bluuebunny/crossref_metadata_2025_split huggingface dataset:
Study of decision tree algorithms: effects of air pollution on under five mortality in Ulaanbaatar
Authors: Tileubai Akhit , Tsend Javzmaa , Oyunbileg Bat-Enkh , Luvsantseren Purevdolgor , Luvsan-Ish Ajnai , Chilhaasuren Baasandorj , Puntsagdash Jargalbat , Chuluunbaatar Galbadrakh , Tsagaan Baatarkhuu 
Published: May 2023

Objectives4.2 million people die every year from many diseases due to air pollution. The WHO confirms that 92% of the world’s population lives in areas where the air quality limit is exceeded. In 251 days of 2011, the concentration of fine particulate matter in Ulaanbaatar exceeded the permissible level by 62%–76%. According to the results of the research, the content of fine particles decreased by 37%–46% in 2019. Because it is harmful to the health of children, we aimed to show the effect of air pollution on the mortality through data mining.MethodsIn many countries, research is being conducted to generate effective knowledge from big data using data mining methods. So, we are working to introduce this method to the health sector of Mongolia. In this study, we used the decision tree algorithms.ResultsWe collected data on air pollution and under five mortality for 2019–2022 in Ulaanbaatar and created the database, built the models using the algorithms, and compared the results with the Mongolian standard. If the average of PM10 in winter is higher than the concentration specified in the standard, the mortality rate is likely to be high. Mortality is likely to be high if the nitrogen dioxide tolerance is high in the spring.ConclusionThe accuracy of the models calculated by the C5.0 algorithm is higher than the determined by the CART algorithm, the sensitivity and specificity values are higher than 0.50, so the mortality rates are uniformly predicted and low mortality prevails.
Accuracy of a tool to prioritise patients awaiting elective surgery: an implementation report
Authors: Sharma Videha , Pritchard-Jones Rowan , Scott Sharon , Ainsworth John 
Published: May 2023

Study objectiveThe objective of this study was to evaluate the accuracy of a new elective surgery clinical decision support system, the ‘Patient Tacking List’ (PTL) tool (C2-Ai(c)) through receiver operating characteristic (ROC) analysis.MethodsWe constructed ROC curves based on risk predictions produced by the tool and compared these with actual patient outcomes on a retrospective cohort of patients awaiting elective surgery.ResultsA total of 11 837 patients were included across three National Health Service (NHS) hospitals in England. ROC analysis revealed an area under the curve of 0.95 (95% CI 0.92 to 0.98) for mortality and 0.8 (95% CI 0.78 to 0.82) for complications.DiscussionThe PTL tool was successfully integrated into existing data infrastructures, allowing real-time clinical decision support and a low barrier to implementation. ROC analysis demonstrated a high level of accuracy to predict the risk of mortality and complications after elective surgery. As such, it may be a valuable adjunct in prioritising patients on surgical waiting lists.Health systems, such as the NHS in England, must look at innovative methods to prioritise patients awaiting surgery in order to best use limited resources. Clinical decision support tools, such as the PTL tool, can improve prioritisation and thus positively impact clinical care and patient outcomes.ConclusionsThe high level of accuracy for predicating mortality and complications after elective surgery using the PTL tool indicates the potential for clinical decision support tools to help tackle rising waiting lists and improve surgical planning.
Routine health information use among healthcare providers in Ethiopia: a systematic review and meta-analysis
Authors: Tadele Maru Meseret , Yilma Tesfahun Melese , Mekonnen Zeleke Abebaw , Tilahun Binyam 
Published: May 2023

IntroductionHealthcare policy formulation, programme planning, monitoring and evaluation, and healthcare service delivery as a whole are dependent on routinely generated health information in a healthcare setting. Several individual research articles on the utilisation of routine health information exist in Ethiopia; however, each of them revealed inconsistent findings.ObjectiveThe main aim of this review was to combine the magnitude of routine health information use and its determinants among healthcare providers in Ethiopia.MethodsDatabases and repositories such as PubMed, Global Health, Scopus, Embase, African journal online, Advanced Google Search and Google Scholar were searched from 20 to 26 August 2022.ResultA total of 890 articles were searched but only 23 articles were included. A total of 8662 (96.3%) participants were included in the studies. The pooled prevalence of routine health information use was found to be 53.7% with 95% CI (47.45% to 59.95%). Training (adjusted OR (AOR)=1.56, 95% CI (1.12 to 2.18)), competency related to data management (AOR=1.94, 95% CI (1.35 to 2.8)), availability of standard guideline (AOR=1.66, 95% CI (1.38 to 1.99)), supportive supervision (AOR=2.07, 95% CI (1.55 to 2.76)) and feedback (AOR=2.20, 95% CI (1.30 to 3.71)) were significantly associated with routine health information use among healthcare providers at p value≤0.05 with 95% CI.ConclusionThe use of routinely generated health information for evidence-based decision-making remains one of the most difficult problems in the health information system. The study’s reviewers suggested that the appropriate health authorities in Ethiopia invest in enhancing the skills in using routinely generated health information.PROSPERO registration numberCRD42022352647.
Involving multiple stakeholders in assessing and reviewing a novel data visualisation tool for a national neonatal data asset
Authors: Lammons William Bishop , Moss Becky , Bignell Charlie , Gale Chris , MacBride Adam , Ribas Ricardo , Battersby Cheryl , Modi Neena 
Published: May 2023

ObjectivesWe involved public and professional stakeholders to assess a novel data interrogation tool, the Neonatal Health Intelligence Tool, for a National Data Asset, the National Neonatal Research Database.MethodsWe recruited parents, preterm adults, data managers, clinicians, network managers and researchers (trialists and epidemiologists) for consultations demonstrating a prototype tool and semi-structured discussion. A thematic analysis of consultations is reported by stakeholder group.ResultsWe held nine on-line consultations (March–December 2021), with 24 stakeholders: parents (n=8), preterm adults (n=2), data managers (n=3), clinicians (n=3), network managers (n=2), triallists (n=3) and epidemiologists (n=3). We identified four themes from parents/preterm adults: struggling to consume information, Dads and data, bring data to life and yearning for predictions; five themes from data managers/clinicians/network managers: benchmarking, clinical outcomes, transfers and activity, the impact of socioeconomic background and ethnicity, and timeliness of updates and widening availability; and one theme from researchers: interrogating the data.DiscussionOther patient and public involvement (PPI) studies have reported that data tools generate concerns; our stakeholders had none. They were unanimously supportive and enthusiastic, citing visualisation as the tool’s greatest strength. Stakeholders had no criticisms; instead, they recognised the tool’s potential and wanted more features. Parents saw the tool as an opportunity to inform themselves without burdening clinicians, while clinicians welcomed an aid to explaining potential outcomes to parents.ConclusionAll stakeholder groups recognised the need for the tool, praising its content and format. PPI consultations with all key groups, and their synthesis, illustrated desire for additional uses from it.
Predicting healthcare professionals’ acceptance towards electronic personal health record systems in a resource-limited setting: using modified technology acceptance model
Authors: Walle Agmasie Damtew , Ferede Tigist Andargie , Baykemagn Nebebe Demis , Shimie Aynadis Worku , Kebede Shimels Derso , Tegegne Masresha Derese , Wubante Sisay Maru , Yehula Chalachew Msganaw , Demsash Addisalem Workie , Melaku Mequannent Sharew , Mengistie Muluken Belachew 
Published: May 2023

ObjectivesPersonal health record systems allow users to manage their health information in a confidential manner. However, there is little evidence about healthcare providers’ intentions to use such technologies in resource-limited settings. Therefore, this study aimed to assess predicting healthcare providers’ acceptance of electronic personal health record systems.MethodsAn institutional-based cross-sectional study was conducted from 19 July to 23 August 2022 at teaching hospitals in the Amhara regional state of Ethiopia. A total of 638 health professionals participated in the study. Simple random sampling techniques were used to select the study participants. Structural equation modelling analysis was employed using AMOS V.26 software.ResultPerceived ease of use had a significant effect on the intention to use electronic personal health records (β=0. 377, p<0.01), perceived usefulness (β=0.104, p<0.05) and attitude (β=0.204, p<0.01); perceived ease of use and information technology experience had a significant effect on perceived usefulness (β=0.077, p<0.05); and digital literacy (β=0.087, p<0.05) and attitude had also a strong effect on intention to use electronic personal health records (β=0.361, p<0.01). The relationship between perceived ease of use and the intention to use was mediated by attitude (β=0.076, p<0.01).ConclusionPerceived ease of use, attitude and digital literacy had a significant effect on the intention to use electronic personal health records. The perceived ease of use had a greater influence on the intention to use electronic personal health record systems. Thus, capacity building and technical support could enhance health providers’ acceptance of using electronic personal health records in Ethiopia.
Survival and health economic outcomes in heart failure diagnosed at hospital admission versus community settings: a propensity-matched analysis
Authors: Bachtiger Patrik , Kelshiker Mihir A , Petri Camille F , Gandhi Manisha , Shah Moulesh , Kamalati Tahereh , Khan Samir Ali , Hooper Gareth , Stephens Jon , Alrumayh Abdullah , Barton Carys , Kramer Daniel B , Plymen Carla M , Peters Nicholas S 
Published: May 2023

Background and aimsMost patients with heart failure (HF) are diagnosed following a hospital admission. The clinical and health economic impacts of index HF diagnosis made on admission to hospital versus community settings are not known.MethodsWe used the North West London Discover database to examine 34 208 patients receiving an index diagnosis of HF between January 2015 and December 2020. A propensity score-matched (PSM) cohort was identified to adjust for differences in socioeconomic status, cardiovascular risk and pre-diagnosis health resource utilisation cost. Outcomes were stratified by two pathways to index HF diagnosis: a ‘hospital pathway’ was defined by diagnosis following hospital admission; and a ‘community pathway’ by diagnosis via a general practitioner or outpatient services. The primary clinical and health economic endpoints were all-cause mortality and cost-consequence differential, respectively.ResultsThe diagnosis of HF was via hospital pathway in 68% (23 273) of patients. The PSM cohort included 17 174 patients (8582 per group) and was matched across all selected confounders (p>0.05). The ratio of deaths per person-months at 24 months comparing community versus hospital diagnosis was 0.780 (95% CI 0.722 to 0.841, p<0.0001). By 72 months, the ratio of deaths was 0.960 (0.905 to 1.020, p=0.18). Diagnosis via hospital pathway incurred an overall extra longitudinal cost of £2485 per patient.ConclusionsIndex diagnosis of HF through hospital admission continues to dominate and is associated with a significantly greater short-term risk of mortality and substantially increased long-term costs than if first diagnosed in the community. This study highlights the potential for community diagnosis—early, before symptoms necessitate hospitalisation—to improve both clinical and health economic outcomes.
The 8 January 2020 theatre ballistic missile attack on US soldiers stationed at Al Asad Air Base, Iraq: case series using a concussion subtypes framework to approach a real-world, chaotic blast-related TBI mass casualty event
Authors: Hainsworth Jeffrey Brian , Johnson Alan , Godfred-Cato Shana , Smolinski George J , Jorgensen-Wagers Kendra 
Published: May 2023

ObjectivesThis study aims to describe which concussion subtype(s) result specifically from the explosions of theatre ballistic missiles (TBMs) blast waves, an extremely rare occurrence in modern warfare. We provide feedback from using the US military’s standard acute concussion screening tool, the Military Acute Concussion Examination version 2, in a deployed, chaotic, real-world environment.BackgroundIran launched 27 professionally manufactured TBMs into Iraq on 8 January 2020. Eleven detonated within Al Asad Air Base, exposing approximately 330 soldiers to TBM-blast waves. The concussion subtype(s) resultant from TBM blast-related concussion is not known.MethodsCase series from the Al Asad TBM-blast exposed cohort who evacuated to Landstuhl Regional Medical Center (LRMC), Germany up to 3 months following the attack and were diagnosed with concussion. Around 4 weeks, TBM-blast exposed individuals still present on Al Asad were screened with the Neurobehavioural Symptom Inventory (NSI) and vestibular ocular motor screening (VOMS); positive screens evacuated to LRMC. Data from 8 January 2020 to 7 April 2020 were cross-sectionally analysed.Results35/38 patients met criteria for mild traumatic brain injury/concussion. 34/35 were within a 100 m blast radius. Migraine/headache, cognitive and mood/anxiety subtypes were common. VOMS was abnormal in 18/18 tested; 16 deferred due to overt symptoms. The 4-week screen identified nine additional concussed individuals.ConclusionsAmong TBM-blast concussion patients, migraine/headache, cognitive, mood/anxiety and likely vestibular/ocular motor subtypes were predominant. Our study supports postconcussion screening that includes both a subjective symptom inventory, for example, NSI, and a performance-based ocular motor/vestibular screening examination, for example, VOMS, to help identify patients who may under recognise or under-report/minimise symptoms.
Sequential Organ Failure Assessment (SOFA) Score for predicting mortality
in patients with sepsis in Vietnamese intensive care units: a multicentre,
cross-sectional study
Authors: Do Son Ngoc , Dao Co Xuan , Nguyen Tuan Anh , Nguyen My Ha , Pham Dung Thi , Nguyen Nga Thi , Huynh Dai Quang , Hoang Quoc Trong Ai , Bui Cuong Van , Vu Thang Dinh , Bui Ha Nhat , Nguyen Hung Tan , Hoang Hai Bui , Le Thuy Thi Phuong , Nguyen Lien Thi Bao , Duong Phuoc Thien , Nguyen Tuan Dang , Le Vuong Hung , Pham Giang Thi Tra , Bui Giang Thi Huong , Bui Tam Van , Pham Thao Thi Ngoc , Nguyen Chi Van , Nguyen Anh Dat , Phua Jason , Li Andrew , Luong Chinh Quoc 
Published: May 2023

Objectives
To compare the accuracy of the Sequential Organ Failure Assessment
(SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II)
Scores in predicting mortality among intensive care unit (ICU) patients
with sepsis in a low-income and middle-income country.

Design
A multicentre, cross-sectional study.

Setting
A total of 15 adult ICUs throughout Vietnam.

Participants
We included all patients aged ≥18 years who were admitted to ICUs
for sepsis and who were still in ICUs from 00:00 to 23:59 of the
specified study days (ie, 9 January, 3 April, 3 July and 9 October of
the year 2019).

Primary and secondary outcome measures
The primary outcome was hospital all-cause mortality (hospital
mortality). We also defined the secondary outcome as all-cause deaths in
the ICU (ICU mortality).

Results
Of 252 patients, 40.1% died in hospitals, and 33.3% died in ICUs.
SOFA Score (areas under the receiver operating characteristic curve
(AUROC): 0.688 (95% CI 0.618 to 0.758); cut-off value≥7.5;
PAUROC<0.001) and APACHE II Score (AUROC:
0.689 (95% CI 0.622 to 0.756); cut-off value ≥20.5;
PAUROC<0.001) both had a poor discriminatory
ability for predicting hospital mortality. However, the discriminatory
ability for predicting ICU mortality of SOFA (AUROC: 0.713 (95% CI 0.643
to 0.783); cut-off value≥9.5; PAUROC<0.001) was
fair and was better than that of APACHE II Score (AUROC: 0.672 (95% CI
0.603 to 0.742); cut-off value≥18.5;
PAUROC<0.001). A SOFA Score≥8 (adjusted OR
(AOR): 2.717; 95% CI 1.371 to 5.382) and an APACHE II Score≥21 (AOR:
2.668; 95% CI 1.338 to 5.321) were independently associated with an
increased risk of hospital mortality. Additionally, a SOFA Score≥10
(AOR: 2.194; 95% CI 1.017 to 4.735) was an independent predictor of ICU
mortality, in contrast to an APACHE II Score≥19, for which this role did
not.

Conclusions
In this study, SOFA and APACHE II Scores were worthwhile in
predicting mortality among ICU patients with sepsis. However, due to
better discrimination for predicting ICU mortality, the SOFA Score was
preferable to the APACHE II Score in predicting mortality.
Clinical trials registry – India:NCT016898.
Neoadjuvant camrelizumab plus chemotherapy for locally advanced cervical cancer (NACI Study): a study protocol of a prospective, single-arm, phase II trial
Authors: Chen Jing , Han Yingyan , Hu Yingjie , Feng Xue , Meng Xiaolin , Guo Shuaiqingying , Sun Chaoyang , Chen Gang , Li Kezhen 
Published: May 2023

IntroductionNeoadjuvant chemotherapy (NACT) is an emerging approach for locally advanced cervical cancer (LACC). However, the clinical response and postoperative adjuvant radiation or chemoradiation trimodality treatment resulted in controversy. PD-1 inhibitors have shown promising role in recurrent or metastatic cervical cancer, and there is preclinical evidence of the activation and synergistic effects of NACT on PD-1 inhibitors. This study aims to evaluate the efficacy and safety of the preoperative PD-1 inhibitor camrelizumab combined with NACT for LACC.Methods and analysisThe study is designed as a multicentre, open-label, single-arm, prospective phase II study. A total of 82 patients will receive neoadjuvant chemo-immunotherapy, defined as one cycle of cisplatin (75–80 mg/m2, intravenously) plus nab-paclitaxel (260 mg/m2, intravenously) NACT and subsequent two cycles of camrelizumab (200 mg, intravenously) combined with NACT. After neoadjuvant chemo-immunotherapy, patients exhibiting complete response and partial response will undergo radical surgery and subsequent adjuvant therapy. In contrast, patients with stable disease and progressive disease will transfer to concurrent chemoradiotherapy (CCRT). Following surgery, patients will receive adjuvant CCRT or radiotherapy. The primary endpoint is the objective response rate. The secondary endpoints are the pathological complete response, patients requiring postoperative adjuvant therapy, safety of neoadjuvant chemo-immunotherapy, surgical complication, event-free survival, and overall survival. An additional aim is to dynamically evaluate peripheral immune responses and local immunological microenvironments and their association with neoadjuvant immunotherapy.Ethics and disseminationThis trial was approved by the Medical Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (S2020-112). This study is among the first to evaluate the efficacy and safety of neoadjuvant chemo-immunotherapy in LACC. The findings of this research will promote neoadjuvant anti-PD-1 immunotherapy with radical surgery as a new therapeutic strategy.Trial registration numberClinicalTrials.gov Registry (NCT04516616).
Protocol for a comprehensive prospective cohort study of trio-based whole-genome sequencing for underlying cancer predisposition in paediatric and adolescent patients newly diagnosed with cancer: the PREDICT study
Authors: Fuentes Bolanos Noemi Auxiliadora , Padhye Bhavna , Daley Macabe , Hunter Jacqueline , Hetherington Kate , Warby Meera , Courtney Eliza , Kirk Judy , Josephi-Taylor Sarah , Chen Yuyan , Alvaro Frank , Barlow-Stewart Kristine , Wong-Erasmus Marie , Barahona Paulette , Ajuyah Pamela , Altekoester Ann-Kristin , Tyrrell Vanessa J , Lau Loretta M S , Wakefield Claire , Sylvester Dianne , Tucker Katherine , Pinese Mark , Dalla Pozza Luciano , O’Brien Tracey A 
Published: May 2023

IntroductionIdentifying an underlying germline cancer predisposition (CP) in a child with cancer has potentially significant implications for both the child and biological relatives. Cohort studies indicate that 10%–15% of paediatric cancer patients carry germline pathogenic or likely pathogenic variants in cancer predisposition genes, but many of these patients do not meet current clinical criteria for genetic testing. This suggests broad tumour agnostic germline testing may benefit paediatric cancer patients. However, the utility and psychosocial impact of this approach remain unknown. We hypothesise that an approach involving trio whole-genome germline sequencing (trio WGS) will identify children and families with an underlying CP in a timely fashion, that the trio design will streamline cancer risk counselling to at-risk relatives if CP was inherited, and that trio testing will not have a negative psychosocial impact on families.Method and analysisTo test this, we present the Cancer PREDisposition In Childhood by Trio sequencing study (PREDICT). This study will assess the clinical utility of trio WGS to identify CP in unselected patients with cancer 21 years or younger in New South Wales, Australia. PREDICT will perform analysis of biological parents to determine heritability and will examine the psychosocial impact of this trio sequencing approach. PREDICT also includes a broad genomics research programme to identify new candidate genes associated with childhood cancer risk.Ethics and disseminationBy evaluating the feasibility, utility and psychosocial impact of trio WGS to identify CP in paediatric cancer, PREDICT will inform how such comprehensive testing can be incorporated into a standard of care at diagnosis for all childhood cancer patients.Trial registration numberNCT04903782.
Demographic trends of patients undergoing ophthalmic surgery in Ontario, Canada: a population-based study
Authors: Balas Michael , Vasiliu Diana , Austria Gener , Felfeli Tina 
Published: May 2023

ObjectiveIn this study, we investigated the demographic trends of patients undergoing ophthalmic surgeries based on geographic region, priority level, and sex.Methods and analysisThis population-based retrospective cohort study used the Ontario Health Wait Times Information System (WTIS) database from 2010 to 2021. The WTIS contains non-emergent surgical case volume and wait time data for 14 different regions, three priority levels (high, medium and low) and six ophthalmic subspecialty procedures.ResultsOver the study period, on average 83 783 women and 65 555 men underwent ophthalmic surgery annually in Ontario. Overall, women waited an aggregate mean of 4.9 days longer than men to undergo surgery, and this disparity persisted across all geographic and priority stratifications. The average age at the time of surgery has been increasing slowly at a rate of 0.02 years/year (95% CI 0.00 to 0.05), with women being 0.6 years older than men overall.ConclusionThese findings indicate that women have consistently longer wait times than men. The results of this study may be a sign of systemic sex-based differences that could be affecting women who need to be further explored for health equity.