bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors and Incidence of Suction Loss during Small Incision Lenticule Extraction (SMILE) in 8493 eyes
Authors: Huang Tian-Ze , Shen Ling , Yu Xiao-Ning , Jin Hong-Ying 
Published: September 2020

Abstract
Background: To report the incidence and risk factors of suction loss during small incision lenticule extraction (SMILE).Methods: This retrospective comparative case control study included 8493 eyes of 4261 patients. Patients underwent SMILE surgery between January 2014 and September 2019 were included. Videos of suction loss were reviewed, and the direct causes of suction loss were noted. An independent samples t-test was used for comparisons between the suction loss group and the control group. A binary logistic regression model was used to determine the possible significant risk factors that might increase the likelihood of suction loss during SMILE surgery.Results: Suction loss occurred in 31 (0.37%) eyes of 30 patients; 23 (74.2%) cases occurred in the right eye (the first operative eye) and 8 (25.8%) cases occurred in the left eye. Among the 30 patients, 23 (76.7%) were male and 7 (23.3%) were female. The incidence in the six consecutive years were 0%, 2.13%, 0.34%, 0.24%, 0.22%, and 0.25%. Head and eye movements during surgery caused suction loss in 16 (51.6%) and 15 (48.4%) eyes, respectively. Comparison between the suction loss group and the control group showed that the first operative eye and male gender are at a significantly high risk for suction loss (p < 0.05).Conclusions: The risk factors of suction loss were first operative eye and male gender. Head and eye movements due to patient anxiety are the most common direct causes of suction loss. Surgeon’s experience may help to reduce the incidence of suction loss. Preoperative education and better communication during surgery needs to be emphasized.Trial registration: Retrospectively registered. ChiCTR-ORC-17011040. Registered 1 April 2017. Name of registry: The observation of clinical results after corneal refractive surgery. Data of enrollment of the first participant to the trial: 1 January 2014.
The value of a method to reduce the exposure of the upper respiratory tract for predicting difficult laryngoscopy
Authors: Wu Hao , Hu Dandan , Chen Xu , Zhang Xuebing , Xia Min , Chai Xiaoqing , Wang Sheng , Zhang Wei 
Published: September 2020

Abstract
Background: The current global situation of COVID-19 epidemic is serious. Routine preoperative methods to assess airway such as the interincisor distance(IID), Mallampati classification, and the upper lip bite test(ULBT) have a certain risk of upper respiratory tract exposure and virus spread. The condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and the assessment method does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic.Methods: We enrolled adult patients who underwent general anesthesia and tracheal intubation. The IID, Mallampati test result, ULBT result, and the C-TMD of each patient were evaluated prior to the initiation of anesthesia. The primary outcome were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 , the number of intubation attempts and intubation time.Results: A total of 304 patients were successfully included in the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD ＞1 finger group 46.8±7.3s, compared with the C-TMD ＜1 finger group 50.8±8.6s (p＜0.01).First attempt success rate was higher in the C-TMD ＞1 finger group than in the C-TMD ＜1 finger group (P＜0.01).The correlation between the C-TMD and Cormack-Lehane Level was 0.317(Spearman correlation coefficient, P＜0.001), and the area under the ROC curve was 0.699(P＜0.01). The C-TMD <1 finger width was the most consistent with difficult laryngoscopy (κ=0.485;95%CI: 0.286-0.612) and its OR value was 10.09(95%CI: 4.19-24.28), sensitivity was 0.469(95%CI: 0.325-0.617), specificity was 0.929(95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847(95%CI :0.825-0.865).Conclusion: Compared with the IID , Mallampati classification and ULBT, the C-TMD has higher value in predicting difficult laryngoscopy, which can become a more favorable airway assessment method during the epidemic of COVID-19.Trial registration: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).
Highly Complex Magnetic Microstructures in Hierarchically Phase Separated AlCo(Cr)FeNi High-entropy Alloys
Authors: Lan Qianqian , Kovács András , Caron Jan , Du Hongchu , Song Dongsheng , Soni Vishal , Dasari Sriswaroop , Chaudhary Varun , Ramanujan Raju , Banerjee Rajarshi , Dunin-Borkowski Rafal 
Published: September 2020

Abstract
The hierarchical microstructures of high-entropy alloys (HEAs) can result in highly complex magnetic textures and properties. Here, we use high spatial resolution correlative magnetic, structural and chemical imaging to investigate magnetic textures in phase separated AlCoxCr1 – xFeNi (x = 0.5 and 1) HEAs. The AlCoFeNi HEA, which contains nm-sized A2 precipitates in a B2 matrix, supports large magnetic domains with small-angle magnetization variations. In contrast, the AlCo(Cr)FeNi HEA, which undergoes hierarchical phase separation, contains an unexpected distribution of magnetic vortices within individual A2 precipitates in a weakly ferromagnetic B2 host, in addition to weakly ferromagnetic or nonmagnetic B2 precipitates in large magnetic domains of the A2 phase, as well as Fe-Co-rich inter-phase A2 regions that have strong magnetization. The coercivity is attributed to a complicated magnetization reversal process, which includes the successive reversal of the magnetic vortices. These results provide important insight for the rational design of HEAs with unique and tailored magnetic properties.
A Qualitative Study of Organisational Response to National Quality Standards for 7-Day Services in English Hospitals
Authors: Sutton Elizabeth , Bion Julian , Mannion Russell , Willars Janet , Shaw Elizabeth , Tarrant Carolyn 
Published: September 2020

Abstract
Background National standards are commonly used as an improvement strategy in healthcare, but organisations may respond in diverse and sometimes negative ways to external quality demands. This paper describes how a sample of NHS hospital trusts in England responded to the introduction of national standards for 7-day service (7DS), from an organisational behaviour perspective. Methods We conducted 43 semi-structured interviews with executive/director level and clinical staff, in eight NHS trusts that varied in size, location, and levels of specialist staffing at weekends. We explored approaches to implementing standards locally, and the impact of organisational culture and local context on organisational response. Results Senior staff in the majority of trusts described a focus on hitting targets and achieving compliance with the standards. Compliance-based responses were associated with a hierarchical organisational culture and focus on external performance. In a minority of Trusts senior staff described mobilising commitment-based strategies. In these trusts senior staff reframed the external standards in terms of organisational values, and used co-operative strategies for achieving change. Trusts that took a commitment-based approach tended to be described as having a developmental organisational culture and a history of higher performance across the board. Audit data on 7DS showed improvement against standards for most trusts, but commitment-focused trusts were less likely to demonstrate improvements on the 7DS audit. The ability of trusts to respond to external standards was limited when they were under pressure due to a history of overall poor performance or resource limitations. Conclusions National standards and audit for service-level improvement generate different types of response in different local settings. Approaches to driving improvement nationally need to be accompanied by tailored support for improvement that takes into account local context and organisational culture.
Comparative Effectiveness of Long-Term Acute Care Hospital versus Skilled Nursing Facility Transfer
Authors: Makam Anil , Nguyen Oanh Kieu , Miller Michael E. , Shah Sachin J , Kapinos Kandice A. , Halm Ethan A. 
Published: September 2020

Abstract
BACKGROUND: Long-term acute care hospital (LTACH) use varies considerably across the U.S., which may reflect uncertainty about the effectiveness of LTACHs vs. skilled nursing facilities (SNF), the principal post-acute care alternative. Given that LTACHs receive over triple the reimbursement of SNFs for comparable diagnoses, we sought to compare outcomes and spending between LTACH versus SNF transfer. METHODS: Using Medicare claims linked to electronic health record (EHR) data from six Texas Hospitals between 2009-2010, we conducted a retrospective cohort study of patients hospitalized on a medicine service in a high-LTACH use region and discharged to either an LTACH or SNF and followed for one year. The primary outcomes included mortality, 60-day recovery without inpatient care, days at home, and healthcare spending.RESULTS: Of 3,503 patients, 18% were transferred to an LTACH. Patients transferred to LTACHs were younger (median 71 vs. 82 years), less likely to be female (50.5 vs 66.6%) and white (69.0 vs. 84.1%), but were sicker (24.3 vs. 14.2% for prolonged intensive care unit stay; median diagnosis resource intensity weight of 2.03 vs. 1.38). In unadjusted analyses, patients transferred to an LTACH vs. SNF were less likely to survive (59.1 vs. 65.0%) or recover (62.5 vs 66.0%), and spent fewer days at home (186 vs. 200). Adjusting for demographic and clinical confounders available in Medicare claims and EHR data, LTACH transfer was not significantly associated with differences in mortality (HR, 1.12, 95% CI, 0.94-1.33), recovery (SHR, 1.07, 0.93-1.23), and days spent at home (IRR, 0.96, 0.83-1.10), but was associated with greater Medicare spending ($16,689 for one year, 95% CI, $12,216-$21,162).CONCLUSION: LTACH transfer for Medicare beneficiaries is associated with similar clinical outcomes but with higher healthcare spending compared to SNF transfer. LTACH use should be reserved for patients who require complex inpatient care and cannot be cared for in SNFs.
Stress, Spirituality and Altruism of Brazilian Medical Students during the Covid-19 Pandemic: A Cross-sectional Analysis
Authors: de Lima David Nunes , de Aguiar Ridson Guilherme Parente , Kubrusly Bruna Sobreira , Macedo Danielle S. , Kubrusly Marcos , Lima Danilo Lopes Ferreira , Sanders Lia Lira Olivier 
Published: September 2020

Abstract
When psychosocial stress overcomes people’s coping capacity, spirituality and altruism may become necessary to minimize psychological damage. This study analyzed self-reported measures of stress, spirituality and altruism of 1105 Brazilian Medical students during the Covid-19 pandemic. We found moderate levels of perceived stress, moderate to high levels spirituality, as well as high levels of altruistic attitudes. Reported stress was higher among participants with a previous diagnosis of mental disorder and women. Spirituality correlated positively with altruistic thoughts and emotions, but only altruism was inversely related to stress. Future research should explore the role of spirituality and altruism in stress management.
Giant infiltrating intermuscular angiolipoma of the posterior axioappendicular region: gross and microscopic features
Authors: Adewale Adesanya Olamide , Okeniran Olatayo Segun , Ssempijja Fred , Afodun Adam Moyosore , Olakunle Ojewale Abdulfatai , Ayuba John Tabakwot , Pius Theophilus , Ochieng Juma J. , Ssengendo Ibrahim , Anaya Amnia Diaz 
Published: September 2020

Abstract
Infiltrating intermuscular angiolipomas are rare. We report a cadaveric case of infiltrating angiolipoma in the muscles of the posterior axioappendicular region with literature in the context of live individuals. The macroscopic assessment showed a non-capsulated homogenous yellow mass was located between the trapezius muscle above and rhomboid major muscle below and invaded the dorsal scapular blood vessels from the rhomboid major muscle. It weighed 47.03 g, 8.5 cm x 6.6 cm x 1.7 cm (length, width, and thickness). Microscopic analysis shows mature fat cells, prominent blood vascular components, and no myxoid areas. Infiltrating intermuscular angiolipomas of the chest wall are very rare and to our knowledge, there is the scantiness of similar cases, hence we are providing an extra case of a giant infiltrating intermuscular angiolipoma of the posterior axioappendicular region, with particular emphasis on gross and microscopic features. In such cases, angiolipomas would require complete surgical excision to prevent continued growth, invasion, and recurrence.
Artificial intelligence algorithm for predicting cardiac arrest using electrocardiography
Authors: Kwon Joon-myoung , Kim Kyung-Hee , Jeon Ki-Hyun , Lee Soo Youn , Park Jinsik , Oh Byung-Hee 
Published: September 2020

Abstract
Background: In-hospital cardiac arrest is a major burden in health care. Although several track-and-trigger systems are used to predict cardiac arrest, they often have unsatisfactory performances. We hypothesized that a deep-learning-based artificial intelligence algorithm (DLA) could effectively predict cardiac arrest using electrocardiography (ECG). We developed and validated a DLA for predicting cardiac arrest using ECG. Methods: We conducted a retrospective study that included 47,505 ECGs of 25,672 adult patients admitted to two hospitals, who underwent at least one ECG from October 2016 to September 2019. The endpoint was occurrence of cardiac arrest within 24 hours from ECG. Using subgroup analyses in patients who were initially classified as non-event, we confirmed the delayed occurrence of cardiac arrest and unexpected intensive care unit transfer over 14 days.Results: We used 32,294 ECGs of 10,461 patients and 4,483 ECGs of 4,483 patients from a hospital were used as development and internal validation data, respectively. Additionally, 10,728 ECGs of 10,728 patients from another hospital were used as external validation data, which confirmed the robustness of the developed DLA. During internal and external validation, the areas under the receiver operating characteristic curves of the DLA in predicting cardiac arrest within 24 hours were 0.913 and 0.948, respectively. The high risk group of the DLA showed a significantly higher hazard for delayed cardiac arrest (5.74% vs. 0.33%, P < 0.001) and unexpected intensive care unit transfer (4.23% vs. 0.82%, P < 0.001). A sensitivity map of the DLA displayed the ECG regions used to predict cardiac arrest, with the DLA focused most on the QRS complex. Conclusions: Our DLA successfully predicted cardiac arrest using diverse formats of ECG. The results indicate that cardiac arrest could be screened and predicted not only with a conventional 12-lead ECG, but also with a single-lead ECG using a wearable device that employs our DLA.
Long-Term Exposure to Air Pollution and The Risk of Developing Sudden Sensorineural Hearing Loss
Authors: Tsai Stella Chin-Shaw , Hsu Yi-Chao , Lai Jung-Nien , Chou Ruey-Hwang , Fan Hueng-Chuen , Lin Frank Cheau-Feng , Zhang Ruihong , Lin Cheng-Li , Chang Kuang-Hsi 
Published: September 2020

Abstract
Background The association between exposure to air pollution and sudden sensorineural hearing loss (SSNHL) has not been extensively discussed in the literature. Therefore, we conducted this nationwide study to evaluate the risk of SSNHL in Taiwanese residents with exposure to air pollution.Methods We enrolled subjects aged older than 20 years with no history of SSNHL from 1998 to 2010, and followed up until developing SSNHL, withdrawn from the National Health Insurance program, and the end of the database (2011/12/31). The air quality data are managed by Taiwan Environmental Protection Administration. The annual concentrations of PM2.5, SO2, CO, NO, and NO2 from 1998 to 2010 were classified into the three levels according to tertiles. We calculated the annual average of pollutants from baseline until the end of the study, and classified into tertiles. The adjusted hazard ratio (aHR) was estimated by using the multivariate Cox proportional hazard model.Results When considered continuous air pollutants concentration, subjects who exposed with higher concentration of CO (aHR=2.19, 95%CI=1.52-3.15), NO (aHR=1.02, 95%CI=1.01-1.03), and NO2 (aHR=1.02, 95%CI=1.01-1.04) developing significant higher risk of SSNHL.When classified air pollutants concentration into low, moderate and high level by tertiles, and selected low level as reference, patients exposed with moderate (aHR=1.58, 95%CI=1.21-2.06) or high level (aHR=1.32, 95%CI=1.00-1.74) of PM2.5 showed significant higher risk of developing SSNHL.Conclusion This study indicated an increased risk of SSNHL in residents with long-term exposure to air pollution. Nevertheless, further experimental and clinical studies are needed to validate the study findings.Disclosure statementAll authors declare that there is no conflicts of interest. This study was approved in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019). The committee agree to waive the requirement for consent.
Techno-Economic Analysis for the Role of Single End Energy User in Mitigating GHG Emission
Authors: Ahmed Waqas , Sheikh Jamil Ahmed , Nouman Muhammad , Ullah Mian Farhan , Mahmud M A Parvez 
Published: September 2020

Abstract
Background
End energy user relies on fossil fuel-based national grid to meet their energy demand; hence, indirectly contributing towards greenhouse gases (GHG) emission and causing climate change. This study aims to investigate the minute role of a single, end energy user in GHG mitigation by shifting to the green renewable energy source, photovoltaics (PV) through its techno-economic analysis.
Method
For the study impact, NASA Meteorological Data is used to select an ideal single energy user equipped with 10 kW PV system based on annual- average daily solar radiations and temperature through MATLAB/Simulink, among eleven populous cities of Pakistan. Helioscope software is used to select tilt and azimuthal angle to expose PV surface for most of the solar radiations. Afterwards, RETScreen software is used for cost, financial and GHG analysis.
Results and Conclusion
The proposed system at single end energy user mitigates 6.9 tonnes of CO2 per annum while producing 16,832 kWh per annum and recovering its 7337$ capital cost in less than five years in the project’s 25-year life span. A single energy user invisible to national grid can play a pivotal role in GHG mitigations while earning from its investment and achieving energy independency from the main grid at the same time.
A Novel Community Detection Based Genetic Algorithm for Feature Selection
Authors: Rostami Mehrdad , Berahmand Kamal , Forouzandeh Saman 
Published: September 2020

Abstract
The selection of features is an essential data preprocessing stage in data mining. The core principle of feature selection seems to be to pick a subset of possible features by excluding features with almost no predictive information as well as highly associated redundant features. In the past several years, a variety of meta-heuristic methods were introduced to eliminate redundant and irrelevant features as much as possible from high-dimensional datasets. Among the main disadvantages of present meta-heuristic based approaches is that they are often neglecting the correlation between a set of selected features. In this article, for the purpose of feature selection, the authors propose a genetic algorithm based on community detection, which functions in three steps. The feature similarities are calculated in the first step. The features are classified by community detection algorithms into clusters throughout the second step. In the third step, features are picked by a genetic algorithm with a new community-based repair operation. Nine benchmark classification problems were analyzed in terms of the performance of the presented approach. Also, the authors have compared the efficiency of the proposed approach with the findings from four available algorithms for feature selection. The findings indicate that the new approach continuously yields improved classification accuracy.
Correlation Study of Chest CT Features of Severe/Critical type COVID-19&nbsp;with Early Renal Damage&nbsp;and Clinical Prognosis
Authors: Li Guan , Ge Yongchun , Sun Zhiyuan , Luo Song , Wang Wen , Zhou Changsheng , zhou Fan , Zhang Xin , Dong Jie , Cao Zhiqiang , Zhang Longjiang , Lu Guangming 
Published: September 2020

Abstract
Background: Among patients with confirmed severe/critical type COVID-19, we found that although the seurm creatinine (Cr) value is in normal range, patients might have occured early renal damage. For severe/critical type COVID-19 patients, whether some chest CT features can be used to predict the early renal damage or clinical prognosis.Methods: 162 patients with severe/critical type COVID-19 were reviewed retrospectively in 13 medical centers from China. According to the level of eGFR, 162 patients were divided into three groups, group A (eGFR < 60 ml/min/1.73m2), group B (60 ml/min/1.73m2 ≤ eGFR < 90 ml/min/1.73m2 group) and group C (eGFR ≥ 90 ml/min/1.73m2). All patients’ baseline clinical characteristics, laboratory data, CT features and clinical outcomes were collected and compared. The eGFR and CT features was assessed using univariate and multivariate Cox regression.Results: Baseline clinical characteristics showed that there were significant differences in age, hypertension, cough and fatigue among groups A, B and C. Laboratory data analysis revealed significant differences between the three groups of leukocyte count, platelet count, C-reactive protein, aspartate aminotransferase, creatine kinase. Chest CT features analysis indicated that crazy-paving pattern has significant statistical difference in groups A and B compared with group C. The eGFR of patients with crazy-paving pattern was significant lower than those without crazy-paving pattern (76.73 ± 30.50 vs. 101.69 ± 18.24 ml/min/1.73m2, p < 0.001), and eGFR (OR = 0.962, 95% CI = 0.940-0.985) was the independent risk factor of crazy-paving pattern. The eGFR (HR = 0.549, 95% CI = 0.331-0.909, p = 0.020) and crazy-paving pattern (HR = 2.996, 95% CI = 1.010-8.714, p = 0.048) were independent risk factors of mortality.Conclusions: In patients with severe/critical type COVID-19, the presence of crazy-paving pattern on chest CT are more likely occured the decline of eGFR and poor clinical prognosis. The crazy-paving pattern appeared could be used as an early warning indicator of renal damage and to guide clinicians to use drugs reasonably.