bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gravity Augmented Fused Filament Fabrication Additive Manufacturing
Authors: Huss John M. , Erdman Arthur G. 
Published: February 2023

Abstract
This article introduces the design, methods, and use cases of a novel gravity augmented additive manufacturing (GAAM) approach to fused filament fabrication (FFF) using a novel seven degree-of-freedom (DoF) delta robotic system. Capable of rotating parts and approaching the workpiece with the deposition head from user-specified or algorithm-determined angles, this system allows users the design freedom to create objects with self-supporting capability, while improving the performance of three-dimensional (3D) printed components. Additionally, this system and the methods of operation described below allow users to create objects that are otherwise impossible or impractical to construct using traditional three axis FFF 3D printing, while maintaining compatibility with existing G-code preparation techniques. Finally, this more flexible 3D printing system has advanced applications in generating patient specific objects, which may benefit from more highly specialized toolpaths and design freedom afforded by this system.
Prevalence of non-alcoholic fatty liver disease in overweight and obese children seeking ambulatory healthcare in Nairobi, Kenya
Authors: Mburu Anne Njeri , Laving Ahmed , Macharia William M , Sande Joyce 
Published: February 2023

BackgroundWhile linked to obesity and associated with an increased cardiovascular morbidity, non-alcoholic fatty liver disease (NAFLD) is an often-asymptomatic cause of chronic liver disease in children. Early detection provides opportunity for interventions to curb progression. Childhood obesity is on the rise in low/middle-income countries, but cause-specific mortality data associated with liver disease are scanty. Establishing the prevalence of NAFLD in overweight and obese Kenyan children would guide in public health policies aimed at early screening and intervention.ObjectivesTo investigate prevalence of NAFLD in overweight and obese children aged 6–18 years using liver ultrasonography.MethodologyThis was a cross-sectional survey. After obtaining informed consent, a questionnaire was administered, and blood pressure (BP) measured. Liver ultrasonography was performed to assess fatty changes. Categorical variables were analysed using frequency and percentages. χ2test and multiple logistic regression model were used to determine relationship between exposure and outcome variables.ResultsPrevalence of NAFLD was 26.2% (27/103, 95% CI=18.0% to 35.8%). There was no association between sex and NAFLD (OR1.13, p=0.82; 95% CI=0.4 to 3.2). Obese children were four times more likely to have NAFLD compared with overweight children (OR=4.52, p=0.02; 95% CI=1.4 to 19.0). About 40.8% (n=41) had elevated BP, but there was no association with NAFLD (OR=2.06; p=0.27; 95% CI=0.6 to 7.6). Older children (13–18 years) were more likely to have NAFLD (OR 4.42; p=0.03; 95% CI=1.2 to 17.9).ConclusionPrevalence of NAFLD was high in overweight and obese school children in Nairobi. Further studies are needed to identify modifiable risk factors to arrest progression and prevent sequelae.
Clinical utility of automatic phenotype annotation in unstructured clinical notes: intensive care unit use
Authors: Zhang Jingqing , Bolanos Trujillo Luis Daniel , Tanwar Ashwani , Ive Julia , Gupta Vibhor , Guo Yike 
Published: February 2023

ObjectiveClinical notes contain information that has not been documented elsewhere, including responses to treatment and clinical findings, which are crucial for predicting key outcomes in patients in acute care. In this study, we propose the automatic annotation of phenotypes from clinical notes as a method to capture essential information to predict outcomes in the intensive care unit (ICU). This information is complementary to typically used vital signs and laboratory test results.MethodsIn this study, we developed a novel phenotype annotation model to extract the phenotypical features of patients, which were then used as input features of predictive models to predict ICU patient outcomes. We demonstrated and validated this approach by conducting experiments on three ICU prediction tasks, including in-hospital mortality, physiological decompensation and length of stay (LOS) for over 24 000 patients using the Medical Information Mart for Intensive Care (MIMIC-III) dataset.ResultsThe predictive models incorporating phenotypical information achieved 0.845 (area under the curve–receiver operating characteristic (AUC-ROC)) for in-hospital mortality, 0.839 (AUC-ROC) for physiological decompensation and 0.430 (kappa) for LOS, all of which consistently outperformed the baseline models using only vital signs and laboratory test results. Moreover, we conducted a thorough interpretability study showing that phenotypes provide valuable insights at both the patient and cohort levels.ConclusionThe proposed approach demonstrates that phenotypical information complements traditionally used vital signs and laboratory test results and significantly improves the accuracy of outcome prediction in the ICU.
Quantifying the association between psychological distress and low back pain in urban Europe: a secondary analysis of a large cross-sectional study
Authors: Ugwu Chukwuebuka Immanuel , Pope Daniel 
Published: February 2023

ObjectivesThis study aims to estimate the prevalence of low back pain (LBP) in Europe and to quantify its associated mental and physical health burdens among adults in European urban areas.DesignThis research is a secondary analysis of data from a large multicountry population survey.SettingThe population survey on which this analysis is based was conducted in 32 European urban areas across 11 countries.ParticipantsThe dataset for this study was collected during the European Urban Health Indicators System 2 survey. There were a total of 19 441 adult respondents but data from 18 028, 50.2% female (9 050) and 49.8% male (8 978), were included in these analyses.Primary and secondary outcome measuresBeing a survey, data on the exposure (LBP) and outcomes were collected simultaneously. The primary outcomes for this study are psychological distress and poor physical health.ResultsThe overall European prevalence of LBP was 44.6% (43.9–45.3) widely ranging from 33.4% in Norway to 67.7% in Lithuania. After accounting for sex, age, socioeconomic status and formal education, adults in urban Europe suffering LBP had higher odds of psychological distress aOR 1.44 (1.32–1.58) and poor self-rated health aOR 3.54 (3.31–3.80). These associations varied widely between participating countries and cities.ConclusionPrevalence of LBP, and its associations with poor physical and mental health, varies across European urban areas.
Can BCG vaccination at first health-facility contact reduce early infant mortality? Study protocol for a cluster-randomised trial (CS-BCG)
Authors: Thysen Sanne Marie , Møller Jensen Andreas , Vedel Julie Odgaard , da Silva Borges Igualdino , Aaby Peter , Jensen Aksel Karl Georg , Benn Christine Stabell , Fisker Ane Bærent 
Published: February 2023

IntroductionIncreasing evidence suggests that the BCG vaccine has non-specific effects, altering the susceptibility to non-tuberculous infections. Thus, early BCG vaccination may reduce mortality. BCG is recommended at birth but is often delayed. Vaccination opportunities are missed due to multidose vials not being opened for a few children. We will assess the effect of making BCG available at the first health-facility contact on early infant mortality and morbidity in a rural setting in Guinea-Bissau.Methods and analysisIn a cluster-randomised crossover trial, we randomise 23 health centres to two different treatment groups. In half of the health centres, BCG is provided as per current practice; in the remaining health centres, we make BCG available everyday to allow opening a vial of BCG if there is just one eligible child present. The randomisation of centres will be crossed over after 12 months and enrolment will continue for another 12 months.We will use logistic regression models with adjustment for village to assess the effect of making BCG available at the first health-facility contact. The main outcome is non-accidental mortality between day 1 and day 42 after birth. We will adjust for sex, health centre, period (before/after crossover) and level of surveillance (level 1 or level 2). Further analyses include assessment of the effect on hospital admission and a cost-effectiveness evaluation.Ethics and disseminationIf BCG vaccination reduces early infant mortality, missed opportunities and delays of vaccinations expose infants in several low-income countries to unnecessary excess mortality risk. The present trial will provide information on the effect of implementing a feasible intervention, where all children receive BCG at their first health-facility contact. Consent is obtained from all pregnant women registered as part of the trial. The results of the study will be published and communicated to the National Institute of Public Health in Guinea-Bissau.Trial registration numberNCT04658680.
Study protocol for a randomised controlled trial of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal: VALID
Authors: Saville Naomi M , Bhattarai Sanju , Harris-Fry Helen , Giri Santosh , Manandhar Shraddha , Morrison Joanna , Copas Andrew , Thapaliya Bibhu , Arjyal Abriti , Haghparast-Bidgoli Hassan , Baral Sushil C , Hillman Sara 
Published: February 2023

IntroductionDespite evidence that iron and folic acid (IFA) supplements can improve anaemia in pregnant women, uptake in Nepal is suboptimal. We hypothesised that providing virtual counselling twice in mid-pregnancy, would increase compliance to IFA tablets during the COVID-19 pandemic compared with antenatal care (ANC alone.Methods and analysisThis non-blinded individually randomised controlled trial in the plains of Nepal has two study arms: (1) control: routine ANC; and (2) ‘Virtual’ antenatal counselling plus routine ANC. Pregnant women are eligible to enrol if they are married, aged 13–49 years, able to respond to questions, 12–28 weeks’ gestation, and plan to reside in Nepal for the next 5 weeks. The intervention comprises two virtual counselling sessions facilitated by auxiliary nurse midwives at least 2 weeks apart in mid-pregnancy. Virtual counselling uses a dialogical problem-solving approach with pregnant women and their families. We randomised 150 pregnant women to each arm, stratifying by primigravida/multigravida and IFA consumption at baseline, providing 80% power to detect a 15% absolute difference in primary outcome assuming 67% prevalence in control arm and 10% loss-to-follow-up. Outcomes are measured 49–70 days after enrolment, or up to delivery otherwise. Primary outcome: consumption of IFA on at least 80% of the previous 14 days. Secondary outcomes: dietary diversity, consumption of intervention-promoted foods, practicing ways to enhance bioavailability and knowledge of iron-rich foods. Our mixed-methods process evaluation explores acceptability, fidelity, feasibility, coverage (equity and reach), sustainability and pathways to impact. We estimate costs and cost-effectiveness of the intervention from a provider perspective. Primary analysis is by intention-to-treat, using logistic regression.Ethics and disseminationWe obtained ethical approval from Nepal Health Research Council (570/2021) and UCL ethics committee (14301/001). We will disseminate findings in peer-reviewed journal articles and by engaging policymakers in Nepal.Trial registration numberISRCTN17842200.
‘Self-Management Intervention through Lifestyle Education for Kidney health’ (the SMILE-K study): protocol for a single-blind longitudinal randomised controlled trial with nested pilot study
Authors: Lightfoot Courtney J , Wilkinson Thomas J , Yates Thomas , Davies Melanie J , Smith Alice C 
Published: February 2023

IntroductionMany people living with chronic kidney disease (CKD) are expected to self-manage their condition. Patient activation is the term given to describe the knowledge, skills and confidence a person has in managing their own health and is closely related to the engagement in preventive health behaviours. Self-management interventions have the potential to improve remote disease management and health outcomes. We are testing an evidence-based and theory-based digital self-management structured 10-week programme developed for peoples with CKD called ‘My Kidneys & Me’. The primary aim of the study (Self-Management Intervention through Lifestyle Education for Kidney health (SMILE-K)) is to assess the effect on patient activation levels.Methods and analysisA single-blind randomised controlled trial (RCT) with a nested pilot study will assess the feasibility of the intervention and study design before continuation to a full RCT. Individuals aged 18 years or older, with established CKD stage 3–4 (eGFR of 15–59 mL/min/1.73 m2) will be recruited through both primary and secondary care pathways. Participants will be randomised into two groups: intervention group (receive My Kidneys & Me in addition to usual care) and control group (usual care). The primary outcome of the nested pilot study is feasibility and the primary outcome of the full RCT is the Patient Activation Measu (PAM-13). The full RCT will assess the effect of the programme on online self-reported outcomes which will be assessed at baseline, after 10 weeks, and then after 20 weeks in both groups. A total sample size of N=432 participants are required based on a 2:1 randomisation. A substudy will measure physiological changes (eg, muscle mass, physical function) and patient experience (qualitative semi-structured interviews).Ethics and disseminationThis study was fully approved by the Research Ethics Committee-Leicester South on the 19 November 2020 (reference: 17/EM/0357). All participants are required to provide informed consent obtained online. The results are expected to be published in scientific journals and presented at clinical research conferences. This is protocol version 1.0 dated 27 January 2021.Trial registration numberISRCTN18314195.
Impact of a multifaceted intervention on physicians’ knowledge, attitudes and practices in relation to pharmaceutical incentivisation: protocol for a randomised control trial
Authors: Noor Muhammad Naveed , Khan Mishal , Rahman-Shepherd Afifah , Siddiqui Amna Rehana , Khan Sabeen Sharif , Azam Iqbal , Shakoor Sadia , Hasan Rumina 
Published: February 2023

IntroductionIn settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients’ well-being. In their interactions with pharmaceutical companies, private general practitioners (GPs) can experience the conflict of interest (COI), a situation whereby the impartiality of GPs’ professional decision making may be influenced by secondary interests such as financial gains from prescribing specific pharmaceutical brands.Methods and analysisThis study is a randomised controlled trial to assess the impact of a multifaceted intervention on GPs’ medical practice. The study sample consists of 419 registered GPs who own/work in private clinics and will be randomly assigned to intervention and control groups. The intervention group GPs will be exposed to emotive and educational seminars on medical ethics, whereas control group GPs will be given seminars on general medical topics. The primary outcome measure will be GPs’ prescribing practices, whereas the secondary outcome measures will be their knowledge and attitudes regarding COI that arises from pharmaceutical incentivisation. In addition to a novel standardised pharmaceutical representatives (SPSR) method, in which field researchers will simulate pharmaceutical marketing with GPs, presurvey and postsurvey, and qualitative interviewing will be performed to collect data on GPs’ knowledge, attitudes and practices in relation to COI linked with pharmaceutical incentives. Univariate and multivariate statistical analyses will be performed to measure a change in GPs’ knowledge, attitudes and practices, while qualitative analysis will add to our understanding of the quantitative SPSR data.Ethics and disseminationEthics approval has been obtained from the Pakistan National Bioethics Committee (# 4-87/NBC-582/21/1364), the Aga Khan University (# 2020-4759-1129) and the London School of Hygiene and Tropical Medicine (# 26506). We will release results within 6–9 months of the study’s completion.Trial registration numberISRCTN12294839.
Cognitive bias modification for interpretation (CBM-I) for post-traumatic stress disorder: study protocol of an app-based randomised controlled trial
Authors: Kroener Julia , Greiner Alexander , Sosic-Vasic Zrinka 
Published: February 2023

IntroductionPrevious studies indicate that computerised trainings implementing cognitive bias modification (CBM) for interpretation bias might be promising treatments for trauma-related cognitive distortions and symptoms. However, results are mixed, which might be related to the implemented task (sentence completion task), setting, or training duration. Within the present study, we aim to evaluate the efficacy and safety of an app-based intervention for interpretation bias using standardised imagery audio scripts, which is designed as a standalone treatment.Methods and analysisThe study is a randomised controlled trial, implementing two parallel arms. 130 patients diagnosed with post-traumatic stress disorder (PTSD) will be allocated to either the intervention group or the waiting-list control group receiving treatment as usual. The intervention consists of 3 weeks of an app-based CBM training for interpretation bias using mental imagery, with three training sessions (20 min) per week. Two months after the last training session, 1 week of booster CBM treatment will be implemented, consisting of three additional training sessions. Outcome assessments will be conducted pretraining, 1 week post-training, 2 months post-training, as well as 1 week after the booster session (approximately 2.5 months after initial training termination). The primary outcome is interpretation bias. Secondary outcomes include PTSD-related cognitive distortions and symptom severity, as well as negative affectivity. Outcome assessment will be conducted by intention-to-treat analysis, as well as per-protocol analysis using linear mixed models.Ethics and disseminationThe study was approved by the Ethics Committee of the State Chamber of Physicians in Baden-Wuerttemberg, Germany (number of approval: F-2022-080). Scientific findings will be published in peer-reviewed journals informing future clinical studies, which focus on the reduction of PTSD-related symptoms using CBM.Trial registration numberGerman Clinical Trials Register (DRKS00030285;https://drks.de/search/de/trial/DRKS00030285).
Needs of parents and carers of children and young people with mental health difficulties: protocol for a systematic review
Authors: Martin Faith , Dahmash Dania , Glover Sarah , Duncan Charlie , Turner Andy , Halligan Sarah L 
Published: February 2023

IntroductionHaving a child or young person (CYP) with mental health problems can be highly distressing for parents/carers. The impact can include parental/carer depression, anxiety, lost productivity and poor family relationships. Currently, there is no synthesis of this evidence, which is needed to provide clarity around what support parents/carers may need, to meet the needs of family mental health. This review aims to identify the needs of the parents/carers of CYP who are receiving mental health services.Methods and analysisA systematic review will be conducted to identify potentially relevant studies that provide evidence concerning the needs and impact on parents/carers linked to their CYP having mental health difficulties. CYP mental health conditions included are anxiety disorders, depression, psychoses, oppositional defiant and other externalising disorders, labels of emerging personality disorders, eating disorders and attention deficit (hyperactive) disorders. The following databases were searched on November 2022 with no date restriction applied: Medline; PsycINFO; CINAHL; AMED; EMBASE; Web of Science; Cochrane Library; WHO International Clinical Trials Registry Platform; Social Policy and Practice; Applied Social Sciences Index and Abstracts; and Open Grey. Only studies reported in English will be included. The quality of the included studies will be assessed using Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies and the Newcastle Ottawa Scale for quantitative studies. Qualitative data will be analysed thematically and inductively.Ethics and disseminationThis review was approved by the ethical committee at Coventry University, UK, reference number P139611. The findings from this systematic review will be disseminated across various key stakeholders and published in peer-reviewed journals.
Statutory Auditors and Tax Compliance: Evidence from a Quasi-Natural Experiment
Authors: Daskalaki Charoula , Karampinis Nikolaos 
Published: February 2023

The research problem We evaluated the effectiveness of statutory auditors as a tax inspection mechanism and examine a regulation change that occurred in Greece. In 2011, the Greek State passed a directive requiring that statutory auditors audit and certify the tax compliance of medium and large firms, and issue a Tax Compliance Report (TCR). Motivation The evidence on the auditors’ effect on tax avoidance is quite limited. Our research setting constitutes a unique quasi-natural experiment to evaluate auditors’ effectiveness and firms’ tax avoidance behavior under a new tax compliance regime. The test hypothesis We tested the following hypothesis: Tax avoidance was significantly reduced in the post-TCR period for firms subject to TCR. Target population Our target population consisted of firms that are subject to audits from statutory auditors for tax compliance purposes. Adopted methodology We employed a difference-in-differences design with Greek firms subject to TCR as the treated group and the rest of the Greek firms as the control group. We examined potential differences from the TCR enforcement for the two groups. Analysis Our main analysis presents results for the treated and the control groups regarding their non-conforming and conforming tax avoidance behavior in the pre- and the post-TCR period. Non-conforming refers to activities that reduce taxable income but leave book income unaffected, whereas conforming tax avoidance refers to activities that reduce both taxable income and book income. Additional analysis evaluates the effect of Big 4 audit firms, increased audit effort, and assignment of the TCR to the financial statements’ auditor. Findings Our empirical results suggest that non-conforming tax avoidance for treated firms (i.e., firms subject to tax audits) significantly decreased in the post-TCR period compared with that of the control sample (i.e., firms not subject to tax audits). Conversely, conforming tax avoidance increased. This evidence suggests that treated firms switched from non-conforming to conforming tax avoidance activities. Our results hold irrespective of the size of the audit firm that performed the TCR program, but we find that increased audit effort to accomplish the TCR program and the assignment of the TCR to the auditor who also audited the financial statements had an incremental impact on the reduction of non-conforming tax avoidance.