bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modified decision-making rule supported by scheduled telephone follow-up reduces head computed tomography utilization in children with mild traumatic brain injury
Authors: Zou Liqun , Li Hong , Jiang Zhen , He Bin , Xie Yong , Zhang Wei , Jiang Jingyuan , Nie Hu 
Published: May 2020

Abstract
Unnecessary computed tomography utilization is common in children with a mild traumatic head injury. It is valuable to find a reasonable strategy for the patient's management.
The aim of this study was to investigate the effect of scheduled telephone follow-up on computed tomography utilization in children with a mild head injury.
A 2-year cohort study was performed. Children diagnosed with mild traumatic brain injury (TBI) were evaluated with a scoring system upon their arrival and during 1 month of scheduled telephone follow-ups by nurses. The rates of head computed tomography utilization, delayed imaging, and delayed diagnosis were analyzed.
The rate of computed tomography utilization was 64.3% and 46.1% (P = .00) in the retrospective and prospective study periods, respectively. During the prospective study period, there were no differences in the rates of delayed imaging (2.3% vs. 2.2%, P = .814) or the rates of delayed diagnosis of significant radiological findings (0.1% vs 0.2%, P = .672) in cases with versus without immediate computed tomography.
Adoption of a modified decision-making rule supported by scheduled telephone follow-up can reduce head computed tomography utilization without increasing the rate of missed or delayed diagnosis of clinically significant TBI in children with mild TBI.
Association rule mining for the ordered placement of traditional Chinese medicine containers
Authors: Chen Chih-Wen , Tsai Chih-Fong , Tsai Yi-Hong , Wu Yang-Chang , Chang Fang-Rong 
Published: May 2020

Abstract
In traditional Chinese medicine (TCM) clinics, the pharmacists responsible for dispensing the herbal medicine usually find the desired ingredients based on positions of the shelves (racks; frames; stands). Generally, these containers are arranged in an alphabetical order depending on the herbal medicine they contain. However, certain related ingredients tend to be used together in many prescriptions, even though the containers may be stored far away from each other. This can cause problems, especially when there are many patients and/or the limited number of pharmacists. If the dispensing time takes longer, it is likely to impact the satisfaction of the patients’ experience. Moreover, the stamina of the pharmacists will be consumed quickly.
In this study, we investigate on an association rule mining technology to improve efficiency in TCM dispensing based on the frequent pattern growth algorithm and try to identify which 2 or 3 herbal medicines will match together frequently in prescriptions. Furthermore, 3 experimental studies are conducted based on a dataset collected from a traditional Chinese medicine hospital. The dataset includes information for an entire year (2014), including 4 seasons and doctors. Afterward, a questionnaire on the usefulness of the extracted rules was administered to the pharmacists in the case hospital. The responses showed the mining results to be very valuable as a reference for the placement and ordering of the frames in the TCM pharmacies and drug stores.
Ultrasound and radiological features of abdominal unicentric castleman's disease
Authors: Lv Kun , Zhao Yanan , Xu Wen , Zhang Chao , Huang Pintong 
Published: May 2020

Abstract
This study aimed to improve the diagnostic accuracy of abdominal unicentric Castleman's disease (UCD) by retrospectively summarizes the relatively specific imaging features of UCD.
This study retrospectively collected fifteen patients with abdominal UCD confirmed by pathology. All patients were underwent ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI) examination. The imaging findings of UCDs were analyzed by senior radiologists.
Fifteen patients included 7 males and 8 females, aged 30 to 68 years old, with an average age of 51.73 ± 13.57. In the 15 cases, 7 were located around the mesentery, 4 were located in the retroperitoneal space, and 4 in the liver. Fifteen cases contained solid masses, of which 13 had clear margins and 2 had blurred margins. The size of the mass ranged from 1.5 to 14.2 cm, with an average of 6.49 ± 4.16 cm. US showed that 9 lesions were presented with hypo-echogenicity while 5 lesions presented with hyper-echogenicity spots. Unenhanced CT showed that the lesions were comprised of soft tissue while calcified lesions were found in 10 of the cases (66.67%, 10/15). T1-weighted imaging (T1WI) suggested the lesions as iso/hypo-signal, and mildly hyper-signal on T2-weighted imaging (T2WI). Diffusion-weighted imaging (DWI) showed different degrees of hyper-signal. Contrast-enhanced US and CT/MRI showed obvious enhancement at the arterial phase in 12 cases (85.71%, 12/14), most of which (50%, 7/14) showed continuous enhancement at the delayed phase. Feeding vessel could be seen within, or around the lesion in 5 cases (35.71%, 5/14).
The study suggests that abdominal UCD commonly manifests as well-defined, homogeneous, solid, and hypervascular masses. Calcification and the presence of feeding vessel in the tumors are relatively specific features of abdominal UCD.
Characteristics of frequent adult emergency department users
Authors: Lee Ji Han , Park Gwan Jin , Kim Sang Chul , Kim Hoon , Lee Suk Woo 
Published: May 2020

Abstract
Emergency department (ED) crowding is a public health burden that impedes the provision of high-quality emergency care and is related to poor outcomes. Frequent ED visits are known to contribute to ED crowding. This study aimed to identify frequent ED users’ characteristics and risk factors related to frequent ED visits.
A retrospective observational study was conducted using ED-based data derived from adult patients at a university hospital. The main exposure variable was frequent ED visits, which were defined as ≥4 visits within 12 months (January 1–December 31, 2018). Characteristics and risk factors for frequent ED users were evaluated using stepwise regression analysis.
Within the study period, there were 36,932 ED visits involving 29,759 patients. Of these, 3031 (8.2%) visits were from 556 (1.9%) patients classified as frequent ED users. The independent risk factors for frequent ED visits were older patients (≥65 years); the winter season; daytime discharge from ED; patients with medical aid insurance; and patients designated as high acuity at their first visit. Patients with a malignant neoplasm, mental health disorder, alcohol-related liver disease, chronic kidney disease, or chronic obstructive pulmonary disease were associated with more frequent ED visits.
Frequent ED users comprised a significant proportion of total ED visits. Frequent ED users were more likely than occasional ED users to be in poorer health, older, or have a chronic disease or a mental health disorder.
Effects of Baseline Systolic Blood Pressure on Outcome in Ischemic Stroke Patients With Intravenous Thrombolysis Therapy
Authors: Lei Zhihao , Li Shuanglin , Hu Shiyu , Ren Lijie 
Published: May 2020

Background:Baseline systolic blood pressure (SBP) is an important parameter that can significantly influence the outcome in ischemic stroke patients who received intravenous thrombolysis, but the target baseline SBP for optimal outcome is uncertain. This study aimed to assess the relationship between baseline SBP and outcome.Materials and Methods:Studies that evaluated the association between the baseline SBP and the outcome of patients undergoing thrombolytic therapy were sought. Data were extracted according to a predefined data extraction form and then analyzed by STATA 12.0 software. The primary endpoint was the occurrence of good outcomes measured by a modified Rankin Scale score at 3 months, while the secondary endpoint was the occurrence of intracranial hemorrhage and death.Results:Eleven studies involving a total of 33,263 patients were included. Pooled data suggested that the odds of good outcome was decreased by 7% per 10 mm Hg increase in baseline SBP (odds ratio=0.93; 95% confidence interval: 0.91-0.94;P<0.001). Patients with higher baseline SBP were more likely to have intracranial hemorrhage (odds ratio=1.12 per 10 mm Hg increase; 95% confidence interval: 1.08-1.16,P<0.001).Conclusions:This study suggested that lower baseline SBP may be positively associated with a greater chance of good outcome and less chance of intracranial hemorrhage. However, this effect was reliable only when the baseline SBP was within a certain range, which has not been explicitly stated. Therefore, more well-designed studies are needed to define the optimal baseline SBP.
Heart Rate Variability Analysis
Authors: Constantinescu Victor , Matei Daniela , Ignat Bogdan , Hodorog Diana , Cuciureanu Dan I. 
Published: May 2020

Background:
Neurogenic heart syndrome represents a phenomenon often encountered in clinical practice after ischemic stroke. Further poststroke cardiovascular complications are possibly related to cardiac autonomic dysregulation. Multiple Trigonometric Regressive Spectral (MTRS) analysis of the heart rate variability (HRV) allows a precise evaluation of cardiovascular modulation under different conditions.

Objectives:
This research aims to evaluate the impact of the middle cerebral artery (MCA) ischemic stroke on cardiac autonomic function, using the MTRS analysis of HRV, during sympathetic and parasympathetic activation tests.

Methods:
The authors analyzed HRV parameters in 20 patients who had a right and 20 who had a left MCA ischemic stroke, under rest condition and during autonomic activation tests (deep breathing and standing tests). Data were compared with 20 age-matched and sex-matched healthy controls.

Results:
Patients who had a right MCA ischemic stroke presented a decreased vagal modulation of the heart rate compared with healthy controls and patients who had a left MCA ischemic stroke, in resting state and during autonomic activation tests. Decreased root mean square of the successive differences, pNN50, high frequency, and high-frequency normalized units values (P<0.05) and increased low frequency/high frequency ratio (P<0.05) in resting state and during autonomic activation tests in patients who had a right MCA stroke indicate a sympathetic predominance in the control of the heart rate. The parasympathetic activation test did not change the sympathovagal balance in this group of patients.

Conclusions:
The autonomic nervous system represents an attractive target for the therapeutic approach. As MCA ischemic stroke, especially in the right hemisphere, seems to cause significant long-lasting autonomic dysregulation, implementing early pharmacological or nonpharmacological intervention for autonomic restoration may improve the outcome of patients who had an ischemic stroke.
Wall-Eyed Bilateral Internuclear Ophthalmoplegia by Ischemic Stroke
Authors: Uzawa Akiyuki , Takeda Yorinobu , Kuwabara Satoshi 
Published: May 2020

Introduction:
Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a rare symptom. Several studies have reported that a small brainstem lesion could cause WEBINO.

Case Report:
The authors present the case of an 88-year-old female individual who developed sudden-onset diplopia and gait disturbance. Neurological examination revealed WEBINO with convergence impairment, gaze-evoked upward nystagmus on upward gaze, and bilateral limb ataxia. Brain magnetic resonance imaging revealed a small paramedian pontine tegmentum infarction, responsible for the symptoms. A literature review of WEBINO in ischemic stroke revealed that most patients exhibited impaired convergence and other neurological symptoms.

Conclusion:
Gaze-evoked upward nystagmus on upward gaze and bilateral limb ataxia accompanied by WEBINO due to a small brainstem lesion were the characteristic findings of our case.
Association of neutrophil-gelatinase-associated lipocalin with microvascular complications in patients with type 2 diabetes: a cross-sectional study
Authors: Aslanhan Erhan , Ojalvo David , Özsenel Ekmek Burak , Ucak Basat Sema , Borlu Fatih 
Published: May 2020

Introduction
Diabetic nephropathy and diabetic retinopathy are serious microvascular complications of diabetes mellitus. Recent studies have demonstrated that neutrophil-gelatinase-associated lipocalin (NGAL) may be accompanied by these complications during and before the appearance of microalbuminuria. In this study, we set out to research the role of NGAL in patients with diabetic nephropathy and diabetic retinopathy.

Material and methods
Eighty-two patients with type 2 diabetes were enrolled in our study. Urinary microalbumine and NGAL levels were measured in urine samples over 24 hours. We also studied NGAL levels in serum. All patients went through an ophthalmologic examination. The results were evaluated based on the presence of microalbuminuria and retinopathy.

Results
There were no significant differences in serum and urine NGAL levels between normoalbuminuric (n = 66) and microalbuminuric (n = 16) patients. We also did not find any significant difference in patients with retinopathy (n = 16) or without retinopathy (n = 66).

Conclusion
There are controversial findings about the role of NGAL in diabetic patients in medical literature. Standard values of urine and serum NGAL levels have yet to be determined. Our study suggests that NGAL is not a useful marker to differentiate microalbuminuric patients from normoalbuminuric subjects. We also did not find a relationship between NGAL levels and the presence of retinopathy. Additional studies with larger sample sizes will be required to confirm or refute these findings.
A treatment-based algorithm for identification of diabetes type in the National Health and Nutrition Examination Survey
Authors: Mosslemi Mitra , Park Hannah L. , McLaren Christine E. , Wong Nathan D. 
Published: May 2020

Background
In epidemiology studies, identification of diabetes type (type 1 vs. type 2) among study participants with diabetes is important; however, conventional diabetes type identification approaches that include age at diabetes diagnosis as an initial criterion introduces biases. Using data from the National Health and Nutrition Examination Survey, we have developed a novel algorithm which does not include age at diagnosis to identify participants with self-reported diagnosed diabetes as having type 1 vs. type 2 diabetes.

Methods
A total of 5457 National Health and Nutrition Examination Survey participants between cycles 1999–2000 and 2015–2016 reported that a health professional had diagnosed them as having diabetes at a time other than during pregnancy and had complete information on diabetes-related questions. After developing an algorithm based on information regarding the treatment(s) they received, we classified these participants as having type 1 or type 2 diabetes.

Results
The treatment-based algorithm yielded a 6–94% split for type 1 and type 2 diabetes, which is consistent with reports from the Centers for Disease Control and other resources. Moreover, the demographics and clinical characteristics of the assigned type 1 and type 2 cases were consistent with contemporary epidemiologic findings.

Conclusion
Applying diabetes treatment information from the National Health and Nutrition Examination Survey, as formulated in our treatment-based algorithm, may better identify type 1 and type 2 diabetes cases and thus prevent the specific biases imposed by conventional approaches which include the age of diabetes diagnosis as an initial criterion for diabetes type classification.
Comparing inpatient costs of heart failure admissions for patients with reduced and preserved ejection fraction with or without type 2 diabetes
Authors: Olchanski Natalia , Vest Amanda R. , Cohen Joshua T. , DeNofrio David 
Published: May 2020

Objective
Both heart failure (HF) and diabetes mellitus (DM) account for major healthcare expenditures. We evaluated inpatient expenditures and cost drivers in patients admitted with HF with and without DM.

Methods
We created a retrospective cohort of acutely decompensated HF patients, using linked data from cost accounting systems and electronic medical records. We stratified patients by LVEF into reduced ejection fraction (HFrEF, LVEF ≤40%) and preserved ejection fraction (HFpEF, LVEF >40%) groups and by DM status at admission.

Results
Our population had 544 people: 285 HFrEF patients (43.5% with DM) and 259 HFpEF patients (43.6% with DM). Patients with HFrEF and DM had the longest hospital stay (5.10 ± 5.21 days). Patients with HFrEF and DM had the highest hospitalization cost ($11 576 ± 15 818). HFrEF and HFpEF patients with DM had the highest cost, and cost per day alive was highest for HFpEF patients with DM [$3153 (95% CI 2332, 4262)].

Conclusion
Overall cost was higher for patients with DM, whether or not they were admitted with acute HF due to HFrEF or HFpEF. Cost per day alive for patients with DM continued to exceed corresponding costs for patients without DM, with HFpEF patients with DM having the highest cost.
Control with uncertain data of socially structured compartmental epidemic models
Authors: Albi Giacomo , Pareschi Lorenzo , Zanella Mattia 
Published: May 2020

AbstractThe adoption of containment measures to reduce the amplitude of the epidemic peak is a key aspect in tackling the rapid spread of an epidemic. Classical compartmental models must be modified and studied to correctly describe the effects of forced external actions to reduce the impact of the disease. In addition, data are often incomplete and heterogeneous, so a high degree of uncertainty must naturally be incorporated into the models. In this work we address both these aspects, through an optimal control formulation of the epidemiological model in presence of uncertain data. After the introduction of the optimal control problem, we formulate an instantaneous approximation of the control that allows us to derive new feedback controlled compartmental models capable of describing the epidemic peak reduction. The need for long-term interventions shows that alternative actions based on the social structure of the system can be as effective as the more expensive global strategy. The importance of the timing and intensity of interventions is particularly relevant in the case of uncertain parameters on the actual number of infected people. Simulations related to data from the recent COVID-19 outbreak in Italy are presented and discussed.
Performance Characteristics of the Abbott Architect SARS-CoV-2 IgG Assay and Seroprevalence Testing in Idaho
Authors: Bryan Andrew , Pepper Gregory , Wener Mark H. , Fink Susan L. , Morishima Chihiro , Chaudhary Anu , Jerome Keith R. , Mathias Patrick C. , Greninger Alexander L. 
Published: May 2020

BackgroundCoronavirus disease-19 (COVID19), the novel respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with severe morbidity and mortality. The rollout of diagnostic testing in the United States was slow, leading to numerous cases that were not tested for SARS-CoV-2 in February and March 2020, necessitating the use of serological testing to determine past infections.MethodsWe evaluated the Abbott SARS-CoV-2 IgG test for detection of anti-SARS-CoV-2 IgG antibodies by testing 3 distinct patient populations.ResultsWe tested 1,020 serum specimens collected prior to SARS-CoV-2 circulation in the United States and found one false positive, indicating a specificity of 99.90%. We tested 125 patients who tested RT-PCR positive for SARS-CoV-2 for which 689 excess serum specimens were available and found sensitivity reached 100% at day 17 after symptom onset and day 13 after PCR positivity. Alternative index value thresholds for positivity resulted in 100% sensitivity and 100% specificity in this cohort. We tested 4,856 individuals from Boise, Idaho collected over one week in April 2020 as part of the Crush the Curve initiative and detected 87 positives for a positivity rate of 1.79%.ConclusionsThese data demonstrate excellent analytical performance of the Abbott SARS-CoV-2 IgG test as well as the limited circulation of the virus in the western United States. We expect the availability of high-quality serological testing will be a key tool in the fight against SARS-CoV-2.
A study’s got to know its limitations
Authors: Gooch Phil , Warren-Jones Emma 
Published: May 2020

AbstractBackgroundAll research has room for improvement, but authors do not always clearly acknowledge the limitations of their work. In this brief report, we sought to identify the prevalence of limitations statements in the medRxiv COVID-19 SARS-CoV-2 dataset.MethodsWe combined automated methods with manual review to analyse manuscripts for the presence, or absence, either of a defined limitations section in the text, or as part of the general discussion.ResultsWe identified a structured limitations statement in 28% of the manuscripts, and overall 52% contained at least one mention of a study limitation. Over one-third of manuscripts contained none of the terms that might typically be associated with reporting of limitations. Overall our method performed with precision of 0.97 and recall of 0.91.ConclusionThe presence or absence of limitations statements can be identified with reasonable confidence using automated tools. We suggest that it might be beneficial to require a defined, structured statement about study limitations, either as part of the submission process, or clearly delineated within the manuscript.
LFA-1 signals to promote actin polymerization and upstream migration in T cells
Authors: Roy Nathan H , Kim Sarah Hyun Ji , Buffone Alexander , Blumenthal Daniel , Huang Bonnie , Agarwal Sangya , Schwartzberg Pamela L , Hammer Daniel A , Burkhardt Janis K 
Published: May 2020

AbstractT cell entry into inflamed tissue requires firm adhesion, cell spreading, and migration along and through the endothelial wall. These events require the T cell integrins LFA-1 and VLA-4 and their endothelial ligands ICAM-1 and VCAM-1, respectively. T cells migrate against the direction of shear flow on ICAM-1 and with the direction of shear flow on VCAM-1, suggesting that these two ligands trigger distinct cellular responses. However, the contribution of specific signaling events downstream of LFA-1 and VLA-4 has not been explored. Using primary mouse T cells, we found that engagement of LFA-1, but not VLA-4, induces cell shape changes associated with rapid 2D migration. Moreover, LFA-1 ligation results in activation of the PI3K and ERK pathways, and phosphorylation of multiple kinases and adaptor proteins, while VLA-4 ligation triggers only a subset of these signaling events. Importantly, T cells lacking Crk adaptor proteins, key LFA-1 signaling intermediates, or the ubiquitin ligase cCbl, failed to migrate against the direction of shear flow on ICAM-1. These studies identify novel signaling differences downstream of LFA-1 and VLA-4 that drive T cell migratory behavior.Summary StatementInflammatory responses require leukocyte migration along the vascular wall. We show that signaling from β2, but not β1, integrins induces cytoskeletal changes needed for upstream migration under shear flow.