bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Family Physicians Practice the Principle of Remission Along the Glycemic Continuum
Authors: Fulleborn Stephanie T. , Crawford Paul F. , Jackson Jeremy T. , Ledford Christy J.W. 
Published: December 2020

Introduction Recent evidence reveals that diabetes and prediabetes (preDM) can be reversed to normal glucose regulation (NGR) through significant weight loss, but how physicians clinically identify the principles of partial and complete remission of diabetes is largely unknown. Methods As part of the cross-sectional omnibus survey conducted in March 2019 at a professional annual meeting in the United States, physician participants answered case scenario questions about the diagnosis and documentation of patients with preDM and type 2 diabetes (T2DM). Results Of the registered conference attendees, 387 (72.7%) responded. When presented with the initial case of preDM, 201 physicians (70.8%) selected R73.03 Prediabetes. In a follow-up encounter with improved lab results, 118 physicians (58.7%) indicated that they would not chart any diabetes-related code and 62 (30.8%) would chart preDM again. When presented with the case of T2DM, 256 physicians (90.1%) indicated E11.0–E11.9 Type 2 Diabetes. In the follow-up encounter, only 38 (14.8%) coded a diagnosis reflecting remission from T2DM to prediabetes and 211 (82.4%) charted T2DM. Conclusion Physicians may be reluctant to document diabetes regression as there is little evidence for long-term outcomes and “downgrading” the diagnosis in the medical record may cause screenings to be missed. Documenting this regression in the medical record should communicate the accurate point on the continuum of glucose intolerance with both the patient and the care team.
Supplementing Clinical Practice in Nursing Homes With Simulation Training: A Qualitative Study of Nursing Students’ Experiences
Authors: Olaussen Camilla , Aase Ingunn , Jelsness-Jørgensen Lars-Petter , Tvedt Christine Raaen , Steindal Simen A. 
Published: December 2020

Introduction Limited access to nurse supervisors, insufficient learning support and staff with high workloads are well documented in the research literature as barriers to nursing students´ learning in clinical practice in nursing homes. Due to these barriers nursing students may benefit from additional learning support from nurse educators during their clinical practice period. Objective The study aimed to explore nursing students’ experiences of supplementary simulation training as a tool to support learning during clinical practice in nursing homes. Methods A descriptive qualitative design was used. Twenty-seven first-year nursing students from a university college in Norway were interviewed after attending a seven-week practice period in nursing homes with supplementary simulation training. Three semi-structured focus group interviews were audio recorded, transcribed, and analysed using systematic text condensation. Findings Three categories of student experiences were identified: enhancing the reasoning behind care, transferring knowledge and experiences between the learning environments and enhancing the sense of mastery. Conclusion The supplementary simulation training seemed to complement clinical practice by consolidating the students’ learning during the clinical practice period, enhance the students’ motivation and sense of mastery, and consequently their efforts to seek out new challenges, explore and learn both in the clinical and the simulated environment.
Exploring the MaaS market with systematic analysis
Authors: Esztergár-Kiss Domokos , Kerényi Tamás , Mátrai Tamás , Aba Attila 
Published: December 2020

AbstractMobility as a Service (MaaS) is a new transport concept which integrates, manages, and distributes private and public mobility alternatives by using intelligent digital technologies. Recently, research and implementations have been widely conducted. In order to reveal future implications, it is crucial to analyze the available MaaS services by using systematic methodology. Cluster analysis was applied to create typical groups of MaaS services and to define the common features of the systems, which may highlight future trends. In order to identify the most relevant MaaS initiatives, the typical parameters of the services were taken into account and a dataset was developed. More than 30 MaaS services from 14 countries were investigated, and the features and the functionalities of these services were analyzed. The findings demonstrate that there is potential for the development of the applications in terms of their payment features, their personalization, and the provision of all attainable elements of MaaS. The number of operators is constantly increasing. However, it is uncertain whether public or private MaaS operators will be dominant on the market. Three cluster groups were created with specific features and directions of development. The Route planners group involves a few modes of transport, but it provides an extensive service. While the Third parties group has primarily private MaaS operators, the Public systems group usually includes public MaaS operators. This comprehensive study might be useful to MaaS operators and regulators for understanding the typical features and the development directions of the market.
Learning to detect the onset of slow activity after a generalized tonic–clonic seizure
Authors: Vance Carroll , Kim Yejin , Zhang Guoqiang , Lhatoo Samden , Tao Shiqiang , Cui Licong , Li Xiaojin , Jiang Xiaoqian 
Published: December 2020

Abstract
Background
Sudden death in epilepsy (SUDEP) is a rare disease in US, however, they account for 8–17% of deaths in people with epilepsy. This disease involves complicated physiological patterns and it is still not clear what are the physio-/bio-makers that can be used as an indicator to predict SUDEP so that care providers can intervene and treat patients in a timely manner. For this sake, UTHealth School of Biomedical Informatics (SBMI) organized a machine learning Hackathon to call for advanced solutions https://sbmi.uth.edu/hackathon/archive/sept19.htm.

Methods
In recent years, deep learning has become state of the art for many domains with large amounts data. Although healthcare has accumulated a lot of data, they are often not abundant enough for subpopulation studies where deep learning could be beneficial. Taking these limitations into account, we present a framework to apply deep learning to the detection of the onset of slow activity after a generalized tonic–clonic seizure, as well as other EEG signal detection problems exhibiting data paucity.

Results
We conducted ten training runs for our full method and seven model variants, statistically demonstrating the impact of each technique used in our framework with a high degree of confidence.

Conclusions
Our findings point toward deep learning being a viable method for detection of the onset of slow activity provided approperiate regularization is performed.
Categorisation of EEG suppression using enhanced feature extraction for SUDEP risk assessment
Authors: Mier Juan C. , Kim Yejin , Jiang Xiaoqian , Zhang Guo-Qiang , Lhatoo Samden 
Published: December 2020

Abstract
Background
Sudden Unexpected Death in Epilepsy (SUDEP) has increased in awareness considerably over the last two decades and is acknowledged as a serious problem in epilepsy. However, the scientific community remains unclear on the reason or possible bio markers that can discern potentially fatal seizures from other non-fatal seizures. The duration of postictal generalized EEG suppression (PGES) is a promising candidate to aid in identifying SUDEP risk. The length of time a patient experiences PGES after a seizure may be used to infer the risk a patient may have of SUDEP later in life. However, the problem becomes identifying the duration, or marking the end, of PGES (Tomson et al. in Lancet Neurol 7(11):1021–1031, 2008; Nashef in Epilepsia 38:6–8, 1997).

Methods
This work addresses the problem of marking the end to PGES in EEG data, extracted from patients during a clinically supervised seizure. This work proposes a sensitivity analysis on EEG window size/delay, feature extraction and classifiers along with associated hyperparameters. The resulting sensitivity analysis includes the Gradient Boosted Decision Trees and Random Forest classifiers trained on 10 extracted features rooted in fundamental EEG behavior using an EEG specific feature extraction process (pyEEG) and 5 different window sizes or delays (Bao et al. in Comput Intell Neurosci 2011:1687–5265, 2011).

Results
The machine learning architecture described above scored a maximum AUC score of 76.02% with the Random Forest classifier trained on all extracted features. The highest performing features included SVD Entropy, Petrosan Fractal Dimension and Power Spectral Intensity.

Conclusion
The methods described are effective in automatically marking the end to PGES. Future work should include integration of these methods into the clinical setting and using the results to be able to predict a patient’s SUDEP risk.
Clinical outcomes in patients with atrial fibrillation and frailty: insights from the ENGAGE AF-TIMI 48 trial
Authors: Wilkinson Chris , Wu Jianhua , Searle Samuel D. , Todd Oliver , Hall Marlous , Kunadian Vijay , Clegg Andrew , Rockwood Kenneth , Gale Chris P. 
Published: December 2020

Abstract
Background
Atrial fibrillation (AF) is common in older people with frailty and is associated with an increased risk of stroke and systemic embolism. Whilst oral anticoagulation is associated with a reduction in this risk, there is a lack of data on the safety and efficacy of direct oral anticoagulants (DOACs) in people with frailty. This study aims to report clinical outcomes of patients with AF in the Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation–Thrombolysis in Myocardial Infarction 48 (ENGAGE AF-TIMI 48) trial by frailty status.

Methods
Post hoc analysis of 20,867 participants in the ENGAGE AF-TIMI 48 trial, representing 98.8% of those randomised. This double-blinded double-dummy trial compared two once-daily regimens of edoxaban (a DOAC) with warfarin. Participants were categorised as fit, living with pre-frailty, mild-moderate, or severe frailty according to a standardised index, based upon the cumulative deficit model. The primary efficacy endpoint was stroke or systemic embolism and the safety endpoint was major bleeding.

Results
A fifth (19.6%) of the study population had frailty (fit: n = 4459, pre-frailty: n = 12,326, mild-moderate frailty: n = 3722, severe frailty: n = 360). On average over the follow-up period, the risk of stroke or systemic embolism increased by 37% (adjusted HR 1.37, 95% CI 1.19–1.58) and major bleeding by 42% (adjusted HR 1.42, 1.27–1.59) for each 0.1 increase in the frailty index (four additional health deficits). Edoxaban was associated with similar efficacy to warfarin in every frailty category, and a lower risk of bleeding than warfarin in all but those living with severe frailty.

Conclusions
Edoxaban was similarly efficacious to warfarin across the frailty spectrum and was associated with lower rates of bleeding except in those with severe frailty. Overall, with increasing frailty, there was an increase in stroke and bleeding risk. There is a need for high-quality, frailty-specific population randomised control trials to guide therapy in this vulnerable population.

Trial registration
ClinicalTrials.gov NCT00781391. First registered on 28 October 2008
Amyloid-β misfolding as a plasma biomarker indicates risk for future clinical Alzheimer’s disease in individuals with subjective cognitive decline
Authors: Stockmann Julia , Verberk Inge M. W. , Timmesfeld Nina , Denz Robin , Budde Brian , Lange-Leifhelm Julia , Scheltens Philip , van der Flier Wiesje M. , Nabers Andreas , Teunissen Charlotte E. , Gerwert Klaus 
Published: December 2020

Abstract
Background
We evaluated Aβ misfolding in combination with Aβ42/40 ratio as a prognostic tool for future clinical progression to mild cognitive impairment (MCI) or dementia due to Alzheimer’s disease (AD) in individuals with subjective cognitive decline (SCD).

Methods
Baseline plasma samples (n = 203) from SCD subjects in the SCIENCe project and Amsterdam Dementia Cohort (age 61 ± 9 years; 57% male, mean follow-up time 2.7 years) were analyzed using immuno-infrared-sensor technology. Within 6 years of follow-up, 22 (11%) individuals progressed to MCI or dementia due to AD. Sensor readout values > 1646 cm− 1 reflected normal Aβ folding; readouts at ≤ 1646 cm− 1 reflected low and at < 1644 cm− 1 high misfolding. We used Cox proportional hazard models to quantify Aβ misfolding as a prognostic biomarker for progression to MCI and dementia due to AD. The accuracy of the predicted development of MCI/AD was determined by time-dependent receiver operating characteristic (t-ROC) curve analyses that take individual follow-up and conversion times into account. Statistical models were adjusted for age, sex, and APOEε4 status. Additionally, plasma Aβ42/40 data measured by SIMOA were statistically analyzed and compared.

Results
All 22 patients who converted to MCI or AD-dementia within 6 years exhibited Aβ misfolding at baseline. Cox analyses revealed a hazard ratio (HR) of 19 (95% confidence interval [CI] 2.2–157.8) for future conversion of SCD subjects with high misfolding and of 11 (95% CI 1.0–110.1) for those with low misfolding. T-ROC curve analyses yielded an area under the curve (AUC) of 0.94 (95% CI 0.86–1.00; 6-year follow-up) for Aβ misfolding in an age, sex, and APOEε4 model. A similar model with plasma Aβ42/40 ratio yielded an AUC of 0.92 (95% CI, 0.82–1.00). The AUC increased to 0.99 (95% CI, 0.99–1.00) after inclusion of both Aβ misfolding and the Aβ42/40 ratio.

Conclusions
A panel of structure- and concentration-based plasma amyloid biomarkers may predict conversion to clinical MCI and dementia due to AD in cognitively unimpaired subjects. These plasma biomarkers provide a noninvasive and cost-effective alternative for screening early AD pathological changes. Follow-up studies and external validation in larger cohorts are in progress for further validation of our findings.
Anisotropic dynamic and static mechanical properties of organic-rich shale: The influence of stress
Authors: Wang Yang , Zhao Luanxiao , Han De-hua , Mitra Abhijit , Li Hui , Aldin Samir 
Published: December 2020

Understanding the relationship between dynamic and static mechanical properties of organic-rich shales is crucial for successful in situ stress profile prediction and hydraulic fracturing stimulation in unconventional reservoirs. However, the relationship between dynamic and static properties remains ambiguous, considering the complex rock microstructure and subsurface stress environment. We have reported pseudotriaxial tests on a pair of outcrop Eagle Ford shale plugs, with the axial load applied perpendicular and parallel to bedding planes, to investigate the effects of intrinsic anisotropy and anisotropic stress on dynamic-static relationships. The bedding-parallel Young’s modulus is larger than the bedding-normal one dynamically and statically, whereas there exist complex relations among three static Poisson’s ratios, which are attributed to the intrinsic anisotropy induced by the lenticular texture and finely laminated alignment of kerogen. Along with a stress increment, static tests respond to superpositions of the elastic, viscoelastic, and nonelastic properties, whereas dynamic tests, with more than two orders of magnitude smaller strain amplitude, only reflect the elastic properties of rocks. As a result, the static properties characteristically exhibit more stress dependence than the dynamic properties. Moreover, the evolutions of static properties, especially two static Poisson’s ratios in the horizontal plug, are significantly influenced by the applied stress orientation with respect to the bedding plane. Lastly, we calculate four independent stiffnesses using the five static mechanical parameters with the assumption of transverse isotropy to compare with those calculated from ultrasonic velocities at different stress levels. Finally, when the deviatoric stress is approximately 20 MPa, static parameters derived from stress loading, unloading, and reloading almost intersect together. At this stress level, dynamic and static stiffnesses demonstrate a reasonable correlation with the fitting coefficient of approximately 1.4.
Influência da Folga Financeira no Gerenciamento de Resultados nas Cooperativas de Crédito Brasileiras
Authors: Rodrigues dos Santos Ramon , Florencio dos Santos Joséte 
Published: December 2020

Objetivo: Identificar a influência da folga financeira no gerenciamento dos resultados (GR) nas cooperativas de crédito singulares brasileiras, como uma estratégia de financiamento pré-perdas.
Método: A amostra compreende 626 cooperativas de crédito singulares brasileiras no período entre 2000 e 2019 (20 anos). O modelo-base segue o proposto por Maia et al. (2013), com accruals específicos, controladas por variáveis relacionadas ao perfil das operações de crédito e características como tamanho, captação de depósitos à vista, proporção de operações vencidas e spread, categorizados pelo Plano COSIF.
Resultados: Os resultados destacaram uma influência negativa da folga financeira no GR nas cooperativas de crédito brasileiras. Com isso, quanto maior (ou menor) a folga financeira à disposição dos gestores, menor (ou maior) a propensão ao GR. Logo, a folga amorteceria a interação entre incerteza e aversão ao risco, como um buffer financeiro, deixando-a em uma posição melhor do que uma empresa presa em um único curso de ação.
Contribuições: Os resultados implicam que a “posse” da folga financeira colabora no reporte dos resultados, mitigando a percepção de risco dos cooperados e do agente regulador, intensificadas devido às características específicas e pressões econômicas, políticas e sociais exercidas pelos stakeholders.
Study of clinical features and laboratory investigations for effective management of hyponatremia
Authors: Bhutto M. G. , B. R. Sandeep , Shah Sharath Kumar D. , . Shabaz 
Published: December 2020

Background: Hyponatremia, a common electrolyte disorder is mostly observed in hospitalized elderly patients. It is a potential cause of morbidity, mortality and has significant economic impact on the patient and health care system. The aim of the present study was to investigate the risk factors, clinical features and management of hyponatremia in hospitalized patients to reduce its incidence and minimize the associated complications.Methods: Current study was conducted in a tertiary care hospital SSMC, Tumkur). Patients were evaluated for the underlying cause of hyponatremia through detailed history and physical examination followed by appropriate laboratory investigations based on urine sodium, serum and urine osmolality. Patients with hyponatremia were classified into categories based on clinical investigations and accordingly treated with suitable therapy.Results: Constitutional symptoms, confusion, fever, vomiting, respiratory symptoms, abdominal pain, loose stools, coma, convulsions and other miscellaneous symptoms were observed in history of hyponatremic patients. Most common etiology was found to be SIADH followed by extrarenal losses, renal failure, cirrhosis, CCF, drug in take and glucocorticoid deficiency. Management of hyponatremia was done using hypertonic saline, administration of diuretics, fluid restriction therapy, administration of vaptans and combination of hypertonic saline and vaptans as treatment alternatives, no potential complications were observed during treatment of hyponatremia.Conclusions: The possible cause of hyponatremia should always be determined, asoutcomeinsevere hyponatremiais governed by etiology and not merely by serum sodium levels. The correction of hyponatremia helps to improve the prognosis of the underlying disease and to prevent further complications.
Clinical profile and outcome of children admitted with acute encephalitis syndrome
Authors: Adhikari Arpita , Gajre Mona , Kothari Rini , Chaudhari Nayan , Sangale Deepali 
Published: December 2020

Background: Acute encephalitis syndrome (AES) is an important cause of mortality and morbidity in children. We undertook this study for better understanding of clinical profile and outcome of AES in our settings.Methods: It was a prospective observational study. We studied 15 patients of AES admitted in a tertiary care hospital from December 2016 to May 2017. For investigating AES cases, WHO case definition was adopted. Clinically a case of AES is defined as fever or recent history of fever with change in mental status (including confusion, disorientation, coma, or inability to talk) and/or new onset of seizures (excluding simple febrile seizures). Other early clinical findings could include an increase in irritability, somnolence or abnormal behavior greater than that seen with usual febrile illness. We evaluated their clinical characteristics and outcomes at the time of discharge.Results: Fever, altered sensorium, seizures and headache were the most common symptoms observed in this study. Among 15 cases of AES patients, 6 (40%) recovered completely, while 5 (33.33%) cases had neurological sequelae with a wide range of severity varying from mild to severe at the time of discharge, 4 (26.66%) patient died in the hospital. Conclusions: This study offers a description of the present etiology, clinical presentation and short-term outcome of AES. Use of mechanical ventilation, lower Glasgow coma score, and concurrent seizures are predictors for a poor outcome. Reporting and appropriate workup of all cases would strengthen the AES surveillance and help in reducing the morbidity and mortality due to this disorder.
Study and correlate the severity of birth asphyxia with serum levels of glucose, uric acid and electrolytes in the cord blood of asphyxiated neonates
Authors: M. Y. Kavya , Rudrappa Sudha , Gopal Girish 
Published: December 2020

Background: Perinatal asphyxia one of the most common primary cause of mortality and morbidity among neonates in India and is the commonest cause of stillbirths.Methods: This prospective study was conducted for a period of 18 months which included cases (124) and controls (124) comprised of asphyxiated and non-asphyxiated neonates respectively. The umbilical cord arterial blood was collected by double clamp technique and sent for analysis of electrolytes, uric acid and glucose.Results: Umbilical arterial sodium, calcium and glucose concentration was significantly lower in cases as compared to Control and potassium, uric acid and creatinine concentration was found to be on the higher in the cases as compared to the controls, and the difference was statistically significant with p<0.001.Conclusions: Metabolic abnormalities like hyponatremia, hypocalcaemia and hyperuricemia are significant risk factors for perinatal brain injury. Identification and treatment of such abnormalities results in improved outcome in affected neonates.