bluuebunny/crossref_metadata_2025_split huggingface dataset:
Augmented Single Loop Single Vector Algorithm Using Nonlinear Approximations of Constraints in Reliability-Based Design Optimization
Authors: Lind Petter N. , Olsson Mårten 
Published: May 2019

Abstract
Reliability-based design optimization (RBDO) aims at minimizing a function of probabilistic design variables, given a maximum allowed probability of failure. The most efficient methods available for solving moderately nonlinear problems are single loop single vector (SLSV) algorithms that use a first-order approximation of the probability of failure in order to rewrite the inherently nested structure of the loop into a more efficient single loop algorithm. The research presented in this paper takes off from the fundamental idea of this algorithm. An augmented SLSV algorithm is proposed that increases the rate of convergence by making nonlinear approximations of the constraints. The nonlinear approximations are constructed in the following way: first, the SLSV experiments are performed. The gradient of the performance function is known, as well as an estimate of the most probable failure point (MPP). Then, one extra experiment, a probe point, per performance function is conducted at the first estimate of the MPP. The gradient of each performance function is not updated but the probe point facilitates the use of a natural cubic spline as an approximation of an augmented MPP estimate. The SLSV algorithm using probing (SLSVP) also incorporates a simple and effective move limit (ML) strategy that also minimizes the heuristics needed for initiating the optimization algorithm. The size of the forward finite difference design of experiment (DOE) is scaled proportionally with the change of the ML and so is the relative position of the MPP estimate at the current iteration. Benchmark comparisons against results taken from the literature show that the SLSVP algorithm is more efficient than other established RBDO algorithms and converge in situations where the SLSV algorithm fails.
Association between cumulative anticholinergic burden and falls and fractures in patients with overactive bladder: US-based retrospective cohort study
Authors: Szabo Shelagh M , Gooch Katherine , Schermer Carol , Walker David , Lozano-Ortega G , Rogula Basia , Deighton Alison , Vonesh Edward , Campbell Noll 
Published: May 2019

ObjectiveTo estimate the association between cumulative anticholinergic burden and falls and fractures in patients with overactive bladder (OAB).DesignA retrospective claims-based study (2007–2015) of patients with OAB; outcomes from a subset were contrasted to a non-OAB comparison.SettingUnited States, commercially and Medicare-insured population.Participants154 432 adults with OAB and 86 966 adults without OAB, mean age of 56 years, and 67.9% women.Main outcome measuresCumulative anticholinergic burden, a unitless value representing exposure over time, was estimated over the 12 months pre-index (‘at baseline’) and every 6 months post index. Burden was categorised as no burden (0), low burden (1–89), medium burden (90–499) or high burden (500+). Unadjusted rates of falls or fractures were estimated, and the increased risk associated with anticholinergic burden (measured at the closest 6-month interval prior to a fall or fracture) was assessed using a Cox proportional hazards model and a marginal structural model.ResultsMedian (IQR) baseline anticholinergic burden was 30 (0.0–314.0) and higher among older (≥65 years, 183 [3.0–713.0]) versus younger (<65 years, 13 [0.0–200.0]) adults. The unadjusted rate of falls or fractures over the period was 5.0 per 100 patient-years, ranging from 3.1 (95% CI 3.0–3.2) for those with no burden, to 7.4 (95% CI 7.1–7.6) for those with high burden at baseline. The adjusted risk of falls and fractures was greater with higher anticholinergic burden in the previous 6 months, with an HR of 1.2 (95% CI 1.2 to 1.3) for low burden versus no burden, to 1.4 (95% CI 1.3 to 1.4) for high versus no burden. Estimates from marginal structural models adjusting for time-varying covariates were lower but remained significantly higher with a higher anticholinergic burden. Rates of falls and fractures were approximately 40% higher among those with OAB (vs those without).ConclusionHigher levels of anticholinergic burden are associated with higher rates of falls and fractures, highlighting the importance of considering anticholinergic burden when treating patients with OAB.
Equal treatment efficacy of direct-acting antivirals in patients with chronic hepatitis C and hepatocellular carcinoma? A prospective cohort study
Authors: Huang Chung-Feng , Yeh Ming-Lun , Huang Ching-I , Liang Po-Cheng , Lin Yi-Hung , Hsieh Ming-Yen , Wei Yu-Ju , Lin Zu-Yau , Chen Shinn-Cherng , Huang Jee-Fu , Dai Chia-Yen , Chuang Wan-Long , Yu Ming-Lung 
Published: May 2019

ObjectiveThe treatment outcome of direct-acting antivirals (DAAs) in chronic hepatitis C patients with hepatocellular carcinoma (HCC) is controversial. The current study aimed to address the treatment efficacy and safety of DAAs in patients with curative or active HCC, compared with those of patients without HCC.DesignA prospective cohort studySettingA medical centre and two regional hospitals in TaiwanParticipantsA total of 713 Taiwanese patients (601 non-HCC, 74 curative HCC and 38 active HCC patients) who received standard-of-care DAAs were consecutively enrolled in the study.Main outcome measurementThe primary objective was to determine treatment efficacy, defined as undetectable hepatitis C virus RNA throughout 12 weeks of the post-treatment follow-up period (sustained virological response 12 [SVR12]).ResultsThe overall SVR12 rate was 96.9%. The SVR12 rate was similar between the patients with HCC and those without HCC (95.5% vs 97.2%, p=0.37). The HCC patients were divided into two groups, those with curative HCC and those with viable HCC; a substantially but not significantly lower SVR rate, 92.1% (35/38), was observed in the patients with viable HCC compared with the SVR rate, 97.3% (72/74), in those with curative HCC (p=0.33). Compared with the patients with curative HCC, the patients with viable HCC had a significantly higher proportion of serious adverse events (10.5% vs 1.0%, p=0.002), early treatment discontinuation (10.5% vs 2.8%, p=0.03) and mortality (5.3% vs 0.1%, p=0.008).ConclusionsAn equivalently high SVR rate was observed in patients with either past or active HCC compared with those without HCC. The safety concerns in the HCC patients did not compromise treatment efficacy.
Phase I open-label trial of intraperitoneal paclitaxel in combination with intravenous cisplatin and oral capecitabine in patients with advanced gastric cancer and peritoneal metastases (IPGP study): study protocol
Authors: Vatandoust Sina , Bright Tim , Roy Amitesh Chandra , Watson David , Gan Susan , Bull Jeff , Abbas Muhammad Nazim , Karapetis Christos Stelios 
Published: May 2019

IntroductionGastric cancer with peritoneal metastasis has a poor outcome. Only a few studies have specifically investigated this group of patients. Japanese researchers have shown that chemotherapy with intraperitoneal paclitaxel (IPP) and oral S-1 (tegafur/gimeracil/oteracil) is active and well tolerated. These results have been achieved in a specific genetic pool (Japanese population), using regimens that may not be available in other parts of the world. We have designed this phase I trial to investigate IPP in combination with a standard chemotherapy combination in these patients.MethodsWe use a 3+3 expanded cohort dose escalation until a predefined number of dose-limiting toxicities are reached. Patients will have an intraperitoneal catheter placed surgically after trial enrolment. Chemotherapy includes a maximum of six cycles (21 days) of capecitabine (X) (1000 mg/m2two times a day, days 1–14)+cisplatin (C) (intravenous 80 mg/m2day 1) and IPP (days 1 and 8) with the following doses: cohort-1: 10 mg/m2, cohort-2: 20 mg/m2and cohort-3: 30 mg/m2. Primary endpoint is to determine the maximum tolerated dose of IPP. Secondary endpoints include determining the safety and tolerability of IPP in combination with C and X, overall response rates, ascites response rate, progression-free survival, overall survival and effects on quality of life.Important inclusion criteria include age ≥18 years, human epidermal growth factor receptor 2 non-amplified gastric adenocarcinoma with histological or cytology-proven peritoneal involvement and adequate organ function. Exclusion criteria include previous malignancy within 5 years, recent abdominal or pelvic radiation treatment, significant abdominal adhesions or sepsis.Ethics and disseminationThe study is approved by Southern Adelaide Clinical Human Research Ethics Committee. A manuscript will be prepared for publication on the completion of the trial. This study will be conducted according to the Note for Guidance on Good Clinical Practice (CPMP/ICH/135/95) annotated with TGA comments (Therapeutic Goods Administration DSEB July 2000) and in compliance with applicable laws and regulations. The study will be performed in accordance with the NHMRC Statement on Ethical Conduct in Research Involving Humans (© Commonwealth of Australia 2007), and the NHMRC Australian Code for the Responsible Conduct of Research (©Australian Government 2007), and the principles laid down by the World Medical Assembly in the Declaration of Helsinki 2008.Trial registration numberACTRN12614001063606.
Intramedullary nails versus distal locking plates for fracture of the distal femur: results from the Trial of Acute Femoral Fracture Fixation (TrAFFix) randomised feasibility study and process evaluation
Authors: Griffin Xavier L , Costa Matthew L , Phelps Emma , Parsons Nicholas , Dritsaki Melina , Achten Juul , Tutton Elizabeth , Lerner Robin Gillmore , McGibbon Alwin , Baird Janis 
Published: May 2019

ObjectivesThis feasibility study and process evaluation assessed the likely success of a definitive trial of intramedullary fixation with locked retrograde nails versus extramedullary fixation with fixed angle plates for fractures of the distal femur.Design & settingA multicentre, parallel, two-arm, randomised controlled feasibility study with an embedded process evaluation was conducted at seven NHS hospitals in England. Treatment was randomly allocated in 1:1 ratio, stratified by centre and chronic cognitive impairment. Participants, but not surgeons or research staff, were blinded to the allocation.ParticipantsPatients 18 years and older with a fracture of the distal femur, who their surgeon believed would benefit from internal fixation, were eligible to take part.Participants were allocated to receive either a retrograde intramedullary nail or an anatomical locking plate.OutcomesThe primary outcomes for this feasibility study were the recruitment rate and completion rate of the EQ-5D-5L at 4 months post-randomisation. Baseline characteristics, disability rating index, quality of life scores, measurements of social support and self-efficacy, resource use and radiographic assessments were also collected. The views of patients and staff were collected during interviews.ResultsRecruitment and data completion were lower than expected. 23 of 82 eligible patients were recruited (nail, 11; plate, 12). The recruitment rate was estimated as 0.42 (95% CI 0.27 to 0.62) participants per centre-month. Data completeness of the EQ-5D-5L at 4 months was 61 per cent (95% CI 43% to 83%). The process evaluation demonstrated that the main barriers to recruitment were variation in treatment pathways across centres, lack of surgeon equipoise and confidence in using both interventions and newly formed research cultures that lacked cohesion.ConclusionsA modified trial design, with embedded recruitment support intervention, comparing functional outcome in cognitively intact adults who have sustained a fragility fracture of the distal femur is feasible.Ethics approvalThe Wales Research Ethics Committee 5 approved the study (ref: 16/WA/0225).Trial registration numberISRCTN92089567; Pre-results.
Burnout as a correlate of depression among medical students in Cameroon: a cross-sectional study
Authors: Njim Tsi , Mbanga Clarence Mvalo , Tindong Maxime , Fonkou Steve , Makebe Haman , Toukam Louise , Fondungallah Johnson , Fondong Azingala , Mulango Isabelle , Kika Belmond 
Published: May 2019

ObjectiveBurnout syndrome has been shown to mediate the pathway between job stress and depression. This study aims to assess the relationship between the various components of burnout syndrome and depression; and to determine the contribution of other sociodemographic variables to depression among medical students in Cameroon.DesignA cross-sectional study.SettingThree of the five medical schools in Cameroon with students in both preclinical and clinical levels of studies.ParticipantsThe study included 413 consenting medical students.Primary outcome measureData were collected via a printed self-administered questionnaire. The primary outcome—depression was assessed using the Patient Health Questionnaire–9 (PHQ-9). Burnout was assessed using the Oldenburg Burnout Inventory. Multivariable linear regression was used to identify independent correlates of depression.ResultsThe overall prevalence of depression (PHQ-9 >4) and major depressive disorder (PHQ-9 >9) in these students was 66.34% and 23.00%, respectively. After multivariable linear regression analysis, four variables—total OLBI (beta=0.32; 95% CI 0.22 to 0.42; p<0.001); number of children (beta=−2.26; 95% CI −3.70 to –0.81; p=0.002); occurrence of a life-changing crises (beta=1.29; 95% CI 0.13 to 2.45; p=0.029) and presence of a chronic illness (beta=3.19; 95% CI 0.96 to 5.42; p=0.005) significantly predicted depression in these students and explained 32.4% of the variance (R2=32.4, F[14, 204]=6.98, p<0.001). The emotional exhaustion component (R2=17.4, F[1, 411]=86.39, p<0.001) explained more of the variance in depression than the disengagement component (R2=6.1, F[1, 411]=26.76, p<0.001) of burnout syndrome.ConclusionThe prevalence of depression among medical students in Cameroon is high. It is important that correlates of depression are identified early in medical students to limit progress to depression.
Care of general practice patients preceding and following a suicide attempt: observational study in Flemish general practices
Authors: Boffin Nicole , Van Casteren Viviane , De Ridder Karin 
Published: May 2019

ObjectivesFirst, to examine general practitioner (GP) knowledge about the care (needs) of their patients; second, to examine the quality of GP follow-up care; third, to examine the transmission of patient care information from hospitals/emergency services (ES) to GPs.Setting105 general practices from the representative Belgian Network of Sentinel General Practices (SGP) in Flanders, the largest region of Belgium, during 2013–2016.Participants245 suicide attempts by regular patients.Outcomes measuresTen care-related measures, including three indicators of quality of follow-up care, were based on data reported by the SGP on structured forms at baseline and at two follow-up points in time.ResultsAs for GP knowledge, 10.5% of SGP failed to report whether suicidal risk was noticed in patients seen in the month preceding the attempt; 9.0% whether there were previous attempts; 22.5% whether the patient was receiving mental health treatment at follow-up and 22.0% whether suicidal behaviour was repeated at follow-up. Relatively more patients≥65 years had no suicide risk evaluation (OR 3.54; 95% CI 1.11 to 11.26). As for quality of follow-up care, there was a GP–patient contact following 90.5% of the attempts, follow-up appointments were planned following 43.4% of the attempts and there was a GP contact with patient proxies following 62.8% of the attempts. Patient age ≥65 years (OR 4.09; 95% CI 1.79 to 9.33), a recent GP–patient contact preceding the attempt (OR 1.97; 95% CI 1.13 to 3.43), depression of patient (OR 1.96; 95% CI 1.14 to 3.37) and a suburban SGP area (OR 2.34; 95% CI 1.13 to 4.82) were determinants of an increased quality of care sum. GPs received patient care information from a hospital (ES) for 67.8% of eligible attempts, with SGP practice location being a determinant.ConclusionsGPs are highly involved in the care of suicide attempters but there is room for improvement, also in informational continuity from hospital (ES) to GPs.
How incremental video training did not guarantee implementation due to fluctuating population prevalence
Authors: Vink Peter , Torensma Bart , Lucas Cees , Hollmann Markus W , van Schaik Ivo N , Vermeulen Hester 
Published: May 2019

Patients with stroke admitted at the neurology/neurosurgery ward of the Academic Medical Centre in Amsterdam, The Netherlands, may experience problems in communication, such as aphasia, severe confusion/delirium or severe language barriers. This may prevent self-reported pain assessment; therefore, pain behaviour observation scales are needed. In this project, we therefore aimed to implement the Rotterdam Elderly Pain Observation Scale (REPOS) by video training.We used a stepped-wedge cluster design with clusters of four to five nurses with intervals of 2 weeks, for a total study duration of 34 weeks. Primary endpoint was the proportion of shifts in which nurses used the REPOS when caring for an eligible patient. A questionnaire was send biweekly to assess self-perceived competence and attitude on pain measurement in patients able or unable to self-report pain intensity. No other strategies were used to promote the use of the REPOS.Though the proportion of shifts in which trained nurses cared for eligible patients increased from 0% at baseline to 83% at the end of the study, the proportion of cumulative shifts where the REPOS was used decreased from 14% to 6%, respectively. Process evaluation suggests that this decrease can (in part) be attributed to low and varying prevalence of eligible patients and opportunities for practice. In total, 24 (45.3%) nurses had used the REPOS at least once after 34 weeks, with a median of two times (1–33). Nurses perceived themselves 'competent' to 'very competent' in pain behaviour observation. There was no negative attitude towards pain measurement.This study shows that education alone may not be effective when implementing a pain behaviour observation scale for non-communicative patients with Acquired Brain Injury. Individual motivation of health professionals and individual patient factors may be of influence for the use of the REPOS.
Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction
Authors: Lindholm Daniel , Sarno Giovanna , Erlinge David , Svennblad Bodil , Hasvold Lars Pål , Janzon Magnus , Jernberg Tomas , James Stefan K 
Published: May 2019

ObjectiveIn patients with myocardial infarction (MI), risk factors for bleeding and ischaemic events tend to overlap, but the combined effects of these factors have scarcely been studied in contemporary real-world settings. We aimed to assess the combined associations of established risk factors using nationwide registries.MethodsUsing the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry, patients with invasively managed MI in 2006–2014 were included. Six factors were assessed in relation to cardiovascular death (CVD)/MI/stroke, and major bleeding: age ≥65, chronic kidney disease, diabetes, multivessel disease, prior bleeding and prior MI.ResultsWe studied 100 879 patients, of whom 20 831 (20.6%) experienced CVD/MI/stroke and 5939 (5.9%) major bleeding, during 3.6 years median follow-up. In adjusted Cox models, all factors were associated with CVD/MI/stroke, and all but prior MI were associated with major bleeding. The majority (53.5%) had ≥2 risk factors. With each added risk factor, there was a marked but gradual increase in incidence of the CVD/MI/stroke. This was seen also for major bleeding, but to a lesser extent, largely driven by prior bleeding as the strongest risk factor.ConclusionsThe majority of patients with MI had two or more established risk factors. Increasing number of risk factors was associated with higher rate of ischaemic events. When excluding patients with prior major bleeding, bleeding incidence rate increased only minimally with increasing number of risk factors. The high ischaemic risk in those with multiple risk factors highlights an unmet need for additional preventive measures.
Serum long-chain omega-3 fatty acids, hair mercury and exercise-induced myocardial ischaemia in men
Authors: Tajik Behnam , Tuomainen Tomi-Pekka , Kurl Sudhir , Salonen Jukka , Virtanen Jyrki K 
Published: May 2019

ObjectiveLong-chain omega-3 polyunsaturated fatty acids (PUFA) from fish have been inversely associated with coronary heart disease (CHD) risk. Fish may also contain methylmercury, which has been associated with higher CHD risk and may diminish the cardioprotective effect of long-chain omega-3 PUFA. We investigated the associations of serum long-chain omega-3 PUFA and hair mercury with the odds for myocardial ischaemia during exercise.MethodsA total of 2199 men from the Kuopio Ischaemic Heart Disease Risk Factor Study, aged 42–60 years were studied in 1984–89. Of the 2199 men, 342 had history of CHD. The men performed a maximal symptom-limited exercise stress test using an electrically braked bicycle ergometer. ORs for exercise-induced myocardial ischaemia were estimated with logistic regression.ResultsIn the multivariable analysis, those in the highest versus lowest serum long-chain omega-3 PUFA quartile had 33% lower odds of myocardial ischaemia (OR 0.67, 95% CI 0.51 to 0.87, p-trend=0.006). The association was stronger among those with CHD history (OR 0.10, 95% CI 0.03 to 0.39, p-trend <0.001), than among those without (OR 0.80, 95% CI 0.57 to 1.12, p-trend=0.17) (p-interaction=0.01). Higher hair mercury concentration was associated with increased odds for myocardial ischaemia in the entire population (OR 1.62, 95% CI 1.22 to 2.14, p-trend=0.002).ConclusionHigher circulating concentrations of the long-chain omega-3 PUFAs, a marker for fish consumption, were associated with lower occurrence of exercise-induced myocardial ischaemia, but only among men with CHD history. Hair mercury concentration was directly associated with the occurrence of exercise-induced myocardial ischaemia in the entire study population.
Long work hours of mothers and fathers are linked to increased risk for overweight and obesity among preschool children: longitudinal evidence from Germany
Authors: Li Jianghong , Kaiser Till , Pollmann-Schult Matthias , Strazdins Lyndall 
Published: May 2019

BackgroundMost existing studies on maternal employment and childhood overweight/obesity are from the USA. They are predominantly cross-sectional and show a consistent linear association between the two. Less is known about the joint impact of fathers’ and mothers’ work hours on childhood overweight and obesity.ObjectivesTo examine the impact of maternal and paternal work hours on overweight/obesity among children aged 1–6 years in Germany using longitudinal data.MethodsChild body weight and height and their parents’ work hours were collected for 2413 children at ages 0–1, ages 2–3 and ages 5–6. Overweight and obesity was defined using the body mass index percentiles based on the Cole LMS-Method. Random effects model was conducted, adjusting for demographic, socioeconomic and health characteristics of parents and children.ResultsCompared with non-employment, when mothers worked 35 or more hours per week, the risk for child overweight and obesity increased among preschool children. When fathers worked 55 or more hours per week, this effect was strengthened and maternal part-time hours (24–34 per week) also became a risk for child overweight and obesity. The effect was mainly found in high-income families.ConclusionsBoth mothers’ and fathers’ long work hours matter to young children’s overweight status. Employment protection and work time regulation for both working parents during the first 6 years of the child’s life should be considered in future policy.