bluuebunny/crossref_metadata_2025_split huggingface dataset:
Professional representation of conversational agents for health care: a scoping review protocol
Authors: MacNeill A. Luke , MacNeill Lillian , Doucet Shelley , Luke Alison 
Published: August 2021

ABSTRACT

Objective:
The purpose of this scoping review is to examine the professional representation of conversational agents that are used for health care. Professional characteristics associated with these agents will be identified, and the prevalence of these characteristics will be determined.

Introduction:
Conversational agents that are used for health care lack the qualifications and capabilities of real health professionals, but this fact may not be clear to some patients and health seekers. This problem may be exacerbated when conversational agents are described as health professionals or are given professional titles or appearances. To date, the professional representation of conversational agents that are used for health care has received little attention in the literature.

Inclusion criteria:
This review will include scholarly publications on conversational agents that are used for health care, particularly descriptive/developmental case studies and intervention/evaluation studies. This review will consider conversational agents designed for patients and health seekers, but not health professionals or trainees. Agents addressing physical and/or mental health will be considered.

Methods:
This review will be conducted in accordance with JBI methodology for scoping reviews. The databases to be searched will include MEDLINE (PubMed), Embase (Elsevier), CINAHL with Full Text (EBSCO), Scopus (Elsevier), Web of Science (Clarivate), ACM Guide to Computing Literature (ACM Digital Library), and IEEE Xplore (IEEE). The extracted data will include study characteristics, basic characteristics of the conversational agent, and characteristics relating to the professional representation of the conversational agent. The extracted data will be presented in tabular format and summarized using frequency analysis. These results will be accompanied by a narrative summary.
Application of Shape Factor to Mechanical Behavior of Thermal Interface Pads and Putties
Authors: Schoch Karl F. , Panackal Philip A. , Bimstefer M. Garrett , Brocki Amanda N. , Urban Daniel N. 
Published: August 2021

Abstract
Thermal interface materials (TIMs) are an essential part of managing the thermal performance of electronic assemblies. Knowledge of the mechanical properties of these materials is required in order to have a robust design that will perform as required over the life of the product, including many thermal cycles, without causing damage to electrical components. In this paper, we report on the mechanical properties of three putty TIMs and four pad TIMs, showing that the stiffness of the TIMs is proportional to the square of the initial shape factor over the range of shape factors from 1 to 18. Since the putties can flow more readily under pressure than the pads, the putties had a lower measured stiffness at a given shape factor compared to the pads. From these relationships, designers can predict loads with various geometries (i.e., shape factors) and loading rates (i.e., shock loading versus temperature cycling), which can impact their design. While all of the materials were tested at compressive strain rates of 20–70% strain/minute, one putty was also tested at a 10× higher rate to determine the effect of a relatively high strain rate on the peak stress. In that case, the peak stress was approximately 3× higher than measured at the lower strain rates. However, the relaxed load at each strain rate tested was unaffected by strain rate, indicating that hardware assembly conditions can be adjusted to minimize stress on components and yet, still achieve an interface having low thermal resistance.
Randomised trials of proton pump inhibitors for gastro-oesophageal reflux disease in patients with asthma: an updated systematic review and meta-analysis
Authors: Zheng Zhoude , Luo Yunyun , Li Jia , Gao Jinming 
Published: August 2021

ObjectiveAsthma often coexists with gastro-oesophageal reflux disease (GERD). The effect of proton pump inhibitors (PPIs) treatment on asthma concomitant with GERD was inconsistent. This study aimed to assess whether PPIs treatment improved morning peak expiratory flow (mPEF) in asthma patients with GERD.Data sourcesPubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library and ClinicalTrials.gov; hand searching for reference lists; contacted with authors if necessary.Study selectionAll eligible trials were randomised clinical trials comparing PPIs with placebo in asthma patients accompanying with GERD.ResultsFourteen randomised clinical trials (2182 participants) were included. Overall, PPIs versus placebo did not affect mPEF in patients with asthma having GERD (weighted mean difference 8.68 L/min, 95% CI −2.02 to 19.37, p=0.11). Trial sequential analysis (TSA) further confirmed this finding (TSA adjusted 95% CI −1.03 to 22.25). Subgroups analyses based on the percentage of patients with symptomatic GERD≥95%, treatment duration >12 weeks also found no statistically significant benefit on mPEF. Similarly, analyses of secondary outcomes (evening PEF, forced expiratory volume in 1 s, asthma symptoms score, asthma quality of life score and episodes of asthma exacerbation) did not show significant difference between PPIs and placebo.ConclusionIn this meta-analysis, PPIs therapy did not show a statistically significant improvement on mPEF in asthma patients having GERD, neither in subgroup with symptomatic GERD nor in subgroup with treatment duration >12 weeks. This analysis does not support a recommendation for PPIs therapy as empirical treatment in asthma patients with GERD.PROSPERO registration numberCRD42020177330.
Prewarming i-gel laryngeal mask for mechanical ventilation: a meta-analysis of randomised control trials and trial sequential analysis
Authors: Zheng Jianqiao , Du Li , Wang Jia , Zhang Lu , Chen Guo 
Published: August 2021

ObjectiveTo systematically evaluate the efficiency of prewarming i-gel laryngeal mask for mechanical ventilation by meta-analysis and trial sequential analysis.DesignSystematic review and meta-analysis.Data sourcesCochrane library, Web of Science, Ovid Medline and PubMed were searched from their inception to 31 August 2020. Only articles published in English language were considered.MethodsRandomised controlled trials (RCTs) comparing the efficiency of prewarming i-gel laryngeal mask versus keeping it at room temperature for mechanical ventilation were included. Primary outcome was sealing pressure immediately after successful ventilation. Secondary outcomes were the first-attempt insertion success rate and the incidence of postoperative pharyngeal pain. Two authors independently selected studies. Quality analysis was performed using the modified Jadad Scale. Trial sequential analysis (TSA) was used to control risk of random errors. Sensitivity analysis was done to assess the effect of a single study on the pooled estimates. Publication bias was assessed by funnel plots and Egger’s regression test.ResultsFour RCTs comprising 374 patients were included. The results of meta-analysis showed that compared with the control group, prewarming i-gel laryngeal mask provides a higher sealing pressure immediately after successful ventilation (mean difference 2.19 cm H2O; 95% CI (1.17 to 3.21); p<0.0001; high quality), with firm evidence from TSA and lower publication bias (p=0.7372). No significant difference was observed in the first-attempt insertion success rate (relative ratio (RR) 1.06; 95% CI (1.00 to 1.12); p=0.07; high quality) with lower publication bias (p=0.1378). The TSA indicating further trials are required. No significant difference was assessed in the incidence of postoperative pharyngeal pain (RR 1.0; 95% CI (0.14 to 6.90); p=1.0; high quality).ConclusionPrewarming i-gel laryngeal mask provides higher sealing pressure compared with keeping it at room temperature. But prewarming i-gel laryngeal mask did not increase the first-attempt insertion success rate, nor did it decrease the incidence of postoperative pharyngeal pain.
Risk factors for malignant transformation of hepatocellular adenoma to hepatocellular carcinoma: protocol for systematic review and meta-analysis
Authors: Thevathasan Tharusan , Colbatzky Teresa , Schmelzle Moritz , Pratschke Johann , Krenzien Felix 
Published: August 2021

IntroductionHepatocellular adenomas (HCAs) are solid liver tumours that are usually found incidentally during routine medical check-ups. Multiple modifiable and non-modifiable factors constitute a risk for the malignant transformation of HCAs to hepatocellular carcinoma (HCC), which has emerged to be one of the fastest growing causes of cancer-related mortality globally. This study protocol for a planned systematic review and meta-analysis documents the methodological approach to identify risk factors and their risk estimates for the transformation from HCA to HCC.Methods and analysisTwo independent reviewers will systematically search and extract data from studies in patients of all ages published between January 1970 and June 2021 on PubMed, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Scopus Web of Science, Ovid, The Cochrane Hepatobiliary Group Controlled Trials Register and The Cochrane Central Register of Controlled Trials by using ana prioridefined search strategy. Study quality will be rated with the National Institute of Health quality assessment tools. Disagreements will be resolved by consensus with a third independent reviewer. The primary outcome will be the odds ratio (OR) of developing HCC in patients with prediagnosed HCA depending on the exposure to risk factors. HCC diagnosis must be inferred based on imaging techniques or pathology. We will use R V.4.0.2 to conduct meta-analyses and generate pooled ORs based on random effects models. Results will be presented as forest plots. Cochran’s Q and I2test will be performed to assess heterogeneity between included studies. Funnel plots and Egger’s weighted regression will be used to evaluate publication bias.Ethics and disseminationNo ethical approval is required as we will use and analyse data from previously published studies in which informed consent was obtained. The results will be disseminated in a peer-reviewed journal on completion.PROSPERO registration numberCRD42020206578.
Impact of the COVID-19 pandemic on rural communities: a cross-sectional study in the Sichuan Province of China
Authors: Shafi Mohsin , Liu Junrong , Jian Deng , Rahman Imran Ur , Chen Xunwei 
Published: August 2021

ObjectiveRecently, China has experienced a considerable influence of the COVID-19 pandemic on the local people’s health and economy. Hence, the current research aims to investigate the psychological and socioeconomic impact of COVID-19 on rural communities in the Sichuan Province of China.MethodsA total of 499 participants (village representatives of Sichuan Province) were approached to partake in a cross-sectional online survey and share their experience regarding the ongoing pandemic. The descriptive statistics and ordinary least squares (OLS) regression were used to analyse the data.ResultsOur analysis revealed that the pandemic has significantly affected local people psychologically, leading to socioeconomic vulnerability. Notably, we find that local households are worried about their income losses regardless of their socioeconomic status (40%–43%), level of income (37%–43%) and industry involvement (38%–43%). However, as income increases, the level of stress decreases. The results further show that government transfer payment is a significant factor in reducing stress due to its reliable and uninterrupted income flow. Contrary to our proposition, the pandemic stress was less observed, which might be because of people’s trust in government and effective antiepidemic countermeasures to contain the disease.ConclusionThis study finds that COVID-19 has a significant impact on local people’s health, psychology and income. This study is one of the first to provide empirical evidence regarding the early health and socioeconomic effects of COVID-19 at the household level in rural communities, which are very important to devise policies to ease the outbreak and prevent further losses at the local community level.
Factors that facilitate or hinder whole system integrated care for obesity and mental health: a scoping review protocol
Authors: Liapi Fani , Chater Angel , Randhawa Gurch , Pappas Yannis 
Published: August 2021

IntroductionIntegrated care aims to improve population health. Obesity and mental health are major health issues worldwide. The complexity of the multifactorial drivers of these public health problems has led to the adoption of a whole system approach. This review aims to highlight factors that influence the planning, implementation and evaluation of whole system integrated care for these conditions.Methods and analysisUsing the framework of Arksey and O’ Malley, we will perform a comprehensive search in the following databases: MEDLINE, CINAHL, PsychINFO, PubMed, British Nursing Database, Web of Science, Health Systems Evidence, Cochrane Library and University of York Centre for Reviews and Dissemination. Further hand-search of reference lists and the grey literature will be conducted. The search will be restricted to articles published from 2000 to 2020. The review is expected to be completed by August 2021. Full texts of the potential studies will be screened for the inclusion criteria. Quality of studies will be appraised. Narrative synthesis will be completed using data extracted from the included studies.Ethics and disseminationA favourable ethics opinion for this study was obtained from the Institute for Health Research Ethics Committee of the University of Bedfordshire (IHREC937). This review expects to identify information relating to factors that facilitate or hinder whole system integrated care for obesity and mental health. The finding from this review will be widely disseminated to stakeholders to inform implementation of whole system integrated care initiatives.
Navigating the shifting sands of filtering facepiece respirator provision during the COVID-19 pandemic: a system response for maximising staff safety
Authors: Allison Carrick , Tennant Mike , Xiang Peter , Stephens Jennifer , Ball Oliver , Wilton Niall 
Published: August 2021

IntroductionPersonal protective equipment is essential to protect health workers and patients and to ensure confidence when dealing with aerosolised disease transmission. We describe the process for ensuring adequate filtering facepiece respirator (FFR) qualitative fit testing at a local level during the COVID-19 pandemic.MethodsCascaded training is described, which allowed rapid spreading of the testing process, with supervision allowing quality assurance throughout. Testing consisted of subjective ‘fit checking’, checking for leaks, followed by qualitative hood testing.ResultsThe original respirators (3M 1870) had a hood test pass rate of 87.5%. Following identification of this as a non-renewable and unsustainable option, a domestically manufactured and sustainable Help-It P2 duckbill-type respirator was adopted as the primary FFR. The hood test pass rate for this respirator was only 54%. A third respirator was made available (3M 1860), with a high pass rate of 80% but also a limited and non-renewable resource. Algorithms were constructed highlighting different proportional use of the respirators depending on the most limited resource.ConclusionThe testing format used is simple, reproducible and can be used by any hospital organisation when occupational health and safety departments are unable to provide the service during overwhelming demand. Qualitative fit testing is a scalable and effective method for ensuring appropriately sized and shaped FFRs, minimising resource consumption in the process. The use of a product with appropriate filtration capacity but a lower fit test pass rate (domestic duckbill respirator) as a replaceable resource facilitated adequate respirator availability for staff that would otherwise not have been possible. The provision of an FFR fit registry allows an organisation to make appropriate respirators available to staff from different sources as supply and demand changes.
COVID-19 admission risk tools should include multiethnic age structures, multimorbidity and deprivation metrics for air pollution, household overcrowding, housing quality and adult skills
Authors: Soltan Marina A , Varney Justin , Sutton Benjamin , Melville Colin R , Lugg Sebastian T , Parekh Dhruv , Carroll Will , Dosanjh Davinder P , Thickett David R 
Published: August 2021

BackgroundEthnic minorities account for 34% of critically ill patients with COVID-19 despite constituting 14% of the UK population. Internationally, researchers have called for studies to understand deterioration risk factors to inform clinical risk tool development.MethodsMulticentre cohort study of hospitalised patients with COVID-19 (n=3671) exploring determinants of health, including Index of Multiple Deprivation (IMD) subdomains, as risk factors for presentation, deterioration and mortality by ethnicity. Receiver operator characteristics were plotted for CURB65 and ISARIC4C by ethnicity and area under the curve (AUC) calculated.ResultsEthnic minorities were hospitalised with higher Charlson Comorbidity Scores than age, sex and deprivation matched controls and from the most deprived quintile of at least one IMD subdomain: indoor living environment (LE), outdoor LE, adult skills, wider barriers to housing and services. Admission from the most deprived quintile of these deprivation forms was associated with multilobar pneumonia on presentation and ICU admission. AUC did not exceed 0.7 for CURB65 or ISARIC4C among any ethnicity except ISARIC4C among Indian patients (0.83, 95% CI 0.73 to 0.93). Ethnic minorities presenting with pneumonia and low CURB65 (0–1) had higher mortality than White patients (22.6% vs 9.4%; p<0.001); Africans were at highest risk (38.5%; p=0.006), followed by Caribbean (26.7%; p=0.008), Indian (23.1%; p=0.007) and Pakistani (21.2%; p=0.004).ConclusionsEthnic minorities exhibit higher multimorbidity despite younger age structures and disproportionate exposure to unscored risk factors including obesity and deprivation. Household overcrowding, air pollution, housing quality and adult skills deprivation are associated with multilobar pneumonia on presentation and ICU admission which are mortality risk factors. Risk tools need to reflect risks predominantly affecting ethnic minorities.
Refined atrial fibrillation screening and cost-effectiveness in the German population
Authors: Schnabel Renate B , Wallenhorst Christopher , Engler Daniel , Blankenberg Stefan , Pfeiffer Norbert , Spruenker Ngoc Anh , Buettner Matthias , Michal Matthias , Lackner Karl J , Münzel Thomas , Wild Philipp S , Martinez Carlos , Freedman Ben 
Published: August 2021

ObjectiveLittle is known on optimal screening population for detecting new atrial fibrillation (AF) in the community. We describe characteristics and estimate cost-effectiveness for a single timepoint electrocardiographic screening.MethodsWe performed a 12-lead ECG in the German population-based Gutenberg Health Study between 2007 and 2012 (n=15 010), mean age 55±11 years, 51% men and collected more than 120 clinical and biomarker variables, including N-terminal pro B-type natriuretic peptide (Nt-proBNP), risk factors, disease symptoms and echocardiographic variables.ResultsOf 15 010 individuals, 466 (3.1%) had AF. New AF was found in 32 individuals, 0.2% of the total sample, 0.5% of individuals aged 65–74 years and predominantly men (86%). The classical risk factor burden was high in individuals with new AF. The median estimated stroke risk was 2.2%/year, while risk of developing heart failure was 21% over 10 years. In the 65–74 year age group, the cost per quality-adjusted life-year gained resulting from a single timepoint screening was €30 361. In simulations, the costs were highly sensitive to AF detection rates, proportion of treatment and type of oral anticoagulant. Prescreening by Nt-proBNP measurements was not cost-effective in the current setting.ConclusionsIn our middle-aged population cohort, we identified 0.2% new AF by single timepoint screening. There was a significant estimated risk of stroke and heart failure in these individuals. Cost-effectiveness for screening may be reached in individuals aged 65 years and older. The simple age cut-off is not improved by using Nt-proBNP as a biomarker to guide a screening programme.
Global DNA hypermethylation in peripheral blood mononuclear cells and cardiovascular disease risk: a population-based propensity score-matched cohort study
Authors: Tsuboi Yoshiki , Yamada Hiroya , Munetsuna Eiji , Fujii Ryosuke , Yamazaki Mirai , Ando Yoshitaka , Mizuno Genki , Ishikawa Hiroaki , Ohashi Koji , Hashimoto Shuji , Hamajima Nobuyuki , Suzuki Koji 
Published: August 2021

BackgroundDNA methylation plays an important role in the pathogenesis and progression of cardiovascular disease (CVD) but the prospective association of DNA methylation with CVD has not been evaluated. Here, we conducted a prospective study to examine whether long interspersed nuclear element-1 (LINE-1) DNA methylation is associated with CVD mortality in a Japanese population.MethodsWe targeted 822 Japanese who participated in a health check-up in 1990 and had no clinical history of cancer, stroke or ischaemic heart disease. DNA was extracted from peripheral blood mononuclear cells and LINE-1 DNA methylation at three CpG sites was measured using a pyrosequencing method. We used propensity score (PS) matching to reduce the effect of potential confounding.ResultsDuring 18 118.7 persons-years of follow-up, there were 329 deaths from all-causes and 85 deaths from CVD. In PS-matched analysis, a significantly higher HR for CVD mortality was observed in the hypermethylation group than in the hypomethylation group for elderly participants (HR 2.77; 95% CI 1.55 to 4.93). No significant association between LINE-1 DNA methylation and CVD was observed for middle-aged participants.ConclusionsBased on this prospective study, we suggest that LINE-1 DNA hypermethylation is associated with increased CVD mortality risk in an elderly population.