bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hadean tectonics: Insights from machine learning
Authors: Chen Guoxiong , Kusky Timothy , Luo Lei , Li Quanke , Cheng Qiuming 
Published: May 2023

Abstract
The tectonic affiliations and magma compositions that formed Earth’s earliest crusts remain hotly debated. Previous efforts toward this goal have relied heavily on determining the provenance of Hadean zircons using low-dimensional discriminant diagrams developed from Phanerozoic samples, which are inadequate for capturing systematic differences without considering secular changes in zircon composition. Here, we developed high-dimensional machine learning (ML) approaches using zircon chemistry data (spanning 19 elements over 4.0 b.y.) to characterize zircons that crystallized in some typical tectonic settings (e.g., arcs, plume-related hotspots, and rifts) and from either igneous (I-type) or sedimentary (S-type) magmas. The proposed ML method, from a nonuniformitarian perspective, identifies the tectonic settings and granitoid types of given zircons (from Archean to Phanerozoic) at a higher prediction accuracy of &gt;89% compared to ∼66%–82% for traditional discriminant diagrams (e.g., U/Yb vs. Y and rare earth elements (REE) + Y vs. P). The ML-based discriminators depend on the systematic differences in zircon chemistry, notably, significant differences in U, Th, and heavy REE for tectonic settings, and P and Hf for I- and S-type magmas. Application of the trained ML models to Hadean zircons from Jack Hills, Australia, suggests that these zircons were mainly crystallized in continental arc–forming magmas (90%) with 45% belonging to S-type melts. This result provides clear evidence of sediment recycling associated with subduction activity in the Hadean.
Protective equipment in youth ice hockey: are mouthguards and helmet age relevant to concussion risk?concussionfor mouthguard wearers
Authors: Kolstad Ash T , Eliason Paul H , Galarneau Jean-Michel , Black Amanda Marie , Hagel Brent E , Emery Carolyn A 
Published: May 2023

ObjectivesTo compare the incidence rates and odds of concussion between youth ice hockey players based on mouthguard use and helmet age.Materials and methodsWithin a 5-year longitudinal cohort (2013/2014 to 2017/2018) of male and female ice hockey players (ages 11–18; n=3330 players) in Alberta (Canada), we analysed the relationship of equipment and concussion in both a prospective cohort and nested case (concussion) control (acute musculoskeletal injury) approach. The prospective cohort included baseline assessments documenting reported mouthguard use (yes/sometimes, no use), helmet age (newer/<2 years old, older/≥2 years old) and important covariables (weight, level of play, position of play, concussion history, body checking policy), with weekly player participation throughout the season. The nested case–control component used injury reports to document equipment (mouthguard use, helmet age) and other information (eg, mechanism and type of injury) for the injury event. Multivariable mixed effects negative binomial regression (prospective cohort, incidence rate ratios (IRRs)) and multivariable mixed effects logistic regression (nested case–control, odds ratios (OR)) examined the association between equipment and concussion.ResultsPlayers who reported wearing a mouthguard had a 28% lower concussion rate (IRR=0.72, 95% CI 0.56 to 0.93) and 57% lower odds of concussion (OR=0.43, 95% CI 0.27 to 0.70) compared with non-wearers. There were no associations in the concussion rate (IRR=0.95, 95% CI 0.77 to 1.18) and odds (OR=1.16, 95% CI 0.73 to 1.86) between newer and older helmets.ConclusionsWearing a mouthguard was associated with a lower concussion rate and odds. Policy mandating use should be considered in youth ice hockey. More research is needed to identify other helmet characteristics (eg, quality, fit) that could lower concussion risk.
Advances in systemic therapies for triple negative breast cancer
Authors: Leon-Ferre Roberto A , Goetz Matthew P 
Published: May 2023

ABSTRACTTriple negative breast cancer (TNBC) continues to be the subtype of breast cancer with the highest rates of recurrence and mortality. The lack of expression of targetable proteins such as the estrogen receptor and absence of HER2 amplification have made relying on cytotoxic chemotherapy necessary for decades. In the operable setting, efforts to improve outcomes have focused on escalation of systemic therapy and a shift toward preoperative delivery followed by a response adapted approach to postoperative systemic therapy. An improved understanding of tumor biology has resulted in the identification of subsets of patients with specific molecular features, leading to testing and approval of multiple new targeted therapies for this disease. Furthermore, advances in drug development have led to the approval of antibody-drug conjugates that are redefining classification schemes for breast cancer. This review focuses on the modern management of TNBC, with particular focus on recent updates in the treatment of operable disease, and an overview of the most recent promising advances in the therapeutic landscape of metastatic disease. It discusses the practical challenges and unanswered questions resulting from the approval of neoadjuvant immunotherapy and shares an approach in the clinic on topics for which evidence is lacking. In addition, it provides a glimpse into the future, highlighting challenges and opportunities for biomarker based right-sizing of preoperative therapy, refining evaluation of response to preoperative therapy after surgery, early diagnosis and detection of relapse, and areas of needed research for metastatic TNBC.
Finding undiagnosed patients with hepatitis C virus: an application of machine learning to US ambulatory electronic medical records
Authors: Rigg John , Doyle Orla , McDonogh Niamh , Leavitt Nadea , Ali Rehan , Son Annie , Kreter Bruce 
Published: May 2023

AimsTo develop and validate a machine learning (ML) algorithm to identify undiagnosed hepatitis C virus (HCV) patients, in order to facilitate prioritisation of patients for targeted HCV screening.MethodsThis retrospective study used ambulatory electronic medical records (EMR) from January 2015 to February 2020. A Gradient Boosting Trees algorithm was trained using patient records to predict initial HCV diagnosis and was validated on a temporally independent held-out cross-section of the data. The fold improvement in precision (proportion of patients identified by the algorithm who are HCV positive) over universal screening was examined and compared with risk-based screening.Results21 508 positive (HCV diagnosed) and 28.2M unlabelled (lacking evidence of HCV diagnosis) patients met the inclusion criteria for the study. After down-sampling unlabelled patients to aid the algorithm’s learning process, 16.2M unlabelled patients entered the analysis. Performance of the algorithm was compared with universal screening on the held-out cross-section, which had an incidence of HCV diagnoses of 0.02%. The algorithm achieved a 101.0 ×, 18.0 × and 5.1 × fold improvement in precision over universal screening at 5%, 20% and 50% levels of recall. When compared with risk-based screening, the algorithm required fewer patients to be screened and improved precision.ConclusionsThis study presents strong evidence towards the use of ML on EMR data for the prioritisation of patients for targeted HCV testing with potential to improve efficiency of resource utilisation, thereby reducing the workload for clinicians and saving healthcare costs. A prospective interventional study would allow for further validation before use in a clinical setting.
Organizational and health professional readiness for the implementation of electronic medical record system: an implication for the current EMR implementation in northwest Ethiopia
Authors: Yilma Tesfahun Melese , Tilahun Binyam , Mamuye Adane , Kerie Hailemariam , Nurhussien Fedlu , Zemen Endalkachew , Mebratu Aragaw , Abebaw Tewodros , Gebeyehu Henok , Abay Sefiw , Sisay Girma , Getachew Redet , Zemene Wondewossen , Tesfaye Selamsew , Tegegne Masresha Derese 
Published: May 2023

ObjectiveThe WHO developed a manual outlining the preliminary organizational and health professionals’ readiness to implement electronic medical records (EMR). On the other hand, the readiness assessment in Ethiopia only includes the evaluation of health professionals, leaving out organisational readiness components. As a result, this research aimed to determine health professionals’ and organizational readiness to implement EMR at a specialized teaching hospital.MethodsAn institutional-based cross-sectional study design was conducted among 423 health professionals and 54 managers. Self-administered and pretested questionnaires were used to collect data. Binary logistic regression analysis was used to identify factors associated with health professionals’ readiness for EMR implementation. An OR with a 95% CI and p<0.05 was used to determine the strength of the association and the statistical significance, respectively.ResultsIn this study, 53.7% management capacity, 33.3% finance and budget capacity, 42.6% operational capacity, 37.0% technology capability and 53.7% organisational alignment among the five dimensions evaluated to assess an organisation’s readiness to implement an EMR system. Of 411 health professionals in this study, 173 (42.1%) with (95 CI 37.3% to 46.8%) were ready to implement an EMR system at the hospital. Sex (AOR 2.69, 95% CI 1.73 to 4.18), basic computer training (AOR 1.59, 95% CI 1.02 to 2.46), knowledge of EMR (AOR 1.88, 95% CI 1.19 to 2.97) and attitudes towards EMR (AOR 1.65, 95% CI 1.05 to 2.59) were significantly associated with health professionals’ readiness towards EMR system implementation.ConclusionsFindings showed that most dimensions of organizational readiness for EMR implementation were below 50%. This study also revealed a lower level of EMR implementation readiness among health professionals compared with previous research studies’ results. To improve organisational readiness to implement an electronic medical record system, a focus on management capability, financial and budget capability, operational capability, technical capability and organisational alignment was crucial. Likewise, having basic computer training, giving special attention to female health professionals and improving health professionals’ knowledge of and attitudes towards EMR could help improve the readiness level of health professionals for implementing an EMR system.
Dynamic treatment regimes (DTRs) to study treatment sequencing in oncology: a scoping review protocol
Authors: Esteves Susana , Alves João Miguel , Rodrigues Pedro Pereira , Gomes da Silva Maria 
Published: May 2023

IntroductionThe rapid evolution of the therapeutic landscape in oncology poses challenges to optimal treatment sequencing. Evidence for clinical decision-making is often limited to studies focused on treatment evaluation at a single decision point, with limited capability of identifying delayed effects of prior treatment decisions on the efficacy and feasibility of future treatments. There is a growing interest in dynamic treatment regimes (DTRs) evaluation as it provides guidance on treatment individualisation based on evolving treatment and patient characteristics. In this scoping review we aim to systematically map how and to what extent DTRs have been evaluated in clinical studies to generate evidence for clinical decision-making in oncology.Methods and analysisWe will do a systematic literature search in MEDLINE (PubMed), Web of Science, Scopus and WHO international clinical trials registry platform to identify clinical studies (including protocols of ongoing studies), with either experimental or observational design, that aim to answer a clinical question and explore treatment sequencing issues in oncology using the concept of DTR. Data extraction will comprise information concerning cancer disease, clinical setting, treatments, tailoring variables, decision rules, decision points and outcomes, type of data, study design and statistical methods used for DTR evaluation. The review will be conducted according to Joanna Briggs Institute Reviewer’s manual for scoping reviews. No patients will be involved.Ethics and disseminationEthics committee approval is not required as this scoping review will undertake secondary analysis of published literature. Results will be disseminated through a peer-reviewed scientific journal and presented in relevant conferences. This scoping review will provide a better understanding of the methods used to generate evidence on treatment sequencing in oncology and will contribute to the identification of knowledge and methodological gaps that should be addressed.
Evaluating the clinical effectiveness of the NHS Health Check programme: a prospective analysis in the Genetics and Vascular Health Check (GENVASC) study
Authors: Debiec Radoslaw , Lawday Daniel , Bountziouka Vasiliki , Beeston Emma , Greengrass Chris , Bramley Richard , Sehmi Sue , Kharodia Shireen , Newton Michelle , Marshall Andrea , Krzeminski Andre , Zafar Azhar , Chahal Anuj , Heer Amardeep , Khunti Kamlesh , Joshi Nitin , Lakhani Mayur , Farooqi Azhar , Patel Riyaz , Samani Nilesh J 
Published: May 2023

ObjectiveThe aim of the study was to assess the clinical effectiveness of the national cardiovascular disease (CVD) prevention programme—National Health Service Health Check (NHSHC) in reduction of CVD risk.DesignProspective cohort study.Setting147 primary care practices in Leicestershire and Northamptonshire in England, UK.Participants27 888 individuals undergoing NHSHC with a minimum of 18 months of follow-up data.Outcome measuresThe primary outcomes were NHSHC attributed detection of CVD risk factors, prescription of medications, changes in values of individual risk factors and frequency of follow-up.ResultsAt recruitment, 18% of participants had high CVD risk (10%–20% 10-year risk) and 4% very high CVD risk (>20% 10-year risk). New diagnoses or hypertension (HTN) was made in 2.3% participants, hypercholesterolaemia in 0.25% and diabetes mellitus in 0.9%. New prescription of stains and antihypertensive medications was observed in 5.4% and 5.4% of participants, respectively. Total cholesterol was decreased on average by 0.38 mmol/L (95% CI −0.34 to −0.41) and 1.71 mmol/L (−1.48 to −1.94) in patients with initial cholesterol >5 mmol/L and >7.5 mmol/L, respectively. Systolic blood pressure was decreased on average by 2.9 mm Hg (−2.3 to −3.7), 15.7 mm Hg (−14.1 to −17.5) and 33.4 mm Hg (−29.4 to −37.7), in patients with grade 1, 2 and 3 HTN, respectively. About one out of three patients with increased CVD risk had no record of follow-up or treatment.ConclusionsMajority of patients identified with increased CVD risk through the NHSHC were followed up and received effective clinical interventions. However, one-third of high CVD risk patients had no follow-up and therefore did not receive any treatment. Our study highlights areas of focus which could improve the effectiveness of the programme.Trial registration numberNCT04417387.
Telehealth-delivered naturalistic developmental behavioural intervention with and without caregiver acceptance and commitment therapy for autistic children and their caregivers: protocol for a multi-arm parallel group randomised clinical trial
Authors: McLay Laurie , Emerson Lisa Marie , Waddington Hannah , van Deurs Jenna , Hunter Jolene , Blampied Neville , Hapuku Aaron , Macfarlane Sonja , Bowden Nicholas , van Noorden Lauren , Rispoli Mandy 
Published: May 2023

IntroductionTimely access to early support that optimises autistic children’s development and their caregiver’s mental health is critical. Naturalistic developmental behavioural interventions (NDBIs) and acceptance and commitment therapy (ACT) are evidence-based supports that can enhance child learning and behaviour, and adult well-being, respectively. The traditional face-to-face delivery of these approaches is resource intensive. Further, little is known about the benefit of parallel child-focused and caregiver-focused supports. The aims of this trial are to evaluate the effectiveness and social validity of telehealth-delivered, caregiver-implemented, child-focused NDBI and caregiver-focused ACT when delivered alone and in parallel, on autistic children’s social communication and caregiver well-being.Methods and analysisThe study will use a randomised, single-blind clinical trial with three parallel arms: NDBI; ACT and ACT+NDBI. We will recruit a minimum of 78, 2–5-year-old autistic children and their families throughout Aotearoa New Zealand. Support will be delivered over 13 weeks using a combination of culturally enhanced web-based modules and online group coaching. Primary outcome variables include children’s social communication/engagement with their caregiver as well as caregiver stress and will be evaluated using a repeated measures multivariate analysis of variance. Outcome variables are assessed at baseline (before randomisation), immediately postparticipation and at 3-month follow-up.Ethics and disseminationThe trial is approved by the Health and Disability Ethics Committee (2022 FULL 12058). The findings of this trial will be disseminated through peer-reviewed journals and national and international conference proceedings regardless of the magnitude/direction of effect. Additionally, data will be shared with stakeholder groups, service providers and health professionals.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12622001134718).
Evaluation of an interprofessional primary healthcare team as a new model of primary care in Quebec: a protocol for a type 2 effectiveness-implementation hybrid study
Authors: Côté Nancy , Frikha Yasmine , Freeman Andrew , Cortez Ghio Sergio , Laberge Maude , Isabelle Maripier , Duhoux Arnaud , Denis Jean-Louis , Jean Emmanuelle , Binette Sébastien 
Published: May 2023

IntroductionOne family medicine group (FMG) in Quebec has commenced a 5-year pilot project, which is herein referred to as theArchimèdemodel, to implement a patient-centred model based on interprofessional care and the optimal use of healthcare providers’ practice scopes. A research project will be conducted to: (1) assess this model’s effect on the FMG’s operational performance, and its users’ resource utilisation at the public health system level; (2) investigate its optimisation with respect to professional roles, interprofessional teamwork and patient-centredness and (3) document users’ experience with the model. The aim of this article is to describe the protocol that will be used for this research.Methods and analysisA hybrid implementation approach (type 2 model) will be used. We will collect both quantitative and qualitative data. Regarding the quantitative dimension, and because this is a single-unit intervention study, we will use either or both synthetic control methods and one-sample generalised linear models for analyses at the FMG level. To evaluate the broader impact ofArchimèdeon the public health system, we will use mixed-effects models and propensity score matching methods. Regarding the qualitative research dimension, using an interpretative descriptive approach, we will document users’ experience and identify the factors that optimise professional scopes of practice, collaborative practices and patient-centredness. We will conduct individual in-depth semistructured interviews with healthcare providers, administrative staff, stakeholders involved in theArchimèdemodel implementation and patients.Ethics and disseminationThis study was approved by the Ethics Committee of the Sectoral Research in Population Health and Primary Care of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (#2019-1503). The results of the investigation will be presented to the stakeholders involved in the advisory committees and at several scientific conferences. Manuscripts will be submitted to peer-reviewed journals.
The randomised thoracoscopic talc poudrage+indwelling pleural catheters versus thoracoscopic talc poudrage only in malignant pleural effusion trial (TACTIC): study protocol for a randomised controlled trial
Authors: Dipper Alexandra , Sundaralingam Anand , Hedley Emma , Tucker Emma , White Paul , Bhatnagar Rahul , Moore Andrew , Dobson Melissa , Luengo-Fernandez Ramon , Mills Janet , Sowden Sandra , Harvey John E , Dobson Lee , Miller Robert F , Munavvar Mohammed , Rahman Najib , Maskell Nick 
Published: May 2023

IntroductionMalignant pleural effusion (MPE) is common, with 50 000 new cases per year in the UK. MPE causes disabling breathlessness and indicates advanced disease with a poor prognosis. Treatment approaches focus on symptom relief and optimising quality of life (QoL). Patients who newly present with MPE commonly require procedural intervention for both diagnosis and therapeutic benefit.Thoracoscopic pleural biopsies are highly sensitive in diagnosing pleural malignancy. Talc poudrage may be delivered at thoracoscopy (TTP) to prevent effusion recurrence by effecting pleurodesis. Indwelling pleural catheters (IPCs) offer an alternative strategy for fluid control, enabling outpatient management and are often used as ‘rescue’ therapy following pleurodesis failure or in cases of ‘trapped lung’. It is unknown whether combining a TTP with IPC insertion will improve patient symptoms or reduce time spent in the hospital.The randomised thoracoscopic talc poudrage + indwelling pleural catheters versus thoracoscopic talc poudrage only in malignant pleural effusion trial (TACTIC) is the first randomised controlled trial (RCT) to examine the benefit of a combined TTP and IPC procedure, evaluating cost-effectiveness and patient-centred outcomes such as symptoms and QoL. The study remains in active recruitment and has the potential to radically transform the pathway for all patients presenting with MPE.Methods and analysisTACTIC is an unblinded, multicentre, RCT comparing the combination of TTP with an IPC to TTP alone. Co-primary outcomes are time spent in the hospital and mean breathlessness score over 4 weeks postprocedure. The study will recruit 124 patients and aims to define the optimal pathway for patients presenting with symptomatic MPE.Ethics and disseminationTACTIC is sponsored by North Bristol NHS Trust and has been granted ethical approval by the London-Brent Research Ethics Committee (REC ref: 21/LO/0495). Publication of results in a peer-reviewed journal and conference presentations are anticipated.Trial registrationISRCTN 11058680.