bluuebunny/crossref_metadata_2025_split huggingface dataset:
Automatic sleep stage classification with deep residual networks in a mixed-cohort setting
Authors: Olesen Alexander Neergaard , Jørgen Jennum Poul , Mignot Emmanuel , Sorensen Helge Bjarup Dissing 
Published: August 2020

Abstract

Study Objectives
Sleep stage scoring is performed manually by sleep experts and is prone to subjective interpretation of scoring rules with low intra- and interscorer reliability. Many automatic systems rely on few small-scale databases for developing models, and generalizability to new datasets is thus unknown. We investigated a novel deep neural network to assess the generalizability of several large-scale cohorts.

Methods
A deep neural network model was developed using 15,684 polysomnography studies from five different cohorts. We applied four different scenarios: (1) impact of varying timescales in the model; (2) performance of a single cohort on other cohorts of smaller, greater, or equal size relative to the performance of other cohorts on a single cohort; (3) varying the fraction of mixed-cohort training data compared with using single-origin data; and (4) comparing models trained on combinations of data from 2, 3, and 4 cohorts.

Results
Overall classification accuracy improved with increasing fractions of training data (0.25%: 0.782 ± 0.097, 95% CI [0.777–0.787]; 100%: 0.869 ± 0.064, 95% CI [0.864–0.872]), and with increasing number of data sources (2: 0.788 ± 0.102, 95% CI [0.787–0.790]; 3: 0.808 ± 0.092, 95% CI [0.807–0.810]; 4: 0.821 ± 0.085, 95% CI [0.819–0.823]). Different cohorts show varying levels of generalization to other cohorts.

Conclusions
Automatic sleep stage scoring systems based on deep learning algorithms should consider as much data as possible from as many sources available to ensure proper generalization. Public datasets for benchmarking should be made available for future research.
Health, social, and economic consequences of rapid eye movement sleep behavior disorder: a controlled national study evaluating societal effects
Authors: Frandsen Rune , Asah Cresta , Ibsen Rikke , Kjellberg Jakob , Jennum Poul Jørgen 
Published: August 2020

Abstract

Study Objectives
Parkinson’s disease (PD) causes significant socioeconomic burdens. One of the strongest predictors of PD is rapid eye movement (REM) sleep behavior disorder (RBD; when there is no known other cause of RBD, referred to as idiopathic RBD [iRBD]), but there is no information about its factual welfare burden. We estimated the direct and indirect total costs of iRBD in a national sample of patients, based on a national register-based cohort study with matched controls.

Methods
Using records from the Danish National Patient Registry, patient’s diagnosis with RBD from 2006 to 2016 were identified. We excluded patients with a prior diagnosis of narcolepsy, PD, and other neurodegenerative diseases. We identified and compared randomly chosen controls matched for age, gender, geographic area, and civil status. Direct costs included frequencies of primary and secondary sector contacts and procedures, and medication. Indirect costs included the effect on labor supply. Social-transfer payments were included to illustrate the effect on national accounts.

Results
A total of 246 iRBD patients and 982 matched controls were registered. iRBD patients had significantly higher rates of health-related contacts and of medication use, and higher socioeconomic costs than controls. The total additional direct net healthcare costs after the diagnosis (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) was €13,088 for patients compared with controls. Patients already exhibited a negative social- and health-related status several years before the first diagnosis.

Conclusions
Diagnoses of iRBD have major socioeconomic consequences for patients, their partners, and society.
Is Sexual Conflict a Driver of Speciation? A Case Study With a Tribe of Brush-footed Butterflies
Authors: Carvalho Ana Paula S , St Laurent Ryan A , Toussaint Emmanuel F A , Storer Caroline , Dexter Kelly M , Aduse-Poku Kwaku , Kawahara Akito Y 
Published: August 2020

Abstract
Understanding the evolutionary mechanisms governing the uneven distribution of species richness across the tree of life is a great challenge in biology. Scientists have long argued that sexual conflict is a key driver of speciation. This hypothesis, however, has been highly debated in light of empirical evidence. Recent advances in the study of macroevolution make it possible to test this hypothesis with more data and increased accuracy. In the present study, we use phylogenomics combined with four different diversification rate analytical approaches to test whether sexual conflict is a driver of speciation in brush-footed butterflies of the tribe Acraeini. The presence of a sphragis, an external mating plug found in most species among Acraeini, was used as a proxy for sexual conflict. Diversification analyses statistically rejected the hypothesis that sexual conflict is associated with shifts in diversification rates in Acraeini. This result contrasts with earlier studies and suggests that the underlying mechanisms driving diversification are more complex than previously considered. In the case of butterflies, natural history traits acting in concert with abiotic factors possibly play a stronger role in triggering speciation than does sexual conflict. [Acraeini butterflies; arms race; exon capture phylogenomics; Lepidoptera macroevolution; sexual selection; sphragis.]
Neurological complications of chimeric antigen receptor T cells and immune-checkpoint inhibitors: ongoing challenges in daily practice
Authors: Berzero Giulia , Picca Alberto , Psimaras Dimitri 
Published: August 2020

Purpose of review
The aim of this review is to summarize the most recent advances in the management of neurological toxicities associated with immune-checkpoint inhibitors (ICIs) and chimeric antigen receptor (CAR)-T cells.

Recent findings
The advent of cancer immunotherapies has dramatically improved the prognosis of several refractory and advanced neoplasms. Owing to their mechanism of action, cancer immunotherapies have been associated with a variety of immune-related adverse events (irAE). Neurological irAE are uncommon compared with other irAE, but they are associated with significant morbidity and mortality. Despite the efforts to draft common protocols and guidelines, the management of neurological irAE remains challenging. Our ability to predict the development of neurotoxicity is still limited, hampering to elaborate prevention strategies. Treatment heavily relies on the administration of high-dose corticosteroids that, however, have the potential to impair oncological efficacy. The experimentation of novel strategies to avoid resorting to corticosteroids is hindered by the lack of an adequate understanding of the pathogenetic mechanisms driving the development of irAE.

Summary
In this review, we will discuss the most recent advances on the diagnosis and management of neurological irAE associated with ICIs and CAR-T cells, focusing on the issues that remain most challenging in clinical practice.
Cancer Management During the COVID-19 Pandemic in the United States
Authors: Hui Jane Yuet Ching , Yuan Jianling , Teoh Deanna , Thomaier Lauren , Jewett Patricia , Beckwith Heather , Parsons Helen , Lou Emil , Blaes Anne H. , Vogel Rachel I. 
Published: August 2020

Objectives:
The coronavirus disease 2019 (COVID-19) has significantly impacted health care delivery across the United States, including treatment of cancer. We aim to describe the determinants of treatment plan changes from the perspective of oncology physicians across the United States during the COVID-19 pandemic.

Methods:
Participants were recruited to an anonymous cross-sectional online survey of oncology physicians (surgeons, medical oncologists, and radiation oncologists) using social media from March 27 to April 10, 2020. Physician demographics, practice characteristics, and cancer treatment decisions were collected.

Results:
The analytic cohort included 411 physicians: 241 (58.6%) surgeons, 106 (25.8%) medical oncologists, and 64 (15.6%) radiation oncologists. In all, 38.0% were practicing in states with 1001 to 5000 confirmed COVID-19 cases as of April 3, 2020, and 37.2% were in states with >5000 cases. Most physicians (N=285; 70.0% of surgeons, 64.4% of medical oncologists, and 73.4% of radiation oncologists) had altered cancer treatment plans. Most respondents were concerned about their patients’ COVID-19 exposure risks, but this was the primary driver for treatment alterations only for medical oncologists. For surgeons, the primary driver for treatment alterations was conservation of personal protective equipment, institutional mandates, and external society recommendations. Radiation oncologists were primarily driven by operational changes such as visitor restrictions.

Conclusions:
The COVID-19 pandemic has caused a majority of oncologists to alter their treatment plans, but the primary motivators for changes differed by oncologic specialty. This has implications for reinstitution of standard cancer treatment, which may occur at differing time points by treatment modality.
A Pilot Validation Study of the Newborn Behavioral Observations System: Associations with Salivary Cortisol and Temperament
Authors: Congdon Jayme L. , Nugent J. Kevin , McManus Beth M. , Coccia Michael , Bush Nicole R. 
Published: August 2020

ABSTRACT:

Objective:
There are few standardized neonatal neurobehavioral instruments available for longitudinal child development research. We adapted an established clinical tool, the Newborn Behavioral Observations (NBO) system, for research by standardizing the administration protocol and expanding the 3-point coding scale to 5 points.

Methods:
We administered the 5-point NBO to 144 racially/ethnically diverse late preterm or term infants born to low-income women (average age 5 weeks). Cronbach's alphas were calculated to determine internal consistency reliability of Autonomic, Motor, Organization of State, and Responsivity subscales. We examined concurrent validity using subscale associations with infant salivary cortisol reactivity to the NBO and maternally reported infant temperament.

Results:
Two of the 4 NBO subscales, Organization of State and Responsivity, had excellent (0.91) and good (0.76) reliability, respectively, and were retained for further analyses. Infants with higher Organization of State scores (more optimal regulation) demonstrated lower cortisol reactivity (r = −0.30, p < 0.01) and temperamental negativity (r = −0.16, p < 0.05). Responsivity was unrelated to cortisol reactivity or temperament.

Conclusions:
State regulation, as measured by the 5-point NBO, was associated with a biologic marker of infant stress response to the NBO administration and reported temperament. Poor reliability of the NBO's 3-item Autonomic and 7-item Motor subscales suggests that further psychometric research in other samples and likely refinement are needed. Given the paucity of neurobehavioral assessment tools for infants, these findings justify such research as next steps in the incremental progression toward the development of a practical, reliable, and predictive measure of early neurobehavioral development.
Ethyl Alcohol Versus Botulinum Toxin A: A Comparative Study of the Visual and Histopathological Outcomes in the Rabbit Anterior Auricular Muscle Model
Authors: Ince Bilsev , Uyanik Orkun , Oltulu Pembe , Ismayilzade Majid , Dadaci Mehmet , Savaci Nedim 
Published: August 2020

BACKGROUND
Botulinum toxin has long been known for its paralytic effects at the neuromuscular junction. Although it has been widely used for vascular and nervous tissues, there has been no study of the aesthetic effects of the application of ethanol to muscle tissues to date.

OBJECTIVE
The authors aimed to demonstrate the effects of the application of ethanol to muscle tissues after an intramuscular injection and to compare the effects of botulinum toxin A (BTA) and ethanol.

METHODS AND MATERIALS:
A total of 28 rabbits were divided into 4 groups (n = 7 each). Botulinum toxin A (5 units) and different concentrations of ethanol (5 cc) were injected into the left and right anterior auricular muscles of all rabbits, respectively. Ear ptosis was assessed, and histopathological examination was performed after all rabbits were euthanized in the eighth week.

RESULTS
Muscle function was affected earlier in ethanol-treated ears than in botulinum-treated ears; however, the ptotic effect lasted for a significantly shorter duration in ethanol-injected ears than in BTA-applied ears.

CONCLUSION
Ethanol can block muscle function reversibly and can serve as an alternative to BTA, particularly when rapid results are desirable.
Types of Cosmetic Procedures Requested by Different Types of Patients and the Reasons for These Preferences
Authors: Maisel Amanda , Waldman Abigail , Poon Emily , Alam Murad 
Published: August 2020

BACKGROUND
The type of cosmetic dermatologic procedures patients' desire may be influenced by demographic factors.

OBJECTIVE
To better understand the type of cosmetic procedures requested by patients of different age, gender, education, race, and geographic location. To understand the most common motivations of patients who requested particular types of treatments.

MATERIALS AND METHODS
Multicenter data from the Cosmetic Motivation Database were analyzed. Bivariable analyses and linear regressions were undertaken to determine whether patient demographic features were associated with particular procedures of interest.

RESULTS
Patients younger than 45 years were more interested in acne scar treatment, laser hair removal, liposuction, and tattoo removal. Older patients were more likely to want soft-tissue fillers and wrinkles and jowls tightening treatment. Non-White patients were more likely to be interested in laser hair removal, liposuction, cellulite treatment, and tattoo removal. Types of procedures desired varied by the geographic region but not by the educational level. Different motivations drove patients who wanted different types of treatments.

CONCLUSION
Different types of patients demand different types of cosmetic treatments, and the motivations of patients who ask for particular procedures also differ. Better understanding of patient preferences may help physicians allocate resources and meet patient needs.
Weathering the Storm: How Superstorm Sandy Shaped the Response to COVID-19
Authors: Simon Maxine dellaBadia 
Published: August 2020

SUMMARY
Catastrophic weather, like a pandemic, can wreak havoc on hospital operations. NYU Langone Health in New York City has experienced the extremes of both phenomena. In 2012, Superstorm Sandy severely damaged the system's core facilities, disabled operations, and forced the evacuation of more than 220 patients to other health systems. In 2020, the arrival of the novel coronavirus severely disrupted operations again—but this time, we were better prepared. Our experience in dealing with Superstorm Sandy taught us critical lessons that supported our readiness for COVID-19. Those lessons can be summed up as preparation, organization, and innovation.
COVID-19: Implications for Supply Chain Management
Authors: Francis James R. 
Published: August 2020

SUMMARY
The COVID-19 pandemic has created global health and economic disruption. Hospitals and other healthcare providers have been hit particularly hard. While efforts to effectively treat and eradicate the coronavirus continue, so do the efforts of supply chains to support the provision of patient care in the event of a resurgence or future pandemic. Supply chain leaders must continuously evaluate their strategic and tactical positions to address critical supply needs. Whether the supply chain can meet expectations remains uncertain, given rolling supply shortages of personal protective equipment (PPE) and other medical–surgical supplies as healthcare providers resume prepandemic levels of operations. The ability to ensure a reliable, sustainable supply of critical PPE in the near term will remain a challenge. Longer-term substantive changes to the function and performance of healthcare supply chains will be necessary across multiple areas to meet demand more effectively during a crisis.
Baseline SCAT Performance in Men and Women: Comparison of Baseline Concussion Screens Between 6288 Elite Men's and 764 Women's Rugby Players
Authors: Tucker Ross , Falvey Eanna , Fuller Gordon , Brown James , Raftery Martin 
Published: August 2020

Objective:
This study compared Sports Concussion Assessment Tool (SCAT) performance in elite male (6288 players) and female (764 players) rugby players, to determine whether reference limits used for the management and diagnosis of concussion should differ between sexes.

Design:
Cross-sectional census sample.

Setting:
Data from World Rugby's Head Injury Assessment management system were analyzed. This data set covers global professional rugby.

Participants:
All professional players who underwent baseline SCAT testing as part of World Rugby's concussion management requirement formed the study cohort. Ten thousand seven hundred fifty-four SCAT assessments from 6288 elite male rugby players and 1071 assessments from 764 elite female players were analyzed.

Intervention:
Elite men and women rugby players are independent variables.

Main Outcome Measures:
Sports Concussion Assessment Tool performance, including symptoms endorsed, cognitive submode performance, and balance performance.

Results:
Women endorsed significantly more symptoms, with greater symptom severity, than men (relative ratio 1.34, 95% confidence interval, 1.25-1.45 women vs men). Women outperformed men in cognitive submodes with the exception of immediate memory and delayed recall and made fewer balance errors than men during the modified Balance Error Scoring System. Clinical reference limits, defined as submode score achieved by the worst-performing 50% of the cohort, did not differ between men and women.

Conclusions:
Women and men perform differently during SCAT baseline testing, although differences are small and do not affect either the baseline or clinical reference limits that identify abnormal test results for most submodes. The greater endorsement of symptoms by women suggests increased risk of adverse concussion outcomes and highlights the importance of accurate evaluation of any symptom endorsement at baseline.
Epidemiology of Injuries in Elite Badminton Players: A Prospective Study
Authors: Guermont Henri , Le Van Philippe , Marcelli Christian , Reboursière Emmanuel , Drigny Joffrey 
Published: August 2020

Objective:
To determine the incidence and characteristics of injuries in elite badminton players over a competitive season.

Design:
Prospective cohort study.

Setting:
The French National Institute of Sport, Expertise, and Performance (INSEP).

Participants:
Twenty international elite badminton players.

Independent Variables:
The type, the location, the occurrence of the injury (match or training), the footwork type, the type of shot, and the perceived fatigue were collected.

Main Outcome Measures:
Injury incidence rates were calculated per 1000 hours of play (Hop).

Results:
Thirty-five injuries were collected over 10 210 hours of player exposure with an overall incidence rate of 3.4 injuries per 1000 Hop, with higher incidence during matches than training (11.6 vs 2.08; P < 0.05). Lower-limb injuries (LLI) were the most frequent (54.3%) especially on the foot (22.9%), and upper-limb injury rate (37.1%) was higher compared with previous studies. The most common type was musculotendinous injuries (51.4%). The smash and the lunge were the most frequent causes of upper-limb injury and LLI, respectively. Injuries occurred mostly during the first third of play (46.2%).

Conclusions:
This is the first prospective study to investigate badminton injuries among international badminton players. Further studies are needed to confirm our results on larger samples.
Adjunct use of radiofrequency coblation for osteochondritis dissecans in children
Authors: Estes Reed 
Published: August 2020

AbstractRationale:Osteochondritis dissecans (OCD) lesions involve disruption of the osteochondral unit along articular surfaces, with significant potential for joint deterioration if not managed appropriately.Patient concerns:A 15-year-old male presented with persistent and insidious right knee pain, which had worsened following a collision with another player during a basketball game, resulting in episodes of locking.Diagnoses:Magnetic resonance imaging revealed a lateral trochlear OCD extending into the anterior lateral femoral condyle.Interventions:Chondral fraying was observed along the margins of the OCD. Retrograde drilling ensued with use of a 0.045-inch Kirschner wire throughout the lesion to a depth that would allow for penetration of healthy underlying subchondral bone to create an influx of healing factors. Three resorbable pegs were arthroscopically placed through an accessory portal overlying the lesion to stabilize the fracture and compress the gapped cartilage mantle to reduce flow of synovial fluid behind the lesion. Bipolar radiofrequency coblation was used to stabilize the chondral fraying and seal the gap along the periphery of the lesion.Outcomes:The patient was put on a nonweight bearing protocol for 6 weeks, after which crutches and brace were discontinued, but therapy persisted. Repeat imaging at 3 months demonstrated excellent interval healing. The patient was released to slowly engage impact activities. Although he returned at approximately 8 months postoperatively with a contralateral anterior cruciate ligament tear, he reported the operative knee with the OCD was doing extremely well.Lessons:Radiofrequency coblation appears to be a viable strategy as an adjunct to management for OCD in children.
Chronic bilateral asynchronous achilles tendon rupture treated using modified whole flexor hallucis longus transfer reconstruction
Authors: Zhang Xiangfeng , Ruan Feng , Wu Yongping , Lu Huang 
Published: August 2020

Abstract

Introduction:
Achilles tendon rupture is common, but bilateral ruptures are very rare. Treatment of chronic Achilles tendon rupture is very challenging due tendon retraction and atrophied. We report a case of bilateral asynchronous Achilles tendon rupture patient who was treated with modified minimally invasive whole flexor hallucis longus (FHL) tendon transfer to repair the defects.

Patient concerns:
A 52-year-old male farmer presented to our hospital complaining of bilateral heel pain that had disrupted his walking for 6 months. The patient had been misdiagnosed and under-treated for 1 year. Physical examination showed that his plantar flexors were tender and weak, with marked hypotrophy of the calf muscles. Bilateral ankle radiographs of both X-ray and computed topography (CT) revealed no bone injure.

Diagnosis:
Magnetic resonance imaging (MRI) indicated a bilateral Achilles tendon rupture. The diagnosis was further confirmed by postoperative histological examination, which revealed Achilles tendonitis accompanied by regional calcification and chondrometaplasia.

Interventions:
Surgical reconstruction of the ruptured Achilles tendons was done through a modified minimally invasive whole FHL tendon transfer followed by physiotherapy.

Outcomes:
The patient was immobilized in a cast for the next 6 weeks, gradual weight bearing gradually was then encouraged for another 6 weeks, and full weight-bearing started 3 months after surgery. By 6-month postoperation, the patient could walk and jog normally returned to his pre-injury working condition.

Conclusion:
Surgical intervention is among the primary treatment of chronic Achilles tendon rupture. However, one of the challenges in its treatment is providing suitable graft for tendon reconstruction. Our case presents a successful reconstruction procedure using less-invasive whole FHL transfer technique. This surgical technique provides satisfactory clinical and functional outcome and can be considered for future therapy.