bluuebunny/crossref_metadata_2025_split huggingface dataset:
HEART rate variability biofeedback for long COVID symptoms (HEARTLOC): protocol for a feasibility study
Authors: Corrado Joanna , Halpin Stephen , Preston Nick , Whiteside Diana , Tarrant Rachel , Davison Jennifer , Simms Alexander D , O'Connor Rory J , Casson Alexander , Sivan Manoj 
Published: November 2022

IntroductionLong COVID (LC), also known as post-COVID-19 syndrome, refers to symptoms persisting 12 weeks after COVID-19 infection. It affects up to one in seven people contracting the illness and causes a wide range of symptoms, including fatigue, breathlessness, palpitations, dizziness, pain and brain fog. Many of these symptoms can be linked to dysautonomia or dysregulation of the autonomic nervous system after SARS-CoV2 infection. This study aims to test the feasibility and estimate the efficacy, of the heart rate variability biofeedback (HRV-B) technique via a standardised slow diaphragmatic breathing programme in individuals with LC.Methods and analysis30 adult LC patients with symptoms of palpitations or dizziness and an abnormal NASA Lean Test will be selected from a specialist Long COVID rehabilitation service. They will undergo a 4-week HRV-B intervention using a Polar chest strap device linked to the Elite HRV phone application while undertaking the breathing exercise technique for two 10 min periods everyday for at least 5 days a week. Quantitative data will be gathered during the study period using: HRV data from the chest strap and wrist-worn Fitbit, the modified COVID-19 Yorkshire Rehabilitation Scale, Composite Autonomic Symptom Score, WHO Disability Assessment Schedule and EQ-5D-5L health-related quality of life measures. Qualitative feedback on user experience and feasibility of using the technology in a home setting will also be gathered. Standard statistical tests for correlation and significant difference will be used to analyse the quantitate data.Ethics and disseminationThe study has received ethical approval from Health Research Authority (HRA) Leicester South Research Ethics Committee (21/EM/0271). Dissemination plans include academic and lay publications.Trial registration numberNCT05228665.
Impact of a reduced nicotine standard on young adult appeal for menthol and non-menthol cigarettes
Authors: Cohn Amy M , Cassidy Rachel , Denlinger-Apte Rachel , Donny Eric , Villanti Andrea C , Hatsukami Dorothy , Dunn Delaney , Wyatt Riley , Niznik Taylor , Cohen-Davidyan Tamar , Smith Michael , Ehlke Sarah J 
Published: November 2022

IntroductionThe Food and Drug Administration (FDA) announced its intention to reduce the nicotine content in cigarettes as a strategy to promote cessation and reduce smoking-related harm. A low nicotine product standard will apply to all cigarettes on the market, including menthol cigarettes. In December 2021, the FDA approved a modified risk tobacco product application for menthol and non-menthol flavoured very low nicotine cigarettes (VLNC) from the 22nd Century Group. Notably, experimentation with menthol cigarettes is linked to smoking progression, as well as greater nicotine dependence relative to non-menthol cigarette use. If menthol VLNCs are perceived as more appealing than non-menthol VLNCs, this would indicate that some aspect of menthol may maintain smoking even in the absence of nicotine and FDA’s regulatory authority to ban or restrict the sale of menthol cigarettes should apply to reduced nicotine content of cigarettes. In April 2022, the FDA announced proposed rulemaking to prohibit menthol cigarettes, however it is unclear if a menthol prohibition would apply to VLNCs.Methods and analysisThis study will recruit 172 young adult menthol smokers (with a specific subsample of n=40 sexual and gender minority young adults) and measure appeal for smoking experimental menthol and non-menthol VLNCs, and the impact of proposed product standards on tobacco product purchasing behaviour using an Experimental Tobacco Marketplace. Appeal across product standards will be assessed in a controlled laboratory and using ecological momentary assessment.Ethics and disseminationThe protocol was approved by the University of Oklahoma Health Sciences Center Institutional Review Board (#11865). Findings will examine the effects of a reduced nicotine standard and a menthol ban on young adult smoking and will be disseminated through peer-reviewed journal articles and presentations at scientific conferences.Trial registration numberNCT04340947.
Success and challenges of health systems resilience-enhancing strategies for managing Public Health Emergencies of International Concerns (PHEIC): A systematic review protocol
Authors: Rajapaksha R M Nayani Umesha , Khatri Resham B , Abeysena Chrishantha , Wijesinghe Millawage Supun Dilara , Endalamaw Aklilu , Thomas Toms K , Perera Nadeeka , Rambukwella Roshan , De Silva Gayani , Fernando Mekala , Alemu Yibeltal Assefa 
Published: November 2022

IntroductionHealth systems resilience is the ability to prepare, manage and learn from a sudden and unpredictable extreme change that impacts health systems. Health systems globally have recently been affected by a number of catastrophic events, including natural disasters and infectious disease epidemics. Understanding health systems resilience has never been more essential until emerging global pandemics. Therefore, the application of resilience-enhancing strategies needs to be assessed to identify the management gaps and give valuable recommendations from the lessons learnt from the global pandemic.MethodsThe systematic review will be reported using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-P) protocols guideline. Reporting data on World Health Organization (WHO) health system building blocks and systematic searches on resilience enhancing strategies for the management of Public Health Emergencies of International Concerns (PHEIC) after the establishment of International Health Regulations (IHR) in 2007 will be included. The search will be conducted in PubMed, Scopus, Web of Science and Google ScholarEthics and disseminationEthics approval and safety considerations are not applicable. Pre-print of the protocol is available online, and the screening of the articles will be done using Rayyan software in a transparent manner. The findings will be presented at conferences and the final review’s findings will be published in a peer-reviewed international journal and will be disseminated to global communities for the application of successful management strategies for the management of future pandemics.PROSPERO registration numberCRD42022352612;https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022352612
An electronic medical record-based intervention to improve hepatitis A vaccination rates in the emergency department during a regional outbreak
Authors: Bukhsh Miriam A. , Thyagarajan Rama , Todd Brett , Chen Nai-Wei , Qu Lihua , Swaminathan Lakshmi 
Published: November 2022

BackgroundIn response to the severe hepatitis A outbreak that occurred in Michigan between August 2016 and September 2019, our multihospital health system implemented an electronic medical record (EMR)-based vaccination intervention across its nine emergency departments (EDs). The objectives were to explore the impact of this intervention on increasing vaccination rates among high-risk individuals and to assess the barriers to use of a computerised vaccine reminder system.MethodsAll patients who were 18 years or older were screened using an electronic nursing questionnaire. If a patient was at high risk based on the questionnaire, an electronic best practice advisory (BPA) would trigger and give the physician or advanced practice provider the option to order the hepatitis A vaccine. We explored the vaccination rates in the 24-month preintervention and the 18-month intervention periods. We then administered a survey to physicians, advanced practice providers and nurses evaluating their perceptions and barriers to use of the EMR intervention.ResultsDuring the preintervention period, 49 vaccines were ordered (5.5 per 100 000 patient visits) and 32 were administered (3.6 per 100 000 patient visits). During the intervention period, 574 865 patient visits (74.3%) were screened. 2494 vaccines (322 per 100 000 patient visits) were ordered, and 1205 vaccines (155 per 100 000 patients visits) were administered. Physicians and advanced practice providers were initially compliant with the BPA’s use, but compliance declined over time. Surveys revealed that the major barrier to use was lack of time.ConclusionsEMR screening tools and BPAs can be used in the ED as an effective strategy to vaccinate high-risk individuals. This may be translatable to outbreaks of other vaccine-preventable illnesses like influenza, measles or SARS-CoV-2. Providing ongoing education about the public health initiative and giving feedback to physicians, advanced practice providers and nurses about tool compliance are needed to sustain the improvement over time.
Emergent themes from a quality improvement programme for CLABSI/CAUTI prevention in ICUs amid the COVID-19 pandemic
Authors: Krauss Daniel M , Molefe Ayrin , Hung Louella , Hayes Kristen , Gorman Claudia , Latterner Michael , Henderson Susan , Miller Melissa 
Published: November 2022

ObjectivesHealthcare-associated infection (HAI) prevention has been difficult for healthcare providers to maintain during the COVID-19 pandemic. This study summarises themes for maintaining infection prevention activities learnt from the implementation of a quality improvement (QI) programme during the pandemic.MethodsWe conducted qualitative analysis of participants’ semistructured exit interviews, self-assessments on HAI prevention activities, participant-created action plans, chat-box discussions during webinars and informal correspondence.SettingIntensive care units (ICUs) with elevated rates of central line-associated bloodstream infections (CLABSI) and/or catheter-associated urinary tract infections (CAUTI) participating in the Agency for Healthcare Research and Quality Safety Programme for ICUs: Preventing CLABSI and CAUTI.ResultsForty-nine ICU teams who participated in the programme between December 2019 and April 2021 found ways to maintain activities such as daily huddles, multidisciplinary rounds, and central line and indwelling urinary catheter monitoring despite barriers, including staff turnover, a lack of time, staff fatigue and pandemic-related guidelines limiting providers’ time around patients. We use four themes to summarise the ICU teams’ adaptations that allowed them to sustain infection prevention activities: (1) Units had CLABSI and CAUTI prevention teams, policies and practices established prior to the pandemic; (2) Units were flexible in their implementation of those policies and practices; (3) Units maintained consistent buy-in for and engagement in HAI prevention activities among both leadership and care teams throughout the pandemic and (4) Units looked to learn from other units in their facility and beyond.ConclusionsFuture shocks such as the pandemic must be anticipated, and the healthcare system must be resilient to the resulting disruptions to HAI prevention activities. This study encountered four themes for successful maintenance of infection prevention activities during the current pandemic: the value of a pre-existing infection prevention infrastructure; a flexibility in approach; broad buy-in for maintaining QI programmes and the facilitation of idea-sharing.
A Thermographic Disease Activity Index for remote assessment of rheumatoid arthritis
Authors: Morales-Ivorra Isabel , Narváez Javier , Gómez-Vaquero Carmen , Moragues Carmen , Nolla Joan M , Narváez José A , Marín-López Manuel Alejandro 
Published: November 2022

ObjectivesRemote assessment of patients with rheumatoid arthritis (RA) has increased during recent years. However, telematic consultations preclude the possibility of carrying out a physical examination and obtaining objective inflammation. In this study, we developed and validated two novel composite disease activity indexes (Thermographic Disease Activity Index (ThermoDAI) and ThermoDAI-CRP) based on thermography of hands and machine learning, in order to assess disease activity easily, rapidly and without formal joint counts.MethodsThermoDAI was developed as the sum of Thermographic Joint Inflammation Score (ThermoJIS), a novel joint inflammation score based on the analysis of thermal images of the hands by machine learning, the Patient Global Assessment (PGA) and, for ThermoDAI-CRP, the C reactive protein (CRP). Construct validity was tested in 146 patients with RA by using Spearman’s correlation with ultrasound-determined grey-scale synovial hypertrophy (GS) and power Doppler (PD) scores, CDAI, SDAI and DAS28-CRP.ResultsCorrelations of ultrasound scores with ThermoDAI (GS=0.52; PD=0.56) and ThermoDAI-CRP (GS=0.58; PD=0.61) were moderate to strong, while the correlations of ultrasound scores with PGA (GS=0.35; PD=0.39) and PGA+CRP (GS=0.44; PD=0.46) were weak to moderate. ThermoDAI and ThermoDAI-CRP also showed strong correlations with Clinical Disease Activity Index (ρ>0.83), Simplified Disease Activity Index (ρ>0.85) and Disease Activity Score with 28-Joint Counts-CRP (ρ>0.81) and high sensitivity for detecting active synovitis using remission criteria.ConclusionsThermoDAI and ThermoDAI-CRP showed stronger correlations with ultrasound-determined synovitis than PGA and PGA + CRP, thus presenting an opportunity to improve remote consultations with patients with RA.
Symptom evolution in the dying
Authors: Heijltjes Madelon T , van Zuylen Lia , van Thiel Ghislaine JMW , van Delden Johannes JM , van der Heide Agnes 
Published: November 2022

ObjectiveProvide insight in the prevalence of symptoms in patients who are in the last days of life.MethodsA retrospective descriptive analysis of data on patients who died between 2012 and 2019 at the age of 18 or older in 1 of 20 Dutch healthcare facilities, including hospitals, inpatient hospices and long-term care facilities. We analysed data from 4 hourly registrations in the Care Programme for the Dying Person, to assess for how many patients symptom-related goals of care were not achieved. We looked at the first 4 hours episode after the start of the Care Programme and the last 4 hours episode prior to death.ResultsWe analysed records of 2786 patients. In the first 4 hours episode, at least one symptom-related care goal was not achieved for 28.5%–42.8% of patients, depending on the care setting. In the last 4 hours episode, these percentages were 17.5%–26.9%. Care goals concerning pain and restlessness were most often not achieved: percentages varied from 7.3% to 20.9% for pain and from 9.3% to 21.9% for restlessness.ConclusionsSymptom control at the end of life is not optimal in a substantial minority of patients. Systematic assessment and attention as well as further research on symptom management are of the essence.
Identifying Good Candidates for Active Surveillance of Ductal CarcinomaIn Situ: Insights from a Large Neoadjuvant Endocrine Therapy Cohort
Authors: Glencer Alexa C. , Miller Phoebe N. , Greenwood Heather , Maldonado Rodas Cristian K. , Freimanis Rita , Basu Amrita , Mukhtar Rita A. , Brabham Case , Kim Paul , Hwang E. Shelley , Rosenbluth Jennifer M. , Hirst Gillian L. , Campbell Michael J. , Borowsky Alexander D. , Esserman Laura J. 
Published: November 2022

Ductal carcinoma in situ (DCIS) is a biologically heterogenous entity with uncertain risk for invasive ductal carcinoma (IDC) development. Standard treatment is surgical resection often followed by radiation. New approaches are needed to reduce overtreatment. This was an observational study that enrolled patients with DCIS who chose not to pursue surgical resection from 2002 to 2019 at a single academic medical center. All patients underwent breast MRI exams at 3- to 6-month intervals. Patients with hormone receptor–positive disease received endocrine therapy. Surgical resection was strongly recommended if clinical or radiographic evidence of disease progression developed. A recursive partitioning (R-PART) algorithm incorporating breast MRI features and endocrine responsiveness was used retrospectively to stratify risk of IDC. A total of 71 patients were enrolled, 2 with bilateral DCIS (73 lesions). A total of 34 (46.6%) were premenopausal, 68 (93.2%) were hormone-receptor positive, and 60 (82.1%) were intermediate- or high-grade lesions. Mean follow-up time was 8.5 years. Over half (52.1%) remained on active surveillance without evidence of IDC with mean duration of 7.4 years. Twenty patients developed IDC, of which 6 were HER2 positive. DCIS and subsequent IDC had highly concordant tumor biology. Risk of IDC was characterized by MRI features after 6 months of endocrine therapy exposure; low-, intermediate-, and high-risk groups were identified with respective IDC rates of 8.7%, 20.0%, and 68.2%. Thus, active surveillance consisting of neoadjuvant endocrine therapy and serial breast MRI may be an effective tool to risk-stratify patients with DCIS and optimally select medical or surgical management.Significance:A retrospective analysis of 71 patients with DCIS who did not undergo upfront surgery demonstrated that breast MRI features after short-term exposure to endocrine therapy identify those at high (68.2%), intermediate (20.0%), and low risk (8.7%) of IDC. With 7.4 years mean follow-up, 52.1% of patients remain on active surveillance. A period of active surveillance offers the opportunity to risk-stratify DCIS lesions and guide decisions for operative management.
La maternidad subrogada: retos para el derecho en un mundo globalizado
Authors: Ricaurte Carlos Jesús Molina 
Published: November 2022

Hay información que los primeros estudios y los primeros nacimientos de niños concebidos mediante fecundación in vitro tuvieron lugar en el último cuarto del siglo XX, pero el primer caso de litigio relacionado con maternidad subrogada (Johnson v. Calvert) se registra a comienzos de los 90 en EE.UU., ante la Corte Suprema de California, esto quiere decir, que la práctica de la maternidad subrogada es relativamente reciente. Los primeros desarrollos jurídicos conocidos son en jurisprudencia; la regulación sobre la materia ha sido posterior. El problema de investigación gira en torno a la pregunta ¿Cuáles son los alcances y límites del Derecho en relación con la maternidad subrogada? Para responderla, se determinan los alcances y límites de intervención del Derecho en relación con la maternidad subrogada en un mundo globalizado. La investigación es teórica con enfoque cualitativo. El método adoptado es el si stémico-estructural-funcional. Aunque comienza haciendo una descripción y comparación entre ordenamientos jurídicos de tres países: Colombia, EE.UU. y España, identifica los elementos esenciales de la maternidad subrogada y termina explicando cómo estos elementos interactúan en el derecho y cómo el derecho interactúa con la ética y la política en el contexto de la maternidad subrogada hoy en día.
Contributions to Dynamic Analysis of Differential Evolution Algorithms
Authors: Resende Lucas , Takahashi Ricardo H. C. 
Published: November 2022

Abstract
The Differential Evolution (DE) algorithm is one of the most successful evolutionary computation techniques. However, its structure is not trivially translatable in terms of mathematical transformations that describe its population dynamics. In this work, analytical expressions are developed for the probability of enhancement of individuals after each application of a mutation operator followed by a crossover operation, assuming a population distributed radially around the optimum for the sphere objective function, considering the DE/rand/1/bin and the DE/rand/1/exp algorithm versions. These expressions are validated by numerical experiments. Considering quadratic functions given by f(x)=xTDTDx and populations distributed according to the linear transformation D-1 of a radially distributed population, it is also shown that the expressions still hold in the cases when f(x) is separable (D is diagonal) and when D is any nonsingular matrix and the crossover rate is Cr=1.0. The expressions are employed for the analysis of DE population dynamics. The analysis is extended to more complex situations, reaching rather precise predictions of the effect of problem dimension and of the choice of algorithm parameters.
Neoplatonic Political Subjectivity?
Authors: Riggs Tim 
Published: November 2022

Abstract
I argue that in his commentary on Epictetus’ Encheiridion, Simplicius derives a method by which his students can enter into the process of self-constitution, which is only achieved through completion of the study of Plato’s dialogues. The result of following the method is the attainment of a perspective consonant with the level of political virtue, which I call ‘political subjectivity’. This is a speculative interpretation of the effect the student would. experience in following the method, accomplished through analyses of Simplicius’ interpretation of Epictetus’ concept of to eph’ hēmīn and the related prohairesis. I complement this with an analysis of the metaphysical foundation Simplicius gives the method in light of Charles Taylor’s notion of ‘strong evaluation’. In this way, I show how Simplicius adapts these concepts to his Neoplatonic psychology and virtue theory to make the method serve as preparation for the development of virtue prior to study of Plato.
State Violence against Mapuche Women in Chile, 1998–2018
Authors: Hiner Hillary , González Karina 
Published: November 2022

Mapuche women both suffer and resist state violence in Chile, particularly with regard to neoliberal, multinational extractive projects in the southern regions and the militarized police that protect these projects. While there is a great deal of historical scholarship on topics related to women or the Mapuche people from 1990 on, there is relatively little specifically on the struggles of Mapuche women. Additionally, the majority of texts on state terrorism and women in Chile focus on the Pinochet dictatorship and non-Mapuche women. A study from the perspective of decolonial feminism reveals the persistence of the “coloniality of gender” while critically reflecting on the tensions between Mapuche women and the Chilean feminist movement. Las mujeres mapuches sufren y resisten violencia estatal en Chile, particularmente en lo relacionado a los proyectos extractivos neoliberales y multinacionales en las regiones del sur y la concomitante presencia de la policía militarizada que protege dichos proyectos. Si bien y desde 1990 ha habido una gran cantidad de investigación histórica sobre temas relacionados con las mujeres, por un lado, y el pueblo mapuche por otro, hay relativamente poca literatura en torno a las luchas de las mujeres mapuche. Lo que es más, la mayor parte de los textos sobre terrorismo de Estado y mujeres en Chile se centra en la dictadura de Pinochet y mujeres que no son mapuche. Un estudio abordado desde una perspectiva de feminismo descolonial nos revela la persistencia de la “colonialidad de género”, al mismo tiempo que reflexiona, de manera crítica, sobre las tensiones entre las mujeres mapuche y el movimiento feminista chileno.