bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost Estimates of COVID-19 Clinical Management in Myanmar
Authors: Thant Phyu Win , Htet Khin Thu , Win Wit Ye , Htwe Ye Min , Htoo Thant Sin 
Published: June 2021

Abstract
Objective: This study aims to estimate the cost of clinical management of COVID-19 infected patients based on their severity by exploring the resources used in care provision in Myanmar. Methods: A multicenter retrospective cost analysis of COVID-19 patients treated was performed using the micro-costing approach from the perspective of the health system. It covered two cost components, namely Direct and Indirect cost of treating a patient. Input data and their quantities were obtained from COVID-19 Standard Treatment Guidelines of Ministry of Health and Sports, and administrative and financial record of resource utilization of three designated health facilities in Yangon Region. Valuation of these resources was based on the price list from the Procurement Section of the Ministry. Results: The analysis estimated the unit cost of clinical management of COVID-19 infected patients with no symptom to be 953,552 MMK(717 USD), with Mild-Moderate Symptoms to be 1,155,222 MMK(869 USD) and with Severe-Critically Ill conditions to be 5,705,052 MMK(4290 USD). Average cost for a patient par day was 86,687 MMK(65 USD) for asymptomatic patients, 105,020 MMK(79 USD) for Mild-Moderate patients and 283,252 MMK(214 USD) for severe-critically ill patients. Since the first case detected till December 31, 2020, COVID-19 clinical management cost was accounted for 139 Billion MMK (104 million USD) for total 124630 confirmed cases. Conclusions: The result of this study indicates that the COVID-19 Pandemic leads Myanmar Health System to incur the significant health care expenses. Timely implementation of the sustainable, affordable and efficient policy for COVID-19 responses is of utmost important for every nation especially in this situation of Pandemic. Specifically, the study results should be of value for strategic planning, for future economic evaluations of different policy interventions, and to contribute healthcare policy recommendations by analyzing the current cost of health care system and preparing for the potential state of COVID-19 infection.
Global Profiling of Proteome, Lysine Acetylome And Succinylome Identifying Silica Injuries In Mice Lung
Authors: Wang Mingyao , Liu Jiangfeng , Zhang Tiantian , Zhang Zhe , Pang Junling , Xing Yanjiang , Liu Ying , Song Meiyue , Li Baicun , Yang Juntao , Wang Jing , Wang Chen 
Published: June 2021

Abstract
The authors have requested that this preprint be removed from Research Square.
Pubertal And Gonadal Outcomes In 46,XY Individuals With Partial Androgen Insensitivity Syndrome Raised As Girls
Authors: Guaragna-Filho Guilherme , Guerra-Junior Gil , Tadokoro-Cuccaro Rieko , Hughes Ieuan A. , Barros Beatriz A. , Hiort Olaf , Balsamo Antonio , Guran Tulay , Holterhus Paul M. , Hannema Sabine , Poyrazoglu Sukran , Darendeliler Feyza , Bryce Jillian , Ahmed S. Faisal , Quigley Charmian A. 
Published: June 2021

Abstract
Purpose: Although it was common in the 1970s-1990s to assign female gender of rearing to 46,XY infants with limited virilisation of varying etiologies, including those with partial androgen insensitivity syndrome (PAIS), long-term data on outcomes for these individuals are sparse. Therefore, our goal was to use the power of an international registry to evaluate clinical features, surgical management and pubertal data in patients with a molecularly confirmed diagnosis of PAIS who were born before 2008 and were raised as girls. Methods: The current study interrogated the I-DSD Registry for available data on management and pubertal outcomes in individuals with genetically confirmed PAIS who were raised as girls. Results: Among the 11 individuals who fulfilled the key criteria for inclusion the external masculinization score at presentation (EMS) ranged from 2 to 6 (median 5); 7 girls underwent gonadectomy before the age of 9 years, whereas 4 underwent gonadectomy in the teenage years (≥ age 13). Clitoral enlargement at puberty was reported for 3 girls (27%) who presented initially at the time of puberty with intact gonads. In the 9 individuals (82%) for whom gonadal pathology data were provided, there was no evidence of germ cell tumor at median age of 8.1 years. All girls received estrogen replacement and 8/11 had attained Tanner stage 4-5 breast development at last assessment. Conclusion: In general, although it appears that female assignment in PAIS is becoming uncommon, our data provide no evidence to support the practice of prophylactic prepubertal gonadectomy with respect to the risk of a germ cell tumour.
Occurrence and Severity of Venous Air Embolism During Neurosurgical Procedures in Semi-Sitting Versus Supine Position
Authors: Konrad Franziska Magdalena , Mayer Angela S , Serna-Higuita Lina Maria , Hurth Helene , Tatagiba Marcos , Reutershan Jörg , Rosenberger Peter , Drexler Berthold 
Published: June 2021

Abstract
Background: Patients undergoing neurosurgical procedures in the posterior cranial fossa can be placed in different positions: the semi-sitting position or the supine position. The major risk of the semi-sitting positioning is venous air embolism (VAE). However, VAEs may also occur in the supine position.Objective: In a prospective study, we investigated the incidence of VAE based on the positioning of the patients (trial registration 553/2013BO1).Methods: In a single-center study with 137 patients, we prospectively evaluated the occurrence of VAEs in patients in the supine and semi-sitting position over the period from January 2014 to April 2015. All patients were monitored for VAE by the use of a transesophageal echocardiography (TEE).Results: 50% of all participating patients experienced a VAE (with 56% of these patients undergoing surgery in the semi-sitting position and 11% in the prone position). 86% of the VAEs were just detected by the use of a TEE. We only observed VAEs with a decrease in EtCO2 in the semi-sitting position. However, none of the patients had any hemodynamic changes due to the VAE. We found that surgeries in patients with a preexisting intracardial shunt such as a patent foramen ovale (PFO) less likely resulted in VAEs (42% vs. 58%).Conclusion: The semi-sitting position with TEE monitoring and a standardized protocol, including a deep central venous line is a safe and advantageous technique, taking also account of a significant rate of VAEs. VAEs also occur in the supine position, however, less frequently.
Assessment of Financial Toxicity Among Advanced Lung Cancer Patients in Western China
Authors: Xu Tianqi , Zhou Ying , Yang Wenhui , Xi Hangtian , Xing Liangliang , Zhang Yan , Zhang Jian 
Published: June 2021

Abstract
Background: Lung cancer is the primary reason of cancer-caused disability adjusted life years. Medical cost burden impacts patient’s well-being through decreasing income, cutting daily expenses, leisure activities and exhausting savings. De Souza and colleagues developed and validated the COmprehensive Score for Financial Toxicity (COST). Our study aims to quantify the financial burdens of cancer therapy, to explore the relationship between financial toxicity and HRQoL in advanced lung cancer population.Methods: Patients aged ≥ 18 years with confirmed stage III to IV lung cancer were eligible. The COST questionnaire verified by de Souza et al. was used to identify financial toxicity. Multivariable linear regression analysis with log transformation univariate analysis and Pearson correlations were used to performed the analysis.Results: Most of the patients had an income of < ¥50,000 ($7,775) annually (90.8%, n = 138/152). The insurance condition of the cohort was that the majority of the cohort had social insurance (64.5%), 20.4% of them had commercial insurance, 22.0% of them had both. Patients who were younger age (50 ~ 59, P < 0.001), employed but on sick leave, and lower income reported increased levels of financial toxicity (P < 0.05). The risk factors for high financial toxicity: (i) younger age (50 ~ 59), (ii) <1 month of savings, and (iii) being employed but on sick leave. Increased financial toxicity is moderately correlated with a decrease in QoL.Conclusion: Increased financial toxicity(lower COST) is related to poorer psychological status and certain demographics. Financial toxicity is moderately correlated with a HRQoL, and it may have a demonstrable correlation with HRQoL measures.
Effects of Reprocessing on Acrylonitrile–Butadiene–Styrene and Additives
Authors: Bai Xiaojuan , Liang Pin , Zhang Mei , Gong Shiqiong , Zhao Lihua 
Published: June 2021

Abstract
Acrylonitrile-butadiene-styrene (ABS) is one of the most extensively used engineering polymers and analysing the chemical structure changes during processing and recycling is extremely important. Hence, in this study, an ABS resin was processed using a torque rheometer at different temperatures and for different numbers of cycles. Pyrolysis gas chromatography mass spectrometry (Py-GC/MS) was used to study the effects of the processing parameters on additives. Fourier transform infrared spectroscopy (FTIR), hydrogen nuclear magnetic resonance (1H NMR) spectroscopy, and gel permeation chromatography (GPC) were used to analyse the structural changes in the resin. GPC results showed that after processing at 290 °C using the torque rheometer, large size soluble polymeric components increased. The increase in the large size soluble polymeric components after processing at 290 °C was probably related to the crosslinking reactions in the grafted polybutadiene (PB). Furthermore, chemical analysis of the ABS resin samples after multiple extrusion cycles in a twin-screw extruder indicated that reprocessing considerably affected the ABS resin.
Handgrip Strength During Admission for COPD Exacerbation: Impact on Further Exacerbation Risk
Authors: Lee Chi-Tai , Wang Ping-Huai 
Published: June 2021

Abstract
Background:
Low handgrip strength (HGS) is independently associated with a higher exacerbation risk in smokers with stable chronic obstructive pulmonary disease (COPD); however, the relationship between HGS on admission for COPD exacerbation admission and further exacerbation risk remains unclear. This study aimed to investigate the relationship between HGS and further exacerbation risk in patients admitted for COPD exacerbation.
Methods:
We enrolled patients admitted for COPD exacerbation between January 2018 and June 2019 who underwent HGS measurement within 3 days after admission. The primary endpoint was exacerbations within 12 months after the index admission. We analyzed the relationships among demographics, HGS, pulmonary function parameters, and acute exacerbation events.
Results:
Among 43 enrolled patients, 31 (72.1%) presented HGS weakness (22.1 ± 4.1 kg). Forced expiratory volume in one second (FEV1) and FEV1 percentage of predicted value (FEV1 predicted%) were significantly lower in patients with HGS weakness (0.82 ± 0.20 vs. 1.59 ± 0.77, p = 0.018; 36.2 ± 10.4% vs. 66.3 ± 22.2, p = 0.004, respectively). Moreover, patients with HGS weakness were more likely to have severe GOLD grade IV (19.4% vs. 8.3%, p = 0.002). Finally, patients with HGS weakness showed a significantly higher rate of emergency room visits within 6, 9, and 12 months after the index admission (0.81 ± 1.30 vs. 0.08 ± 0.29, p = 0.045; 1.26 ± 1.59 vs. 0.17 ± 0.38, p = 0.019; 1.48 ± 1.86 vs. 0.25 ± 0.62, p = 0.027, respectively).
Conclusions:
HGS weakness measured upon admission for COPD exacerbation was associated with a higher risk of further exacerbation.
Trial registration:
ClinicalTrials.gov Identifier: NCT04885933
Anomaly Detection and Classification of Physiological Signals in IoT- Based Healthcare Framework
Authors: Nawaz Menaa , Ahmed Jameel 
Published: June 2021

Abstract
Physiological signals retrieve the information from sensors implanted or attached to the human body. These signals are vital data sources that can assist in predicting the disease well before time and thus proper treatment can be made possible. With the addition of Internet of Things in healthcare, real-time data collection and pre-processing for signal analysis has reduced burden of in-person appointments and decision making on healthcare. Recently, Deep learning-based algorithms have been implemented by researchers for recognition, realization and prediction of diseases by extracting and analyzing the important features. In this research real-time 1-D timeseries data of on-body non-invasive bio-medical sensors have been acquired and pre-processed and analyzed for anomaly detection. Feature engineered parameters of large and diverse dataset have been used to train the data to make the anomaly detection system more reliable. For comprehensive real-time monitoring the implemented system uses wavelet time scattering features for classification and deep learning based autoencoder for anomaly detection of time series signals for assisting the clinical diagnosis of cardiovascular and muscular activity. In this research, an implementation of IoT based healthcare system using bio-medical sensors has been presented. This paper also aims to provide the analysis of cloud data acquired through bio-medical sensors using signal analysis techniques for anomaly detection and timeseries classification has been done for the disease prognosis in real-time. Wavelet time scattering based signals classification accuracy of 99.88% is achieved. In real time signals anomaly detection, 98% accuracy is achieved. The average Mean Absolute Error loss of 0.0072 for normal signals and 0.078 is achieved for anomaly signals.
Mixture Toxic Impacts and the Related Mechanism of Aflatoxin B1 and Deoxynivalenol on Embryonic Zebrafish (Danio Rerio)
Authors: Wang Yanhua , Wang Qiang , Ji Chun , Guo Xiaoxuan , Yang Guiling , Wang Dou , Weng Hongbiao , Qian Yongzhong , Chen Chen 
Published: June 2021

Abstract
BackgroundAlthough humans and animals are often simultaneously exposed to a variety of mycotoxins via feed and food consumption, in which aflatoxin B1 (AFB1) and deoxynivalenol (DON) is one of the most prevalent combination of mycotoxins. Many toxicological reports have merely focused on the impacts of single mycotoxins. In the present study, the combined toxicity and the related mechanism of AFB1 and DON to zebrafish (Danio rerio) were investigated. ResultsWe showed that DON had lower toxicity to embryonic zebrafish with a 7-day LC50 of 218.3 mg a.i. L-1 in comparison to AFB1 (0.031 mg a.i. L-1). The mixture of AFB1 and DON elicited an additive combined effect on zebrafish embryos. The levels of CAT, caspase-3, and T4 markedly varied in most single and mixture groups. The expressions of four genes (cas3, apaf-1, cc-chem, and cyp19a) associated with oxidative stress, cellular apoptosis, immune system, and endocrine system were markedly varied upon the mixture exposure in comparison to the corresponding single exposure of AFB1 or DON.ConclusionsOur results demonstrate that the impacts of a mixture could not be estimated solely based on toxicities of the single mycotoxins. Taken together, our comprehensive investigation on the mycotoxin mixtures and their potential mechanisms could better reflect the reality of mycotoxin contamination in food and feed.
Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality?
Authors: Servia-Goixart Lluís , Lopez-Delgado Juan Carlos , Grau-Carmona Teodoro , Trujillano-Cabello Javier , Bordeje-Laguna M Luisa , Mor-Marco Esther , Portugal-Rodriguez Esther , Cárdenas Carol Lorencio , Montejo-Gonzalez Juan C , Vera-Artazcoz Paula , Macaya-Redin Laura , Martinez-Carmona Juan Francisco , Iglesias-Rodriguez Rayden , Monge-Donaire Diana , Flordelis-Lasierra José L , Llorente-Ruiz Beatriz , Menor-Fernández Eva M , de Lagran Itziar Martínez , Yebenes-Reyes Juan C 
Published: June 2021

Abstract
Background: The importance of artificial nutritional therapy is underrecognized, typically being considered an adjunctive rather than a primary therapy. We aimed to evaluate the influence of nutritional therapy on mortality in critically ill patients.Methods: This multicenter prospective observational study included adult patients needing artificial nutritional therapy for >48 h if they stayed in one of 38 participating intensive care units for ≥72 h between April and July 2018. Demographic data, comorbidities, diagnoses, nutritional status and therapy (type and details for ≤14 days), and outcomes were registered in a database. Confounders such as disease severity, patient type (e.g., medical, surgical or trauma), and type and duration of nutritional therapy were also included in a multivariate analysis, and hazard ratios (HRs) and 95% confidence intervals (95%CIs) were reported.Results: We included 639 patients among whom 448(70.1%) and 191(29.9%) received enteral and parenteral nutrition, respectively. Mortality was 25.6%, with non-survivors having the following characteristics: older age; more comorbidities; higher Sequential Organ Failure Assessment (SOFA) scores (6.6±3.3 vs 8.4±3.7; P<0.001); greater nutritional risk (Nutrition Risk in the Critically Ill [NUTRIC] score: 3.8±2.1 vs 5.2±1.7; P<0.001); more vasopressor requirements (70.4% vs 83.5%; P=0.001); and more renal replacement therapy (12.2% vs 23.2%; P=0.001). Multivariate analysis showed that older age (HR: 1.023; 95% CI: 1.008–1.038; P=0.003), higher SOFA score (HR: 1.096; 95% CI: 1.036–1.160; P=0.001), higher NUTRIC score (HR: 1.136; 95% CI: 1.025–1.259; P=0.015), requiring parenteral nutrition after starting enteral nutrition (HR: 2.368; 95% CI: 1.168–4.798; P=0.017), and a higher mean Kcal/Kg/day intake (HR: 1.057; 95% CI: 1.015–1.101; P=0.008) were associated with mortality. By contrast, a higher mean protein intake protected against mortality (HR: 0.507; 95% CI: 0.263–0.977; P=0.042).Conclusions: Old age, higher organ failure scores, and greater nutritional risk appear to be associated with higher mortality. Patients who need parenteral nutrition after starting enteral nutrition may represent a high-risk subgroup for mortality due to illness severity and problems receiving appropriate nutritional therapy. Mean calorie and protein delivery also appeared to influence outcomes.Trial Registration: ClinicaTrials.gov NCT: 03634943.
The risk of SARS-CoV-2 outbreaks in low prevalence settings following the removal of travel restrictions
Authors: Sachak-Patwa Rahil , Byrne Helen , Dyson Louise , Thompson Robin 
Published: June 2021

Abstract
Countries around the world have introduced travel restrictions to reduce SARS-CoV-2 transmission. As vaccines are gradually rolled out, attention has turned to when travel restrictions and other non-pharmaceutical interventions (NPIs) can be relaxed. Here, using SARS-CoV-2 as a case study, we develop a mathematical branching process model to assess the risk that, following the removal of NPIs, cases introduced into new locations initiate a local outbreak. Our model accounts for changes in background population immunity due to vaccination. We consider two locations in which the vaccine rollout has progressed quickly – specifically, the Isle of Man (a British crown dependency in the Irish Sea) and the country of Israel. We show that the outbreak risk is unlikely to be eliminated completely when travel restrictions and other NPIs are removed, even once the vaccine programmes in these locations are complete. Specifically, the risk that an imported case initiates an outbreak following the vaccine rollout and removal of NPIs is projected to be 0.373 (0.223,0.477) for the Isle of Man and 0.506 (0.387,0.588) for Israel. Key factors underlying these risks are the potential for transmission even following vaccination, incomplete vaccine uptake, and the recent emergence of SARS-CoV-2 variants with increased transmissibility. Combined, these factors suggest that when travel restrictions are relaxed, it will still be necessary to implement surveillance of incoming passengers to identify infected individuals quickly. This measure, as well as tracing and isolating contacts of detected infected passengers, should remain in place to suppress potential outbreaks until case numbers globally are reduced.
Increased Nodular P Level Induced by Intercropping Stimulated Nodulation in Soybean Under Phosphorus Deficiency
Authors: Qin Xiao Min , Pan Hao Nan , Xiao Jing Xiu , Tang Li , Zheng Yi 
Published: June 2021

Abstract
Low P availability is a vital constraint for nodulation and efficient N2 fixation of legume, including soybean. To elucidate the mechanisms involved in nodule adaption to low P availability under legume/cereal intercropping systems, two experiments consisting of three cropping patterns (monocropped soybean, monocropped maize, soybean/maize intercropping) were studied under both sufficient-and deficient-P levels. Our results demonstrated that intercropped soybean with maize showed a higher nodulation and N2 fixation efficiency under low P availability than monocropped soybean as evidenced by improvement in the number, dry weight and nitrogenase activity of nodules. These differences might be attributed to increase in P level in intercropping-induced nodules under low P supply, which was caused by the elevated activities of phytase and acid phosphatases in intercropping-induced nodules. Additionally, the enhanced expression of phytase gene in nodules supplied with deficient P level coincided with an increase in phytase and acid phosphatase activities. Our results revealed a mechanism for how intercropped maize stimulated nodulation and N2 fixation of soybean under P deficient environments, where enhanced synthesis of phytase and acid phosphatases in intercropping-induced nodules, and stimulated nodulation and N2 fixation.
Epidemiology of Measles in West Arsi Zone, Oromia Region, Ethiopia: 2011-2015
Authors: Solomon Tesfaye , Nigatu Mamo , Areda Birhanu 
Published: June 2021

Abstract
Background

Measles is a leading vaccine-preventable childhood disease, which has been designated for elimination. Despite the success of measles control, measles is still responsible for 145,700 deaths worldwide each year, with many of the outbreaks in developing countries including Ethiopia. We analyzed to characterize the epidemiology of measles and recommend better prevention and control strategies in West Arsi Zone, Ethiopia.
Methods

Data from 2011–2015 from the Public Health Emergency and Management Unit of the West Arsi Zone Health Department database were obtained using a semi-standard checklist. We analyzed and described the data by person, place, and time.
Results

We identified 1735 cases of measles between 2011–2015. The annual average measles incidence rate during 2011–2014 was 3.4/100,000 while the incidence rate in 2015 was 14/100,000. During 2011–2015, most of the cases occurred in children age less than 15 years old (87%), and 33 % were under five. Measles cases were reported every month, and March had the highest number of cases (24%). The districts with the highest incidence rates of measles had high routine measles vaccination coverage’s. The proportion of districts with an annual detection rate for non-measles febrile rash was 67% both in 2014 and 2015 which was below the national target (> 80%).
Conclusions

Measles outbreaks in children in 2015 in an area with high routine vaccination coverage were identified. We recommended improving vaccine management and supplementary vaccination for children less than 15 years. It needs further study to identify contributing factors for measles outbreaks and evaluating the effectiveness of measles control and prevention strategies.