bluuebunny/crossref_metadata_2025_split huggingface dataset:
Husband’s Social Support for Mother of Children With Autism Spectrum Disorder
Authors: Desiningrum Dinie Ratri , Suminar Dewi Retno , Surjaningrum Endang Retno , Suryanto  , Hendriani Wiwin 
Published: July 2021

Purpose: The purpose of the research is to find husband’s social support for mother of children with autism spectrum disorder (ASD). The problem of this study is how the forms of husband’s social support are perceived by mothers of children with ASD, and what are the factors and impacts for mothers perceived about husband’s social support. Method: The research was conducted on family having children with autism aged 5–14 years, employing a qualitative method by interviewing 10 mother participants. Data were analyzed using interpretative phenomenological analysis (IPA). Results: The analysis resulted in five themes. First, the impact of disability of children with ASD on marriage relationship; second, the role of husband in parenting children with ASD; third, the perception of mother for husband’s social support; fourth, some factors influences to husband social supports; and fifth, the effects of husband’s social support for mother, children with ASD, and family. The discussion and limitations of this study are considered. Applications/Originality/Value: The results of this study are expected to be a reference for scientists, especially in the field of psychology of children with special needs, and can also contribute to the application of science to institutions related to ASD and observers of children with ASD.
Ophthalmic features of craniosynostosis: A Malaysian experience
Authors: Rafique Ali Abdullah Ashraf , Ismail Fazliana , May May Choo , Mohd Abdullah Azlindarita Aisyah , Khaliddin Nurliza , Hariri Firdaus , Abdul Rahman Zainal Ariff , Iqbal Tajunisah 
Published: July 2021

Background: This study aims to collect local Malaysian data regarding the ophthalmic features and complications in craniosynostosis patients who attended the Combined Craniofacial Clinic (CFC) in University Malaya Medical Centre (UMMC). Methods: Retrospective study of medical notes of craniosynostosis patients who attended the CFC in UMMC from 2014 to December 2020. Results: Out of 37 patients, 29 had syndromic craniosynostosis, and 8 had non-syndromic craniosynostosis. Visual impairment was present in 32.1% of patients. Causes for visual impairment were as follows – amblyopia (25.0%), exposure keratopathy (3.6%), and optic atrophy (3.6%). Hypermetropia and myopia were each seen in 20.6% of patients. Astigmatism was seen in 47.1% of patients, and 29.1% had anisometropia. Proptosis was present in 78.6% and lagophthalmos in 53.3% of patients. Strabismus in primary position occurred in 51.7% of patients. Thirty-one percent of the patients had exposure keratopathy. Optic disc atrophy was seen in 13.7% of patients, and 8.3% had optic disc swelling. Optic disc swelling was resolved in all patients who underwent craniofacial surgery. Conclusion: Our experience in Malaysia was consistent with previously reported data on ophthalmic features of craniosynostosis patients. Additionally, we found that non-syndromic craniosynostosis patients are also at risk of ocular complications just as much as syndromic patients. Appropriate treatment of amblyogenic risk factors, ocular complications, and timely detection of papilledema, and prompt surgical intervention are crucial in preserving long-term visual function in these patients.
Spatial Distribution of Cancer Cases Seen in Three Major Public Hospitals in KwaZulu-Natal, South Africa
Authors: Motlana Mpho KTN , Ginindza Themba G , Mitku Aweke A , Jafta Nkosana 
Published: July 2021

Background: Noncommunicable diseases (NCDs) like cancer are posing a challenge in the health system especially in low- and middle-income countries (LMICs). In South Africa, cancer is under-reported due to the lack of a comprehensive cancer surveillance system. The limited knowledge on the extent of cancer burden has led to inaccurate allocation of public health resources. The aim of this study was to describe cancer incidence and spatial distribution of cancer cases seen at 3 main public oncology facilities in KwaZulu-Natal. Methods: In this retrospective study, cases of cancer observed from year 2015 to 2017 were extracted from medical records. The crude incidence rate was estimated for the total cancer cases and for different type of cancer reported over that period. Age-standardised incidence rates (ASR) per 100 000 was calculated per year using age groups and sex according to the district population data of KwaZulu-Natal. The comparisons of cancer diagnosed incidences were made between 11 districts using the ASR. Choropleth spatial maps and Moran’s Index were used to assess the ASR cancer spatial distribution along with geographical patterns among the districts. One sample chi-square test was used to assess the significant increase/decrease over time. Results: The study lost numerous cases due to incompleteness. A total of 4909 new cases were diagnosed with cancer during 2015 to 2017, 62% of which were female. Both uMgungundlovu and eThekwini districts had the highest ASR among district municipalities of KwaZulu-Natal for both male and female (83.6 per 100 000 per men year for men, 158.2 per 100 000 women per year, and 60.1 per 100 000 men per year and 96.9 per 100 000 women per year, respectively). Random distribution of reported cancer cases in KwaZulu-Natal was observed with a high concentration being in and around 2 metropolitan districts. Spatial variation showed a significant difference from year to year between the districts with the random spatial distribution. Overall, there was a significant decline of cancer incidences observed from 2015 to 2017 ( P < .05) in the province. Conclusion: The overall cancer incidence in the study shows that female cancers (breast and cervical) are still on the rise and still need to be given priority as they were most prevalent in KwaZulu-Natal. Spatial analysis (choropleth maps) was used to show a pattern of higher concentration of cancer incidence in the north-western parts of the province.
The Potential of Computer Vision-Based Marker-Less Human Motion Analysis for Rehabilitation
Authors: Hellsten Thomas , Karlsson Jonny , Shamsuzzaman Muhammed , Pulkkis Göran 
Published: July 2021

Background: Several factors, including the aging population and the recent corona pandemic, have increased the need for cost effective, easy-to-use and reliable telerehabilitation services. Computer vision-based marker-less human pose estimation is a promising variant of telerehabilitation and is currently an intensive research topic. It has attracted significant interest for detailed motion analysis, as it does not need arrangement of external fiducials while capturing motion data from images. This is promising for rehabilitation applications, as they enable analysis and supervision of clients’ exercises and reduce clients’ need for visiting physiotherapists in person. However, development of a marker-less motion analysis system with precise accuracy for joint identification, joint angle measurements and advanced motion analysis is an open challenge. Objectives: The main objective of this paper is to provide a critical overview of recent computer vision-based marker-less human pose estimation systems and their applicability for rehabilitation application. An overview of some existing marker-less rehabilitation applications is also provided. Methods: This paper presents a critical review of recent computer vision-based marker-less human pose estimation systems with focus on their provided joint localization accuracy in comparison to physiotherapy requirements and ease of use. The accuracy, in terms of the capability to measure the knee angle, is analysed using simulation. Results: Current pose estimation systems use 2D, 3D, multiple and single view-based techniques. The most promising techniques from a physiotherapy point of view are 3D marker-less pose estimation based on a single view as these can perform advanced motion analysis of the human body while only requiring a single camera and a computing device. Preliminary simulations reveal that some proposed systems already provide a sufficient accuracy for 2D joint angle estimations. Conclusions: Even though test results of different applications for some proposed techniques are promising, more rigour testing is required for validating their accuracy before they can be widely adopted in advanced rehabilitation applications.
The Strength of the Corticospinal Tract Not the Reticulospinal Tract Determines Upper-Limb Impairment Level and Capacity for Skill-Acquisition in the Sub-Acute Post-Stroke Period
Authors: Hammerbeck Ulrike , Tyson Sarah F. , Samraj Prawin , Hollands Kristen , Krakauer John W. , Rothwell John 
Published: July 2021

Background. Upper-limb impairment in patients with chronic stroke appears to be partly attributable to an upregulated reticulospinal tract (RST). Here, we assessed whether the impact of corticospinal (CST) and RST connectivity on motor impairment and skill-acquisition differs in sub-acute stroke, using transcranial magnetic stimulation (TMS)–based proxy measures. Methods. Thirty-eight stroke survivors were randomized to either reach training 3-6 weeks post-stroke (plus usual care) or usual care only. At 3, 6 and 12 weeks post-stroke, we measured ipsilesional and contralesional cortical connectivity (surrogates for CST and RST connectivity, respectively) to weak pre-activated triceps and deltoid muscles with single pulse TMS, accuracy of planar reaching movements, muscle strength (Motricity Index) and synergies (Fugl-Meyer upper-limb score). Results. Strength and presence of synergies were associated with ipsilesional (CST) connectivity to the paretic upper-limb at 3 and 12 weeks. Training led to planar reaching skill beyond that expected from spontaneous recovery and occurred for both weak and strong ipsilesional tract integrity. Reaching ability, presence of synergies, skill-acquisition and strength were not affected by either the presence or absence of contralesional (RST) connectivity. Conclusion. The degree of ipsilesional CST connectivity is the main determinant of proximal dexterity, upper-limb strength and synergy expression in sub-acute stroke. In contrast, there is no evidence for enhanced contralesional RST connectivity contributing to any of these components of impairment. In the sub-acute post-stroke period, the balance of activity between CST and RST may matter more for the paretic phenotype than RST upregulation per se.
Stratification of Microvascular Disease Severity in the Foot Using Spatial Frequency Domain Imaging
Authors: Jett Samuel , Thompson Mallory R. , Awasthi Shubhangi , Cuccia David J. , Tan Tze-Woei , Armstrong David G. , Mazhar Amaan , Weinkauf Craig C. 
Published: July 2021

Background: Microvascular disease (MVD) describes systemic changes in the small vessels (~100 um diameter) that impair tissue oxygenation and perfusion. MVD is a common but poorly monitored complication of diabetes. Recent studies have demonstrated that MVD: (i) is an independent risk factor for ulceration and amputation and (ii) increases risk of adverse limb outcomes synergistically with PAD. Despite the clinical relevance of MVD, microvascular evaluation is not standard in a vascular assessment. Methods: We evaluated 299 limbs from 153 patients seen clinically for possible lower extremity PAD. The patients were assessed by ankle brachial index (ABI), toe brachial index (TBI), and spatial frequency domain imaging (SFDI). These measurements were evaluated and compared to patient MVD status, defined by clinical diagnoses of (in ascending order of severity) no diabetes; diabetes; diabetes + neuropathy; diabetes + neuropathy + retinopathy. Results: SFDI-derived parameters HbT1 and StO2 were significantly different across the MVD groups ( P < .001). A logistic regression model based on HbT1 and StO2 differentiated limbs with severe MVD (diabetes+neuropathy+retinopathy) from the larger group of limbs from patients with only diabetes ( P = .001, area under the curve = 0.844). Neither ABI nor TBI significantly differentiated these populations. Conclusions: Standard assessment of PAD using ABI and TBI are inadequate for detecting MVD in at-risk populations. SFDI-defined HbT1 and StO2 are promising tools for evaluating MVD. Prospective studies with wound-based outcomes would be useful to further evaluate the role MVD assessment could play in routine clinical evaluation of patients at risk for lower extremity complications.
Who Should Make Medical Decisions When a Patient Lacks an Advance Directive?
Authors: Dygert Levi , Lewis Ariane 
Published: July 2021

Patients admitted to the hospital with neurological problems are sometimes incapacitated and unable to make end-of-life decisions. In these instances, without an advanced directive from the patient, clinicians and family members must make critical medical decisions without input from the patient. This paper looks at two cases - one child and one adult – in which neuroprognosis was uncertain, and physician and family members’ beliefs on end-of-life care clash. We provide insight into these disagreements and reflect on how best to manage them. We argue that when considering withdrawing treatment, respecting autonomy is of paramount importance, while decision-making about continuing life-sustaining treatment requires clinicians to ensure surrogates are adequately educated about the principle of beneficence.
Fatty Acid–Binding Protein 4 (FABP4) Is Associated with Cartilage Thickness in End-Stage Knee Osteoarthritis
Authors: Schadler Paul , Lohberger Birgit , Thauerer Bettina , Faschingbauer Martin , Kullich Werner , Stradner Martin Helmut , Husic Rusmir , Leithner Andreas , Steinecker-Frohnwieser Bibiane 
Published: July 2021

Background There is no single blood biomarker for the staging of knee osteoarthritis (KOA). The purpose of this study was to assess the relationship of obesity, serum biomarkers, the hip-knee-ankle angle (HKAA) with sonographic cartilage thickness. Methods We conducted a cross-sectional study of n = 33 patients undergoing knee arthroplasty. Body mass index (BMI) was recorded, and patients were grouped based on BMI. Serum blood samples were collected, and the following biomarkers were measured using the ELISA technique (subgroup of n = 23): oxidized low-density lipoprotein (oxLDL), soluble receptor for advanced glycation end-products (sRAGE), fatty acid–binding protein 4 (FABP4), membrane-bound phospholipase A2 (PLA2G2A). The HKAA was analyzed on full-length limb standing x-ray images. Cartilage thickness was assessed on ultrasound images. Multivariable regression analysis was performed to account for confounding. Results After adjusting for age, gender, and HKAA, obese patients had thicker medial femoral cartilage (β = 0.165, P = 0.041). Furthermore, lateral cartilage thickness was negatively correlated with FABP4 level after adjusting for of age, gender, BMI, and HKAA (β = −0.006, P = 0.001). Confirming previous studies, after adjustment, FABP4 level was associated with a higher BMI group (β = 42.99, P < 0.001). None of the other markers (oxLDL, PLA2G2A, and sRAGE) was associated with BMI or cartilage thickness. Discussion Our results indicate that BMI has a weak, positive association with cartilage thickness in end-stage KOA patients. FABP4 levels were negatively associated with cartilage thickness. While our study is limited by a small sample size, these results further highlight the role of FABP4 as promising biomarkers of burden of disease in KOA.
A review of neuroradiological abnormalities in patients with coronavirus disease 2019 (COVID-19)
Authors: Bahranifard Bahar , Mehdizadeh Somayeh , Hamidi Ali , Khosravi Alireza , Emami Ramin , Mirzaei Kamran , Nemati Reza , Nemati Fatemeh , Assadi Majid , Gholamrezanezhad Ali 
Published: July 2021

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to various neurological manifestations. There is an urgent need for a summary of neuroimaging findings to accelerate diagnosis and treatment plans. We reviewed prospective and retrospective studies to classify neurological abnormalities observed in patients with the SARS-CoV-2 infection. Methods The relevant studies published in Scopus, PubMed and Clarivate Analytics databases were analysed. The search was performed for full-text articles published from 23 January 2020 to 23 February 2021. Results In 23 studies the number of patients with SARS-CoV-2 infection was 20,850 and the number of patients with neurological manifestations was 1996 (9.5%). The total number of patients with neuroradiological abnormalities was 602 (2.8%). SARS-CoV-2 has led to various neuroimaging abnormalities which can be categorised by neuroanatomical localisation of lesions and their main probable underlying pathogenesis. Cranial nerve and spinal root abnormalities were cranial neuritis and polyradiculitis. Parenchymal abnormalities fell into four groups of: (a) thrombosis disorders, namely ischaemic stroke and sinus venous thrombosis; (b) endothelial dysfunction and damage disorders manifested as various types of intracranial haemorrhage and posterior reversible encephalopathy syndrome; (c) hypoxia/hypoperfusion disorders of leukoencephalopathy and watershed infarction; and (d) inflammatory disorders encompassing demyelinating disorders, encephalitis, vasculitis-like disorders, vasculopathy and cytotoxic lesions of the corpus callosum. Leptomeninges disorders included meningitis. Ischaemic stroke was the most frequent abnormality in these studies. Conclusion The review study suggests that an anatomical approach to the classification of heterogeneous neuroimaging findings in patients with SARS-CoV-2 and neurological manifestations would lend itself well for use by practitioners in diagnosis and treatment planning.
Normalized intraplaque hemorrhage signal on MP-RAGE as a marker for acute ischemic neurological events
Authors: Larson Anthony S , Brinjikji Waleed , Kroll Neil J , Savastano Luis , Huston John , Benson John C 
Published: July 2021

Purpose This study sought to validate whether the signal intensity ratio (SIR) of carotid intraplaque hemorrhage (IPH) was associated with acute ischemic neurologic events. Methods A retrospective review was completed of consecutive patients that underwent neck magnetic resonance angiography using magnetization prepared-rapid gradient echo (MP-RAGE) and T1-CUBE sequences between 2017 and 2020. Patients with magnetic resonance evidence of IPH were included. SIRs were measured by comparing the maximum IPH signal with the mean intramuscular signal from the adjacent sternocleidomastoid. Patients were stratified into ischemic or non-ischemic groups based on the presence of acute ipsilateral ischemic events (stroke, retinal artery occlusion). Logistic regression analysis was performed to determine if increasing IPH SIR was associated with an increased risk of ipsilateral ischemic events. Results Of 85 included patients (85 arteries), 66 were male (77.6%). Mean age was 71.0 (SD ± 11.1). There were 70 arteries with IPH that were ipsilateral to an ischemic event, and 15 that belonged to patients without an ischemic event. No association was found between increasing IPH SIR seen on MP-RAGE (odds ratio (OR): 0.82; 95% confidence interval (CI): 0.58–1.4; P = 0.43) or T1-CUBE sequences (OR: 0.85; 95% CI: 0.53–1.5; P = 0.56). Conclusions There was no association between the SIR of IPH and acute ischemia on either MP-RAGE or T1-CUBE sequences. Further investigation is required prior to widespread acceptance of SIR as a predictive imaging marker of symptomatic carotid plaque.
Polio Supplementary Immunization Activities During COVID-19 Pandemic: Experience from Penampang District, Sabah, Malaysia
Authors: Jiee Sam Froze , Bondi Melvin Ebin , Emiral Muhammad Ezmeer , Jantim Anisah 
Published: July 2021

Background: Polio Supplementary Immunization Activities (SIAs) were carried out in the State of Sabah in response to the Vaccine Derived Poliovirus outbreak declared in December 2019. Prior to this, Malaysia had been polio-free over the past 27 years. This paper reported on the successful implementation of SIAs in the district of Penampang, Sabah, adapting (vaccine administration) to the COVID-19 pandemic. Methods: A series of meticulous planning, healthcare staff training, advocacy, and community engagement activities were conducted by the Penampang District Health Office. Bivalent Oral Polio Vaccine (bOPV) and monovalent Oral Polio Vaccine were administered over the period of 1 year via these methods: house to house, drive-through, static, and mobile posts. The targeted group was 22 096 children aged 13 years and below. Results: Polio SIAs in Penampang managed to achieve more than 90% coverage for both bOPV and mOPV. The overall vaccine wastage was reported to be 1.63%. No major adverse reaction was reported. Conclusion: High vaccine uptake during Polio SIAs in Penampang was attributed to good inter-agency collaboration, community engagement, intensified health promotion activities, and drive-through vaccination campaign.
Automatic Diagnosis of Spinal Disorders on Radiographic Images: Leveraging Existing Unstructured Datasets With Natural Language Processing
Authors: Galbusera Fabio , Cina Andrea , Bassani Tito , Panico Matteo , Sconfienza Luca Maria 
Published: July 2021

Study Design: Retrospective study. Objectives: Huge amounts of images and medical reports are being generated in radiology departments. While these datasets can potentially be employed to train artificial intelligence tools to detect findings on radiological images, the unstructured nature of the reports limits the accessibility of information. In this study, we tested if natural language processing (NLP) can be useful to generate training data for deep learning models analyzing planar radiographs of the lumbar spine. Methods: NLP classifiers based on the Bidirectional Encoder Representations from Transformers (BERT) model able to extract structured information from radiological reports were developed and used to generate annotations for a large set of radiographic images of the lumbar spine (N = 10 287). Deep learning (ResNet-18) models aimed at detecting radiological findings directly from the images were then trained and tested on a set of 204 human-annotated images. Results: The NLP models had accuracies between 0.88 and 0.98 and specificities between 0.84 and 0.99; 7 out of 12 radiological findings had sensitivity >0.90. The ResNet-18 models showed performances dependent on the specific radiological findings with sensitivities and specificities between 0.53 and 0.93. Conclusions: NLP generates valuable data to train deep learning models able to detect radiological findings in spine images. Despite the noisy nature of reports and NLP predictions, this approach effectively mitigates the difficulties associated with the manual annotation of large quantities of data and opens the way to the era of big data for artificial intelligence in musculoskeletal radiology.