bluuebunny/crossref_metadata_2025_split huggingface dataset:
The epidemiologic and economic impact of a quadrivalent human papillomavirus vaccine in Thailand
Authors: Termrungruanglert Wichai , Khemapech Nipon , Vasuratna Apichai , Havanond Piyalamporn , Deebukkham Preyanuch , Kulkarni Amit Sharad , Pavelyev Andrew 
Published: February 2021

Background
The human papillomavirus (HPV) vaccine was introduced into Thailand’s national immunization program in 2017 for 11–12 year old school girls. The objectives of this study were to examine the epidemiological consequences and cost-effectiveness of a routine quadrivalent HPV (4vHPV) vaccination and the routine 4vHPV vaccination plus 5-year catch-up vaccination by comparing with cervical cancer screening only (no vaccination) in Thailand.

Method
A transmission dynamic model was used to assess the cost-effectiveness of the routine 4vHPV vaccination and the routine 4vHPV vaccination plus catch-up vaccination, compared with no vaccination (screening only) in Thai population. The vaccination coverage rate assumptions were 95% in 11-12-year-old girls for the routine vaccination and 70% in 13–24 year-old females for the 5-year catch-up vaccination. Vaccination costs, direct medical costs of HPV-related diseases, and the number of quality of life years (QALYs) gained were calculated for over a 100-year time horizon with discount rate of 3%.

Result
The model indicated that the routine 4vHPV vaccination and the routine plus catch-up 4vHPV vaccination strategies could prevent approximately 434,130 and 472,502 cumulative cases of cervical cancer, 182,234 and 199,068 cumulative deaths from cervical cancer and 12,708,349 and 13,641,398 cumulative cases of HPV 6/11 related genital warts, respectively, when compared with no vaccination over 100 years. The estimated cost per QALY gained (ICER) when compared to no vaccination in Thailand was 8,370 THB/QALY for the routine vaccination and 9,650 THB/QALY for the routine with catch-up vaccination strategy.

Conclusion
Considering the recommended threshold of 160,000 THB/QALY for Thailand, the implementation of the routine 4vHPV vaccination either alone or plus the catch-up vaccination was cost-effective as compared to the cervical cancer screening only.
Estimation of time of HIV seroconversion using a modified CD4 depletion model
Authors: Lima Viviane D. , Wang Lu , Sereda Paul , McLinden Taylor , Barrios Rolando , Montaner Julio S. G. 
Published: February 2021

IntroductionSeveral methods have been proposed to estimate the time of HIV seroconversion, including those based on CD4 cell depletion models. However, previous models have failed to consider the heterogeneity that exists in CD4 trajectories among different sub-populations. Our objective was to estimate the time from HIV seroconversion relative to the HIV diagnosis date in a population-based cohort of people living with HIV (PLWH) in the province of British Columbia, Canada.MethodsWe used linked administrative and clinical data from the British Columbia Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort, which contains longitudinal individual-level data on all PLWH ever diagnosed in the province. Eligible participants were aged ≥18 years and diagnosed with HIV between 1989 and 2013. The outcome was pre-antiretroviral treatment CD4 cell count measurements assessed every six months. Models were stratified by age and stage of HIV infection at diagnosis. Several explanatory variables were considered including longitudinal viral load measurements. Longitudinal CD4, square root transformed, was modeled via a non-linear mixed effects model; time was modeled using an exponential decay function. We assumed a Gaussian distribution (identity link), an AR(1) correlation structure, and a random intercept and slope for the longitudinal viral load measurements. Due to the population variation in CD4 count among uninfected individuals, we assumed 500 to 1500 cells/mm3as the normal range when estimating the time of HIV seroconversion.ResultsLongitudinal data on 1,253 individuals were analysed: 80% male, 33% White, and the median age at diagnosis was 38 years (25th-75thpercentile [Q1-Q3], 31 to 45). CD4 decay differed by stage of infection at diagnosis and age, with those ≥50 years in Stages 1 and 2 experiencing a faster decline in CD4 over time. The median duration of infection from seroconversion until HIV diagnosis was 6.9 (Q1-Q3, 3.9 to 10.1) years.ConclusionsConsidering the heterogeneity that exists in individual CD4 cell trajectories in a population, we presented a methodology that only relies on routinely collected HIV-related data, which can be further extended to estimate other epidemic measures.
Refractive error and its associated factors among pregnant women attending antenatal care unit at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia
Authors: Diress Mengistie , Yeshaw Yigizie , Bantihun Minychil , Dagnew Baye , Ambelu Adugnaw , Seid Mohammed Abdu , Akalu Yonas 
Published: February 2021

BackgroundRefractive error is one of the commonly encountered problems during pregnancy and being the cause of deleterious effects on health. Despite its impacts, there is no evidence on the magnitude and associated factors of refractive error among pregnant women in Ethiopia. This study aimed to determine the prevalence of refractive error and its associated factors among pregnant women attending antenatal care unit at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2020.MethodsAn institution-based cross-sectional study was employed. An ocular examination was performed using Retinoscope and Snellen’s illiterate “E” chart. The required data were collected using an interviewer-administered questionnaire which comprised socio-demographic, clinical and pregnancy-related variables. EpiData 3.02 and STATA 14 were used for data entry and analysis respectively. Both bivariable and multivariable binary logistic regression analyses were executed to identify factors associated with refractive error. Variables with a p-value ≤ 0.05 in the multivariable logistic regression analysis were declared as significantly associated factors with refractive error.ResultsA total of 401 pregnant women with a median age of 27 (IQR = 24–31) years participated in this study. The overall prevalence of refractive error among the study participants was 35.66% (95% CI: 30.95–40.37). Of the total study participants, ninety-two (22.90%) of them were myopic, forty-five (11.22%) were hyperopic and the rest were antimetropic. Increased maternal age (AOR = 1.31; 95% CI: 1.16–1.48)), increased parity (AOR = 3.17, 95% CI: 1.92–5.25), increased gestational age (AOR = 1.15, 95% CI: 1.08–1.22), and regular use of computers/ watching television (AOR = 6.19, 95% CI: 2.46–15.59) were significantly associated with refractive error.ConclusionThe prevalence of refractive error among pregnant women was high where myopia was the most common variety. Advanced maternal age, increased gestational age, increased parity and regular use of computer or watching television were significantly associated with refractive error among pregnant women. Therefore, apart from providing other maternal health services, routine screening and evaluation of pregnant women for refractive error during antenatal care visit is recommended to avoid its negative impacts.
Prevalence and risk indicators of first-wave COVID-19 among oral health-care workers: A French epidemiological survey
Authors: Jungo Sébastien , Moreau Nathan , Mazevet Marco E. , Ejeil Anne-Laure , Biosse Duplan Martin , Salmon Benjamin , Smail-Faugeron Violaine 
Published: February 2021

Background
Previous studies have highlighted the increased risk of contracting the COVID-19 for health-care workers and suggest that oral health-care workers may carry the greatest risk. Considering the transmission route of the SARS-CoV-2 infection, a similar increased risk can be hypothesized for other respiratory infections. However, no study has specifically assessed the risk of contracting COVID-19 within the dental profession.

Methods
An online survey was conducted within a population of French dental professionals between April 1 and April 29, 2020. Univariable and multivariable logistic regression analyses were performed to explore risk indicators associated with laboratory-confirmed COVID-19 and COVID-19-related clinical phenotypes (i.e. phenotypes present in 15% or more of SARS-CoV-2-positive cases).

Results
4172 dentists and 1868 dental assistants responded to the survey, representing approximately 10% of French oral health-care workers. The prevalence of laboratory-confirmed COVID-19 was 1.9% for dentists and 0.8% for dental assistants. Higher prevalence was found for COVID-19-related clinical phenotypes both in dentists (15.0%) and dental assistants (11.8%). Chronic kidney disease and obesity were associated with increased odds of laboratory-confirmed COVID-19, whereas working in a practice limited to endodontics was associated with decreased odds. Chronic obstructive pulmonary disease, use of public transportation and having a practice limited to periodontology were associated with increased odds of presenting a COVID-19-related clinical phenotype. Moreover, changes in work rhythm or clinical practice were associated with decreased odds of both outcomes.

Conclusions
Although oral health-care professionals were surprisingly not at higher risk of COVID-19 than the general population, specific risk indicators could exist, notably among high aerosol-generating dental subspecialties such as periodontology. Considering the similarities between COVID-19-related clinical phenotypes other viral respiratory infections, lessons can be learned from the COVID-19 pandemic regarding the usefulness of equipping and protecting oral health-care workers, notably during seasonal viral outbreaks, to limit infection spread.

Impact
Results from this study may provide important insights for relevant health authorities regarding the overall infection status of oral health-care workers in the current pandemic and draw attention to particular at-risk groups, as illustrated in the present study. Protecting oral health-care workers could be an interesting public health strategy to prevent the resurgence of COVID-19 and/or the emergence of new pandemics.
Psychological features of adult patients with langerhans cell histiocytosis
Authors: Bugnet Emmanuelle , Gupta Nishant , Lorillon Gwenaël , Arbabzadeh-Bouchez Sayena , Lemogne Cédric , Chevret Sylvie , Tazi Abdellatif 
Published: February 2021

Background
The prevalence of psychological symptoms and the co-occurrence of substance abuse disorders in adult patients with Langerhans cell histiocytosis (LCH) has not been previously explored. We aimed to use validated scales to evaluate depression and anxiety symptoms experienced by adult LCH patients.

Methods
In this cross-sectional study, all consecutive adult LCH patients seen at our national reference center between January 2012 and January 2013 were asked to complete the following instruments: the Hospital Anxiety and Depression scale (HADS); Barratt Impulsiveness Scale, Version 10 (BIS-10); and Cannabis Use Disorders Identification Test (CUDIT). Self-reported scores on these scales were used to determine the point prevalence of clinically significant psychological symptoms and substance use disorders in LCH patients. Patient profiles in terms of psychological features were assessed by principal component analysis including the HADS and BIS-10 instruments values, followed by hierarchical clustering. Fisher exact tests and Wilcoxon tests were used to examine the associations between disease-related parameters and high levels of anxiety and impulsivity.

Results
Seventy-one adult LCH patients, mainly with pulmonary LCH (PLCH), completed the evaluations. Clinically significant anxiety and depression symptoms were reported by 22 (31%) and 4 (6%) subjects, respectively. Impulsivity was detected in 14% (10/71) of the patients. Seventeen percent (12/71) of the patients used cannabis on a regular basis, with 50% of these individuals (6/12) exhibiting scores consistent with cannabis use disorder. Three derived clusters of patients were identified in the principal component analysis; these patient clusters differed in successful weaning from tobacco at the time of evaluation (p = 0.03). In univariate analyses, isolated PLCH and the use of psychotropic treatments were statistically associated with clinically significant anxiety symptoms.

Conclusions
High levels of anxiety and impulsivity are common in adult patients with LCH. The consequences of these symptoms for the management of LCH patients warrant further evaluation.
Postoperative acute respiratory dysfunction and the influence of antibiotics after acute type A aortic dissection surgery: A retrospective analysis
Authors: Möller Christina M. , Ellmauer Peter-Paul , Zeman Florian , Bitzinger Diane , Flörchinger Bernhard , Graf Bernhard M. , Zausig York A. 
Published: February 2021

Objectives
Surgery for acute type A aortic dissection is associated with several perioperative complications, such as acute respiratory dysfunction (ARD). The aim of this study was to investigate perioperative risk factors involved in the development of ARD and whether antibiotic treatment has an impact.

Methods
243 patients underwent surgery for acute type A aortic dissection between 2008 and 2017. The patients were retrospectively divided into the ARD and NON-ARD group. ARD was defined as PaO2/FiO2 ≤ 200 mmHg (PF ratio) within 48 hours after surgery. All patients received either narrow- or broad-spectrum antibiotics.

Results
After the exclusion of 42 patients, 201 patients were analyzed. The PF ratio of the ARD group was significantly lower than of the NON-ARD group within the first 7 days. ARD patients (n = 111) were significantly older (p = .031) and had a higher body mass index (BMI) (p = .017). ARD patients required longer postoperative ventilation (2493 vs. 4695 [min], p = .006) and spent more days in the intensive care unit (7.0 vs. 8.9 [days], p = .043) compared to NON-ARD. The mortality was significantly lower for ARD than for NON-ARD patients (p = .030). The incidence of pneumonia was independent of the antibiotic treatment regime (p = .391). Renal and neurological complication rate was higher in patients treated with broad-spectrum antibiotic.

Conclusion
ARD is the main complication (55%) that occurs approximately 24 hours after surgery for acute type A aortic dissection. The preoperative risk factors for ARD were higher age and increased BMI. Patients on broad-spectrum antibiotics did not show an improved postoperative outcome compared to patients with narrow-spectrum antibiotics.
Hepatorenal index for grading liver steatosis with concomitant fibrosis
Authors: Stahlschmidt Fabio Lucio , Tafarel Jean Rodrigo , Menini-Stahlschmidt Carla Martinez , Baena Cristina Pellegrino 
Published: February 2021

Introduction
Ultrasonography is widely used as the first tool to evaluate fatty liver disease, and the hepatorenal index is a semi-quantitative method that improves its performance. Fibrosis can co-exist with steatosis or even replace it during disease progression. This study aimed to evaluate the influence of fibrosis on the measurement of steatosis using the hepatorenal index.

Materials and methods
This cross-sectional study included 89 patients with nonalcoholic fatty liver disease and in whom liver fibrosis was determined by ultrasound elastography. The Pearson’s correlation coefficient was used to compare between the results of the sonographic hepatorenal index and the quantification of steatosis using magnetic resonance spectroscopy as well the accuracy of detecting moderate to severe steatosis using sonography in two groups of patients: (A) without advanced fibrosis and (B) with advanced fibrosis. Advanced fibrosis was defined as a shear wave speed ≥ 1.78 m/s on ultrasound elastography. We calculated the area under the curve (AUC-ROC) to detect the ability of the hepatorenal index to differentiate light from moderate to severe steatosis in both groups. Moderate to severe steatosis was defined as a fat fraction > 15% on the magnetic resonance spectroscopy. The intra-observer variability was assessed using the Bland-Altman plot.

Results
Among patients, the mean age was 54.6 years and 59.6% were women, 50.6% had a body mass index ≥ 30 kg/m2, 29.2% had moderate to severe steatosis, and 27.2% had advanced fibrosis. There was a correlation between steatosis grading by ultrasonography and magnetic resonance in group A (0.73; P < 0.001), but not in Group B (0.33; P = 0.058). The AUC-ROC for detecting a steatosis fraction ≥ 15% was 0.90 and 0.74 in group A and group B, respectively. The intra-observer variability for the hepatorenal index measurements was not significant (-0.036; P = 0.242).

Conclusion
The hepatorenal index is not appropriate for estimating steatosis in livers with advanced fibrosis.
The impact of medical cannabis consumption on the oral flora and saliva
Authors: Habib George , Steinberg Doron , Jabbour Adel 
Published: February 2021

Objective
To evaluate the effect of medical cannabis consumption on oral flora and saliva.

Design
A clinical prospective study, at the rheumatology clinic of the Nazareth Hospital in Nazareth, recruiting consecutively patients approved for medical cannabis, evaluating their saliva flow, pH and microbial load of Streptococcus mutans and Lactobacillus, prior to and under medical cannabis treatment.

Methods
Patients recently licensed for medical cannabis treatment, were recruited just prior to starting medical cannabis consumption (week 0), 1 and 4 weeks later, patients provided 5-minute time saliva samples, which were measured for their volume and pH, and cultured on a special microbial kit, evaluating the growth of Streptococcus mutans and Lactobacillus.

Results
Out of 16 patients enrolled, 14 were female and had fibromyalgia. The mean age of the patients was 52.8±12.9 years. The mean saliva flow at week 0, week 1 and week 4 were 5.38±3.36 ml/5-minutes, 6 (p = 0.769) and 5.45 (p = 0.391), respectively, and for saliva pH were 6.28, 5.94 (p = 0.51) and 5.5 (p = 0.07) respectively also. The mean Streptococcus mutans growth score at weeks 0, 1 and 4 was1.8±0.75, 1.6±0.83 (p = 0.234), and 2.4±0.84 (p = 0.058), respectively. The mean Lactobacilli growth score at weeks 0, 1 and 4 was 2.59±0.88, 3.1±0.69 (p = 0.033) and 3.3±0.67 (p = 0.025), respectively.

Conclusions
The results of this study show that medical cannabis consumption has no significant effect on saliva volume or pH, but it may be associated with changes in salivary levels of oral microbes such as Streptococcus mutans and Lactobacilli.
External Goods and the Complete Exercise of Virtue in Aristotle’s
Nicomachean Ethics
Authors: Hirji Sukaina 
Published: February 2021

Abstract
In Nicomachean Ethics 1.8, Aristotle seems to argue that certain external goods are needed for happiness because, in the first place, they are needed for virtuous activity. This has puzzled scholars. After all, it seems possible for a virtuous agent to exercise her virtuous character even under conditions of extreme hardship or deprivation. Indeed, it is natural to think these are precisely the conditions under which one’s virtue shines through most clearly. I argue that there is good sense to be made of Aristotle’s stance on external goods. Drawing on passages in Politics 7.13 and Nicomachean Ethics 3.1, I develop and defend a distinction between the “mere” exercise of virtue, and the full or complete exercise of virtue. I explain how, on his view, a range of external goods is required for the full exercise of virtue, and I show that it is only this full exercise that is constitutive of eudaimonia. I argue that, for Aristotle, the distinguishing feature of this distinction is the value of the virtuous action’s ends. An action that fully expresses virtue aims at an end that is unqualifiedly good, while an action that merely exercises virtue does not. The external goods Aristotle mentions in NE 1.8 are necessary for performing actions with unqualifiedly good ends, and so necessary for the complete exercise of virtue.
5G as enabler for Digital Healthcare
Authors: Hamm Steffen , Schleser Ann-Christin , Hartig Juliana , Thomas Petra , Zoesch Silke , Bulitta Clemens 
Published: February 2021

Abstract
Healthcare in rural areas faces specific challenges, which make homecare of elderly people and cross-sectoral integrated care of chronically ill and multimorbid patients very complex and costly. Mobility and logistics are among other issues that need to be solved in this context. Therefore, it will be crucial to realize the potential of innovative solutions along the complete healthcare value chain, in order to deliver patient focused healthcare according to a value-based-healthcare-approach in the future. Against this background it is the objective of the project 5G4 Healthcare, which is funded by the Federal Ministry of Transport and Infrastructure, to establish a platform based on 5G technology, that enables the testing and the evaluation of digital applications in the context of rural healthcare. Consequently, the project 5G4 Healthcare aims at assessing the feasibility, opportunities and limitations of 5G regarding efficiency and effectiveness improvements in rural healthcare in order to derive recommendations and scalable solutions.
A novel combined level set model for automatic MR image segmentation
Authors: Li Jianzhang , Nebelung Sven , Rath Björn , Tingart Markus , Eschweiler Jörg 
Published: February 2021

Abstract
Medical image processing comes along with object segmentation, which is one of the most important tasks in that field. Nevertheless, noise and intensity inhomogeneity in magnetic resonance images challenge the segmentation procedure. The level set method has been widely used in object detection. The flexible integration of energy terms affords the level set method to deal with variable difficulties. In this paper, we introduce a novel combined level set model that mainly cooperates with an edge detector and a local region intensity descriptor. The noise and intensity inhomogeneities are eliminated by the local region intensity descriptor. The edge detector helps the level set model to locate the object boundaries more precisely. The proposed model was validated on synthesized images and magnetic resonance images of in vivo wrist bones. Comparing with the ground truth, the proposed method reached a Dice similarity coefficient of > 0.99 on all image tests, while the compared segmentation approaches failed the segmentations. The presented combined level set model can be used for the object segmentation in magnetic resonance images.
Global Inhomogeneity Index Evaluation of a DCT-based EIT Lung Imaging
Authors: Chen Rongqing , Möller Knut 
Published: February 2021

Abstract
Purpose: To evaluate a novel structural-functional DCT-based EIT lung imaging method against the classical EIT reconstruction. Method: Taken retrospectively from a former study, EIT data was evaluated using both reconstruction methods. For different phases of ventilation, EIT images are analyzed with respect to the global inhomogeneity (GI) index for comparison. Results: A significant less variant GI index was observed in the DCTbased method, compared to the index from classical method. Conclusion: The DCT-based method generates more accurate lung contour yet decreasing the essential information in the image which affects the GI index. These preliminary results must be consolidated with more patient data in different breathing states.