bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validity of Surrogate Endpoints and Their Impact on Coverage Recommendations: A Retrospective Analysis across International Health Technology Assessment Agencies
Authors: Ciani Oriana , Grigore Bogdan , Blommestein Hedwig , de Groot Saskia , Möllenkamp Meilin , Rabbe Stefan , Daubner-Bendes Rita , Taylor Rod S. 
Published: March 2021

Background Surrogate endpoints (i.e., intermediate endpoints intended to predict for patient-centered outcomes) are increasingly common. However, little is known about how surrogate evidence is handled in the context of health technology assessment (HTA). Objectives 1) To map methodologies for the validation of surrogate endpoints and 2) to determine their impact on acceptability of surrogates and coverage decisions made by HTA agencies. Methods We sought HTA reports where evaluation relied on a surrogate from 8 HTA agencies. We extracted data on the methods applied for surrogate validation. We assessed the level of agreement between agencies and fitted mixed-effects logistic regression models to test the impact of validation approaches on the agency’s acceptability of the surrogate endpoint and their coverage recommendation. Results Of the 124 included reports, 61 (49%) discussed the level of evidence to support the relationship between the surrogate and the patient-centered endpoint, 27 (22%) reported a correlation coefficient/association measure, and 40 (32%) quantified the expected effect on the patient-centered outcome. Overall, the surrogate endpoint was deemed acceptable in 49 (40%) reports ( k-coefficient 0.10, P = 0.004). Any consideration of the level of evidence was associated with accepting the surrogate endpoint as valid (odds ratio [OR], 4.60; 95% confidence interval [CI], 1.60–13.18, P = 0.005). However, we did not find strong evidence of an association between accepting the surrogate endpoint and agency coverage recommendation (OR, 0.71; 95% CI, 0.23–2.20; P = 0.55). Conclusions Handling of surrogate endpoint evidence in reports varied greatly across HTA agencies, with inconsistent consideration of the level of evidence and statistical validation. Our findings call for careful reconsideration of the issue of surrogacy and the need for harmonization of practices across international HTA agencies.
rpoB gene mutations in rifampin-resistant Mycobacterium tuberculosis isolates from rural areas of Zhejiang, China
Authors: Zeng Mei-Chun , Jia Qing-Jun , Tang Lei-Ming 
Published: March 2021

Objective The aim was to analyze genetic mutations in the rpoB gene of rifampin-resistant Mycobacterium tuberculosis isolates (RIFR-MTB) from Zhejiang, China. Methods We prospectively analyzed RIFR-associated mutations in 13 rural areas of Zhejiang. Isolates were subjected to species identification, phenotype drug susceptibility testing (DST), DNA extraction, and rpoB gene sequencing. Results A total of 103 RIFR isolates were identified by DST (22 RIFR only, 14 poly-drug resistant, 49 multidrug resistant, 13 pre-extensively drug resistant [pre-XDR], and 5 extensively drug resistant [XDR]) from 2152 culture-positive sputum specimens. Gene sequencing of rpoB showed that the most frequent mutation was S450L (37.86%, 39/103); mutations P280L, E521K, and D595Y were outside the rifampicin resistance-determining region (RRDR) but may be associated with RIFR. Mutations associated with poly-drug resistant, pre-XDR, and XDR TB were mainly located at codon 445 or 450 in the RRDR. Conclusions The frequency of rpoB RRDR mutation in Zhejiang is high. Further studies are needed to clarify the relationships between RIFR and the TTC insertion at codon 433 in the RRDR and the P280L and D595Y mutations outside the RRDR.
Occupational performance coaching for stroke survivors delivered via telerehabilitation using a single-case experimental design
Authors: Kessler Dorothy , Anderson Nicole D , Dawson Deirdre R 
Published: March 2021

Introduction Sustaining a stroke has a devastating, long-term impact on participation in everyday life. Despite the recognition of participation as a key outcome of stroke rehabilitation, there are few effective interventions that address participation. Occupational performance coaching is a promising intervention designed to improve participation among stroke survivors. Delivery of occupational performance coaching using telerehabilitation could improve access. This study examined the feasibility, acceptability and potential efficacy of telerehabilitation occupational performance coaching. Method A single-case experimental design was used. Six community-dwelling stroke survivors received 10 sessions of telerehabilitation occupational performance coaching over 16 weeks. We examined the feasibility and acceptability of telerehabilitation occupational performance coaching, improvement in performance and satisfaction with identified goals. Results Telerehabilitation occupational performance coaching was feasible and acceptable to deliver; participants who started the intervention completed it and reported high satisfaction and a strong therapeutic relationship. All participants experienced technological issues that required resolution. Goal-performance and/or satisfaction improved for five of six participants. Sixty-four percent of goals showed trends for improvement and 43% showed significant improvements. Conclusions Findings support the feasibility and acceptability of telerehabilitation occupational performance coaching, along with its efficacy for improving performance and satisfaction with performance of goals. Further research is needed to prove the effectiveness of telerehabilitation occupational performance coaching and to determine who may benefit most.
Black feminist intersectionality is vital to group analysis: Can group analysis allow outsider ideas in?
Authors: Nayak Suryia 
Published: March 2021

This is the transcript of a speech I gave at an Institute of Group Analysis (IGA) event on the 28th November 2020 about intersectionality and groups analysis. This was momentous for group analysis because it was the first IGA event to focus on black feminist intersectionality. Noteworthy, because it is so rare, the large group was convened by two black women, qualified members of the IGA—a deliberate intervention in keeping with my questioning of the relationship between group analysis and power, privilege, and position. This event took place during the Covid-19 pandemic via an online platform called ‘Zoom’. Whilst holding the event online had implications for the embodied visceral experience of the audience, it enabled an international attendance, including members of Group Analysis India. Invitation to the event: ‘Why the black feminist idea of intersectionality is vital to group analysis’ Using black feminist intersectionality, this workshop explores two interconnected issues: • Group analysis is about integration of parts, but how do we do this across difference in power, privilege, and position? • Can group analysis allow outsider ideas in? This question goes to the heart of who/ what we include in group analytic practice—what about black feminism? If there ‘cannot possibly be one single version of the truth so we need to hear as many different versions of it as we can’ (Blackwell, 2003: 462), we need to include as many different situated standpoints as possible. Here is where and why the black feminist idea of intersectionality is vital to group analysis. On equality, diversity and inclusion, intersectionality says that the ‘problems of exclusion cannot be solved simply by including black [people] within an already established analytical structure’ (Crenshaw, 1989: 140). Can group analysis allow the outsider idea of intersectionality in?
YouTube to Teach Central Lines, The Expert vs Learner Perspective
Authors: King Daniel , Davison Danielle , Benjenk Ivy , Heinz Eric , Vaziri Khashayar , Hawkins Katrina , Yamane David 
Published: March 2021

Purpose: Instructional videos of medical procedures can be a useful guide for learners, demonstrating proper and safe technique. Open publishing sites such as YouTube are readily accessible, however the content is not peer reviewed and quality of videos vary greatly. Our aim was to evaluate a learner’s ability to interpret the quality of openly published content by comparing their rating of the most popular central line insertion videos on YouTube to expert evaluations. Method: YouTube search results for “central line placement” sorted by views or relevance compiled a list of the four most common videos. A fifth gold standard video, published by the New England Journal, was included, however was not found in the top results. Eleven expert practitioners from varying medical specialties (Critical Care, Surgery, Anesthesia, & Emergency Medicine) evaluated the 5 videos, utilizing a 22-item Likert scaled questionnaire emphasizing: preparation, sterility, anatomy, technique, & complications. Videos were compared as a composite average of the individual items on the survey. The highest, lowest, and 3rd ranked videos were evaluated by 45 residents (“learners”) in varying specialties (Internal Medicine, Emergency Medicine, Surgery, Anesthesia) and post graduate year (PGY). Learners assessed the videos using the same scale. A Welch T-test assessed statistical significance between the two groups. Subgroup analysis compared experts against different PGY and specialty cohorts. Results: The lowest scored video among the experts and learners was the most popular on YouTube, with 858,933 views at the time of inclusion. Though lowest in rank, this video was judged higher by learners than the experts (2.63/5 vs 2.18/5, P = 0.0029). The 3rd ranked video by experts with 249,746 views on YouTube, was also rated higher by learners (3.77/5 vs 3.45/5, P = 0.0084). The gold standard video by NEJM had 320,580 views and was rated highest by both the experts and learners (4.37/5 vs 4.28/5, P = 0.518). Subgroup analysis showed similar results with learners rating the videos overall better than experts, this was particularly true in the PGY-1 subgroup. Conclusion: The most popular central line insertion video was the worst rated by both experts and learners. Learners rated all the videos better than the expert. YouTube videos demonstrating medical procedures including central line insertion should come from peer reviewed sources if they are to be incorporated into educational curriculum.
An Intergenerational Exploration of Breastfeeding Journeys Through the Lens of African American Mothers and Grandmothers
Authors: Muse Mary M. , Morris Jerome E. , Dodgson Joan E. 
Published: March 2021

Background Many individuals comprise a nursing mother’s social support network. Grandmothers within African American families, historically, have played a vital role in the transmission of culture. Understanding intergenerational perspectives within African American families related to infant feeding and scholarship about breastfeeding is critical, given the breastfeeding patterns among African American women. Research aim To describe intergenerational perspectives within African American families, where the mother has successfully breastfed. Methods A prospective, cross-sectional, qualitative design using semi-structured interviews was used. African American nursing mothers and maternal grandmothers ( N = 14) residing in the Metro–St. Louis area, who reflected economic and educational diversity, were recruited. Inductive and iterative data analysis, framed by Black Feminist Theory allowed for emerging patterns reflecting the participants’ voices. Results Three of the six (50%) grandmother participants had breastfed. The majority of the mother participants were married ( n = 5; 62.5%) and had a college degree ( n = 4; 50.0%) or a high school diploma ( n = 1; 12.5%); and four (50.0%) had received the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Three patterns emerged: (a) intergenerational connections; (b) changes in breastfeeding experiences over time; and (c) going with the flow (referring to the choice to work within the constraints of one’s circumstances). Grandmothers supported mothers’ breastfeeding decisions; grandmothers who had breastfed benefited from the updated information the mothers provided; and grandmothers who did not breastfeed acquired new breastfeeding knowledge, which informed the ways they supported the mothers. Conclusion The intergenerational perspectives surrounding breastfeeding within African American families participating in this study offer future research directions.
Assessment of breast positioning criteria in mammographic screening: Agreement between artificial intelligence software and radiographers
Authors: Waade Gunvor G , Danielsen Anders Skyrud , Holen Åsne S , Larsen Marthe , Hanestad Berit , Hopland Nina-Merete , Kalcheva Vanya , Hofvind Solveig 
Published: March 2021

Objectives To determine the agreement between artificial intelligence software (AI) and radiographers in assessing breast positioning criteria for mammograms from standard digital mammography and digital breast tomosynthesis. Methods Assessment of breast positioning was performed by AI and by four radiographers in pairs of two on 156 examinations of women screened in Bergen, April to September 2019, as part of BreastScreen Norway. Ten criteria were used; three for craniocaudal and seven for mediolateral-oblique view. The criteria evaluated the appearance of the nipple, breast rotation, pectoral muscle, inframammary fold and pectoral nipple line. Intraclass correlation and Cohen’s kappa coefficient (κ) were used to investigate the correlation and agreement between the radiographer’s assessments and AI. Results The intraclass correlation for the pectoral nipple line between the radiographers and AI was >0.92. A substantial to almost perfect agreement (κ > 0.69) was observed between the radiographers and AI on the nipple in profile criterion. We observed a slight to moderate agreement for the other criteria (κ = 0.06–0.52) and generally a higher agreement between the two pairs of radiographers (mean κ = 0.70) than between the radiographers and AI (mean κ = 0.41). Conclusions AI has great potential in evaluating breast position criteria in mammography by reducing subjectivity. However, varying agreement between radiographers and AI was observed. Standardized and evidence-based criteria for definitions, understandings and assessment methods are needed to reach optimal image quality in mammography.
Investigation of the Effect of Bone Mineral Density on the Postoperative Outcome of Ankle Fractures in Elderly Patients
Authors: Park Young Hwan , Cho Hyun Woo , Choi Jung Woo , Kim Hak Jun 
Published: March 2021

Background: The association between ankle fractures in elderly patients and low bone mineral density (BMD) has recently been recognized, but the effect of BMD on the postoperative outcome of these fractures is unknown. The aim of this study was to investigate the effect of BMD on the postoperative outcome of ankle fractures in elderly patients to evaluate the need for BMD screening. Methods: We retrospectively reviewed 48 patients aged 65 years or older who had ankle fractures and underwent dual-energy x-ray absorptiometry to assess BMD after surgical treatment of the fracture. Postoperative outcomes were assessed using the Olerud-Molander Ankle Score (OMAS), visual analog scale (VAS) score for pain, Kellgren and Lawrence (K&L) grading scale score, and quality of fracture reduction. The correlation between the BMD and the outcome measures at 12 months after surgery was analyzed using the Pearson correlation coefficient. Results: The mean absolute value of BMD was 0.6 ± 0.1 g/cm2 (T-score, –1.5 ± 1.2) at the femoral neck and 0.8 ± 0.2 g/cm2 (T-score, –1.2 ± 1.5) at the lumbar spine. Osteoporosis was present in 33% of female patients and in 11% of male patients. At 12 months after surgery, the OMAS was 70 ± 17 and the VAS score for pain was 18 ± 17. Of the patients, 20, 21, 5, 1, and 1 had K&L grades of 0, 1, 2, 3, and 4, respectively. None of the clinical and radiographic outcome measures were correlated with the BMD values of the patients. Conclusion: The postoperative outcome of the ankle fractures in elderly patients at 12 months after surgery showed no correlation with femoral neck or lumbar spine BMD at the time of fracture. Level of Evidence: Level III, retrospective comparative study.
Iterative feedback control based on frequency response model for a six-degree-of-freedom micro-vibration platform
Authors: Zhu He , He Shuai , Xu Zhenbang , Wang XiaoMing , Qin Chao , Yang Jianfeng , Zhang Lei 
Published: March 2021

In this article, a six-degree-of-freedom (6-DOF) micro-vibration platform (6-MVP) based on the Gough–Stewart configuration is designed to reproduce the 6-DOF micro-vibration that occurs at the installation surfaces of sensitive space-based instruments such as large space optical loads and laser communications equipment. The platform’s dynamic model is simplified because of the small displacement characteristics of micro-vibrations. By considering the multifrequency line spectrum characteristics of micro-vibrations and the parameter uncertainties, an iterative feedback control strategy based on a frequency response model is designed, and the effectiveness of the proposed control strategy is verified by performing integrated simulations. Finally, micro-vibration experiments are performed with a 10 kg load on the platform. The results of these micro-vibration experiments show that after several iterations, the amplitude control errors are less than 3% and the phase control errors are less than 1°. The control strategy presented in this article offers the advantages of a simple algorithm and high precision and it can also be used to control other similar micro-vibration platforms.
Evaluation of inflammatory biomarkers in patients with keratoconus
Authors: Oltulu Refik , Katipoğlu Zeynep , Gündoğan Ali Osman , Mirza Enver , Belviranlı Selman 
Published: March 2021

Objective: To investigate the monocyte-to-HDL-cholesterol ratio (MHR), neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), eosinophil-to-lymphocytes ratio (ELR), platelet distribution width (PDW), red blood cell distribution width (RDW), mean platelet volume (MPV), MPV to platelet count ratio (MPV/PC), and RDW to platelet ratio (RPR) that are accepted as inflammatory markers in patients with keratoconus. Methods: In this study, 43 patients with keratoconus and 43 healthy individuals as the control group were retrospectively evaluated. High density lipoprotein cholesterol (HDL-c), lymphocyte, neutrophil, eosinophil, monocyte, platelet, MPV, PDW, and RDW values were obtained with complete blood count performed on the peripheral blood samples. Results: Absolute monocyte (593 ± 182 vs 492 ± 177; p < 0.05) and neutrophil (4860 ± 1553 vs 3954 ± 1297; p < 0.01) counts were statistically significantly higher in the keratoconus groups compared to the control group. MHR (13.18 ± 5.02 vs 9.88 ± 4.45; p < 0.01) and NLR (2.30 ± 0.87 vs 1.77 ± 0.61; p < 0.01) were statistically significantly higher and LMR (4.07 ± 1.67 vs 5.18 ± 2.06; p < 0.01) was significantly lower in the keratoconus group. As a result of univariate logistic regression analysis, it was observed that MHR and NLR were statistically significant relationship with keratoconus ( p = 0.02 and p = 0.021) (Odds ratio = 5.41 (95% CI: 1.169–6.669) and Odds ratio:5.28 (95% CI: 1.024–6.321); respectively). No statistically significant difference was found between the groups in terms of PLR, ELR, RDW, MPV, PDW, MPV/PC, and RPR. Adjusting for age and gender, multivariate regression analysis revealed that MHR was the most significant parameter to demonstrate relationship with keratoconus ( p = 0.025) (Odds ratio = 4.99 (95% CI: 1.019–6.332)). Conclusion: MHR and NLR values considered as inflammatory markers were statistically significantly higher and LMR value was significantly lower in the keratoconus group. Among these values, MHR was the most reliable parameter.
Diagnosis and management of secondary malposition of PICC into the azygos vein
Authors: Wang Yaping , Zhao Linfang 
Published: March 2021

Background: Peripherally inserted central catheter (PICC) has been widely used. The catheter-related complications might occur and the reports of secondary malposition into azygos veins were rare. Methods: This retrospective review summarized the experience in diagnosis and management of secondary malposition of PICC into azygos veins in 25 cases. Results: When the catheter dysfunction occurred in the PICC on the left limb, it was necessary to consider whether there would be malposition into azygos veins after other reasons were excluded. The malposition could be diagnosed by chest lateral radiograph or chest computed tomography. The secondary malposition into azygos veins was resolved by repositioning or withdrawing the PICC. After re-inserting the catheter, it should be closely monitored whether the malposition occurred again. Intracavitary electrocardiogram positioning technology was used to confirm the catheter tip position before using corrosive drug. After the catheters withdrawn from the azygos veins, close attention should be paid to the property and concentration of the infusion drug strictly and the complications such as blockage and re-malposition. No serious complications such as infection, thrombosis and extravasation occurred in this group of patients after treatment. Conclusions: The results of our study suggested that the right limb is recommended for PICC catheterization in order to avoid secondary malposition into azygos veins and the malposition into azygos veins should be dealt with in time.
An Update on the Cutaneous Manifestations of Darier Disease
Authors: Yeshurun Algit , Ziv Michael , Cohen-Barak Eran , Vered Shiraz , Rozenman Dganit , Sah Muhammad , Khayat Morad , Polyakov Olga , Amichai Boaz , Zlotogorski Abraham , Shalev Stavit , Dodiuk-Gad Roni P. 
Published: March 2021

Background Knowledge about the clinical features of Darier disease, an orphan autosomal-dominant genetic disorder, is sparse and has been evaluated only in few studies. Objectives To investigate the clinical features of a large group of patients with Darier disease, and to explore for associations between disease characteristics and severity of the disease. Methods Seventy-six individuals with Darier disease were evaluated utilizing a structured questionnaire-based interview, a physical examination, and a retrospective assessment of their medical records. Results The most frequent locations of lesions were hands (99%) and fingernails (93%). Wart-like lesions on the hands were more visible after soaking them in water for 5 minutes, we therefore named this phenomenon the “wet hand sign”. Oral involvement was found in 43% of patients, while 48% of women and 16% of men showed genital lesions. Patients with severe Darier disease had a tenfold greater risk of developing genital lesions than those with mild disease ( P = .01). Most patients (88%) in our study exhibited a combination of the four types of the disease patterns of distribution (flexural, seborrheic, nevoid, and acral). Conclusions Documentation of disease on the hands and fingernails provides a highly sensitive means to aid in the diagnosis of Darier disease. It is important to evaluate mucosal lesions including genital and oral mucosa.