bluuebunny/crossref_metadata_2025_split huggingface dataset:
External validation of the sepsis severity score
Authors: Wełna Marek , Adamik Barbara , Goździk Waldemar , Kübler Andrzej 
Published: June 2020

Introduction: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Mortality rates are high, exceeding 50% in patients with septic shock. The sepsis severity score (SSS) was developed to determine the severity of sepsis and as a prognostic model. The aim of this study was to externally validate the SSS model. Methods: Calibration and discrimination of the SSS were retrospectively evaluated using data from a single-center sepsis registry. Results: Data from 156 septic patients were recorded; 56% of them had septic shock, 94% of patients required mechanical ventilation. The observed hospital mortality was 60.3%. The mean SSS value was 94.4 (95% CI 90.5–98.3). The SSS presented excellent discrimination with an area under the receiver operating characteristic curve (AUC) of 0.806 (95% CI 0.734–0.866). The pairwise comparison of APACHE II (AUC = 0.789; 95% CI 0.715–0.851) with SSS and 1st day SOFA (AUC = 0.75; 95% CI 0.673–0.817) with SSS revealed no significant differences in discrimination between the models. The calibration of the SSS was good with the Hosmer-Lemeshow goodness-of-fit H test 9.59, P > 0.05. Analyses of calibration curve show absence of accurate predictions in lower deciles of lower risk (2nd and 4th). Conclusion: The SSS demonstrated excellent discrimination. The calibration evaluation gave conflicting results; the H-L test result indicated a good calibration, while the visual analysis of the calibration curve suggested the opposite. The SSS requires further evaluation before it can be safely recommended as an outcome prediction model.
China’s New Laws and Policies on Nongovernmental Education: Background, Characteristics, and Impact Analysis
Authors: Dong Shengzu 
Published: June 2020

Purpose: China has a long history of private school education. Since the founding of the People’s Republic of China, nongovernmental education (private school education) once disappeared from Chinese society until its revival following the 3rd Plenary Session of the 11th Central Committee of the Communist Party of China. With its development of more than four decades, nongovernmental education has become an important part of China’s educational system and is vigorously promoting the modernization progress of Chinese education. Design/Approach/Methods: Being different from the overseas private school education, which is mostly funded by donations, China’s nongovernmental education sector has operated on the basis of private capital investments and contributions, with the organizers (contributors) typically expecting economic returns. Marked by the introduction of regulations and policies for nongovernmental education around the year of 2016, China’s nongovernmental education sector officially entered a new era of registration, support, and regulation by category. Findings: The macroscopic policies of China’s nongovernmental education in new era present the following new characters: (I) Emphasizing education provision as a public interest and comprehensively strengthening private school leadership; (II) managing negative lists and broadening the means by which social forces participate in operating schools; (III) implementing preferential policies for private schools through categories based on the principle of being fair but different; (IV) supporting the development of private schools with the goal of improving education quality; (V) standardizing private schools’ operating practices in order to promote healthy and orderly development. Originality/Value: The implementing of the new policies on nongovernmental education shall have significant impact on the development and reform of China’s nongovernmental education in the future: (1) The rapid development of nonprofit private schools due to government support; (2) for-profit private schools may face polarization in a fiercely competitive market environment; (3) heavy burden of categorizing and transferring existing stock of schools due to various historical and realistic constraints.
The Mathematics Learning Attributes Valued by Students in Eastern China
Authors: Tang (唐恒钧) Hengjun , Seah (佘伟忠) Wee Tiong , Zhang (张侨平) Qiaoping , Zhang (张维忠) Weizhong 
Published: June 2020

Purpose: Given that prior research has confirmed that students’ mathematics values significantly affect their mathematics learning, understanding how students’ values form and change, especially during different learning stages, is an important topic. Design/Approach/Methods: This study administered a questionnaire to investigate the values of primary, junior high, and senior high school students in Eastern China. A principal component analysis was conducted to investigate the factor structure of the students’ learning values. Then, paired sample t-tests were used to examine the differences in the two continuous categories ranking of each group, and a one-way analysis of variance with a Brown–Forsythe test was used to test the differences in the ranking of each dimension by the different grade-level groups. Findings: We found that students’ mathematics learning values consist of seven elements: culture, memorization, technology, objectism, practice, understanding, and control. Students placed different degrees of importance on these seven elements at different learning stages. Additionally, we found that junior high school is a critical period of change in students’ values. Originality/Value: These findings will be invaluable to teachers and educators as they reflect on their teaching approaches. Moreover, the findings that students’ values undergo changes in the course of their schooling are important information for educators seeking to foster students’ learning.
Aboard the Smile Train: Outcomes of Primary Cleft Palate Repair at a Tertiary Care Center: À bord du Smile Train : les résultats cliniques de réparations de fentes palatines dans un centre de soins tertiaires
Authors: Khan Daniyal A. , Farooq Ayesha , Jiwani Uswa , Ahsan Muhammad Asif , Shahzad Farooq , Rahman Mohammad Fazlur 
Published: June 2020

Introduction: Cleft palate repair is considered to be a safe procedure, yet still carries a 5% to 30% risk of complications. This study sought to assess the outcomes of this procedure in a high-burden Asian country that partners with the Smile Train to perform cleft surgeries. Methods: The Aga Khan University medical records database was queried for pediatric patients undergoing cleft surgery between 2014 and 2017. Data were abstracted from the patient medical records, and details of the clinical, demographic factors, and postoperative outcomes were assessed. Results: Among 142 patients with orofacial clefts, 102 (72%) underwent primary cleft palate repair, one-third (n = 36, 35%) of whom were operated as part of the Smile Train. The median preoperative hemoglobin was 11.4 g/dL (interquartile range: 10.7-12.0 g/dL), whereas the median weight was 8.3 kg (7.7-11.4 kg). Nearly two-thirds (n = 64, 63%) of the cohort underwent preoperative cardiology screening, with only a minority undergoing orthodontic treatment (n = 6, 6%). Approximately 15% (n = 15) of patients experienced a postoperative complication, most often a fistula (n = 11, 73%). On multivariable analysis, with each unit increase in hemoglobin levels, there was a 50% reduction in the odds of experiencing a complication (odds ratio: 0.51, 95% CI: 0.28-0.87). There were no in-patient deaths among the cohort. Conclusion: The results of the current study provide useful information to key stakeholders including patients, plastic surgeons, and policy makers on the outcomes of cleft palate repair in a developing country.
Biomarkers and antithrombotic treatment in cervical artery dissection – Design of the TREAT-CAD randomised trial
Authors: Traenka Christopher , Gensicke Henrik , Schaedelin Sabine , Luft Andreas , Arnold Marcel , Michel Patrik , Kägi Georg , Kahles Timo , Nolte Christian H , Kellert Lars , Rosenbaum Sverre , Sztaizel Roman , Brehm Alex , Stippich Christoph , Psychogios Marios , Lyrer Philippe , Engelter Stefan T ,   for the TREAT-CAD investigators
Published: June 2020

Introduction The type of antithrombotic treatment in cervical artery dissection patients is still a matter of debate. Most physicians prefer anticoagulants over antiplatelet agents for stroke prevention. However, this approach is not evidence-based and antiplatelets might be as safe and as effective. The ‘Biomarkers and Antithrombotic Treatment in Cervical Artery Dissection’ (‘TREAT-CAD’) trial (clinicaltrials.gov: NCT02046460) compares Aspirin to oral anticoagulants (vitamin K antagonists) with regard to efficacy and safety by using both clinical and imaging surrogate outcome measures. TREAT-CAD tests the hypothesis, that aspirin is as safe and effective as vitamin K antagonists. Patients and methods TREAD-CAD is a Prospective, Randomised controlled, Open-labelled, multicentre, non-inferiority trial with Blinded assessment of outcome Events (PROBE-design). Key eligibility criteria are (i) clinical symptoms attributable to cervical artery dissection and (ii) verification of the cervical artery dissection diagnosis by established magnetic resonance imaging criteria. Patients are randomised to receive either Aspirin 300 mg daily or vitamin K antagonists for 90 days. Results Primary outcomes are assessed at 14 ± 10 days (magnetic resonance imaging and clinical examination) and at 90 ± 30 days (clinical examinations). The primary endpoint is a composite outcome measure – labelled Cerebrovascular Ischemia, major Hemorrhagic events or Death (CIHD) – and includes (i) occurrence of any stroke (including retinal infarction), (ii) new ischaemic lesions on diffusion-weighted magnetic resonance imaging, (iii) any major extracranial haemorrhage, (iv) any symptomatic intracranial haemorrhage, (v) any new haemorrhagic lesion visible on paramagnetic-susceptible sequences and (vi) death. Discussion After database closure, (i) central verification of cervical artery dissection diagnosis will be done by two experienced raters, (ii) adjudication of outcome events will be performed by independent adjudication committees, separately for clinical and imaging outcomes. The primary analysis will be done on the per protocol data set. The targeted sample size consists of 169 evaluable patients in the per protocol data set. Conclusion TREAT-CAD is testing the non-inferiority of Aspirin versus vitamin K antagonists treatment in patients with symptomatic cervical artery dissection by combined clinical and magnetic resonance imaging outcomes.
Reliability of and Minimal Detectable Changes in Gait Performance Tests in Patients With Chronic Hemiplegic Stroke
Authors: Hayakawa Jun , Ochi Mitsuhiro , Yano Yudai , Matsugaki Ryutaro , Ogata Yuto , Murakami Takeshi , Kuhara Satoshi , Itoh Hideaki , Hachisuka Kenji , Saeki Satoru 
Published: June 2020

Purpose: This study aimed to determine the inter- and intra-rater reliability of and minimal detectable changes (MDCs) at the 95% confidence interval in gait performance tests in patients with chronic hemiplegic stroke who can walk independently. Materials and Methods: Thirty patients with chronic hemiplegic stroke (24 men, 6 women, mean age 62.5 ± 11.6 years) were enrolled. Physical therapists (mean clinical experience: 9.1 ± 9.3 years) performed the timed up and go test (TUG), 10-m walk test (10MWT), and 6-min walk test (6MWT) 1 day apart. Reliability was evaluated using the intraclass correlation coefficient (ICC) and Bland–Altman analysis. Results: The ICC was ≥0.9 for all tests, and no systematic bias was found. MDC at the 95% confidence interval was 1.9 s for the TUG, 0.16 m/s for the 10MWT, and 28.4 m for the 6MWT. Discussion: We demonstrated excellent intra- and inter-rater reliability of all tests. These results suggest that gait performance tests are reliable. Conclusion: These commonly used gait performance tests demonstrated high reliability and can be recommended to evaluate clinically meaningful improvements in patients with chronic hemiplegic stroke who can walk independently.
Women’s employment, income and divorce in West Germany: a causal approach
Authors: Brüggmann Daniel 
Published: June 2020

AbstractIn this paper, I assess the employment and income effect of divorce for women in West Germany between 2000 and 2005. With newly available administrative data that allows me to adopt a causal approach, I find strong negative employment effects with respect to marginal employment and strong positive effects with respect to regular employment. However, in sum, the overall employment rate (marginal and regular employment combined) is not affected. Furthermore, the lower the labor market attachment before separation is, the more pronounced employment effects are. In addition, I also estimate the impact of divorce on daily gross incomes. I find no convincing evidence for an income effect. I conclude that a divorce might have a pure labor supply effect only.
Pseudoscorpion Wolbachia symbionts: diversity and evidence for a new supergroup S
Authors: Lefoulon Emilie , Clark Travis , Borveto Fanni , Perriat-Sanguinet Marco , Moulia Catherine , Slatko Barton E. , Gavotte Laurent 
Published: June 2020

Abstract
Background
Wolbachia are the most widely spread endosymbiotic bacteria, present in a wide variety of insects and two families of nematodes. As of now, however, relatively little genomic data has been available. The Wolbachia symbiont can be parasitic, as described for many arthropod systems, an obligate mutualist, as in filarial nematodes or a combination of both in some organisms. They are currently classified into 16 monophyletic lineage groups (“supergroups”). Although the nature of these symbioses remains largely unknown, expanded Wolbachia genomic data will contribute to understanding their diverse symbiotic mechanisms and evolution.

Results
This report focuses on Wolbachia infections in three pseudoscorpion species infected by two distinct groups of Wolbachia strains, based upon multi-locus phylogenies. Geogarypus minor harbours wGmin and Chthonius ischnocheles harbours wCisc, both closely related to supergroup H, while Atemnus politus harbours wApol, a member of a novel supergroup S along with Wolbachia from the pseudoscorpion Cordylochernes scorpioides (wCsco). Wolbachia supergroup S is most closely related to Wolbachia supergroups C and F. Using target enrichment by hybridization with Wolbachia-specific biotinylated probes to capture large fragments of Wolbachia DNA, we produced two draft genomes of wApol. Annotation of wApol highlights presence of a biotin operon, which is incomplete in many sequenced Wolbachia genomes.

Conclusions
The present study highlights at least two symbiont acquisition events among pseudoscorpion species. Phylogenomic analysis indicates that the Wolbachia from Atemnus politus (wApol), forms a separate supergroup (“S”) with the Wolbachia from Cordylochernes scorpioides (wCsco). Interestingly, the biotin operon, present in wApol, appears to have been horizontally transferred multiple times along Wolbachia evolutionary history.
A novel VPS13B mutation in Cohen syndrome: a case report and review of literature
Authors: Momtazmanesh Sara , Rayzan Elham , Shahkarami Sepideh , Rohlfs Meino , Klein Christoph , Rezaei Nima 
Published: June 2020

Abstract
Background
Cohen syndrome, an autosomal recessive syndrome, is a rare syndrome with diverse clinical manifestations including failure to thrive, hypotonia, hypermobile joints, microcephaly, intellectual disabilities, craniofacial and limb anomalies, neutropenia and a friendly character. It is associated with mutations of the vacuolar protein sorting 13 homolog B (VPS13B) gene, which is involved in the development of the ocular, hematological and central nervous systems. This gene encodes a transmembrane protein playing a crucial role in preserving the integrity of the Golgi complex. To date, more than 150 mutations of VPS13B have been reported in over 200 Cohen syndrome patients. Missense or nonsense mutations are the most common mutations.

Case presentation
A 4-year-old girl, born to consanguineous parents, was referred to the pediatric clinical immunology outpatient clinic for investigation of recurrent neutropenia with a history of recurrent infections in the past year. On physical examination, she had the characteristic facial features of Cohen syndrome, developmental delay and speech disorder. She had a cheerful disposition, and her mother gave a history of feeding difficulties in her first months of life. She did not present any ophthalmologic or cardiac abnormalities. Her lab results revealed moderate neutropenia. Serum IgG, IgM, IgA and IgE levels were normal. She fulfilled the clinical diagnostic criteria for Cohen syndrome. WES revealed a novel homozygous frameshift variant in VPS13B (LRG_351t1: c.7095del; p.Ser2366AlafsTer49). Currently, she is not experiencing any severe problem, and she undergoes irregular medical treatment once her neutrophil count decreases under the normal limit. Her verbal and motor abilities have improved as a result of speech and occupational therapies.

Conclusion
We reported a novel homozygous frameshift variant in VPS13B (LRG_351t1: c.7095del; p.Ser2366AlafsTer49) in a 4-year-old girl with Cohen syndrome. Cohen syndrome should be considered in differential diagnosis of any child with intellectual disability and neutropenia.
Analytical evaluation of the clonoSEQ Assay for establishing measurable (minimal) residual disease in acute lymphoblastic leukemia, chronic lymphocytic leukemia, and multiple myeloma
Authors: Ching Travers , Duncan Megan E. , Newman-Eerkes Tera , McWhorter Mollie M. E. , Tracy Jeffrey M. , Steen Michelle S. , Brown Ryan P. , Venkatasubbarao Srivatsa , Akers Nicholas K. , Vignali Marissa , Moorhead Martin E. , Watson Drew , Emerson Ryan O. , Mann Tobias P. , Cimler B. Melina , Swatkowski Pamela L. , Kirsch Ilan R. , Sang Charles , Robins Harlan S. , Howie Bryan , Sherwood Anna 
Published: June 2020

Abstract
Background
The clonoSEQ® Assay (Adaptive Biotechnologies Corporation, Seattle, USA) identifies and tracks unique disease-associated immunoglobulin (Ig) sequences by next-generation sequencing of IgH, IgK, and IgL rearrangements and IgH-BCL1/2 translocations in malignant B cells. Here, we describe studies to validate the analytical performance of the assay using patient samples and cell lines.

Methods
Sensitivity and specificity were established by defining the limit of detection (LoD), limit of quantitation (LoQ) and limit of blank (LoB) in genomic DNA (gDNA) from 66 patients with multiple myeloma (MM), acute lymphoblastic leukemia (ALL), or chronic lymphocytic leukemia (CLL), and three cell lines. Healthy donor gDNA was used as a diluent to contrive samples with specific DNA masses and malignant-cell frequencies. Precision was validated using a range of samples contrived from patient gDNA, healthy donor gDNA, and 9 cell lines to generate measurable residual disease (MRD) frequencies spanning clinically relevant thresholds. Linearity was determined using samples contrived from cell line gDNA spiked into healthy gDNA to generate 11 MRD frequencies for each DNA input, then confirmed using clinical samples. Quantitation accuracy was assessed by (1) comparing clonoSEQ and multiparametric flow cytometry (mpFC) measurements of ALL and MM cell lines diluted in healthy mononuclear cells, and (2) analyzing precision study data for bias between clonoSEQ MRD results in diluted gDNA and those expected from mpFC based on original, undiluted samples. Repeatability of nucleotide base calls was assessed via the assay’s ability to recover malignant clonotype sequences across several replicates, process features, and MRD levels.

Results
LoD and LoQ were estimated at 1.903 cells and 2.390 malignant cells, respectively. LoB was zero in healthy donor gDNA. Precision ranged from 18% CV (coefficient of variation) at higher DNA inputs to 68% CV near the LoD. Variance component analysis showed MRD results were robust, with expected laboratory process variations contributing ≤3% CV. Linearity and accuracy were demonstrated for each disease across orders of magnitude of clonal frequencies. Nucleotide sequence error rates were extremely low.

Conclusions
These studies validate the analytical performance of the clonoSEQ Assay and demonstrate its potential as a highly sensitive diagnostic tool for selected lymphoid malignancies.
Impact of obesity and metabolic health status in the development of non-alcoholic fatty liver disease (NAFLD): A United Kingdom population-based cohort study using the health improvement network (THIN)
Authors: Vusirikala A. , Thomas T. , Bhala N. , Tahrani A. A. , Thomas G. N. , Nirantharakumar K. 
Published: June 2020

Abstract
Background
With the obesity epidemic reaching crisis levels, there has been attention around those who may be resilient to the effects of obesity, termed metabolically healthy obesity (MHO), who initially present without associated metabolic abnormalities. Few longitudinal studies have explored the relationship between MHO and non-alcoholic fatty liver disease (NAFLD), which we address using over 4 million primary care patient records.

Methods
A retrospective population-based longitudinal cohort was conducted using The Health Improvement Network (THIN) database incorporating adults with no history of NAFLD or alcohol excess at baseline. Individuals were classified according to BMI category and metabolic abnormalities (diabetes, hypertension and dyslipidaemia). Diagnosis of NAFLD during follow-up was the primary outcome measure. NAFLD was identified by Read codes.

Results
During a median follow-up period of 4.7 years, 12,867 (0.3%) incident cases of NAFLD were recorded in the cohort of 4,121,049 individuals. Compared to individuals with normal weight and no metabolic abnormalities, equivalent individuals who were overweight, or obese were at significantly greater risk of incident NAFLD (Adjusted HR 3.32 (95%CI 2.98–3.49), and 6.92 (6.40–7.48, respectively). Metabolic risk factors further increased risk, including in those with normal weight and 1 (2.27, 1.97–2.61) or = < 2 (2.39, 1.99–2.87) metabolic abnormalities.

Conclusions
MHO individuals are at greater risk of developing NAFLD compared to those with normal weight. This finding supports that the MHO phenotype is a temporary state, and weight must be considered a risk factor even before other risk factors develop. Being normal weight with metabolic abnormalities was also associated with risk of NAFLD.