bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical referrals in Northern Tanzania: a prospective assessment of rates, preventability, reasons and patterns
Authors: Jumbam Desmond T. , Menon Gopal , Lama Tenzing N. , Lodge II William , Maongezi Sarah , Kapologwe Ntuli A. , Citron Isabelle , Barash David , Varallo John , Barringer Erin , Cainer Monica , Ulisubisya Mpoki , Alidina Shehnaz , Nguhuni Boniface 
Published: August 2020

AbstractBackgroundAn effective referral system is essential for a high-quality health system that provides safe surgical care while optimizing patient outcomes and ensuring efficiency. The role of referral systems in countries with under-resourced health systems is poorly understood. The aim of this study was to examine the rates, preventability, reasons and patterns of outward referrals of surgical patients across three levels of the healthcare system in Northern Tanzania.MethodsReferrals from surgical and obstetric wards were assessed at 20 health facilities in five rural regions prospectively over 3 months. Trained physician data collectors used data collection forms to capture referral details daily from hospital referral letters and through discussions with clinicians and nurses. Referrals were deemed preventable if the presenting condition was one that should be managed at the referring facility level per the national surgical, obstetric and anaesthesia plan but was referred.ResultsSeven hundred forty-three total outward referrals were recorded during the study period. The referral rate was highest at regional hospitals (2.9%), followed by district hospitals (1.9%) and health centers (1.5%). About 35% of all referrals were preventable, with the highest rate from regional hospitals (70%). The most common reasons for referrals were staff-related (76%), followed by equipment (55%) and drugs or supplies (21%). Patient preference accounted for 1% of referrals. Three quarters of referrals (77%) were to the zonal hospital, followed by the regional hospitals (17%) and district hospitals (12%). The most common reason for referral to zonal (84%) and regional level (66%) hospitals was need for specialist care while the most common reason for referral to district level hospitals was non-functional imaging diagnostic equipment (28%).ConclusionsImproving the referral system in Tanzania, in order to improve quality and efficiency of patient care, will require significant investments in human resources and equipment to meet the recommended standards at each level of care. Specifically, improving access to specialists at regional referral and district hospitals is likely to reduce the number of preventable referrals to higher level hospitals, thereby reducing overcrowding at higher-level hospitals and improving the efficiency of the health system.
Segmentation of health-care consumers: psychological determinants of subjective health and other person-related variables
Authors: Bloem Sjaak , Stalpers Joost , Groenland Edward A. G. , van Montfort Kees , van Raaij W. Fred , de Rooij Karla 
Published: August 2020

Abstract
Background
There is an observable, growing trend toward tailoring support programs – in addition to medical treatment – more closely to individuals to help improve patients’ health status. The segmentation model developed by Bloem & Stalpers [Nyenrode Research Papers Series 12:1–22, 2012] may serve as a solid basis for such an approach. The model is focused on individuals’ ‘health experience’ and is therefore a ‘cross-disease’ model. The model is based on the main psychological determinants of subjective health: acceptance and perceived control. The model identifies four segments of health-care consumers, based on high or low values on these determinants. The goal of the present study is twofold: the identification of criteria for differentiating between segments, and profiling of the segments in terms of socio-demographic and socio-economic variables.

Methods
The data (acceptance, perceived control, socio-economic, and socio-demographic variables) for this study were obtained by using an online survey (a questionnaire design), that was given (random sample N = 2500) to a large panel of Dutch citizens. The final sample consisted of 2465 participants – age distribution and education level distribution in the sample were similar to those in the Dutch population; there was an overrepresentation of females. To analyze the data factor analyses, reliability tests, descriptive statistics and t-tests were used.

Results
Cut-off scores, criteria to differentiate between the segments, were defined as the medians of the distributions of control and acceptance. Based on the outcomes, unique profiles have been formed for the four segments: 1. ‘Importance of self-management’ – relatively young, high social class, support programs: high-quality information. 2. ‘Importance of personal control’ – relatively old, living in rural areas, high in homeownership; supportive programs: developing personal control skills. 3. ‘Importance of acceptance’ – relatively young male; supportive programs: help by physicians and nurses. 4. ‘Importance of perspective and direction’ – female, low social class, receiving informal care; support programs: counseling and personal care.

Conclusions
The profiles describe four segments of individuals/patients that are clearly distinct from each other, each with its own description. The enriched descriptions provide a better basis for the allocation and developing of supportive programs and interventions across individuals.
Certification as support for resilience? Behind the curtains of a certification body — a qualitative study
Authors: Johannesen Dag Tomas Sagen , Lindøe Preben Hempel , Wiig Siri 
Published: August 2020

AbstractBackgroundCertification in healthcare often involves independent private sector bodies performing legally required or voluntary external assurance activities. These certification practices are embedded in international standards founded in traditional beliefs about rational and predictable processes for quality and safety improvement. Certification can affect organizational and cultural changes, support collaboration and encourage improvement that may be conducive to resilient performance. This study explores whether ISO 9001 quality management system certification can support resilience in healthcare, by looking at characteristics in the objectives, methods, and practice of certification from a certification body’s perspective.MethodsOne of Norway’s four certification bodies in healthcare was studied, using an explorative embedded single-case design. The study relies on document analysis of the international standards and associated guidances for the performance of certification bodies and thematic analyses of data from 60 h of observations of auditors in three certification processes and nine qualitative interviews with managers and personnel from the certification body. Results from the analyses were compared to identify discrepancies between the written and perceived certification approach and practice.ResultsStandards and guidances for certification embed an elasticity between formal and consistent assessments of nonconformities in organizations and emphasize holistic approaches that brings added value. Auditors were then left with the latitude to navigate their auditing strategy during interaction with the auditees. Members of the certification body perceived and practiced a holistic and flexible auditing approach using opportunities to share knowledge, empower and make guidance for improvement.ConclusionsISO certification expects structures and systems to ensure consistent and objective certification processes. At the same time, it embodies a latitude to adopt flexible and context-specific certification approaches, as demonstrated by a certification body in this study, to give added value to the certified organizations. Such an ISO 9001 certification approach may support resilient performance in healthcare by nurturing the potential to respond and learn. These results are important for further development of methods that certification bodies use in the auditing encounter.
A comparison of four different models of acute respiratory distress syndrome in sheep
Authors: Engel Monique , Nowacki Relana M. E. , Jonker Elly M. , Ophelders Daan , Nikiforou Maria , Kloosterboer Nico , Zimmermann Luc J. I. , van Waardenburg Dick A. , Kramer Boris W. 
Published: August 2020

AbstractBackgroundAcute respiratory distress syndrome (ARDS) can have various causes. The study objective was to investigate whether different pathophysiologic models of ARDS would show different respiratory, cardiovascular and inflammatory outcomes.MethodsWe performed a prospective, randomized study in 27 ventilated ewes inducing ARDS using three different techniques to mimic the pulmonary causes of ARDS (ARDSp): warm saline lavage (n = 6), intratracheal hydrochloric acid (HCl; n = 6), intratracheal albumin (n = 10), and one technique to mimic an extrapulmonary cause of ARDS (ARDSexp): intravenous lipopolysaccharide (LPS iv;n = 5). ARDS was defined when PaO2was < 15 kPa (112 mmHg) when ventilated with PEEP 10 cm H2O and FiO2 = 1.0. The effects on gas exchange were investigated by calculating the oxygenation index (OI) and the ventilation efficacy index (VEI) every 30 min for a period of 4 h. Post mortem lung lavage was performed to obtain broncho-alveolar lavage fluid (BALF) to assess lung injury and inflammation. Lung injury and inflammation were assessed by measuring the total number and differentiation of leukocytes, the concentration of protein and disaturated phospholipids, and interleukine-6 and -8 in the BALF. Histology of the lung was evaluated by measuring the mean alveolar size, alveolar wall thickness and the lung injury score system by Matute-Bello et al., as markers of lung injury. The concentration of interleukin-6 was determined in plasma, as a marker of systematic inflammation.ResultsThe OI and VEI were most affected in the LPS iv group and thereafter the HCl group, after meeting the ARDS criteria. Diastolic blood pressure was lowest in the LPS iv group. There were no significant differences found in the total number and differentiation of leukocytes, the concentration of protein and disaturated phospholipids, or interleukin-8 in the BALF, histology of the lung and the lung injury score. IL-6 in BALF and plasma was highest in the LPS iv group, but no significant differences were found between the other groups. It took a significantly longer period of time to meet the ARDS criteria in the LPS iv group.ConclusionsThe LPS model caused the most severe pulmonary and cardiovascular insufficiency. Surprisingly, there were limited significant differences in lung injury and inflammatory markers, despite the different pathophysiological models, when the clinical definition of ARDS was applied.
Significance of tumor mutation burden combined with immune infiltrates in the progression and prognosis of ovarian cancer
Authors: Bi Fangfang , Chen Ying , Yang Qing 
Published: August 2020

Abstract
Background
Ovarian cancer (OC) is the most malignant tumor in the female reproductive system. About 75% of OC in complete remission of clinical symptoms still develop a recurrence. Therefore, searching for new treatment methods plays an important role in improving the prognosis of OC.

Methods
We downloaded the MAF files, RNA-seq data and clinical information from the TCGA database. The “maftools” package in R software was used to visualize the OC mutation data. We calculated the tumor mutation burden (TMB) of OC and analyzed its correlation with clinicopathological parameters and prognostic value. Tumor mutation burden related signature model was constructed to predict the overall survival (OS) of OC.

Results
The results revealed that there was a statistical correlation between TMB and FIGO stage, grade and tumor residual size of ovarian cancer patients. The Kaplan–Meier curve indicated that a high TMB is associated with better clinical outcomes of OC. The difference analysis indicated 24 upregulated genes and 619 downregulated genes in the high-TMB group compared with the low-TMB group. Besides, the TMBRS model based on five hub genes (RBMS3, PLA2G5, CDH2, AMHR2 and ADAMTS8) was constructed to predict the OS of OC. The ROC curve and validation data sets all revealed that the TMBRS model was reliable in predicting recurrence risk. Immune microenvironment analysis indicated the correlations between TMB and infiltrating immune cells.

Conclusions
Our results suggest that TMB plays an important role in the prognosis and guiding immunotherapy of OC. By detecting the TMB of OC, clinicians can more accurately treat patients with immunotherapy, thereby improving their survival rate.
Association between triglyceride glucose index and obstructive sleep apnea risk in Korean adults: a cross-sectional cohort study
Authors: Kang Hyeon Hui , Kim Sei Won , Lee Sang Haak 
Published: August 2020

AbstractBackgroundTriglyceride glucose (TyG) index is a reliable marker of insulin resistance, which is linked to obstructive sleep apnea (OSA). However, the relationship between TyG index and OSA has not been adequately assessed. This study aimed to evaluate the association between TyG index and OSA.MethodsTyG index was assessed in 180 (mean age: 48.6 ± 13.8 years; 73.9% male) consecutive Korean adults with suspected OSA admitted to the sleep clinic at St. Paul’s Hospital between 2010 and 2012. The occurrence of more than 5 apnea-hypopnea index (AHI) events/h was used to define OSA. TyG index was calculated using the following equation: In [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. All participants were grouped according to TyG index tertiles. Multivariate logistic regression analysis was used to determine factors associated with increased OSA risk.ResultsThe overall prevalence of OSA in study participants was determined to be 83.9%. The prevalence of OSA increased (I [lowest]: 71.6%; II: 88.7%; III [highest]: 91.4%), and lowest peripheral oxygen saturation (SpO2) levels decreased (I: 83.3 ± 8.5%; II: 79.9 ± 8.7%; III: 79.0 ± 8.3%), as TyG index tertile increased (P < 0.05). TyG index was correlated with AHI (r = 0.179) and lowest SpO2(r = − 0.188) (P < 0.05, respectively). Univariate linear regression analysis revealed an association between TyG and AHI (β = 10.084;P = 0.016). Multivariate logistic regression analysis showed that TyG index (odds ratio [OR]: 3.348; 95% confidence interval [CI]: 1.081–10.372), age ≥ 55 years (OR: 5.426; 95% CI: 1.642–17.935), and obesity (OR: 3.801; 95% CI: 1.468–9.842) were associated with increased OSA risk (allP < 0.05). The optimal TyG index cut-off value for predicting OSA was 8.83 (sensitivity: 61.6%; specificity: 69.0%; area under the curve: 0.688;P = 0.001). The predictive value of the OSA cut-off value improved when age ≥ 55 years and obesity were considered.ConclusionIncreased TyG index was independently associated with increased OSA risk.
The adaptation of sport assessment-patella questionnaire into simplified Chinese version: cross-cultural adaptation, reliability and validity
Authors: Weng Weizong , Zhi Xin , Jia Zhenyu , Liu Shanshan , Huang Jianming , Wan Fang , He Jia , Chen Shiyi , Cui Jin 
Published: August 2020

Abstract
Background
The original version of Victorian Institute of Sport Assessment-Patella Questionnaire (VISA-P) is developed in English, and aimed to assess the severity of patellar tendinopathy symptoms. Before used in China, it should be translated to Chinese version.

Objectives
Our aim is to make a translation/cross-culturally adaption for the VISA-P into simplified Chinese version (VISA-PC). And primarily validate the VISA-PC in Chinese speaking population.

Methods
The translation process of VISA-P questionnaire into simplified Chinese version (VISP-PC) followed the International recognized guideline. Cross-cultural adaptation was carried out with a clinical measurement study. A total of 128 projects which consisted 33 healthy students, 39 patients with patellar tendinopathy and 56 military students (receive military training as at-risk population) were included into this study. Internal consistency was evaluated with Cronbach’s alpha, and test-retest reliability was assessed with intraclass correlation coefficients (ICCs). Construct validity and floor and ceiling effects were also tested.

Results
The scores were 95.84 ± 5.97 of healthy group, 91.87 ± 9.03 of at-risk group, 62.49 ± 11.39 of pathological group. There is no ceiling and floor effect of VISA-PC. The Cronbach’s alpha (0.895) and ICC (0.986) values showed good internal consistency and reliability. There were high correlations between VISA-PC and Kujala patellofemoral score (r = 0.721). VISA-PC score also had good correlation with the relevant SF-36 items.

Conclusion
The VISA-PC was well translated into simplified Chinese version (VISA-PC), which is reliable and valid for Chinese-speaking patients with patellar tendinopathy.

Level of evidence
II.
Erythropoietin prevents necrotizing enterocolitis in very preterm infants: a randomized controlled trial
Authors: Wang Yong , Song Juan , Sun Huiqing , Xu Falin , Li Kenan , Nie Chunxia , Zhang Xiaoli , Peng Xirui , Xia Lei , Shen Ziyun , Yuan Xiao , Zhang Shan , Ding Xue , Zhang Yaodong , Kang Wenqing , Qian Liling , Zhou Wenhao , Wang Xiaoyang , Cheng Xiuyong , Zhu Changlian 
Published: August 2020

AbstractBackgroundNecrotizing enterocolitis (NEC) is one of the most severe complications in very preterm infants, but there are currently no accepted methods to prevent NEC. Studies have shown that erythropoietin (EPO) has the potential to prevent NEC or improve outcomes of preterm NEC. This study aimed to determine whether recombinant human EPO (rhEPO) could protect against NEC in very preterm infants.MethodsThe study was a prospective randomized clinical trial performed among four NICU centers. A total of 1327 preterm infants with gestational age ≤ 32 weeks were admitted to the centers, and 42 infants were excluded leaving 1285 eligible infants to be randomized to the rhEPO or control group. Infants in the rhEPO group were given 500 IU/kg rhEPO intravenously every other day for 2 weeks, while the control group was given the same volume of saline. The primary outcome was the incidence of NEC in very preterm infants at 36 weeks of corrected gestational age.ResultsA total of 1285 infants were analyzed at 36 weeks of corrected age for the incidence of NEC. rhEPO treatment significantly decreased the incidence of NEC (stage I, II and III) (12.0% vs. 17.1%,p = 0.010), especially confirmed NEC (stage II and III) (3.0% vs. 5.4%,p = 0.027). Meanwhile, rhEPO treatment significantly reduced the number of red blood cells transfusion in the confirmed NEC cases (1.2 ± 0.4 vs. 2.7 ± 1.0,p = 0.004). Subgroup analyses showed that rhEPO treatment significantly decreased the incidence of confirmed NEC at gestational age < 28 weeks (p = 0.019), and the incidence of all stages NEC in preterm infants with hemoglobin < 90 g/l (p = 0.000) and 5 min Apgar score > 5 (p = 0.028).ConclusionRepeated low-dose rhEPO treatment is beneficial against NEC in very preterm infants.Trial registrationThe protocol was registered retrospectively at ClinicalTrials.gov (NCT03919500) on April 18, 2019.https://clinicaltrials.gov/ct2/show/NCT03919500
Maize tassels detection: a benchmark of the state of the art
Authors: Zou Hongwei , Lu Hao , Li Yanan , Liu Liang , Cao Zhiguo 
Published: August 2020

Abstract
Background
The population of plants is a crucial indicator in plant phenotyping and agricultural production, such as growth status monitoring, yield estimation, and grain depot management. To enhance the production efficiency and liberate labor force, many automated counting methods have been proposed, in which computer vision-based approaches show great potentials due to the feasibility of high-throughput processing and low cost. In particular, with the success of deep learning, more and more deeper learning-based approaches are introduced to deal with agriculture automation. Since different detection- and regression-based counting models have distinct characteristics, how to choose an appropriate model given the target task at hand remains unexplored and is important for practitioners.

Results
Targeting in-field maize tassels as a representative case study, the goal of this work is to present a comprehensive benchmark of state-of-the-art object detection and object counting methods, including Faster R-CNN, YOLOv3, FaceBoxes, RetinaNet, and the leading counting model of maize tassels—TasselNet. We create a Maize Tassel Detection Counting (MTDC) dataset by supplementing bounding box annotations to the Maize Tassels Counting (MTC) dataset to allow the training of detection models. We investigate key factors effecting the practical applications of the models, such as convergence behavior, scale robustness, speed-accuracy trade-off, as well as parameter sensitivity. Based on our benchmark, we summarise the advantages and limitations of each method and suggest several possible directions to improve current detection- and regression-based counting approaches to benefit next-generation intelligent agriculture.

Conclusions
Current state-of-the-art detection- and regression-based counting approaches can all achieve a relatively high degree of accuracy when dealing with in-field maize tassels, with at least 0.85 $$R^2$$

R
2

values and 28.2% rRMSE error. While detection-based methods are more robust than regression-based methods in scale variations and can infer extra information (e.g., object positions and sizes), the latter ones have significantly faster convergence behaviors and inference speed. To choose an appropriate in-filed plant counting method, accuracy, robustness, speed and some other algorithm-specific factors should be taken into account with the same priority. This work sheds light on different aspects of existing detection and counting approaches and provides guidance on how to tackle in-field plant counting. The MTDC dataset is made available at https://git.io/MTDC