bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of the change in accuracy of an artificial intelligence algorithm for the detection of skin cancer in camera images following diversification and training
Authors: Phillips Michael , Greenhalgh Jack 
Published: September 2020

Abstract
Background The US FDA recently stated in its Proposed Regulatory Framework for software as a medical device (SaMD) that “One of the greatest benefits of AI/ML in software resides in its ability to learn from real-world use and experience, and its capability to improve its performance.” This study follows two previous publications which addressed the accuracy of a machine learning algorithm for the detection of malignant melanoma. The aim of this study was to quantify the change in the accuracy following modifications to the algorithm (DERM) for the detection of non-melanoma skin cancers and potential precursors of skin cancer. A secondary aim was to assess any improvement in accuracy associated with continued training of the algorithm.Methods A total of 16,550 images of skin lesions with histopathology based assessment were available for assessment. The primary indicator of diagnostic accuracy was the area under the ROC curve with 95% confidence intervals. Sensitivity and specificity at the most efficient cut-point was also estimated together with the numbers of false negative and false positive results.Results The inclusion of squamous cell cancer, basal cell cancer and intra-epidermal carcinoma in addition to melanoma results in an improvement in the scope of the algorithm. For the most recent version of the algorithm all skin cancers show an area under the ROC curve greater than 95%. For melanoma sensitivity=91% and specificity = 89%; for all non-melanoma skin cancers sensitivity=97% and specificity=94%. Continued training of the algorithm results in a statistically significant (p<0.01) improvement in accuracy which diminishes as the ROC area approaches 100%. Conclusions The results indicate that as the algorithm is used in clinical practice it will become more accurate with continued training but the rate of improvement will diminish as the ROC area approaches 100%. A smartphone or other camera fitted with a dermoscopic lens and with internet access to the algorithm can provide an accurate additional assessment of a suspected skin cancer lesion or precursor for primary care physicians and dermatologists.
Routine Health Information System Utilization for Evidence-Based Decision Making in Amhara National Regional State, Northwest Ethiopia: a multi-level analysis.
Authors: Chanyalew Moges Asressie , Yitayal Mezgebu , Atnafu Asmamaw , Tilahun Binyam 
Published: September 2020

Abstract
Background: Health Information System (HIS) is the key to making evidence-based decisions. Ethiopia has been implementing the Health Management Information System (HMIS) since 2008 to collect routine health data and revised it in 2017. However, the evidence is meager on the use of routine health information for decision making among department heads in the health facilities. The study aimed to assess the proportion of routine health information systems utilization for evidence-based decisions and factors associated with it. Method: A cross-sectional study was carried out among 386 department heads from 83 health facilities in ten selected districts in the Amhara region Northwest of Ethiopia from April to May 2019. The study participants were selected using a simple random sampling technique. Descriptive statistics mean and percentage were calculated. The study employed a generalized linear mixed-effect model. Adjusted Odds Ratio (AOR) and the 95% CI were calculated. Variables with p-value <0.05 were considered as predictors of routine health information system use. Result: Proportion of information use among department heads for decision making was estimated at 46%. Displaying demographic (AOR= 12.42, 95% CI: [5.52, 27.98]) and performance (AOR= 1.68; 95% CI: [1.33, 2.11]) data for monitoring, and providing feedback to HMIS unit (AOR= 2.29; 95% CI: [1.05, 5.00]) were individual (level-1) predictors. Maintaining performance monitoring team minute (AOR= 3.53; 95% CI: [1.61, 7.75]), receiving senior management directives (AOR= 3.56; 95% CI: [1.76, 7.19]), supervision (AOR= 2.84; 95% CI: [1.33, 6.07]), using HMIS data for target setting (AOR= 3.43; 95% CI: [1.66, 7.09]), and work location (AOR= 0.16; 95% CI: [0.07, 0.39]) were organizational (level-2) explanatory variables. Conclusion: The proportion of routine health information utilization for decision making was low. Displaying demographic and performance data, providing feedback to HMIS unit, maintaining performance monitoring team minute, conducting supervision, using HMIS data for target setting, and work location were factors associated with the use of routine health information for decision making. Therefore, strengthening the capacity of department heads on data displaying, supervision, feedback mechanisms, and engagement of senior management are highly recommended.
3D Printing Technology-Assisted Endoscopy Surgery in the Treatment of Skull Base Tumors : A retrospective study
Authors: Gao Peng , Liu Angsi , Zuo Fuxing , Kong Jianxin , Li Xueji 
Published: September 2020

Abstract
Object 3D printing technology has becoming more and more popular in medicine, we aim to describe the application experiences of 3D printing technology in endoscopic surgery for skull base tumors, with the assessment of 3D-printed models in skull base endoscopic surgery simulation and anatomy learning.Method Five patients with 3D-printed models were enrolled in our institution from October 2015 to March 2019. 5 individual models, created by different 3D printing methods and printing materials, were used to design the optimal surgical approach before surgery. Besides, the 3D-printed models were applied in endoscopic surgery simulation and anatomy learning. Likert scale questionnaires (1 indicating strongly disagree; 2, disagree; 3, neutral; 4, agree; and 5, strongly agree) were administered to 9 neurosurgeons in our institution to evaluate the application of 3D printed models. Result We successfully printed 5 cases of complex skull base tumor 3D models and performed endoscopic surgery with the help of information of the 5 3D-printed models. Evaluation of the Likert scores showed that model 4 which was printed by the mixed photosensitive resin material was the most conducive in surgery simulation and anatomy learning. The mean (standard deviation) 3D printing time is 16.3 (4.96) hours, and the mean (SD) printing cost is 4,500 (1183.22) RMB.Conclusion 3D printing technology has a high value in the application of endoscopic surgery for skull base tumors. The fast 3D printing time can satisfy the requirement of tight preoperative inspection time. Besides, the average price is acceptable for patients and clinical anatomy learning. The combination of the technology of 3D printing and the techniques of skull base endoscopy shows many unique advantages.
Inhalation of Heliox as a potential treatment for the ARDS caused by COVID-19
Authors: Ma Juan , Shi Yuan , Mao Qing , Liu Hui-Min 
Published: September 2020

Abstract
Corona virus disease 2019 (COVID-19) is currently a global pandemic It presents as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to COVID-19 infection. Despite the widespread use of symptomatic, antiviral, , and supportive treatment, the daily death toll from COVID-19 is still rising. The most common lethal complication is acute respiratory distress syndrome (ARDS). Mechanical ventilation is one of the necessary support methods of treating ARDS. Heliox (Helium-oxygen mixture) inhalation can reduce respiratory work of breathing, improve oxygenation, improve lung compliance, and effectively optimize the treatment of ARDS. Heliox also has potential anti-inflammatory, neuroprotective, and cardiac effects, and could reduce the inflammatory storm caused by SARS-CoV-2. This article reviews the properties of heliox, the therapeutic mechanism for ARDS, and the effects of heliox on inflammation, nerves, and the heart. Conclusion We suggests that heliox is a potential treatment for COVID-19.
Differential Protein Expression in Exponential and Stationary Growth Phases of Mycobacterium avium subsp. hominissuis 104
Authors: Enany Shymaa , Ato Manabu , Matsumoto Sohkichi 
Published: September 2020

Abstract
Background:Mycobacterium avium complex (MAC) is the most common non-tuberculous mycobacteria (NTM) causing different types of pulmonary diseases. Although, genomic and transcriptomic analysis of Mycobacterium avium 104 (M. avium 104) have extensively done, little is known about the proteomics of M. avium 104. Methods:We utilized the proteomics technology to analyze the changes in the whole proteome of M. avium 104 during exponential and stationary growth phases. Results:We found 12 dys-regulated proteins; the up-regulated protein hits in the stationary phase were involved in aminopeptidase, choline dehydrogenase, oxidoreductase, and ATP binding, while, the down-regulated proteins in the stationary phase were acetyl-CoA acetyltransferase, universal stress protein, catalase peroxidase, and elongation factor (Tu). The differently expressed proteins between exponential and stationary phases were implicated in metabolism and stress response pointing to the functional adaptation of the cells to the environment. Conclusion:Proteomic analysis in different growth phases could participate in understanding the course of infection, the mechanisms of virulence, the means of survival, and the possible targets for treatment.
Eudiplozoon Nipponicum : Morphofunctional Adaptations of Diplozoid Monogeneans for Confronting Their Host
Authors: Valigurová Andrea , Vaškovicová Naděžda , Gelnar Milan , Kováčiková Magdaléna , Hodová Iveta 
Published: September 2020

Abstract
BackgroundMonogeneans, in general, show a range of unique adaptations to a parasitic lifestyle, making this group enormously diverse. Due to their unique biological properties, diplozoid monogeneans represent an attractive model group for various investigations on diverse biological interactions. However, despite numerous studies, there are still gaps in our knowledge of diplozoid biology and morphofunctional adaptation.ResultsIn this study, we provide a complex microscopic analysis of systems/structures involved in niche searching, sensing and self-protection against the host environment, and excretory/secretory processes in Eudiplozoon nipponicum. Freeze-etching enabled us to detect syncytium organisational features not visible by TEM alone, such as the presence of a membrane subjacent to the apical plasma membrane (separated by a dense protein layer) and a lack of basal plasma membrane. We located several types of secretory/excretory vesicles and bodies, including those attached to the superficial membranes of the tegument. Giant unicellular glands were seen accumulating predominantly in the apical forebody and hindbody haptor region. Muscle layer organisation differed from that generally described, with the outer circular and inner longitudinal muscles being basket-like interwoven by diagonal muscles with additional perpendicular muscles anchored to the tegument. Abundant muscles within the tegumentary ridges were detected, which presumably assist in fixing the parasite between the gill lamellae. Freeze-etching, alongside transmission electron and confocal microscopy with tubulin labelling, enabled visualisation of the protonephridia and nervous system, including the peripheral network and receptor innervation. Three types of receptor were identified: 1) uniciliated sensory endings with a less prominent (or missing) tegumentary rim, 2) obviously raised uniciliated receptors with a prominent tegumentary rim (packed with massive innervation and muscles) and 3) non-ciliated papillae (restricted to the hindbody lateral region). ConclusionsThis study points to specific morphofunctional adaptations that have evolved in diplozoid monogeneans to confront their fish host. We clearly demonstrate that the combination of different microscopic techniques is beneficial and can reveal hidden differences, even in much-studied model organisms such as E. nipponicum.
Simplified Regional Citrate Anticoagulation Using a Calcium-Containing Replacement Solution for Continuous Renal Replacement Therapy: A Randomized Controlled Trial
Authors: Wei Tiantian , Tang Xin , Zhang Ling , Lin Li , Li Peiyun , Wang Fang , Fu Ping 
Published: September 2020

Abstract
Introduction A simplified protocol for regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without continuous calcium infusion, is more efficient to be used in continuous renal replacement therapy (CRRT). We aim to design a randomized clinical trial (RCT) to compare the safety and efficacy between calcium-free and calcium-containing replacement solution in CRRT with RCA. Methods Of the 64 patients receiving RCA-based post-dilution continuous venovenous hemodiafiltration (CVVHDF) enrolled from 2017-2019, 35 patients were randomized to calcium-containing group and 29 to calcium-free replacement solution group. Primary endpoint was circuit lifespan. Secondary endpoints included mortality, kidney function recovery and complications. The amount of 4% trisodium citrate solution infusion was recorded. Serum and effluent total and ionized calcium concentration were measured during CVVHDF. Results Total 149 circuits (82 in calcium-containing group and 67 in calcium-free group) and 7609 circuit hours (4335 versus 3274 hours) were included. Mean circuit lifespan was 58.1 hours (95% CI 53.8-62.4) in calcium-containing group versus 55.3 hours (95% CI 49.7-60.9, log rank P=0.89) in calcium-free group. The serum total (tCa) and ionized (iCa) calcium concentration was slightly lower in calcium-containing group during CRRT, whereas the post-filter iCa concentration was lower in calcium-free group. Moreover, mean 4% trisodium citrate solution infusion doses had no difference between groups (171.1±15.9 versus 169.0±15.1 ml/h, P=0.49). The mortality (40.0% versus 44.8%, P=0.70) and kidney function recovery rates (54.3% versus 48.3%, P=0.63) were similar in calcium-containing and calcium-free group during hospitalization, respectively. Six (3 in each group) patients showed the signs of citrate accumulation in this study. Conclusions When compared with calcium-free replacement solution, RCA based CVVHDF with calcium-containing replacement solution had similar circuit lifespan, hospital mortality and kidney outcome. Since the calcium-containing solution obviates the need for a separate venous catheter and large dose of intravenous calcium solution preparation for continuous calcium supplement, it is more convenient to be applied in RCA-CRRT practice.Trial registration Chinese Clinical Trial Registry. ChiCTR-IPR-17012629, registered on 10th September 2017. http://www.chictr.org.cn/showprojen.aspx?proj=17644
Small Business and the COVID-19 Pandemic: The Role of Work from Home
Authors: Zhang Ting , Gerlowski Dan , Acs Zoltan 
Published: September 2020

Abstract
While work from home (WFH) becomes the new norm in the COVID-19 pandemic and while small businesses could be more vulnerable in crisis, whether the WFH norm will fade after the stay-at-home mandate ended and whether WFH could be a Schumpeterian “creative” force that helps small businesses do well in the pandemic is unknown. The study first builds a theoretical framework based on marginal revenue product cost utility theory subject to a “contagion” agglomeration parameter and argues that WFH is a rational choice for businesses. Then, we compiled from multiple data sources an up-to-date real-time daily and weekly multifaceted data set tracking WFH propensity from March 20 through July 28. Our empirical analysis estimated a variety of fixed-effects panel data models, population-averaged generalized linear panel-data models with the generalized estimating equation (GEE) approach, and two-level mixed-effects panel-data models. After controlling for the local pandemic, economic, and demographic factors, we find (1) after the stay-at-home order ended, WFH rate got higher; (2) small businesses in states with higher WFH rate are more likely to have higher increases in operating revenue, better cash flow and lower chances of temporary closure. Our robust empirics confirm our theories and hypotheses and demonstrate WFH as a potential force that expedited the “creative destruction” into a new efficient work paradigm.
Near-complete resolution of Nerve Constriction in Neuralgic Amyotrophy on Magnetic Resonance Neurography
Authors: Warner DO Robin , Zusstone Esther , Feinberg Joseph , Nwawka Ogonna , Sneag Darryl 
Published: September 2020

Abstract
INTRODUCTION/BACKGROUND: The diagnosis of brachial plexitis is based on history and clinical findings, supported by needle EMG and MRI. MR neurography can detect focal and multifocal inflammation within nerve.OBJECTIVE: To determine if MR neurography allows objective data mirroring clinical improvement in brachial plexitis.CASE REPORT: A 39-year-old man developed sudden onset pain in his left shoulder after a mild infection, which intensified over 3-4 days. Weakness followed, being unable to lift his left arm above the level of his shoulder. There were no sensory symptoms. There was a remote history of Bell’s palsy, but no relevant family history. Initial examination showed weakness of the left deltoid and infraspinatus (2/4). Reflexes were present. Needle EMG/NCSs showed left C5 radiculopathy, primarily involving the anterior ramus division with severe denervation of C5-innervated muscles, then progressive reinnervation of the C5 muscles through axonal regeneration. A left brachial plexus MR neurography with gadolinium showed an enlarged hyperintensity in the C5 nerve root at the level of the interscalene triangle with a denervation pattern edema of regional muscles. The patient was treated with IVIg. Ten months after onset, strength of all muscles is normal, although there is decreased muscle bulk in his deltoid and pectoral muscles. Serial MRIs show progressively decreasing nerve root hyperintensity and size in the post foraminal nerve root. The last MRI and needle EMG/NCSs were normal, correlating with the clinical syndrome.SUMMARY/CONCLUSION: MR neurography of the brachial plexus may be important in diagnosis and prognosis in patients with brachial plexitis.
A hybrid SIR model applied to “Covid- 19” pandemic
Authors: IV samuel Ismael BILLONG , Kouamou Georges Edouard , Bouetou Thomas 
Published: September 2020

Abstract
Modeling has become a tool capable of guiding public policies, especially in the area of health. Specifically, modeling in epidemiology makes it possible to follow the evolution of infections and to understand the behavior of viruses. Unfortunately, the traditional SIR models and the statistical prediction models commonly used suffer from the lack of accurate information and the unavailability of a large amount of data, also they do not take into account the interactions within the population. This paper proposes a hybrid SIR model which takes into consideration the spatio-temporal dynamics of individuals. The model is based on the discrete stochastic diffusion equations. To build the equation system, the 2D diffusion equations are coupled to the human displacement probability law pattern through a discretization made by the finite volume method for complex geometries. Beyond the health consequences it causes, COVID-19 (coronavirus) is a test case used to validate the proposed model. We used the case of a developed country before confinement to fit to the chosen displacement pattern, and to analyze the sensitivity of the parameters of the model taking into account the accuracy of the statistics provided.
Anti-SAE Autoantibody-Positive Japanese Patient with Juvenile Dermatomyositis complicated with Interstitial Lung Disease - A Case Report
Authors: Kishi Takayuki , Tani Yumi , Okiyama Naoko , Mizuochi Kiyoshi , Ichimura Yuki , Harigai Masayoshi , Nagata Satoru , Miyamae Takako 
Published: September 2020

Abstract
Background Clinical phenotypes and outcomes in juvenile dermatomyositis (JDM) have been defined by various myositis-specific autoantibodies (MSAs). One of the recently described MSAs associated with DM is targeted against the small ubiquitin-like modifier 1 activating enzyme (SAE). We report an anti-SAE autoantibody-positive JDM patient complicated with interstitial lung disease (ILD).Case presentation: An 8-year-8-month-old Japanese girl presented with bilateral eyelid edema and facial erythema. At 8 years 4 months, she had dry cough and a papule with erythema on the dorsal side of the bilateral phalangeal joints. Her facial erythema gradually worsened and did not improve with topical steroids. At the first visit to our department at 8 years 8 months of age, she had a typical heliotrope rash and Gottron’s papules, with no fever or weight loss, and a chest computed tomography scan showed ground-grass opacity under visceral pleura. There was no clinical evidence of myositis, muscle weakness, myalgia, or muscle magnetic resonance imaging (MRI) findings. She had mild dry cough, without any signs of respiratory distress. Laboratory tests showed no elevated inflammatory markers. She had a normal serum creatine kinase level with a slightly elevated aldolase level, and serum anti-SAE autoantibody was detected by immunoprecipitation—western blotting. She was diagnosed with juvenile amyopathic DM complicated by ILD and received two courses of methylprednisolone pulse therapy followed by oral corticosteroid and cyclosporin A. We gradually reduced the corticosteroid dose as her skin rash tended to improve after treatment initiation. There was no progression of muscle symptoms, dysphagia, or disease flare during an 18-month follow-up period.Conclusions: We report a patient with anti-SAE autoantibody-positive JDM complicated by interstitial pneumonia. This patient had no progression of muscle symptoms and dysphagia during an 18-month follow-up period, which differs from previous reports in adult patients with MSAs. There have been no previous reports of pediatric patients with SAE presenting with ILD. However, ILD seen in this case was not rapidly progressive and did not require cytotoxic agents. To prevent overtreatment, appropriate treatment choices are required considering the type of ILD.
Multi-Objective Optimization Approach based on Deterministic and Metaheuristic Techniques to Resource Management in Health Crisis Scenarios under Uncertainty
Authors: Hernández-Pérez Luis Germán , Ponce-Ortega José María 
Published: September 2020

Abstract
This paper presents an optimization strategy based on mathematical programming to solve resource management problems regarding hospitalization of sick patients, considering emergency scenarios, such as those that can occur in a pandemic. This optimization strategy is based on the use of efficient optimization tools in solving complex problems in which other strategies are not efficient. The mathematical modeling of epidemiological phenomena is a very useful tool to predict the direction of a disease, as well as to adequately and timely manage the available resources and thus save as many lives as possible. This work uses a mathematical model formulation based on deterministic optimization developed in general algebraic modelling system (GAMS) environment. The main user interface has been developed in a MicrosoftTM (MS) Excel worksheet, which is familiar to many users. The linking code to send values from MS Excel to GAMS has been programmed in visual basic for applications (VBA) and it uses GAMS data exchange (GDX) files. The proposed optimization methodology is applied to case studies based on data obtained from affected people by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the virus that causes coronavirus disease 2019 (COVID-19). The distances were taken as example from severely affected cities in USA. The obtained results offer attractive alternatives for the specified objective function in an acceptable computation time.