bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using an Artificial Neural Network to Predict Flame Spread Across Electrical Wires
Authors: Gagnon Lauren , Carey Van P. , Fernandez-Pello Carlos 
Published: April 2021

Abstract
There is currently a global-scale transition from fossil fuel energy technologies toward increasing use of electrically driven energy technologies, especially transportation and heat, fueled by renewable energy sources, which is making fire safety in electrically powered systems increasingly important. The work presented here provides a coherent understanding of flame spread parametric trends and associated fire safety issues in electrical systems for structural, transportation, and space applications. This understanding was obtained through the use of an artificial neural network (ANN) that was trained to predict the flame spread rate along “laboratory” wires of different sizes and compositions (copper, nichrome, iron, and stainless-steel tube cores and HDPE, LDPE, and ETFE insulation sheaths) and exposed to different ambient conditions (varying flows, pressure, oxygen concentration, orientation, and gravitational strength). For these predictions, a comprehensive database of 1200 data points was created by incorporating flame spread rate results from both in-house experiments (400 data points) and external experiments from other sources (800 data points). The predictions from the ANN show that it is possible to merge various data sets, including results from horizontal, inclined, vertical, and microgravity experiments, and obtain unified predictive results. While these initial results are very encouraging with an overall average error rate of 14%, they also show that future improvements to the ANN could still be made to increase prediction accuracy.
Prevalence and coprevalence of modifiable risk factors for upper digestive tract cancer among residents aged 40–69 years in Yangzhong city, China: a cross-sectional study
Authors: Feng Xiang , Hua Zhao-Lai , Zhou Qin , Shi Ai-Wu , Song Tong-Qiu , Qian Dong-Fu , Chen Ru , Wang Gui-Qi , Wei Wen-Qiang , Zhou Jin-Yi , Wang Jie-Jun , Shao Gang , Wang Xi 
Published: April 2021

ObjectivesTo describe the prevalence of modifiable risk factors for upper digestive tract cancer (UDTC) and its coprevalence, and investigate relevant influencing factors of modifiable UDTC risk factors coprevalence among residents aged 40–69 years in Yangzhong city, China.DesignCross-sectional study.ParticipantsA total of 21 175 participants aged 40–69 years were enrolled in the study. 1962 subjects were excluded due to missing age, marital status or some other selected information. Eventually, 19 213 participants were available for the present analysis.Main outcomes measuresPrevalence and coprevalence of eight modifiable UDTC risk factors (overweight or obesity, current smoking, excessive alcohol consumption, insufficient vegetables intake, insufficient fruit intake and the consumption of pickled, fried and hot food) were analysed.ResultsThe prevalence of overweight/obesity, current smoking, excessive alcohol consumption, insufficient vegetables intake, insufficient fruit intake and the consumption of pickled, fried and hot food in this study was 45.3%, 24.1%, 16.2%, 66.1%, 94.5%, 68.1%, 36.0% and 88.4%, respectively. Nearly all (99.9%) participants showed one or more UDTC risk factors, 98.6% of the participants showed at least two risk factors, 92.2% of the participants had at least three risk factors and 69.7% of the participants had four or more risk factors. Multivariate logistic regression analysis revealed that men, younger age, single, higher education, higher annual family income and smaller household size were more likely to present modifiable UDTC risk factors coprevalence.ConclusionsThe prevalence and coprevalence of modifiable UDTC risk factors are high among participants in Yangzhong city. Extra attention must be paid to these groups who are susceptible to risk factors coprevalence during screening progress. Relative departments also need to make significant public health programmes that aim to decrease modifiable UDTC risk factors coprevalence among residents aged 40–69 years from high-risk areas of UDTC.
3219 hospitalised patients with COVID-19 in Southeast Michigan: a retrospective case cohort study
Authors: Mulhem Elie , Oleszkowicz Andrew , Lick David 
Published: April 2021

ObjectiveTo report the clinical characteristics of patients hospitalised with COVID-19 in Southeast Michigan.DesignRetrospective cohort study.SettingEight hospitals in Southeast Michigan.Participants3219 hospitalised patients with a positive SARS-CoV-2 infection by nasopharyngeal PCR test from 13 March 2020 until 29 April 2020.Main outcomes measuresOutcomes were discharge from the hospital or in-hospital death. Examined predictors included patient demographics, chronic diseases, home medications, mechanical ventilation, in-hospital medications and timeframe of hospital admission. Multivariable logistic regression was conducted to identify risk factors for in-hospital mortality.ResultsDuring the study period, 3219 (90.4%) patients were discharged or died in the hospital. The median age was 65.2 (IQR 52.6–77.2) years, the median length of stay in the hospital was 6.0 (IQR 3.2–10.1) days, and 51% were female. Hypertension was the most common chronic disease, occurring in 2386 (74.1%) patients. Overall mortality rate was 16.0%. Blacks represented 52.3% of patients and had a mortality rate of 13.5%. Mortality was highest at 18.5% in the prepeak hospital COVID-19 volume, decreasing to 15.3% during the peak period and to 10.8% in the postpeak period. Multivariable regression showed increasing odds of in-hospital death associated with older age (OR 1.04, 95% CI 1.03 to 1.05, p<0.001) for every increase in 1 year of age and being male (OR 1.47, 95% CI 1.21 to 1.81, p<0.001). Certain chronic diseases increased the odds of in-hospital mortality, especially chronic kidney disease. Administration of vitamin C, corticosteroids and therapeutic heparin in the hospital was associated with higher odds of death.ConclusionIn-hospital mortality was highest in early admissions and improved as our experience in treating patients with COVID-19 increased. Blacks were more likely to get admitted to the hospital and to receive mechanical ventilation, but less likely to die in the hospital than whites.
Qualitative evaluation of a mandatory provincial programme auditing emergency department return visits
Authors: Chartier Lucas B , Jalali Hanna , Seaton M. Bianca , Ovens Howard , Borgundvaag Bjug , McLeod Shelley L , Dainty Katie N , Ostrow Olivia 
Published: April 2021

ObjectiveThe objective of this qualitative study was to evaluate the perceived impact and value of the Return Visit Quality Programme (RVQP), a mandatory province-wide emergency department audit programme.DesignWe employed an interpretive descriptive qualitative approach with maximum variation sampling to ensure diverse representation across several geographical and institutional factors. RVQP programme leads were invited to participate in semistructured interviews and snowball sampling was used to reach non-lead physicians to capture the perspectives of those working within the programme.SettingIn Ontario’s RVQP, participating emergency departments must audit their return visits resulting in admission to identify issues that can be addressed through quality improvement initiatives.ParticipantsBetween June and August 2018, we interviewed 32 participants (local programme leads and non-lead physicians) from 23 out of the 86 participating centres.ResultsParticipants’ perceived impact and value of the programme was associated with the existence (or absence) and nature of the local quality improvement culture, the implementation approach of the programme within their emergency departments, and key aspects of the programme pertaining to medicolegal concerns and resource availability.ConclusionsThis study of an innovative, large-scale programme aimed at promoting continuous quality improvement in emergency departments showed that while its perceived impact has been meaningful, there are key structural and operational elements that support and hinder this aim. Healthcare leaders should consider these findings when looking to implement large-scale audit or quality improvement programmes.
Efficacy of parent-mediated communication-focused treatment in toddlers with autism (PACT) delivered via videoconferencing: a randomised controlled trial study protocol
Authors: Jurek Lucie , Occelli Pauline , Denis Angelique , Amestoy Anouck , Maffre Thierry , Dauchez Tom , Oreve Marie-Joelle , Baghdadli Amaria , Schroder Carmen , Jay Agathe , Zelmar Amélie , Revah-Levy Anne , Gallifet Natacha , aldred Catherine , Garg Shruti , Green Jonathan , Touzet Sandrine , Geoffray Marie-Maude 
Published: April 2021

IntroductionIntervention in the preschool period is currently recommended for autism spectrum disorder. Therapies delivered by parents are particularly suitable for young children. Preschool Autism Communication Trial (PACT) is a parent-mediated therapy that has shown a significant and sustained impact on autism symptom reduction. However, access to such evidence-based therapies for families is limited due to autism centres located in large urban areas. Using videoconferencing to deliver PACT training to parents may improve accessibility for families living in underserved areas.Methods and analysisThis single-blind randomised controlled trial, involving six sites in France, will investigate the efficacy of a telehealth, videoconferencing-based, parent-mediated PACT therapy on autism symptoms, over a 12-month period. It will compare PACT plus treatment as usual (TAU) against TAU only in a cohort of 238 toddlers (119 per group) aged 18–36 months at inclusion and living with their families more than 40 min away from the specialist centres for autism. Primary outcome will include change of overall autism score on the Autism Diagnostic Observation Scale (ADOS) at 12 months. Secondary outcomes will measure change in child skills, child functioning, impact on parents (stress, health, priorities) and implementation characteristics. Repeated measures analyses will be used to test the effect of PACT intervention on the overall ADOS module 1 score over the 12-month study period. Linear mixed models will be used with time, treatment allocation and the interaction between treatment and time as fixed effects and individual variation as random effect.Ethics and disseminationThis protocol (V.5, date: 25 October 2019) is approved by the French National Review Board (reference no 2018-A02516-49). The results will be disseminated via peer-reviewed journalsTrial registration numberNCT04244721.
Association between CVDs and initiation and adherence to statin treatment in patients with newly diagnosed hypercholesterolaemia: a retrospective cohort study
Authors: Ryou In Sun , Chang Jooyoung , Son Joung Sik , Ko Ahryoung , Choi Seulggie , Kim Kyuwoong , Kim Sung Min , Park Sang Min 
Published: April 2021

ObjectivesTo evaluate the association between incident cardiovascular disease (CVD) and initiation and adherence to statin treatment for primary prevention of CVD in patients with newly diagnosed hypercholesterolaemia.DesignA population-based retrospective cohort study.SettingThis study used National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) from Republic of Korea.ParticipantsThis study included 11 320 participants without previous history of CVD aged between 40 and 79 years who had elevated total cholesterol level (more than 240 mg/dL) and had initiated statin treatment within 24 months of the national health screening from 2004 to 2012 identified in the NHIS-HEALS.Primary and secondary outcome measuresThe primary outcome, CVD, was defined as first-ever admission or death due to ischaemic heart disease, acute myocardial infarction, revascularisation or stroke, or December 31 2013. The HRs of CVD according to statin adherence were calculated according to stratification by Systematic COronary Risk Evaluation.ResultsEarly statin initiation significantly lowered risk of CVD outcomes compared with late initiation (HR of late statin user, 1.24; 95% CI 1.02 to 2.51). Among early initiators, statin discontinuers had a significantly higher risk for CVD compared with persistent users (HR, 1.71; 95% CI 1.10 to 2.67), while statin reinitiators had an attenuated risk increase (HR 1.34, 95% CI 0.79 to 2.30).ConclusionsAmong statin users with newly diagnosed hypercholesterolaemia, early statin initiation is associated with lower CVD risk compared with late initiation. Furthermore, statin discontinuation is associated with increased risk of CVD, but reinitiation attenuated the risk.
Rationale and design of the EMPA-ELDERLY trial: a randomised, double-blind, placebo-controlled, 52-week clinical trial of the efficacy and safety of the sodium–glucose cotransporter-2 inhibitor empagliflozin in elderly Japanese patients with type 2 diabetes
Authors: Yabe Daisuke , Shiki Kosuke , Suzaki Keiko , Meinicke Thomas , Kotobuki Yutaro , Nishida Kenichiro , Clark Douglas , Yasui Atsutaka , Seino Yutaka 
Published: April 2021

IntroductionElderly people (≥65 years) with type 2 diabetes mellitus (T2DM) are becoming increasingly prevalent, notably in Japan. As cardiovascular (CV) risk increases with age and sodium–glucose cotransporter-2 (SGLT2) inhibitors reduce CV risk, elderly patients with T2DM are increasingly likely to be prescribed these glucose-lowering drugs. There is controversy surrounding the effects of SGLT2 inhibitors on muscle mass, particularly in elderly patients for whom loss of muscle is especially undesirable; however, robust evidence on this important issue is lacking. Consequently, we have designed a clinical trial of the SGLT2 inhibitor empagliflozin in elderly Japanese patients with T2DM (Empagliflozin in Elderly T2DM Patients (EMPA-ELDERLY)) to assess its effects on body composition as well as glycaemic control. EMPA-ELDERLY will be the first randomised clinical trial of an SGLT2 inhibitor in elderly patients with T2DM to evaluate effects on skeletal muscle mass, muscle strength and physical performance concurrently.Methods and analysisEMPA-ELDERLY is a randomised, double-blind, placebo-controlled, parallel-group clinical trial to be conducted in Japan. Patients with T2DM aged ≥65 years are eligible if they are Japanese with a body mass index of ≥22 kg/m2and glycated haemoglobin (HbA1c) levels from ≥7.0% to ≤10.0% from either diet and exercise alone or treatment with oral glucose-lowering drugs. Approximately 128 participants will be randomised 1:1 to once per day, oral, double-blind treatment with empagliflozin 10 mg or matching placebo for 52 weeks. The primary endpoint is the change in HbA1c level from baseline at week 52. Secondary endpoints include changes from baseline to 52 weeks in body composition, including muscle mass and body fat, measured by bioelectrical impedance analysis, as well as skeletal muscle index, grip strength and time in the five-time chair stand test. Other endpoints include changes in patient-reported outcomes (including quality of life), cognitive function and safety.Ethics and disseminationWe will submit the trial results to conferences and peer-reviewed journals.Trial registration numberNCT04531462.
Multi-stakeholder perspectives in defining health services quality indicators and dimensions: a concept mapping based comparison for cataract care between Singapore and The Netherlands
Authors: Stolk-Vos Aline , De Korne Dirk , Lamoureux Ecosse , Wai Charity , Busschbach Jan JV , van de Klundert Joel Joris 
Published: April 2021

ObjectiveThis study aims to advance understanding of globally valid versus country-specific quality dimensions and indicators, as perceived by relevant stakeholders. It specifically addresses patient-level indicators for cataract surgery.DesignA mixed-methods case study comparing Singapore and The NetherlandsSettingSingapore (2017–2019) and The Netherlands (2014–2015).ParticipantsStakeholder representatives of cataract care in Singapore and The Netherlands.InterventionBased on the previously identified complete set of stakeholders in The Netherlands, we identified stakeholders of cataract care in Singapore. Stakeholder representatives then established a multi-stakeholder perspective on the quality of cataract care using a concept mapping approach. This yielded a multidimensional cluster map based on multivariate statistical analyses. Consensus-based quality dimensions were subsequently defined during a plenary session. Thereafter, Singaporean dimensions were matched with dimensions obtained in The Netherlands to identify commonalities and differences.Main outcome measureHealth-services quality dimensions of cataract care.Results19 Singaporean stakeholders representing patients, general practitioners, ophthalmologists, nurses, care providers, researchers and clinical auditors defined health-services quality of cataract care using the following eight dimensions: clinical outcome, patient outcomes, surgical process, surgical safety, patient experience, access, cost and standards of care. Compared with the Dutch results, 61% of the indicators were allocated to dimensions of comparable names and compositions. Considerable differences also existed in the composition of some dimensions and the importance attached to indicators.Conclusions and relevanceThis study on cataract care in Singapore and The Netherlands shows that cataract care quality measurement instruments can share a common international core. At the same time, it emphasises the importance of taking a country-specific multi-stakeholder approach to quality definition and measurement. Complementing an international core set with country-specific measures is required to ensure that the included dimensions and indicators adequately capture the country-specific quality views.
Sociodemographic differences in self-reported exposure to high fat, salt and sugar food and drink advertising: a cross-sectional analysis of 2019 UK panel data
Authors: Yau Amy , Adams Jean , Boyland Emma J , Burgoine Thomas , Cornelsen Laura , de Vocht Frank , Egan Matt , Er Vanessa , Lake Amelia A , Lock Karen , Mytton Oliver , Petticrew Mark , Thompson Claire , White Martin , Cummins Steven 
Published: April 2021

ObjectivesTo explore sociodemographic differences in exposure to advertising for foods and drinks high in fat, salt and sugar (HFSS) and whether exposure is associated with body mass index (BMI).DesignCross-sectional survey.SettingUK.Participants1552 adults recruited to the Kantar Fast Moving Consumer Goods panel for London and the North of England.Outcome measuresSelf-reported advertising exposure stratified by product/service advertised (processed HFSS foods; sugary drinks; sugary cereals; sweet snacks; fast food or digital food delivery services) and advertising setting (traditional; digital; recreational; functional or transport); BMI and sociodemographic characteristics.ResultsOverall, 84.7% of participants reported exposure to HFSS advertising in the past 7 days. Participants in the middle (vs high) socioeconomic group had higher odds of overall self-reported exposure (OR 1.48; 95% CI 1.06 to 2.07). Participants in the low (vs high) socioeconomic group had higher odds of reporting exposure to advertising for three of five product categories (ORs ranging from 1.41 to 1.67), advertising for digital food delivery services (OR 1.47; 95% CI 1.05 to 2.05), traditional advertising (OR 1.44; 95% CI 1.00 to 2.08) and digital advertising (OR 1.50; 95% CI 1.06 to 2.14). Younger adults (18–34 years vs ≥65 years) had higher odds of reporting exposure to advertising for digital food delivery services (OR 2.08; 95% CI 1.20 to 3.59), digital advertising (OR 3.93; 95% CI 2.18 to 7.08) and advertising across transport networks (OR 1.96; 95% CI 1.11 to 3.48). Exposure to advertising for digital food delivery services (OR 1.40; 95% CI 1.05 to 1.88), digital advertising (OR 1.80; 95% CI 1.33 to 2.44) and advertising in recreational environments (OR 1.46; 95% CI 1.02 to 2.09) was associated with increased odds of obesity.ConclusionsExposure to less healthy product advertising was prevalent, with adults in lower socioeconomic groups and younger adults more likely to report exposure. Broader restrictions may be needed to reduce sociodemographic differences in exposure to less healthy product advertising.
Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections (QUALITII): Development of a patient-reported measure to assess treatment burden of repeat intravitreal injections
Authors: McClard Cynthia K , Wang Rui , Windham Victoria , Munoz Jose , Gomez Samuel , Fried Sagit , Saroj Namrata , Regillo Carl , Wykoff Charles Clifton , Strutt Adriana M 
Published: April 2021

ObjectiveTo understand patient burden of treatment of repeated intravitreal injections (IVI) in the management of exudative retinal diseases.Methods and analysisParticipants were sampled from a large urban retina specialty practice in Houston, Texas, USA, based on history of ongoing receipt of IVI. The 50-item Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections questionnaire was developed to evaluate the patient experience including discomfort, anxiety, inconvenience and satisfaction. Categorial principal components analysis (CATPCA) was performed to assess construct validity and internal consistency. A subset of these items was used to establish a measure of total treatment burden, referred to as the IVI Treatment Burden Score (TBS).Results142 patients participated in this study. CATPCA analysis revealed five dimensions of patient burden: disruption of normal routine or capacity, anxiety, frequency of visits, chronicity of disease and perceived treatment value or satisfaction. Together, these dimensions accounted for 67% of variance explained. Cronbach’s alpha was 0.97. The most frequently cited cause of discomfort was the feeling after anaesthetic wore off. The most common source of anxiety was fear of injection and associated discomfort or pain. Regarding inconvenience, patients reported temporary postinjection debilitation, requiring an average of 8 hours for recovery per treatment. The most frequently identified sources of satisfaction were confidence in the provider or treatment and interactions with staff.ConclusionsUnderstanding and quantifying the patient burden associated with repeated IVI for exudative retinal diseases can reveal opportunities to improve delivery methods. The TBS could serve to inform strategies to maximise treatment adherence and optimise patient experiences.