bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis
Authors: Antequera Alba , Lopez-Alcalde Jesus , Stallings Elena , Muriel Alfonso , Fernández Félix Borja , del Campo Rosa , Ponce-Alonso Manuel , Fidalgo Pilar , Halperin Ana Veronica , Madrid-Pascual Olaya , Álvarez-Díaz Noelia , Solà Ivan , Gordo Federico , Urrutia Gerard , Zamora Javier 
Published: September 2021

ObjectiveTo assess the role of sex as an independent prognostic factor for mortality in patients with sepsis admitted to intensive care units (ICUs).DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase, Web of Science, ClinicalTrials.gov and the WHO Clinical Trials Registry from inception to 17 July 2020.Study selectionStudies evaluating independent associations between sex and mortality in critically ill adults with sepsis controlling for at least one of five core covariate domains prespecified following a literature search and consensus among experts.Data extraction and synthesisTwo authors independently extracted and assessed the risk of bias using Quality In Prognosis Studies tool. Meta-analysis was performed by pooling adjusted estimates. The Grades of Recommendations, Assessment, Development and Evaluation approach was used to rate the certainty of evidence.ResultsFrom 14 304 records, 13 studies (80 520 participants) were included. Meta-analysis did not find sex-based differences in all-cause hospital mortality (OR 1.02, 95% CI 0.79 to 1.32; very low-certainty evidence) and all-cause ICU mortality (OR 1.19, 95% CI 0.79 to 1.78; very low-certainty evidence). However, females presented higher 28-day all-cause mortality (OR 1.18, 95% CI 1.05 to 1.32; very low-certainty evidence) and lower 1-year all-cause mortality (OR 0.83, 95% CI 0.68 to 0.98; low-certainty evidence). There was a moderate risk of bias in the domain adjustment for other prognostic factors in six studies, and the certainty of evidence was further affected by inconsistency and imprecision.ConclusionThe prognostic independent effect of sex on all-cause hospital mortality, 28-day all-cause mortality and all-cause ICU mortality for critically ill adults with sepsis was uncertain. Female sex may be associated with decreased 1-year all-cause mortality.PROSPERO registration numberCRD42019145054.
Primary health care physicians’ perspective on COVID-19 pandemic management in Qatar: a web-based survey
Authors: Ismail Mansoura , Joudeh Anwar , Neshnash Marwa , Metwally Nourhan , Seif Mai Hassan , Al Nuaimi Ahmed , Alsaadi Muna Mehdar , Al Abdulla Samya , Selim Nagah Abdel Aziz 
Published: September 2021

ObjectivesTo assess primary care physicians’ satisfaction towards COVID-19 pandemic management in Qatar and to identify the associated factors with their satisfaction.DesignA cross-sectional web-based survey conducted from 1 June to 30 July 2020.SettingAll the 27 public primary healthcare centres in Qatar.Participants294 primary care physicians working in the publicly run primary healthcare corporation in Qatar.Primary outcome measuresOverall satisfaction towards COVID-19 management in Qatar and satisfaction towards each aspect of this management including COVID-19 clinical practice guidelines, psychological support, team dynamics, work safety as well as institutional and governmental regulations.Results294 primary care physicians participated in the survey with a response rate of 65%. Overall satisfaction of physicians towards COVID-19 19 management at Primary Health Care Corporation was 77%. The highest satisfaction was towards institutional and governmental support while it was the lowest towards the corporation case definition and management of COVID-19 guidelines. Female physicians were less satisfied with psychological support in comparison to males (64.1% and 51% respectively, p=0.049). Overall satisfaction towards case definition and management of COVID-19 guidelines were strongly correlated with their clarity, updating these guidelines in due time and applicability of the guidelines (r=0.759 P<0.001; r=0.701 P<0.001; r=0.698 P<0.001) respectively, while satisfaction towards work safety was strongly correlated with availability and quality of Personal Protective Equipment provided (r=0.83 P<0.001 and r=0.811 P<0.001 respectively).ConclusionMost primary care physicians in Qatar who responded to the survey were satisfied with the COVID-19 guidelines developed rapidly in response to this pandemic. Availability and quality of PPE were a particular concern. The clinicians who were less satisfied were younger and female.
Evidence of health system resilience in Myanmar during Cyclone Nargis: a qualitative analysis
Authors: Grimm Pauline Yongeun , Merten Sonja , Wyss Kaspar 
Published: September 2021

ObjectiveThe aim of this study is to improve the understanding of the characteristics of health system resilience in Myanmar’s response to Cyclone Nargis and to explore ways to improve resilience at the system level.Design and settingThis is an explanatory qualitative study exploring the institutional capacity of resilience in Myanmar’s health system. Analysis proceeded using a data-driven thematic analysis closely following the framework method. This process enabled comparisons and contrasts of key emergent themes between the participants, which later generated key results describing the foundational assets, barriers and opportunities for achieving resilience in Myanmar.ParticipantsThe study comprised of 12 in-depth interviews conducted with representatives from international organisations and non-governmental organisations (NGOs). The inclusion criteria to recruiting the participants were that they had directly been a part of the Cyclone Nargis response at the time. There was a balanced distribution of participants across UN, bilateral and NGOs, and most of them were either Myanmar citizens or expatriates with extensive working experience based in Myanmar.ResultsKey findings elucidate the characteristics of resilience that have been salient or absent in Myanmar’s response to Cyclone Nargis. Strong social capital and motivation propelled by its deep-rooted culture and religion served as Myanmar’s greatest assets that filled major gaps in the system. Meanwhile, its postcolonial and military legacy posed barriers towards investing in building its long-term foundations towards resilience.ConclusionsThis study revealed that resilience in the health system can be built through strategic investments towards building the foundations of resilience to better prepare for future shocks. In the case of Myanmar, social capital and motivation, which surfaced as its foundational assets, can be channelled into opportunities that can help achieve its long-term health goals, accelerating its journey towards resilience in the health system.
Unequal access and use of contraceptives among parenting adolescent girls in sub-Saharan Africa: a cross-sectional analysis of demographic and health surveys
Authors: Ahinkorah Bright Opoku , Obisesan Matthew Tobiloba , Seidu Abdul-Aziz , Ajayi Anthony Idowu 
Published: September 2021

ObjectiveWe examined the divergent patterns, prevalence and correlates of contraceptive use among parenting adolescents in sub-Saharan Africa using the Demographic and Health Survey datasets of 17 countries.DesignWe included a weighted sample of 9488 parenting adolescent girls in our analysis. Current contraceptive use was defined as the use of any methods to delay or avoid getting pregnant at the survey time. We reported the prevalence of any contraceptive use for all countries and used multilevel binary logistic regression analysis to examine the individual and contextual factors associated with contraceptive use.Outcome measuresContraceptive use.ResultsWe found an overall contraceptive prevalence of 27.12% (CI 27.23% to 28.03%) among parenting adolescent girls in sub-Saharan Africa, ranging from 70.0% (CI 61.76% to 77.16%) in South Africa to only 5.10% (CI 3.04% to 8.45%) in Chad. The prevalence of contraceptive use was lowest in West andCentral Africa, with most countries having less than 20% prevalence. Increasing age (adjusted OR (aOR)=1.46, 95% CI 1.28 to 1.65), being married (aOR=1.63, 95% CI 1.43 to 1.87), having a secondary or higher level of education (aOR=2.72, 95% CI 2.25 to 2.3.27), and media exposure (aOR=1.21, 95% CI 1.08 to 1.36), were associated with higher odds of contraceptive use in the pooled data but preference for a higher number of children (more than five children) (aOR=0.61, 95% CI 0.52 to 0.72) was related to lower likelihood of use. Significant heterogeneity was observed in the country-level disaggregated results.ConclusionAfrican countries differ widely when it comes to contraceptive use among parenting adolescent girls, with only three countries having a relatively high prevalence of use. The governments of countries in sub-Saharan Africa, particularly those in West and Central Africa, should invest in expanding access to contraceptives for adolescent mothers to prevent repeat pregnancy and improve the overall well-being of parenting adolescent girls.
Neurosurgeons’ experiences of conducting and disseminating clinical research in low-income and middle-income countries: a reflexive thematic analysis
Authors: Whiffin Charlotte Jane , Smith Brandon George , Esene Ignatius N , Karekezi Claire , Bashford Tom , Mukhtar Khan Muhammad , Hutchinson Peter John , Kolias Angelos G , Fontoura Solla Davi Jorge , Paiva Wellingson S , Figaji Anthony 
Published: September 2021

ObjectivesLow-income and-middle-income countries (LMICs) are increasing investment in research and development, yet there remains a paucity of neurotrauma research published by those in LMICs. The aim of this study was to understand neurosurgeons’ experiences of, aspirations for, and ability to conduct and disseminate clinical research in LMICs.DesignThis was a two-stage inductive qualitative study situated within the naturalistic paradigm. This study committed to an interpretivist way of knowing (epistemology), and considered reality subjective and multiple (ontology). Data collection used online methods and included a web-based survey tool for demographic data, an asynchronous online focus group and follow-up semistructured interviews. Data were analysed using Braun and Clarke’s Reflexive Thematic Analysis supported by NVivo V.12.SettingLMICs.ParticipantsIn April–July 2020, 26 neurosurgeons from 11 LMICs participated in this study (n=24 in the focus groups, n=20 in follow-up interviews).ResultsThe analysis gave rise to five themes: The local landscape; creating capacity; reach and impact; collaborative inquiry; growth and sustainability. Each theme contained an inhibitor and stimulus to neurosurgeons conducting and disseminating clinical research, interpreted as ‘the neurosurgical research potential in LMICs’. Mentorship, education, infrastructure, impact and engagement were identified as specific accelerators. Whereas lack of generalisability, absence of dissemination and dissemination without peer review may desensitise the impact of research conducted by neurosurgeons.ConclusionThe geographical, political and population complexities make research endeavour challenging for neurosurgeons in LMICs. Yet in spite of, and because of, these complexities LMICs provide rich opportunities to advance global neurosurgery. More studies are required to evaluate the specific effects of accelerators of research conducted by neurosurgeons and to understand the effects of desensitisers on high-quality, high-impact clinical research.
Mental health and well-being of older adults living with HIV in sub-Saharan Africa: a systematic review
Authors: Mwangala Patrick Nzivo , Mabrouk Adam , Wagner Ryan , Newton Charles R J C , Abubakar Amina A 
Published: September 2021

ObjectiveIn this systematic review, we aimed to summarise the empirical evidence on common mental disorders (CMDs), cognitive impairment, frailty and health-related quality of life (HRQoL) among people living with HIV aged ≥50 years (PLWH50 +) residing in sub-Saharan Africa (SSA). Specifically, we document the prevalence and correlates of these outcomes.Design, data sources and eligibility criteriaThe following online databases were systematically searched: PubMed, CINAHL, PsycINFO, Embase and Scopus up to January 2021. English-language publications on depression, anxiety, cognitive function, frailty and quality of life among PLWH50+ residing in SSA were included.Data extraction and synthesisWe extracted information, including study characteristics and main findings. These were tabulated, and a narrative synthesis approach was adopted, given the substantial heterogeneity among included studies.ResultsA total of 50 studies from fifteen SSA countries met the inclusion criteria. About two-thirds of these studies emanated from Ethiopia, Uganda and South Africa. Studies regarding depression predominated (n=26), followed by cognitive impairment (n=13). Overall, PLWH50+ exhibited varying prevalence of depression (6%–59%), cognitive impairments (4%–61%) and frailty (3%–15%). The correlates of CMDs, cognitive impairment, frailty and HRQoL were rarely investigated, but those reported were sociodemographic variables, many of which were inconsistent.ConclusionsThis review documented an increasing number of published studies on HIV and ageing from SSA. However, the current evidence on the mental and well-being outcomes in PLWH50+ is inadequate to characterise the public health dimension of these impairments in SSA, because of heterogeneous findings, few well-designed studies and substantial methodological limitations in many of the available studies. Future work should have sufficiently large samples of PLWH50+, engage appropriate comparison groups, harmonise the measurement of these outcomes using a standardised methodology to generate more robust prevalence estimates and confirm predictors.PROSPERO registration numberCRD42020145791.
Effect of a Mediterranean diet intervention on gastrointestinal function in Parkinson’s disease (the MEDI-PD study): study protocol for a randomised controlled trial
Authors: Rusch Carley , Beke Matthew , Tucciarone Lily , Dixon Katherine , Nieves Carmelo , Mai Volker , Stiep Tamara , Tholanikunnel Tracy , Ramirez-Zamora Adolfo , Hess Christopher W , Langkamp-Henken Bobbi 
Published: September 2021

IntroductionConstipation is a common and sometimes debilitating non-motor symptom of Parkinson’s disease (PD) that can result in intestinal inflammation and microbial dysbiosis. The Mediterranean diet, rich in fermentable fibres and anti-inflammatory phenolic compounds, is associated with reduced risk of developing PD and slower progression of parkinsonism. The Mediterranean diet is often recommended for people with PD; however, no studies to date examine this diet as a therapeutic intervention to modulate gastrointestinal (GI) dysfunction.Methods and analysisThis is a randomised, controlled, parallel study. During a 2-week run-in, participants with PD and constipation symptoms (n=52) will undergo baseline nutritional and neurological assessments and provide a stool sample. Participants will be stratified by sex and Hoehn and Yahr stage and randomised to follow standard of care for constipation (control) or standard of care plus a Mediterranean diet (intervention) for 8 weeks. A study dietitian will provide dietary instruction and weekly follow-up via telephone to both groups to support adherence and monitor adverse events. Questionnaires will assess dietary intake and GI function including stool frequency, form, symptoms and laxative usage. Measurements completed at baseline will be repeated at 4 and 8 weeks of the intervention. The primary outcome is to evaluate the difference between mean change (final–baseline) in Gastrointestinal Symptom Rating Scale (GSRS) constipation syndrome scores for the control versus intervention groups. Secondary outcomes will assess stool frequency and form, weekly GSRS syndrome scores, digestive quality of life, laxative usage, faecal microbial communities and inflammatory markers, anxiety, depression, quality life, body weight and composition, dietary fibre intake and Mediterranean diet adherence.Ethics and disseminationThe study has received University of Florida Institutional Review Board-01 approval (IRB202001333). Findings will be disseminated via conference presentations, lectures and peer-reviewed publications.Trial registration numberNCT04683900.
Transition to clinical practice during the COVID-19 pandemic: a qualitative study of young doctors’ experiences in Brazil and Ireland
Authors: Montagna Erik , Donohoe Jessica , Zaia Victor , Duggan Eileen , O'Leary Paula , Waddington John , O'Tuathaigh Colm 
Published: September 2021

ObjectivesTo explore and compare the perspectives of junior doctors in Brazil and Ireland regarding transition and professional socialisation during the COVID-19 pandemic, with the purpose of identifying better ways to support doctors as they assume their new professional role.Design27 semistructured interviews. Transcripts were analysed using qualitative thematic analysis. Cruess’ framework of professional socialisation in medicine supported the interpretation of these data.SettingPublic health hospitals across four Brazilian states (Santa Catarina, São Paulo, Ceará, Paraíba) and County Cork in the South of Ireland.ParticipantsTwenty-seven male and female medical junior doctors who had graduated between November 2019 and April 2020.ResultsFourteen Brazilian and 13 Irish junior doctors were interviewed for this study. Entry to clinical practice during the pandemic had a significant impact on factors influencing the professional socialisation of junior doctors. This impact was reflected across the following six thematic areas: lack of preparedness; disrupted trajectory of role adaptation; fewer opportunities for experiential learning; solidarity and isolation; altered interactions with patients; challenges to health and well-being.ConclusionsTransition to clinical practice is an important stage in junior doctors’ professional socialisation and identity formation. The COVID-19 pandemic created the opportunity for medical graduates to enter the workforce earlier than usual. Entering the workforce during this period created a lack of confidence among junior doctors concerning the boundaries of their new role and responsibilities, while simultaneously disrupting their social integration. Priorities to mitigate the impact of COVID-19 and future pandemics on this transition are presented.
Higher-derivative Lorentz-breaking dispersion relations: a thermal description
Authors: Araújo Filho A. A. , Petrov A. Yu. 
Published: September 2021

AbstractThis paper is devoted to study the thermal aspects of a photon gas within the context of Planck-scale-modified dispersion relations. We study the spectrum of radiation and the correction to theStefan–Boltzmannlaw in different cases when the Lorentz symmetry is no longer preserved. Explicitly, we examine two models within the context of CPT-even and CPT-odd sectors respectively. To do so, three distinct scenarios of the Universe are considered: the Cosmic Microwave Background (CMB), the electroweak epoch, and the inflationary era. Moreover, the equations of state in these cases turn out to display a dependence on Lorentz-breaking parameters. Finally, we also provide for both theories the analyses of the Helmholtz free energy, the mean energy, the entropy and the heat capacity.
Towards an Integrated Vehicle Management System in DriveOS
Authors: Sinha Soham , West Richard 
Published: September 2021

Modern automotive systems feature dozens of electronic control units (ECUs) for chassis, body and powertrain functions. These systems are costly and inflexible to upgrade, requiring ever increasing numbers of ECUs to support new features such as advanced driver assistance (ADAS), autonomous technologies, and infotainment. To counter these challenges, we propose DriveOS, a safe, secure, extensible, and timing-predictable system for modern vehicle management in a centralized platform. DriveOS is based on a separation kernel, where timing and safety-critical ECU functions are implemented in a real-time OS (RTOS) alongside non-critical software in Linux or Android. The system enforces the separation, or partitioning, of both software and hardware among different OSes.
DriveOS runs on a relatively low-cost embedded PC-class platform, supporting multiple cores and hardware virtualization capabilities. Instrument cluster, in-vehicle infotainment and advanced driver assistance system services are implemented in a Yocto Linux guest, which communicates with critical real-time services via secure shared memory. The RTOS manages a real-time controller area network (CAN) interface that is inaccessible to Linux services except via well-defined and legitimate communication channels. In this work, we integrate three Qt-based services written for Yocto Linux, running in parallel with a real-time longitudinal controller task and multiple CAN bus concentrators, for vehicular sensor data processing and actuation. We demonstrate the benefits and performance of DriveOS with a hardware-in-the-loop CARLA simulation using a real car dataset.
Verified Lustre Normalization with Node Subsampling
Authors: Bourke Timothy , Jeanmaire Paul , Pesin Basile , Pouzet Marc 
Published: September 2021

Dataflow languages allow the specification of reactive systems by mutually recursive stream equations, functions, and boolean activation conditions called clocks. Lustre and Scade are dataflow languages for programming embedded systems. Dataflow programs are compiled by a succession of passes. This article focuses on the normalization pass which rewrites programs into the simpler form required for code generation.
Vélus is a compiler from a normalized form of Lustre to CompCert’s Clight language. Its specification in the Coq interactive theorem prover includes an end-to-end correctness proof that the values prescribed by the dataflow semantics of source programs are produced by executions of generated assembly code. We describe how to extend Vélus with a normalization pass and to allow subsampled node inputs and outputs. We propose semantic definitions for the unrestricted language, divide normalization into three steps to facilitate proofs, adapt the clock type system to handle richer node definitions, and extend the end-to-end correctness theorem to incorporate the new features. The proofs require reasoning about the relation between static clock annotations and the presence and absence of values in the dynamic semantics. The generalization of node inputs requires adding a compiler pass to ensure the initialization of variables passed in function calls.