bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mediterranean Diet Reduces Risk of Incident Stroke in a Population With Varying Cardiovascular Disease Risk Profiles
Authors: Paterson Katherine E. , Myint Phyo K. , Jennings Amy , Bain Lucy K.M. , Lentjes Marleen A.H. , Khaw Kay-Tee , Welch Ailsa A. 
Published: June 2021

Background and Purpose—
Although some evidence has found that the Mediterranean diet (MD) is protective for stroke risk, few studies have investigated whether this relationship differs by sex or cardiovascular disease risk.

Methods—
We investigated the relationship between adherence to the MD score, estimated using 7-day dietary diaries and risk of incident stroke in an observational prospective population-based cohort study of 23 232 men and women (54.5% women) aged 40 to 77 years who participated in the European Prospective Investigation into Cancer study in Norfolk, United Kingdom. Risk of incident stroke was calculated using multivariable Cox regression, in the whole population, and also stratified by sex and cardiovascular disease risk profile, using the Framingham risk score.

Results—

During 17.0 years of follow-up (395 048 total person-years), 2009 incident strokes occurred. Risk of stroke was significantly reduced with greater adherence to the MD score (quartile 4 versus quartile 1 hazard ratio [HR], 0.83; 95% CI, 0.74–0.94;
P
-trend <0.01) in the whole population and in women (quartile 4 versus quartile 1 HR, 0.78; 95% CI, 0.65, 0.93;
P
-trend <0.01) but not in men (quartile 4 versus quartile 1 HR, 0.94; 95% CI, 0.79–1.12;
P
-trend =0.55). There was reduced risk of stroke in those at high risk of cardiovascular disease and across categories of the MD score (quartile 4 versus quartile 1 HR, 0.87; 95% CI, 0.76–0.99;
P
-trend =0.04). However, this was driven by the associations in women (quartile 4 versus quartile 1 HR, 0.80; 95% CI, 0.65–0.97;
P
-trend =0.02).

Conclusions—
Greater adherence to the MD was associated with lower risk of stroke in a UK white population. For the first time in the literature, we also investigated the associations between the MD score in those at both low and high risk of cardiovascular disease. Although the findings in our study were driven by the associations in women, they have implications for the general public and clinicians for prevention of stroke.
Combined Effect of ENSO and AO on Winter Temperatures of the Korean Peninsula on Subseasonal Time Scales
Authors: Kim Gaeun , Yang Sinil , Lee Woo-Seop 
Published: June 2021

AbstractThe combined effect of the El Niño–Southern Oscillation (ENSO) and Arctic Oscillation (AO) on the variability of boreal winter (December–February) temperature over South Korea is examined at the subseasonal time scale using subseasonal-to-seasonal (S2S) hindcast data. Daily hindcast data from the European Centre for Medium-Range Weather Forecasts (ECMWF) database is used. We selected the following six composite cases using a threshold of ±0.5 for each index: El Niño and positive AO (EP), El Niño and negative AO (EN), La Niña and positive AO (LP), La Niña and negative AO (LN), positive AO only (PA), and negative AO only (NA). Results from reanalysis data suggest the possibility of using these two climate factors as predictors for 1-month prediction of South Korea up to 4 weeks in advance. Thus, we confirmed that the ENSO plays a statistically significant role in strengthening (weakening) the AO influences on the temperature anomalies in the in phase (out of phase). For example, there is a significant increase (decrease) in mean temperature anomalies through positive (negative) geopotential height (GPH) anomalies and warm (cold) temperature advection over South Korea in the EP (LN) case. The ECMWF S2S hindcast demonstrated an acceptable ability to reproduce circulation patterns over East Asia up to 3 weeks in advance, and sufficiently predicted weekly mean temperature anomalies over South Korea in EP, LN, and PA cases.
The Use of Hemostatic Agents to Decrease Bleeding Complications in Breast Cancer Surgery
Authors: Bloom Joshua A. , Foroutanjazi Sina , Erlichman Zachary , Beqiraj Zhaneta , Jonczyk Michael M. , Persing Sarah M. , Chatterjee Abhishek 
Published: June 2021

Introduction Following breast cancer surgery, patients often require adjuvant radiation and chemotherapy for locoregional and systemic disease control. These procedures may result in postoperative complications, which may delay adjuvant therapy. To potentially decrease these complications, hemostatic agents may be used. This study evaluated the rate of postoperative bleeding complications and duration of Jackson-Pratt (JP) drain use in oncologic breast surgery with and without hemostatic agents. Methods After obtaining institutional review board approval, a retrospective chart review was performed. Patients who underwent oncoplastic breast surgery, mastectomy with or without expander/implant-based reconstruction, and subsequent reconstruction with expander to implant exchange were included. Data collected included indication for surgery, type of operation, use of hemostatic agent, specifically fibrin sealant (FS, EVICEL®, Ethicon, USA) or combination powder (CP, HEMOBLAST™ Bellows, biom’up, France), length of follow-up, time to JP drain removal, and post-operative complications (seroma, hematoma, or operating room (OR) takeback). This was a consecutive experience where initially no hemostatic agent was used, followed by use of FS, and then CP. Results The use of a hemostatic agent resulted in fewer bleeding complications and significantly decreased time until JP drain removal. Although not significant, subgroup analysis demonstrated that this was more pronounced in the CP group. JP drain duration was decreased among all procedures for CP compared to FS. Conclusions The use of hemostatic agents in oncologic breast surgery may result in decreased postoperative complications and significantly reduce time to JP drain removal.
Mobilizing Occupation for Social Transformation: Radical Resistance, Disruption, and Re-Configuration: Mobiliser l'occupation pour une transformation sociale : résistance radicale, perturbation et reconfiguration
Authors: Rudman Debbie Laliberte 
Published: June 2021

Background. Given the sociopolitical roots of widening occupational, social, and health inequities, it is imperative that occupational therapy move forward in mobilizing occupation for social transformation. Purpose. Three key aims are addressed: articulating the imperative to mobilize occupation for social transformation; highlighting the political nature of occupation and occupational therapy; and providing guideposts for embracing a radical sensibility to inform moving forward in mobilizing occupation for social transformation. Key issues. Conditions of possibility within occupational therapy leave the profession ill equipped to enact social transformation. Enacting calls to mobilize occupation for social transformation requires radically reconfiguring these conditions of possibility to inform practices that resist, disrupt, and re-configure sociopolitical conditions perpetuating occupational inequities. Implications. Mobilizing occupation for social transformation holds much potential to contribute toward creating more equitable, humane societies. Realizing this potential involves committing to transforming our profession, as well as societal discourses, structures, systems, relations, and practices.
Financial Inclusion and Quality of Life: Empirical Evidences from Indian States with Special Reference to West Bengal
Authors: Sen Avisek , Laha Arindam 
Published: June 2021

The conceptual connection between financial inclusion and quality of life (QOL) can be realized by a two-way relationships. On the one hand, financial inclusion induces QOL, while an improvement in QOL facilitates in generating demand for financial services, on the other hand. Even though several studies seek to find out the role of finance in the well-being of the population (especially human development), this article concentrates on QOL to eliminate the financial attributes of development (as captured by income dimension in Human Development Index). In this sense, this study addresses the research gap in the existing literature by establishing the relationship between financial inclusion and QOL. Specifically, the article attempts to explain the two-way tie-up between the financial inclusion and the QOL in India in the context of Indian states, in general, and West Bengal, in particular. Canonical correlation (CC; a multivariate data analysis technique) is used to estimate the relation between the financial inclusion and QOL. Empirical results suggest that western and the southern Indian states excel in the attainment of education, health and other amenities-based indicators of QOL. The conditions of the eastern part of the country in case of financial inclusion and the QOL are not at all satisfactory. In case of West Bengal, Kolkata being the state capital is performing well in both the factors. CC results suggest a significant association between the financial inclusion and QOL across Indian states. The deposit account of financial inclusion indicator and the infant survival rate of QOL indicator are playing a pivotal role in the relationship (both the Indian states and districts of West Bengal as well). This article establishes the effectiveness of the demand following approach of financial inclusion than that of supply leading approach. As the demand-side aspect of financial inclusion is becoming more important to the policymakers, the next policy priority of financial inclusion measures could be the generation of awareness on the financial services through financial literacy. JEL Codes: G2, O15, C39
Removal From Activity After Sports- Related Concussion in Sex-Comparable Sports From the Michigan High School Athletic Association
Authors: Zynda Aaron J. , Petit Kyle M. , Anderson Morgan , Tomczyk Christopher P. , Covassin Tracey 
Published: June 2021

Background: Research has demonstrated that female athletes are more likely to report their sports-related concussion (SRC) symptoms compared with male athletes; however, it is unknown if these reporting behaviors correspond to immediate removal from activity in sex-comparable sports. Purpose: To compare the incidence of high school student-athletes removed and not removed from activity after SRC in sex-comparable sports in Michigan. Study Design: Descriptive epidemiology study. Methods: Participants included student-athletes diagnosed with SRC participating in Michigan High School Athletic Association–sponsored athletic activities (22 sex-comparable sports) between 2016 and 2019. All SRCs were recorded in the association’s Head Injury Reporting System (HIRS) by certified athletic trainers, administrators, or coaches. Removal from activity indicated that the student-athlete was removed from play at the time of an injury event. If the student-athlete reported that his or her suspected injury event occurred earlier during activity or if symptom onset was delayed, “not removed from activity” was entered into the HIRS. Incidence proportions were calculated by dividing SRCs not removed by total SRCs in each sport. Risk ratios were calculated by dividing the incidence proportions of girls not removed by boys not removed in each sport. Results: A total of 4418 (2773 female, 1645 male) SRCs were reported, with the most occurring in female soccer players (n = 1023). Overall, 515 girls and 243 boys were not removed from activity, resulting in incidences of 0.19 (95% CI, 0.17-0.20) and 0.15 (95% CI, 0.13-0.17), respectively. Across all sports, girls were 1.26 (95% CI, 1.09-1.45) times as likely to not be removed from activity compared with boys. Of the sports with the most SRCs—soccer, basketball, baseball/softball, and lacrosse—girls had 1.37 (95% CI, 1.09-1.72), 1.15 (95% CI, 0.89-1.47), 1.19 (95% CI, 0.77-1.84), and 1.35 (95% CI, 0.94-1.95) times the risk of not being removed, respectively. Conclusion: Girls were at greater risk of not being removed from activity compared with boys in sex-comparable sports. Results from this study should be incorporated into SRC education in Michigan and potentially elsewhere to inform affiliated personnel of potential sex differences and protect female student-athletes from further harm.
Low-Dose Tocilizumab With High-Dose Corticosteroids in Patients Hospitalized for COVID-19 Hypoxic Respiratory Failure Improves Mortality Without Increased Infection Risk
Authors: Brosnahan Shari B. , Chen Xian Jie Cindy , Chung Juri , Altshuler Diana , Islam Shahidul , Thomas Sarun V. , Winner Megan D. , Greco Allison A. , Divers Jasmin , Spiegler Peter , Sterman Daniel H. , Parnia Sam 
Published: June 2021

Background Severe hypoxic respiratory failure from COVID-19 pneumonia carries a high mortality risk. There is uncertainty surrounding which patients benefit from corticosteroids in combination with tocilizumab and the dosage and timing of these agents. The balance of controlling inflammation without increasing the risk of secondary infection is difficult. At present, dexamethasone 6 mg is the standard of care in COVID-19 hypoxia; whether this is the ideal choice of steroid or dosage remains to be proven. Objectives The primary objective was to assess the impact on mortality of tocilizumab only, corticosteroids only, and combination therapy in patients with COVID-19 respiratory failure. Methods A multihospital, retrospective study of adult patients with severe respiratory failure from COVID-19 who received supportive therapy, corticosteroids, tocilizumab, or combination therapy were assessed for 28-day mortality, biomarker improvement, and relative risk of infection. Propensity-matched analysis was performed between corticosteroid alone and combination therapies to further assess mortality benefit. Results The steroid-only, tocilizumab-only, and combination groups showed hazard reduction in mortality at 28 days when compared with supportive therapy. In a propensity-matched analysis, the combination group (daily equivalent dexamethasone 10 mg and tocilizumab 400 mg) had an improved 28-day mortality compared with the steroid-only group (daily equivalent dexamethasone 10 mg; hazard ratio (95% CI) = 0.56 (0.38-0.84), P = 0.005] without increasing the risk of infection. Conclusion and Relevance Combination of tocilizumab and corticosteroids was associated with improved 28-day survival when compared with corticosteroids alone. Modification of steroid dosing strategy as well as steroid type may further optimize therapeutic effect of the COVID-19 treatment.
The Italian version of the Keratoconus Outcomes Research Questionnaire (KORQ): Translation and validation of psychometric properties
Authors: Ferrini Erica , Aleo Davide , Posarelli Chiara , Albert Timothy , Miccoli Mario , Orrù Graziella , Figus Michele 
Published: June 2021

Purpose: To develop and validate the Italian version of the Keratoconus Outcomes Research Questionnaire (KORQ). Methods: Cross-sectional validation study. Keratoconus patients with routine appointments at the outpatient clinic were consecutively enrolled in conjunction with a sample of non-keratoconus controls for comparison. The Italian translation from the original English version of the KORQ was administered to the patients together with the Italian version of the 25-item version of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). The reliability and validity of the Italian KORQ were assessed using standardized internationally accepted methods for cultural adaptation and validation of health-related quality of life measures. Results: One hundred patients were deemed eligible and completed the questionnaires. The Cronbach’s alpha coefficient for internal consistency ranged from 0.71 to 0.956 across the subscales. Spearman correlation coefficient and intraclass correlation coefficient of 0.98 showed excellent test-retest reliability. The control group had better scores on every subscale. Statistically significant correlations were found between the KORQ and analogous domain of the NEI VFQ-25 and with disease severity indicators, such as visual acuity, maximum keratometry, and steepest keratometry, thus demonstrating good construct and concurrent validity. Conclusion: The Italian version of the KORQ exhibited excellent internal consistency, test-retest reliability, validity, discriminatory power, and psychometric properties comparable with those of the original English version, and thus may be adopted as a powerful vision-targeted quality of life assessment tool for Italian keratoconus patients.
Performance of Regression Models as a Function of Experiment Noise
Authors: Li Gang , Zrimec Jan , Ji Boyang , Geng Jun , Larsbrink Johan , Zelezniak Aleksej , Nielsen Jens , Engqvist Martin KM 
Published: June 2021

Background: A challenge in developing machine learning regression models is that it is difficult to know whether maximal performance has been reached on the test dataset, or whether further model improvement is possible. In biology, this problem is particularly pronounced as sample labels (response variables) are typically obtained through experiments and therefore have experiment noise associated with them. Such label noise puts a fundamental limit to the metrics of performance attainable by regression models on the test dataset. Results: We address this challenge by deriving an expected upper bound for the coefficient of determination ( R2) for regression models when tested on the holdout dataset. This upper bound depends only on the noise associated with the response variable in a dataset as well as its variance. The upper bound estimate was validated via Monte Carlo simulations and then used as a tool to bootstrap performance of regression models trained on biological datasets, including protein sequence data, transcriptomic data, and genomic data. Conclusions: The new method for estimating upper bounds for model performance on test data should aid researchers in developing ML regression models that reach their maximum potential. Although we study biological datasets in this work, the new upper bound estimates will hold true for regression models from any research field or application area where response variables have associated noise.
Adherence to Neuromuscular Electrical Stimulation Interventions for Muscle Impairment in Hip and Knee Osteoarthritis: A Systematic Review
Authors: Burgess Louise C , Taylor Paul , Wainwright Thomas W , Bahadori Shayan , Swain Ian D 
Published: June 2021

Background: Neuromuscular electrical stimulation (NMES) provides a promising approach to counteract muscle impairment in hip and knee osteoarthritis, and to expedite recovery from joint replacement surgery. Nonetheless, application into clinical orthopaedic practice remains limited, partly due to concerns regarding patient tolerance. Objectives: This systematic review aimed to quantify levels of adherence to NMES interventions for muscle impairment in hip and knee osteoarthritis and identify strategies to increase compliance. Data Sources: Randomised controlled trials (RCTs) were identified in a web-based literature review, completed in December 2020. The databases sourced included the Cochrane Library, CINAHL Complete, Medline Complete and PubMed. Eligibility Criteria: Studies were included if they were: (i) conducted in cohorts of adults with hip or knee osteoarthritis; (ii) a protocol of electrical muscle stimulation prescribed to treat muscle impairment; and (iii) reported intervention adherence or attrition rate. Data were extracted on adherence rate, reasons for non-adherence and potential strategies to increase adherence. Risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) scale. Results: The search yielded 120 articles, of which 15 studies were considered eligible and included in the analysis (n = 922). All NMES treatment was applied to the quadriceps, with 1 study targeting the quadriceps and calves. The mean PEDRO score of the included studies was 6.80 out of a possible 10 (range 6-8). Mean adherence did not differ between groups receiving treatment with NMES (85% ± 12%) and control groups receiving voluntary exercise or education (84% ± 9%) ( P = .97). Reasons for non-adherence or attrition included a dislike of the device, dizziness, pain and discomfort. Strategies to increase adherence included NMES education, a familiarisation period, supervision, setting thresholds based upon patient tolerance, monitoring pain levels during stimulation and using built-in adherence trackers. Conclusions: This systematic review indicates that adherence to NMES interventions for muscle impairment in hip and knee osteoarthritis in clinical trials does not differ to control groups receiving education or voluntary exercise, and hence should not be a barrier to application in clinical practice.
“Awake” Spinal Cord Monitoring Under Local Anesthesia and Conscious Sedation in Fenestrated and Branched Endovascular Aortic Repair
Authors: Abisi Said , Musto Liam , Lyons Oliver , Carmichael Michelle , Sallam Morad , Gkoutzios Panos , Zayed Hany , Puchakayala Madhusudan 
Published: June 2021

Introduction Endovascular repair of thoracoabdominal aortic aneurysms carries a risk of spinal cord ischemia, the causes of which remain uncertain. We hypothesized that local anesthesia (LA) with conscious sedation could abrogate the potential suppressive cardiovascular effects of general anesthesia (GA) and facilitate intraoperative monitoring of neurological function. Here, we examine the feasibility of this technique during fenestrated (FEVAR) or branched endovascular aortic repair (BEVAR). Materials and Methods Consecutive patients undergoing FEVAR or BEVAR under LA and conscious sedation by a team at a single center were analyzed. Patients received conscious sedation using intravenous remifentanil and propofol infusions in conjunction with a local anesthetic agent. No patient had a prophylactic spinal drain inserted. Outcome measures included conversion to GA, need for vasopressors and/or spinal drainage, length of stay, complications, and patient survival. Results A total of 44 patients underwent FEVAR or BEVAR under LA and conscious sedation. The cohort included thoracoabdominal aortic aneurysms (n=41) and pararenal aneurysms treated with endografts covering the supraceliac segment (n=3). Four patients (9%) required conversion to GA at a median operative duration of 198 minutes (range 97–495 minutes). Vasopressors were required intraoperatively in 3 of the cases that were converted to GA. No patient developed spinal cord ischemia and none had insertion of a spinal drain. The median hospital length of stay was 4 days (range 2–41 days). Postoperative delirium and hospital-acquired pneumonia was seen in 7% of patients. All patients survived to 30 days, with 95% alive at a median follow-up of 15 months (range 3–26 months). Conclusion LA and conscious sedation is a feasible anesthetic technique for the endovascular repair of thoracoabdominal aortic aneurysms.