bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preparing for partnerships in cancer care: an explorative analysis of the role of family-based caregivers
Authors: Harrison Reema , Raman Madhav , Walpola Ramesh Lahiru , Chauhan Ashfaq , Sansom-Daly Ursula M. 
Published: June 2021

AbstractBackgroundFamily-based ‘informal’ caregivers are critical to enable sustainable cancer care that produces optimal health outcomes but also gives rise to psychological burdens on caregivers. Evidence of psychosocial support for caregivers does not currently address the impacts of their role in providing clinical and health-related care for their loved ones. The present study sought to address this gap including with those from priority populations.MethodsQualitative data was collected using focus group and interview methods. We purposively sampled caregivers identified as having a high burden of responsibility for providing clinical care including those from ethnic minority backgrounds, parental caregivers and those living rurally. Transcripts were subject to thematic analysis utilising a team-based approach.ResultsFamily-based caregivers included spouses (11), parents (7), children (1), siblings (1). Ten participants were from ethnic minority backgrounds and five participants were from regional or rural locations. Four resulting inter-related themes were; 1) Dual burden of providing clinical care and managing personal emotional distress; 2) Navigating healthcare partnership dynamics; 3) Developing a caregiving skillset, and 4) Unique supportive needs and barriers to access. These data provide evidence of the unique challenge of providing clinical care as part of family-based caregiving for a loved one with cancer, and the absence of support for caregivers to take up this role.ConclusionOur findings highlight the substantial contribution of family-based caregivers to the provision of cancer care in contemporary health systems. Inadequate support for caregivers is apparent with regard to their role in providing clinical aspects of care such as medication administration and management. Support programs to prepare caregivers to provide clinical care while building capacity to manage their stressors and emotions through this challenging period may be valuable towards sustainable, person-centred care.
The state of harm reduction in prisons in 30 European countries with a focus on people who inject drugs and infectious diseases
Authors: Stöver Heino , Tarján Anna , Horváth Gergely , Montanari Linda 
Published: June 2021

Abstract
Background
People who inject drugs are often imprisoned, which is associated with increased levels of health risks including overdose and infectious diseases transmission, affecting not only people in prison but also the communities to which they return. This paper aims to give an up-to-date overview on availability, coverage and policy framework of prison-based harm reduction interventions in Europe.

Methods
Available data on selected harm reduction responses in prisons were compiled from international standardised data sources and combined with a questionnaire survey among 30 National Focal Points of the European Monitoring Centre for Drugs and Drug Addiction to determine the level of availability, estimated coverage and policy framework of the interventions.

Results
Information about responses to health harms in prisons is limited and heterogeneous. Cross-country comparability is hampered by diverging national data collection methods. Opioid substitution treatment (OST) is available in 29 countries, but coverage remains low (below 30% of people in need) in half of the responding countries. Needle and syringe programmes, lubricant distribution, counselling on safer injecting and tattooing/piercing are scarcely available. Testing for infectious diseases is offered but mostly upon prison entry, and uptake remains low in about half of the countries. While treatment of infections is mostly available and coverage is high for human immunodeficiency virus (HIV) and tuberculosis, hepatitis B and C treatment are less often provided. Health education as well as condom distribution is usually available, but provision remains low in nearly half of the countries. Post-release linkage to addiction care as well as to treatment of infections is available in a majority of countries, but implementation is often partial. Interventions recommended to be provided upon release, such as OST initiation, take-home naloxone and testing of infections, are rarely provided. While 21 countries address harm reduction in prison in national strategic documents, upon-release interventions appear only in 12.

Conclusions
Availability and coverage of harm reduction interventions in European prisons are limited, compared to the community. There is a gap between international recommendations and ‘on-paper’ availability of interventions and their actual implementation. Scaling up harm reduction in prison and throughcare can achieve important individual and public-health benefits.
Climatic niche differences among Zootoca vivipara clades with different parity modes: implications for the evolution and maintenance of viviparity
Authors: Horreo J. L. , Jiménez-Valverde A. , Fitze P. S. 
Published: June 2021

AbstractParity mode (oviparity/viviparity) importantly affects the ecology, morphology, physiology, biogeography and evolution of organisms. The main hypotheses explaining the evolution and maintenance of viviparity are based on bioclimatic predictions and also state that the benefits of viviparity arise during the reproductive period. We identify the main climatic variables discriminating between viviparous and oviparous Eurasian common lizard (Zootoca vivipara) occurrence records during the reproductive period and over the entire year.Analyses based on the climates during the reproductive period show that viviparous clades inhabit sites with less variable temperature and precipitation. On the contrary, analyses based on the annual climates show that viviparous clades inhabit sites with more variable temperatures.Results from models using climates during reproduction are in line with the “selfish-mother hypothesis”, which can explain the success of viviparity, the maintenance of the two reproductive modes, and why viviparous individuals cannot colonize sites inhabited by oviparous ones (and vice versa). They suggest that during the reproductive period viviparity has an adaptive advantage over oviparity in less risky habitats thanks to the selfish behaviour of the mothers. Moreover, the results from both analyses stress that hypotheses about the evolution and maintenance of viviparity need to be tested during the reproductive period.
Comparison of different mechanical chest compression devices in the alpine rescue setting: a randomized triple crossover experiment
Authors: Alexander Egger , Katharina Tscherny , Verena Fuhrmann , Jürgen Grafeneder , Maximilian Niederer , Calvin Kienbacher , Andreas Schachner , Wolfgang Schreiber , Harald Herkner , Dominik Roth 
Published: June 2021

Abstract
Background
Cardiopulmonary resuscitation in mountain environment is challenging. Continuous chest compressions during transport or hoist rescue are almost impossible without mechanical chest compression devices. Current evidence is predominantly based on studies conducted by urbane ambulance service. Therefore, we aimed to investigate the feasibility of continuous mechanical chest compression during alpine terrestrial transport using three different devices.

Methods
Randomized triple crossover prospective study in an alpine environment. Nineteen teams of the Austrian Mountain Rescue Service trained according to current ERC guidelines performed three runs each of a standardised alpine rescue-scenario, using three different devices for mechanical chest compression. Quality of CPR, hands-off-time and displacement of devices were measured.

Results
The primary outcome of performed work (defined as number of chest compressions x compression depth) was 66,062 mm (2832) with Corpuls CPR, 65,877 mm (6163) with Physio-Control LUCAS 3 and 40,177 mm (4396) with Schiller Easy Pulse. The difference both between LUCAS 3 and Easy Pulse (Δ 25,700; 95% confidence interval 21,118 – 30,282) and between Corpuls CPR and Easy Pulse (Δ 25,885; 23,590 – 28,181) was significant. No relevant differences were found regarding secondary outcomes.

Conclusion
Mechanical chest compression devices provide a viable option in the alpine setting. For two out of three devices (Corpuls CPR and LUCAS 3) we found adequate quality of CPR. Those devices also maintained a correct placement of the piston even during challenging terrestrial transport. Adequate hands-off-times and correct placement could be achieved even by less trained personnel.
Bilateral cervical plexus block for anterior cervical spine surgery: study protocol for a randomised placebo-controlled trial
Authors: Mulcahy Michael J. , Elalingam Thananchayan , Jang Kevin , D’Souza Mario , Tait Matthew 
Published: June 2021

Abstract
Background
There has been increasing focus to improve the quality of recovery following anterior cervical spine surgery (ACSS). Postoperative pain and nausea are the most common reasons for prolonged hospital stay and readmission after ACSS. Superficial cervical plexus block (SCPB) provides site-specific analgesia with minimal side effects, thereby improving the quality of recovery. The aim of our study was to investigate the effect bilateral cervical plexus block has on postoperative recovery in patients undergoing ACSS.

Methods
The study is a pragmatic, multi-centre, blinded, parallel-group, randomised placebo-controlled trial. 136 eligible patients (68 in each group) undergoing ACSS will be included. Patients randomised to the intervention group will have a SCPB administered under ultrasound guidance with a local anaesthetic solution (0.2% ropivacaine, 15mL); patients randomised to the placebo group will be injected in an identical manner with a saline solution. The primary outcome is the 40-item quality of recovery questionnaire score at 24 h after surgery. In addition, comparisons between groups will be made for a 24-h opioid usage and length of hospital stay. Neck pain intensity will be quantified using the numeric rating scale at 1, 3, 6 and at 24 h postoperatively. Incidence of nausea, vomiting, dysphagia or hoarseness in the first 24 h after surgery will also be measured.

Discussion
By conducting a blinded placebo trial, we aim to control for the bias inherently associated with a tangible medical intervention and show the true treatment effect of SCPB in ACSS. A statistically significant result will indicate an overall improved quality of recovery for patients; alternatively, if no benefit is shown, this trial will provide evidence that this intervention is unnecessary.

Trial registration
ClinicalTrials.gov ACTRN12619000028101. Prospectively registered on 11 January 2019 with Australia New Zealand Clinical Trials Registry
The Italian document: decisions for intensive care when there is an imbalance between care needs and resources during the COVID-19 pandemic
Authors: Riccioni Luigi , Ingravallo Francesca , Grasselli Giacomo , Mazzon Davide , Cingolani Emiliano , Forti Gabrio , Zagrebelsky Vladimiro , Zoja Riccardo , Petrini Flavia 
Published: June 2021

Abstract
Background
In early 2020, the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) published clinical ethics recommendations for the allocation of intensive care during COVID-19 pandemic emergency. Later the Italian National Institute of Health (ISS) invited SIAARTI and the Italian Society of Legal and Insurance Medicine to prepare a draft document for the definition of triage criteria for intensive care during the emergency, to be implemented in case of complete saturation of care resources.

Methods
Following formal methods, including two Delphi rounds, a multidisciplinary group with expertise in intensive care, legal medicine and law developed 12 statements addressing: (1) principles and responsibilities; (2) triage; (3) previously expressed wishes; (4) reassessment and shifting to palliative care; (5) collegiality and transparency of decisions. The draft of the statements, with their explanatory comments, underwent a public consultation opened to Italian scientific or technical-professional societies and other stakeholders (i.e., associations of citizens, patients and caregivers; religious communities; industry; public institutions; universities and research institutes). Individual healthcare providers, lay people, or other associations could address their comments by e-mail.

Results
Eight stakeholders (including scientific societies, ethics organizations, and a religious community), and 8 individuals (including medical experts, ethicists and an association) participated to the public consultation. The stakeholders’ agreement with statements was on average very high (ranging from 4.1 to 4.9, on a scale from 1—full disagreement to 5—full agreement). The 4 statements concerning triage stated that in case of saturation of care resources, the intensive care triage had to be oriented to ensuring life-sustaining treatments to as many patients as possible who could benefit from them. The decision should follow full assessment of each patient, taking into account comorbidities, previous functional status and frailty, current clinical condition, likely impact of intensive treatment, and the patient's wishes. Age should be considered as part of the global assessment of the patient.

Conclusions
Lacking national guidelines, the document is the reference standard for healthcare professionals in case of imbalance between care needs and available resources during a COVID-19 pandemic in Italy, and a point of reference for the medico-legal assessment in cases of dispute.
An efficient pruning scheme of deep neural networks for Internet of Things applications
Authors: Qi Chen , Shen Shibo , Li Rongpeng , Zhao Zhifeng , Liu Qing , Liang Jing , Zhang Honggang 
Published: June 2021

AbstractNowadays, deep neural networks (DNNs) have been rapidly deployed to realize a number of functionalities like sensing, imaging, classification, recognition, etc. However, the computational-intensive requirement of DNNs makes it difficult to be applicable for resource-limited Internet of Things (IoT) devices. In this paper, we propose a novel pruning-based paradigm that aims to reduce the computational cost of DNNs, by uncovering a more compact structure and learning the effective weights therein, on the basis of not compromising the expressive capability of DNNs. In particular, our algorithm can achieve efficient end-to-end training that transfers a redundant neural network to a compact one with a specifically targeted compression rate directly. We comprehensively evaluate our approach on various representative benchmark datasets and compared with typical advanced convolutional neural network (CNN) architectures. The experimental results verify the superior performance and robust effectiveness of our scheme. For example, when pruning VGG on CIFAR-10, our proposed scheme is able to significantly reduce its FLOPs (floating-point operations) and number of parameters with a proportion of 76.2% and 94.1%, respectively, while still maintaining a satisfactory accuracy. To sum up, our scheme could facilitate the integration of DNNs into the common machine-learning-based IoT framework and establish distributed training of neural networks in both cloud and edge.
Using machine learning to predict habitat suitability of sloth bears at multiple spatial scales
Authors: Rather Tahir Ali , Kumar Sharad , Khan Jamal Ahmad 
Published: June 2021

Abstract
Background
Habitat resources occur across the range of spatial scales in the environment. The environmental resources are characterized by upper and lower limits, which define organisms’ distribution in their communities. Animals respond to these resources at the optimal spatial scale. Therefore, multi-scale assessments are critical to identifying the correct spatial scale at which habitat resources are most influential in determining the species-habitat relationships. This study used a machine learning algorithm random forest (RF), to evaluate the scale-dependent habitat selection of sloth bears (Melursus ursinus) in and around Bandhavgarh Tiger Reserve, Madhya Pradesh, India.

Results
We used 155 spatially rarified occurrences out of 248 occurrence records of sloth bears obtained from camera trap captures (n = 36) and scats located (n = 212) in the field. We calculated focal statistics for 13 habitat variables across ten spatial scales surrounding each presence-absence record of sloth bears. Large (> 5000 m) and small (1000–2000 m) spatial scales were the most dominant scales at which sloth bears perceived the habitat features. Among the habitat covariates, farmlands and degraded forests were the essential patches associated with sloth bear occurrences, followed by sal and dry deciduous forests. The final habitat suitability model was highly accurate and had a very low out-of-bag (OOB) error rate. The high accuracy rate was also obtained using alternate validation matrices.

Conclusions
Human-dominated landscapes are characterized by expanding human populations, changing land-use patterns, and increasing habitat fragmentation. Farmland and degraded habitats constitute ~ 40% of the landform in the buffer zone of the reserve. One of the management implications may be identifying the highly suitable bear habitats in human-modified landscapes and integrating them with the existing conservation landscapes.
Intensivists’ beliefs about rapid multiplex molecular diagnostic testing and its potential role in improving prescribing decisions and antimicrobial stewardship: a qualitative study
Authors: Pandolfo Alyssa M. , Horne Robert , Jani Yogini , Reader Tom W. , Bidad Natalie , Brealey David , Enne Virve I. , Livermore David M. , Gant Vanya , Brett Stephen J. ,   the INHALE WP2 Study Group, Barber Julie , Shallcross Laura , Cuesta Jeronimo , Peters Mark , Klein Nigel , Moondi Parvez , O’Grady Justin , High Juliet , Russell Charlotte , Swart Ann Marie , Turner David , Singh Suveer 
Published: June 2021

Abstract
Background
Rapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs). Clinicians’ endorsement and uptake of these tests is crucial to maximise engagement; however, adoption may be impeded if users harbour unaddressed concerns or if device usage is incompatible with local practice. Accordingly, we strove to identify ICU clinicians’ beliefs about molecular diagnostic tests for pneumonias before implementation at the point-of-care.

Methods
We conducted semi-structured interviews with 35 critical care doctors working in four ICUs in the United Kingdom. A clinical vignette depicting a fictitious patient with signs of pneumonia was used to explore clinicians’ beliefs about the importance of molecular diagnostics and their concerns. Data were analysed thematically.

Results
Clinicians’ beliefs about molecular tests could be grouped into two categories: perceived potential of molecular diagnostics to improve antibiotic prescribing (Molecular Diagnostic Necessity) and concerns about how the test results could be implemented into practice (Molecular Diagnostic Concerns). Molecular Diagnostic Necessity stemmed from beliefs that positive results would facilitate targeted antimicrobial therapy; that negative results would signal the absence of a pathogen, and consequently that having the molecular diagnostic results would bolster clinicians’ prescribing confidence. Molecular Diagnostic Concerns included unfamiliarity with the device’s capabilities, worry that it would detect non-pathogenic bacteria, uncertainty whether it would fail to detect pathogens, and discomfort with withholding antibiotics until receiving molecular test results.

Conclusions
Clinicians believed rapid molecular diagnostics for pneumonias were potentially important and were open to using them; however, they harboured concerns about the tests’ capabilities and integration into clinical practice. Implementation strategies should bolster users’ necessity beliefs while reducing their concerns; this can be accomplished by publicising the tests’ purpose and benefits, identifying and addressing clinicians’ misconceptions, establishing a trial period for first-hand familiarisation, and emphasising that, with a swift (e.g., 60–90 min) test, antibiotics can be started and refined after molecular diagnostic results become available.
Factor IX p.A37V mutation causes severe bleeding in a patient with phenprocoumon therapy
Authors: Mülling Nils , Rosery Vivian , Reinhardt H. Christian , Hanoun Maher 
Published: June 2021

Abstract
Background
Bleeding is the most common complication of oral anticoagulants, due to inadequate dosing.

Case presentation
This report describes the clinical course of a patient who developed severe bleeding under therapy with phenprocoumon, despite an INR in the lower therapeutic range. Strikingly, aPTT was prolonged, while factor IX activity was significantly reduced. Acquired hemophilia was excluded, due to missing detection of inhibitors. Finally, sequencing part of the factor IX gene including nucleotide position c.110 revealed a hemizygous factor IX mutation c.110C > T p (Ala37Val).

Conclusions
In rare cases, missense mutations in factor IX propeptide are associated with severe bleeding complications. The substitution of alanin at position 37 to either valin or threonin (Ala37Val or Ala37Thr) leads to hypersensitivity to vitamin k antagonists.
Inherited unbalanced reciprocal translocation with 3q duplication and 5p deletion in a foetus revealed by cell-free foetal DNA (cffDNA) testing: a case report
Authors: Ali Taccyanna M. , Mateu-Brull Emilia , Balaguer Nuria , Dantas Camila , Borges Haline Risso , de Oliveira Mariana Quintans Guerra , Rodrigo Lorena , Campos-Galindo Inmaculada , Navarro Roser , Milán Miguel 
Published: June 2021

Abstract
Background
Since 2011, screening maternal blood for cell-free foetal DNA (cffDNA) fragments has offered a robust clinical tool to classify pregnancy as low or high-risk for Down, Edwards, and Patau syndromes. With recent advances in molecular biology and improvements in data analysis algorithms, the screening’s scope of analysis continues to expand. Indeed, screening now encompassess additional conditions, including aneuploidies for sex chromosomes, microdeletions and microduplications, rare autosomal trisomies, and, more recently, segmental deletions and duplications called copy number variations (CNVs). Yet, the ability to detect CNVs creates a new challenge for cffDNA analysis in couples in which one member carries a structural rearrangement such as a translocation or inversion.

Case presentation
We report a segmental duplication of the long arm of chromosome 3 and a segmental deletion of the short arm of chromosome 5 detected by cffDNA analysis in a 25-year-old pregnant woman. The blood sample was sequenced on a NextSeq 550 (Illumina) using the VeriSeq NIPT Solution v1 assay. G-band karyotyping in amniotic fluid only detected an abnormality in chromosome 5. Next-generation sequencing in amniocytes confirmed both abnormalities and identified breakpoints in 3q26.32q29 and 5p13.3p15. The foetus died at 21 weeks of gestation due to multiple abnormalities, and later G-band karyotyping in the parents revealed that the father was a carrier of a balanced reciprocal translocation [46,XY,t(3;5)(q26.2;p13)]. Maternal karyotype appeared normal.

Conclusion
This case provides evidence that extended cffDNA can detect, in addition to aneuploidies for whole chromosomes, large segmental aneuploidies. In some cases, this may indicate the presence of chromosomal rearrangements in a parent. Such abnormalities are outside the scope of standard cffDNA analysis targeting chromosomes 13, 18, 21, X, and Y, potentially leading to undiagnosed congenital conditions.