bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prehospital Identification of Covid-19: An Observational Study
Authors: Spangler Douglas Nils , Blomberg Hans , Smekal David 
Published: November 2020

Abstract
Background The novel coronavirus disease 2019 (Covid-19) pandemic has affected prehospital care systems across the world, but the prehospital presentation of affected patients and the extent to which prehospital care providers are able to identify them is not well characterized. In this study, we describe the presentation of Covid-19 patients in a Swedish prehospital care system, and asses the predictive value of Covid-19 suspicion as documented by dispatch and ambulance nurses.Methods Data for all patients with dispatch, ambulance, and hospital records between January 1 - August 31, 2020 were extracted. A descriptive statistical analysis of patients with and without hospital-confirmed Covid-19 was performed. In a subset of records beginning from April 14, we assessed the sensitivity and specificity of documented Covid-19 suspicion in dispatch and ambulance patient care records.Results A total of 11 894 prehospital records were included, of which 481 had a primary hospital diagnosis code related to-, or positive test results for Covid-19. Covid-19-positive patients had considerably worse outcomes than patients with negative test results, with 30-day mortality rates of 24% vs 11%, but lower levels of prehospital acuity (e.g. emergent transport rates of 14% vs 22%). About half (46%) of Covid-19-positive patients presented to dispatchers with primary complaints typically associated with Covid-19. 6 776 of records were included in the assessment of predictive value. Sensitivity was 76% (95% CI 71 - 80) and 82% (78 - 86) for dispatch and ambulance suspicion respectively, while specificities were 86% (85 - 87) and 78% (77 - 79).Conclusions While prehospital suspicion was strongly indicative of hospital-confirmed Covid-19, based on the sensitivity identified in this study, prehospital suspicion should not be relied upon as a single factor to rule out the need for isolation precautions. The data provided may be used to develop improved guidelines for identifying Covid-19 patients in the prehospital setting.
Association of Multiple Rib Fractures With Pneumonia After Successful Cardiopulmonary Resuscitation: A Retrospective Cohort Study Using Propensity Score Matching
Authors: Kawai Yasuyuki , Takano Keisuke , Miyazaki Keita , Yamamoto Koji , Tada Yusuke , Asai Hideki , Maegawa Naoki , Urisono Yasuyuki , Saeki Keigo , Fukushima Hidetada 
Published: November 2020

Abstract
Background: Few studies have examined the impact of chest wall injury on respiratory complications after cardiopulmonary resuscitation. This is due to many confounding factors for the development of complications after cardiopulmonary resuscitation. Accordingly, we investigated the association between multiple rib fractures and the incidence of pneumonia during the post-resuscitation period after adjusting for confounding factors using a propensity score.Methods: This single-centre, retrospective cohort study enrolled adult, non-traumatic, out-of-hospital, cardiac arrest patients who maintained circulation for >48 h between June 2015 and May 2019. Rib fractures were evaluated by computed tomography on the day of hospital admission, and the association with newly developed pneumonia within 7 days of hospitalisation was analysed using propensity score matching with adjustment for variables previously reported to be risk factors for the development of pneumonia.Results: Of the 683 out-of-hospital cardiac arrest patients treated during the study period, 87 eligible cases were enrolled for analysis. Thirty-two patients had multiple rib fractures identified by computed tomography and 35 patients developed pneumonia. The presence of multiple rib fractures was significantly associated with a higher incidence of pneumonia (propensity score-adjusted hazard ratio: 3.51; 95% confidence interval: 1.59–7.72; p=0.002). Consistently, after propensity score matching, the multiple rib fracture group showed significantly shorter pneumonia-free survival than the non-multiple rib fracture group (p<0.01).Conclusion: Multiple rib fractures are independently associated with the development of pneumonia after successful resuscitation.
The impact of helicopter emergency medical services and craniocervical traction on the early reduction of cervical spine dislocation in a rural area of Japan
Authors: Lee Deokcheol , Kawano Keisuke , Ishida Shotaro , Yamaguchi Yoichiro , Kuroki Tomofumi , Nagai Takuya , Higa Kiyoshi , Kurogi Syuji , Hamanaka Hideaki , Ochiai Hidenobu , Chosa Etsuo 
Published: November 2020

Abstract
Background
Several clinical and basic studies have shown that an association exists between achieving decompression of the spinal cord within a few hours and neurological recovery, even in patients with complete paralysis due to cervical spine dislocation. This study aimed to clarify the impact of helicopter emergency medical services(HEMS)and craniocervical traction using a halo ring on rapid reduction of lower cervical spine dislocation in rural Japan.
Methods
The success rate of and factors inhibiting closed reduction, time from injury to reduction and functional prognosis of lower cervical spine dislocations treated between July 2012 and January 2020 were retrospectively analysed.
Results
Fourteen patients were transported by HEMS (group H), seven were by ambulances (group A) and two were by themselves. Although the average travelled distance and injury severity score were significantly higher in group H (64.5 km, 28.0) than in group A (24.7 km, 18.6), there was no significant difference in the average time to admission or the time to start craniocervical traction after admission between group H (159.4 min, 52.2 min) and group A (163.6 min, 53.2 min). The urgent traction could be administered for 20 patients. The success rate of closed reduction was 95%, and neurological deterioration following traction was not observed in any cases. The average traction time and weight for reduction were 30.3 min and 16.3 kg, respectively. Patients’ body size and fracture-dislocation types did not significantly affect the traction time or weight. The rate of reduction within 4 h after injury was higher in group H (79%) than in group A (33%). Herniated discs were found at dislocation levels in five patients by magnetic resonance imaging scans performed after closed reduction, and all cases of inner fixation were treated via the posterior approach an average of 5.7 days after admission. After these treatment, three of nine AIS A patients recovered the ability to walk, and all the three patients underwent successful closed reduction within 4 h after injury.
Conclusion
HEMS and highly successful closed reduction considerably contributed to the early reduction of cervical spine dislocation and can potentially improve complete paralysis.
“To Do or Not To Do?” Clinical Integration of Point-Of-Care Ultrasound After Training: A Prospective Study
Authors: Lien Wan-Ching , Chang Chih-Heng , Chong Kah-Meng , Wu Meng-Che , Wu Cheng-Yi , Wang Hsiu-Po 
Published: November 2020

Abstract
Background: Point-of-care ultrasound (PoCUS) can serve as a valuable adjunct for patient care. This study aimed to investigate the clinical integration of PoCUS of the first post-graduate year (PGY-1) residents after a PoCUS curriculum.Methods: The prospective study was conducted at the emergency department (ED) of the National Taiwan University Hospital between July 2015 and October 2017. Every PGY-1 resident had one-month ED training and a PoCUS curriculum was implemented during the first week. The post-training objective structured clinical examination global ratings were obtained, as well as the sonographic examinations the residents performed on shifts. Four groups could be identified: group 1 performed PoCUS before and after the curriculum; group 2 performed only after the curriculum; group 3 performed only before the curriculum; the last did not perform any examinations.Results: 239 residents participated. The median global rating was 4 (interquartile ranges, 4-5). After the curriculum, an increasing number of residents integrated PoCUS into patient care (64 vs. 170, p=0.037) with acceptable image quality. No differences existed in the global ratings between 4 groups, however, nearly 30% of residents did not use PoCUS during their shifts. Group 1 performed more cases with better image quality and using ≥2 US applications (8/100 vs. 82/359, p=0.0009), compared with those before the curriculum. Comparing with those in groups 1 and 2, group 1 performed more cases (p<0.0001) with better image quality (p=0.03). “No suitable cases” (25/69), and “choosing other imaging priorities” (43/69) were the main feedbacks in groups 3 and 4.Conclusions: A short focused US training had an immediate positive impact on OSCE global ratings and integration of PoCUS of PGY-1 residents in the ED. The global ratings could not predict whether to use PoCUS in the ED practice. Although the working climate was designated to be friendly for utilizing US, a substantial percentage of residents did not use PoCUS. Further longitudinal studies would be needed for the sustained effects of the curriculum.Trial registration: NCT03738033.
Long Non-Coding RNA H19 Expression and Functional Polymorphism rs217727 Are Linked to Increased Ischemic Stroke Risk
Authors: Rezaei Mohadese , Mokhtari Mohammad Javad , Bayat Mahnaz , Safari Anahid , Dianatpuor Mehdi , Tabrizi Reza , Borhani-Haghighi Afshin 
Published: November 2020

Abstract
Background: Efforts to identify potential biomarkers for the diagnosis of ischemic stroke (IS) are valuable. The H19 gene plays a functional role in increasing the prevalence of IS risk factors. We evaluated the correlation between H19 rs217727 polymorphism and the expression level of H19 lncRNA with susceptibility to IS among the Iranian population.Methods: Blood samples were collected from IS patients (n = 114) and controls (n = 114). We concentrated on the expression pattern of H19 at different time points (i.e., 0-24, 24-48, and 48-72 hours after stroke). The tetra-primer ARMS-PCR method was applied for DNA genotyping. We used the quantitative real-time PCR to evaluate H19 expression levels. Results: The rs217727polymorphism of H19 was related with IS susceptibility in the co-dominant (OR=2.92, 95% CI=0.91-10.92, P=0.04) and recessive models (OR=2.80, 95% CI=0.96-8.15, P=0.04). H19 expression was signiﬁcantly upregulated in IS and remained high for 72 hours after stroke. ROC curves showed that H19 expression within the first 24 hours from stroke onset might serve as a biomarker for the early diagnosis of IS with 79.49% sensitivity and 80.00% specificity. H19 expression in SVO and LAA patients were 3.74 and 3.34 times higher than the UD subtype, respectively [OR=3.74 95% CL (1.14-12.27) P=0.030 and OR=3.34 95% CL (1.13-9.85) P=0.029].Conclusion: The rs217727 polymorphism of the H19 is correlated with IS susceptibility, and H19 expression levels were higher in SVO and LAA patients. The upregulation of H19 may be considered as a diagnostic biomarker in IS among the Iranian population.
Hypersensitive C-Reactive Protein-Albumin Ratio Predicts Symptomatic Intracranial Hemorrhage After Endovascular Therapy in Acute Ischemic Stroke Patients
Authors: Peng Qiang , Hou Jiankang , Wang Siyu , Zhou Feng , E Yan , Wang Wei , Huang Ting , Wang Meng , Huang Shi , Zhou Junshan , Chen Nihong , Zhang Yingdong 
Published: November 2020

Abstract
Background and purpose: A fraction of patients would develop symptomatic intracranial hemorrhage (sICH) after endovascular therapy. The aim of our study was to explore the ability of hypersensitive C-reactive protein-albumin ratio (HAR) in predicting sICH after endovascular therapy.Methods: From April 2016 to December 2018, 334 consecutive patients with anterior circulation infarction undergoing endovascular therapy were enrolled in our study. sICH was defined as a National Institutes of Health Stroke Scale score increase of ≥ 4 points within 24 hours after endovascular therapy. Multiple regression analysis was used to investigate the potential risk factors of sICH after endovascular therapy. We used receiver operating characteristic curve analysis and nomogram analysis to assess the overall discriminative ability of the HAR in predicting sICH after endovascular therapy.Results: Among these 334 patients enrolled, 37 (11.1%) patients with anterior circulation infarction were identified with sICH after endovascular therapy. Univariate logistic regression analysis demonstrated that patients with higher levels of HAR may be inclined to develop sICH [odds ratio, 10.994; 95% confidence interval (CI), 4.567–26.463; P = 0.001]. This association remained significant even after adjustment for potential confounders. Also, a cutoff value of 0.526×10-3 for HAR was detected in predicting sICH (area under curve, 0.763). Furthermore, nomogram analysis also suggested that HAR was an indicator of sICH (c-index was 0.890, P<0.001).Conclusions: This study showed that high levels of HAR may predict sICH after endovascular therapy.
Coagulation Functions Are Associated With Hemorrhagic Transformation in Non-Atrial Fibrillation Patients: A Case Control Study
Authors: Cheng Hao-Ran , Chen Yun-Bin , Zeng Ya-Ying , Ruan Yi-Ting , Yuan Cheng-Xiang , Cheng Qian-Qian , Chen Hui-Jun , Luan Xiao-Qian , Huang Gui-Qian , He Jincai 
Published: November 2020

Abstract
Background: Hemorrhagic transformation (HT) is a serious neurological complication of acute ischemic stroke (AIS) after revascularization. The majority of AIS patients do not have atrial fibrillation (AF) which could also develop to HT. In this study, we aimed to explore whether coagulation parameters are risk factors of HT in non-AF patients.Methods: We consecutively enrolled 285 AIS patients with HT. Meanwhile, age- and sex-matched 285 AIS patients without HT were included. The diagnosis of HT was determined by brain CT or MRI during hospitalization. All patients were divided into two subgroups based on the presence of AF and explore the differences between the two subgroups. Blood samples were obtained within 24 hours of admission, and all patients were evenly classified into three tertiles according to platelet counts (PLT) levels.Results: In this study, we found the first PLT tertile (OR = 3.509, 95%CI = 1.268-9.711, P = 0.016) was independently associated with HT in non-AF patients, taking the third tertile as a reference. Meanwhile, we also found mean platelet volume (MPV) (OR = 0.605, 95%CI = 0.455-0.805, P = 0.001) and fibrinogen (FIB) (OR = 1.928, 95%CI = 1.346-2.760, P <0.001) were significantly associated with HT in non-AF patients. But in AF patients, coagulation parameters showed no significant difference. Meanwhile, we found the MPV (OR = 1.314, 95%CI = 1.032-1.675, P = 0.027) and FIB (OR = 1.298, 95%CI = 1.047-1.610, P = 0.018) were significantly associated with long-term outcomes in non-AF HT patients.Conclusions: Low PLT, low MPV and high FIB levels were independently associated with HT in non-AF patients. Additionaly, MPV and FIB levels were significantly associated with unfavorable long-term outcomes in non-AF HT patients. Our study showed that coagulation functions at admission may be beneficial for clinicians to recognize patients with high risk of HT at early stage and improve unfavorable long-term outcomes in non-AF patients.
Title: Keep It Up! 3.0: Study Protocol for a Type III Hybrid Implementation-Effectiveness Cluster-Randomized Trial
Authors: Mustanski Brian , Jones Justin Patrick , Macapagal Kathryn , Benbow Nanette , Li Dennis H. , Brown C. Hendricks , Janulis Patrick , Smith Justin D. , Schackman Bruce R. , Linas Benjamin P. , Madkins Krystal L. , Swann Gregory , Saber Rana , Dean Abigael , Bettin Emily , Savinkina Alexandra 
Published: November 2020

Abstract

BackgroundYoung men who have sex with men are disproportionately impacted by the HIV epidemic in the United States. Few rigorously tested HIV prevention interventions have been developed for young men who have sex with men; previous interventions have primarily focused on in-person programming, with high variability in fidelity. With nearly all young men who have sex with men going online daily, eHealth approaches to prevention may successfully bridge research and practice. Keep It Up! is an eHealth HIV Prevention program for young men who have sex with men. Previous research has demonstrated its effectiveness in reducing sexually transmitted infections and condomless anal sex and efficiency in delivering HIV prevention education. Aim 1 is to compare two strategies for implementing KIU—implementation in community-based organizations and a centralized direct-to-consumer recruitment arm. Aim 2 is to examine adoption characteristics which explain variability in implementation success. Our exploratory aim will develop recommendations and materials for sustainment of KIU after completion of the trial.MethodsThis is a Type III Hybrid Effectiveness-Implementation cluster randomized trial. Using estimates of young men who have sex with men per county in the United States, we identified 113 counties for our sample frame. Using an iterative process, we selected 66 counties to randomize 2:1 to our two strategies in Aim 1. The RE-AIM model for implementation science will be used to drive our outcome measurements in reach, effectiveness, implementation variability, and cost. Outcome measures will be collected from community-based organization staff participants, young men who have sex with men participants, and the technology provider. Our second aim will use mixed-methods research mapped onto the domains of the consolidated framework for implementation research. DiscussionThe trial has launched and is ongoing. This study is among the first to use a cluster randomized trial design in HIV implementation science. In comparing the community-based organization and direct to consumer models for recruitment and ongoing participant engagement, we are examining two strategies which have shown effectiveness in delivering health and technology interventions in the past, but with little base knowledge on their comparative advantages and disadvantages in implementation. The results of the trial will further understanding of the implementation of eHealth prevention interventions.Trial RegistrationNCT03896776, clinicaltrials.gov, 1 April 2019
Self-Reported Experience of Tinnitus Patients for Different Outpatient Modes
Authors: Xiang Tao , Xu Tao , Ren Jing , Pu Jun-mei , Liu Lu , Xiao Yan , Lai Dan 
Published: November 2020

Abstract
Objective: To explore self-reported experience for different outpatient modes in tinnitus patients.Methods: A observational study design was adopted. Tinnitus outpatients from the otological medicine and routine otolaryngology of our hospital fulfilling the study criteria were enrolled between October 2018 and January 2020. They were examined by semi-structured interview questionnaire. Groups were formed according to the different outpatient modes. The data were analyzed with SPSS 23.0.Results: 193 questionnaires were included; 118 questionnaires of otological medicine outpatients, 75 questionnaires of otolaryngology outpatients. Nearly half of the otological medicine patients (48.3%) said that they communicated for 5–10 minutes with their doctor and a routine otolaryngology outpatient service usually takes 3–5 minutes (61.3%). However, most patients expected a longer time. Patient satisfaction and return visit rate of otological medicine (95.5% and 43.9%) were better than routine otolaryngology (77.3% and 7.1%). The main factors of efficacy considered physician interpretation and guidance.Conclusion: Both outpatient models can give patients a more satisfactory experience. Specialized outpatient service can better fit the shared decision making model, conducive to the rehabilitation and management of tinnitus. However, the long-term follow-up and management of patients still need to be scrutinized and improved continuously.
Validation of the Portuguese Version of Amsterdam Preoperative Anxiety and Information Scale (APAIS)
Authors: Maurício Sandra , Rebêlo Isabel , Madeira Catarina , Resende Filipa , Esteves Susana 
Published: November 2020

Abstract
BackgroundPreoperative anxiety is common among the oncological surgical population. Due to its psychological and physiological detrimental effects, identifying and addressing it is of uttermost importance to improve anesthetic management and patient’s experience. The aim of this study is to establish the Portuguese version of Amsterdam Preoperative Anxiety and Information Scale (APAIS) in the oncological populationMethodsFollowing forward and backward translation of the original APAIS scale, further adaptation was obtained through cognitive interviewing. The resulting instrument was tested on the day before surgery on a sample of adult cancer surgical patients from a Portuguese oncology centre. Psychometric evaluation was derived from inter-item correlation, confirmatory factor analysis, Cronbach’s alpha, correlation with comparative scales, receiver operating characteristic curve and Youden index.Results109 patients (58 males, 51 females) were included. A three-dimensional model - anxiety about anesthesia, anxiety about surgery and desire for information, showed the best fit to the data. The questionnaire revealed high internal consistency (Cronbach alpha 0.81) and good inter-item correlation. Also, Portuguese APAIS correlated well with the gold standard anxiety scale. Therefore, the psychometric properties of this scale version make it a valid and reliable instrument. The optimal cutoff to maximize both sensitivity and specificity was 12.ConclusionsPortuguese APAIS version is an accurate tool to identify preoperative anxiety among cancer patients and might impact its management, from premedication choice to provision of information and reassurance about either anesthesia or surgery.
Synthesis of Ti3GeC2 Powders from Ti-Ge-TiC Mixtures by Pressureless Sintering
Authors: Qiaodan Liu , Tian Wubian , Sun Zhengming , Zhang Peigen , Zha Wenwen , Sun Shuo 
Published: November 2020

Abstract
Ti3GeC2 compound has excellent electrical and mechanical properties, which can be used as a potential reinforcement for Ag-based electrical contact materials. However, few reports have been addressed on the synthesis of its powders. The present study, therefore, presents a new route to fabricate high-purity Ti3GeC2 powders from Ti/Ge/TiC by pressureless sintering in vacuum. The influence of sintering temperature and Ge content on the powder purity was studied and the optimized conditions are found to be 1550 ℃ and Ti:Ge:TiC=1:1.1:2. In addition, the reaction path of Ti/Ge/TiC was revealed to be three steps: First, liquid Ge starts to react with Ti to form Ti5Ge3 compounds at around 1140 ℃; Then Ti5Ge3 consumes the liquid Ge and TiC to form Ti2GeC at around 1200 ℃; Finally, Ti2GeC transfers into Ti3GeC2 with the consumption of residual TiC. The present study lays the foundation for the subsequent applications of Ti3GeC2 powders in high performance composites.
Contextualization of the Shane Theory and the Entrepreneurial Learning Model at University: A Narrative Method
Authors: Santoso R. Tri Priyono Budi , Ruspendi I Wayan , Priyanto Sony Heru , Santoso Donald Samuel Slamet 
Published: November 2020

Abstract
The novelty of this research is in applying the construction of the Shane Theory and the ELM Theory in applying Entrepreneurship Education at higher education institutions. This study used action research by utilizing a narrative method. The business field which matched with the academic discipline as well as hobby was more successful than that which was different had a prospect as a start-up. Leadership, entrepreneurship and managerial ability were determining factors in the success of a start-up company. It can delve more into the entrepreneurship process of start-ups to recognize opportunities to create ideas, start businesses, and develop businesses.