bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient experience of long-term recovery after open fracture of the lower limb: a qualitative study using interviews in a community setting
Authors: Rees Sophie , Tutton Elizabeth , Achten Juul , Bruce Julie , Costa Matthew L 
Published: October 2019

ObjectivesTreatment of open fractures is complex and patients may require muscle and skin grafts. The aim of this study was to gain a greater understanding of patient experience of recovery from open fracture of the lower limb 2–4 years postinjury.DesignA phenomenological approach was used to guide the design of the study. Interviews took place between October 2016 and April 2017 in the participants’ own homes or via telephone.SettingEngland, UK.ParticipantsA purposive sample of 25 patients were interviewed with an age range of 26–80 years (median 51), 19 were male and six female, and time since injury was 24–49 months (median 35 months).ResultsThe findings identified a focus on struggling to recover as participants created a new way of living, balancing moving forward with accepting how they are, while being uncertain of the future and experiencing cycles of progress and setbacks. This was expressed through three themes: (i) ‘being disempowered’ with the emotional impact of dependency and uncertainty, (ii) ‘being changed’ and living with being fragile and being unable to move freely and (iii) ‘being myself’ with a loss of self, feeling and looking different, alongside recreation of self in which they integrated the past, present and future to find meaningful ways of being themselves.ConclusionThis study identified the long-term disruption caused by serious injury, the hidden work of integration that is required in order to move forward and maximise potential for recovery. Supportive strategies that help people to self-manage their everyday emotional and physical experience of recovery from injury are required. Research should focus on developing and testing effective interventions that provide support and self-management within a holistic rehabilitation plan.Trial registration numberCurrent Controlled TrialsISRCTN33756652; Post-results.
Prostate cancer incidence and mortality in the Baltic states, Belarus, the Russian Federation and Ukraine
Authors: Patasius Ausvydas , Innos Kaire , Barchuk Anton , Ryzhov Anton , Leja Marcis , Misins Janis , Yaumenenka Alesya , Smailyte Giedre 
Published: October 2019

BackgroundProstate cancer incidence varies internationally largely attributable to differences in prostate-specific antigen (PSA) use. The aim of this study was to provide the most recent detailed international epidemiological comparison of prostate cancer incidence and mortality in six north-eastern European countries (Belarus, Estonia, Latvia, Lithuania, the Russian Federation and Ukraine).MethodsThe number of incident prostate cancer cases was obtained from the countries national cancer registries. Prostate cancer mortality and corresponding population data were extracted from the WHO Mortality Database. Age-specific and age-standardised incidence and mortality rates were calculated (European Standard). The joinpoint regression model was used to provide an average annual percentage change and to detect points in time where significant changes in trends occurred. The observation period was between 13 (Ukraine) and 48 (Estonia) years regarding incidence and around 30 years regarding mortality.ResultsThe comparison of prostate cancer incidence in six European countries showed almost sixfold differences in the age-adjusted rates in most recent years with highest incidence rates in Lithuania and Estonia. Through the observation period, overall a continuous rise was seen in incidence in all countries and a continuous rise in mortality, with a stabilisation in Estonia and a decrease in Lithuania in recent years. Data limitations included a descriptive design using ecological data.ConclusionsA widespread use of PSA testing seems to be responsible for the changes in the epidemiology of the disease in north-eastern European countries. Substantial variation in the incidence of prostate cancer in the Baltic states suggests the possibility that PSA performance and utilisation spread have had a major influence on observed incidence trends, with a lack of effect on prostate cancer mortality.
A systematic review protocol for examining 30-day readmission costs for atrial fibrillation patients
Authors: Woods Taylor-Jade , Speck Peter , Kaambwa Billingsley 
Published: October 2019

IntroductionAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia and readmissions of AF patients place a huge burden on the healthcare system, including economically. With an increasing prevalence, the burden of AF will continue evolving. To illuminate the readmission-specific economic burden, we aim to provide quality evidence on the cost of readmissions within 30 days where AF has been the primary diagnosis at the index admission.Methods and analysisWe will conduct a systematic review of all peer-reviewed articles examining readmission costs for AF patients. We will search MedLine, Cumulative Index to Nursing and Allied Health Literature, Scopus and Cochrane Library for articles written in English, published in peer-reviewed journals from inception to 2019. Reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols checklist. Studies will be included if patients were aged 18 years and over, AF was the primary diagnosis of index admission and costs of readmission within 30 days were reported. Quality assessment of studies will be done using a modified Evers checklist. Study results will be summarised in a Forest plot and heterogeneity tested for using the Cochran’s Q and I2statistic. A random-effects model will be applied for meta-analysis if studies are sufficiently homogeneous. The cost of readmission to hospital within 30 days for AF patients is the main outcome of interest while additional outcomes are 30-day readmission rate, predictors of readmission and predictors of readmission costs.Ethics and disseminationFormal ethical approval is not required as no patients will be involved. Dissemination of results will be through a peer-reviewed publication.PROSPERO registration numberCRD42019132017
Ambulance use for ‘primary care’ problems: an ethnographic study of seeking and providing help in a UK ambulance service
Authors: Booker Matthew James , Purdy Sarah , Barnes Rebecca , Shaw Ali R G 
Published: October 2019

ObjectivesTo explore what factors shape a service user’s decision to call an emergency ambulance for a ‘primary care sensitive’ condition (PCSC), including contextual factors. Additionally, to understand the function and purpose of ambulance care from the perspective of service users, and the role health professionals may play in influencing demand for ambulances in PCSCs.DesignAn ethnographic study set in one UK ambulance service. Patient cases were recruited upon receipt of ambulance treatment for a situation potentially manageable in primary care, as determined by a primary care clinician accompanying emergency medical services (EMS) crews. Methods used included: structured observations of treatment episodes; in-depth interviews with patients, relatives and carers and their GPs; purposeful conversations with ambulance clinicians; analysis of routine healthcare records; analysis of the original EMS ‘emergency’ telephone call recording.ResultsWe analysed 170 qualitative data items across 50 cases. Three cross-cutting concepts emerged as central to EMS use for a PCSC: (1) There exists a typology of nine ‘triggers’, which we categorise as either ‘internal’ or ‘external’, depending on how much control the caller feels they have of the situation; (2) Calling an ambulance on behalf of someone else creates a specific anxiety about urgency; (3) Healthcare professionals experience conflict around fuelling demand for ambulances.ConclusionsPrevious work suggests a range of sociodemographic factors that may be associated with choosing ambulance care in preference to alternatives. Building on established sociological models, this work helps understand how candidacy is displayed during the negotiation of eligibility for ambulance care. Seeking urgent assistance on behalf of another often requires specific support and different strategies. Use of EMS for such problems—although inefficient—is often conceptualised as ‘rational’ by service users. Public health strategies that seek to advise the public about appropriate use of EMS need to consider how individuals conceptualise an ‘emergency’ situation.
‘Your Tube’: the role of different diets in children who are gastrostomy fed: protocol for a mixed methods exploratory sequential study
Authors: Taylor Johanna , O'Neill Mark , Maddison Jane , Richardson Gerry , Hewitt Catherine , Horridge Karen , Cade Janet , McCarter Alison , Beresford Bryony , Fraser Lorna Katharine 
Published: October 2019

IntroductionIncreasing numbers of children require having all, or part, of their nutritional intake via gastrostomy. More parents are using home-blended meals to feed their children, with many reporting beneficial effects such as improved gastro-oesophageal reflux, less constipation and less distress in their child.This study aims to identify the important outcomes of tube feeding in this population, compare the safety, outcomes and resource use of those on a home-blended diet compared with a formula diet and assess feasibility of long-term follow-up of children recruited to this study.Methods and analysesThis is a mixed methods study of children (aged 6 months to 18 years) who are gastrostomy feed dependent recruited via general, community and specialist paediatric and dietetic services.Workstream1(WS1): a qualitative study involving semistructured interviews with parents (n~20) and young people (n~5–10), and focus groups with health professionals (n~25), will provide evidence of appropriate outcome measures and the feasibility/acceptability of proposed data collection methods for WS2. It will gather data on: desired outcomes of gastrostomy feeding, variability in diets and reasons; use of oral feeding; perceived benefits of the alternative diets, resources associated with gastrostomy feeding and safety issues. Data will be analysed using thematic analysis.WS2: a cohort study of 300 children who are gastrostomy fed. Data will be collected at months 0, 9 and 18 from parents, children (if appropriate) and clinicians using standardised measures and questionnaires developed specifically for the study. Data collected will include gastrointestinal symptoms, health and other outcomes (child, parent), dietary intake, anthropometry, healthcare usage, safety outcomes and resource use. Outcomes in the home-blended and formula groups will be compared using appropriate multiple regression analyses.Ethics and disseminationThe study has been approved by a research ethics committee (REC reference: 19/YH/0028). Results will be disseminated through publications and presentations for professionals and families.Study registration numberISRCTN13977361.
Discordances between predicted and actual risk in obese patients with suspected cardiac ischaemia
Authors: Litwin Sheldon E , Coles Adrian , Hill C Larry , Alhanti Brooke , Pagidipati Neha , Lee Kerry L , Pellikka Patricia A , Mark Daniel B , Udelson James E , Cooper Lawton , Tardif Jean-Claude , Hoffmann Udo , Douglas Pamela S 
Published: October 2019

ObjectivesTo test the relationship between increasing severity of obesity, calculated risk and observed outcomes.MethodsPatients with symptoms suggestive of coronary artery disease (CAD) (n=10 003) were stratified according to body mass index (BMI). We compared risk factors, pooled risk scores and physicians’ perception of risk. Cox regression tested the association between BMI and (1) presence of obstructive CAD and (2) composite clinical endpoints (death, cardiovascular death, unstable angina hospitalisation and myocardial infarction).ResultsBMI was ≥30 kg/m2in 48% of patients and ≥35 in 20%. Increasingly obese patients were younger, female and non-smoking but with higher prevalence of hypertension, diabetes, black race and sedentary lifestyle. Pooled risk estimates of CAD were highest in those with mid-range BMI. In contrast, physicians’ estimation of the likelihood of significant CAD based on clinical impression increased progressively with BMI. For a 10% increase in the Diamond-Forrester probability of CAD, the adjusted OR for obstructive CAD was 1.5 (95% CI 1.4 to 1.5) in patients with BMI <35, but only 1.2 (95% CI 1.1 to 1.3) in those with BMI ≥35 (interaction p<0.001). Framingham Risk Score increased across increasing BMI categories. However, there was a strong and consistent inverse relationship between degree of obesity and all three composite clinical endpoints over a median 25 months of follow-up.ConclusionsDespite perceptions of higher risk and higher risk scores, increasingly obese patients had obstructive CAD less frequently than predicted and had fewer adverse clinical outcomes. There is a need for risk assessment tools and guidelines that account for obesity.Trial registration numberNCT01174550.
Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study
Authors: Banerjee Amitava , Benedetto Valerio , Gichuru Philip , Burnell Jane , Antoniou Sotiris , Schilling Richard J , Strain William David , Ryan Ronan , Watkins Caroline , Marshall Tom , Sutton Chris J 
Published: October 2019

BackgroundDespite simpler regimens than vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (EHRs).ObjectiveWe investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence.MethodsIn UK primary care EHR (The Health Information Network 2011–2016), we investigated adherence and persistence at 1 year for oral anticoagulants (OACs) in adults with incident AF. Baseline characteristics were analysed by OAC and adherence/persistence status. Risk factors for non-adherence and non-persistence were assessed using Cox and logistic regression. Patterns of adherence and persistence were analysed.ResultsAmong 36 652 individuals with incident AF, cardiovascular comorbidities (median CHA2DS2VASc[Congestive heart failure, Hypertension, Age≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category] 3) and polypharmacy (median number of drugs 6) were common. Adherence was 55.2% (95% CI 54.6 to 55.7), 51.2% (95% CI 50.6 to 51.8), 66.5% (95% CI 63.7 to 69.2), 63.1% (95% CI 61.8 to 64.4) and 64.7% (95% CI 63.2 to 66.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. One-year persistence was 65.9% (95% CI 65.4 to 66.5), 63.4% (95% CI 62.8 to 64.0), 61.4% (95% CI 58.3 to 64.2), 72.3% (95% CI 70.9 to 73.7) and 78.7% (95% CI 77.1 to 80.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. Risk of non-adherence and non-persistence increased over time at individual and system levels. Increasing comorbidity was associated with reduced risk of non-adherence and non-persistence across all OACs. Overall rates of ‘primary non-adherence’ (stopping after first prescription), ‘non-adherent non-persistence’ and ‘persistent adherence’ were 3.5%, 26.5% and 40.2%, differing across OACs.ConclusionsAdherence and persistence to OACs are low at 1 year with heterogeneity across drugs and over time at individual and system levels. Better understanding of contributory factors will inform interventions to improve adherence and persistence across OACs in individuals and populations.
Mobile phone text-messaging interventions aimed to prevent cardiovascular diseases (Text2PreventCVD): systematic review and individual patient data meta-analysis
Authors: Shariful Islam Sheikh Mohammed , Farmer Andrew J , Bobrow Kirsten , Maddison Ralph , Whittaker Robyn , Pfaeffli Dale Leila Anne , Lechner Andreas , Lear Scott , Eapen Zubin , Niessen Louis Wilhelmus , Santo Karla , Stepien Sandrine , Redfern Julie , Rodgers Anthony , Chow Clara K 
Published: October 2019

BackgroundA variety of small mobile phone text-messaging interventions have indicated improvement in risk factors for cardiovascular disease (CVD). Yet the extent of this improvement and whether it impacts multiple risk factors together is uncertain. We aimed to conduct a systematic review and individual patient data (IPD) meta-analysis to investigate the effects of text-messaging interventions for CVD prevention.MethodsElectronic databases were searched to identify trials investigating a text-messaging intervention focusing on CVD prevention with the potential to modify at least two CVD risk factors in adults. The main outcome was blood pressure (BP). We conducted standard and IPD meta-analysis on pooled data. We accounted for clustering of patients within studies and the primary analysis used random-effects models. Sensitivity and subgroup analyses were performed.ResultsNine trials were included in the systematic review involving 3779 participants and 5 (n=2612) contributed data to the IPD meta-analysis. Standard meta-analysis showed that the weighted mean differences are as follows: systolic blood pressure (SBP), −4.13 mm Hg (95% CI −11.07 to 2.81, p<0.0001); diastolic blood pressure (DBP), −1.11 mm Hg (−1.91 to −0.31, p=0.002); and body mass index (BMI), −0.32 (−0.49 to −0.16, p=0.000). In the IPD meta-analysis, the mean difference are as follows: SBP, −1.3 mm Hg (−5.4 to 2.7, p=0.5236); DBP, −0.8 mm Hg (−2.5 to 1.0, p=0.3912); and BMI, −0.2 (−0.8 to 0.4, p=0.5200) in the random-effects model. The impact on other risk factors is described, but there were insufficient data to conduct meta-analyses.ConclusionMobile phone text-messaging interventions have modest impacts on BP and BMI. Simultaneous but small impacts on multiple risk factors are likely to be clinically relevant and improve outcome, but there are currently insufficient data in pooled analyses to examine the extent to which simultaneous reduction in multiple risk factors occurs.PROSPERO registration numberCRD42016033236.
The contribution of effective quantum gravity to the high energy scattering in the framework of modified perturbation theory and one loop approximation
Authors: Han Nguyen Suan , Ha Do Thu , Xuan Nguyen Nhu 
Published: October 2019

Abstract
The asymptotic behavior of the scattering amplitude for two scalar particles at high energies with fixed momentum transfers is studied. The study is done within the effective theory of quantum gravity based on quasi-potential equation. By using the modified perturbation theory, a systematic method is developed to find the leading eikonal scattering amplitudes together with corrections to them in the one-loop gravitational approximation. The relation is established and discussed between the solutions obtained by means of the operator and functional approaches applied to quasi-potential equation. The first non-leading corrections to the leading eikonal amplitude are found.
Anisotropic Tolman VII solution by gravitational decoupling
Authors: Hensh Sudipta , Stuchlík Zdeněk 
Published: October 2019

Abstract
Using the gravitational decoupling by the minimal geometric deformation approach, we build an anisotropic version of the well-known Tolman VII solution, determining an exact and physically acceptable interior two-fluid solution that can represent behavior of compact objects. Comparison of the effective density and density of the perfect fluid is demonstrated explicitly. We show that the radial and tangential pressure are different in magnitude giving thus the anisotropy of the modified Tolman VII solution. The dependence of the anisotropy on the coupling constant is also shown.
Output-based Intermediate Representation for Translation of Test-pattern Program
Authors: Kim Minsu , Park Jeong-Keun , Kim Sungyeol , Yang Insu , Jung Hyunsoo , Moon Soo-Mook 
Published: October 2019

An
Intermediate Representation
(IR) used by compilers is normally generated
statically
, as a result of parsing or analyzing the source program. This paper proposes a completely different type of IR, generated as a result of running the source program, the
output-based IR
. There is a practical translation problem where such an IR is useful, in the domain of
test-pattern programs
.

Test-pattern programs run on ATE (automatic test equipment), a special embedded system to test semiconductors such as DRAMs. They generate a pattern for each clock, a bit vector input to the pins of the chip. One issue is that different ATEs require different programming since each ATE manufacturer has its own programming language. Nonetheless, we should be able to test a memory chip on different ATEs as long as they generate the same patterns with the same speed. Therefore, a memory chipmaker wants to make a pattern program portable across ATEs, to fully utilize their ATE resources.
One solution is translating between pattern programs, for which we need an IR since there are multiple source ATEs and target ATEs. Instead of a conventional, static IR, we propose using the output pattern itself as an IR. Since the pattern is independent of ATEs and easily obtainable, the output-based IR obviates designing a static IR considering all ATE programming languages and hardware differences. Moreover, we might synthesize a better target program from the IR, more optimized to the target ATE. However, the full pattern generated by a product-level pattern program is huge, so we propose using an IR of abbreviated patterns, annotated with the repetition information obtained while executing the source program. Our experimental results with product-level pattern programs show that our approach is feasible.
Honey, I Shrunk the ELFs
Authors: Ziegler Andreas , Geus Julian , Heinloth Bernhard , Hönig Timo , Lohmann Daniel 
Published: October 2019

In the embedded domain, industrial sectors (i.e., automotive industry, avionics) are undergoing radical changes. They broadly adopt commodity hardware and move away from special-purpose control units. During this transition, heterogeneous software components are consolidated to run on commodity operating systems.

To efficiently consolidate such components, a modular encapsulation of common functionality into reusable binary files (i.e., shared libraries) is essential. However, shared libraries are often unnecessarily large as they entail a lot of generic functionality that is not required in a narrowly defined scenario. As the source code of proprietary components is often unavailable and the industry is heading towards binary-only distribution, we propose an approach towards
lightweight binary tailoring
.

As demonstrated in the evaluation, lightweight binary tailoring effectively reduces the amount of code in all shared libraries on a Linux-based system by 63 percent and shrinks their files by 17 percent. The reduction in size is beneficial to cut down costs (e.g., lower storage and memory footprint) and eases code analyses that are necessary for code audits.