bluuebunny/crossref_metadata_2025_split huggingface dataset:
Digital breast tomosynthesis: sensitivity for cancer in younger symptomatic women
Authors: Whelehan Patsy , Ali Kulsam , Vinnicombe Sarah , Ball Graham , Cox Julie , Farry Paul , Jenkin Maggie , Lowry Keith , McIntosh Stuart A , Nutt Rachel , Oeppen Rachel , Reilly Michael , Stahnke Michaela , Steel Jim , Sim Yee Ting , Warwick Violet , Wilkinson Louise , Zafeiris Dimitrios , Evans Andrew J 
Published: January 2021

Objective:
Full-field digital mammography (FFDM) has limited sensitivity for cancer in younger women with denser breasts. Digital breast tomosynthesis (DBT) can reduce the risk of cancer being obscured by overlying tissue. The primary study aim was to compare the sensitivity of FFDM, DBT and FFDM-plus-DBT in women under 60 years old with clinical suspicion of breast cancer.

Methods:
This multicentre study recruited 446 patients from UK breast clinics. Participants underwent both standard FFDM and DBT. A blinded retrospective multireader study involving 12 readers and 300 mammograms (152 malignant and 148 benign cases) was conducted.

Results:
Sensitivity for cancer was 86.6% with FFDM [95% CI (85.2–88.0%)], 89.1% with DBT [95% CI (88.2–90%)], and 91.7% with FFDM+DBT [95% CI (90.7–92.6%)]. In the densest breasts, the maximum sensitivity increment with FFDM +DBT over FFDM alone was 10.3%, varying by density measurement method. Overall specificity was 81.4% with FFDM [95% CI (80.5–82.3%)], 84.6% with DBT [95% CI (83.9–85.3%)], and 79.6% with FFDM +DBT [95% CI (79.0–80.2%)]. No differences were detected in accuracy of tumour measurement in unifocal cases.

Conclusions:
Where available, DBT merits first-line use in the under 60 age group in symptomatic breast clinics, particularly in women known to have very dense breasts.

Advances in knowledge:
This study is one of very few to address the accuracy of DBT in symptomatic rather than screening patients. It quantifies the diagnostic gains of DBT in direct comparison with standard digital mammography, supporting informed decisions on appropriate use of DBT in this population.
From impact evaluation to decision-analysis: assessing the extent and quality of evidence on ‘value for money’ in health impact evaluations in low- and middle-income countries
Authors: Kreif Noemi , Mirelman Andrew J. , Love-Koh James , Kim Sangjun , Moreno-Serra Rodrigo , Revill Paul , Sculpher Mark , Suhrcke Marc 
Published: January 2021

Background:Health impact evaluations (HIEs) are currently the main way of assessing policy changes in low-and middle-income countries (LMICs). However, evidence on effectiveness alone cannot reliably inform decisions over the allocation of limited resources. Health economic evaluation provides a suitable framework for ‘value for money’ assessments.Methods:In this article we explore to what extent economic evaluations have been conducted alongside published health impact evaluations, then we assess the quality of these, using criteria from an economic evaluation reference case developed for use in LMICs.Results:Among the 2419 HIEs stored in the International Initiative for Impact Evaluations (3ie) database, and among the 8155 studies identified by the Ovid Medline database search, only 70 studies included an economic evaluation. When measured against the quality assessment criteria, study quality showed great variation. Many studies did not fulfil the basic requirements for economic evaluation, such as stating the perspective of the budget holder, using generic health measures that can be compared across diseases, or suitably reflecting uncertainty.Conclusions:Greater effort should be directed towards bringing the fields of impact evaluation and economic evaluation together to better inform resource allocation decisions in global health.
A meta-analysis of COVID-19: Challenging Australias’ Vocational Education sector
Authors: Pearson Matthew 
Published: January 2021

With the advent of the digital age, vocational education and associated policy documents can create an awkward marriage for the student and educator. For the student, the move to an online platform of learning containing digital tools is more than just mastery of a program but requires support, to resolve the financial costs and connectivity issues associated with learning in isolation. For the educator, online platforms provide a challenge not only will they became a student to learn the new platform. The educator confronted with new or unfamiliar pedagogical practices vastly different from their past learning experiences. However, the digital divide is complexing with no one issue attributing or resolving the digital divide.
70 mJ nonlinear compression and scaling route for an Yb amplifier using large-core hollow fibers
Authors: Fan G. , Carpeggiani P. A. , Tao Z. , Coccia G. , Safaei R. , Kaksis E. , Pugzlys A. , Légaré F. , Schmidt B. E. , Baltuška A. 
Published: January 2021

In this Letter, we investigate the energy-scaling rules of hollow-core fiber (HCF)-based nonlinear pulse propagation and compression merged with high-energy Yb-laser technology, in a regime where the effects such as plasma disturbance, optical damages, and setup size become important limiting parameters. As a demonstration, 70 mJ 230 fs pulses from a high-energy Yb laser amplifier were compressed down to 40 mJ 25 fs by using a 2.8-m-long stretched HCF with a core diameter of 1 mm, resulting in a record peak power of 1.3 TW. This work presents a critical advance of a high-energy pulse (hundreds of mJ level) nonlinear interactions platform based on high energy sub-ps Yb technology with considerable applications, including driving intense THz, X-ray pulses, Wakefield acceleration, parametric wave mixing and ultraviolet generation, and tunable long-wavelength generation via enhanced Raman scattering.
Assessment patient satisfaction towards emergency medical care and its determinants at Ayder comprehensive specialized hospital, Mekelle, Northern Ethiopia
Authors: Molalign Takele Goitom , Abreha Weldesenbet Negash , Girmay Nahom , Degefe Habtamu , Kinfe Rigbe 
Published: January 2021

BackgroundAs the healthcare industry shifts toward patient-centered models, providers will need to fully understand patient satisfaction and how they affect their practices. This study aimed to assess patient satisfaction towards the emergency medical care and factors associated with at Ayder specialized comprehensive hospital, Emergency room, Mekelle, Ethiopia.MethodsAn institution-based cross-sectional study was conducted from March 1–30, 2019. A systematic random sampling method was used to enroll 299 study participants. Data were collected using a standard Brief Emergency Department Patient Satisfaction Scale questionnaire by trained data collectors. Data was entered into EpiData 3.1 then exported and analyzed by SPSS version 22. Binary and multiple logistic regression were used to assess the factors associated with patient satisfaction. Where the p-value of <0.05 was considered significant.ResultsA total of 299 participants were enrolled in the study with a response rate of 99.3%. On overall patient satisfaction score majority (81.9%) of them were satisfied with the emergency medical care provided. The satisfaction rate towards emergency staff courtesy, emergency room environment, physician care satisfaction, general patient satisfaction, and patient family satisfaction was 80.3%, 37.5%, 75.9%, 70.9%, and 49.8% respectively. Those who arrived during the morning time of the day tend to be satisfied more with the emergency services (AOR = 4.8, 95% CI: 2.08, 11.4), while having low educational status (able to read and write) (AOR = 0.12, 95% CI: 0.03, 0.50) and waiting time till seen by a doctor (AOR = 1.3, 95% CI: 1.003, 1.4) was found to affect patient satisfaction negatively.ConclusionsThe total patient satisfaction score towards emergency medical care was found to be good. The hospital management and emergency room staff should act on the identified factors especially on minimizing the patients waiting time to improve the quality of care in the emergency department.
Nobody ever questions—Polypharmacy in care homes: A mixed methods evaluation of a multidisciplinary medicines optimisation initiative
Authors: Jordan Sue , Prout Hayley , Carter Neil , Dicomidis John , Hayes Jamie , Round Jeffrey , Carson-Stevens Andrew 
Published: January 2021

Background
Nurse-led monitoring of patients for signs and symptoms associated with documented ‘undesirable effects’ of medicines has potential to prevent avoidable harm, and optimise prescribing.

Intervention
The Adverse Drug Reaction Profile for polypharmacy (ADRe-p) identifies and documents putative adverse effects of medicines commonly prescribed in primary care. Nurses address some problems, before passing ADRe-p to pharmacists and prescribers for review, in conjunction with prescriptions.

Objectives
We investigated changes in: the number and nature of residents’ problems as recorded on ADRe-p; prescription regimens; medicines optimisation: and healthcare costs. We explored aetiologies of problems identified and stakeholders’ perspectives.

Setting and participants
In three UK care homes, 19 residents completed the study, December 2018 to May 2019. Two service users, three pharmacists, six nurses gave interviews.

Methods
This mixed-method process evaluation integrated data from residents’ ADRe-ps and medicines charts, at the study’s start and 5–10 weeks later.

Results
We recruited three of 27 homes approached and 26 of 45 eligible residents; 19 completed ADRe-p at least twice. Clinical gains were identified for 17/19 residents (mean number of symptoms 3 SD 1.67, range 0–7). Examples included management of: pain (six residents), seizures (three), dyspnoea (one), diarrhoea (laxatives reduced, two), falls (two of five able to stand). One or more medicine was de-prescribed or dose reduced for 12/19 residents. ADRe administration and review cost ~£30 in staff time. ADRe-p helped carers and nurses bring residents’ problems to the attention of prescribers.

Implications
ADRe-p relieved unnecessary suffering. It supported carers and nurses by providing a tool to engage with pharmacists and prescribers, and was the only observable strategy for multidisciplinary team working around medicines optimisation. ADRe-p improved care by: a) regular systematic checks and problem documentation; b) information transfer from care home staff to prescribers and pharmacists; c) recording changes.

Registration
NLM Identifier NCT03955133; ClinicalTrials.gov.
Altered acylated ghrelin response to food intake in congenital generalized lipodystrophy
Authors: Araújo Camilla O. D. , Montenegro Renan M. , Pedroso Amanda P. , Fernandes Virgínia O. , Montenegro Ana Paula D. R. , de Carvalho Annelise B. , Oyama Lila M. , Maia Carla S. C. , Ribeiro Eliane B. 
Published: January 2021

Background
Patients with congenital generalized lipodystrophy (CGL) have very low levels of leptin and are described as having a voracious appetite. However, a direct comparison between CGL and eutrophic individuals is lacking, regarding both appetite parameters and acylated ghrelin, the hormone form that is active in acute food intake stimulation. The objective of the present study was to address whether and in what extent the subjective appetite parameters and acylated ghrelin response to a meal are affected in CGL individuals, in comparison to eutrophic individuals. Additionally, an obese group was included in the study, to allow the comparison between a leptin-resistant and a leptin-deficient condition on these aspects.

Methods
Eutrophic controls (EUT, n = 10), obese subjects (OB, n = 10) and CGL (n = 11) were fasted overnight and then received an ad libitum meal. Blood was collected and the visual analogue scale was applied before and 90 minutes after the meal. An additional blood sample was collected at 60 minutes for ghrelin determination.

Results
The CGL patients showed low fasting levels of leptin and adiponectin, dyslipidemia, and insulin resistance. The caloric intake was similar among the 3 groups. However, both CGL (p = 0.02) and OB (p = 0.04) had shorter satiation times than EUT. The CGL patients also had lower satiety time (p = 0.01) and their sensation of hunger was less attenuated by the meal (p = 0.03). Fasting acylated ghrelin levels were lower in CGL than in EUT (p = 0.003). After the meal, the levels tended to decrease in EUT but not in CGL and OB individuals.

Conclusion
The data indicate that, although not hyperphagic, the CGL patients present appetite disturbances in relation to eutrophic individuals. Their low fasting levels of acylated ghrelin and the absence of the physiological drop after meal intake suggest a role of these disturbances in hunger attenuation and satiety but not in acute satiation.
Comparison of clinical outcomes between multiple antithrombotic therapy versus left atrial appendage occlusion with dual antiplatelet therapy in patients with atrial fibrillation undergoing drug-eluting stent implantation
Authors: Kook Hyungdon , Kim Hee-Dong , Shim Jaemin , Kim Young-Hoon , Kim Jung-Sun , Pak Hui-Nam , Lee Hyun-Jong , Choi Rak-Kyeong , Kang Woong-Chol , Shin Eun-Seok , Park Jai-Wun , Yu Cheol Woong , Lim Do-Sun 
Published: January 2021

Background
Complex antithrombotic regimens are recommended for patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation but carry high bleeding risk.

Hypothesis
We aimed to evaluate whether left atrial appendage occlusion (LAAO) with dual antiplatelet therapy (DAPT) improve clinical outcomes when compared with multiple antithrombotic therapy (MAT) in patients with AF undergoing DES implantation.

Methods
Among 475 AF patients who underwent DES, 41 patients treated by LAAO with DAPT and 434 patients on MAT were compared. MAT was defined as any combination of warfarin-based antithrombotic therapy. Among the MAT group, 34.8% were on triple antithrombotic therapy. The primary endpoint was a net adverse clinical event (NACE), a composite of cerebrovascular accident (CVA) and major bleeding. Secondary endpoints were CVA, major bleeding, major adverse cardiac and cerebral event (MACCE), MI, cardiovascular death, and all-cause death. Additional analysis between the new oral anticoagulant (NOAC)-based antithrombotic therapy group (n = 45) and the LAAO group was performed for the same endpoints. To adjust the confounding factors, inverse probability of treatment weighting (IPTW) was applied during the endpoint analysis.

Results
The LAAO group showed higher incidences of diabetes mellitus, prior CVA, higher CHA2DS2-VASc score (4.56±1.55 vs. 2.96±1.60; P<0.0001), and higher HAS-BLED score (3.24±1.20 vs. 2.13±0.75; P<0.0001). NACE occurred less frequently in the LAAO group than the MAT group at 24 months (9.4% vs. 15.3%; hazard ratio 0.274; 95% confidence interval 0.136 – 0.553; P = 0.0003), mainly driven by the reduction in major bleeding (2.4% vs. 9.3%; hazard ratio 0.119; 95% confidence interval 0.032 – 0.438; P = 0.001). The LAAO group with greater thrombotic and hemorrhagic risks showed comparable primary/secondary outcomes with the NOAC-based anti-thrombotic therapy group.

Conclusions
Among patients with AF who underwent DES implantation, the LAAO group had better net clinical outcomes for preventing CVA and major bleeding than the MAT group. Further large-scale trials including comparisons with NOACs are warranted.
Overestimation of volatility in schizophrenia and autism? A comparative study using a probabilistic reasoning task
Authors: Kreis Isabel , Biegler Robert , Tjelmeland Håkon , Mittner Matthias , Klæbo Reitan Solveig , Pfuhl Gerit 
Published: January 2021

Background and objectives
A plethora of studies has investigated and compared social cognition in autism and schizophrenia ever since both conditions were first described in conjunction more than a century ago. Recent computational theories have proposed similar mechanistic explanations for various symptoms beyond social cognition. They are grounded in the idea of a general misestimation of uncertainty but so far, almost no studies have directly compared both conditions regarding uncertainty processing. The current study aimed to do so with a particular focus on estimation of volatility, i.e. the probability for the environment to change.

Methods
A probabilistic decision-making task and a visual working (meta-)memory task were administered to a sample of 86 participants (19 with a diagnosis of high-functioning autism, 21 with a diagnosis of schizophrenia, and 46 neurotypically developing individuals).

Results
While persons with schizophrenia showed lower visual working memory accuracy than neurotypical individuals, no significant group differences were found for metamemory or any of the probabilistic decision-making task variables. Nevertheless, exploratory analyses suggest that there may be an overestimation of volatility in subgroups of participants with autism and schizophrenia. Correlations revealed relationships between different variables reflecting (mis)estimation of uncertainty, visual working memory accuracy and metamemory.

Limitations
Limitations include the comparably small sample sizes of the autism and the schizophrenia group as well as the lack of cognitive ability and clinical symptom measures.

Conclusions
The results of the current study provide partial support for the notion of a general uncertainty misestimation account of autism and schizophrenia.
Obesity defined by body mass index and waist circumference and risk of total knee arthroplasty for osteoarthritis: A prospective cohort study
Authors: Lim Yuan Z. , Wang Yuanyuan , Cicuttini Flavia M. , Giles Graham G. , Graves Stephen , Wluka Anita E. , Hussain Sultana Monira 
Published: January 2021

ObjectiveTo examine the risk of total knee arthroplasty (TKA) due to osteoarthritis associated with obesity defined by body mass index (BMI) or waist circumference (WC) and whether there is discordance between these measures in assessing this risk.Methods36,784 participants from the Melbourne Collaborative Cohort Study with BMI and WC measured at 1990–1994 were included. Obesity was defined by BMI (≥30 kg/m2) or WC (men ≥102cm, women ≥88cm). The incidence of TKA between January 2001 and December 2018 was determined by linking participant records to the National Joint Replacement Registry.ResultsOver 15.4±4.8 years, 2,683 participants underwent TKA. There were 20.4% participants with BMI-defined obesity, 20.8% with WC-defined obesity, and 73.6% without obesity defined by either BMI or WC. Obesity was classified as non-obese (misclassified obesity) in 11.7% of participants if BMI or WC alone was used to define obesity. BMI-defined obesity (HR 2.69, 95%CI 2.48–2.92), WC-defined obesity (HR 2.28, 95%CI 2.10–2.48), and obesity defined by either BMI or WC (HR 2.53, 95%CI 2.33–2.74) were associated with an increased risk of TKA. Compared with those without obesity, participants with misclassified obesity had an increased risk of TKA (HR 2.06, 95%CI 1.85–2.30). 22.7% of TKA in the community can be attributable to BMI-defined obesity, and a further 3.3% of TKA can be identified if WC was also used to define obesity.ConclusionsBoth BMI and WC should be used to identify obese individuals who are at risk of TKA for osteoarthritis and should be targeted for prevention and treatment.
Personality dimensions of patients can change during the course of parkinson’s disease
Authors: Boussac Mathilde , Arbus Christophe , Dupouy Julia , Harroch Estelle , Rousseau Vanessa , Croiset Aurélie , Ory-Magne Fabienne , Rascol Olivier , Moreau Caroline , Rolland Anne-Sophie , Maltête David , Rouaud Tiphaine , Meyer Mylène , Drapier Sophie , Giordana Bruno , Anheim Mathieu , Hainque Elodie , Jarraya Béchir , Benatru Isabelle , Auzou Nicolas , Belamri Lhaouas , Tir Mélissa , Marques Ana-Raquel , Thobois Stephane , Eusebio Alexandre , Corvol Jean Christophe , Devos David , Brefel-Courbon Christine ,   on behalf of the PREDI-STIM study group
Published: January 2021

Background
Studies assessing personality dimensions by the “Temperament and Character Inventory” (TCI) have previously found an association between Parkinson’s disease (PD) and lower Novelty Seeking and higher Harm Avoidance scores. Here, we aimed to describe personality dimensions of PD patients with motor fluctuations and compare them to a normative population and other PD populations.

Methods
All PD patients awaiting Deep Brain Stimulation (DBS) answered the TCI before neurosurgery. Their results were compared to those of historical cohorts (a French normative population, a de novo PD population, and a PD population with motor fluctuations).

Results
Most personality dimensions of our 333 included PD patients with motor fluctuations who are candidates for DBS were different from those of the normative population and some were also different from those of the De Novo PD population, whereas they were similar to those of another population of PD patients with motor fluctuations.

Conclusions
During the course of PD, personality dimensions can change in parallel with the development of motor fluctuations, either due to the evolution of the disease and/or dopaminergic treatments.
Patients’ experiences and wellbeing after injury: A focus group study
Authors: Visser Eva , Den Oudsten Brenda Leontine , Traa Marjan Johanna , Gosens Taco , De Vries Jolanda 
Published: January 2021

Background
Injury can have physical, psychological and social consequences. It is unclear which factors have an impact on patients’ wellbeing after injury. This study aimed to explore, using focus groups, patients’ experiences and wellbeing after injury and which factors, impede or facilitate patients’ wellbeing.

Methods
Trauma patients, treated in the shock room of the Elisabeth-TweeSteden Hospital, the Netherlands, participated in focus groups. Purposive sampling was used. Exclusion criteria were younger than 18 years old, severe traumatic brain injury, dementia, and insufficient knowledge of the Dutch language. The interviews were recorded, transcribed verbatim, and analyzed using coding technique open, axial, and selective coding, based on phenomenological approach.

Results
Six focus groups (3 to 7 participants) were held before data saturation was reached. In total, 134 patients were invited, 28 (21%) agreed to participate (Median age: 59.5; min. 18 –max. 84). Main reasons to decline were fear that the discussion would be too confronting or patients experienced no problems regarding the trauma or treatment. Participants experienced difficulties on physical (no recovery to pre-trauma level), psychological (fear of dying or for permanent limitations, symptoms of posttraumatic stress disorder, cognitive dysfunction), social (impact on relatives and social support) wellbeing. These are impeding factors for recovery. However, good communication, especially clarity about the injury and expectations concerning recovery and future perspectives could help patients in surrendering to care. Patients felt less helpless when they knew what to expect.

Conclusions
This is the first study that explored patients’ experiences and wellbeing after injury. Patients reported that their injury had an impact on their physical, psychological, and social wellbeing up to 12 months after injury. Professionals with the knowledge of consequences after injury could improve their anticipation on patients’ need.