bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing a contextually appropriate foot-ankle exercise programme in primary care for the prevention of modifiable risk factors for ulcers in people with diabetes: protocol for a hybrid type 2 study
Authors: Rodrigues Carla B , Soares Paula N C , Schmitt Ana Carolina B , Sacco Isabel C N 
Published: February 2024

IntroductionDiabetes is a highly prevalent disease that negatively impacts people’s health and quality of life. It can result in diabetic peripheral neuropathy (DPN) and foot complications, which in turn lead to ulcers and amputations. The international guidelines on diabetic foot included specific foot-ankle exercises as preventive strategy capable of modifying the risk factors for ulcers. Our aim is to test the effectiveness and to implement a contextually appropriate preventive intervention—a foot-ankle exercises programme alongside educational strategies—in a primary care setting to improve range of motion (ROM), strength, functionality of foot-ankle, and quality of life in people with diabetes.Methods and analysisThis is a hybrid type 2 implementation-effectiveness study organised in four phases, being undertaken in Limeira, São Paulo. Phase 1, preimplementation, aims to gather information about the contextual characteristics, barriers, and facilitators and to form the implementation team. In phase 2, the implementation team will structure the foot-ankle programme, adapting it to the context of primary healthcare, and develop the training for health professionals. In phase 3, effectiveness of the 12 week group-based intervention will be tested by a cluster randomised controlled trial. Primary care units (18 clusters) will be randomly allocated to a control or intervention group, with a total sample of 356 people. Primary outcomes will be DPN symptoms and ankle and first metatarsal phalangeal joint ROM. Reach, adoption, and implementation will be evaluated by Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. In phase 4, maintenance and expansion of the programme in the municipality will be assessed.Ethics and disseminationThis protocol and the informed consent to be signed by the participants were approved by the Ethics Committee of the School of Medicine of the University of São Paulo (CAAE:63457822.0.0000.0068, 29 November 2022). The project will generate and share data in a public repository. Results will be disseminated through peer-reviewed journals, conference proceedings, and electronic communications for health professionals.Trial registration numberNCT05639478.
Missed opportunities in hospital quality measurement during the COVID-19 pandemic: a retrospective investigation of US hospitals’ CMS Star Ratings and 30-day mortality during the early pandemic
Authors: Pollock Benjamin D , Devkaran Subashnie , Dowdy Sean C 
Published: February 2024

ObjectivesIn the USA and UK, pandemic-era outcome data have been excluded from hospital rankings and pay-for-performance programmes. We assessed the relationship between US hospitals’ pre-pandemic Centers for Medicare and Medicaid Services (CMS) Overall Hospital Star ratings and early pandemic 30-day mortality among both patients with COVID and non-COVID to understand whether pre-existing structures, processes and outcomes related to quality enabled greater pandemic resiliency.Design and data sourceA retrospective, claim-based data study using the 100% Inpatient Standard Analytic File and Medicare Beneficiary Summary File including all US Medicare Fee-for-Service inpatient encounters from 1 April 2020 to 30 November 2020 linked with the CMS Hospital Star Ratings using six-digit CMS provider IDs.Outcome measureThe outcome was risk-adjusted 30-day mortality. We used multivariate logistic regression adjusting for age, sex, Elixhauser mortality index, US Census Region, month, hospital-specific January 2020 CMS Star rating (1–5 stars), COVID diagnosis (U07.1) and COVID diagnosis×CMS Star Rating interaction.ResultsWe included 4 473 390 Medicare encounters from 2533 hospitals, with 92 896 (28.2%) mortalities among COVID-19 encounters and 387 029 (9.3%) mortalities among non-COVID encounters. There was significantly greater odds of mortality as CMS Star Ratings decreased, with 18% (95% CI 15% to 22%; p<0.0001), 33% (95% CI 30% to 37%; p<0.0001), 38% (95% CI 34% to 42%; p<0.0001) and 60% (95% CI 55% to 66%; p<0.0001), greater odds of COVID mortality comparing 4-star, 3-star, 2-star and 1-star hospitals (respectively) to 5-star hospitals. Among non-COVID encounters, there were 17% (95% CI 16% to 19%; p<0.0001), 24% (95% CI 23% to 26%; p<0.0001), 32% (95% CI 30% to 33%; p<0.0001) and 40% (95% CI 38% to 42%; p<0.0001) greater odds of mortality at 4-star, 3-star, 2-star and 1-star hospitals (respectively) as compared with 5-star hospitals.ConclusionOur results support a need to further understand how quality outcomes were maintained during the pandemic. Valuable insights can be gained by including the reporting of risk-adjusted pandemic era hospital quality outcomes for high and low performing hospitals.
Association between perioperative glucose proﬁles assessed by the continuous glucose monitoring (CGM) system and prognosis in patients with ST-segment elevation myocardial infarction (STEMI): protocol for a cohort study
Authors: Shi Jie , Wang Xulin , Zhang Hongqiang , Ding Yu , Wu Jiawei , Luo Sihui , Hu Hao , Zheng Xueying 
Published: February 2024

IntroductionST-segment elevation myocardial infarction (STEMI) presents a serious cardiovascular condition requiring prompt intervention. Dysglycaemia has been identified as a significant risk factor impacting STEMI prognosis. However, limited research has focused on comprehensively examining the association between glucose dynamics during the perioperative period and patient outcomes. This study aims to address this gap by leveraging continuous glucose monitoring (CGM) technology to gain real-time insights into glucose fluctuations and their potential impact on STEMI prognosis.Methods and analysisThis is a multicentre, prospective, 3-year follow-up cohort study. Between May 2023 and May 2024, 550 eligible STEM patients who underwent percutaneous coronary intervention are expected to be recruited. Using the CGM system, continuous glucose levels will be collected throughout the perioperative phase. Key clinical parameters, including cardiac biomarkers, angiographic findings and major adverse cardiovascular events, will be assessed in relation to glucose profile.Ethics and disseminationThe study was approved by the Medical Research Ethics Committee of The First Affiliated Hospital of University of Science and Technology of China and will be conducted in accordance with the moral, ethical and scientific principles of the Declaration of Helsinki. Written informed consent will be obtained from all participants before any study-related procedures are implemented. Study results will be disseminated through conferences and peer-reviewed scientific journals.Trial registration numberChiCTR2300069662.
RECITAL: a non-inferiority randomised control trial evaluating a virtual fracture clinic compared with in-person care for people with simple fractures (study protocol)
Authors: Teng Min Jiat , Zadro Joshua R , Pickles Kristen , Copp Tessa , Shaw Miranda J , Khoudair Isabella , Horsley Mark , Warnock Benjamin , Hutchings Owen R , Petchell Jeffrey F , Ackerman Ilana N , Drayton Alison , Liu Rong , Maher Christopher G , Traeger Adrian C 
Published: February 2024

IntroductionMost simple undisplaced fractures can be managed without surgery by immobilising the limb with a splint, prescribing medication for pain, and providing advice and early rehabilitation. Recent systematic reviews based on retrospective observational studies have reported that virtual fracture clinics can deliver follow-up care that is safe and cost-effective. However, no randomised controlled trial has investigated if a virtual fracture clinic can provide non-inferior physical function outcomes compared with an in-person clinic for patients with simple fractures.Methods and analysis312 participants will be recruited from 2 metropolitan hospitals located in Sydney, Australia. Adult patients will be eligible if they have an acute simple fracture that can be managed with a removable splint and is deemed appropriate for follow-up at either the virtual or in-person fracture clinic by an orthopaedic doctor. Patients will not be eligible if they have a complex fracture that requires a cast or surgery. Eligible participants will be randomised to receive their follow-up care either at the virtual or the in-person fracture clinic. Participants at the virtual fracture clinic will be reviewed within 5 days of receiving a referral through video calls with a physiotherapist. Participants at the in-person fracture clinic will be reviewed by an orthopaedic doctor within 7–10 days of receiving a referral. The primary outcome will be the patient’s function measured using the Patient-Specific Functional Scale at 12 weeks. Secondary outcomes will include health-related quality of life, patient-reported experiences, pain, health cost, healthcare utilisation, medication use, adverse events, emergency department representations and surgery.Ethics and disseminationThe study has been approved by the Sydney Local Health District Ethics Review Committee (RPAH Zone) (X23-0200 and 2023/ETH01038). The trial results will be submitted for publication in a reputable international journal and will be presented at professional conferences.Trial registration numberACTRN12623000934640.
Perceptions of Australia’s e-cigarette regulations and recommendations for future reforms: a qualitative study of adolescents and adults
Authors: Brierley Mary-Ellen E , Yaw Sean J L , Jongenelis Michelle I 
Published: February 2024

ObjectiveTo assess public perceptions of the effectiveness of e-cigarette regulations in minimising use among adolescents and those who have never smoked. Specifically, we explored (1) perceived effectiveness of current regulations relating to e-cigarettes and (2) ideas for further regulations that could reduce use.Design and participantsFocus groups (n=16) were conducted with Australian adolescents (14–17 years), young adults (18–24 years) and adults (25–39 years). Groups were stratified by age, gender and e-cigarette use status. Data were analysed using reflexive thematic analysis.SettingFocus groups were conducted in-person in two major Australian cities.ResultsGroups lacked a comprehensive understanding of e-cigarette regulations in Australia. When informed of these regulations, half of the groups considered the prescription model for nicotine e-cigarette products to be effective when enforced appropriately. Almost all groups considered access to non-nicotine products problematic. All groups suggested a range of demand reduction regulations, including plain packaging, health warnings, flavour restrictions and increased vape-free areas. Most groups (predominantly those who had never vaped) also recommended supply reduction regulations such as banning all e-cigarettes. The need for supply reduction measures to include addiction and mental health supports was discussed.ConclusionsThe regulations recommended by participants largely align with those that are to be introduced in Australia, indicating that these reforms are likely to be accepted by the public. Ensuring these reforms are complemented by formal supports for young people experiencing nicotine dependence and related mental health concerns is critical.
Efficacy and safety of autologous haematopoietic stem cell transplantation versus alemtuzumab, ocrelizumab, ofatumumab or cladribine in relapsing remitting multiple sclerosis (StarMS): protocol for a randomised controlled trial
Authors: Brittain Gavin , Petrie Jennifer , Duffy Kate E M , Glover Rachel , Hullock Katie , Papaioannou Diana , Roldan Elisa , Beecher Colette , Bursnall Matthew , Ciccarelli Olga , Coles Alasdair J , Cooper Cindy , Giovannoni Gavin , Gabriel Ian , Kazmi Majid , Kyriakou Charalampia , Nicholas Richard , Paling David , Peniket Andy , Scolding Neil , Silber Eli , de Silva Thushan , Venneri Annalena , Walters Stephen J , Young Carolyn , Muraro Paolo A , Sharrack Basil , Snowden John A 
Published: February 2024

IntroductionAutologous haematopoietic stem cell transplantation (aHSCT) is increasingly used as treatment for patients with active multiple sclerosis (MS), typically after failure of disease-modifying therapies (DMTs). A recent phase III trial, ‘Multiple Sclerosis International Stem Cell Transplant, MIST’, showed that aHSCT resulted in prolonged time to disability progression compared with DMTs in patients with relapsing remitting MS (RRMS). However, the MIST trial did not include many of the current high-efficacy DMTs (alemtuzumab, ocrelizumab, ofatumumab or cladribine) in use in the UK within the control arm, which are now offered to patients with rapidly evolving severe MS (RES-MS) who are treatment naïve. There remain, therefore, unanswered questions about the relative efficacy and safety of aHSCT over these high-efficacy DMTs in these patient groups. The StarMS trial (Autologous Stem Cell Transplantation versus Alemtuzumab, Ocrelizumab, Ofatumumab or Cladribine in Relapsing Remitting Multiple Sclerosis) will assess the efficacy, safety and long-term impact of aHSCT compared with high-efficacy DMTs in patients with highly active RRMS despite the use of standard DMTs or in patients with treatment naïve RES-MS.Methods and analysisStarMS is a multicentre parallel-group rater-blinded randomised controlled trial with two arms. A total of 198 participants will be recruited from 19 regional neurology secondary care centres in the UK. Participants will be randomly allocated to the aHSCT arm or DMT arm in a 1:1 ratio. Participants will remain in the study for 2 years with follow-up visits at 3, 6, 9, 12, 18 and 24 months postrandomisation. The primary outcome is the proportion of patients who achieve ‘no evidence of disease activity’ during the 2-year postrandomisation follow-up period in an intention to treat analysis. Secondary outcomes include efficacy, safety, cost-effectiveness and immune reconstitution of aHSCT and the four high-efficacy DMTs.Ethics and disseminationThe study was approved by the Yorkshire and Humber—Leeds West Research Ethics Committee (20/YH/0061). Participants will provide written informed consent prior to any study specific procedures. The study results will be submitted to a peer-reviewed journal and abstracts will be submitted to relevant national and international conferences.Trial registration numberISRCTN88667898.
Leisure time physical activity is associated with improved diastolic heart function and is partly mediated by unsupervised quantified metabolic health
Authors: Klarenberg Hugo , van der Velde Jeroen HPM , Peeters Carel FW , Dekkers Ilona A , de Mutsert R , Jukema J Wouter , Rosendaal Frits R , Leiner Tim , Froeling Martijn , Jorstad Harald , Boekholdt S Matthijs , Strijkers Gustav J , Lamb Hildo J 
Published: February 2024

ObjectivesTo investigate the association between leisure time physical activity (LTPA) and MRI-based diastolic function and the mediating role of metabolic health.MethodsThis cross-sectional analysis comprised 901 participants (46% women, mean age (SD): 56 (6) years (The Netherlands, 2008–2012)). LTPA was assessed via questionnaire, quantified in metabolic equivalent of tasks (METs)-minutes per week and participants underwent abdominal and cardiovascular MRI. Confirmatory factor analysis was used to construct the metabolic load factor. Piecewise structural equation model with adjustments for confounders was used to determine associations between LTPA and diastolic function and the mediating effect of metabolic load.ResultsSignificant differences in mitral early/late peak filling rate (E/A) ratio per SD of LTPA (men=1999, women=1870 MET-min/week) of 0.18, (95% CI= 0.03 to 0.33, p=0.021) were observed in men, but not in women: −0.01 (−0.01 to 0.34, p=0.058). Difference in deceleration time of mitral early filling (E-DT) was 0.13 (0.01 to 0.24, p=0.030) in men and 0.17 (0.05 to 0.28, p=0.005) in women. Metabolic load, including MRI-based visceral and subcutaneous adipose tissue, fasting glucose, high-density lipoprotein cholesterol and triglycerides, mediated these associations as follows: E/A-ratio of 0.030 (0.000 to 0.067, 19% mediated, p=0.047) in men but not in women: 0.058 (0.027 to 0.089, p<0.001) and E-DT not in men 0.004 (−0.012 to 0.021, p=0.602) but did in women 0.044 (0.013 to 0.057, 27% mediated, p=0.006).ConclusionsA larger amount of LTPA was associated with improved diastolic function where confirmatory factor analysis-based metabolic load partly mediated this effect. Future studies should assess whether improving indicators of metabolic load alongside LTPA will benefit healthy diastolic function even more.
Stress urinary incontinence prevalence and risk factors in female rugby players: a common health problem across four nations
Authors: McCarthy-Ryan Molly , Perkins Joanna , Donnelly Gráinne M , Caithriona Yeomans , Liston Mairead , Leahy Karina , Bø Kari , O'Halloran Patrick , Moore Isabel S 
Published: February 2024

ObjectivesFemale athletes engaging in high-impact sports have a higher prevalence of experiencing stress urinary incontinence (SUI). However, the prevalence of sport-specific SUI and associated risk factors in female rugby players is relatively unknown. We aimed to determine the prevalence of general and rugby-related SUI and identify associated risk factors and inciting events in female rugby players.MethodsObservational, cross-sectional study of 396 female rugby players (age 28±8 years, mass 80±18 kg, height 1.90±0.19 m, playing years 7±6 years) participating in rugby across UK and Ireland completed an electronic questionnaire regardless of SUI status.Results63 to 88% of players had SUI, and 43% had rugby-related SUI. There was an association with players reporting a change in incontinence status due to playing rugby (p<0.001). Players who experienced constipation (OR 2.33 (95% CI 1.49 to 3.66)), had given birth (OR 2.36 (95% CI 1.18 to 4.73)) or who had a higher body mass index (BMI) (OR 1.04 (95% CI 1.01 to 1.08)), were identified as having increased odds of rugby-related SUI. For rugby-specific risk factors, playing as a forward (OR 1.97 (95% CI 1.29 to 3.01)) increased the odds, whereas playing at a national compared with amateur level (OR 0.44 (95% CI 0.20 to 0.97)) decreased the odds of rugby-related SUI. The most prevalent inciting SUI events were being tackled (75%), tackling (66%), running (63%) and jumping/landing (59%).ConclusionRugby-related SUI was prevalent in female rugby players. Risk factors were having constipation, a high BMI, being postpartum, playing position and level. Player welfare strategies addressing pelvic floor dysfunction and postpartum rehabilitation are warranted.
Toward the development of an ecosystem model ensemble to support adaptive management in Lake Ontario
Authors: Neumann Alex , Fernando Yasasi , Saber Ali , Arhonditsis George B. 
Published: February 2024

Notwithstanding the continuing advancement of our understanding of the broader ecosystem functioning in Lake Ontario, emerging evidence suggests that there are fundamental knowledge gaps to accurately describe the relationship between exogenous phosphorus (P) loading and in-lake total phosphorus (TP) concentrations. The whole-lake load appears to frequently exceed the Great Lakes Water Quality Agreement (GLWQA) interim target of 7000 metric tonnes·year−1, although the offshore-water P concentrations are consistently below the GLWQA interim substance concentration objective of 10 µg TP·L–1. Contrasting ecological conditions prevail in different locations of Lake Ontario, owing to the significant urban footprint along the shoreline but also the capacity of dreissenid mussels to sequester P in the littoral zone. Specifically, low ambient P levels threaten fisheries productivity in offshore waters, while nuisance benthic algae (predominantly Cladophora) and toxin-producing cyanobacteria blooms affect the water quality in the nearshore zone. The present study offers a technical analysis of the recent and ongoing modelling work that has been conducted in Lake Ontario and can be potentially used to address the multitude of ecosystem management challenges. Our aim is to provide an overview of all the major models developed by identifying their fundamental assumptions, structural attributes, and general consistency against empirical knowledge derived from the system. The existing modelling work has opted for parsimonious representations of the lower food web coupled with granular grid configurations to effectively link hydrodynamic processes and mass transport between nearshore and offshore waters. The establishment of comprehensive ecophysiological modules that will recreate the mechanisms underlying the interplay among bioavailable phosphorus, planktonic dynamics, dreissenid mussels, and Cladophora is a critical undertaking to reproduce the water quality conditions in the nearshore zone of Lake Ontario. Striving to integrate the lower food web with fisheries and ecosystem-service modelling, we also offer a technical analysis of knowledge gaps and monitoring-assessment objectives that should be addressed to ensure that ecosystem processes of management interest are adequately measured and the local modelling enterprise is focused on suitable performance indicators.
Systematics of fully heavy dibaryons
Authors: Weng Xin-Zhen , Zhu Shi-Lin 
Published: February 2024

AbstractWe systematically study the mass spectra of the fully heavy dibaryons in an extended chromomagnetic model, which includes both the colorelectric and chromomagnetic interactions. We find no stable state below the corresponding baryon–baryon thresholds. Besides the masses, we also estimate the relative width ratios of the two-body decay channels. We hope our study will be of help for future experiments.
Relativistic orbits of S2 star in the presence of scalar field
Authors: Bambhaniya Parth , Joshi Ashok B. , Dey Dipanjan , Joshi Pankaj S. , Mazumdar Arindam , Harada Tomohiro , Nakao Ken-ichi 
Published: February 2024

AbstractThe general theory of relativity predicts the relativistic effect in the orbital motions of S-stars which are orbiting around our Milky-way Galactic Center. The post-Newtonian or higher-order approximated Schwarzschild black hole models have been used by GRAVITY and UCLA Galactic Center groups to carefully investigate the S2 star’s periastron precession. In this paper, we investigate the scalar field effect on the orbital dynamics of S2 star. Hence, we consider a spacetime, namely Janis-Newman-Winicour (JNW) spacetime which is seeded by a minimally coupled, mass-less scalar field. The novel feature of this spacetime is that one can retain the Schwarzschild spacetime from JNW spacetime considering zero scalar charge. We constrain the scalar charge of JNW spacetime by best fitting the astrometric data of S2 star using the Monte-Carlo–Markov-Chain (MCMC) technique assuming the charge to be positive. Our best-fitted result implies that similar to the Schwarzschild black hole spacetime, the JNW naked singularity spacetime with an appropriate scalar charge also offers a satisfactory fitting to the observed data for S2 star. Therefore, the JNW naked singularity could be a contender for explaining the nature of Sgr A* through the orbital motions of the S2 star.