bluuebunny/crossref_metadata_2025_split huggingface dataset:
Needs of family caregivers of hospitalised adults with dementia during care transitions: a qualitative study in a US Department of Veterans Affairs Hospital
Authors: Horstman Molly J , Evans Tracy L , Guo Crystal , Sonnenfeld Mandi , Naik Aanand D , Stevens Alan , Kunik Mark E 
Published: August 2024

ObjectiveTo identify the needs of caregivers of hospitalised adults with dementia in the hospital and during care transitions.DesignPragmatic qualitative inquiry with semi-structured interviews.SettingMichael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, USA.Participants12 family caregivers (family member (n=11); friend (n=1)) and 15 health professionals (hospital medicine physicians (n=4), inpatient nurse case managers (n=2), social workers (n=4), outpatient geriatrics providers (n=2), a primary care provider (n=1), geriatric psychiatrists (n=2)) were interviewed. Caregivers were recruited while their care recipient was hospitalised and were interviewed at least 2 weeks after the care recipient was discharged from the hospital. Health professionals were eligible for the study if they provided care to patients with dementia in the inpatient or outpatient setting.ResultsFour recommendations emerged from the analysis: (1) engage caregivers as partners in the care team, (2) provide dementia-specific information and training, (3) connect caregivers to home and community-based services and (4) provide care navigation and support for the caregiver posthospitalisation.ConclusionsHospital care transitions are challenging for caregivers of hospitalised adults living with dementia. Care transition interventions designed to support caregivers with tailored, dementia-specific information and services are needed.
Trial to assess the tolerability of using felodipine to upregulate autophagy as a treatment of Huntington’s disease (FELL-HD): a phase II, single-centre, open-label, dose-finding trial protocol
Authors: Andresen Katie , Cutting Emma , Apostolopoulos Dimitrios , Evans Amy H , Oakley Laura , Dayimu Alimu , Demiris Nikolaos , Bongaerts Katherine , Staples Robyn , Gooding Wendy , Rubinsztein David C , Barker Roger A 
Published: August 2024

IntroductionHuntington’s disease (HD) is an autosomal dominant neurodegenerative disorder that presents with a progressive movement disorder along with cognitive and psychiatric problems. It is caused by a Cytosine-adenin-guanine (CAG) expansion in exon 1 of the huntingtin gene which codes for mutant huntingtin (mHTT) that over time accumulates in cells, causing dysfunction and then death through new toxic gain-of-function mechanisms. Autophagy has been shown to be critical for the degradation of diverse intracytoplasmic aggregate-prone proteins that cause neurodegenerative disease, including mHTT. From a screen of a library enriched in approved drugs, felodipine was selected as the most suitable candidate showing strong autophagy-inducing effects in preclinical models of HD. We are, therefore, conducting a trial to assess the safety and tolerability of felodipine in people with early HD.Methods and analysisFELL-HD is a phase II, single-centre, open-label, dose-finding trial in people with early HD. 18 participants with early clinical features of the disease will be treated with felodipine for 58 weeks, with a further 4-week follow-up. The primary outcome measure is the number of adverse events attributable to felodipine. Exploratory outcomes include additional measures of motor and cognitive function, non-motor symptoms and quality of life scales, as well as peripheral and central disease biomarkers assessed through brain MRI. Analysis of blood and cerebrospinal fluid will also be performed through an associated sample study, FELL HD-s.Ethics and disseminationThe study was approved by the London-Brent Research Ethics Committee (reference 22/LO/0387) and has been accepted by the Medicines and Healthcare products Regulatory Agency for clinical trials authorisation (reference CTA 12854/0256/001-0001). A lay summary of the results of the trial will be uploaded to our research group website which is publicly accessible. A webinar or in-person open day, to present results of the trial to participants and our wider cohort of patients who attend our centre, will be held once the trial is completed. The results of the trial will also be published in scientific journals and presented at national and international conferences.Trial registration numbersEudraCT-2021-000897-27,ISRCTN56240656.
Treating severe paediatric asthma with mepolizumab or omalizumab: a protocol for the TREAT randomised non-inferiority trial
Authors: Cornelius Victoria , Babalis Daphne , Carroll William D , Cunningham Steven , Fleming Louise , Gaillard Erol , Gupta Atul , Janani Leila , Kennington Erika , Murray Clare , Nagakumar Prasad , Roberts Graham , Seddon Paul , Sinha Ian , Streatfield Claire , Weir Elise , Saglani Sejal 
Published: August 2024

IntroductionA minority of school-aged children with asthma have persistent poor control and experience frequent asthma attacks despite maximal prescribed maintenance therapy. These children have higher morbidity and risk of death. The first add-on biologic therapy, omalizumab, a monoclonal antibody that blocks immunoglobulin (Ig)E, was licensed for children with severe asthma in 2005. While omalizumab is an effective treatment, non-response is common. A second biologic, mepolizumab which blocks interleukin 5 and targets eosinophilic inflammation, was licensed in 2018, but the licence was granted by extrapolation of adult clinical trial data to children. This non-inferiority (NI) trial will determine whether mepolizumab is as efficacious as omalizumab in reducing asthma attacks in children with severe therapy resistant asthma (STRA) and refractory difficult asthma (DA).Methods and analysisThis is an ongoing multicentre 1:1 randomised NI open-label trial of mepolizumab and omalizumab. Up to 150 children and young people (CYP) aged 6–17 years with severe asthma will be recruited from specialist paediatric severe asthma centres in the UK. Prior to randomisation, children will be monitored for medication adherence for up to 16 weeks to determine STRA and refractory DA diagnoses. Current prescribing recommendations of serum IgE and blood eosinophils will not influence eligibility or enrolment. The primary outcome is the 52-week asthma attack rate. Bayesian analysis using clinician-elicited prior distributions will be used to calculate the posterior probability that mepolizumab is not inferior to omalizumab. Secondary outcomes include Composite Asthma Severity Index, Paediatric Asthma Quality of Life Questionnaire, lung function measures (forced expiratory volume in one second (FEV1), bronchodilator reversibility), fractional exhaled nitric oxide, Asthma Control Test (ACT), health outcomes EuroQol 5 Dimension (EQ-5D) and optimal serum IgE and blood eosinophil levels that may predict a response to therapy. These outcomes will be analysed in a frequentist framework using longitudinal models.Ethics and disseminationThe study has been approved by the South Central—Berkshire Research Ethics Committee REC Number 19/SC/0634 and had Clinical Trials Authorisation from the Medicines and Healthcare Products Regulatory Agency (MHRA) (EudraCT 2019-004085-17). All parents/legal guardians will give informed consent for their child to participate in the trial, and CYP will give assent to participate. The results will be published in peer-reviewed journals, presented at international conferences and disseminated via our patient and public involvement partners.Trial registration numberISRCTN12109108; EudraCT Number: 2019-004085-17.
Serum Chloride and the Response to Acetazolamide in Patients With Acute Heart Failure and Volume Overload: A Post Hoc Analysis From the ADVOR Trial
Authors: Van den Eynde Jef , Martens Pieter , Dauw Jeroen , Nijst Petra , Meekers Evelyne , ter Maaten Jozine M. , Damman Kevin , Filippatos Gerasimos , Lassus Johan , Mebazaa Alexandre , Ruschitzka Frank , Dupont Matthias , Mullens Wilfried , Verbrugge Frederik H. 
Published: August 2024

BACKGROUND:
Chloride plays a crucial role in renal salt sensing. This study investigates whether serum chloride is associated with clinical outcomes and decongestive response to acetazolamide in patients with acute decompensated heart failure.

METHODS:
This post hoc analysis includes all 519 patients from the ADVOR trial (Acetazolamide in Decompensated Heart Failure With Volume Overload), randomized to intravenous acetazolamide or matching placebo on top of intravenous loop diuretics. The impact of baseline serum chloride on the main trial end points and the treatment effect of acetazolamide was assessed, as was the evolution of serum chloride under decongestive treatment.

RESULTS:

Hypochloremia (<96 mmol/L) and hyperchloremia (>106 mmol/L) were present in 80 (15%) and 53 (10%), respectively, at baseline. Hypochloremia was associated with significantly slower decongestion, a longer length of hospital stay, and increased risk of all-cause mortality and heart failure readmissions. Acetazolamide increased the odds of successful decongestion and reduced length of stay irrespectively of baseline serum chloride levels. No statistically significant interaction between serum chloride levels and the effect of acetazolamide on death or heart failure readmissions was observed. The placebo group exhibited a progressive decline in serum chloride, which was effectively prevented by acetazolamide (
P
<0.001).

CONCLUSIONS:
Hypochloremia is associated with diuretic resistance and worse clinical outcomes. Add-on acetazolamide therapy improves decongestion across the entire range of serum chloride and prevents the drop in chloride levels caused by loop diuretic monotherapy.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03505788
The Changing Morphology of Global Precipitation Systems during the Last Two Decades
Authors: Zhang Yan , Wang Kaicun 
Published: August 2024

Abstract
The morphology of global precipitation systems can enhance our comprehension of precipitation patterns and the underlying physical processes. However, several unresolved issues remain in the existing studies of precipitation system morphology. This study employs Integrated Multi-satellitE Retrievals for Global Precipitation Measurement (GPM) (IMERG)-derived precipitation system dataset to investigate the climatological and changing characteristics of global precipitation system morphology from 2001 to 2022. The results show that precipitation systems with larger scales tend to be more flattened in morphology, while no clear differences in morphological characteristics are observed across systems with different intensities. In terms of geographic distributions, a notable land–sea contrast is observed, with land systems more circular than those over oceans. Due to the impact of the Coriolis force, the orientation distribution of precipitation systems shows obvious hemispherical contrast. Precipitation systems over tropical regions are more regular in shape and more likely to be organized convective systems. During the period of 2001–22, there is a significant trend of global precipitation systems becoming more flattened and are more likely to manifest as organized convective systems. Our results also indicate that the precipitation system morphology is under combined influence of subtropical highs, lateral stretching influences of wind, and the organizing effects of moisture transport and convergence. Moreover, the increasing flattening of precipitation systems could be attributed to enhanced atmospheric stability which constrains vertical expansion and increased moisture availability which favors wider horizontal extension. This study could provide new insights into precipitation changes under global warming.
Efficient and Accurate Shortcuts for Calculating the Extended Heat Index
Authors: Lanzante John R. 
Published: August 2024

Abstract
The heat index (HI), based on Steadman’s model of thermoregulation, has found wide applicability for estimating human heat stress. It has proven useful in research endeavors aimed at estimating future changes associated with global climate change as well as operationally for the issuance of heat advisories by the U.S. National Weather Service (NWS). The actual computation of the HI based on ambient temperature and humidity has been streamlined by the use of a polynomial fit by Rothfusz to Steadman’s model output. Recently, Steadman’s model has been updated by Lu and Romps to provide applicability to temperature and humidity values that were “out of range” of Steadman’s model. The authors of this extended HI (EHI) have provided computer code to enable application. However, because of the complexity of the model, execution of the code would be relatively costly for use in applications involving dense grids and multimodel ensembles covering decades such as those appropriate for assessing the range of possible changes in human heat stress. Here, shortcuts are provided in the form of a “lookup table” and polynomials that provide computational savings of several orders of magnitude. Error analyses provide estimates of accuracy.

Significance Statement
Over 40 years ago, an index was developed to estimate the heat stress on the human body due to the combined effects of temperature and humidity. It has been used widely both to issue public heat advisories and in studies aimed at assessing possible future changes in heat stress due to climate change. Recently, that index has been updated and extended to handle higher temperatures that are becoming more common due to climate change. This work provides efficient and accurate shortcuts to compute the new index which require much less computing time and can be beneficial for more demanding tasks such as estimating the range of possibilities in the future.
The Representative Kanpur Tannery’s Ganges Water Pollution Problem
Authors: Batabyal Amitrajeet A. 
Published: August 2024

In this research note, we focus on a representative leather-producing tannery in Kanpur, India and shed light on two specific questions that, to the best of our knowledge, have not been studied previously in the literature. First, what is the deadweight loss from water pollution caused by this tannery? Second, how might an effluent fee be used to ensure that the socially optimal amount of leather is produced by this same tannery? Our linear model provides answers to these two questions and also shows how our results can be used to guide pollution regulation policy. JEL Codes: Q53, R11
The mediating effect of resilience between work fatigue and psychological distress among healthcare workers in Brazil, Lebanon, Nigeria, Pakistan, Poland, Qatar, Serbia, and Tunisia
Authors: Fekih-Romdhane Feten , Hallit Souheil , Mohammed Irfan , El Khatib Sarah , Brytek-Matera Anna , Eze Shadrach Chinecherem , Egwu Kenneth , Jabeen Rawshan , Pavlović Nebojša , Salameh Pascale , Cherfane Michelle , Younes Samar , Akel Marwan , Haddad Chadia , Choueiry Randa , Iskandar Katia 
Published: August 2024

Objectives To test the hypothesis that resilience has a mediating effect on the association between work fatigue and psychological distress. Methods A cross-sectional survey was conducted online in eight countries in 2021: Brazil, Lebanon, Nigeria, Pakistan, Poland, Qatar, Serbia, and Tunisia. A total of 1094 healthcare professionals specialized in medicine, pharmacy, and nurse practitioners that were exposed to/worked with COVID-19 patients were included (age: 33.89 ± 10.79 years; 59.6% females). Results After adjusting for potential confounders (i.e., country, gender, primary work in emergency department, primary work in infectious disease, primary work in intensive care unit, working in a COVID-19 ward, and working voluntary hours), the results of the mediation analysis showed that resilience fully mediated the association between physical work fatigue and psychological distress and partially mediated the associations between mental and emotional work fatigue and psychological distress. Higher work fatigue was significantly associated with less resilience; higher resilience was significantly associated with less psychological distress. Finally, higher mental and emotional, but not physical, work fatigue, were directly and significantly associated with more psychological distress. Conclusion Identifying resilience as an important mediator in the path from fatigue to distress helps elucidate underlying mechanisms and pathways leading to the mental health-alteration process among healthcare workers during COVID-19. New strategies targeting resilience may be developed to further improve mental health outcomes among healthcare workers.
Implementing the organizational readiness for change survey during a novel midwifery preceptor program in Sierra Leone: stakeholder results
Authors: van de Water Brittney J. , Longacre Ashley H. , Hotchkiss Jenny , Sonnie Mustapha , Mann Julie , Lemor Elizabeth 
Published: August 2024

Abstract
Background
Sierra Leone has one of the world’s highest maternal and infant mortality rates and suffers from a shortage of well-trained health professionals, including midwives. Prior to engaging in systematic interventions, it is critical to measure organizational readiness to gauge members’ psychological and behavioral preparedness to implement change. We aimed to measure the organizational readiness for implementing change and compare results among midwives and administrative leaders at two schools of midwifery in Sierra Leone prior to the rollout of a midwifery preceptor program.

Methods
The Organizational Readiness for Implementing Change (ORIC) survey is a validated 12-item questionnaire designed to assess two domains of organizational readiness for change: change commitment (motivation) and change efficacy (capacity). All survey items begin with the same prompt and a five-item Likert scale response, with seven questions about change commitment and five about change efficacy. Data collection occurred in two schools of midwifery in Sierra Leone during two day-long meetings with stakeholders. Statistical analysis was conducted using descriptive statistics and Wilcoxon rank-sum test to compare independent samples: School 1 versus School 2 (site), midwife versus other roles (role).

Results
Participants included 42 respondents (mean age 41 years, 95% female). Surveys were distributed evenly between the two sites. Occupations included midwifery faculty (n = 8), administrators (n = 5), clinicians (n = 25), and clinical educators (n = 4). Domain 1 (change commitment) had a mean score of 4.72 (SD 0.47) while Domain 2 (change efficacy) had a mean score of 4.53 (SD 0.54) out of a total potential score of five. There were no statistically significant differences between site responses for Domain 1 (p = 0.5479) and Domain 2 (p = 0.1026) nor role responses for Domain 1 (p = 0.0627) and Domain 2 (p = 0.2520).

Conclusion
Stakeholders had very high overall readiness for change across all ORIC questions for both change commitment and change efficacy. Mean scores for change commitment were slightly higher which is not surprising given the low-resourced settings stakeholders work in while training students. High mean scores across sites and roles is encouraging as this novel preceptor program is currently being rolled out.
Predictive digital twin driven trust model for cloud service providers with Fuzzy inferred trust score calculation
Authors: John Jomina , K John Singh 
Published: August 2024

AbstractCloud computing has become integral to modern computing infrastructure, offering scalability, flexibility, and cost-effectiveness. Trust is a critical aspect of cloud computing, influencing user decisions in selecting Cloud Service Providers (CSPs). This paper provides a comprehensive review of existing trust models in cloud computing, including agreement-based, SLA-based, certificate-based, feedback-based, domain-based, prediction-based, and reputation-based models. Building on this foundation, we propose a novel methodology for creating a trust model in cloud computing using digital twins for CSPs. The digital twin is augmented with a fuzzy inference system, which computes the trust score of a CSP based on trust-related parameters. The architecture of the digital twin with the fuzzy inference system is detailed, outlining how it processes security parameter values obtained through penetration testing mechanisms. These parameter values are transformed into crisp values using a linear ridge regression function and then fed into the fuzzy inference system to calculate a final trust score for the CSP. The paper also presents the outputs of the fuzzy inference system, demonstrating how different security parameter inputs yield various trust scores. This methodology provides a robust framework for assessing CSP trustworthiness and enhancing decision-making processes in cloud service selection.
Automated Extraction of Patient-Centered Outcomes After Breast Cancer Treatment: An Open-Source Large Language Model–Based Toolkit
Authors: Luo Man , Trivedi Shubham , Kurian Allison W. , Ward Kevin , Keegan Theresa H.M. , Rubin Daniel , Banerjee Imon 
Published: August 2024

PURPOSE Patient-centered outcomes (PCOs) are pivotal in cancer treatment, as they directly reflect patients' quality of life. Although multiple studies suggest that factors affecting breast cancer–related morbidity and survival are influenced by treatment side effects and adherence to long-term treatment, such data are generally only available on a smaller scale or from a single center. The primary challenge with collecting these data is that the outcomes are captured as free text in clinical narratives written by clinicians. MATERIALS AND METHODS Given the complexity of PCO documentation in these narratives, computerized methods are necessary to unlock the wealth of information buried in unstructured text notes that often document PCOs. Inspired by the success of large language models (LLMs), we examined the adaptability of three LLMs, GPT-2, BioGPT, and PMC-LLaMA, on PCO tasks across three institutions, Mayo Clinic, Emory University Hospital, and Stanford University. We developed an open-source framework for fine-tuning LLM that can directly extract the five different categories of PCO from the clinic notes. RESULTS We found that these LLMs without fine-tuning (zero-shot) struggle with challenging PCO extraction tasks, displaying almost random performance, even with some task-specific examples (few-shot learning). The performance of our fine-tuned, task-specific models is notably superior compared with their non–fine-tuned LLM models. Moreover, the fine-tuned GPT-2 model has demonstrated a significantly better performance than the other two larger LLMs. CONCLUSION Our discovery indicates that although LLMs serve as effective general-purpose models for tasks across various domains, they require fine-tuning when applied to the clinician domain. Our proposed approach has the potential to lead more efficient, adaptable models for PCO information extraction, reducing reliance on extensive computational resources while still delivering superior performance for specific tasks.