bluuebunny/crossref_metadata_2025_split huggingface dataset:
A single tertiary centre outlook on the short-term outcome of bariatric surgery in improving pulmonary parameters and sleep apnoea
Authors: Mohd Nasir Ahmad Adib Bin , Ban Andrea Yu-Lin , Syed Zakaria Syed Zulkifli , Nik Mahmood Nik Ritza Kosai , Abdul Hamid Mohamed Faisal 
Published: August 2020

Background: Obesity is associated with obstructive sleep apnoea (OSA). Weight loss is an effective treatment. Bariatric surgery for obese, symptomatic OSA patients results in weight loss and improvement in lung function and sleep apnoea. This study aimed to determine the effectiveness of bariatric surgery in improving the respiratory mechanics and sleep apnoea using a lung function test and sleep study. Methods: A prospective study was conducted at the Pusat Perubatan Universiti Kebangsaan Malaysia Medical Centre involving adults undergoing bariatric work-up, attending respiratory clinic or admitted for bariatric work-up. We included subjects with a body mass index (BMI) >35 kg/m2 and Apnoea–Hypopnoea Index (AHI) of >5 events/hour. Subjects were assessed at baseline and at 12±2 weeks post bariatric surgery using the following methods: a partial sleep study, lung function test, six-minute walk test (6MWT) and Epworth Sleepiness Scale (ESS) score. Results: Twelve subjects were analysed. Their mean age was 36±5.7 years, and eight (67%) were female. The baseline mean AHI was 24.75±9.51 events/hour, the nadir mean oxygen saturation during sleep (SpO2) was 83.6±3.8%, the mean ESS score was 16±4, the mean forced expiratory volume in one second (FEV1) was 2.66±0.35 L, the mean forced vital capacity (FVC) was 3.23±0.45 L, the mean total lung capacity (TLC) was 4.97±1.19 L, the mean expiratory reserve volume (ERV) was 0.5±0.46 L, the mean residual volume (RV) was 1.46±0.91 L, the mean adjusted diffusing lung capacity for carbon monoxide (DLCO Adj) was 22.71±5.22 mL/mmHg/min, the mean adjusted diffusing lung capacity corrected for alveolar volume (DLVA Adj) was 5.61±0.90 mL/mmHg/min and the mean 6MWT was 293±49 m. Post surgery (12±2 weeks), the mean BMI decreased from 45.5 kg/m2 to 39.7 kg/m2, with a clinically significant improvement in AHI, ESS score, nadir SpO2, FEV1, FVC, TLC, ERV, RV, DLCO Adj, DLVA Adj and 6MWT ( p<0.05). Conclusion: Bariatric surgery improves sleep apnoea and lung function and reduces daytime somnolence.
Inter-professional collaboration to improve outpatient attendance rates on a cochlear implant aural rehabilitation programme
Authors: Chua Kenneth Wei De , Yuen Heng Wai 
Published: August 2020

Background: The cochlear implant (CI) programme at Changi General Hospital started in 2010. As the number of patients gradually increased over the years, a review of attendance rates from 2010 to 2016 showed that CI patients were not compliant in attending post-surgical aural rehabilitation sessions. A significant number of no-shows or appointment cancellations without rescheduling suggest that patients may not be motivated enough to go through aural rehabilitation. Hence, it was hard to evaluate clinical outcomes, which was demoralising for both the patient and health-care professionals involved. As transdisciplinary care is often involved in the aural rehabilitation process, we reviewed the existing CI clinical pathway to identify gaps in services, and with better fostering of inter-professional collaboration (IPC) in 2017, we compared the difference in outpatient aural rehabilitation attendance rates for patients seen before and after 2017. Methods: A retrospective review was undertaken of the outpatient administrative system to look at appointment cancellation rates before and after IPC for CI patients undergoing post-surgical aural rehabilitation from 2010 to 2019. A paired-sample t-test of significance was used, with the level of significance set at p=0.05. Problem analysis using the Problem, Intervention, Comparison, Outcomes framework helped in identifying the possible reasons for non-compliance with aural rehabilitation attendance. Inter-professional education among audiologists, otologists and speech therapists allowed for a close-knit IPC. Results: There were 78 patients with CIs from 2010 to 2019. Of these, 46 patients were implanted between 2010 and 2016, and 32 were implanted after IPC was introduced in 2017. The median cancellations rates were significantly reduced from 23% to 15%, with a p-value of 0.00. Days to switch-on and aural rehabilitation, number of appointment cancellations and total number of individual visits were significant independent predictors of the percentage of cancellations in regression analysis. Conclusion: Future studies are warranted to see if IPC can indirectly drive clinical outcomes, given that IPC encouraged better compliance with aural rehabilitation attendance post CI. It is imperative to have IPC in this dynamic health-care landscape with increasing complexities. IPC cannot be achieved without a close-knit relationship among the relevant health professionals.
Improving the Attitudes to Homeless Persons in a Family Medicine Residency
Authors: Zha Mengyi , Olson Cheri L. , Goulet Carol 
Published: August 2020

Introduction: Family medicine providers are at the forefront of serving homeless persons. It is important to prepare family medicine residents for this responsibility during residency. In the current study, we aimed to assess the effect of a series of enrichment activities on the attitudes toward homeless persons held by residents, faculty, and staff in a rural family medicine residency program. Methods: The residency program implemented a 6-month enrichment activities series that provided various educational experiences and aimed to improve the participants’ knowledge of and attitudes toward homeless persons. Participants completed 2 anonymous online surveys before and after the enrichment series: (1) the Health Professional’s Attitude Toward the Homeless Inventory (HPATHI) and (2) a short survey assessing the understanding of local issues that affected homeless persons. Two-tailed Student t tests were used to compare the survey results. Results: Of the 48 eligible participants, 42 (88%) completed the surveys before enrichment activities and 41 (85%) completed the surveys afterward. Engagement in the enrichment series was associated with a significant improvement in attitudes supporting social advocacy, but it did not affect self-reported levels of cynicism or personal advocacy. Participant knowledge of local homelessness issues improved, but the difference was not statistically significant. Conclusions: The longitudinal enrichment activities series, which was implemented in a rural family medicine residency program and aimed to provide experiences working with homeless individuals, was effective in improving attitudes supporting social advocacy among participants.
Factors Associated With Short Length of Stay After Long Fusions for Adult Spinal Deformity: Initial Steps Toward Developing an Enhanced Recovery Pathway
Authors: Lovecchio Francis , Steinhaus Michael , Elysee Jonathan Charles , Huang Alex , Ang Bryan , Lafage Renaud , Yang Jingyan , Soffin Ellen , Craig Chad , Lafage Virginie , Schwab Frank , Kim Han Jo 
Published: August 2020

Study Design: Retrospective cohort study. Objectives: The identification of case types and institutional factors associated with reduced length of stay (LOS) is a key initial step to inform the creation of clinical care pathways that can assist hospitals to maximize the benefit of value-based payment models. The objective of this study was to identify preoperative, intraoperative, and postoperative factors associated with shorter than expected LOS after adult spinal deformity (ASD) surgery. Methods: A retrospective cohort study was performed of 82 patients with ASD who underwent ≥5 levels of fusion to the pelvis between 2013 and 2018. A LOS <6 days was determined as a basis for comparison, as 5.7 days was the “expected LOS” generated through Poisson regression modeling of the sample. Clinical, radiographic, surgical, and postoperative factors were compared between those staying ≥6 days (L group) and <6 days (S group). Logistic regression was used to identify factors associated with LOS <6 days. Results: A total of 35 patients were in group S (42.7%). Gender, age, body mass index, ASA (American Society of Anesthesiologists) class, and use of preoperative narcotics, revision surgery, day of admission, and surgical complications did not vary between the cohorts ( P > .05). Mild-moderate preoperative sagittal deformity (sagittal Schwab modifiers 0 or +), lower estimated blood loss (<1200 mL), fewer levels fused (7 vs 10 levels), shorter operating room time, procedure end time before 15:00, and no intensive care unit stay, were associated with short LOS ( P < .05). Only 1 major medical complication occurred in the short LOS group ( P < .05). Conclusions: This study identifies the ASD “case phenotype,” intra-, and postoperative benchmarks associated with shorter LOS, providing targets for pathways designed to reduce LOS.
Quantifying Subclinical and Longitudinal Microvascular Changes Following Episcleral Plaque Brachytherapy Using Spectral Domain–Optical Coherence Tomography Angiography
Authors: Green Kyle M. , Toy Brian C. , Ashimatey Bright S. , Mustafi Debarshi , Jennelle Richard L. , Astrahan Melvin A. , Chu Zhongdi , Wang Ruikang K. , Kim Jonathan , Berry Jesse L. , Kashani Amir H. 
Published: August 2020

Purpose: This work assesses longitudinal microvascular changes in eyes treated with iodine-125 episcleral plaque brachytherapy (EPB). Methods: High-resolution optical coherence tomography angiograms (OCTAs) of the central 3 × 3-mm macula were obtained from iodine-125 EPB–treated and untreated fellow eyes of 61 patients. Previously validated semiautomated algorithms quantified capillary density (vessel skeleton density [VSD]) and caliber (vessel diameter index). Nonperfusion was also quantified as flow impairment region (FIR). Examinations from treated and fellow eyes obtained before treatment and at 6-month, 1-year, and 2-year intervals were compared using generalized estimating equation linear models. Dosimetry maps evaluated spatial correlation between radiation dose and microvascular metrics. Results: At 6 months, treated eyes had significantly lower VSD (0.145 ± 0.003 vs 0.155 ± 0.002; P = .009) and higher FIR (2.01 ± 0.199 vs 1.46 ± 0.104; P = .01) compared with fellow eyes. There was a significant decrease in VSD and a corresponding increase in FIR even for treated eyes without clinically identifiable retinopathy at 6 months. Vessel diameter index was significantly higher in treated eyes than in fellow eyes at 2 years (2.92 ± 0.025 vs 2.84 ± 0.018; P  < .001). We categorized our cohort into low-dose (< 15 Gy) and high-dose (> 45 Gy) radiation to the fovea and noted significant differences in VSD and FIR between groups. Conclusions: OCTA can quantify and monitor EPB-induced retinopathy and can detect vascular abnormalities even without clinically observable retinopathy. OCTA may be useful in investigating treatment interventions aiming to delay EPB-induced radiation retinopathy.
Sino-US Disorder: Power and Policy in Post-COVID Indo-Pacific
Authors: Basu Titli 
Published: August 2020

Great powers have invested in order-building projects with competing vision of political values and ideologies. How the Coronavirus (COVID-19) pandemic shapes the balance of power and order are debated. The pandemic arrived in the midst of Sino-US strategic contestation, a crumbling European project, de-globalisation and contested economic governance architecture. While the pandemic exacerbated Washington abdicating leadership role, Beijing also has alienated itself from the followers of rules based order. It has sharpened the clash of rhetoric, narratives, and perceptions. The pandemic will reorganise the international system and power structures. Situating the Indo-Pacific project in this backdrop, this article critically analyses the debates, discourses and nuanced divergences that are shaping the Indo-Pacific puzzle in the power corridors of Washington, Tokyo and Delhi, in addition to mapping Beijing’s approach to Indo-Pacific. The article evaluates the contrast in their respective visions of order, China strategy, ASEAN centrality and multilateral free-trade regimes. But these subtle departures have not restricted major Indo-Pacific powers to weave a strategic web of democracies and pursue a win-win issue-based multi-alignment on matters of mutual strategic interests. With new realities in play, the India-US-Japan triangle will feature as one of the key building blocks of Indo-Pacific to deliver on the shared responsibility of providing global public goods. JEL Codes: F5, K3
Physician snapshot: the forming landscape of MAiD in northwestern Ontario
Authors: Durant Keri-Lyn , Kortes-Miller Katherine 
Published: August 2020

Background: Options available to Canadians at the end of life increased with the legalization of medical assistance in dying (MAiD). Bill C-14 modified the Canadian Criminal Code allowing individuals who meet very specific criteria to receive a medical intervention to hasten their death. June 2019 marked 3 years since the legislation has changed and while met with favour from most Canadians who believe it will provide enhanced options for quality of life at the end of life, there remains much debate over both its moral implications and practical components. Little is known regarding the Canadian healthcare provider experience with MAiD, in particular in rural and remote parts of the country such as northwestern Ontario. Objectives: The purpose of this study was to explore physicians’ experiences in Northwestern Ontario with MAiD. The geographic location of this study is of particular significance as physicians in rural and remote parts of Canada face unique challenges in the provision of high-quality palliative and end-of-life services. This qualitative research focused on developing a better understanding of physicians’ perceptions and practices with MAiD, in particular regarding access, decision-making, provision of service and role clarity. Methods: The researchers employed an exploratory qualitative research approach, using 1 semi-structured focus group and 18 semi-structured interviews comprising 9 set of questions. Data were collected through audio-taped semi-structured interviews, in person and by telephone. Findings: Four distinct but interconnected themes emerged from thematic analysis of the transcripts of the focus group and interviews: physician perception of patient awareness, appreciation and understanding of MAiD; challenges providing true choice at end of life; burgeoning relationships between palliative care and MAiD; and physician recommendations. Conclusion: The results of this study provide a snapshot of the Northwestern physician experiences with MAiD and contribute to the growing body of work exploring these issues on a national scale. MAiD is highlighted as both a rewarding and challenging experience for physicians in Northwestern Ontario in this study.
Subunits of ARID1 serve as novel biomarkers for the sensitivity to immune checkpoint inhibitors and prognosis of advanced non-small cell lung cancer
Authors: Sun Dantong , Tian Lu , Zhu Yan , Wo Yang , Liu Qiaoling , Liu Shihai , Li Hong , Hou Helei 
Published: August 2020

AbstractIntroductionPatients with advanced non-small cell lung cancer (NSCLC) benefit from treatment with immune checkpoint inhibitors (ICIs). Biomarkers such as programmed death-ligand 1 (PD-L1), the tumor mutational burden (TMB) and the mismatch repair (MMR) status are used to predict the prognosis of ICIs therapy. Nevertheless, novel biomarkers need to be further investigated, and a systematic prognostic model is needed for the evaluation of the survival risks of ICIs treatment.MethodsA cohort of 240 patients who received ICIs from the cBioPortal for Cancer Genomics was evaluated in this research. Clinical information and targeted sequencing data were acquired for analyses. The Kaplan-Meier plot method was used to perform survival analyses, and selected variables were then confirmed by a novel nomogram constructed by the “rms” package of R software.ResultsSeven percent of the NSCLC patients harboredARID1Amutations, while 4% of the NSCLC patients harboredARID1Bmutations. Mutations inARID1AandARID1Bwere confirmed to be associated with sensitivity to ICIs. Patients harboring these mutations were found to have a better response to treatment (ARID1A:P = 0.045;ARID1B:P = 0.034) and prolonged progression-free survival (ARID1B:P = 0.032). Here, a novel nomogram was constructed to predict the prognosis of ICIs treatment. Elevation of the TMB, enhanced expression of PD-L1 and activation of the antigen presentation process and cellular immunity were found to be correlated withARID1AandARID1Bmutations.ConclusionARID1A and ARID1B could serve as novel biomarkers for the prognosis and sensitivity to ICIs of advanced NSCLC.
Infectious endophthalmitis at a Philippine tertiary hospital: a ten-year retrospective study
Authors: Dimacali Victoria Grace , Lim Bon Siong Ruben 
Published: August 2020

Abstract
Background
Endophthalmitis is a sight-threatening disease characterized by marked progressive inflammation of the vitreous and/or aqueous humors. Limited information is currently available regarding endophthalmitis in the Philippines. This study aimed to provide long-term summary data on endophthalmitis cases seen at the largest tertiary referral hospital in the Philippines.

Methods
All endophthalmitis cases diagnosed at the Philippine General Hospital from January 1, 2007 to December 31, 2016 were retrieved and classified by etiology. Data pertaining to history, associated risk factors, isolated microorganisms, management, and final visual outcomes for each patient were reviewed.

Results
A total of 202 cases diagnosed within the audit period were included in the study. These were classified as post-traumatic (55.94%), endogenous (14.36%), acute post-operative (10.40%), keratitis-induced (6.93%), chronic post-operative (5.44%), bleb-associated (3.96%), and suture-associated (2.97%) endophthalmitis. Males comprised 71.29% of the population, while the largest age group affected was 0–10 years (24.75%). The culture-positive rate was 57.89%. The predominant etiology was Gram-positive bacteria (38.18%), followed by Gram-negative bacteria and mixed pathogens (21.82% each), and fungi (18.18%). The most common organisms were Streptococcus, Staphylococcus, Pseudomonas, Aspergillus, and Candida, accounting for 56.45% of isolates. Pars plana vitrectomy was done for 62.87% of patients, intravitreal and other antibiotic therapy in 23.27%, and primary enucleation/evisceration in 10.89%. The final outcomes and best corrected visual acuities were: anophthalmia 11.86%, no light perception/no dazzle 27.84%, light perception 8.76%, hand motions 24.23%, counting fingers 5.15%, 3/200 to 20/50 12.89%, and 20/40 to 20/20 9.28%.

Conclusions
There was a higher proportion of post-traumatic endophthalmitis cases compared to traditional estimates but consistent with studies from China and Thailand. The majority of these cases involved younger children as well as young to middle-aged males engaged in carpentry and construction work, implying a need for increased public health awareness and strengthening of childcare and workplace safety policies. Our microbiologic profile showed a lower proportion of Gram-positive infections and a higher proportion of mixed pathogen infections compared to other studies. There was also a higher proportion of fungi associated with post-operative and keratitis-induced endophthalmitis. The best outcomes were seen in acute post-operative and bleb-associated endophthalmitis, and the worst outcomes in endogenous and keratitis-induced endophthalmitis. Visual outcomes were poorer compared to other Western and Asian countries, with only 21.7% of patients improving from presentation.
A transcriptomic variation map provides insights into the genetic basis of Pinus massoniana Lamb. evolution and the association with oleoresin yield
Authors: Liu Qinghua , Xie Yini , Liu Bin , HuanhuanYin  , Zhou Zhichun , Feng Zhongping , Chen Yadong 
Published: August 2020

Abstract
Background
Masson pine (Pinus massoniana Lamb.), the dominant native coniferous species in southern China, is commercially important for supplying timber and oleoresin. However, knowledge of the genetic variability of masson pine germplasm is still limited. In this study, the genetic diversity and population structure of masson pine germplasm were assessed using 204 wild accessions from 10 main distribution regions using 94,194 core single-nucleotide polymorphisms (SNPs) obtained from transcriptome sequencing data.

Results
The average expected heterozygosity was 0.2724, implying abundant genetic diversity within masson pine germplasm. Analysis of molecular variance (AMOVA) revealed that 3.29% of the variation was sourced from genetic differentiation. Structure analysis identified two geographically distinct groups. Discriminant analysis of principal components (DAPC) showed that one of those groups was further divided into two clusters. Sichuan and Chongqing provenance is the geographical origin, which diffused outward along two different lines. Oleoresin yield is reflected in the evolution of the two groups, and exhibits two different trends along the two lines of diffusion. The oleoresin yield may be associated with the genes of chitinase, CYP720B, cytochrome P450, ABC transporter, and AP2/ethylene-responsive transcription factor (ERF) based on SNPs and expression.

Conclusions
SNP markers from transcriptome sequencing are highly capable of evaluating genetic diversity within different species, as well as the genetic control of objective traits. The functions of these genes will be verified in future studies, and those genes strongly associated with oleoresin yield will be used to improve yields by means of early genotype selection and genetic engineering.
Metabolic syndrome in haemodialysis patients: prevalence, determinants and association to cardiovascular outcomes
Authors: Delautre Arnaud , Chantrel François , Dimitrov Yves , Klein Alexandre , Imhoff Olivier , Muller Clotilde , Schauder Nicole , Hannedouche Thierry , Krummel Thierry 
Published: August 2020

Abstract
Background
In the general population, metabolic syndrome (MetS) is predictive of major adverse cardiovascular events (MACE). Waist circumference (WC), a component of the MetS criteria, is linked to visceral obesity, which in turn is associated with MACE. However, in haemodialysis (HD) patients, the association between MetS, WC and MACE is unclear.

Methods
In a cross-sectional study of 1000 HD patients, we evaluated the prevalence and characterised the clinical predictors of MetS. The relationship between MetS and its components, alone or in combination, and MACE (coronary diseases, peripheral arteriopathy, stroke or cardiac failure), was studied using receiver operating characteristics (ROC) curves and logistic regression.

Results
A total of 753 patients were included between October 2011 and April 2013. The prevalence of MetS was 68.5%. Waist circumference (> 88 cm in women, 102 cm in men) was the best predictor of MetS (sensitivity 80.2; specificity 82.3; AUC 0.80; p <  0.05). In multivariate analysis, MetS was associated with MACE (OR: 1.85; 95CI 1.24–2.75; p <  0.01), but not WC alone. There was a stronger association between the combination of abdominal obesity, hypertriglyceridaemia and low high-density lipoprotein cholesterol with MACE after exclusion of impaired fasting glucose and hypertension.

Conclusions
MetS is frequent and significantly associated with MACE in our haemodialysis cohort and probably in other European dialysis populations as well. In HD patients, a new simplified definition could be proposed in keeping with the concept of the “hypertriglyceridaemic waist”.