bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Gamification, Financial Incentives, or Both to Increase Physical Activity Among Patients at High Risk of Cardiovascular Events: The BE ACTIVE Randomized Controlled Trial
Authors: Fanaroff Alexander C. , Patel Mitesh S. , Chokshi Neel , Coratti Samantha , Farraday David , Norton Laurie , Rareshide Charles , Zhu Jingsan , Klaiman Tamar , Szymczak Julia E. , Russell Louise B. , Small Dylan S. , Volpp Kevin G.M. 
Published: April 2024

BACKGROUND:
Physical activity is associated with a lower risk of major adverse cardiovascular events, but few individuals achieve guideline-recommended levels of physical activity. Strategies informed by behavioral economics increase physical activity, but their longer-term effectiveness is uncertain. We sought to determine the effect of behaviorally designed gamification, loss-framed financial incentives, or their combination on physical activity compared with attention control over 12-month intervention and 6-month postintervention follow-up periods.

METHODS:
Between May 2019 and January 2024, participants with clinical atherosclerotic cardiovascular disease or a 10-year risk of myocardial infarction, stroke, or cardiovascular death of ≥7.5% by the Pooled Cohort equation were enrolled in a pragmatic randomized clinical trial. Participants received a wearable device to track daily steps, established a baseline, selected a step goal increase, and were randomly assigned to control (n=151), behaviorally designed gamification (n=304), loss-framed financial incentives (n=302), or gamification+financial incentives (n=305). The primary outcome of the trial was the change in mean daily steps from baseline through the 12-month intervention period.

RESULTS:

A total of 1062 patients (mean±SD age, 67±8; 61% female; 31% non-White) were enrolled. Compared with control subjects, participants had significantly greater increases in mean daily steps from baseline during the 12-month intervention in the gamification arm (adjusted difference, 538.0 [95% CI, 186.2–889.9];
P
=0.0027), financial incentives arm (adjusted difference, 491.8 [95% CI, 139.6–844.1];
P
=0.0062), and gamification+financial incentives arm (adjusted difference, 868.0 [95% CI, 516.3–1219.7];
P
<0.0001). During the 6-month follow-up, physical activity remained significantly greater in the gamification+financial incentives arm than in the control arm (adjusted difference, 576.2 [95% CI, 198.5–954];
P
=0.0028), but it was not significantly greater in the gamification (adjusted difference, 459.8 [95% CI, 82.0–837.6];
P
=0.0171) or financial incentives (adjusted difference, 327.9 [95% CI, −50.2 to 706];
P
=0.09) arms after adjustment for multiple comparisons.

CONCLUSIONS:
Behaviorally designed gamification, loss-framed financial incentives, and the combination of both increased physical activity compared with control over a 12-month intervention period, with the largest effect in gamification+financial incentives. These interventions could be a useful component of strategies to reduce cardiovascular risk in high-risk patients.

REGISTRATION:

URL:
https://clinicaltrials.gov
; Unique Identifier: NCT03911141.
Reversion of the Inflammatory Markers in Patients With Chronic Limb‐Threatening Ischemia
Authors: Ferreira Joana , Roque Susana , Lima Carneiro Alexandre , Longatto‐Filho Adhemar , Vila Isabel , Cunha Cristina , Silva Cristina , Mesquita Amílcar , Cotter Jorge , Correia‐Neves Margarida , Mansilha Armando , Cunha Pedro Guimarães 
Published: April 2024

Background
Peripheral artery disease is characterized by an intense inflammatory process that can be associated with a higher mortality rate, particularly in chronic limb‐threatening ischemia (CLTI). This study aims to compare the evolution of inflammatory markers between patients with claudication with those with CLTI at 3, 6, and 12 months.

Methods and Results

An observational, single‐center, and prospective study was conducted. A total of 119 patients with peripheral artery disease (65 with claudication and 54 with CLTI) were observed and inflammatory markers collected at admission and 3, 6, and 12 months. At admission, patients with CLTI, when compared with patients with claudication, had significantly higher serum levels of C‐reactive protein and fibrinogen (positive acute‐phase proteins) and lower serum level of albumin, total cholesterol, and high‐density lipoprotein (negative acute‐phase proteins): C‐reactive protein (g/dL), 2.90 (25th–75th percentile, 2.90–4.90) versus 6.80 (25th–75th percentile, 2.90–53.26) (
P
=0.000); fibrinogen (mg/dL), 293.00 (25th–75th percentile, 269.25–349.00) versus 415.50 (25th–75th percentile, 312.00–615.75) (
P
=0.000); total cholesterol (mg/dL), 161.79±95% [152.74–170.85] versus 146.42%±95% [135.30–157.53] (
P
=0.034); high‐density lipoprotein (mg/dL), 50.00 (25th–75th percentile, 41.00–60.00) versus 37.00 (25th–75th percentile, 30.00–45.50) (
P
=0.000); albumin (g/dL): 4.00 (25th–75th percentile, 3.70–4.20) versus 3.60 (25th–75th percentile, 3.10–4.00) (
P
=0.003). The association between CLTI and total cholesterol was lost after adjusting for confounders. Three months after the resolution of the CLTI, there was an increase in the levels of negative acute‐phase proteins and a decrease in positive acute‐phase proteins. These inflammatory proteins did not register an evolution in patients with claudication. The differences in the inflammatory proteins between groups disappeared at 6 months.

Conclusions
CLTI has an inflammatory environment that can be partially reverted after resolution of the ischemic process, emphasizing the importance of timely intervention.
Anticoagulation for Patients With Concomitant Atrial Fibrillation and End‐Stage Renal Disease: A Systematic Review and Network Meta‐Analysis
Authors: Kao Ting‐Wei , Chen Zheng‐Wei , Lin Yen‐Hung 
Published: April 2024

Background
Concomitant atrial fibrillation and end‐stage renal disease is common and associated with an unfavorable prognosis. Although oral anticoagulants have been well established to prevent thromboembolism, the applicability in patients under long‐term dialysis remains debatable. The study aimed to determine the efficacy and safety of anticoagulation in the dialysis‐dependent population.

Methods and Results
An updated network meta‐analysis based on MEDLINE, EMBASE, and the Cochrane Library was performed. Studies published up to December 2022 were included. Direct oral anticoagulants (DOACs, dabigatran, rivaroxaban, apixaban 2.5/5 mg twice daily), vitamin K antagonists (VKAs), and no anticoagulation were compared on safety and efficacy outcomes. The outcomes of interest were major bleeding, thromboembolism, and all‐cause death. A total of 42 studies, including 3 randomized controlled trials, with 185 864 subjects were pooled. VKAs were associated with a significantly higher risk of major bleeding than either no anticoagulation (hazard ratio [HR], 1.47; 95% CI, 1.34–1.61) or DOACs (DOACs versus VKAs; HR, 0.74 [95% CI, 0.64–0.84]). For the prevention of thromboembolism, the efficacies of VKAs, DOACs, and no anticoagulation were equivalent. Nevertheless, dabigatran and rivaroxaban were associated with fewer embolic events. There were no differences in all‐cause death with the administration of VKAs, DOACs, or no anticoagulation.

Conclusions
For dialysis‐dependent populations, dabigatran and rivaroxaban were associated with better efficacy, while dabigatran and apixaban demonstrated better safety. No anticoagulation was a noninferior alterative, and VKAs were associated with the worst outcomes.
Conflicts of Interest Among Cardiology Clinical Practice Guideline Authors in Japan
Authors: Murayama Anju , Aizawa Megumi , Byreddy Keerthana R. , Higuchi Kenichi , Senoo Yuki 
Published: April 2024

Background
Clinical practice guidelines (CPGs) offer disease management recommendations based on scientific evidence. However, financial conflicts of interest between CPG developers and the pharmaceutical industry could bias these recommendations, potentially affecting patient care. Proper management of these conflicts of interest is particularly crucial for maintaining the integrity of CPGs. The study aimed to evaluate the extent of financial relationships between the pharmaceutical industry and authors of CPGs for cardiovascular diseases in Japan.

Methods and Results
The study analyzed personal payments from the pharmaceutical industry to authors of cardiovascular disease CPGs published by the Japanese Circulation Society from January 2015 to December 2022. Payment data, including speaking, consultancy, and writing fees from 2016 to 2020, were extracted from a publicly available database containing personal payments disclosed by all major pharmaceutical companies. A total of 929 unique authors from 37 eligible Japanese Circulation Society CPGs were identified. Notably, 94.4% of these authors received personal payments from pharmaceutical companies, totaling >US $70.8 million. The mean±SD payment per author was US $76 314±138 663) and the median payment per author was US $20 792 (interquartile range: US $4262–US $76 998) over the 5‐year period. Chairs of CPGs received significantly higher payments than other authors. More than 80% of authors in each CPG received personal payments.

Conclusions
The study elucidated that there were considerable financial relationships between pharmaceutical companies and cardiology CPG authors in Japan. This finding deviates from international conflict of interest management policies, suggesting the need for more stringent conflict of interest management strategies by the Japanese Circulation Society to ensure the development of trustworthy and evidence‐based CPGs.
Large Language Models Enable Few-Shot Clustering
Authors: Viswanathan Vijay , Gashteovski Kiril , Gashteovski Kiril , Lawrence Carolin , Wu Tongshuang , Neubig Graham 
Published: April 2024

Abstract
Unlike traditional unsupervised clustering, semi-supervised clustering allows users to provide meaningful structure to the data, which helps the clustering algorithm to match the user’s intent. Existing approaches to semi-supervised clustering require a significant amount of feedback from an expert to improve the clusters. In this paper, we ask whether a large language model (LLM) can amplify an expert’s guidance to enable query-efficient, few-shot semi-supervised text clustering. We show that LLMs are surprisingly effective at improving clustering. We explore three stages where LLMs can be incorporated into clustering: before clustering (improving input features), during clustering (by providing constraints to the clusterer), and after clustering (using LLMs post-correction). We find that incorporating LLMs in the first two stages routinely provides significant improvements in cluster quality, and that LLMs enable a user to make trade-offs between cost and accuracy to produce desired clusters. We release our code and LLM prompts for the public to use.1
Nipple-Sparing Mastectomy and Adequate Margins for Patients With Ductal Carcinoma In Situ
Authors: Shaffer Kristina , Harris Lilian , Ng Stephanie , Tjoe Judy A. 
Published: April 2024

Background For patients with ductal carcinoma in situ (DCIS) undergoing breast conservation surgery (BCS), guidelines advise a margin width of at least 2 mm, with studies demonstrating decreased recurrence risk compared to narrower margins. However, limited data exist establishing if this margin is appropriate in mastectomies, and specifically for nipple-sparing mastectomy (NSM). Consequently, we evaluated the margins of DCIS patients undergoing NSM and resulting oncologic outcomes. Methods A single-institution retrospective review was performed in patients with DCIS or DCIS with microinvasion (DCIS + MI) undergoing NSM from April 2010 to December 2021. Patient and tumor characteristics, margin status, treatment, and outcomes information were collected. The association between margins and local-regional (LRR) and distant recurrence (DR) were examined. Results 161 patients were included, comprising 284 NSM (164 therapeutic, 120 prophylactic). 153 patients had DCIS and 8 had DCIS + MI. Most patients had hormone sensitive, 123 (76.4%), and nuclear grade 2, 72 (44.7%), disease. In total, 35 (21.7%) patients had positive or <2 mm margins. Of these, 21 (60%) involved the anterior margin. At a median follow-up of 45 months (range 0-151), 2.5% (n = 4) had a LRR and .6% (n = 1) had a DR. Of patients with a recurrence, only 2 had positive or <2 mm margins, 1 had received endocrine therapy, and none received adjuvant radiation. Discussion No specific margin status was found to correlate with recurrence for patients with DCIS or DCIS + MI undergoing NSM, with an altogether low recurrence risk. Overall, this suggests that recommended DCIS margins in BCS doesn’t necessarily apply in NSM, where margins of <2 mm may be acceptable.
Return and Volatility Spillover in Equity and Commodity Market: Some Indian Evidence
Authors: Sethy Tapas Kumar , Tripathy Naliniprava 
Published: April 2024

This study empirically investigates the return and volatility spillover among equity markets, Agro and non-Agro commodity markets. The study has used daily return data of BSE SENSEX as equity index, MCX iCOMEDEX, including Gold, Silver, and Crude oil, as non-agro indices, and NCDEX (AGRIDEX) as agro commodity indices to analyze volatility transmission between assets and markets using Generalized Autoregressive Conditional Heteroscedasticity (GARCH) and Exponential Generalized Autoregressive Conditional Heteroscedastic (EGARCH) model. The study has used dummy variables in the variance equation to identify the structural breaks during the COVID 19 pandemic. Further, Vector Auto Regression (VAR) pair-wise Granger causality test has been used to understand returns’ causality. The study has found a bidirectional and unidirectional causal relationship between variables. The study indicates that NCDEX could influence all the variables except MCX Gold. In structural breaks with deterministic dummy variables during COVID-19, we have found mixed evidence of asymmetric impact on conditional volatility. The study also indicates a positive and significant asymmetric volatility effect in the case of MCX Gold and MCX Silver during the COVID-19 period. The study has specified that SENSEX dominates the inflow of information to all commodity markets. Also, the findings signpost that information flows from NCDEX to MCX Gold, MCX Silver, and MCX Crude Oil. JEL Codes: C32, E30, E44, F41, G15, Q43
Contribution to the percolation threshold study of Silicon carbide filled polydimethylsiloxane composites used for field grading application
Authors: Metz Renaud , Terzi Sofiane , Fayard Barbara , Bantignies Jean-Louis , Hassanzadeh Mehrdad 
Published: April 2024

The correlations between the electrical behavior and microstructural properties of samples consisting of particle composites fabricated from SiC particles embedded in a silicone matrix, were investigated using X-ray computed tomography. In the voltage field range 200-1000 V/mm, the measured conductivity as a function of SiC volume fraction exhibits two distinct gaps. Upon further investigations, we attribute these observations to percolation thresholds at the microscale. The first gap, corresponding to interconnections between SiC particles that were originally disconnected, is more significant at higher voltage; while the second one, resulting from shortening conductivity pathways between the external surfaces of the samples with the increase of SiC volume fraction, seems more sensitive to lower voltages and is correlated with a decrease of the tortuosity of the percolated SiC network.
CIBSE TM54 energy projections I: A case study using quasi-steady state modelling
Authors: Jain Nishesh , Burman Esfand , Mumovic Dejan 
Published: April 2024

CIBSE TM54 was recently revised and covers best practice methods to evaluate the operational energy use of buildings. TM54 is a guidance document that can be used for performance evaluation at every stage of the design and construction process, and during the occupied stage, to ensure that long-term operational performance aligns with the design intent. The main performance evaluation principles in TM54 are a step-by-step modelling approach and scenario testing, to improve the robustness of the design proposal calculations. The latest edition of this technical memorandum brings an updated perspective to the modelling approaches, including detailed Heating, Ventilation and Air Conditioning (HVAC) modelling and simulation. It also incorporates more detailed guidance around risks, target setting, scenario testing and sensitivity analysis. A case study approach is used to explore and demonstrate some important aspects described in TM54. TM54 recommends three modelling approaches (aka implementation routes) that a project can follow depending on its scale and complexity: using quasi-steady state tools; dynamic simulation with a template HVAC system; and dynamic simulation with detailed HVAC system modelling. As part of a series of three, this case study provides an application of the first implementation route: modelling using quasi-steady state tools. Practical Application This case study provides detailed guidance on undertaking CIBSE TM54 modelling and projecting design stage building performance. The study covers the interpretation and clarifications of how TM54 can be applied, through the quasi-steady-state modelling tools.
Prevalence and Risk of Schizophrenia and Bipolar Disorder in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis
Authors: Toomukuntla Sindhu , Vemula Chandra Vamshi , Spoorthy Mamidipalli Sai , Zaki Syed Ahmed , Tikka Sai Krishna 
Published: April 2024

Purpose: Schizophrenia and bipolar disorder are understood to have neuroinflammatory/neuro-immunological basis in their etiopathogenesis. There are few studies synthesizing the association of schizophrenia and bipolar disorder in type 1 diabetes mellitus (T1DM), a common immunological disorder. Data Collection and Analysis: We performed meta-analyses of studies assessing the prevalence and risk of schizophrenia and related disorders and bipolar disorder in individuals with T1DM. Fifteen studies consisting of a total sample of 9,768,028 (T1DM: 435,553; non-T1DM controls: 9,332,475) were included. Random-effects meta-analyses using the restricted maximum likelihood method for pooling logit transformed prevalence values and the Mantel–Haenszel test for pooling risk ratios were used. I2 statistic and the rank correlation test for Funnel plots’ asymmetry were used to assess heterogeneity and publication bias, respectively. Results: Pooled (transformed-back-transformed) prevalence for schizophrenia and related psychotic disorders was 0.37% (95%CI: 0.19–0.73), and for bipolar disorder it was 0.39% (95%CI: 0.05–2.99) (together: 0.38% (95%CI: 0.2–0.71)] in T1DM. The prevalence models showed significant heterogeneity but were statistically significant, had low publication bias, and survived sensitivity analysis. The pooled risk ratio for schizophrenia and related disorders together with bipolar disorder was 1.80 (95%CI: 0.64–5.03), and for schizophrenia and related disorders alone it was 1.19 (95%CI: 0.46–3.11), indicating higher rates of these disorders in T1DM. The pooled risk ratios were not statistically significant and did not survive sensitivity analysis. Trial sequential analysis suggested the need for more studies to confirm increased risk. Conclusion: With available studies, we could not provide convincing evidence for the hypothesis that the prevalence and risk of schizophrenia and related disorders and bipolar disorder are significantly greater in individuals with T1DM.
A Comparative Study of Internalized Stigma in Patients with Schizophrenia and Bipolar Affective Disorder in Remission
Authors: Borhade Shraddha Rajendra , Mishra Kshirod Kumar , John Sally 
Published: April 2024

Background: Internalized stigma experienced by individuals with schizophrenia and bipolar affective disorder dramatically affects their overall quality of life. While several studies have explored this topic, there remains a scarcity of research comparing internalized stigma across both these illnesses. We investigated and compared how internalized stigma is associated with different socio-demographic factors among individuals diagnosed with schizophrenia and bipolar affective disorder in remission. Aim: To carry out a comparative study of the internalized stigma experienced by patients with schizophrenia and bipolar affective disorder in remission. Materials and Methods: A total of 106 patients with schizophrenia and 53 with bipolar affective disorder (BPAD) in remission underwent assessment using the Internalized Stigma of Mental Illness Scale (ISMIS), Positive and Negative Syndrome Scale (PANSS), and Young Mania Rating Scale (YMRS). Results: The study revealed that internalized stigma was significantly more ( p value = .0001) in patients with schizophrenia (84.84 ± 6.02) compared to those with BPAD (78.55 ± 6.07). Further analysis of the ISMIS domains revealed significant correlations between internalized stigma and stereotype endorsement ( p value = .005), stigma resistance ( p value = .009), social withdrawal ( p value = .0001), and alienation ( p value = .0001). Conclusion: The study suggests that individuals with schizophrenia experience higher levels of internalized stigma in comparison to those with BPAD.
Collective Intelligence Increases Diagnostic Accuracy in a General Practice Setting
Authors: Blanchard Matthew D. , Herzog Stefan M. , Kämmer Juliane E. , Zöller Nikolas , Kostopoulou Olga , Kurvers Ralf H. J. M. 
Published: April 2024

Background General practitioners (GPs) work in an ill-defined environment where diagnostic errors are prevalent. Previous research indicates that aggregating independent diagnoses can improve diagnostic accuracy in a range of settings. We examined whether aggregating independent diagnoses can also improve diagnostic accuracy for GP decision making. In addition, we investigated the potential benefit of such an approach in combination with a decision support system (DSS). Methods We simulated virtual groups using data sets from 2 previously published studies. In study 1, 260 GPs independently diagnosed 9 patient cases in a vignette-based study. In study 2, 30 GPs independently diagnosed 12 patient actors in a patient-facing study. In both data sets, GPs provided diagnoses in a control condition and/or DSS condition(s). Each GP’s diagnosis, confidence rating, and years of experience were entered into a computer simulation. Virtual groups of varying sizes (range: 3–9) were created, and different collective intelligence rules (plurality, confidence, and seniority) were applied to determine each group’s final diagnosis. Diagnostic accuracy was used as the performance measure. Results Aggregating independent diagnoses by weighing them equally (i.e., the plurality rule) substantially outperformed average individual accuracy, and this effect increased with increasing group size. Selecting diagnoses based on confidence only led to marginal improvements, while selecting based on seniority reduced accuracy. Combining the plurality rule with a DSS further boosted performance. Discussion Combining independent diagnoses may substantially improve a GP’s diagnostic accuracy and subsequent patient outcomes. This approach did, however, not improve accuracy in all patient cases. Therefore, future work should focus on uncovering the conditions under which collective intelligence is most beneficial in general practice. Highlights We examined whether aggregating independent diagnoses of GPs can improve diagnostic accuracy. Using data sets of 2 previously published studies, we composed virtual groups of GPs and combined their independent diagnoses using 3 collective intelligence rules (plurality, confidence, and seniority). Aggregating independent diagnoses by weighing them equally substantially outperformed average individual GP accuracy, and this effect increased with increasing group size. Combining independent diagnoses may substantially improve GP’s diagnostic accuracy and subsequent patient outcomes.