic innovation with the reference technique. The trial inclusion criteria require that a pregnant woman with obesity be undergoing a fetal morphology examination by ultrasound from 20+0to 25+0gestational weeks.Randomisation will allocate women into two groups. The first will be the ‘modulable speed’ group, in which operators can choose the speed of ultrasound propagation to be considered for the morphological analysis: 1420, 1480 or 1540 m/s. In the second ‘conventional speed’ group, operators will perform the morphological examination with the ultrasound speed fixed at 1540 m/s. The adjudication committee, two independent experts, will validate the completeness of each examination and the quality of the images.Ethics and disseminationThis research protocol does not change the standard management. The only possible impact is an improvement of the ultrasound examination by improving the quality of the image and the completeness of morphological examination. TheAgence du Médicament et produits de santéapproved this study (2018-A03478-47). The anonymised data will be available on request from the principal investigator. Results will be reported in peer-reviewed journals and at scientific meetings.Trial registration numberClinicalTrials.gov (http://www.clinicaltrials.gov) Registry (NCT04212234).
Clinician attitude towards safety in medication management: a participatory action research study in an emergency department
Authors: Bakhshi Fatemeh , Mitchell Rebecca , Nikbakht Nasrabadi Alireza , Javadi Mostafa , Varaei Shokoh 
Published: September 2021

ObjectivesEdication management is a process in which medications are selected, procured, delivered, prescribed, reviewed, administered and monitored to assure high-quality patient care and safety. This paper explores clinicians’ attitudes towards medication management which is both open to influence and strongly linked to successful changes in mediation behaviour. We aimed to investigate effects of engaging in participatory action research to improve emergency medicine clinicians’ attitudes to safety in medication management.SettingEmergency department of one university affiliated hospital.ParticipantsA total of 85 clinicians including nurses and physicians partook as participants. Eight managers and clinicians participated as representatives.DesignData are drawn from two-cycle participatory action research. Initially, a situation analysis on the current medication management and clinician views regarding medication management was conducted using three focus groups. Evaluation and reflection data were obtained through qualitative interviews. All qualitative data were analysed using content analysis.ResultsClinicians initially expressed negative attitudes towards existing and new plans for medication management, in that they were critical of current medication-related policy and procedures, as well as wary of the potential relevance and utility of potential changes to medication management. Through the action research, improvement actions were implemented including interprofessional courses, pharmacist-led interventions and the development of new guidelines regarding medication management. Participants and their representatives were engaged in all participatory action research stages with different levels of involvement. Extracted results from evaluation and reflection stages revealed that by engaging in the action research and practice new interventions, clinicians’ attitude towards medication management was improved.ConclusionsThe results support the impact of participatory action research on enhancing clinicians’ positive attitudes through their involvement in planning and implementing safety enhancing aspects of medication management.
Predictors of physical activity levels in children and adolescents with cerebral palsy: clinical cohort study protocol
Authors: Fonvig Christina Esmann , Troelsen Jens , Dunkhase-Heinl Ulrike , Lauritsen Jens Martin , Holsgaard-Larsen Anders 
Published: September 2021

IntroductionChildren and adolescents with cerebral palsy may be trapped in a vicious circle of low physical fitness, resulting in deconditioning that causes a further decrease in physical activity (PA), a lower quality of life and an increased risk of developing non-communicable diseases. Therefore, establishing a healthy and active lifestyle during childhood is even more important for individuals with a disability. However, the factors that influence habitual PA in children and adolescents with cerebral palsy remain unknown.The present protocol outlines a prospective cohort study with the aim of investigating potential predictors of habitual PA in children and adolescents with cerebral palsy in order to provide evidence for optimising PA levels and associated overall health.Methods and analysisThis prospective cohort study will enrol participants with cerebral palsy between the ages of 8 and 15 years at Gross Motor Function Classification System levels I–III. Using a modified version of the International Classification of Functioning, Disability and Health model as a conceptual analytical framework, the analysis will be divided into six components and will provide predictors for habitual PA measured by accelerometry. The potential predictive variables are registry data on physical function (Danish Cerebral Palsy Follow-Up Programme); validated proxy-reported questionnaires on quality of life (Paediatric Quality of Life Inventory), overall health, pain and participation in daily activities (Paediatric Outcomes Data Collection Instrument) and supplementary questions regarding sleep, screen time and socioeconomic status.Ethics and disseminationThe project is approved by the Danish Data Protection Agency (19/16396) and has been declared not notifiable by the Regional Committee on Health Research Ethics, cf. Committee Act Art. 14, paragraph 1 (S-20192000-23). The study results will be published in international peer-reviewed journals, presented at international conferences, and published in a PhD dissertation.Trial registration numberNCT04614207.
Diagnosis of infection after cardiovascular surgery (DICS): a study protocol for developing and validating a prediction model in prospective observational study
Authors: Zhang Hai-Tao , Han Xi-Kun , Wang Chuang-Shi , Zhang He , Li Ze-Shi , Chen Zhong , Pan Ke , Zhong Kai , Pan Tuo , Wang Dong-Jin 
Published: September 2021

IntroductionPostoperative infection (PI) is one of the main severe complications after cardiovascular surgery. Therefore, antibiotics are routinely used during the first 48 hours after cardiovascular surgery. However, there is no effective method for early diagnosis of infection after cardiovascular surgery, particularly, to determine whether postoperative patients need to prolong the use of antibiotics after the first 48 hours. In this study, we aim to develop and validate a diagnostic model to help identify whether a patient has been infected after surgery and guide the appropriate use of antibiotics.Methods and analysisIn this prospective study, we will develop and validate a diagnostic model to determine whether the patient has a bacterial infection within 48 hours after cardiovascular surgery. Baseline data will be collected through the electronic medical record system. A total of 2700 participants will be recruited (n=2000 for development, n=700 for validation). The primary outcome of the study is the newly PI during the first 48 hours after cardiovascular surgery. Logistic regression penalised with elastic net regularisation will be used for model development and bootstrap and k-fold cross-validation aggregation will be performed for internal validation. The derived model will be also externally validated in patients who are continuously included in another time period (N=700). We will evaluate the calibration and differentiation performance of the model by Hosmer-Lemeshow good of fit test and the area under the curve, respectively. We will report sensitivity, specificity, positive predictive value and negative predictive value in the validation data-set, with a target of 80% sensitivity.Ethics and disseminationEthical approval was obtained from Medical Ethics Committee of Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical College (2020-249-01).Trial registration numberChinese Clinical Trial Register (www.chictr.org.cn, ChiCTR2000038762); Pre-results.
Exploring contextual factors influencing the implementation of evidence-based care for hypertension in Rwanda: a cross-sectional study using the COACH questionnaire
Authors: Baumann Ana A , Hooley Cole , Goss Charles W , Mutabazi Vincent , Brown Angela L , Schechtman Kenneth B , Twagirumukiza Marc , de las Fuentes Lisa , Reeds Dominic , Williams Makeda , Mutimura Eugene , Bergström Anna , Nishimwe Aurore , Ingabire Cecile , Davila-Roman Victor G 
Published: September 2021

ImportanceHypertension is the largest contributor to the Global Burden of Disease. In Rwanda, as in most low-income and middle-income countries, an increasing prevalence of hypertension and its associated morbidity and mortality is causing major healthcare and economic impact. Understanding healthcare systems context in hypertension care is necessary.ObjectiveTo study the hypertension healthcare context as perceived by healthcare providers using the Context Assessment for Community Health (COACH) tool.DesignA cross-sectional cohort responded to the COACH questionnaire and a survey about hypertension training.SettingThree tertiary care hospitals in Rwanda.ParticipantsHealthcare professionals (n=223).Primary outcome(s) and measure(s)The COACH tool consists of 49 items with eight subscales: resources, community engagement, commitment to work, informal payment, leadership, work culture, monitoring services for action (5-point Likert Scale) and sources of knowledge (on a 0–1 scale). Four questions surveyed training on hypertension.ResultsResponders (n=223, 75% women; 56% aged 20–35 years) included nurses (n=142, 64%, midwives (n=42, 19%), primary care physicians (n=28, 13%) and physician specialists (n=11, 5%)). The subscales commitment to work, leadership, work culture and informal payment scored between 4.7 and 4.1 and the community engagement, monitoring services for action and organizational resources scored between 3.1 and 3.5. Sources of knowledge had a mean score of 0.6±0.3. While 73% reported having attended a didactic hypertension seminar in the past year, only 28% had received long-term training and 51% had <3-year experience working with hypertension care delivery. The majority (99%) indicated a need for additional training in hypertension care.ConclusionsThere is a need for increased and continuous training in Rwanda. Healthcare responders stated a commitment to work and reported supportive leadership, while acknowledging limited resources and no monitoring systems. The COACH tool provides contextual guidance to develop training strategies prior to the implementation of a sustainable hypertension care programme.
Willingness to seek medical care for tuberculosis and associated factors among the elderly population in Shenzhen: a cross-sectional study
Authors: Wang Yunxia , Feng Jing , Zhang Juanjuan , Shen Xin , Lei Zihui , Zhu Yi , Meng Xin , Di Hongkun , Xia Wenqi , Lu Zuxun , Guo Yanfang , Yuan Qing , Wang Xiaojun , Gan Yong 
Published: September 2021

ObjectivesThis study was aimed to assess the willingness of elderly people to seek medical care for tuberculosis (TB) and the associated influencing factors.DesignA cross-sectional study.SettingA multistage random survey was conducted in Bao’an District of Shenzhen in China.ParticipantsA total of 1200 elderly people aged 65 or above were recruited for the study and completed a structured questionnaire between September and October 2019.Main outcome measuresDescriptive and binary logistic stepwise regression analyses were conducted to analyse the characteristics of elderly individuals, their willingness to seek medical care for TB and associated factors.ResultsAmong the final 1123 respondents, 943 (84.0%) were willing to seek medical care if they discovered suspicious TB symptoms. Binary logistic stepwise regression analysis indicated that respondents whose family annual income per capita was 50 000–100 000¥ (OR=2.56, 95% CI: 1.44 to 4.54, p<0.01) and who had positive attitudes (≥3 scores: OR=3.10, 95% CI: 1.90 to 5.05, p<0.01) or practices (≥4 scores: OR=3.13, 95% CI: 1.82 to 5.39, p<0.01) towards TB were more willing to seek medical care for TB.ConclusionsWillingness to seek medical care for TB in the elderly population can be improved according to the determinants.
Prevalence of midline cervical spine tenderness in the non-trauma population
Authors: Delaney J Scott , Al-Kashmiri Ammar , Alalshaikh Abdulaziz , Al-Ghafri Saif , Saluja Sanjeet Singh , Correa Jose A 
Published: September 2021

ObjectiveThe Canadian C-Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) criteria are two commonly used clinical decision rules which use midline cervical spine (c-spine) tenderness on palpation as an indication for c-spine imaging post-trauma. This study was undertaken to determine the prevalence and location of midline c-spine tenderness in the non-trauma population.MethodsWe prospectively evaluated consenting adult patients presenting to an urban ED or university sport medicine clinic in Montreal, Canada between 2018 and 2020 for atraumatic non-head and neck-related reports over a 20-month period. The presence and location of pain during midline c-spine palpation as assessed by two examiners during separate evaluations was recorded. Patient information such as age, neck length and circumference, gender, body mass index (BMI) and scaphoid tenderness was also collected.ResultsOf 478 patients enrolled, 286 (59.8%) had midline c-spine tenderness on palpation with both examiners. The majority of those with tenderness were female (70.6%). When examining all patients, tenderness was present in the upper third of the c-spine in 128 (26.8%) patients, middle third in 270 (56.5%) patients and lower third in 6 (1.3%) patients. Factors associated with having increased odds of midline c-spine tenderness on palpation included a lower BMI and the presence of scaphoid tenderness on palpation.ConclusionsThere is a high prevalence of c-spine tenderness on palpation in patients who have not undergone head or neck trauma. This finding may help explain the low specificity in some of the validation studies examining the CCR and the NEXUS criteria.
J. David Jackson (January 19, 1925–May 20, 2016): A Biographical Memoir
Authors: Cahn Robert N. 
Published: September 2021

John David (“Dave”) Jackson, a Canadian-born theoretical physicist, contributed significantly to particle, nuclear, and atomic physics. He is best known, however, for his text Classical Electrodynamics, which has been a fixture in physics graduate education around the world for more than 50 years. It is generally referred to simply as “Jackson.” This textbook, which has inspired fear and wonder alike in generations of students, clearly reflects the author's fascination with physical phenomena, his renowned mathematical dexterity, and his appreciation of the elegance of physical laws. Jackson's major contributions to research included the theory of muon-catalyzed fusion; the analysis, with Kurt Gottfried, of angular distributions in quasi-two-body elementary particle collisions; and the elucidation of charmonium-state decays. Jackson influenced the development of physics research throughout the United States as well as internationally—particularly through his work on the nascent Superconducting Super Collider. An active promoter of civil liberties and human rights, he was one of the leaders of the efforts to free Andrei Sakharov, Yuri Orlov, and Anatoly Shcharansky from Soviet imprisonment.
The Technique of English Word Syllable Division in Speech Synthesis Based on Neural Network
Authors: Ma Hongjuan 
Published: September 2021

With the increasing maturity of speech synthesis technology, on the one hand, it has been more and more widely used in people’s lives; on the other hand, it also brings more and more convenience to people. The requirements for speech synthesis systems are getting higher and higher. Therefore, advanced technology is used to improve and update the accent recognition system. This paper mainly introduces the word stress annotation technology combined with neural network speech synthesis technology. In Chinese speech synthesis, prosodic structure prediction has a great influence on naturalness. The purpose of this paper is to accurately predict the prosodic structure, which has become an important problem to be solved in speech synthesis. Experimental data show that the average error of samples in the network training process is lel/85, and the minimum value of the training error after 500 steps is 0.00013127, so the final sample average error is lel = 85

∗

0.0013127 = 0.112 < 0.5, and use the deep neural network (DNN) to train different parameters to obtain the conversion model, and then synthesize these conversion models, and finally achieve the effect of improving the synthesized sound quality.
A Quantitative Framework to Study Potential Benefits and Harms of Multi-Cancer Early Detection Testing
Authors: Jiao Boshen , Gulati Roman , Katki Hormuzd A. , Castle Philip E. , Etzioni Ruth 
Published: September 2021

Abstract

Background:
Multi-cancer tests offer screening for multiple cancers with one blood draw, but the potential population impact is poorly understood.

Methods:
We formulate mathematical expressions for expected numbers of: (i) individuals exposed to unnecessary confirmation tests ( ${\rm{EUC}}$ ), (ii) cancers detected ( ${\rm{CD}}$ ), and (iii) lives saved ( ${\rm{LS}}$ ) given test performance, disease incidence and mortality, and mortality reduction. We add colorectal, liver, lung, ovary, and pancreatic cancer to a test for breast cancer, approximating prevalence at ages 50, 60, or 70 using incidence over the next 5 years and mortality using corresponding probabilities of cancer death over 15 years in the Surveillance, Epidemiology, and End Results registry.

Results:
${\rm{EUC}}$ is overwhelmingly determined by specificity. For a given specificity, ${\rm{EUC}}/{\rm{CD}}$ is most favorable for higher prevalence cancers. Under 99% specificity and sensitivities as published for a 50-cancer test, ${\rm{EUC}}/{\rm{CD}}$ is 1.1 for breast + lung versus 1.3 for breast + liver at age 50. Under a common mortality reduction associated with screening, ${\rm{EUC}}/{\rm{LS}}$ is most favorable when the test includes higher mortality cancers (e.g., 19.9 for breast + lung vs. 30.4 for breast + liver at age 50 assuming a common 10% mortality reduction).

Conclusions:
Published multi-cancer test performance suggests a favorable tradeoff of ${\rm{EUC}}$ to ${\rm{CD}}$, yet the full burden of unnecessary confirmations will depend on the posttest work-up protocol. Harm–benefit tradeoffs will be improved if tests prioritize more prevalent and/or lethal cancers for which curative treatments exist.

Impact:
The population impact of multi-cancer testing will depend not only on test performance but also on disease characteristics and efficacy of early treatment.
See related commentary by Duffy and Sasieni, p. 3
Integrated Molecular and Immune Phenotype of HER2-Positive Breast Cancer and Response to Neoadjuvant Therapy: A NeoALTTO Exploratory Analysis
Authors: Pizzamiglio Sara , Ciniselli Chiara Maura , Triulzi Tiziana , Gargiuli Chiara , De Cecco Loris , de Azambuja Evandro , Fumagalli Debora , Sotiriou Christos , Harbeck Nadia , Izquierdo Miguel , Nuciforo Paolo , Huober Jens , Cappelletti Vera , Cinieri Saverio , Piccart Martine , Daidone Maria Grazia , Pruneri Giancarlo , Colombo Mario Paolo , Tagliabue Elda , Verderio Paolo , Di Cosimo Serena 
Published: September 2021

Abstract

Purpose:
Little is known about the efficacy of HER2-targeted therapy in patients with breast cancer showing different HER2-pathway dependence and immune phenotypes. Herein, we report a NeoALTTO exploratory analysis evaluating the clinical value of 22 types of tumor-infiltrating immune cells by CIBERSORT and 5 immune-related metagenes in the overall patient population, and in subgroups defined by the TRAR classifier as HER2-addicted (TRAR-low) or not (TRAR-high).

Patients and Methods:
Association of baseline TRAR, immune-related metagenes, and CIBERSORT data with pathologic complete response (pCR) and event-free survival (EFS) were assessed using logistic and Cox regression models. Corrections for multiple testing were performed by the Bonferroni method.

Results:
A total of 226 patients were analyzed: 80 (35%) achieved a pCR, and 64 (28%) experienced a relapse with a median follow-up of 6.7 (interquartile range 6.1–6.8) years; 108 cases were classified as TRAR-low, and 118 TRAR-high. Overall, γδ T-cell fraction [OR = 2.69; 95% confidence interval (CI), 1.40–5.18], and no immune-related metagenes were predictive of pCR. Notably, lymphocyte-specific kinase (LCK) predicted pCR to combination (OR = 2.53; 95% CI, 1.12–5.69), but not to single-agent trastuzumab or lapatinib [OR = 0.74; 95% CI, 0.45–1.22 (Pinteraction = 0.01)]. Integrating LCK with γδ T cells in a multivariate model added to the discriminatory capability of clinical and molecular variables with a shift in AUC from 0.80 (95% CI, 0.74–0.86) to 0.83 (95% CI, 0.78–0.89). In TRAR-low cases, activated mast cells, IFN and MHCII were reduced, and STAT1, HCK1, and γδ T cells were associated with pCR. STAT1 was broadly associated with improved EFS regardless of pCR, and nodal status in overall (HR = 0.68; 95% CI, 0.49–0.94) and in TRAR-low cases (HR = 0.50; 95% CI, 0.30–0.86).

Conclusions:
Immuno-phenotyping holds the promise to complement current predictive models in HER2-positive breast cancer and to assist in new therapeutic development.