bluuebunny/crossref_metadata_2025_split huggingface dataset:
Protocol for a feasibility randomised control trial for continuous glucose monitoring in patients with type 1 diabetes at first-level hospitals in rural Malawi
Authors: Adler Alma J , Ruderman Todd , Valeta Francis , Drown Laura , Trujillo Celina , Ferrari Gina , Msekandiana Amos , Wroe Emily , Kachimanga Chiyembekezo , Bukhman Gene , Park Paul H 
Published: February 2022

IntroductionThe majority of people living with type 1 diabetes (PLWT1D) struggle to access high-quality care in low-income countries (LICs), and lack access to technologies, including continuous glucose monitoring (CGM), that are considered standard of care in high resource settings. To our knowledge, there are no studies in the literature describing the feasibility or effectiveness of CGM at rural first-level hospitals in LICs.Methods and analysisThis is a 3-month, 2:1 open-randomised trial to assess the feasibility and clinical outcomes of introducing CGM to the entire population of 50 PLWT1D in two hospitals in rural Neno, Malawi. Participants in both arms will receive 2 days of training on diabetes management. One day of training will be the same for both arms, and one will be specific to the diabetes technology. Participants in the intervention arm will receive Dexcom G6 CGM devices with sensors and solar chargers, and patients in the control arm will receive Safe-Accu home glucose metres and logbooks. All patients will have their haemoglobin A1c (HbA1c) measured and take WHO Quality of Life assessments at study baseline and endline. We will conduct qualitative interviews with a selection of participants from both arms at the beginning and end of study and will interview providers at the end of the study. Our primary outcomes of interest are fidelity to protocols, appropriateness of technology, HbA1c and severe adverse events.Ethics and disseminationThis study is approved by National Health Sciences Research Committee of Malawi (IRB Number IR800003905) and the Mass General Brigham (IRB number 2019P003554). Findings will be disseminated to PLWT1D through health education sessions. We will disseminate any relevant findings to clinicians and leadership within our study catchment area and networks. We will publish our findings in an open-access peer-reviewed journal.Trial registration numberPACTR202102832069874.
Effects of individual and parental educational levels on multimorbidity classes: a register-based longitudinal study in a Danish population
Authors: Schramm Stine , Møller Sanne Pagh , Tolstrup Janne Schurmann , Laursen Bjarne 
Published: February 2022

ObjectivesTo assess the effects of individual educational level in adulthood and parental educational level during childhood, as well as combinations of individual and parental educational levels, on multimorbidity classes.Design and settingIn this longitudinal study, we used data from a random sample of the Danish population aged 32–56 years without multimorbidity in 2010 (n=102 818). The study population was followed until 2018. Information on individual and parental educational levels and chronic conditions was obtained from national registers. Multinomial logistic regression analyses were adjusted for sex, age and ethnicity.Outcome measureSeven multimorbidity classes were identified using latent class analysis based on 47 chronic conditions. Persons deceased during follow-up comprised a separate class.ResultsWe found an independent effect of individual educational level on five multimorbidity groups and death, most pronounced for the multimorbidity group ‘Many conditions’ (OR=1.89, 95% CI 1.58 to 2.26 for medium and OR=3.22, 95% CI 2.68 to 3.87 for short compared with long educational level) and of parental education on four groups and death, most pronounced for the multimorbidity group ‘Many conditions’ (OR=1.36, 95% CI 1.07 to 1.73 for medium and OR=1.48, 95% CI 1.15 to 1.89 for short compared with long educational level). Odds of belonging to four multimorbidity classes increased with lower combination of individual and parental educational levels, most pronounced for the multimorbidity group ‘Many conditions’.ConclusionAs both individual and parental educational levels contribute to the risk of multimorbidity, it is important to address inequality throughout the life course to mitigate multimorbidity. Future studies could adopt a life course approach to investigate the mediating role of behavioural, clinical, environmental and other social factors.
Influence of the COVID-19 pandemic on abortions and births in Sweden: a mixed-methods study
Authors: Rydelius Johanna , Edalat Mina , Nyman Viola , Jar-Allah Tagrid , Milsom Ian , Hognert Helena 
Published: February 2022

IntroductionAlthough considered an essential service by the WHO, there are indications that access to induced abortion care has been restricted during the COVID-19 pandemic.ObjectivesTo investigate if the number of induced abortions and ongoing pregnancies changed during the first pandemic wave of COVID-19 in 2020 compared with recent years prior to the pandemic and explore possible reasons for the findings.DesignConvergent parallel mixed-methods design. Collection of quantitative data from the Swedish National Board of Health and Welfare and the Swedish Pregnancy Register, and qualitative data from interviews.Setting and time periodNational data on abortions (January 2018–June 2020) and births (January 2018–March 2021). Interviews performed at the main abortion clinic, Gothenburg, Sweden, in June 2020.ParticipantsAll women aged 15–44 years living in Sweden 2018–2020, approximately 1.9 million. 15 women who sought abortion were interviewed.Primary and secondary outcome measuresNumber of abortions and births/1000 women aged 15–44 years. Themes and subthemes identified from interviews.ResultsThe number of abortions and ongoing pregnancies did not change significantly during the study period compared with before the pandemic started. Interview themes identified were the following: meeting with abortion care during the COVID-19 pandemic (availability, and fear of being infected and infecting others); and the impact of the COVID-19 pandemic on the abortion decision (to catch COVID-19 during pregnancy, feelings of loneliness and isolation, and social aspects).ConclusionsThis study shows that the number of abortions and ongoing pregnancies remained unchanged during the first wave of the COVID-19 pandemic in 2020 in Sweden compared with before the start of the pandemic. Abortion-seeking women did not hesitate to proceed with the abortion. The women expressed a number of fears concerning both availability of care and their health, which could have been properly addressed by the authorities.
Effect of triclosan-coated sutures for abdominal wound closure on the incidence of abdominal wound dehiscence: a protocol for an individual participant data meta-analysis
Authors: Timmer Allard S , Wolfhagen Niels , Pianka Frank , Knebel Phillip , Justinger Christoph , Stravodimos Christos , Ichida Kosuke , Rikiyama Toshiki , Baracs József , Vereczkei András , Gianotti Luca , Ruiz-Tovar Jaime , Hernández Artur M , Nakamura Toru , Dijkgraaf Marcel G W , Boermeester Marja A , de Jonge Stijn W 
Published: February 2022

IntroductionAcute abdominal wound dehiscence (AWD) or burst abdomen is a severe complication after abdominal surgery with an incidence up to 3.8%. Surgical site infection (SSI) is the biggest risk factor for the development of AWD. It is strongly suggested that the use of triclosan-coated sutures (TCS) for wound closure reduces the risk of SSI. We hypothesise that the use of TCS for abdominal wound closure may reduce the risk of AWD. Current randomised controlled trials (RCTs) lack power to investigate this. Therefore, the purpose of this individual participant data meta-analysis is to evaluate the effect of TCS for abdominal wound closure on the incidence of AWD.Methods and analysisWe will conduct a systematic review of Medline, Embase and Cochrane Central Register of Controlled Trials for RCTs investigating the effect of TCS compared with non-coated sutures for abdominal wound closure in adult participants scheduled for open abdominal surgery. Two independent reviewers will assess eligible studies for inclusion and methodological quality. Authors of eligible studies will be invited to collaborate and share individual participant data. The primary outcome will be AWD within 30 days after surgery requiring reoperation. Secondary outcomes include SSI, all-cause reoperations, length of hospital stay and all-cause mortality within 30 days after surgery. Data will be analysed with a one-step approach, followed by a two-step approach. In the one-step approach, treatment effects will be estimated as a risk ratio with corresponding 95% CI in a generalised linear mixed model framework with a log link and binomial distribution assumption. The quality of evidence will be judged using the Grading of Recommendations Assessment Development and Evaluation approach.Ethics and disseminationThe medical ethics committee of the Amsterdam UMC, location AMC in the Netherlands waived the necessity for a formal approval of this study, as this research does not fall under the Medical Research involving Human Subjects Act. Collaborating investigators will deidentify data before sharing. The results will be submitted to a peer-reviewed journal.PROSPERO registration numberCRD42019121173.
Impact of interankle blood pressure difference on major adverse cardiovascular events in cryptogenic stroke patients without peripheral artery disease: a retrospective cohort study
Authors: Han Minho , Baik Minyoul , Kim Young Dae , Choi Junghye , Seo Kangsik , Park Eunjeong , Heo Ji Hoe , Nam Hyo Suk 
Published: February 2022

ObjectiveWe investigated whether interankle blood pressure difference (IAND) can predict major adverse cardiovascular events (MACEs) in patients with cryptogenic stroke (CS) without peripheral artery disease (PAD).DesignA retrospective cohort study.SettingRetrospective medical record data of patients with first-ever acute cerebral infarction who were admitted between 1 January 2007 and 31 July 2013.ParticipantsCS patients admitted within 7 days of symptom onset were included.Outcome measuresMACEs were defined as stroke recurrence, myocardial infarction occurrence, or death. Survival analyses were conducted using the Kaplan-Meier method and Cox regression analysis.MethodsConsecutive CS patients without PAD who underwent ankle–brachial index (ABI) measurements were enrolled. PAD was defined if a patient had an ABI of <0.90 or a history of angiographically confirmed PAD. Systolic and diastolic IANDs were calculated as follows: right ankle blood pressure—left ankle blood pressure.ResultsA total of 612 patients were enrolled and followed up for a median 2.6 (interquartile range, 1.0–4.3) years. In the Cox regression analysis, systolic and diastolic IANDs ≥15 mm Hg were independently associated with MACEs in CS patients without PAD (hazard ratio (HR) 2.115, 95% confidence interval (CI) 1.230 to 3.635 and HR 2.523, 95% CI 1.086 to 5.863, respectively). In the subgroup analysis, systolic IAND ≥15 mm Hg was independently associated with MACEs in older patients (age ≥65 years) (HR 2.242, 95% CI 1.170 to 4.298) but not in younger patients (age <65 years).ConclusionsLarge IAND is independently associated with the long-term occurrence of MACEs in patients with CS without PAD. In particular, the association between IAND and MACEs is only valid in elderly patients.
Does the presence of general practitioners in emergency departments affect quality and safety in English NHS hospitals? A retrospective observational study
Authors: Gaughan James , Liu Dan , Gutacker Nils , Bloor Karen , Doran Tim , Benger Jonathan Richard 
Published: February 2022

ObjectivesEmergency departments (EDs) in NHS hospitals in England have faced considerable increases in demand over recent years. Most hospitals have developed general practitioner services in emergency departments (GPEDs) to treat non-emergency patients, aiming to relieve pressure on other staff and to improve ED efficiency and patient experience. We measured the impact of GPED services on patient flows, health outcomes and ED workload.DesignRetrospective observational study. Differences in GPED service availability across EDs and time of day were used to identify the causal effect of GPED, as patients attending the ED at the same hour of the day are quasi-randomly assigned to treatment or control groups based on their local ED’s service availability.ParticipantsAttendances to 40 EDs in English NHS hospitals from April 2018 to March 2019, 4 441 349 observations.Primary and secondary outcomes measuredOutcomes measured were volume of attendances, ‘non-urgent’ attendances, waiting times over 4 hours, patients leaving without being treated, unplanned reattendances within 7 days, inpatient admissions and 30-day mortality.ResultsWe found a small, statistically significant reduction in unplanned reattendances within 7 days (OR 0.968, 95% CI 0.948 to 0.989), equivalent to 302 fewer reattendances per year for the average ED. The clinical impact of this was judged to be negligible. There was no detectable impact on any other outcome measure.ConclusionsWe found no adverse effects on patient outcomes; neither did we find any evidence of the hypothesised benefits of placing GPs in emergency settings beyond a marginal reduction in reattendances that was not considered clinically significant.
Joint associations of fresh fruit intake and physical activity with glycaemic control among adult patients with diabetes: a cross-sectional study
Authors: Wu Jie , Hong Xin , Wang Chenchen , Qi Shengxiang , Ye Qing , Qin Zhenzhen , Zhou Hairong , Li Chao , Wang Weiwei , Zhou Nan 
Published: February 2022

ObjectiveTo investigate the joint associations of fresh fruit intake and physical activity with glycaemic control in adult patients with diabetes mellitus (DM).DesignIt was an observational study involving adult patients with DM through a face-to-face questionnaire survey, physical measurements and laboratory examinations. Data were analysed by introducing a generalised linear mixed model, and a significant difference was set at p<0.05.SettingNanjing, Jiangsu, China.ParticipantsA total of 5663 adult patients with DM from the 2017 Nanjing Chronic Disease and Risk Factor Surveillance were recruited.ResultsBased on the food frequency questionnaire, fresh fruit intake was classified as ‘not eat’, ‘1~99 g/day’ and ‘≥100 g/day’. Physical activity level was calculated based on the data of Global Physical Activity Questionnaire and classified into insufficient physical activity (<600 MET-min/week) and sufficient physical activity (≥600 MET-min/week). The likelihood of glycaemic control in adult patients with DM with fresh fruit intake ≥100 g/day was 37.8% (OR: 1.378; 95% CI: 1.209 to 1.571) higher than those with fresh fruit intake <100 g/day, which was 26% (OR: 1.260; 95% CI: 1.124 to 1.412) higher in adult patients with DM with sufficient physical activity than those with insufficient physical activity. Adult patients with DM with fresh fruit intake ≥100 g/day and sufficient physical activity presented the greatest likelihood of glycaemic control (OR: 1.758; 95% CI: 1.471 to 2.102) compared with those with both fresh fruit intake <100 g/day and insufficient physical activity.ConclusionsFresh fruit intake ≥100 g/day combined with sufficient physical activity is associated with a significantly higher likelihood of glycaemic control in adult patients with DM.
Type 1 interferon status in systemic lupus erythematosus: a longitudinal analysis
Authors: Northcott Melissa , Jones Sarah , Koelmeyer Rachel , Bonin Julie , Vincent Fabien , Kandane-Rathnayake Rangi , Hoi Alberta , Morand Eric 
Published: February 2022

ObjectivesType 1 interferon (IFN) is key to the pathogenesis of SLE, evidenced by the expression of IFN-stimulated genes (ISGs) in most patients, but the clinical utility of serial ISG assessment remains unknown. With the emergence of IFN-blocking drugs, we aimed to examine IFN status in relation to clinical findings longitudinally to provide insights into the value of testing ISG levels over time.MethodsClinical data and whole blood were collected prospectively on adult patients with SLE from a single tertiary lupus centre. IFN status was measured using a panel of ISGs.Findings729 samples were analysed from 205 patients. At baseline, 62.9% of patients were IFN high, 30.2% IFN low and 6.8% borderline. 142 patients had multiple samples collected, and 87.3% of these demonstrated stable ISG status over time. In longitudinal follow-up, IFN high patients had higher activity in multiple organ domains and spent less time in Lupus Low Disease Activity State, but IFN score did not correlate with SLE Disease Activity Index in individual patients. In the small subset of patients who had large fluctuations in ISG across the observation period, most had high-dose glucocorticoids that correlated with ISG suppression. However, low-moderate-dose glucocorticoids did not suppress ISG expression.ConclusionAlthough IFN high status is associated with indicators of more severe SLE, in the majority of patients, ISGs are stable across time and do not correlate with disease activity. Changes in ISG expression may be seen with high-dose, but not routine dose, glucocorticoid exposure. These findings suggest baseline but not serial ISG measurement may be of value in the management of SLE.
The Minimum Principle of SINR: A Useful Discretization Tool for Wireless Communication
Authors: Kantor Erez , Lotker Zvi , Parter Merav , Peleg David 
Published: February 2022

Theoretical study of optimization problems in wireless communication often deals with tasks that concern a single point. For example, the
power control
problem requires computing a power assignment guaranteeing that each transmitting station

s
i

is successfully received at a
single receiver point

r
i

. This paper aims at addressing communication applications that require handling two-dimensional tasks (e.g., guaranteeing successful transmission in entire
regions
rather than at specific points).

The natural approach to two-dimensional optimization tasks is to
discretize
the optimization domain, e.g., by sampling points within the domain. The straightforward implementation of the discretization approach, however, might incur high time and memory requirements, and moreover, it cannot guarantee exact solutions.

The alternative proposed and explored in this paper is based on establishing the
minimum principle

1

for the

signal to interference and noise ratio (SINR)

function with free space path loss (i.e., when the signal decays in proportion to the square of the distance between the transmitter and receiver). Essentially, the minimum principle allows us to reduce the dimension of the optimization domain
without
losing anything in the accuracy or quality of the solution. More specifically, when the two-dimensional optimization domain is bounded and free from any interfering station, the minimum principle implies that it is sufficient to optimize the SINR function over the
boundary
of the domain, as the “hardest” points to be satisfied reside on the boundary and not in the interior.

We then utilize the minimum principle as the basis for an improved discretization technique for solving two-dimensional problems in the SINR model. This approach is shown to be useful for handling optimization problems over two dimensions (e.g., power control, energy minimization); in providing tight bounds on the number of null cells in the reception map; and in approximating geometric and topological properties of the wireless reception map (e.g., maximum inscribed sphere).
The minimum principle, as well as the interplay between continuous and discrete analysis presented in this paper, are expected to pave the way to future study of algorithmic SINR in higher dimensions.
Picking publication targets
Authors: Baquero Carlos 
Published: February 2022

The
Communications
website, http://cacm.acm.org, features more than a dozen bloggers in the BLOG@CACM community. In each issue of
Communications
, we'll publish selected posts or excerpts.

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Follow us on Twitter at http://twitter.com/blogCACM
http://cacm.acm.org/blogs/blog-cacm
Carlos Baquero offers guidance on how to decide where to publish one's paper.
An FPGA-based Approach to Evaluate Thermal and Resource Management Strategies of Many-core Processors
Authors: Mettler Marcel , Rapp Martin , Khdr Heba , Mueller-Gritschneder Daniel , Henkel Jörg , Schlichtmann Ulf 
Published: February 2022

The continuous technology scaling of integrated circuits results in increasingly higher power densities and operating temperatures. Hence, modern many-core processors require sophisticated thermal and resource management strategies to mitigate these undesirable side effects. A simulation-based evaluation of these strategies is limited by the accuracy of the underlying processor model and the simulation speed. Therefore, we present, for the first time, an field-programmable gate array (FPGA)-based evaluation approach to test and compare thermal and resource management strategies using the combination of benchmark generation, FPGA-based application-specific integrated circuit (ASIC) emulation, and run-time monitoring. The proposed benchmark generation method enables an evaluation of run-time management strategies for applications with various run-time characteristics. Furthermore, the ASIC emulation platform features a novel distributed temperature emulator design, whose overhead scales linearly with the number of integrated cores, and a novel dynamic voltage frequency scaling emulator design, which precisely models the timing and energy overhead of voltage and frequency transitions. In our evaluations, we demonstrate the proposed approach for a tiled many-core processor with 80 cores on four Virtex-7 FPGAs. Additionally, we present the suitability of the platform to evaluate state-of-the-art run-time management techniques with a case study.