bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: A retrospective cohort study
Authors: Sawaya Rasha , Wakil Cynthia , Wazir Adonis , Shayya Sami , Berbari Iskandar , Safa Rawan , Makki Maha , Hamade Mahdi , Tamim Hani 
Published: July 2020

Abstract
Background: Managing children with minor head trauma remains challenging for physicians who evaluate for the need for computed tomography (CT) imaging for clinically important traumatic brain injury (ciTBI) identification. The Pediatric Emergency Care Applied Research Network (PECARN) prediction rules were adopted in our pediatric emergency department (PED) in December 2013 to identify children at low risk for ciTBI. This study aimed to evaluate this implementation’s impact on CT rates and clinical outcomes. Methods: Retrospective cohort study on pediatric patients with head trauma presenting to the PED of the American University of Beirut Medical Center in Lebanon. Participants were divided into pre- (December 2012 to 2013) and post-PECARN (January 2014 to December 2016) groups. Patients were further divided into <2 and ≥2 years and stratified into groups of low, intermediate and high risk for ciTBI. Bivariate analysis was conducted to determine differences between both groups. Results: We included 1362 children of which 425 (31.2%) presented pre- and 937 (68.8%) presented post-PECARN rules implementation with 1090 (80.0%) of low, 214 (15.7%) of intermediate and 58 (4.3%) of high risk for ciTBI. CTs were ordered on 92 (21.6%) pre- versus 174 (18.6%) patients post-PECARN (p=0.18). Among patients <2 years, CT rates significantly decreased from 25.2% (34/135) to 16.5% (51/309) post-PECARN (p=0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% (24/116) to 11.4% (30/264) (p=0.02). There was no significant decrease in CT rates in patients ≥2 years (20% pre (58/290) vs 19.6% post (123/628), p=0.88). There was no increase in bounce back numbers, nor in admission rates or positive CT findings among bounce backs. Conclusions: PECARN rules implementation did not significantly change the overall CT scan rate but reduced the CT scan rate in patients aged <2 years at low risk of ciTBI. The implementation did not increase the number of missed ciTBI.
Deep learning vs. atlas-based models for fast auto-segmentation of the masticatory muscles on head and neck CT images
Authors: Chen Wen , Li Yimin , Dyer Brandon A , Feng Xue , Rao Shyam , Benedict Stanley H. , Chen Quan , Rong Yi 
Published: July 2020

Abstract
Background: Impaired function of masticatory muscles will lead to trismus. Routine delineation of these muscles during planning may improve dose tracking and facilitate dose reduction resulting in decreased radiation-related trismus. This study aimed to compare a deep learning model with a commercial atlas-based model for fast auto-segmentation of the masticatory muscles on head and neck computed tomography (CT) images. Material and methods: Paired masseter (M), temporalis (T), medial and lateral pterygoid (MP, LP) muscles were manually segmented on 56 CT images. CT images were randomly divided into training (n=27) and validation (n=29) cohorts. Two methods were used for automatic delineation of masticatory muscles (MMs): Deep learning auto-segmentation (DLAS) and atlas-based auto-segmentation (ABAS). The automatic algorithms were evaluated using Dice similarity coefficient (DSC), recall, precision, Hausdorff distance (HD), HD95, and mean surface distance (MSD). A consolidated score was calculated by normalizing the metrics against interobserver variability and averaging over all patients. Differences in dose (∆Dose) to MMs for DLAS and ABAS segmentations were assessed. A paired t-test was used to compare the geometric and dosimetric difference between DLAS and ABAS methods.Results: DLAS outperformed ABAS in delineating all MMs (p < 0.05). The DLAS mean DSC for M, T, MP, and LP ranged from 0.83±0.03 to 0.89±0.02, the ABAS mean DSC ranged from 0.79±0.05 to 0.85±0.04. The mean value for recall, HD, HD95, MSD also improved with DLAS for auto-segmentation. Interobserver variation revealed the highest variability in DSC and MSD for both T and MP, and the highest scores were achieved for T by both automatic algorithms. With few exceptions, the mean ∆D98%, ∆D95%, ∆D50%, and ∆D2% for all structures were below 10% for DLAS and ABAS and had no detectable statistical difference (P >0.05). DLAS based contours had dose endpoints more closely matched with that of the manually segmented when compared with ABAS. Conclusions: DLAS auto-segmentation of masticatory muscles for the head and neck radiotherapy had improved segmentation accuracy compared with ABAS with no qualitative difference in dosimetric endpoints compared to manually segmented contours.
Sensitization to cat and dog components and prediction of symptoms in cat-sensitized children.
Authors: Smejda Katarzyna , Jerzyńska Joanna , Podlecka Daniela , Brzozowska Agnieszka 
Published: July 2020

Abstract
Background: Sensitization to cat and/or dog allergens during childhood represents a risk factor for the development of allergic diseases later in life.Material and Methods: The study investigated the association of patterns of sensitization to cat and dog allergen components with clinical symptoms of allergy to these furry animals among cat-sensitized children. It included 50 children aged 5-17 years who showed sensitization to cat in the skin prick test. They were considered to have cat allergy if they suffered from one or more allergy symptoms when being exposed to contact with a cat. The children were evaluated for the presence of bronchial asthma, atopic dermatitis and allergic rhinitis. Their mothers completed a questionnaire on pet exposure at home. Levels of serum IgE cat epitopes Fel d (1, 2, 4), as well as dog components Can f (1, 2, 3, 5) were measured in all the studied children.Results: Respiratory symptoms following exposure to the cat allergen were most common in children with Fel d 2 epitope (p = 0.041). After contact with a dog, respiratory symptoms were most common in children with Can f 1 epitope (p = 0.042), eczema in children with sensitization to both Can f 1 (p = 0.009) and Can f 2 (p = 0.002), whereas eye symptoms occurred mostly in children with Can f 3 (p = 0.039).Conclusions: Molecular diagnosis in patients with pet allergy may help clinicians to predict clinical symptoms and their severity.
Adjuvant Therapy by High-Speed Burr May Cause Intraoperative Bone Tumor Seeding: an animal study
Authors: Wang Pai-han , Wu Chia-Lun , Chen Chao-Ming , Wang Jir‐You , Wu Po-Kuei , Chen Wei-Ming 
Published: July 2020

Abstract
Background Bone tumors are often treated with intralesional curettage. High-speed burring, an adjuvant therapy, was performed to maximize the tumor cell killing; however, tumor recurrence might still occur, which may be caused by residual tumor or local tumor spread during surgery. Methods A porcine cadaver (femur) was utilized to determine whether the use of a high-speed burr causes bone cement spray. To mimic residual tumor after curettage, luminescent cement was smeared on two locations of the bone cavity, the wall and the bottom. The cavity in the femoral bone was then placed in the middle of a sheet of drawing paper featuring 10 cm, 20 cm, and 30 cm concentric circles. The luminescent cement was then burred totally with a high-speed burr. Results The intensity of the area in the wall in circle I was 72.6% ± 5.8%; within circle II, it was 22.1% ± 4.2%; and within circle III, it was 5.4% ± 1.5%. The intensity of the area within the bottom of the femoral bone within circle I was 66.5% ± 6.1%, within circle II was 28.1 ± 4.8%, and within circle III, it was 5.4% ± 1.4%. The amount of luminescent cement seeding decreased with distance, but there was no difference while burring at different locations of the bone cavity. Under the handpiece cover, a greater amount of cement spray was retained in circle I during burring of the cement in the bottom of the cavity and less was sprayed out in circle III. Conclusions High-speed burring may cause explosive bone cement spray, which could extend to 20 cm. The intensities of spray did not decrease, even when the handpiece cover was used. The wide range of bone cement spray caused by high-speed burr was inspected in this pilot study, which may lead to tumor seeding.
Predictors of Mental Health Problems in Formal and Informal Caregivers of Patients with Alzheimer's Disease
Authors: Sołtys Anna , Tyburski Ernest 
Published: July 2020

Abstract
Background: Caring for a person with Alzheimer's disease (AD) is associated with significant mental burden e.g., depression and anxiety, and difficulties with social, familial, and professional functioning. To date, few studies have examined variables which would allow for a comprehensive and detailed study of the relationship between personal resources and caregiver health status, with a majority of studies focusing on factors that contribute to increased caregiver's burden. Moreover, the available evidence fails to address differences in the functioning of formal and informal carers. Paying proper attention to the problems of nursing home staff can help identify important risk factors. Therefore, this study compared mental health problems in informal and formal caregivers and examined the relationship between mental resources and mental health problems in both groups of caregivers. Methods: This cross-sectional study examined 100 formal (n = 50) and informal (n = 50) caregivers of AD patients. Personal resources were measured with the Social Support Questionnaire (SSQ), the Generalized Self-Efficacy Scale (GSES), and the Sense of Coherence Questionnaire (SCQ), while mental health was assessed with the Depression Assessment Questionnaire (DAQ) and the General Health Questionnaire (GHQ). Multivariate stepwise regression was performed separately for both investigated groups. Results: There were no significant differences between informal and formal caregivers in terms of psychological variables, i.e., sense of coherence, social support, self-efficacy, or mental health problems. In contrast, there were different significant predictors of mental health problems in both groups. Comprehensibility (SCQ) was a significant predictor of mental health problems measured by DAQ and self-efficacy (GSES) was a significant predictor of mental health problems measured by GHQ in informal caregivers. For formal caregivers, emotional support (SSQ) and comprehensibility (SCQ) were significant predictors of mental health problems measured by DAQ, while tangible support (SSQ) and meaningfulness (SCQ) were significant predictors of mental health problems measured by GHQ. Conclusions: Personal resources are significant predictors of mental health outcomes in caregivers of AD patients. Preventive actions should therefore include assessment of factors affecting caregivers’ mental health in order to provide them with necessary care and create appropriate support groups.
Grooved pegboard test performance before and after cerebral-spinal fluid tap test in patients with normal pressure hydrocephalus
Authors: Liu Caiyan , Dong Liling , Mao Chenhui , Li Jie , Huang Xinying , Wei Junji , Hou Bo , Feng Feng , Cui Liying , Gao Jing 
Published: July 2020

Abstract
Background Motor impairment in patients with normal pressure hydrocephalus (NPH) can extend beyond gait and include deficits in upper extremity functions and psychomotor speed. Evaluation of upper extremity function will be helpful for NPH patients who are unable to ambulate (e.g., wheelchair-bound patients) and may not be able to comply with the gait evaluation. Our study aimed to explore the use of the grooved pegboard test to assess responsiveness to the cerebrospinal fluid (CSF) tap test in patients with NPH. Methods Seventy-five possible NPH patients were enrolled from 2012 to 2018. All patients underwent detailed neuropsychological and walking assessments, CSF tap tests, and brain magnetic resonance imaging. The grooved pegboard test results before and after the CSF tap test were compared and correlated with the other clinical assessments. In diffusion tensor imaging analysis, the fractional anisotropy (FA) and mean diffusivity (MD) values of periventricular white matter were measured by the region of interest method and were correlated with pegboard test performance. Results The grooved pegboard test scores significantly improved after the CSF tap test and correlated with patient walking ability, cognitive function, and functional scores (P < 0.01). The improvement ratios in the complex visual motor speed index (i.e., the grooved pegboard test performance combined with the Symbol-Digit Modalities Test performance) were significantly different between the CSF tap test responder and nonresponder groups. The grooved pegboard test times were significantly correlated with the FA values in right periventricular lesions (P=0.017). Conclusions The performance on the grooved pegboard test was related to lower extremity motor ability and cognitive function. It can be used as an alternative evaluation tool for patients who are unable to ambulate and may not be able to comply with the gait evaluation.
Serial Multiple Mediation of the Association Between Internet Gaming Disorder and Suicidal Ideation by Insomnia and Depression in Adolescents in Shanghai, China
Authors: Yu Yuelin , Yang Xue , Wang Suping , Wang Huwen , Chang Ruijie , Tsamlag Lhakpa , Zhang Shuxian , Xu Chen , Yu Xiaoyue , Cai Yong , Lau Joseph TF 
Published: July 2020

Abstract
Background: High prevalence and strong relationships among suicidal ideation, Internet gaming disorder (IGD), insomnia, and depression have been reported for adolescents worldwide, but the mechanism underlying these psychological problems remains unclear. This cross-sectional study explored the mediating effect of insomnia and depression on the association between IGD and suicidal ideation.Methods: Participants were 1,066 adolescents (median age= 13.0 years) with Internet games exposure in the previous 12 months from junior high schools in Shanghai, China. Questionnaire measures of suicidal ideation, IGD, insomnia, depressive symptoms, and background characteristics were obtained. Path analysis was conducted to test the multiple mediating roles of insomnia and depression.Results: Suicidal ideation, IGD, insomnia, and depression prevalence was 27.2%, 13.6%, 9.2%, and 17.0%, respectively. A serial multiple mediation model was generated. The mediation effect of insomnia and depression on the pathway from IGD to suicidal ideation was 45.5% (direct effect: standardized estimate [Std. estimate] = 0.186; total indirect effect: Std. estimate = 0.155). The association between IGD and depression was partially mediated by insomnia (direct effect: Std. estimate = 0.211; indirect effect: Std. estimate = 0.135). The proposed model fit the data well.Conclusions: Insomnia and depression may serially mediate the association between IGD and suicidal ideation. IGD was positively associated with insomnia, then with depression, which in turn positively contributed to suicidal ideation. We suggest greater monitoring of Internet use and prevention of insomnia and depression to mitigate the risk of suicidal ideation among Chinese adolescents.
Caregivers' Perception of the Caring challenges in Coronavirus (COVID-19) Crisis: A Qualitative Study
Authors: Mohammadi Fateme , Farjam Mojtaba , Gholampour Yousef , Sohrabpour Mojtaba , Oshvandid Khodayar , Bijani Mostafa 
Published: July 2020

Abstract
Background

The medical personnel act as the guardians of people's health by preventing, controlling, and curing emerging diseases, including coronavirus, a highly infectious and contagious disease which has presented the caregivers in the Iranian healthcare system with many clinical challenges. The aim in present study was to describe the caregivers’ experiences of the caring challenges in patients with coronavirus (COVID-19).
Methods

The present study is a qualitative work with a phenomenological-descriptive design. Data were collected via semi-structured, in-depth, individual interviews. The collected data was analyzed according to Colaizzi's method. The participants were 23 members of the medical staff responsible for coronavirus patients in Iran who met the inclusion criteria. The participants were selected via purposeful sampling which was continued to the point of data saturation. The study lasted from February to May2020.
Results

The results yielded 3 main themes “invasion of psychological tension”, “inefficient management”, and “contextual factors” with 11 categories.
Conclusion

In dealing with coronavirus patients and providing quality care to them, medical personnel face a variety of clinical challenges which affect their performance. Administrators must, alongside giving instructions to people on how to prevent the coronavirus disease and taking effective security measures, make sure that clinical centers are managed efficiently in order for medical personnel to fulfill their caring objectives satisfactorily.
The Role of the Media on Parental Confidence in Provider HPV Recommendation
Authors: Walker Kimberly , Owens Heather , Zimet Gregory 
Published: July 2020

Abstract
Background
Despite a growing understanding of the importance of provider HPV recommendation on parental acceptance, US HPV vaccination rates remain suboptimal. Given the prevalence and use of the media for health decisions, this study examined the relationship between the media and provider HPV recommendation on parental HPV vaccine hesitancy.
Methods
Thirty individual interviews with vaccine accepting mothers in the Midwest were conducted to examine their experiences with initial hesitancy to accept HPV vaccination at point of provider recommendation and their suggestions for improving the HPV vaccine patient/provider recommendation experience.
Results
Results found that the media served as an antecedent to hesitancy for three main vaccination concerns: protection, efficacy and sexual stigma. A model for understanding the influence of the media as it relates to the three topical HPV vaccination concerns and its process on parental HPV vaccine decision making emerged.
Conclusions
Findings suggest that mothers experience hesitancies from passive and active HPV vaccination media information that prompt confusion and fear with accepting provider HPV vaccination recommendation. Providers’ approach to HPV vaccination recommendation must consider concerns reported in the media with delivery techniques modified to adjust to parental fears absorbed from adverse media information.
Urinary neutrophil gelatinase-associated lipocalin values alone and combined with Prognostic Index predict septic AKI, DIC, and shock: a pilot study
Authors: Shimoyama Yuichiro , Umegaki Osamu , Kadono Noriko , Minami Toshiaki 
Published: July 2020

Abstract
Objective: Sepsis is a syndrome involving life-threatening organ dysfunction. The present study aimed to determine whether septic AKI, ARDS, DIC, and shock can be predicted more readily by combining uNGAL values and inflammation-based prognostic scores, over the use of uNGAL values alone.Results: ROC curve analyses yielded the following cut-off values: AKI: 438.5 (ng/ml) for uNGAL at Day 1 (AUC, 0.8), 476.9 (ng/ml) for uNGAL at Day 2 (AUC, 0.86), 123.8 (ng/ml) for uNGAL at Day 3 (AUC, 0.81), 133.6 (ng/ml) for uNGAL at Day 4 (AUC, 0.78), 1.0 for iNS NGAL-NLR (AUC, 0.75), 2.0 for iNS NGAL-PI (AUC, 0.77), DIC; 648.5 (ng/ml) for uNGAL at Day 1 (AUC, 0.77); shock; 123.8 (ng/ml) for uNGAL at Day 3 (AUC, 0.71) and 9 for SOFA (AUC, 0.71). Multivariate logistic regression analyses revealed iNS NGAL-PI to be a significant independent predictor of AKI (OR, 20.62; 95%CI, 1.03-412.3; p=0.048).
­­­­­­Genomic analysis of worldwide sheep breeds reveals PDGFD as a major target of fat-tail selection in sheep
Authors: Dong Kunzhe , Yang Min , Han Jiangang , Ma Qing , Han Jilong , Song Ziyi , Luosang Cuicheng , Gorkhali Neena Amatya , Yang Bohui , He Xiaohong , Ma Yuehui , Jiang Lin 
Published: July 2020

Abstract
Background: Fat tail is a special trait in sheep acquired during sheep domestication. Several genomic analyses have been conducted in sheep breeds from limited geographic origins to identify the genetic factors underlying this trait. Nevertheless, these studies obtained different candidates. The results of these regional studies were easily biased by the breed structures. Results: To minimize the bias and distinguish the true candidates, we used an extended data set of 968 sheep representing 18 fat-tailed breeds and 14 thin-tailed breeds from around the world, and integrated two statistic tests to detect selection signatures, including Genetic Fixation Index (FST) and difference of derived allele frequency (ΔDAF). The results showed that platelet derived growth factor D (PDGFD) exhibited the highest genetic differentiation between fat- and thin-tailed sheep breeds. Further analysis of sequence variation identified that a 6.8-kb region within the first intron of PDGFD is likely the target of positive selection and contains regulatory mutation(s) in fat-tailed sheep. Histological analysis and gene expression analysis demonstrated that PDGFD expression is associated with maturation and hemostasis of adipocytes. Luciferase reporter assays showed that a segment of conserved sequence surrounding the orthologous site of one mutation found in sheep is functional in regulating PDGFD expression. Conclusions: These results reveal that PDGFD is the predominant factor for the fat tail phenotype in sheep by contributing to adiopogenesis and maintaining the hemostasis of mature adipocytes. This study provides insights into the evolution of fat-tailed sheep and has important application to animal breeding, as well as obesity-related human diseases.