bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers to equitable access to quality trauma care in Rwanda: a qualitative study
Authors: Nzasabimana Pascal , Ignatowicz Agnieszka , Alayande Barnabas Tobi , Abdul-Latif Abdul-Malik , Odland Maria Lisa , Davies Justine , Bekele Abebe , Byiringiro Jean Claude 
Published: September 2023

ObjectivesUsing the ‘Four Delay’ framework, our study aimed to identify and explore barriers to accessing quality injury care from the injured patients’, caregivers’ and community leaders’ perspectives.DesignA qualitative study assessing barriers to trauma care comprising 20 in-depth semistructured interviews and 4 focus group discussions was conducted. The data were analysed thematically.SettingThis qualitative study was conducted in Rwanda’s rural Burera District, located in the Northern Province, and in Kigali City, the country’s urban capital, to capture both the rural and urban population’s experiences of being injured.ParticipantsPurposively selected participants were individuals from urban and rural communities who had accessed injury care in the previous 6 months or cared for the injured people, and community leaders. Fifty-one participants, 13 females and 38 males ranging from 21 to 68 years of age participated in interviews and focus group discussions. Thirty-six (71%) were former trauma patients with a wide range of injuries including fractured long bones (9, 45%), other fractures, head injury, polytrauma (3, 15% each), abdominal trauma (1, 5%), and lacerations (1, 5%), while the rest were caregivers and community leaders.ResultsMultiple barriers were identified cutting across all levels of the ‘Four Delays’ framework, including barriers to seeking, reaching, receiving and remaining in care. Key barriers mentioned by participants in both interviews and focus group discussions were: lack of community health insurance, limited access to ambulances, insufficient number of trauma care specialists and a high volume of trauma patients. The rigid referral process and lack of decentralised rehabilitation services were also identified as significant barriers to accessing quality care for injured patients.ConclusionsFuture interventions to improve access to injury care in Rwanda must be informed by the identified barriers along the spectrum of care, from the point of injury to receipt of care and rehabilitation.
Addressing the marketing and availability of unhealthy food and beverages in and around selected schools in Ghana: a community readiness appraisal
Authors: Tandoh Akua , Laar Amos , Pradeilles Rebecca , Le Port Agnes , Osei-Kwasi Hibbah , Amevinya Gideon Senyo , Aryeetey Richmond Nii Okai , Agyemang Charles , Holdsworth Michelle 
Published: September 2023

ObjectiveThis study assessed stakeholder readiness to address unhealthy food and beverage marketing and availability in/around Public Basic Schools (for children 4–15 years) in Greater Accra Region, the highly urbanised administrative capital of Ghana.DesignThe community readiness model was used to conduct in-depth mixed methods interviews with stakeholders. Using predefined anchored rating statements, quantitative readiness scores ranging from 1 to 9 were generated. Thematic qualitative analysis was undertaken to understand barriers and facilitators that could influence the implementation of interventions.SettingGreater Accra Region, Ghana.Participants18 key informants from various school/education/citizen sectors, which together represented the ‘school community’ of Greater Accra Region.ResultsThe mean readiness scores indicated that the ‘school community’ was at the ‘preplanning’ stage of readiness (4.44±0.98) to address the marketing and availability of unhealthy food and beverages in and around schools. The mean readiness score for ‘leadership’ was the highest of all dimensions (5.36±1.60), corresponding to the ‘preparation’ stage. The lowest scores were found for ‘community knowledge of efforts’ (3.19±2.45) and ‘resources for efforts’ (3.64±0.87), both of which were at a ‘vague awareness’ stage.ConclusionsThe ‘school community’ recognised that the marketing and availability of unhealthy food and beverages was a problem. Additionally, current leadership was actively supportive of continuing/improving efforts that create healthier children’s food environments. However, actions that aim to increase the ‘school community’s’ knowledge of existing interventions and securing resources to sustain those interventions are needed before introducing readiness appropriate strategies.
Diagnostic value of triglyceride–glucose index and related parameters in metabolism-associated fatty liver disease in a Chinese population: a cross-sectional study
Authors: Yu Rong , Xie Weijiang , Peng Hewei , Lu Lili , Yin Shuo , Xu Shanghua , Hu Zhijian , Peng Xian-E 
Published: September 2023

ObjectiveOur study aimed to explore the diagnostic value of triglyceride–glucose (TyG) and its related parameters in metabolism-associated fatty liver disease (MAFLD).DesignA cross-sectional study of residents who attended medical checkups at the First Hospital of Nanping City, Fujian Medical University, between 2015 and 2017.SettingOne participation centre.Participants2605 subjects met the inclusion–exclusion criteria and were grouped according to whether they had MAFLD.ResultsThe TyG index and its associated parameters are positively associated with the risk of developing MAFLD (p<0.001). Restriction cube spline analysis showed a significant dose–response relationship between the TyG index and MAFLD. The risk of developing MAFLD increases significantly with a higher TyG index. After adjusting for confounders, this relationship remains (OR: 4.89, 95% CI 3.98 to 6.00). The areas under the receiver operating characteristic curves of the TyG index for MAFLD detection were 0.793 (0.774 to 0.812). The areas under the curve (AUC) of TyG-related parameters were improved, among which TyG-waist circumference (TyG-WC) showed the largest AUC for MAFLD detection (0.873, 95% CI 0.860 to 0.887). In addition, the best cut-off value of the TyG-WC was 716.743, with a sensitivity and specificity of 88.7% and 71.4%, respectively.ConclusionThe TyG index effectively identifies MAFLD, and the TyG-related parameters improved the identification and diagnosis of MAFLD, suggesting that TyG-related parameters, especially TyG-WC, may be a useful marker for diagnosing MAFLD.
Are people interested in receiving advice from their general practitioner on how to protect their health during heatwaves? A survey of the German population
Authors: Kastaun Sabrina , Herrmann Alina , Müller Beate S , Klosterhalfen Stephanie , Hoffmann Barbara , Wilm Stefan , Kotz Daniel 
Published: September 2023

ObjectiveClimate change increases the frequency, intensity and length of heatwaves, which puts a particular strain on the health of vulnerable population groups. General practitioners (GPs) could reach these people and provide advice on protective health behaviour against heat. Data is lacking on whether and what topic of GP advice people are interested in, and whether specific person characteristics are associated with such interests.DesignCross-sectional, nationwide, face-to-face household survey, conducted during winter 2022/2023.SettingGermany.ParticipantsPopulation-based sample of 4212 respondents (aged 14–96 years), selected by using multistratified random sampling (50%) combined with multiquota sampling (50%).Main outcome measureInterest in receiving GP advice on health protection during heatwaves (yes/no), and the topic people find most important (advice on drinking behaviour, nutrition, cooling, cooling rooms, physical activity or medication management). Associations between predefined person characteristics and the likelihood of interest were estimated using adjusted logistic regressions.ResultsA total of 4020 respondents had GP contact and provided data on the outcome measure. Of these, 23% (95% CI=22% to 25%) expressed interest in GP advice. The likelihood of expressing interest was positively associated with being female, older age (particularly those aged 75+ years: 38% were interested), having a lower level of educational attainment, having a migration background, living in a more urban area, and living in a single-person household. It was negatively associated with increasing income. Advice on medication management received highest interest (25%).ConclusionsDuring winter season 2022/2023, around one quarter of the German population with GP contact—and around 40% of those aged 75+ years—was estimated to have a stated interest in receiving GP advice on protective health behaviour during heatwaves, especially on medication management. Climate change is creating new demands for healthcare provision in general practice. This study provides initial relevant information for research and practice aiming to address these demands.
General psychiatric inpatient care for persons with anorexia nervosa—an integrative literature review protocol
Authors: Sandsten Anna , Lindgren Britt-Marie , Strömbäck Maria , Ejneborn-Looi Git-Marie , Gabrielsson Sebastian 
Published: September 2023

IntroductionPeople diagnosed with anorexia nervosa are offered or compelled to undergo various treatments and therapies. In Sweden, the lack of highly specialised eating disorder services means that people with anorexia nervosa might be cared for in general psychiatric wards. However, there has been limited research attention paid to how this specific context might benefit or harm persons with anorexia nervosa. There is also limited evidence regarding which form of care is most effective in anorexia nervosa and which type of treatment is optimal in general psychiatric inpatient care. Our intention is to highlight personal and professional perspectives of care for patients with anorexia nervosa in this context, with a focus on person-centred care, gender and power. This protocol describes an integrative literature review aiming to synthesise existing knowledge on general psychiatric inpatient care for persons with anorexia nervosa.Methods and analysisThe study will be an integrative literature review following Whittemore and Knafl. We will search the academic databases PubMed, CINAHL and PsycInfo in accordance with a specific search strategy determined in collaboration with a librarian with expertise on systematic reviews. Data will be analysed using a constant comparison method. Persons with their own experience of anorexia nervosa in general psychiatric inpatient care will be involved as coresearchers.Ethics and disseminationAs this is a literature review, formal ethical review is not required. The findings will be disseminated through peer-reviewed publication and presented at conferences related to this field.AmendmentsIf we need to amend this protocol, we will give the date of each amendment, describe the change and give the rationale in this section.PROSPERO registration numberCRD42023426095.
Optimising psoriatic arthritis therapy with immunological methods to increase standard evaluation: the protocol of an open-label multicentre, parallel-group, two-arm randomised controlled study evaluation precision medicine approach in the treatment of psoriatic arthritis
Authors: Ooms Alexander , Al-Mossawi Hussein , Bennett Louise , Bogale Mimi , Bowness Paul , Francis Anne , Goodyear Carl , Kirkham Bruce W , Lalnunhlimi Sylvine , McInnes Iain B , Richards Duncan , Siebert Stefan , Taams Leonie S , Tulunay Virlan Aysin , Yager Nicole , Coates Laura C 
Published: September 2023

IntroductionPsoriatic arthritis (PsA) affects around 150 000 people in the UK of whom around 50% require treatment with biologics. The most used biologics for PsA target tumour necrosis factor (TNF) or interleukin-17A (IL-17A). About 50% of patients respond to each, but it is not currently possible to predict response for individual patients, necessitating sequential treatment steps. A recent proof of concept study in PsA suggested that using peripheral immunophenotype to choose therapy could improve time to treatment response.This study will test the hypothesis, within an open-label parallel-group biomarker-stratified multicentre randomised controlled trial, which the baseline proportion of CD4+T cells with an activated type 17 immunophenotype (Th17 levels) predicts response to IL-17A or TNF inhibitors in PsA. Additional analyses will identify if the model can be refined by combining additional clinical and immunophenotypic factors. Statistical modelling will be used to predict the likely effectiveness of these approaches compared with standard care.Methods and analysisPatients with PsA eligible to start their first biologic as part of standard care are recruited and baseline blood tests are taken for immunophenotyping. Participants are stratified equally by Th17 levels and randomised 1:1 to receive either TNF (adalimumab) or IL-17A (secukinumab) inhibitors. The primary analysis will establish the interaction between baseline immunophenotype and treatment on the primary outcome (achievement of minimal disease activity criteria at week 24). In secondary analysis, modelling will identify if this prediction model can be optimised further by incorporating clinical phenotypes and additional immunophenotyping techniques.Ethics and disseminationEthical approval for the study was granted by the North West Preston Research Ethics Committee (ref 21/NW/0016). Dissemination will be via conference presentations and peer-reviewed publications, aiming to impact on treatment guidelines.Trial registration numberISRCTN17228602.
Quality of care for secondary cardiovascular disease prevention in 2009–2017: population-wide cohort study of antiplatelet therapy use in Scotland
Authors: Thalmann Inna , Preiss David , Schlackow Iryna , Gray Alastair , Mihaylova Borislava 
Published: September 2023

BackgroundAntiplatelet therapy (APT) can substantially reduce the risk of further vascular events in individuals with established atherosclerotic cardiovascular disease (ASCVD). However, knowledge regarding the extent and determinants of APT use is limited.ObjectivesEstimate the extent and identify patient groups at risk of suboptimal APT use at different stages of the treatment pathway.MethodsRetrospective cohort study using linked NHS Scotland administrative data of all adults hospitalised for an acute ASCVD event (n=150 728) from 2009 to 2017. Proportions of patients initiating, adhering to, discontinuing and re-initiating APT were calculated overall and separately for myocardial infarction (MI), ischaemic stroke and peripheral arterial disease (PAD). Multivariable logistic regression and Cox proportional hazards models were used to assess the contribution of patient characteristics in initiating and discontinuing APT.ResultsOf patients hospitalised with ASCVD, 84% initiated APT: 94% following an MI, 83% following an ischaemic stroke and 68% following a PAD event. Characteristics associated with lower odds of initiation included female sex (22% less likely than men), age below 50 years or above 70 years (aged <50 years 26% less likely, and aged 70–79, 80–89 and ≥90 years 21%, 39% and 51% less likely, respectively, than those aged 60–69 years) and history of mental health-related hospitalisation (45% less likely). Of all APT-treated individuals, 22% discontinued treatment. Characteristics associated with discontinuation were similar to those related to non-initiation.ConclusionsAPT use remains suboptimal for the secondary prevention of ASCVD, particularly among women and older patients, and following ischaemic stroke and PAD hospitalisations.
Detection of patients with COVID-19 by the emergency medical services in Lombardy through an operator-based interview and machine learning models
Authors: Spina Stefano , Gianquintieri Lorenzo , Marrazzo Francesco , Migliari Maurizio , Sechi Giuseppe Maria , Migliori Maurizio , Pagliosa Andrea , Bonora Rodolfo , Langer Thomas , Caiani Enrico Gianluca , Fumagalli Roberto 
Published: September 2023

BackgroundThe regional emergency medical service (EMS) in Lombardy (Italy) developed clinical algorithms based on operator-based interviews to detect patients with COVID-19 and refer them to the most appropriate hospitals. Machine learning (ML)-based models using additional clinical and geospatial epidemiological data may improve the identification of infected patients and guide EMS in detecting COVID-19 cases before confirmation with SARS-CoV-2 reverse transcriptase PCR (rtPCR).MethodsThis was an observational, retrospective cohort study using data from October 2020 to July 2021 (training set) and October 2021 to December 2021 (validation set) from patients who underwent a SARS-CoV-2 rtPCR test within 7 days of an EMS call. The performance of an operator-based interview using close contact history and signs/symptoms of COVID-19 was assessed in the training set for its ability to determine which patients had an rtPCR in the 7 days before or after the call. The interview accuracy was compared with four supervised ML models to predict positivity for SARS-CoV-2 within 7 days using readily available prehospital data retrieved from both training and validation sets.ResultsThe training set includes 264 976 patients, median age 74 (IQR 55–84). Test characteristics for the detection of COVID-19-positive patients of the operator-based interview were: sensitivity 85.5%, specificity 58.7%, positive predictive value (PPV) 37.5% and negative predictive value (NPV) 93.3%. Contact history, fever and cough showed the highest association with SARS-CoV-2 infection. In the validation set (103 336 patients, median age 73 (IQR 50–84)), the best-performing ML model had an AUC of 0.85 (95% CI 0.84 to 0.86), sensitivity 91.4% (95 CI% 0.91 to 0.92), specificity 44.2% (95% CI 0.44 to 0.45) and accuracy 85% (95% CI 0.84 to 0.85). PPV and NPV were 13.3% (95% CI 0.13 to 0.14) and 98.2% (95% CI 0.98 to 0.98), respectively. Contact history, fever, call geographical distribution and cough were the most important variables in determining the outcome.ConclusionML-based models might help EMS identify patients with SARS-CoV-2 infection, and in guiding EMS allocation of hospital resources based on prespecified criteria.
Comparison between low-volume local anesthetic with intravenous dexamethasone and conventional volume without dexamethasone for superior trunk block after arthroscopic shoulder surgery: a randomized controlled non-inferiority trial
Authors: Kim Youngwon , Yoo Seokha , Kim Sae Hoon , Kim Hansol , Bae Jinyoung , Park Sun-Kyung , Kim Jin-Tae , Lim Young-Jin 
Published: September 2023

Introduction
This study aimed to investigate whether low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while maintaining the analgesic duration compared with conventional volume of local anesthetic without intravenous dexamethasone when performing ultrasound-guided superior trunk block in patients undergoing arthroscopic shoulder surgery.

Methods
Eighty-four adult patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to receive ultrasound-guided superior trunk block using 7 mL of 0.5% ropivacaine with 0.15 mg/kg of intravenous dexamethasone (treatment group), or 15 mL of 0.5% ropivacaine with intravenous normal saline (control group). The co-primary outcomes were (1) the duration of analgesia (time between block completion and onset of surgical pain with a Numeric Rating Scale pain score of 4 or higher), which was compared against a non-inferiority margin of 3 hours, and (2) the incidence of diaphragmatic paresis evaluated using M-mode ultrasonography in the post-anesthesia care unit.

Results
The mean duration of analgesia was 12.4 (6.8) and 11.2 (4.6) hours in the treatment and control groups, respectively (mean difference: −1.2 hours; 95% CI −3.8 to 1.3]; p for non-inferiority<0.001), meeting the non-inferiority criteria. The incidence of diaphragmatic paresis was 45.2% and 85.4% in the treatment and control groups, respectively (relative risk: 0.53; 97.5% CI 0.35 to 0.80; p<0.001).

Conclusions
Superior trunk block using low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while providing non-inferior analgesic duration compared with the conventional volume of local anesthetic in patients undergoing arthroscopic shoulder surgery.

Trial registration number
Clinical Research Information Service of Republic of Korea Registry (KCT0005998).
Reviving sub-TeV $$SU(2)_L$$ lepton doublet dark matter
Authors: Ghosh Purusottam , Jeesun Sk 
Published: September 2023

AbstractIn this work we study the hybrid kind of dark matter (DM) production mechanism where both thermal and non-thermal contribution at two different epochs set the DM relic abundance. This hybrid set up in turn shifts the parameter space of DM in contrast to pure thermal DM scenario. We review such production mechanism in the context of the$$SU(2)_L$$SU(2)Llepton doublet dark matter$$(\Psi )$$(Ψ)augmented with an additional singlet dark scalar (S). The neutral component of the dark doublet can serve as a stable DM candidate and in pure thermal scenario, it is under-abundant as well as excluded from direct detection constraints due to its strong gauge interactions in the sub-TeV mass regime. However, in addition to the thermal contribution, the late time non-thermal DM production from the decay of the long-lived dark scalarShelps to fulfill the deficit in DM abundance. On the other hand, the strong gauge mediated direct detection constraint can be evaded with the help of a$$SU(2)_L$$SU(2)Ltriplet scalar(with$$Y=2),$$Y=2),resulting a pseudo-Dirac DM. To realize our proposed scenario we impose a discrete$${\mathcal {Z}}_2$$Z2symmetry under which both$$\Psi $$ΨandSare odd while rest of the fields are even. We find the lepton doublet pseudo-Dirac DM with mass$$\sim 450{-}1200$$∼450-1200 GeV, compatible with the observed relic density, direct, indirect, and existing collider search constraints.
Parameterized Algorithms for Fixed-Order Book Drawing with Few Crossings Per Edge
Authors: Huang Jingui , Chen Jie , Liu Yunlong , Xiao Guang , Wang Jianxin 
Published: September 2023

Given an [Formula: see text]-vertex graph [Formula: see text] with a fixed linear ordering of [Formula: see text] and two integers [Formula: see text], the problem FIXED-ORDER BOOK DRAWING with few crossings per edge asks whether or not [Formula: see text] admits a [Formula: see text]-page book drawing where the maximum number of crossings per edge can be upper bounded by the number [Formula: see text]. This problem was posed as an open question by Bhore et al. (J. Graph Algorithms Appl. 2020). In this paper, we study this problem from the viewpoint of parameterized complexity, in particular, we develop fixed-parameter tractable algorithms for it. More specifically, we show that this problem parameterized by both the bound number [Formula: see text] of crossings per edge and the vertex cover number [Formula: see text] of the input graph admits an algorithm with running time in [Formula: see text], and this problem parameterized by both the bound number [Formula: see text] of crossings per edge and the pathwidth [Formula: see text] of the vertex ordering admits an algorithm with running time in [Formula: see text]. Our results provide a specific answer to Bhore et al.’s question.