bluuebunny/crossref_metadata_2025_split huggingface dataset:
Digital twin maturity levels: a theoretical framework for defining capabilities and goals in the life and environmental sciences
Authors: Metcalfe Brett , Boshuizen Hendriek C. , Bulens Jandirk , Koehorst Jasper J. 
Published: August 2023

Background: Digital twins (DT) are the coupling of a real-world physical asset to a virtual representation to provide insight and actionable knowledge. The benefits of DT are considered to include improvements in reproducibility, reliability of interventions, increased productivity, as well as increased time for innovation. For instance, a DT could be used to boost agricultural productivity whilst also meeting various targets (e.g., biodiversity, sustainability). Or a DT could be used to monitor a cell culture, predict interactions, and make subtle adjustments to maintain the environment allowing researchers to conduct other work. Yet in developing DT two fundamental questions emerge: ‘What will the DT capabilities be?’ (i.e., the range of features and possible actions) and ‘What will the DT do?’ (i.e., which capabilities will it utilise). Methods: Here we discuss a theoretical framework for DTs developed during Wageningen University & Research’s Investment Programme on DTs that aims to answer these questions. Focusing on the Life and Environmental Sciences to help developers and stakeholders to agree on the capabilities, purpose, and goal of a DT. As well as identifying iterative design stages that may help set interim development goals such as a minimum viable product. Results: This framework defines a DT as sitting at one of five maturity, or capability, levels associated with specific types of DT: a status, an informative, a predictive, an optimisation, and an autonomous twin. Conclusions: The aim of DTs is to make better, data-driven, decisions yet there can be a gulf between expectations of what a Digital Twin will do and the reality. The five maturity levels outlined here can be used to first identify and communicate about the type of Digital Twin required for a particular project prior to DT development. Bridging the gap between what project leads, developers, and stakeholders envision the end-product will be.
The long-term outcomes of patients with negative prolonged ambulatory electroencephalography tests: A cross-sectional follow-up study
Authors: Ouchida Sumika , Nikpour Armin , Zhang Xin , Faulkner Howard , Senturias Maricar , Reid Nicole , Stephens Eleanor , Fairbrother Greg 
Published: August 2023

Background: Ambulatory electroencephalography (AEEG) recording is an essential aid for detecting interictal discharges and providing a clinical diagnosis. This study aimed to describe long-term outcomes among a cohort of patients who yielded negative results on AEEG at the time of assessment and identify factors associated with contemporary quality of life (QOL) and ultimate epilepsy diagnosis. Methods: This cross-sectional telephone follow-up study was conducted in June-November 2021 at the Neurology Department in a metropolitan hospital in Sydney, Australia. Results: Forty-seven of 105 eligible (45%) participants were enrolled. Twenty-one (45%) participants had been diagnosed with epilepsy at a 12-year follow-up. Taking anti-seizure medication, having experienced a seizure event, and having marriage and education-related characteristics were associated with an epilepsy diagnosis. QOL was found to be associated with age, employment status and history of experience of a seizure event. QOL and an epilepsy diagnosis were not shown to be statistically related. Conclusion: Nearly half of the participants had received an epilepsy diagnosis at long-term follow-up, despite having tested negative on AEEG at the time of assessment. Prolonged AEEG testing is an important tool to aid the diagnostic process. However, clinical examination, including accurate history taking, is vital in establishing an epilepsy diagnosis.
Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - ‘eHealth: It’s TIME’: a study protocol
Authors: Kelly Marie , Fullen Brona , Martin Denis , Bradley Colin , O'Mahony Billy , McVeigh Joseph G. 
Published: August 2023

Background: Musculoskeletal disorders (MSDs) are a leading cause of global morbidity, with the burden expected to increase in the near future. Self-management, with the support of healthcare professionals, is recommended for many MSDs. However, frequent clinical contact is not feasible. Previous research has highlighted the need for a co-designed eHealth-mediated self-management follow-up support intervention which integrates remote monitoring and behavioural change. Thus, the current study aims to develop and design a user-centred, eHealth-mediated self-management support prototype for people with MSDs. Methods: A three-step, iterative system development cycle will be utilised to develop and design the “eHealth: It’s TIME prototype”. The three-step process will include creating website features and content using two sequential focus groups with people with MSDs (n = 6 – 8); heuristic testing using the 10 heuristic principles of Nielsen (n = 5); and usability testing through in-person 60-minute interviews with people with MSDs (n = 3 – 5) and musculoskeletal physiotherapists (n = 3 – 5). Conclusion: The eHealth: It’s TIME prototype will be a systematically developed, follow-up self-management support intervention guided by behavioural change theory and the preferences of end users.
Traducir poesía es descubrir los volcanes sepultados debajo de los pies. A propósito de Valitud tõlkeluulet 1970–2020 (Selección de la poesía traducida, 1970–2020), por Jüri Talvet
Authors: Kotta Merilin 
Published: August 2023

Jüri Talvet, Valitud tõlkeluulet. I. Hiliskeskajast modernismini. TÜ Kirjastus, 2021, 298 pp.
Jüri Talvet, Valitud tõlkeluulet. II. 20. sajandi keskpaigast 21. sajandi alguseni. TÜ Kirjastus, 2021, 489 pp.
Predictive validity of the EVARUCI scale to evaluate risk for pressure injury in critical care patients
Authors: de Souza Mariana Fernandes Cremasco , Zanei Suely Sueko Viski , Whitaker Iveth Yamaguchi 
Published: August 2023

Objective: To compare the predictive capacity of the current risk assessment scale for pressure ulcers in intensive care (EVARUCI), translated into Brazilian Portuguese, using the Braden scale. Method: This cross-sectional study collected prospective data from adult patients in three intensive care units. The receiver operating characteristic (ROC) and precision-recall curve (PR curve) were used to analyse the predictive capacity for pressure injury (PI) using both predictive values and odds ratios (ORs). Results: The incidence of PIs in the study sample of 324 patients was 14.2%. The area under the ROC curve was 0.807 for EVARUCI and 0.798 for the Braden scale. At a cutoff point of 10 on the EVARUCI scale, sensitivity was 69.6%; specificity 78.4%; positive predictive value 34.8%; and OR 8.3. At a cutoff point of 11 on the Braden scale, sensitivity was 76.1%; specificity 75.9%; positive predictive value 34.3%; and OR 10. The area under the PR curve was 0.396 for the EVARUCI scale and 0.348 for the Braden scale, reflecting a smaller area for both. The F1 score value was 0.476 with 37.5% precision and 65.2% recall for the EVARUCI scale, and 0.473 with 34.3% precision and 76.1% recall for the Braden scale. Conclusion: The EVARUCI scale predictive capacity was similar to that of the Braden scale. However, the precision of both scales was low for the accurate prediction of patients at risk of developing PIs.
How do perceptions of Covid-19 risk impact pregnancy-related health decisions? A convergent parallel mixed-methods study protocol
Authors: Vanstone Meredith , Correia Rebecca H. , Howard Michelle , Darling Elizabeth , Bayrampour Hamideh , Carruthers Andrea , Davis Amie , Hadid Dima , Hetherington Erin , Jones Aaron , Kandasamy Sujane , Kuyvenhoven Cassandra , Liauw Jessica , McDonald Sarah D. , Mniszak Caroline , Molinaro Monica L. , Pahwa Manisha , Patel Tejal , Sadik Marina , Sanya Njideka , Shen Katrina , Greyson Devon 
Published: August 2023

Introduction
Pregnant people have a higher risk of severe COVID-19 disease. They have been disproportionately impacted by COVID-19 infection control policies, which exacerbated conditions resulting in intimate partner violence, healthcare access, and mental health distress. This project examines the impact of accumulated individual health decisions and describes how perinatal care and health outcomes changed during the COVID-19 pandemic.

Objectives

Quantitative strand: Describe differences between 2019, 2021, and 2022 birth groups related to maternal vaccination, perinatal care, and mental health care. Examine the differential impacts on racialized and low-income pregnant people.
Qualitative strand: Understand how pregnant people’s perceptions of COVID-19 risk influenced their decision-making about vaccination, perinatal care, social support, and mental health.

Methods and analysis
This is a Canadian convergent parallel mixed-methods study. The quantitative strand uses a retrospective cohort design to assess birth group differences in rates of Tdap and COVID-19 vaccination, gestational diabetes screening, length of post-partum hospital stay, and onset of depression, anxiety, and adjustment disorder, using administrative data from ICES, formerly the Institute for Clinical Evaluative Sciences (Ontario) and PopulationData BC (PopData) (British Columbia). Differences by socioeconomic and ethnocultural status will also be examined. The qualitative strand employs qualitative description to interview people who gave birth between May 2020- December 2021 about their COVID-19 risk perception and health decision-making process. Data integration will occur during design and interpretation.

Ethics and dissemination
This study received ethical approval from McMaster University and the University of British Columbia. Findings will be disseminated via manuscripts, presentations, and patient-facing infographics.

Trial registration
Registration: Clinicaltrials.gov registration number: NCT05663762.
Associations between clinical and social factors and anticoagulant prescription among patients with atrial fibrillation: A retrospective cohort study from a large healthcare system
Authors: Khatib Rasha , Glowacki Nicole , Colavecchia Carmine , Mills J. Rebecca , Glosner Scott , Cato Matthew , Brady Peter 
Published: August 2023

Background
Patient clinical factors and social determinants of health (SDOH) are associated with an increased risk of stroke for patients with atrial fibrillation (AF); however, the association between these factors and the management of AF is not well characterized, particularly among those factors commonly collected in electronic health records (EHRs). This study used EHR data to evaluate the associations between patient clinical factors and SDOH and prescribing of an oral anticoagulant (OAC) for stroke prevention in AF.

Methods
This analysis included adult patients with newly diagnosed AF who had ≥2 encounters in the Advocate Aurora Health system in Wisconsin between May 2016 and May 2021. Patient-level demographics, comorbidities, medications, and SDOH were retrospectively extracted from EHRs. Area deprivation index (ADI) was linked to patient records as a measure of socioeconomic status.

Results
Of 16,656 patients with AF, 10,898 (65.4%) were prescribed an OAC within the first year of diagnosis. Patients were less likely to be prescribed an OAC (relative risk [95% CI]) if they were widowed (0.98 [0.96–0.99] vs single) or had a history of alcoholism (0.86 [0.79–0.95] vs no history). Most patients (53.3%) received prescriptions from a primary care provider. A linear relationship was found between worsening ADI and increased prescriptions for warfarin vs those for direct-acting OACs.

Conclusions
Although guideline-concordant anticoagulant use remained suboptimal, clinical characteristics were strongly associated for whether a patient with AF would be prescribed an OAC. Disparities in patient care regarding the prescribing of OACs due to SDOH and associated behaviors were small but present, particularly for national ADI.
Association of short-term hospital-level outcome metrics with 1-year mortality and recurrence for US Medicare beneficiaries with ischemic stroke
Authors: Wang Yun , Leifheit Erica C. , Goldstein Larry B. , Lichtman Judith H. 
Published: August 2023

Background
Whether stroke patients treated at hospitals with better short-term outcome metrics have better long-term outcomes is unknown. We investigated whether treatment at US hospitals with better 30-day hospital-level stroke outcome metrics was associated with better 1-year outcomes, including reduced mortality and recurrent stroke, for patients after ischemic stroke.

Methods
This cohort study included Medicare fee-for-service beneficiaries aged ≥65 years discharged alive from US hospitals with a principal diagnosis of ischemic stroke from 07/01/2015 to 12/31/2018. We categorized patients by the treating hospital’s performance on the CMS hospital-specific 30-day risk-standardized all-cause mortality and readmission measures for ischemic stroke from 07/01/2012 to 06/30/2015: Low-Low (both CMS mortality and readmission rates for the hospital were <25th percentile of national rates), High-High (both >75th percentile), and Intermediate (all other hospitals). We balanced characteristics between hospital performance categories using stabilized inverse probability weights (IPW) based on patient demographic and clinical factors. We fit Cox models assessing patient risks of 1-year all-cause mortality and ischemic stroke recurrence across hospital performance categories, weighted by the IPW and accounting for competing risks.

Results
There were 595,929 stroke patients (mean age 78.9±8.8 years, 54.4% women) discharged from 2,563 hospitals (134 Low-Low, 2288 Intermediate, 141 High-High). For Low-Low, Intermediate, and High-High hospitals, respectively, 1-year mortality rates were 23.8% (95% confidence interval [CI] 23.3%-24.3%), 25.2% (25.1%-25.3%), and 26.5% (26.1%-26.9%), and recurrence rates were 8.0% (7.6%-8.3%), 7.9% (7.8%-8.0%), and 8.0% (7.7%-8.3%). Compared with patients treated at High-High hospitals, those treated at Low-Low and Intermediate hospitals, respectively, had 15% (hazard ratio 0.85; 95% CI 0.82–0.87) and 9% (0.91; 0.89–0.93) lower risks of 1-year mortality but no difference in recurrence.

Conclusions
Ischemic stroke patients treated at hospitals with better CMS short-term outcome metrics had lower risks of post-discharge 1-year mortality, but similar recurrent stroke rates, compared with patients treated at other hospitals.
Multisectoral actions in primary health care: A realist synthesis of scoping review
Authors: Khatri Resham B. , Erku Daniel , Endalamaw Aklilu , Wolka Eskinder , Nigatu Frehiwot , Zewdie Anteneh , Assefa Yibeltal 
Published: August 2023

Background
Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems.

Methods
We reviewed published evidence that reported the MSAs, PHC and UHC. The keywords used in the search strategy were built on these three key concepts. We employed Pawson and Tilley’s realist review approach to synthesize data following Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist synthesis. We explained findings using a multilevel lens: MSAs at the strategic level (macro-level), coordination and partnerships at the operational level (meso-level) and MSAs employing to modify behaviours and provide services at the local level (micro-level).

Results
A total of 40 studies were included in the final review. The analysis identified six themes of MSAs contributing to the implementation of PHC towards UHC. At the macro-level, themes included influence on the policy rules and regulations for governance, and health in all policies for collaborative decision makings. The meso-level themes were spillover effects of the non-health sector, and the role of community health organizations on health. Finally, the micro-level themes were community engagement for health services/activities of health promotion and addressing individuals’ social determinants of health.

Conclusion
Multisectoral actions enable policy and actions of other sectors in health involving multiple stakeholders and processes. Multisectoral actions at the macro-level provide strategic policy directions; and operationalise non-health sector policies to mitigate their spillover effects on health at the meso-level. At micro-level, MSAs support service provision and utilisation, and lifestyle and behaviour modification of people leading to equity and universality of health outcomes. Proper functional institutional mechanisms are warranted at all levels of health systems to implement MSAs on health.
Validity and reliability of an app-based medical device to empower individuals in evaluating their physical capacities
Authors: Mazéas Alexandre , Blond Marine , Chalabaev Aïna , Duclos Martine 
Published: August 2023

Background
Cardiorespiratory fitness and muscle strength are valid markers of health and strong predictors of mortality and morbidity. The tests used to measure these variables require in-person visits with specialized equipment and trained personnel–leading to organizational constraints both for patients and hospitals, and making them difficult to implement at a large scale. In this context, technologies embedded in smartphones offer new opportunities to develop remote tests.

Objectives
This study aimed to test the validity and reliability of MediEval, a newly developed app-based medical device that allows individuals to perform the 6-minute walk test (6MWT) and the 30-second sit-to-stand (30s-STS) test on their own using GPS signal and camera detection with a skeleton extraction algorithm.

Methods
A total of 53 healthy adults performed the two tests in three different sessions to determine the intra- and inter-day reproducibility. Test validity was assessed by comparing the results obtained from the app to gold standard measures. Pearson correlations and concordance correlation coefficients, the relative measurement error, intraclass correlation coefficients, the standard error of measure and the minimal detectable change were computed for each test.s

Results
The results revealed high to excellent validity of the app in comparison to gold standards (ρ = 0.84 for the 6MWT and ρ = 0.99 for the 30s-STS test) with low relative measurement error. The mean differences between the app and the gold standard measures were 8.96m for the 6MWT and 0.28 repetition for the 30s-STS test. Both tests had good test-retest reliability (ICCs = 0.77). The minimal detectable changes were respectively 97.56 meters for the 6MWT and 7.37 repetitions for the 30s-STS test.

Conclusion
The MediEval medical device proposes valid and reproducible measures of the 6MWT and the 30s-STS test. This device holds promise for monitoring the physical activity of large epidemiologic cohorts while refining patient experience and improving the scalability of the healthcare system. Considering minimal detectable change values, it may be important to ask participants to perform several tests and average them to improve accuracy. Future studies in clinical context are needed to evaluate the responsiveness and the smallest detectable changes of the device for specific populations with chronic diseases.
Potential facilitators and inhibitors to the implementation and sustainability of the community-based tuberculosis care interventions. A case study from Moshupa, Botswana
Authors: Sejie Gabalape Arnold , Mahomed Ozayr H. 
Published: August 2023

Background
Eliminating Tuberculosis is one of the targets of Sustainable Development Goal Three. Decentralizing TB care beyond health facilities by leveraging community involvement is crucial for safeguarding effective tuberculosis care. In this study, we explored potential facilitators and inhibitors of the implementation and sustainability of community-based interventions for the prevention and treatment of TB in the Moshupa district, Botswana.

Methods
This study adopted a qualitative approach using a collective case design. An interpretive paradigm based on relativist ontology and subjectivist epistemology along with abductive research logic was used. The study enrolled treatment supporters of tuberculosis patients diagnosed with drug-susceptible tuberculosis between January 2019 and December 2019 in Moshupa Village for semi-structured interviews, Health care professionals for in-depth interviews, and e community leaders for focus group discussions. Clinic-based observations in Mma-Seetsele clinic were also conducted to corroborate the participants’ views. The data collected was analyzed using the NVivo version 12 software package, and statements of the participants were presented as quotes to substantiate the issues discussed.

Results
This study highlighted effective partnerships between health services and external stakeholders, community empowerment, and the availability of policies and standard operating procedures as facilitators of community TB implementation and sustainability. However, Insufficient funding, low service provider training, policies not embracing age and educational eligibility for treatment supporters, shortage of equipment, medicines, and supplies, inadequate transport availability and incentives to meet clients’ basic needs, paper-based systems, inadequate supervision, incomplete data reporting, and low service quality affected the Community TB program efficacy and sustainability in Moshupa. We also found that there was low service provider motivation and retention and that clients had low trust in treatment supporters.

Conclusion
The findings of this study imply that the operational effectiveness of the community TB care approach to disease elimination is compromised; therefore, initiatives addressing the key components, including the availability of resources, governance arrangements and supportive systems for community health workers, are required for successful community TB implementation and sustainability.