bluuebunny/crossref_metadata_2025 huggingface dataset:
Police visibility, trust in police fairness, and collective efficacy: A multilevel Structural Equation Model
Authors: Yesberg Julia , Brunton-Smith Ian , Bradford Ben
Published: July 2021

Areas high in collective efficacy – where residents know and trust one another and are willing to intervene to solve neighbourhood problems – tend to experience less crime. Policing is thought to be one antecedent to collective efficacy, but little empirical research has explored this question. Using three waves of survey data collected from London residents over three consecutive years, and multilevel Structural Equation Modelling, this study tested the impact of police visibility and police–community engagement on collective efficacy. We explored direct effects as well as indirect effects through trust in police. The findings showed levels of police visibility predicted trust in police. Trust in police fairness, in turn, predicted collective efficacy. There was a small indirect relationship between police visibility and collective efficacy, through trust in police fairness. In other words, police presence in neighbourhoods was associated with more positive views about officer behaviour, which in turn was associated with collective efficacy. The findings have important implications for policies designed to build stronger, more resilient communities.
The problem of educational theory
Authors: Siegel Stefan T , Biesta Gert
Published: July 2021

This interview sheds light on current developments threatening the disciplinary ‘heart’ of education. Taking a starting point in the continental ‘configuration’ of the field, Gert Biesta and Stefan T Siegel argue that there are forms of theory considered distinctively educational. Based on this premise, they discuss why defining educational theories ( Erziehungswissenschaftliche Theorien) is so challenging, and why it is nevertheless a rewarding endeavour. By distinguishing between (genuinely) educational theories in a narrow sense and (educationally relevant) theories in a wider sense, Biesta and Siegel attempt to tackle the problem of educational theory and to stimulate the discourse on theorizing education.
Interview as Social Practice: How Can Nexus Analysis Enhance Reflexivity?
Authors: Dordah Amos Dangbie , Horsbøl Anders
Published: July 2021

This article suggests that the understanding of an interview as a social practice can be enhanced by the notion of social action mediated by language and material tools as proposed in nexus analysis methodology. Interviews can be viewed either as a source of gathering information or social practice. The latter approach advocates for a greater sense of reflexivity about the interview situation. This article suggests that nexus analysis methodology can help concretize the greater reflexivity about interactional resources of an interview in different ways. One such way is to explore how parties in an interview interaction use material places to bring out discourses that may otherwise not have been triggered if conventional qualitative interview approaches were used. This is illustrated with interviews about the impact of gold mining on human well-being in the Ahafo Region of Ghana, carried out on a gold mining site. This article concludes that paying attention to the interview site has an unrealized potential to strengthen the reflexivity about the interview situation.
“Tell Me Something Good”: Testing the Longitudinal Effects of Constructive News Using the Google Assistant
Authors: McIntyre Karen
Published: July 2021

Americans say that reading, watching, or listening to the news is one of their leading causes of stress. And indeed, research has shown that negative news can negatively impact people’s attitudes, behaviors, and mental health. To combat the unwelcome effects of negative news, some have suggested that reporters practice more constructive or solution-oriented journalism by reporting stories that highlight societal progress. Drawing on cognitive appraisal theory and the broaden-and-build theory of positive emotions, this study tested the impact of constructive news. In a mixed-design quasi-experiment, participants received access to a Google Assistant feature in which they could prompt the assistant to summarize a constructive news story. After 2 weeks, those who used the feature were more likely, between pretest and posttest, than those who did not to feel positive while consuming traditional news, suggesting constructive news could mitigate the effects of more typical, negative news.
Efficient Closed Loop Simulation of Do-It-Yourself Artificial Pancreas Systems
Authors: Schmitzer Jana , Strobel Carolin , Blechschmidt Ronald , Tappe Adrian , Peuscher Heiko
Published: July 2021

Background:

Numerical simulations, also referred to as in silico trials, are nowadays the first step toward approval of new artificial pancreas (AP) systems. One suitable tool to run such simulations is the UVA/Padova Type 1 Diabetes Metabolic Simulator (T1DMS). It was used by Toffanin et al. to provide data about safety and efficacy of AndroidAPS, one of the most wide-spread do-it-yourself AP systems. However, the setup suffered from slow simulation speed. The objective of this work is to speed up simulation by implementing the algorithm directly in MATLAB®/Simulink®.

Method:

Firstly, AndroidAPS is re-implemented in MATLAB® and verified. Then, the function is incorporated into T1DMS. To evaluate the new setup, a scenario covering 2 days in real time is run for 30 virtual patients. The results are compared to those presented in the literature.

Results:

Unit tests and integration tests proved the equivalence of the new implementation and the original AndroidAPS code. Simulation of the scenario required approximately 15 minutes, corresponding to a speed-up factor of roughly 1000 with respect to real time. The results closely resemble those presented by Toffanin et al. Discrepancies were to be expected because a different virtual population was considered. Also, some parameters could not be extracted from and harmonized with the original setup.

Conclusions:

The new implementation facilitates extensive in silico trials of AndroidAPS due to the significant reduction of runtime. This provides a cheap and fast means to test new versions of the algorithm before they are shared with the community.
Development of a nomogram for predicting treatment default under facility-based directly observed therapy short-course in a region with a high tuberculosis burden
Authors: Wang Saibin
Published: July 2021

Background:

Poor adherence to tuberculosis (TB) treatment is a substantial barrier to global TB control. The aim of this study was to construct a nomogram for predicting the probability of TB treatment default.

Methods:

A total of 1185 TB patients who had received treatment between 2010 and 2011 in Peru were analyzed in this study. Patient demographics, social, and medical information were recorded. Predictors were selected by least absolute shrinkage and selection operator (LASSO) regression analysis, and a nomogram for predicting TB treatment default was constructed by using multivariable logistic regression analysis. Bootstrapping method was applied for internal validation. Calibration and clinical utility of the nomogram was also evaluated.

Results:

The incidence of TB treatment default among the study patients was 11.6% (138/1185). Six predictors (secondary education status, alcohol use, illegal drug use, body mass index, multidrug-resistant tuberculosis, and human immunodeficiency virus serostatus) were selected through the LASSO regression analysis. A nomogram was developed based on the six predictors and it yielded an area under the curve (AUC) value of 0.797 [95% confidence interval (CI), 0.755–0.839]. In the internal validation, the AUC achieved 0.805 (95% CI, 0.759–0.844). Additionally, the nomogram was well-calibrated, and it showed clinical utility in decision curve analysis.

Conclusion:

A nomogram was constructed that incorporates six characteristics of the TB patients, which provides a good reference for predicting TB treatment default.
A single-dose nitrate-producing dietary supplement affects cardiorespiratory endurance and muscular fitness in healthy men: A randomized controlled pilot trial
Authors: Todorovic Nikola , Stajer Valdemar , Ratgeber Laszlo , Betlehem Jozsef , Acs Pongrac , Maksimovic Nebojsa , Ostojic Sergej M
Published: July 2021

Introduction:

The main aim of this pilot study was to examine the effects of a single-dose intervention with a novel nitrate-producing formulation (MagNOVOx™) on biomarkers of cardiorespiratory endurance and muscular fitness in 12 healthy men.

Methods:

The study participants (age = 22.7 ± 2.8 years, height = 184.1 ± 5.7 cm, and weight = 82.5 ± 8.4 kg) were randomly allocated to receive either a single dose of MagNOVOx™ or a placebo (inulin) in a cross-over design. The primary outcome for this study was the change in running time to exhaustion evaluated at baseline (before supplementation) and post-intervention.

Results:

Time to exhaustion was improved after the intervention in 8 out of 11 participants (72.7%) who received MagNOVOx™, and in 1 out of 11 participants (9.1%) who received placebo ( p = 0.004), and MagNOVOx™ outcompeted placebo in terms of improving leg press performance ( p < 0.01). No significant differences between MagNOVOx™ and placebo were found for blood pressure responses ( p > 0.05).

Conclusion:

These promising findings should be further corroborated in medium- and long-term trials, and different populations, while the exact mechanism of MagNOVOx™ requires additional physiological studies.
Long-term evaluation of pain reduction after vertebroplasty and kyphoplasty
Authors: Hackbarth Christoph B , Vogl Thomas J , Naguib Nagy , Albrecht Moritz H , von Knebel-Doeberitz Philipp L
Published: July 2021

Background

Various studies have been made about the most effective and safest type of treatment for vertebral compression fractures (VCFs). Long-term results are needed for qualitative evaluation.

Purpose

The purpose of the study is to evaluate the effectiveness of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) procedures for VCFs.

Materials and Methods

Forty-nine patients who received either PVP or PKP between 2002 and 2015 returned a specially developed questionnaire and were included in a cross-sectional outcome analysis. The questionnaire assessed pain development by use of a visual analog scale (VAS). Imaging data (CT scans) were retrospectively analyzed for identification of cement leakage.

Results

Patients’ VAS scores significantly decreased after treatment (7.0 ± 3.4 => 3.7 ± 3.4), ( p < 0.001). The average pain reduction in patients treated with PVP was −3.3 ± 3.8 ( p < 0.001) (median −3.5) and −4.0 ± 3.9 ( p < 0.001) (median −4.5) in patients treated with PKP. Fifteen Patients (41.7%) receiving PVP and four patients (30.7%) receiving PKP experienced recurrence of pain. Cement leakage occurred in 10 patients (22.73%). Patients with cement leakage showed comparable VAS scores after treatment (6.8 ± 3.5 => 1.4 ± 1.6), ( p = 0.008). Thirty-nine patients reported an increase in mobility (79.6%) and 41 patients an improvement in quality of life (83.7%).

Conclusion

Pain reduction by means of PVP or PKP in patients with VCFs was discernible over the period of observation. Percutaneous vertebroplasty and PKP contribute to the desired treatment results. However, the level of low pain may not remain constant.
Papillary craniopharyngioma coexisting with an intratumoral abscess in a pediatric patient: A case report and review of the literature
Authors: Takagi Katsuhiro , Kikuchi Kazufumi , Hiwatashi Akio , Togao Osamu , Sangatsuda Yuhei , Kuga Daisuke , Mizoguchi Masahiro , Yamamoto Hidetaka , Iwaki Toru , Ishigami Kousei
Published: July 2021

Craniopharyngiomas are benign neoplasms with two histological subtypes: adamantinomatous and papillary. Papillary craniopharyngiomas are rare in children, and those with a pituitary abscess within are even rarer. Herein, we present the case of a 14-year-old boy with a papillary craniopharyngioma and a coexisting intratumoral abscess, who was hospitalized for persistent pyrexia, polyuria, and polydipsia. The absence of calcification on computed tomography, high signal intensity inside the tumor on diffusion-weighted imaging, and clinical findings such as fever, a high inflammatory response, and meningitis, as well as short-term morphological changes on imaging, could aid in diagnosis.
The use of Lactobacillus reuteri DSM 17938 and ATCC PTA 5289 on oral health indexes in a school population: A pilot randomized clinical trial
Authors: Borrell García Carla , Ribelles Llop Marta , García Esparza Maria Ángeles , Flichy-Fernández Antonio Juan , Marqués Martínez Laura , Izquierdo Fort Regina
Published: July 2021

To assess the effects of a probiotic upon oral health indices in adolescents and to establish relationships between these indices and dietary habits and oral hygiene. Twenty-seven adolescents between 12 and 18 years of age were randomized into two groups. The study group received tablets containing Lactobacillus reuteri DSM 17938/ ATCC 5289 for 28 days, while the control group received tablets without any bacteria. Streptococcus mutans, Lactobacillus sp., and salivary pH were assessed at baseline and at 7, 14, 21, 28, and 45 days. The plaque, gingivitis, and bleeding indices were recorded at baseline and at 14, 28, and 45 days. Dietary and oral hygiene habits were also evaluated by means of a questionnaire. A less marked rise in S. mutans was recorded in the study group. Improvements were observed in terms of plaque, gingivitis, and bleeding, though statistical significance was not reached. Oral pH increased in the study group, though not to a significant degree. Poorer eating habits were significantly correlated to increased plaque. The study parameters decreased with the two strains of L. reuteri DSM 17938 and ATCC PTA 5289, though the results failed to reach statistical.
Does Police Stop and Search Make Everyone Feel Safe? Evidence From the United States
Authors: Mulaphong Dhanakorn , Cheurprakobkit Sutham
Published: July 2021

Stop and search is an innovative policing approach aimed at deterring crime and disorder and promoting public trust and confidence in law enforcement. While many studies have investigated racial biases in this approach and its effectiveness in reducing crime and disorder, little attention has been paid to its role in fostering citizens’ feelings of safety. Using the 2016 General Social Survey data ( N = 2,876), this study examined whether police use of pedestrian stop-and-search practices generated citizens’ feelings of safety. Our results revealed prevailing disparities between Black and White Americans on the effectiveness of police stop-and-search practices. Namely, police stop and search made White persons feel safer and more protected in their neighborhood, compared to Blacks. The conclusion discusses the implications of this disparity, and potential policy and managerial solutions.
Determinants of the Intention to Purchase Branded Meat: Mediation of Brand Trust
Authors: Ling Xie , Shahzad Muhammad Faisal , Abrar Zia ul , Khattak Jamshid Khan
Published: July 2021

This article provides an overview of some recent findings on consumer attitudes and other vital antecedents of purchase intention of branded meat. Based on a sample of 349 respondents in Pakistan, this study tests a model including factors associated with branded meat purchase intentions. SPSS, version 21.0 (Statistical Package for Social Sciences) and AMOS (Analysis of Moment Structure) were used for data analysis. Structural equation modeling (SEM) is a statistical modeling method of analysis that enables the testing of a series of separate yet, interrelated constructs and regression equations, allowing for the study of multiple relationships at once. Consumer attitude, subjective norms, and perceived behavioral control are the most critical factors in forming consumers’ intentions toward buying and consuming branded meat. The overall mediating role of brand trust is less driven by subjective norms and perceived behavioral control, more by consumer attitude than branded meat products. The findings can help public policymakers and managers to understand consumers’ branded meat purchase tendencies and help promote healthier consumption habits.
Chondrogenesis with Stem Cells in Massive Chondral Defects: A Randomized Controlled Trial
Authors: Saw Khay Yong , Ng Reza , Jee Caroline , Low Soo Fin , Dorvault Christopher , Johnson Kevin , Anz Adam
Published: July 2021

Objectives:

The purpose of this study was to evaluate the safety and efficacy of intra-articular injections of autologous peripheral blood stem cells (PBSC) with hyaluronic acid (HA) after arthroscopic subchondral drilling into massive chondral defects of the knee joint and to determine whether PBSC therapy can improve functional outcome and reduce pain of the knee joint better than the standard of care.

Methods:

This is a dual centre, US-FDA phase IIB randomized controlled trial (RCT). Sixty-nine patients age 18-55 years with International Cartilage Repair Society (ICRS) grade 3 and 4 chondral lesions (size ≥ 3cm2) of the knee joint were randomized equally into (i) control group receiving intra-articular injections of HA plus physiotherapy (standard of care) and (ii) intervention group receiving arthroscopic subchondral drilling into chondral defects and postoperative intra-articular injections of PBSC with HA. The co-primary efficacy endpoints are subjective International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS)-pain subdomain measured at month-24. The secondary efficacy endpoints include all other KOOS subdomains, Numeric Rating Scale (NRS) and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores.

Results:

At 24 months, the mean IKDC scores for the control and intervention groups were 48.1 and 65.6, respectively ( P < 0.0001). The mean for KOOS-pain subdomain scores were 59.0 (control) and 86.0 (intervention) with P < 0.0001. All other KOOS subdomains, NRS and MOCART scores were statistically significant ( P < 0.0001) at month-24. Figure 1 shows the bar graphs of the co-primary endpoints. Figure 2 shows the MRI images of: (A) ‘Bone-on-bone’ chondral defects of the lateral femoral condyle (white arrows) and lateral tibial plateau (yellow arrows) following subchondral drilling, with corresponding arthroscopic images and (B) the same lesions at 2 years after surgery showing full thickness articular cartilage regeneration There were no notable adverse events that are unexpected and related to the study drug or procedures.

Conclusions:

Arthroscopic subchondral drilling into massive chondral defects of the knee joint followed by postoperative intra-articular injections of autologous PBSC with HA is safe and showed a significant improvement of clinical and radiological scores as compared to the standard of care.
Osteochondral Lesions of the Talus: Factors Predictive of Cartilage Integrity
Authors: Erickson John , Braithwaite Kiery , Busch Michael , Willimon S. Clifton , Perkins Crystal
Published: July 2021

Objectives:

The integrity of articular cartilage in patients with osteochondral lesions of the talus (OLTs) guides treatment. The ability to predict cartilage integrity in OLTs, as previously published for OCD of the knee, would be beneficial. The purpose of this study is to evaluate the association of radiographic and MRI findings and articular cartilage integrity at the time of ankle arthroscopy for OLTs.

Methods:

A single-institution retrospective review identified patients 19 years of age and younger with operative treatment of OLTs from 2010 – 2017. Demographics and intra-operative findings at the time of ankle arthroscopy were identified by chart review. Radiographs were assessed for physeal status, OLT location, and Berndt and Hardy grade. MRIs were reviewed for OLT size and location, modified Kramer grade, and cartilage status.

Results:

53 patients with 54 OLTs and a mean age of 13.6 years (range 7 – 19 years) were included. Radiographic details are listed in Table 1. OLTs were located in the posteromedial talus in 39 patients (72%). Physeal status was closed/closing in 32 patients (59%) and open in 22 patients (41%). On MRI, the cartilage was predicted to be disrupted in 40 patients (74%) and intact in 14 patients (26%). At the time of ankle arthroscopy, the cartilage was found to be disrupted in 38 OLTs (70%) and intact in 16 OLTs (30%). Table 1 lists variables predictive of cartilage integrity. MRI classification of cartilage integrity was 95% sensitive and 75% specific for arthroscopic integrity, with 11% misclassification. In the 16 patients less than 13 years, MRI perfectly predicted arthroscopic cartilage integrity. In patients with open physes, MRI sensitivity was 92% and specificity 100%. In patients with closing/closed physes, MRI sensitivity was 89% and specificity 50%. Receiver operator curve characteristics of a model to predict arthroscopic cartilage integrity combining MRI cartilage integrity, physeal status, and radiographic grade has an AUC of 0.955.

Conclusions:

Physeal status, radiographic grade, MRI grade, and cartilage integrity on MRI are independent predictors of cartilage integrity at the time of ankle arthroscopy for patients with OLTs. Overall, MRI has 95% sensitivity and 75% specificity for cartilage integrity at the time of arthroscopy, which improves to near 100% sensitivity and specificity in patients with open physes. A model combining MRI cartilage integrity, physeal status, and radiographic grade has the highest predictability of intra-operative cartilage integrity.
Is axillary botulinum toxin efficient in controlling secondary Raynaud’s phenomenon? A case report
Authors: DeMasters David , Sturgill Emily , Bartholomew Alan
Published: July 2021

Raynaud’s phenomenon when secondary to underlying systemic disease such as systemic sclerosis occurs early in the disease course and progression can bring significant morbidity such as pain, digital ulceration, and necrosis. Standard medical therapies are aimed at promoting distal arterial vasodilation but are often inadequate in managing Raynaud’s phenomenon. Options for refractory cases include surgical and chemical sympathectomy with Botulinum neurotoxin type A (BoNT/A) hand injections but the latter can be associated with transient hand weakness. We describe the case of a 35-year-old woman with undifferentiated connective tissue disease, Raynaud’s phenomenon, and concomitant primary focal axillary hyperhidrosis for which she received axillary BoNT/A therapy every 6 months who noted significant improvement in her Raynaud’s phenomenon and hand arthralgias for 5 months following the axillary injections. This effect remained durable after 24 months of therapy. This improvement in Raynaud’s phenomenon after axillary BoNT/A has not been previously described.
Characteristics of Pentosan Polysulfate Sodium–Associated Maculopathy and Similarities With Other Maculopathies Commonly Managed in a Retina Practice
Authors: Ohning Collin , Skopis George , Levinson Joshua , Kasi Sundeep
Published: July 2021

Purpose:

This work describes characteristics of pentosan polysulfate sodium (PPS)–associated maculopathy and its similarities with common maculopathies in a retina practice cohort.

Methods:

Thirty-two patients were identified through electronic medical record query who were exposed to PPS. One patient was excluded for lack of retinal imaging. Thirty-one patients (62 eyes) were included. A retrospective review was used to obtain patient characteristics, examination findings, and retinal imaging of the study patients. Classification into “likely,” “unlikely,” or “possible” to have PPS-associated maculopathy groups was based on the fundus photography and retinal imaging. Main outcome measures were best-corrected visual acuity, age, sex, diagnosis of reason for referral, allocation into designated maculopathy group, and presence of choroidal neovascularization.

Results:

Of 31 patients (62 eyes), the median age was 70 years (range, 24-104 years) and the majority were women (87%). Mean best-corrected visual acuity was 0.3 ± 0.4 logMAR at presentation. The most common reason for referral was age-related macular degeneration (29%). Maculopathy grades were “likely” (29%, 9 total patients), “possible” (26%, 8 total patients), or “unlikely” (45%, 14 total patients). Choroidal neovascularization was noted in 9.7% of all eyes and 11% of eyes in the “likely” group. The “possible” and “likely” groups had older ages of presentation ( P < .05) compared with the “unlikely” group.

Conclusions:

A high percentage (55%) of patients with a history of chronic PPS exposure showed features of “likely” or “possible” maculopathy. Similarities with common maculopathies such as age-related macular degeneration and the importance of screening and recognizing at-risk patients are highlighted.
Role of CGRP pathway polymorphisms in migraine: a systematic review and impact on CGRP mAbs migraine therapy
Authors: Scuteri Damiana , Corasaniti Maria Tiziana , Tonin Paolo , Nicotera Pierluigi , Bagetta Giacinto
Published: July 2021

Background

the interest of clinical reaseach in polymorphisms and epigenetics in migraine has been growing over the years. Due to the new era of preventative migraine treatment opened by monoclonal antibodies (mAbs) targeting the signaling of the calcitonin-gene related peptide (CGRP), the present systematic review aims at identifying genetic variants occurring along the CGRP pathway and at verifying whether these can affect the clinical features and the course of disease and the responsiveness of patients to therapy.

Methods

the literature search has been conducted consulting the most relevant scientific databases, i.e. PubMed/MEDLINE, Scopus, Web of Science, the Human Genome Epidemiology (HuGE) Published Literature database (Public Health Genomics Knowledge Base) and Clinicaltrials.gov from database inception until April 1, 2021. The process of identification and selection of the studies included in the analysis has followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) criteria for systematic reviews and meta-analyses and the guidance from the Human Genome Epidemiology Network for reporting gene-disease associations.

Results

the search has retrieved 800 results, among which only 7 studies have met the eligibility criteria for inclusion in the analysis. The latter are case-control studies of genetic association and an exploratory analysis and two polymorphisms have been detected as the most recurring: the rs3781719 (T > C) of the CALC A gene encoding CGRP and the rs7590387 of the gene encoding the receptor activity-modifying protein (RAMP) 1 (C > G). Only one study assessing the methylation pattern with regard to CGRP pathway has been found from the search. No genetic association studies investigating the possible effect of genetic variants affecting CGRP signaling on the responsiveness to the most recent pharmacological approaches, i.e. anti-CGRP(R) mAbs, gepants and ditans, have been published. According to the Human Genome Epidemiology (HuGE) systematic reviews and meta-analyses risk-of-bias score for genetic association studies, the heterogeneity between and across studies and the small sample size do not allow to draw conclusions and prompt future studies.

Conclusions

adequately powered, good quality genetic association studies are needed to understand the impact of genetic variants affecting the pathway of CGRP on migraine susceptibility and clinical manifestation and to predict the response to therapy in terms of efficacy and safety.
Picture fuzzy WASPAS method for selecting last-mile delivery mode: a case study of Belgrade
Authors: Simić Vladimir , Lazarević Dragan , Dobrodolac Momčilo
Published: July 2021

Background

Last-mile delivery (LMD) is becoming more and more demanding due to an increasing number of users and traffic problems in cities. Besides, medical crises (like the COVID-19 outbreak) and air pollution represent additional motives for the transition from traditional to socially and environmentally sustainable LMD mode. An emerging problem for companies in the postal and logistics industry is how to determine the best LMD mode in a multi-criteria setting under uncertainty.

Method

For the first time, an extension of the Weighted Aggregated Sum Product ASsessment (WASPAS) method under the picture fuzzy environment is presented to solve the LMD mode selection problem. The introduced picture fuzzy set (PFS) based multi-criteria decision-making (MCDM) method can be highly beneficial to managers who are in charge of LMD since it can take into account the neutral/refusal information and efficiently deal with high levels of imprecise, vague, and uncertain information. The comparative analysis with the existing state-of-the-art PFS-based MCDM methods approved the high reliability of the proposed picture fuzzy WASPAS method. Its high robustness and consistency are also confirmed. The presented method can be used to improve LMD in urban areas worldwide. Besides, it can be applied to solve other emerging MCDM problems in an uncertain environment.

Findings

A real-life case study of Belgrade is presented to fully illustrate the potentials and applicability of the picture fuzzy WASPAS method. The results show that postomates are the best mode for LMD in Belgrade, followed by cargo bicycles, drones, traditional delivery, autonomous vehicles, and tube transport.
Case report: the etiology of anterior inferior cerebellar artery infarction: what does basi-parallel anatomic scanning magnetic resonance imaging tell us?
Authors: Zhang Zhi-yong , Zhou Zhi , Zhang Hai-bo , Jiao Jin-song
Published: July 2021

Background

The precise etiology of anterior inferior cerebellar artery (AICA) infarction is difficult to identify because of the high anatomic variability of vertebrobasilar arteries and the limitations of conventional vascular examinations. Basi-parallel anatomic scanning magnetic resonance imaging (BPAS-MRI) can reveal the outer contour of the intracranial vertebrobasilar arteries, which may be helpful to distinguish the arteriosclerosis from congenital dysplasia and dissection.

Case presentation

In this study, we reported 3 cases of AICA infarction and discussed the diagnostic value of BPAS-MRI in the evaluation of vascular etiology.

Conclusions

The BPAS-MRI could be considered as an important supplementary in the diagnosis of vascular etiology of infarction in AICA territory.
NR1D1 suppressed the growth of ovarian cancer by abrogating the JAK/STAT3 signaling pathway
Authors: Wang Huailin , Fu Yan
Published: July 2021

Background

Nuclear receptor subfamily 1 group D member 1 (NR1D1), a nuclear receptor associated with a variety of physiological processes, has a low level in ovarian cancer tissues compared with adjacent normal tissues. However, its role in ovarian cancer remains unclear.

Methods

The level of NR1D1 in ovarian cancer cells was determined by quantitative real-time PCR. Its role in ovarian cancer was explored through gain-of-function and lose-of-function. Cell growth was evaluated by CCK8 assay, immunofluorescence and flow cytometry. Western blot was conducted to assess the activation of JAK/STAT3 signaling pathway. A xenograft model of ovarian cancer was established to explore the role of NR1D1 in vivo.

Results

Up-regulation of NR1D1 repressed the ovarian cancer cell proliferation and induced cell cycle arrest and apoptosis, while silencing NR1D1 promoted their proliferation and G1/S transition. In addition, the JAK/STAT3 signaling pathway, an intracellular signal transduction closely associated with cancer progression, was inhibited by NR1D1. Consistently, xenografts with NR1D1 over-expression grew more slowly in vivo than the controls. Furthermore, NR1D1 up-regulated the expression of suppressor of cytokine signaling 3 (SOCS3), an inhibitor of the JAK/STAT3 signaling pathway. Whereas, SOCS3 silencing abolished the function of NR1D1 over-expression on ovarian cancer growth and JAK/STAT3 signaling pathway.

Conclusions

NR1D1 up-regulated the expression of SOCS3, resulting in suppression of the JAK/STAT3 signaling pathway, thus retarding the growth of ovarian cancer cells. This study highlights a profound role of NR1D1 in the treatment of ovarian cancer.
Higher psychological distress in patients seeking care for a knee disorder is associated with diagnostic discordance between health care providers: a secondary analysis of a diagnostic concordance study
Authors: Lowry Véronique , Bass Alec , Vukobrat Tatiana , Décary Simon , Bélisle Patrick , Sylvestre Marie-Pierre , Desmeules François
Published: July 2021

Background

Knee disorders are highly prevalent and may be a disabling condition. An accurate diagnosis is necessary to guide toward a rapid and efficient management of knee disorders. However, the ability to make a valid diagnosis is often complex for clinicians and evidence is mainly focused on clinician cognitive biases or errors produced during clinical reasoning. The aim of this secondary exploratory analysis is to identify patient-specific characteristics associated with diagnostic discordance between health care providers in making a diagnosis for a new knee disorder.

Methods

We performed a secondary analysis of a diagnostic study comparing the diagnostic ability of a physiotherapist to medical musculoskeletal specialists. Patients’ socio-demographic, psychosocial and clinical characteristics were compared between the concordant and discordant diagnostic groups. Psychosocial symptoms were evaluated using the validated Kessler 6 (K6) questionnaire. We performed multivariable logistic regressions using the Bayesian Information Criterion to identify the most probable model including patients’ characteristics associated with diagnostic discordance. Overall probability of identified variables to explain diagnostic discordance and associated odd ratios (OR) with 95% credibility intervals (95% CrI) were calculated.

Results

Overall, 279 participants were evaluated by a physiotherapist and medical musculoskeletal specialists. The mean age of the participants was 49.1 ± 15.8 years and 57.7% were female. The most common disorder was osteoarthritis (n = 117, 18.8% of cases were discordant). The most probable model explaining diagnostic discordance (11.13%) included having depressive symptoms, which was associated with an increased probability of diagnostic discordance (OR: 3.9; 95% CrI: 1.9 – 8.0) and having a higher number of comorbidities, which was associated with a decreased probability of diagnostic discordance (OR: 0.6; 95% CrI: 0.5 – 0.9). The depression item of the K6 questionnaire had a 99.4% chance to be included in a model explaining diagnostic discordance. Other variables taken separately had less than 50% chance to be included in a model explaining diagnostic discordance and cannot be considered significant.

Conclusion

Our results suggest that depressive symptoms may increase the risk of knee diagnostic discordance. Clinicians may be more likely to make diagnostic errors and should be more cautious when evaluating patients with knee disorders suffering from psychological distress.
Advance care planning conversations in primary care: a quality improvement project using the Serious Illness Care Program
Authors: Hafid Abe , Howard Michelle , Guenter Dale , Elston Dawn , Fikree Shireen , Gallagher Erin , Winemaker Samantha , Waters Heather
Published: July 2021

Background

Advance care planning (ACP) conversations are associated with improved end-of-life healthcare outcomes and patients want to engage in ACP with their healthcare providers. Despite this, ACP conversations rarely occur in primary care settings. The objective of this study was to implement ACP through adapted Serious Illness Care Program (SICP) training sessions, and to understand primary care provider (PCP) perceptions of implementing ACP into practice.

Methods

We conducted a quality improvement project guided by the Normalization Process Theory (NPT), in an interprofessional academic family medicine group in Hamilton, Ontario, Canada. NPT is an explanatory model that delineates the processes by which organizations implement and integrate new work. PCPs (physicians, family medicine residents, and allied health care providers), completed pre- and post-SICP self-assessments evaluating training effectiveness, a survey evaluating program implementability and sustainability, and semi-structured qualitative interviews to elaborate on barriers, facilitators, and suggestions for successful implementation. Descriptive statistics and pre-post differences (Wilcoxon Sign-Rank test) were used to analyze surveys and thematic analysis was used to analyze qualitative interviews.

Results

30 PCPs participated in SICP training and completed self-assessments, 14 completed NoMAD surveys, and 7 were interviewed. There were reported improvements in ACP confidence and skills. NoMAD surveys reported mixed opinions towards ACP implementation, specifically concerning colleagues’ abilities to conduct ACP and patients’ abilities to participate in ACP. Physicians discussed busy clinical schedules, lack of patient preparedness, and continued discomfort or lack of confidence in having ACP conversations. Allied health professionals discussed difficulty sharing patient prognosis and identification of appropriate patients as barriers.

Conclusions

Training in ACP conversations improved PCPs’ individual perceived abilities, but discomfort and other barriers were identified. Future iterations will require a more systematic process to support the implementation of ACP into regular practice, in addition to addressing knowledge and skill gaps.
Investigation of patients’ access to EHR data via smart apps in Chinese Hospitals
Authors: Shu Ting , Xu Fan , Li Hongxia , Zhao Wei
Published: July 2021

Background

Given that China has encouraged EHR usage in hospitals for more than a decade, patients’ access to their own EHR data is still not as widely utilized as expected.

Methods

We cultivated a survey with four categories and field interviews of measures to identify whether hospitals have already released EHR data to patients, inpatients or outpatients, the top EHR release contents and the most popular release software.

Results

Of the 1344 responding hospitals from 30 provinces nationwide, 41.37% of hospitals have already released their EHR data to patients, of which 97.12% are through smart apps. More than 91% of hospitals use WeChat, and 32.37% of hospitals developed their own standalone apps or use vendors’ apps. A total of 54.63% were released to both outpatients and inpatients, and the top release contents were all objective. A rough estimation is made that releasing EHR data to patients via smart apps may save the hospital 15.9 million RMB per year and patients 9.4 million RMB altogether.

Conclusions

EHR data release is believed to bring both patient and hospital cost savings and efficiency gains but is still considered spontaneous and requires legal support and government regulation.
A deep semantic segmentation correction network for multi-model tiny lesion areas detection
Authors: Liu Yue , Li Xiang , Li Tianyang , Li Bin , Wang Zhensong , Gan Jie , Wei Benzheng
Published: July 2021

Background

Semantic segmentation of white matter hyperintensities related to focal cerebral ischemia (FCI) and lacunar infarction (LACI) is of significant importance for the automatic screening of tiny cerebral lesions and early prevention of LACI. However, existing studies on brain magnetic resonance imaging lesion segmentation focus on large lesions with obvious features, such as glioma and acute cerebral infarction. Owing to the multi-model tiny lesion areas of FCI and LACI, reliable and precise segmentation and/or detection of these lesion areas is still a significant challenge task.

Methods

We propose a novel segmentation correction algorithm for estimating the lesion areas via segmentation and correction processes, in which we design two sub-models simultaneously: a segmentation network and a correction network. The segmentation network was first used to extract and segment diseased areas on T2 fluid-attenuated inversion recovery (FLAIR) images. Consequently, the correction network was used to classify these areas at the corresponding locations on T1 FLAIR images to distinguish between FCI and LACI. Finally, the results of the correction network were used to correct the segmentation results and achieve segmentation and recognition of the lesion areas.

Results

In our experiment on magnetic resonance images of 113 clinical patients, our method achieved a precision of 91.76% for detection and 92.89% for classification, indicating a powerful method to distinguish between small lesions, such as FCI and LACI.

Conclusions

Overall, we developed a complete method for segmentation and detection of WMHs related to FCI and LACI. The experimental results show that it has potential clinical application potential. In the future, we will collect more clinical data and test more types of tiny lesions at the same time.
Early warning of citric acid overdose and timely adjustment of regional citrate anticoagulation based on machine learning methods
Authors: Chen Huan , Ma Yingying , Hong Na , Wang Hao , Su Longxiang , Liu Chun , He Jie , Jiang Huizhen , Long Yun , Zhu Weiguo
Published: July 2021

Background

Regional citrate anticoagulation (RCA) is an important local anticoagulation method during bedside continuous renal replacement therapy. To improve patient safety and achieve computer assisted dose monitoring and control, we took intensive care units patients into cohort and aiming at developing a data-driven machine learning model to give early warning of citric acid overdose and provide adjustment suggestions on citrate pumping rate and 10% calcium gluconate input rate for RCA treatment.

Methods

Patient age, gender, pumped citric acid dose value, 5% NaHCO3solvent, replacement fluid solvent, body temperature value, and replacement fluid PH value as clinical features, models attempted to classify patients who received regional citrate anticoagulation into correct outcome category. Four models, Adaboost, XGBoost, support vector machine (SVM) and shallow neural network, were compared on the performance of predicting outcomes. Prediction results were evaluated using accuracy, precision, recall and F1-score.

Results

For classifying patients at the early stages of citric acid treatment, the accuracy of neutral networks model is higher than Adaboost, XGBoost and SVM, the F1-score of shallow neutral networks (90.77%) is overall outperformed than other models (88.40%, 82.17% and 88.96% for Adaboost, XGBoost and SVM). Extended experiment and validation were further conducted using the MIMIC-III database, the F1-scores for shallow neutral networks, Adaboost, XGBoost and SVM are 80.00%, 80.46%, 80.37% and 78.90%, the AUCs are 0.8638, 0.8086, 0.8466 and 0.7919 respectively.

Conclusion

The results of this study demonstrated the feasibility and performance of machine learning methods for monitoring and adjusting local regional citrate anticoagulation, and further provide decision-making recommendations to clinicians point-of-care.
Study on structured method of Chinese MRI report of nasopharyngeal carcinoma
Authors: Huang Xin , Chen Hui , Yan Jing-Dong
Published: July 2021

Background

Image text is an important text data in the medical field at it can assist clinicians in making a diagnosis. However, due to the diversity of languages, most descriptions in the image text are unstructured data. The same medical phenomenon may also be described in various ways, such that it remains challenging to conduct text structure analysis. The aim of this research is to develop a feasible approach that can automatically convert nasopharyngeal cancer reports into structured text and build a knowledge network.

Methods

In this work, we compare commonly used named entity recognition (NER) models, choose the optimal model as our triplet extraction model, and present a Chinese structuring algorithm. Finally, we visualize the results of the algorithm in the form of a knowledge network of nasopharyngeal cancer.

Results

In NER, both accuracy and recall of the BERT-CRF model reached 99%. The structured extraction rate is 84.74%, and the accuracy is 89.39%. The architecture based on recurrent neural network does not rely on medical dictionaries or word segmentation tools and can realize triplet recognition.

Conclusions

The BERT-CRF model has high performance in NER, and the triplet can reflect the content of the image report. This work can provide technical support for the construction of a nasopharyngeal cancer database.
A novel deep learning approach to extract Chinese clinical entities for lung cancer screening and staging
Authors: Zhang Huanyao , Hu Danqing , Duan Huilong , Li Shaolei , Wu Nan , Lu Xudong
Published: July 2021

Background

Computed tomography (CT) reports record a large volume of valuable information about patients’ conditions and the interpretations of radiology images from radiologists, which can be used for clinical decision-making and further academic study. However, the free-text nature of clinical reports is a critical barrier to use this data more effectively. In this study, we investigate a novel deep learning method to extract entities from Chinese CT reports for lung cancer screening and TNM staging.

Methods

The proposed approach presents a new named entity recognition algorithm, namely the BERT-based-BiLSTM-Transformer network (BERT-BTN) with pre-training, to extract clinical entities for lung cancer screening and staging. Specifically, instead of traditional word embedding methods, BERT is applied to learn the deep semantic representations of characters. Following the long short-term memory layer, a Transformer layer is added to capture the global dependencies between characters. Besides, pre-training technique is employed to alleviate the problem of insufficient labeled data.

Results

We verify the effectiveness of the proposed approach on a clinical dataset containing 359 CT reports collected from the Department of Thoracic Surgery II of Peking University Cancer Hospital. The experimental results show that the proposed approach achieves an 85.96% macro-F1 score under exact match scheme, which improves the performance by 1.38%, 1.84%, 3.81%,4.29%,5.12%,5.29% and 8.84% compared to BERT-BTN, BERT-LSTM, BERT-fine-tune, BERT-Transformer, FastText-BTN, FastText-BiLSTM and FastText-Transformer, respectively.

Conclusions

In this study, we developed a novel deep learning method, i.e., BERT-BTN with pre-training, to extract the clinical entities from Chinese CT reports. The experimental results indicate that the proposed approach can efficiently recognize various clinical entities about lung cancer screening and staging, which shows the potential for further clinical decision-making and academic research.