bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Health Care Providers’ Use of the ‘Exercise and Depression Toolkit’: a Case Study.
Authors: Glowacki Krista , Zumrawi Daniah , Michalak Erin , Faulkner Guy 
Published: December 2020

Abstract
Background: Exercise is now recommended as a primary treatment for mild-moderate depression in Canada. The ‘Exercise and Depression Toolkit’ was developed to help health care providers (HCP) integrate these treatment guidelines into practice. The purpose of this study was to evaluate acceptability and perceived effectiveness of the toolkit in practice by HCPs working with individuals with depression. Methods: A case study design was utilized. The toolkit was given to 6 HCPs to use in practice for four weeks. Pre- and post-intervention phone interviews were conducted, and weekly logs were provided to track use and satisfaction of interactions with individuals with depression when using the toolkit. The study was conceptually guided by a hybrid theoretical approach using the Diffusion of Innovation Theory and the Theoretical Framework of Acceptability.Results: All HCPs used the toolkit at least once. Participants viewed their interactions when using the toolkit to be successful (considering individuals’ receptiveness, its usefulness and general satisfaction.) The average success score for all participants was 5.5/7. HCPs found the toolkit to be acceptable. All participants (n=6) viewed the toolkit as having relative advantage in helping them to discuss exercise with individuals with depression, and as relatively simple and easy to use (not complex) and adaptable to their practice needs (having trialability). Participants liked the toolkit and had mostly positive things to say about it. Participants had mixed feelings about whether changes in the people they worked with (such as mood and activity levels) could be observed (observability) and whether the toolkit changed their belief in their ability to recommend or discuss exercise (self-efficacy). Recommended dissemination strategies were adopted in promoting the toolkit. Conclusions: Future work should address observability and the ability for health care providers to see other providers using it, as well as effectiveness considering outcomes for people with depression such as mood and activity changes. The results of this initial evaluation seem promising for uptake and future adoption of the toolkit by health care providers working with adults with depression in Canada.
A Systematic Review and Meta-Analysis of Deep Brain Stimulation for Progressive Supranuclear Palsy
Authors: Wen Yafei , Jiao Bin , Zhou Yafang , Shen Lu 
Published: December 2020

Abstract
Background: Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease and currently no effective symptomatic or neuroprotective treatment is available for PSP. Deep brain stimulation (DBS), as a neurosurgical procedure, plays an important role in a range of neurological and psychiatric disorders. However, there are no systematic investigations about the DBS in PSP patients. Objective: We performed a systematic review and meta-analysis to evaluate the safety and efficacy of DBS for PSP. Methods: PubMed, EMBASE, Cochrane library, Chinese National Knowledge Infrastructure and Wan Fang databases were systematically searched without time restrictions. We assessed the data between DBS-OFF and DBS-ON groups, as measured by the Unifed Parkinson Disease Rating Scale (UPDRS). Results: Of 154 identified studies, 13 were eligible and were included in our meta-analysis (N = 36 participants). A reduction of UPDRS Ⅲ scores under DBS-ON conditions was observed, but the differences yielded no statistical significance. Conclusion: Since part of PSP patients could benefit from DBS, we speculate that DBS may become a safe and promising tool for PSP in axial symptoms as well as non-motor symptoms though further investgations are needed. Our findings will provide design strategies for following clinical trials and ultimately help improve the clinical application of DBS in PSP patients.
Patient and Caregiver Experiences of Living With Acute Hepatic Porphyria in the UK: A Mixed-Methods Study
Authors: Gill Liz , Burrell Sue , Chamberlayne John , Lombardelli Stephen , Mora Jordanna , Mason Nicola , Schurer Marieke , Merkel Madeline , Meninger Stephen , Ko John 
Published: December 2020

Abstract
BackgroundThis study used quantitative and qualitative research methods to analyze how acute hepatic porphyria (AHP) affects patients with varying annualized porphyria attack rates (AARs). The overall impact of AHP on patients and caregivers, including their quality of life, was explored. The nature and treatment of acute attacks, experiences of long-term heme arginate treatment and access to other appropriate treatment, as well as the extent of, and treatment for, chronic symptoms, were also included within this study. MethodsPatient and caregiver data were collected via an online survey of members of the British Porphyria Association, followed by an optional one-hour telephone interview. ResultsThirty-eight patients and 10 caregivers responded to the survey. Of those, 10 patients and three caregivers completed follow-up interviews. Overall, 19 patients (50%) had experienced an acute attack within the previous two years, and the severity and types of symptoms experienced during or between acute attacks varied considerably. There was no clear definition among patients or caregivers of a ‘mild’ or ‘severe’ attack. Treatment used to manage attacks also varied, and previous experience with hospital care while managing an attack also affected whether a patient chose to return to hospital or manage the attack at home. Managing the attack at home is therefore not a signifier of the severity of the attack itself. Ninety-four percent of patients also experienced chronic symptoms, which were as varied as acute attacks. Pain was the predominant chronic symptom and was managed with opioids in severe cases. Regardless of AAR, porphyria heavily impacted the daily lives of patients and caregivers. Although patients experiencing frequent attacks generally endured a greater impact on their daily life, patients with less frequent attacks also experienced impacts on all domains (social, pain, discomfort, mobility, diet, relationship with family, relationships, psychological wellbeing, finances, employment and study). Caregivers were most affected in finance, relationships with family and employment domains, and just over half of the caregivers reported a moderate impact on their psychological wellbeing. Conclusions/implications﻿The burden of illness with AHP is high across all patients, regardless of frequency of attacks, and AHP negatively affects patients and caregivers alike.
Clinical Outcome of COVID 19 Patients After Hospitalization: Observational Study from a Tertiary Care Hospital, PAKISTAN
Authors: Ishaque Sadia , Syed Beenish , Akhter Saima , Safeer Talha , Hashmi Atif , Mansoor Yousra , khawaja Shahroz , Durrani Noureen 
Published: December 2020

Abstract
Introduction: The outbreak of novel coronavirus (COVID-19) is a public health emergency that had caused disastrous results in more than 100 countries. Method: This observational study is conducted with aim to track the course of clinical outcomes of the course of COVID 19 patients after discharge. Demographics, baseline characteristics of COVID-19 patients discharged from May till August 2020, in Liaquat National hospital Karachi, Pakistan were collected and analyzed by reviewing the medical records retrospectively. Post-hospitalization data related to clinical outcomes were obtained by following up the patients for 4 weeks. Results: Total 96 records of discharged patients were reviewed. Mean age of them was 53.83 ± 12.89 years with male predominance (78.1%). Out of 96 patients, 19(19.8%) patients were asymptomatic at the time of discharge whereas 77(80.2%) had improved symptoms. The frequent symptoms at time of discharged was fatigue (69.8%) followed by shortness of breath (34.4%). Over the follow-up of 4 weeks, there was significant reduction in symptoms from discharge to 4th week excluding first week only. Patients were found to have significantly improved chest x-ray findings from discharge to first week of follow-up. Out of 77 symptomatic patients, 50(64.9%) patients were found to be asymptomatic while 27(35.1%) were persistently symptomatic on fourth week of the discharge with most frequent symptom of fatigue (33%) followed by shortness of breath (18%).Conclusion: There was significant recovery in most of the COVID 19 survivors after discharge, confirmed by reduction in the symptoms and radiological improvement.
SSCA-Net: Simultaneous Self- and Channel-attention Neural Network for Multi-scale Structure-Preserving Vessel Segmentation
Authors: Ni Jiajia , Wu Jianhuang , Tong Jing , Wei Mingqiang , Chen Zhengming 
Published: December 2020

Abstract
Background: Vessel segmentation is a fundamental, yet not well-solved problem in medical image analysis, due to complicated geometrical and topological structures of human vessels. Unlike existing rule- and conventional learning-based techniques, which hardly capture the location of tiny vessel structures and perceive their global spatial structures, Methods: we propose Simultaneous Self- and Channel-attention Neural Network (termed SSCA-Net) to solve the multi-scale structure-preserving vessel segmentation (MSVS) problem. SSCA-Net differs from the conventional neural networks in modeling image global contexts, showing more power to understand the global semantic information by both self- and channel-attention (SCA) mechanism, and offering high performance on segmenting vessels with multi-scale structures. Specifically, the SCA module is designed and embedded in the feature decoding stage to learn SCA features at different layers, which the self-attention is used to obtain the position information of the feature itself, and the channel attention is designed to guide the shallow features to obtain global feature information. Results: Three blood vessel data sets are train and validate the models. our SSCA-Net achieves 96.21% in Dic and 92.70% in Mean IoU on the intracranial vessel dataset and achieved 98.20 %, 83.52% and 96.14% in AUC, Sen and Acc respectively on retinal vessel dataset. The obtain model can segment the leg arteries and Dic score is 97.21% and the Mean IoU score is 94.42%. Conclusions: The results demonstrated that the proposed SSCA-Net clear improvements of our method over the state-of-the-arts in terms of preserving vessel details and global spatial structures.
Patient, Family, Caregiver, and Community Engagement in Research: A Sensibility Evaluation of a Novel Infographic and Planning Guide
Authors: Giannini Andrew Theodore , Leong Megan , Chan Kelvin , Ghaltaei Arman , Graham Eden , Robinson Craig Craig , Skorska Malvina Nina , Cross Andrea , Gabison Sharon 
Published: December 2020

Abstract
Background: Engaging patients, their families, caregivers and the community (PFCCs) throughout the research cycle provides many benefits of ensuring that research is meaningful for the population it is meant to benefit. Several engagement tools, guidelines, and recommendations have been developed to guide researchers in engaging PFCCs. However, many of these tools are lengthy, complex, and lack the recommended behaviours to facilitate engagement of PFCCs in research. An infographic and planning guide was developed as part of a family engagement in research course including families and researchers in order to facilitate engagement of PFCCs in research. The aim of this study was to evaluate the sensibility of this infographic and accompanying planning. Methods: Thirteen rehabilitation researchers reviewed the PFCC engagement tool, participated in a semi-structured interview, and completed a 10-item sensibility questionnaire. Interviews were transcribed, imported into NVivo Plus, and analyzed using direct content analysis. Median scores and proportions of responses for each of the 10 items in the questionnaire were calculated. Results: Median scores for all questionnaire items were ≥ 4 on a 7-point Likert Scale and none of the items’ median scores were ≤ 3. Participants reported the tool was easy to navigate, contained relevant items to promote PFCC engagement, and followed a logical sequence. Participants’ suggestions for modifications included reformatting the tool, redesigning the infographic redesign, and changing the title. Conclusions: The tool was deemed sensible for overt format, purpose and framework, face and content validity, and ease of usage. The tool is useful for researchers who require guidance to engage PFCCs across the research cycle. Further studies are recommended to assess the effectiveness of the tool to engage PFCCs in research.
Association of “Hypertriglyceridemic Waist” with Increased 5-Year Risk of Subclinical Atherosclerosis in a Multi-Ethnic Population: A Prospective Cohort Study
Authors: Namdarimoghaddam Peyman , Fowokan Adeleke O. , Humphries Karin H. , Mancini G.B. John , Lear Scott A. 
Published: December 2020

Abstract
Background: Hypertriglyceridemic waist (HTGW), which incorporates measures of waist circumference and levels of triglyceride in blood, could act as an early-stage predictor to identify the individuals at high-risk for subclinical atherosclerosis. Previous studies have explored the cross-sectional association between HTGW and atherosclerosis; however, understanding how this association might change over time is necessary. This study will assess the association between HTGW with five-year subclinical carotid atherosclerosis.Methods: 517 participants of Aboriginal, Chinese, European, and South Asian ethnicities were examined for baseline HTGW and five-year indices of subclinical atherosclerosis (intima media thickness (mm), total area (mm2), and plaque presence). Family history of cardiovascular disease, sociodemographic measures (age, sex, ethnicity, income level, maximum education), and traditional risk factors (systolic blood pressure, smoking status, total cholesterol, high-density lipoprotein cholesterol, body mass index) were incorporated into the models of association. These models used multiple linear regression and logistic regression.Results: Baseline HTGW phenotype is a statistically significant and clinically meaningful predictor of five-year intima media thickness (b = 0.08 [0.04, 0.11], p < 0.001), total area (b = 0.20 [0.07, 0.33], p = 0.002), and plaque presence (OR = 2.17 [1.13, 4.19], p = 0.02) compared to the non-HTGW group independent of sociodemographic factors and family history. However, this association is no longer significant after adjusting for the traditional risk factors of atherosclerosis (p = 0.27, p = 0.45, p = 0.66, respectively). Moreover, change in status of HTGW phenotype does not correlate with change in indices of atherosclerosis over five years.Conclusions: Our results suggest that when the traditional risk factors of atherosclerosis are known, HTGW may not offer additional value as a predictor of subclinical atherosclerosis over five years. Changes in HTGW may not be a reliable progress metric for prevention programs.
Vestibular Dose Correlates With Dizziness After Radiosurgery for the Treatment of Vestibular Schwannoma
Authors: Ermiş Ekin , Anschuetz Lukas , Leiser Dominic , Poel Robert , Raabe Andreas , Manser Peter , Aebersold Daniel M , Caversaccio Marco , Mantokoudis Georgios , Abu-Isa Janine , Wagner Franca , Herrmann Evelyn 
Published: December 2020

Abstract
BackgroundStereotactic radiosurgery (SRS) has been recognized as a first-line treatment option for small to moderate sized vestibular schwannoma (VS). Our aim is to evaluate the impact of SRS doses and other patient and disease characteristics on vestibular function in patients with VS.MethodsData on VS patients treated with single-fraction SRS to 12 Gy were retrospectively reviewed. No dose constraints were given to the vestibule during optimization in treatment planning. Patient and tumor characteristics, pre- and post-SRS vestibular examination results and patient-reported dizziness were assessed from patient records. ResultsFifty-three patients were analyzed. Median follow-up was 32 months (range, 6–79). The median minimum, mean and maximum vestibular doses were 2.6 ± 1.6 Gy, 6.7 ± 2.8 Gy, and 11 ± 3.6 Gy, respectively. On univariate analysis, Koos grade (p=0.04; OR: 3.45; 95% CI: 1.01–11.81), tumor volume (median 6.1 cm³; range, 0.8–38; p=0.01; OR: 4.85; 95% CI: 1.43–16.49), presence of pre-SRS dizziness (p=0.02; OR: 3.98; 95% CI; 1.19–13.24) and minimum vestibular dose (p=0.033; OR: 1.55; 95% CI: 1.03–2.32) showed a significant association with patient-reported dizziness. On multivariate analysis, minimum vestibular dose remained significant (p=0.02; OR: 1.75; 95% CI: 1.05–2.89). Patients with improved caloric function had received significantly lower mean (1.5 ± 0.7 Gy, p=0.01) and maximum doses (4 ± 1.5 Gy, p=0.01) to the vestibule.ConclusionsOur results reveal that 5 Gy and above minimum vestibular doses significantly worsened dizziness. Additionally, mean and maximum doses received by the vestibule were significantly lower in patients who had improved caloric function. Further investigations are needed to determine dose-volume parameters and their effects on vestibular toxicity.
Methodological Reflection on an Initiated Expert Stakeholder Engagement Process. A Case Study of a Dementia Prediction Discourse
Authors: Perry Julia 
Published: December 2020

Abstract
BackgroundEngagement and participation are vital for including experiences, opinions, or expertise regarding the need for action and specifying goals of relevant stakeholders. In recent years, engagement processes have significantly gained in prominence especially in the field of healthcare; and participation has been actively demanded by public health agencies as well as by health research funding organizations. Despite numerous international work and wide agreement on the benefits of stakeholder engagement, there is still limited published empirical evidence on methodological best practices for stakeholder approaches and even less on evaluation or outcomes in the process of developing policy.MethodsOn the basis of previous research on stakeholder discourses and with the German case study at hand, I inferred normative criteria for the evaluation of discourse processes. For the methodological examination, my manuscript presents a comprehensive framework of normative criteria relevant to stakeholder engagement planning, implementation, evaluation and reporting, and to illustrate different evaluation and reporting needs for research on stakeholder engagement, namely, depth of participation, legitimate selection of stakeholders, representativeness, process management, output, role definition, and transparency. ResultsThe developed normative evaluation criteria make the evaluation of an engagement process with a large amount of material possible. My analysis indicates the key facilitating elements and also barriers of this participatory approach, demonstrating the importance of especially deploying the following evaluation criteria: output, representativeness, process management, and transparency.ConclusionThe seven developed evaluation criteria have been effective for the evaluation of the stakeholder discourse on dementia prediction. These evaluation criteria may also be conducive to the evaluation of engagement processes on other health research topics with a large corpus of material. To date and to my knowledge, a comprehensive evaluation framework for engagement processes with experts in the field of assessing biomedical issues is missing in the literature and my work aims at bridging this gap.
Beneficial Effects of Dantrolene in the Treatment of Rhabdomyolysis as a Potential Late Complication Associated With COVID-19: A Case Report
Authors: Chiba Nobutaka , Matsuzaki Masakazu , Mawatari Takayuki , Mizuochi Minori , Sakurai Atsushi , Kinoshita Kosaku 
Published: December 2020

Abstract
Background: Patients with severe COVID-19 have disorders of the respiratory, cardiovascular, coagulation, skeletal muscle and central nervous systems. These system failures may be associated with cytokine release syndrome, characterized by hyperpyrexia, thrombocytopenia, hyperferritinemia, and the elevation of other inflammatory markers. Rhabdomyolysis with high fever is a complication that is rarely found in COVID-19. The exact relations of these clinical conditions in patients with COVID-19 are still unknown.Case presentation: We present the case of a 36-year-old man with severe COVID-19 complicated by rhabdomyolysis and high fever. After admission, his condition continued to deteriorate, with a high body temperature. After 9 days, in his laboratory examination, creatine kinase and myoglobin levels were noted to increase (to 26046 U/L, 3668 ng/mL). In addition to viral therapy, he was immediately treated with hydration. However, high fever and levels of rhabdomyolysis continued. The patient had been diagnosed with malignant hyperthermia associated with a late complication of COVID-19, although he had no hereditary predisposition to malignant hyperthermia or neuroleptic malignant syndrome. The administration of dantrolene with muscle relaxation and anti-inflammatory function showed potential efficacy for rhabdomyolysis, high fever and increased plasma inflammatory markers. Conclusions: Malignant hyperthermia is triggered by not only anesthetic agents but also viral infections. A possible mechanism of malignant hyperthermia is a hypersensitivity of calcium release from the sarcoplasmic reticulum. These include mutations in or the activation of the skeletal muscle ryanodine receptor calcium release channel. Dantrolene is a ryanodine receptor antagonist and is used as an anti-inflammatory agent. The administration of dantrolene showed potential efficacy for rhabdomyolysis, high body temperature due to inflammation, and increased inflammatory markers. The underlying mechanism of the association of rhabdomyolysis and high fever in COVID-19 might be a similar pathogenesis in malignant hyperthermia.
Establishment and Validation of a Clinically Predictive Nomogram Model for Thyroid Carcinoma Patients
Authors: Zhang Ruyi , Xu Mei , Liu Xiangxiang , Wang Miao , Jia Qiang , Wang Shen , Zheng Xiangqian , He Xianghui , Huang Chao , Fan Yaguang , Wu Heng , Xu Ke , Li Dihua , Meng Zhaowei 
Published: December 2020

Abstract
Objectives To develop a clinically predictive nomogram model which can maximize patients’ net benefit in terms of predicting the prognosis of patients with thyroid carcinoma based on the 8th edition of the AJCC Cancer Staging method. MethodsWe selected 134,962 thyroid carcinoma patients diagnosed between 2004 and 2015 from SEER database with details of the 8th edition of the AJCC Cancer Staging Manual and separated those patients into two datasets randomly. The first dataset, training set, was used to build the nomogram model accounting for 80% (94,474 cases) and the second dataset, validation set, was used for external validation accounting for 20% (40,488 cases). Then we evaluated its clinical availability by analyzing DCA (Decision Curve Analysis) performance and evaluated its accuracy by calculating AUC, C-index as well as calibration plot.ResultsDecision curve analysis showed the final prediction model could maximize patients’ net benefit. In training set and validation set, Harrell’s Concordance Indexes were 0.9450 and 0.9421 respectively. Both sensitivity and specificity of three predicted time points (12 Months,36 Months and 60 Months) of two datasets were all above 0.80 except sensitivity of 60-month time point of validation set was 0.7662. AUCs of three predicted timepoints were 0.9562, 0.9273 and 0.9009 respectively for training set. Similarly, those numbers were 0.9645, 0.9329, and 0.8894 respectively for validation set. Calibration plot also showed that the nomogram model had a good calibration.ConclusionThe final nomogram model provided with both excellent accuracy and clinical availability and should be able to predict patients’ survival probability visually and accurately.