bluuebunny/crossref_metadata_2025_split huggingface dataset:
Artificial intelligence-enabled retinal vasculometry for prediction of circulatory mortality, myocardial infarction and stroke
Authors: Rudnicka Alicja Regina , Welikala Roshan , Barman Sarah , Foster Paul J , Luben Robert , Hayat Shabina , Khaw Kay-Tee , Whincup Peter , Strachan David , Owen Christopher G 
Published: October 2022

AimsWe examine whether inclusion of artificial intelligence (AI)-enabled retinal vasculometry (RV) improves existing risk algorithms for incident stroke, myocardial infarction (MI) and circulatory mortality.MethodsAI-enabled retinal vessel image analysis processed images from 88 052 UK Biobank (UKB) participants (aged 40–69 years at image capture) and 7411 European Prospective Investigation into Cancer (EPIC)-Norfolk participants (aged 48–92). Retinal arteriolar and venular width, tortuosity and area were extracted. Prediction models were developed in UKB using multivariable Cox proportional hazards regression for circulatory mortality, incident stroke and MI, and externally validated in EPIC-Norfolk. Model performance was assessed using optimism adjusted calibration, C-statistics and R2statistics. Performance of Framingham risk scores (FRS) for incident stroke and incident MI, with addition of RV to FRS, were compared with a simpler model based on RV, age, smoking status and medical history (antihypertensive/cholesterol lowering medication, diabetes, prevalent stroke/MI).ResultsUKB prognostic models were developed on 65 144 participants (mean age 56.8; median follow-up 7.7 years) and validated in 5862 EPIC-Norfolk participants (67.6, 9.1 years, respectively). Prediction models for circulatory mortality in men and women had optimism adjusted C-statistics and R2statistics between 0.75–0.77 and 0.33–0.44, respectively. For incident stroke and MI, addition of RV to FRS did not improve model performance in either cohort. However, the simpler RV model performed equally or better than FRS.ConclusionRV offers an alternative predictive biomarker to traditional risk-scores for vascular health, without the need for blood sampling or blood pressure measurement. Further work is needed to examine RV in population screening to triage individuals at high-risk.
Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis
Authors: Resch Stephen Charles , Suarez Sebastian , Omotayo Moshood Olanrewaju , Griffin Jennifer , Sessler Daniel , Burke Thomas 
Published: October 2022

ObjectivesLack of anaesthesia services is a frequent barrier to emergency surgeries such as caesarean delivery in Kenya. This study aimed to estimate the survival gains and cost-effectiveness of scaling up the Every Second Matters (ESM)-Ketamine programme that trains non-anaesthetist providers to administer and monitor ketamine during emergency caesarean deliveries.SettingHospitals in Kenyan counties with low rates of caesarean delivery.ParticipantsPatients needing emergency caesarean delivery in settings without availability of standard anaesthesia service.InterventionsSimulated scales up of the ESM-Ketamine programme over 5 years (2020–24) was compared with status quo.Outcome measuresCost of implementing the programme and corresponding additional emergency caesarean deliveries. Maternal and fetal/neonatal deaths prevented, and corresponding life-years gained due to increased provision of emergency caesarean procedures. Cost-effectiveness was assessed by comparing the cost per life-year gained of the ESM-Ketamine programme compared with status quo.ResultsOver 5 years, the expected gap in emergency caesarean deliveries was 157 000. A US$1.2 million ESM-Ketamine programme reduced this gap by 28 700, averting by 316 maternal and 4736 fetal deaths and generating 331 000 total life-years gained. Cost-effectiveness of scaling up the ESM-Ketamine programme was US$44 per life-year gained in the base case and US$251 in the most pessimistic scenario—a very good value for Kenya at less than 20% of per capita GDP per life-year gained.ConclusionIn areas of Kenya with significant underprovision of emergency caesarean delivery due to a lack of availability of traditional anaesthesia, an ESM-Ketamine programme is likely to enable a substantial number of life-saving surgeries at reasonable cost.
Effectiveness and feasibility of telerehabilitation in patients with COVID-19: a systematic review and meta-analysis
Authors: Seid Abubeker Alebachew , Aychiluhm Setognal Birara , Mohammed Ahmed Adem 
Published: October 2022

ObjectivesTo determine the pooled effectiveness and feasibility of telerehabilitation in patients with COVID-19.DesignSystematic review and meta-analysis of randomised controlled trials (RCTs).Data sourcesPubMed, CINAHL, Science Direct, PEDro, Google Scholar and Cochrane Library databases were systematically searched to the end of March 2022.Eligibility criteria and outcomesRCTs investigating the effects of telerehabilitation in the management of patients with COVID-19 were included. The outcomes of interest were functional capacity, cardiopulmonary exercise tests, quality of life and other variables where data are available.Data extraction and synthesisTwo reviewers screened, extracted data and performed methodological quality assessment independently. The revised Cochrane Risk of Bias tool was used to assess the risk of bias. Review Manager V.5.4 and Stata V.14.0 software were used for statistical analysis. Mean difference (MD) with 95% CI and the corresponding p value were used to determine the treatment effect between groups. A fixed-effect model was used for all variables as no significant heterogeneity was observed.ResultsFour studies with 334 patients with COVID-19 were included. The pooled result of telerehabilitation showed statistically significant improvement on 6-minute walking test (MD 75.50; 95% CI 54.69 to 96.30; p=0.48), 30-second sit-to-stand test (MD 1.76; 95% CI 1.47 to 2.04; p=0.30), Borg Scale (MD 2.49; 95% CI 2.16 to 2.83; p=0.28) and level of dyspnoea (MD 6.26; 95% CI 5.42 to 7.10; p=0.66). The overall treatment completion rate was 88.46%, and the most common reason for withdrawal after randomisation was lost to follow-up or uncooperativeness.ConclusionsThe findings showed that telerehabilitation interventions could improve functional capacity and exercise perception among patients affected by COVID-19 and can be implemented with a high completion rate and minimal adverse events. However, more studies are required to investigate the effects on cardiopulmonary function, quality of life, anxiety, depression and other variables.PROSPERO registration numberCRD42021287975.
Development and validation of a prediction rule for patients suspected of acute coronary syndrome in primary care: a cross-sectional study
Authors: Wouters Loes T C M , Zwart Dorien L M , Erkelens Daphne C A , Adriaansen Elisabeth J M , den Ruijter Hester M , De Groot Esther , Damoiseaux Roger A M J , Hoes Arno W , van Smeden Maarten , Rutten Frans H 
Published: October 2022

ObjectiveTo develop and validate a symptom-based prediction rule for early recognition of acute coronary syndrome (ACS) in patients with acute chest discomfort who call out-of-hours services for primary care (OHS-PC).DesignCross-sectional study. A diagnostic prediction rule was developed with multivariable regression analyses. All models were validated with internal-external cross validation within seven OHS-PC locations. Both age and sex were analysed as statistical interaction terms, applying for age non-linear effects.SettingSeven OHS-PC in the Netherlands.Participants2192 patients who called OHS-PC for acute chest discomfort (pain, pressure, tightness or discomfort) between 2014 and 2017. Backed up recordings of telephone triage conversations were analysed.Primary and secondary outcomes measuresDiagnosis of ACS retrieved from the patient’s medical records in general practice, including hospital specialists discharge letters. Performance of the prediction rules was calculated with the c-statistic and the final model was chosen based on net benefit analyses.ResultsAmong the 2192 patients who called the OHS-PC with acute chest discomfort, 8.3% females and 15.3% males had an ACS. The final diagnostic model included seven predictors (sex, age, acute onset of chest pain lasting less than 12 hours, a pressing/heavy character of the pain, radiation of the pain, sweating and calling at night). It had an adjusted c-statistic of 0.77 (95% CI 0.74 to 0.79) with good calibration.ConclusionThe final prediction model for ACS has good discrimination and calibration and shows promise for replacing the existing telephone triage rules for patients with acute chest discomfort in general practice and OHS-PC.Trial registration numberNTR7331.
Recontacting biobank participants to collect lifestyle, behavioural and cognitive information via online questionnaires: lessons from a pilot study within FinnGen
Authors: Rodosthenous Rodosthenis S , Niemi Mari E K , Kallio Lila , Perala Merja , Terho Perttu , Knopp Theresa , Punkka Eero , Makkonen Enni M , Nurmi Paula , Makela Johanna , Wihuri Pauli , Hautalahti Marco , Moffatt Corianna , Martini Paolo , Germine Laura , Makela Viola A , Karhunen Oona A , Lahti Jari , Hiekkalinna Tero S , Jyrhama Tero , Shen Huei-yi , Runz Heiko , Palotie Aarno , Perola Markus , Ganna Andrea 
Published: October 2022

ObjectivesTo recontact biobank participants and collect cognitive, behavioural and lifestyle information via a secure online platform.DesignBiobank-based recontacting pilot study.SettingThree Finnish biobanks (Helsinki, Auria, Tampere) recruiting participants from February 2021 to July 2021.ParticipantsAll eligible invitees were enrolled in FinnGen by their biobanks (Helsinki, Auria, Tampere), had available genetic data and were >18 years old. Individuals with severe neuropsychiatric disease or cognitive or physical disabilities were excluded. Lastly, 5995 participants were selected based on their polygenic score for cognitive abilities and invited to the study. Among invitees, 1115 had successfully participated and completed the study questionnaire(s).Outcome measuresThe primary outcome was the participation rate among study invitees. Secondary outcomes included questionnaire completion rate, quality of data collected and comparison of participation rate boosting strategies.ResultsThe overall participation rate was 18.6% among all invitees and 23.1% among individuals aged 18–69. A second reminder letter yielded an additional 9.7% participation rate in those who did not respond to the first invitation. Recontacting participants via an online healthcare portal yielded lower participation than recontacting via physical letter. The completion rate of the questionnaire and cognitive tests was high (92% and 85%, respectively), and measurements were overall reliable among participants. For example, the correlation (r) between self-reported body mass index and that collected by the biobanks was 0.92.ConclusionIn summary, this pilot suggests that recontacting FinnGen participants with the goal to collect a wide range of cognitive, behavioural and lifestyle information without additional engagement results in a low participation rate, but with reliable data. We suggest that such information be collected at enrolment, if possible, rather than via post hoc recontacting.
What influences cancer treatment service access in Ghana? A critical interpretive synthesis
Authors: Tuck Chloe Zabrina , Akparibo Robert , Gray Laura A , Aryeetey Richmond Nii Okai , Cooper Richard 
Published: October 2022

ObjectivesMultiple social-cultural and contextual factors influence access to and acceptance of cancer treatment in Ghana. The aim of this research was to assess existing literature on how these factors interplay and could be susceptible to local and national policy changes.DesignThis study uses a critical interpretive synthesis approach to review qualitative and quantitative evidence about access to adult cancer treatment services in Ghana, applying the socioecological model and candidacy framework.ResultsOur findings highlighted barriers to accessing cancer services within each level of the socioecological model (intrapersonal, interpersonal community, organisational and policy levels), which are dynamic and interacting, for example, community level factors influenced individual perceptions and how they managed financial barriers. Evidence was lacking in relation to determinants of treatment non-acceptance across all cancers and in the most vulnerable societal groups due to methodological limitations.ConclusionsFuture policy should prioritise multilevel approaches, for example, improving the quality and affordability of medical care while also providing collaboration with traditional and complementary care systems to refer patients. Research should seek to overcome methodological limitations to understand the determinants of accessing treatment in the most vulnerable populations.
Using virtual wards and long-term conditions management network to improve practice and performance
Authors: Kanyimo Ezra 
Published: October 2022

England has more than 15 million people and counting with long-term conditions who have the greatest healthcare needs of the population accounting for 50% of all General Practitioner (GP) appointments and 70% of all bed days. Digital technology has the potential to transform care through empowering patients, establishing more robust therapeutic relationships as well as supporting stronger teamworking across boundaries and enabling creation of communities and networks to support patients.There is some hesitancy in National Health Service to adopt digital innovation, but the pandemic has transformed use of remote monitoring in a matter of weeks. The pandemic has highlighted how collaboration and digital technology innovation can radically transform health and care services at pace when people are provided with the space and support to be innovative. Nurse and clinical leaders with digital knowledge are key in engaging nurses who need to be at the heart of technological developments and implementation to make sure changes facilitate, enhance patient care and improve clinical practice. This project aimed to create a forum that offered time, space and opportunities to innovate; share learning; and develop cross boundary relationships for project teams implementing technology-enabled remote monitoring or virtual ward solutions.Florence Nightingale Foundation scholar and NHSX Digital Health team ran the forum using community of practice principles. Qualitative data were used to measure any potential value created. Forum members reported increase in their personal knowledge as they managed to learn from others. An online platform created as an extension to the forum enabled members to continue networking and access resources. The forum provided space for relationships to get stronger. This enabled innovation that changed practice and performance around increased uptake of tech-enabled remote monitoring solutions by patients as well as indirect health outcomes. Further work is required to collate quantitative data to confirm these claims from the forum members.
Evaluation of implementation and effects of a health-promoting sports club intervention using a mixed-method design: PROSCeSS protocol
Authors: Tezier Benjamin , Guillemin Francis , Vuillemin Anne , Johnson Stacey , Lemonnier Fabienne , Rostan Florence , Van Hoye Aurélie 
Published: October 2022

Public authorities and academics have advocated for applying been advocating for the application of the setting-based approach to sports clubs. However, studies have shown that existing health promotion (HP) interventions in sports clubs poorly understand and apply this approach. Moreover, methods used to evaluate these interventions do not inform their implementation process, limiting the generation effectiveness’ proofs. This study aims at evaluating the implementation process and effectiveness of an HP intervention in sports clubs (PROmotion de la Santé dans les ClubS de Spor; PROSCeSS), based on the health-promoting sports club (HPSC) model.A type 3 hybrid design, using a multiphase mixed-method: QUAN→QUAL→ QUAN+QUAL (qual)→QUAL (quan+qual), will be used. Phase A will be a pre–post–quantitative study with one HP officer, five managers and five coaches from 30 sports clubs exploring the effects of the PROSCeSS intervention on HP perceptions and health literacy. Phase B will be focus groups with participants from HP initiatives that the 30 sports clubs will have previously put in place to detect changes in health. Phase C will explain the results of phases A and B by choice of strategies and adherence to standardised steps, measured through semistructured interviews and implementation data collection. Phase D will cross-reference the semistructured interviews, the sports club characteristics questionnaire and the implementation data collection to study the relationships between the context and the implementation process. This protocol will identify ‘what works’, ‘for whom’, in ‘what context’ in terms of HPSC and clarify which intervention components are more effective at improving HP. This evaluation design will help to develop appropriate approaches to evaluate HP interventions.
Inclusion of women into ground close combat roles: an organisational change perspective
Authors: Harvey Joanna 
Published: October 2022

IntroductionWomen have formally been excluded from ground close combat (GCC) roles in the UK military until 2018. The opening of the final roles to all genders has been the result of a steady process and progression, gathering pace since the early 1990s. This paper considers the integration of women into GCC roles against a number of influential organisational change management theories.MethodA series of 12 focus groups were conducted in April 2018 with personnel from 4 infantry units, including attached women, to understand the key issues and attitudes surrounding women joining the infantry. A total of 123 personnel took part in the focus groups.ResultsThemes from the focus groups were broken down by dominant groupings as per the discussions. Male personnel were largely concerned with physical and medical issues, infrastructure, potential dual standards and social cohesion. Attached females main concerns were regarding physical and medical issues, team dynamics, potential bias and the need to prove themselves as combat soldiers. Positives were identified by all male and female focus groups, including the benefits of increased diversity, more opportunities and equality for women, improvement of Army fitness levels and an increase in numbers.ConclusionsThese findings helped to inform the Army approach to the integration of women into combat roles. The opportunity to discuss the change in policy was seen as positive by attendees, providing a 'safe space' to air any concerns and was important for the organisation to understand and mitigate any potential barriers.
Do It Yourself, Rain! Dabbling Drops, Splashes, and Waves: Experiments in Art and Science
Authors: Närhinen Tuula 
Published: October 2022

Abstract
The author’s visual practice draws from the natural sciences. Playful installations create “portraits” of naturally occurring phenomena. The artworks invite the viewer to witness the spontaneous emergence of patterns and traces induced by water. Facilitated by the artist, the drops and splashes are allowed to manifest in autographic renderings, generated by exposing sensitized substrates to rainfall or to waves. The article describes the empiric scientific method, followed by a discussion of the information the visual inscriptions contain. Drawing analogies between the experimental approaches of art and science, the article considers the impact of images in shaping the world we inhabit.
Symbiosis, Anarchy, and Fermentation
Authors: Katran Sergey 
Published: October 2022

Abstract
In this article, artist Sergey Katran reflects on practice-based interaction with live nonhuman agents. A kombucha, cultivated at home, gradually assumes anthropic qualities and, promoted by the artist, even starts participating in exhibitions and roundtable discussions. This can be viewed as the first step in establishing and developing ideas of biocentrism within an artistic community. The author also views this case as precedent for the participation of other biological species (and nonhuman agents) in exhibitions normally intended for humans. As the cultivating of kombucha normally involves double fermentation, the artist then proceeds contemplating on the process and its possible outcomes. Fermentation, which brings about rapid change in the environment with subsequent synthesis of various substances, while yeast fungi and bacteria continue producing necessary ferments, is metaphorically linked to major changes in art and society.
Urbanization-Induced Increases in Heavy Precipitation are Magnified by Moist Heatwaves in an Urban Agglomeration of East China
Authors: Li Chenxi , Gu Xihui , Slater Louise J. , Liu Jianyu , Li Jianfeng , Zhang Xiang , Kong Dongdong 
Published: October 2022

Abstract
Heavy precipitation (HP) events can be preceded by moist heatwaves (HWs; i.e., hot and humid weather), and both can be intensified by urbanization. However, the effect of moist HWs on increasing urban HP remains unknown. Based on statistical analyses of daily weather observations and ERA5 reanalysis data, we herein investigate the effect of moist HWs on urban-intensified HP by dividing summer HP events into NoHW- and HW-preceded events in the Yangtze River delta (YRD) urban agglomeration of China. During the period 1961–2019, the YRD has experienced more frequent, longer-lasting, and stronger intense HP events in the summer season (i.e., June–August), and urbanization has contributed to these increases (by 22.66%–37.50%). In contrast, urban effects on HP are almost absent if we remove HW-preceded HP events from all HP events. Our results show that urbanization-induced increases in HP are associated with, and magnified by, moist HWs in urban areas of the YRD region. Moist HWs are conducive to an unstable atmosphere and stormy weather, and they also enhance urban heat island intensity, driving increases in HP over urban areas.

Significance Statement
The contribution of urbanization to increases in heavy precipitation has been widely reported in previous studies. HP events can be preceded by moist heatwaves (hot and humid extremes); however, it is unknown whether moist HWs enhance urban effects on HP. We choose the Yangtze River delta urban agglomeration to explore this question and find that urbanization contributes to the increasing frequency, duration, maximum intensity, and cumulative intensity of HP events in the summer season. However, this urban signal is not detectable if we remove HW-preceded events from all HP events. In other words, moist HWs play a key role in magnifying urbanization-induced increases in HP. Given that urban areas are projected to continue expanding and moist HWs are projected to occur with increasing frequency and intensity in the future, the role of HWs in the urban water cycle merits further investigation.