bluuebunny/crossref_metadata_2025_split huggingface dataset:
The statistical importance of a study for a network meta-analysis estimate
Authors: Rücker Gerta , Nikolakopoulou Adriani , Papakonstantinou Theodoros , Salanti Georgia , Riley Richard D. , Schwarzer Guido 
Published: June 2020

Abstract
Background
In pairwise meta-analysis, the contribution of each study to the pooled estimate is given by its weight, which is based on the inverse variance of the estimate from that study. For network meta-analysis (NMA), the contribution of direct (and indirect) evidence is easily obtained from the diagonal elements of a hat matrix. It is, however, not fully clear how to generalize this to the percentage contribution of each study to a NMA estimate.MethodsWe define the importance of each study for a NMA estimate by the reduction of the estimate's variance when adding the given study to the others. An equivalent interpretation is the relative loss in precision when the study is left out. Importances are values between 0 and 1. An importance of 1 means that the study is an essential link of the pathway in the network connecting one of the treatments with another. ResultsImportances can be defined for two-stage and one-stage NMA. These numbers in general do not add to one and thus cannot be interpreted as `percentage contributions'. After briefly discussing other available approaches, we question whether it is possible to obtain unique percentage contributions for NMA. ConclusionsImportances generalize the concept of weights in pairwise meta-analysis in a natural way. Moreover, they are uniquely defined, easily calculated, and have an intuitive interpretation. We give some real examples for illustration.
Traditional and Cortical Trajectory Screws of Static and Dynamic Lumbar Fixation- A Finite Element Study
Authors: Liu Che-Wei , Wang Lu-Lin , Xu Yu-Kun , Chen Chun-Ming , Wang Jian-Cyuan , Tsai Wei-Tsung , Lin Shang-Chih 
Published: June 2020

Abstract
Background: Two types of screw trajectories are commonly used in lumbar surgery. Both traditional trajectory (TT) and cortical bone trajectory (CBT) were shown to provide equivalent pull-out strengths of a screw. CBT utilizing a laterally-directed trajectory engaging only cortical bone in the pedicle is widely used in minimal invasive spine posterior fusion surgery. It has been demonstrated that CBT exerts a lower likelihood of violating the facet joint, and superior pull-out strength than the TT screws, especially in osteoporotic vertebral body. No design yet to apply this trajectory to dynamic fixation. To evaluate kinetic and kinematic behavior in both static and dynamic CBT fixation a finite element study was designed. This study aimed to simulate the biomechanics of CBT-based dynamic system for an evaluation of CBT dynamization. Methods: A validated nonlinearly lumbosacral finite-element model was used to simulate four variations of screw fixation. Responses of both implant (screw stress) and tissues (disc motion, disc stress, and facet force) at the upper adjacent (L3-L4) and fixed (L4-L5) segments were used as the evaluation indices. Flexion, extension, bending, and rotation of both TT and CBT screws were simulated in this study for comparison. Results: The results showed that the TT static was the most effective stabilizer to the L4-L5 segment, followed by CBT static, TT dynamic, and the CBT dynamic, which was the least effective. Dynamization of the TT and CBT fixators decreased stability of the fixed segment and alleviate adjacent segment stress compensation. The 3.5-mm diameter CBT screw deteriorated stress distribution and rendered it vulnerable to bone-screw loosening and fatigue cracking. Conclusions: Modeling the effects of TT and CBT fixation in a full lumbosacral model suggest that dynamic TT provide slightly superior stability compared with dynamic CBT especially in bending and rotation. In dynamic CBT design, large diameter screws might avoid issues with loosening and cracking.
Comparison of Methods for Handling Covariate Missingness in Propensity Score Estimation with a Binary Exposure
Authors: Coffman Donna , Zhou Jiangxiu , Cai Xizhen 
Published: June 2020

Abstract
Background: Causal effect estimation with observational data is subject to bias due to confounding, which is often controlled for using propensity scores. One unresolved issue in propensity score estimation is how to handle missing values in covariates.Method: Several approaches have been proposed for handling covariate missingness, including multiple imputation (MI), multiple imputation with missingness pattern (MIMP), and treatment mean imputation. However, there are other potentially useful approaches that have not been evaluated, including single imputation (SI) + prediction error (PE), SI+PE + parameter uncertainty (PU), and Generalized Boosted Modeling (GBM), which is a nonparametric approach for estimating propensity scores in which missing values are automatically handled in the estimation using a surrogate split method. To evaluate the performance of these approaches, a simulation study was conducted. Results: Results suggested that SI+PE, SI+PE+PU, MI, and MIMP perform almost equally well and better than treatment mean imputation and GBM in terms of bias; however, MI and MIMP account for the additional uncertainty of imputing the missingness. Conclusions: Applying GBM to the incomplete data and relying on the surrogate split approach resulted in substantial bias. Imputation prior to implementing GBM is recommended.
Modified prediction system using combined preoperative anthropomorphic imbalance and fistula risk score for predicting clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy
Authors: Abe Tomoyuki , Amano Hironobu , Kobayashi Tsuyoshi , Hanada Keiji , Hattori Minoru , Nakahara Masahiro , Ohdan Hideki , Noriyuki Toshio 
Published: June 2020

Abstract
Background

This study aimed to evaluate the efficacy of the combination of fistula risk score (FRS) and preoperative body composition factors for predicting the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD).

Methods

In this study, 136 consecutive patients who underwent PD between 2006 and 2018 were enrolled. The risk factors of CR-POPF (grades B and C) were analyzed. Preoperative visceral adipose tissue area (VATA), skeletal mass index (SMI), and subcutaneous adipose tissue area (SATA) were calculated from computed tomography data.

Results

The overall 30-day mortality and morbidity rates were 0.7% and 38%, respectively. The incidence of grade B and C CR-POPF was 27% and 4%, respectively. Univariate analysis revealed that male sex, habitual smoking, prognostic nutritional index (PNI) < 45, VATA ≥ 90, VATA/SATA ≥ 0.9, VATA/SMI ≥ 1.4, and FRS > 4 were significantly associated with the incidence of CR-POPF. Multivariate analysis revealed that PNI < 45, VATA/SMI ≥ 1.4, and FRS > 4 were the independent risk factors of CR-POPF. A modified prediction score using the combination of VATA/SMI and FRS significantly predicted CR-POPF after PD.

Conclusions

Preoperative anthropomorphic imbalance and FRS were equally accurate in predicting CR-POPF. Patients with high-risk factors should be closely monitored during the postoperative period.
Validity, reliability and feasibility of a new observation rating tool and a post encounter rating tool for the assessment of clinical reasoning skills of medical students during their internal medicine clerkship. A pilot study.
Authors: Haring Catharina Maria , Klaarwater Claudia , Bouwmans Geert , Cools Bernadette , Gurp Petra van , Meer Jos van der , Postma Cornelis 
Published: June 2020

Abstract
Background Systematic assessment of clinical reasoning skills of medical students in clinical practice is very difficult. This is partly caused by the lack of understanding of the fundamental mechanisms underlying the process of clinical reasoning. Methods We previously developed an observation tool to assess the clinical reasoning skills of medical students during clinical practice. This observation tool consists of an 11-item observation rating form (ORT). In the present study we verified the validity, reliability and feasibility of this tool and of an already existing post-encounter rating tool (PERT) in clinical practice among medical students during the internal medicine clerkshipResults Six raters each assessed the same 15 student-patient encounters. The internal consistency (Cronbach’s alfa) for the (ORT) was 0.87 (0.71-0.84) and the 5-item (PERT) was 0.81 (0.71-0.87). The intraclass-correlation coefficient for single measurements was poor for both the ORT; 0.32 (p<0.001) as well as the PERT; 0.36 (p<0.001). The Generalizability study (G-study) and decision study (D-study) showed that 6 raters are required to achieve a G-coefficient of > 0.7 for the ORT and 7 raters for the PERT. The largest sources of variance are the interaction between raters and students. There was a consistent correlation between the ORT and PERT of 0.53 (p=0.04)Conclusions The ORT and PERT are both feasible, valid and reliable instruments to assess students’ clinical reasoning skills in clinical practice.
Onset and remission of common mental disorders among adults living in temporary housing for three years after the triple disaster in Northeast Japan: comparisons with the general population
Authors: Kawakami Norito , Fukasawa Maiko , Sakata Kiyomi , Suzuki Ruriko , Tomita Hiroaki , Nemoto Harumi , Yasumura Seiji , Yabe Hirooki , Horikoshi Naoko , Umeda Maki , Suzuki Yuriko , Shimoda Haruki , Tachimori Hisateru , Takeshima Tadashi , Bromet Evelyn J 
Published: June 2020

Abstract
Background: People living in temporary housing for long periods after a disaster are at risk of (developing) poor mental health. This study investigated the post-disaster incidence and remission of common mental disorders among adults living in temporary housing for the three years following the 2011 Great East Japan Earthquake.Methods: Three years after the disaster, face-to-face interviews were conducted with 1,089 adult residents living in temporary housing in the disaster area, i.e., the shelter group, and a random sample of 852 community residents of East Japan. The World Health Organization Composite International Diagnostic Interview was used to diagnose DSM-IV mood, anxiety, and alcohol use disorders. Information on demographic variables and disaster experiences was also collected. Results: Response rates were 49% and 46%, for the shelter group and the community residents, respectively. The incidence of mood/anxiety disorder in the shelter group was elevated only in the first year post-disaster compared to that of the general population. The rate of remission for mood and anxiety disorders was significantly lower in the shelter group than in the community residents. The proportion seeking medical treatment was higher in the shelter group.Conclusions: The onset of common mental disorders increased in the first year, but then levelled off in the following years among residents in temporary housing after the disaster. Remission from incident post-disaster mental disorders was slower in the shelter group than in the general population. Post-disaster mental health service could consider the greater incidence in the first year and prolonged remission of mental disorders among survivors with a long-term stay in temporary housing after a disaster.
Symptoms in the general Norwegian adult population - prevalence and associated factors
Authors: Krogstad Hilde , Loge Jon Håvard , Grotmol Kjersti , Kaasa Stein , Kiserud Cecilie Essholt , Salvesen Øyvind , Hjermstad Marianne Jensen 
Published: June 2020

Abstract
Background: Patients´ own perceptions and evaluations of symptoms, functioning and other health-related factors, i.e. Patient Reported Outcomes (PROs), are important elements for providing good patient care. Symptoms are subjective and best elicited by the patient orally or by using PRO measures (PROMs), be it on paper, or as electronic assessment tools. Reference values on frequently used PROMs facilitate the interpretation of scores for use in clinics and research settings, by comparing patient data with relevant samples from the general population. Study objectives were to (1) present reference values for the M.D. Anderson Symptom Inventory (MDASI) (2) examine the occurrence and intensity of symptoms assessed by the MDASI in a general Norwegian adult population sample, and (3) examine factors associated with higher symptom burden defined as the sum score of all symptoms, and factors associated with symptoms` interference on functions.Methods: In 2015, MDASI was sent by mail as part of a larger survey, to a representative sample of the general Norwegian adult population (N = 6165). Medical comorbidities were assessed by the Self-Administered Comorbidity Questionnaire. Depression was self-reported on the Patient Health Questionnaire 9 (PHQ-9). Linear multivariable regression analysis was used to examine for factors associated with MDASI sum score and factors associated with symptoms’ interference on functions. Results: The response rate was 36%. More women (54%) than men (46%) responded. Mean age was 55 years (SD 14). The most frequent symptoms were fatigue (59.7%), drowsiness (56.2%) and pain (56.1%). Fatigue, pain and disturbed sleep had the highest mean scores. The presence of one or more comorbidities, increasing PHQ-9 score and lower level of education were associated with higher MDASI sum score (p<0.001). The MDASI sum score and the PHQ-9 score were positively associated with all interference items (p<0.001) except for walking (p=0.22). Conclusion: This study provides the first Norwegian reference values for MDASI. The presence of one or more comorbidities, higher level of depressive symptoms and lower level of education were significantly associated with higher MDASI sum score. These covariates must be controlled for when using the reference values.
Barriers and opportunities for management of shared sanitation facilities in low-income settlements in Kenya
Authors: Simiyu Sheillah , Kweyu Raphael M. , Antwi-Agyei Prince , Adjei Kwaku A. 
Published: June 2020

Abstract

Background: Sharing of sanitation is commonly being practiced in low income areas in Sub Saharan Africa. However, the Joint Monitoring Program (JMP) categorizes shared sanitation as a limited sanitation service. These shared facilities are often the only option available for most of the residents in low income settlements, and improving their management is key to reducing open defecation and risk of disease. This study sought to investigate barriers and opportunities for improved management of shared sanitation in low income settlements of Kisumu in Kenya. Methods: Thirty-nine In-depth interviews and 11 focus group discussions were held with residents, who mainly included tenants and landlords. Analysis followed a thematic approach to define the problem, specify the target behaviour and define what needs to change. Results: Pit latrines were commonly shared among landlords and tenants. Shared sanitation facilities were unclean due to poor use and lack of cleaning. Participants identified behavioural challenges such as poor use of the shared toilets, and social challenges such as lack of cooperation in cleaning. These results led to identification of opportunities for improvement such as instituting clear cleaning plans, communication among users, and problem solving mechanisms between landlords and tenants. These approaches could form the basis for designing intervention strategies for improving the management of shared sanitation. Conclusion: The results highlight the need to focus on social aspects for improvement of shared sanitation management in low income settlements. Through a social approach, shared sanitation facilities can be managed appropriately to afford the millions of low income dwellers an opportunity to access sanitation. This study provides further evidence on approaches for improved management of shared sanitation facilities in line with the JMP’s recommendation for high quality shared facilities.
Routine Health Information System in the Health Facilities in Yaoundé-Cameroon: Assessing the Gaps for Strengthening
Authors: Tamfon Brian Bongwong , Ndongo Chanceline Bilounga , Bataliack Serge Marcial , Ngoufack Marie Nicole , Nguefack-Tsague Georges 
Published: June 2020

Abstract
Background: Management of health data and its use for informed decision making is a challenging health sector aspect in developing countries. Monitoring and evaluation of health interventions for meeting health-related Sustainable Development Goals (SDGs), and Cameroon Health Sector Strategy (HSS) targets is facilitated through evidence-based decision-making and public health action. Thus, a Routine Health Information System (RHIS) producing quality data is imperative. The objective of this study was to assess the RHIS in the health facilities (HFs) in Yaoundé in order to identify gaps and weaknesses and to propose measures for strengthening. Methods: A health facility-based cross-sectional descriptive study was carried out in the six health districts (HDs) of Yaoundé; followed by a qualitative aspect consisting of in-depth interviews of key informants at the Regional Health Office. HFs were selected using a stratified sampling method with probability proportional to the size of each HD. Data were collected (one respondent per HF) using the World Health Organization (WHO) and MEASURE Evaluation RHIS rapid assessment tool. Data were entered into Microsoft Excel 2013 and analyzed with IBM-SPSS version 20. Results: A total of 111 HFs were selected for the study. Respondents aged 24-60 years with an average of 38.3±9.3 years; 58 (52.3%) male and 53(47.7%) female. Heads of HFs and persons in charge of statistics/data management were most represented with 45.0% and 21.6% respectively. All the twelve subdomains of the RHIS were adequately functioning at between 7% and 30%. These included Human Resources (7%), Data Analysis (10%), Information and Communication Technology (11%), Standards and System Design (15%), Policies and Planning (15%), Information Dissemination (16%), Data Demand and Use (16%), Management (18%), Data Needs (18%), Data Quality Assurance (20%), Collection and Management of Individual Client Data (26%), Collection, Management, and Reporting of Aggregated Facility Data (30%). Conclusions: The level of functioning of subdomains of the RHIS in Yaoundé was low; thus, immediate and district-specific strengthening actions should be implemented if health-related SDGs and HSS targets are to be met. A nation-wide assessment should be carried out in order to understand the determinants of these poor performances and to strengthen the RHIS.
Utilization of Denture Adhesives and the Factors Associated with its Use: A Cross-Sectional Survey
Authors: BO TUN MIN , Hama Yohei , AKIBA NORIHISA , MINAKUCHI SHUNSUKE 
Published: June 2020

Abstract
Background: An increase in the number of elderly edentulous patients likely leads to a greater demand for dentures and denture adhesives. As denture adhesives have both positive and negative features, dentists need to know the types of denture adhesive users to be able to provide instruction to denture wearers on how to use denture adhesives effectively. This study aims to examine the utilization of denture adhesives and associated factors.Methods: Seven closed-ended questionnaires were developed for a web-based survey. After that, Fisher’s exact tests were performed to determine the difference in the denture adhesive usage rate by gender, type of denture, last dental visit, and smoking status. A multivariate-adjusted logistic regression analysis was performed with denture adhesive use or non-use as the dependent variable and the other items as independent variables. Next, Fisher’s exact tests and a multivariate-adjusted logistic regression analysis were performed with the type of denture adhesives as the dependent variable in the same way. Statistical analyses were performed for all denture wearers, complete denture wearers, and partial denture wearers. The level of statistical significance was set at p=0.05. Results: A total of 1470 denture wearers in Japan participated in this study. Of these, 318 used denture adhesives, while 212 (66.7%) used cream; 74 (23.3%) used home liner; 25 (7.9%) used powder; four (1.3%) used sheets; and three (0.9%) used several types. The Fisher’s exact tests revealed that the ratios of using denture adhesives were significantly higher for complete denture wearers (p<0.001), last dental visit over one year (p=0.005), and smokers (p=0.005). For partial denture wearers, the ratio was significantly higher in smokers (p=0.262). The multivariate adjusted logistic regression revealed that denture adhesive use or non-use were significantly associated with the type of denture and smoking status in all denture wearers, and just smoking status in partial denture wearers. There were no significant results about the type of denture adhesive selection.Conclusions: From all denture wearers, complete denture wearers and smokers are more likely to use denture adhesives. In addition, smokers significantly use denture adhesives if they are partial denture wearers.
Adult spinal deformity and its relationship with height loss: A 34-year longitudinal cohort study
Authors: Shimizu Mutsuya , Kobayashi Tetsuya , Chiba Hisashi , Senoo Issei , Ito Hiroshi , Matsukura Keisuke , Saito Senri 
Published: June 2020

Abstract
Background: Age-related height loss is a normal physical change that occurs in all individuals over 50 years of age. Although many epidemiological studies on height loss have been conducted worldwide, none have been long-term longitudinal epidemiological studies spanning over 30 years. This study was designed to investigate changes in adult spinal deformity and examine the relationship between adult spinal deformity and height loss.Methods: Fifty-three local healthy subjects (32 men, 21 women) from Furano, Hokkaido, Japan, volunteered for this longitudinal cohort study. Their heights were measured in 1983 and again in 2017. Spino-pelvic parameters were compared between measurements obtained in 1983 and 2017. Individuals with height loss were then divided into two groups, those with degenerative spondylosis and those with degenerative lumbar scoliosis, and different characteristics were compared between the two groups.Results: The mean age of the subjects was 44.4 (31-55) years at baseline and 78.6 (65-89) years at the final follow-up. The mean height was 157.4 cm at baseline and 153.6 cm at the final follow-up, with a mean height loss of 3.8 cm over 34.2 years. All parameters except for thoracic kyphosis were significantly different between measurements taken in 1983 and 2017 (p<0.05). Height loss in both sexes was related to changes in pelvic parameters including pelvic incidence-lumbar lordosis (R=0.460 p=0.008 in men, R=0.553 p=0.012 in women), pelvic tilt (R=0.374 p=0.035 in men, R=0.540 p=0.014 in women), and sagittal vertical axis (R=0.535 p=0.002 in men, R=0.527 p=0.017 in women). Greater height loss was more commonly seen in women (p=0.001) and in patients with degenerative lumbar scoliosis (p=0.02).Conclusions: This longitudinal study revealed that height loss is more commonly observed in women and is associated with adult spinal deformity and degenerative lumbar scoliosis. Height loss is a normal physical change with aging, but excessive height loss is due to spinal kyphosis and scoliosis leading to spinal malalignment. Our findings suggest that height loss might be an early physical symptom for spinal malalignment.