bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seismic site response of layered saturated sand: comparison of finite element simulations with centrifuge test results
Authors: Nagula Sparsha Sinduri , Hwang Yu-Wei , Dashti Shideh , Grabe Jürgen 
Published: September 2021

AbstractA numerical model based on the finite element framework was developed to predict the seismic response of saturated sand under free-field conditions. The finite element framework used a non-linear coupled hypoplastic model based on the u-p formulation to simulate the behaviour of the saturated sand. The u-p coupled constitutive model was implemented as a user-defined routine in commercial ABAQUS explicit 6.14. Results of centrifuge experiments simulating seismic site response of a layered saturated sand system were used to validate the numerical results. The centrifuge test consisted of a three-layered saturated sand system subjected to one-dimensional seismic shaking at the base. The test set-up was equipped with accelerometers, pore pressure transducers, and LVDTs at various levels. Most of the constitutive models used to date for predicting the seismic response of saturated sands have underestimated volumetric strains even after choosing material parameters subjected to rigorous calibration measures. The hypoplastic model with intergranular strains calibrated against monotonic triaxial test results was able to effectively capture the volumetric strains, reasons for which are discussed in this paper. The comparison of the numerical results to centrifuge test data illustrates the capabilities of the developed u-p hypoplastic formulation to perform pore fluid analysis of saturated sand in ABAQUS explicit, which inherently lacks this feature.
Small studies, big decisions: the role of pilot/feasibility studies in incremental science and premature scale-up of behavioral interventions
Authors: Beets Michael W. , von Klinggraeff Lauren , Weaver R. Glenn , Armstrong Bridget , Burkart Sarah 
Published: September 2021

Abstract
Background
Careful consideration and planning are required to establish “sufficient” evidence to ensure an investment in a larger, more well-powered behavioral intervention trial is worthwhile. In the behavioral sciences, this process typically occurs where smaller-scale studies inform larger-scale trials. Believing that one can do the same things and expect the same outcomes in a larger-scale trial that were done in a smaller-scale preliminary study (i.e., pilot/feasibility) is wishful thinking, yet common practice. Starting small makes sense, but small studies come with big decisions that can influence the usefulness of the evidence designed to inform decisions about moving forward with a larger-scale trial. The purpose of this commentary is to discuss what may constitute sufficient evidence for moving forward to a definitive trial. The discussion focuses on challenges often encountered when conducting pilot/feasibility studies, referred to as common (mis)steps, that can lead to inflated estimates of both feasibility and efficacy, and how the intentional design and execution of one or more, often small, pilot/feasibility studies can play a central role in developing an intervention that scales beyond a highly localized context.

Main body
Establishing sufficient evidence to support larger-scale, definitive trials, from smaller studies, is complicated. For any given behavioral intervention, the type and amount of evidence necessary to be deemed sufficient is inherently variable and can range anywhere from qualitative interviews of individuals representative of the target population to a small-scale randomized trial that mimics the anticipated larger-scale trial. Major challenges and common (mis)steps in the execution of pilot/feasibility studies discussed are those focused on selecting the right sample size, issues with scaling, adaptations and their influence on the preliminary feasibility and efficacy estimates observed, as well as the growing pains of progressing from small to large samples. Finally, funding and resource constraints for conducting informative pilot/feasibility study(ies) are discussed.

Conclusion
Sufficient evidence to scale will always remain in the eye of the beholder. An understanding of how to design informative small pilot/feasibility studies can assist in speeding up incremental science (where everything needs to be piloted) while slowing down premature scale-up (where any evidence is sufficient for scaling).
Difference in perception of advantages and disadvantages of automated peritoneal dialysis for patients undergoing peritoneal dialysis: a conjoint analysis
Authors: Yoshida Hisako , Tsuruya Kazuhiko 
Published: September 2021

Abstract
Background
In Japan, only less than 3% of patients undergoing maintenance dialysis select peritoneal dialysis (PD) as the mode of renal replacement therapy. Half of patients undergoing PD use a cycler for automated PD (APD). However, it remains unclear what patients undergoing PD regard as the benefits of APD. The purpose of this study was to objectively clarify what patients undergoing PD regard as the advantages and disadvantages of APD.

Methods
We designed case simulations that varied according to 6 characteristics of PD, such as the adequacy of dialysis and frequency of bag exchange, and created 16 simulation cards for conjoint analysis. For each case vignette, the respondents were asked to indicate whether they would receive this modality of PD on a 5-point scale.

Results
Thirty-two patients undergoing PD were recruited for this study and completed conjoint analysis simulation questionnaires. The factor with the highest importance in evaluating the modality of PD was the frequency of bag exchange among all participants. When participants were divided into those undergoing APD and continuous ambulatory PD (CAPD), the factor was different between them; that is, the low frequency of bag exchange is regarded as an advantage of APD for patients undergoing APD, while the large-sized cycler device is regarded as a disadvantage of APD for those undergoing CAPD.

Conclusions
The perception of advantages and disadvantages of APD differed between patients undergoing APD and CAPD; the former focus on the frequency of bag exchange, whereas the latter focused the size of device.
Patterns of death among migrant domestic workers in Jordan: retrospective analysis of 63 cases in a tertiary hospital
Authors: Abder-Rahman Hasan A. , Al-Soleiti Majd , Habash Ibrahim H. , Al-Abdallat Imad M. , Al-Abdallat Laith I. 
Published: September 2021

Abstract
Background
This article examines the patterns of death in migrant domestic workers (MDWs) in Jordan. Abuse and difficult circumstances may lead to attempts to escape, neglect, or suicide, but the current literature on death in this population is limited. We systematically explored all medico-legal cases of MDW deaths referred between 2006 and 2016 to the forensic department of one of the main tertiary medical centers in Jordan.

Results
Sixty-three recorded cases of MDWs death were found. Forty-seven (74.6%) died due to unnatural causes, 15 (23.8%) died naturally, and 1 (1.6%) was undetermined. The rate of suspected suicide comprised 58.3% of unnatural deaths. The most common methods of suicide were hanging and falling from a height.

Conclusions
This study shows high rates of unnatural death among MDWs in Jordan, many of which with suspicious circumstances. It also indicates that natural deaths are largely attributed to preventable causes. Future studies should include other referral sites (hospitals and forensics departments), to better address the complexity and magnitude of this population’s death circumstances, gain a comprehensive understanding of their issues, and work toward finding a solution. We recommend that special attention is given to MDWs in Jordan and the region to protect their rights on all levels.
A study of anxiety, depression and stress symptoms among Fayoum medical students during COVID-19 lockdown, Egypt
Authors: Soltan Mohamed R. , Soliman Shaimaa S. , Dawoud Mariam E. 
Published: September 2021

Abstract
Background
The widespread pandemic of COVID-19 virus carries not only physical hazards, but also major psychological effects especially among medical students. The aim was to investigate the psychological effects of COVID-19 on medical students and the factors affecting them. The study was carried out with an online questionnaire distributed through Google Forms for medical students at Faculty of Medicine, Egypt. The questionnaire included socio-demographic questions, validated psychometric tools for the assessment of depression, anxiety and stress (Depression Anxiety Stress Scales DASS-21) and the Impact of Event Stress Scale-Revised (IES-R) were applied.

Results
The total number of participants was 282 students. Percentage of participants with clinically significant depression was 75.2%, anxiety was 56.4% and stress was 52.9%. Those showed PTSD probability was 54.3%. The multivariate regression analysis revealed that IES remained significantly associated with gender and previous road accidents, depression and anxiety remained significantly associated with personal history of psychiatric illness, while stress remained significantly associated with gender and previous road accidents.

Conclusions
Medical students were highly depressed, anxious and stressed during period of COVID-19 pandemic. Being a female, having previous history of psychiatric illness and previous road accident were highly associated with increasing the psychological impact of COVID-19.
Practice-Changing Use of the 21-Gene Test for the Management of Patients With Early-Stage Breast Cancer in Latin America
Authors: Gomez Henry L. , Bargallo-Rocha Juan E. , Billinghurst Roberto J. , Núñez De Pierro Aníbal R. , Coló Federico A. , Gil Lisandro L. B. , Allemand Carola , McLean Ignacio L. , Lema-Medina Mauricio , Herazo-Maya Fernando , Terrier Francisco J. , Cwilich Raquel G. , Leon Mauricio , Falcon Silvia G. , Castaño Roberto E. , Oliveira Sergio C. , Jakubowski Debbie M. , Chao Calvin 
Published: September 2021

PURPOSEWe present a physician survey of the impact of 21-gene Breast Recurrence Score test results on treatment decisions in clinical practice in Latin America.METHODSThis prospective survey enrolled consecutive patients at 14 sites in Argentina, Colombia, Mexico, and Peru who had routine 21-gene testing. Physician surveys captured patient and tumor characteristics and treatment decisions before and after 21-gene test results. The survey spanned the period before and after Trial Assigning Individualized Options for Treatment (TAILORx) results reported (June 2018). Overall net percent change in adjuvant chemotherapy recommendations was estimated, and asymptotic 95% CIs with continuity correction were calculated. The proportion with a change between pretest treatment recommendation and actual treatment received was calculated overall and by Recurrence Score groups per TAILORx.RESULTSBetween March 2015 and December 2019, the survey was completed for 647 patients; 20% were node-positive. The mean patient age was 54 years (24-85 years); 55% were postmenopausal; 17%, 63%, and 20% had grade 1, 2, and 3 tumors, respectively; and 30% had tumors > 2 cm. Recurrence Score (RS) results were as follows: 20% RS 0-10, 56% RS 11-25, and 24% RS 26-100. Overall, chemotherapy recommendations fell by a relative proportion of 39% (95% CI, 33.4 to 44.3) after 21-gene testing (33% decrease in node-negative and 55% decrease in node-positive). Among node-negative patients, the relative decrease in chemotherapy recommendations was 28% (95% CI, 18.9 to 39.5) before TAILORx and 36% (95% CI, 28.4 to 43.7) after.CONCLUSIONTo our knowledge, this large survey of 21-gene test practice patterns was the first conducted in Latin America and showed the relevance of 21-gene testing in low- and medium-resource countries to minimize chemotherapy overuse and underuse in breast cancer. The results showed substantial reductions in chemotherapy use overall—especially after TAILORx reported—indicating the practice-changing potential of that study.
Late Toxicity After Adjuvant Conventional Radiation Versus Image-Guided Intensity-Modulated Radiotherapy for Cervical Cancer (PARCER): A Randomized Controlled Trial
Authors: Chopra Supriya , Gupta Sudeep , Kannan Sadhana , Dora Tapas , Engineer Reena , Mangaj Akshay , Maheshwari Amita , Shylasree T. Surappa , Ghosh Jaya , Paul Siji N. , Phurailatpam Reena , Charnalia Mayuri , Alone Mitali , Swamidas Jamema , Mahantshetty Umesh , Deodhar Kedar , Kerkar Rajendra , Shrivastava Shyam K. 
Published: September 2021

PURPOSE Postoperative Adjuvant Radiation in Cervical Cancer (PARCER), a phase III randomized trial, compared late toxicity after image-guided intensity-modulated radiotherapy (IG-IMRT) with three-dimensional conformal radiation therapy (3D-CRT) in women with cervical cancer undergoing postoperative radiation. METHODS Patients were randomly assigned to receive either IG-IMRT or 3D-CRT after stratification for the type of hysterectomy and use of concurrent chemotherapy. The primary end point was 3-year grade ≥ 2 late GI toxicity assessed using Common Toxicity Criteria for Adverse Events v 3.0 and estimated using time-to-event, intention-to-treat analysis, with a study level type I error of 0.05 and a nominal α of .047 after accounting for one interim analysis. Secondary end points included acute toxicity, health-related quality of life, and pelvic relapse-free, disease-free, and overall survival. RESULTS Between 2011 and 2019, 300 patients were randomly assigned (IG-IMRT 151 and 3D-CRT 149). At a median follow-up of 46 (interquartile range, 20-72) months, the 3-year cumulative incidence of grade ≥ 2 late GI toxicity in the IG-IMRT and 3D-CRT arms were 21.1% versus 42.4% (hazard ratio [HR] 0.46; 95% CI, 0.29 to 0.73; P < .001). The cumulative incidence of grade ≥ 2 any late toxicity was 28.1% versus 48.9% (HR 0.50; 95% CI, 0.33 to 0.76; P < .001), respectively. Patients reported reduced diarrhea ( P = .04), improved appetite ( P = .008), and lesser bowel symptoms ( P = .002) with IG-IMRT. However, no difference was observed in the time by treatment interaction. The 3-year pelvic relapse-free survival and disease-free survival in the IG-IMRT versus the 3D-CRT arm were 81.8% versus 84% (HR 1.17; 95% CI, 0.68 to 1.99; P = .55) and 76.9% versus 81.2% (HR 1.03; 95% CI, 0.62 to 1.71; P = .89), respectively. CONCLUSION IG-IMRT results in reduced toxicity with no difference in disease outcomes.
Prevalence and Workplace Drivers of Burnout in Cancer Care Physicians in Ontario, Canada
Authors: Singh Simron , Farrelly Ashley , Chan Catherine , Nicholls Brett , Nazeri-Rad Narges , Bellicoso Daniela , Eisen Andrea , Falkson Conrad B. , Fox Colleen , Holloway Claire , Kennedy Erin , McLeod Robin , Rothenberger David , Trudeau Maureen , Shanafelt Tait , Bauman Glenn 
Published: September 2021

PURPOSE: Provider well-being has become the fourth pillar of the quadruple aim for providing quality care. Exacerbated by the global COVID-19 pandemic, provider well-being has become a critical issue for health care systems worldwide. We describe the prevalence and key system-level drivers of burnout in oncologists in Ontario, Canada. METHODS: This is a cross-sectional survey study conducted in November-December 2019 of practicing cancer care physicians (surgical, medical, radiation, gynecologic oncology, and hematology) in Ontario, Canada. Ontario is Canada's largest province (with a population of 14.5 million), and has a single-payer publicly funded cancer system. The primary outcome was burnout experience assessed through the Maslach Burnout Inventory. RESULTS: A total of 418 physicians completed the questionnaire (response rate was 44% among confirmed oncologists). Seventy-three percent (n = 264 of 362) of oncologists had symptoms of burnout (high emotional exhaustion and/or depersonalization scores). Significant drivers of burnout identified in multivariable regression modeling included working in a hectic or chaotic atmosphere (odds ratio [OR] = 15.5; 95% CI, 3.4 to 71.5; P < .001), feeling unappreciated on the job (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), reporting poor or marginal control over workload (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), and not being comfortable talking to peers about workplace stress (OR = 3.0; 95% CI, 1.1 to 7.9; P < .001). Older age (≥ 56 years) was associated with lower odds of burnout (OR = 0.16; 95% CI, 0.1 to 0.4; P < .001). CONCLUSION: Nearly three quarters of participants met predefined standardized criteria for burnout. This number is striking, given the known impact of burnout on provider mental health, patient safety, and quality of care, and suggests Oncologists in Ontario may be a vulnerable group that warrants attention. Health care changes being driven by the COVID-19 pandemic provide an opportunity to rebuild new systems that address drivers of burnout. Creating richer peer-to-peer and leadership engagement opportunities among early- to mid-career individuals may be a worthwhile organizational strategy.
Application of Quantitative CT Imaging in Rehabilitation Nursing of Cerebral Apoplexy Patients
Authors: Yan Bing , Zhang Huanhuan , Liu Jie 
Published: September 2021

Objectives: Electronic computed tomography (CT) is an important imaging method for the diagnosis of cerebral infarction. This paper explores the preventive effects of quantitative CT imaging and early rehabilitation nursing on patients with cerebral apoplexy and shoulder-hand syndrome.
Methods: Sixty cerebral apoplexy patients treated were included as control group and given routine care from September 2018 to May 2020. Sixty cerebral apoplexy patients were included as observation group, and early rehabilitation nursing intervention was given based on control group. The incidence of shoulder-hand syndrome and upper limb function were compared between the two groups, to explore the effectiveness of the CT examination in promoting the physical function restoration.
Results: The incidence of shoulder-hand syndrome in observation group after three months of intervention was lower than that in control group, and the severity was less than that in control group (P<0.05); The Ashworth score of muscle tension in observation group after three months of intervention was lower than that in control group, and the simplified FMA score of the upper limbs was higher than that in control group.
Conclusion: Early rehabilitation nursing intervention after CT examination can prevent the occurrence of cerebral apoplexy and shoulder-hand syndrome and improve upper limb function, which is worthy of promotion.
doi: https://doi.org/10.12669/pjms.37.6-WIT.4840
How to cite this:Yan B, Zhang H, Liu J. Application of Quantitative CT Imaging in Rehabilitation Nursing of Cerebral Apoplexy Patients. Pak J Med Sci. 2021;37(6):1574-1579. doi: https://doi.org/10.12669/pjms.37.6-WIT.4840
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Construction and application of color fundus image segmentation algorithm based on Multi-Scale local combined global enhancement
Authors: Hao Yanjie , Xie Hongbo , Qiu Rong 
Published: September 2021

Objective: Aiming at the problem of low accuracy in extracting small blood vessels from existing retinal blood vessel images, a retinal blood vessel segmentation method based on a combination of a multi-scale linear detector and local and global enhancement is proposed.
Methods: The multi-scale line detector is studied, and it is divided into two parts: small scale and large scale. The small scale is used to detect the locally enhanced image and the large scale is used to detect the globally enhanced image. Fusion the response functions at different scales to get the final retinal vascular structure.
Results: Experiments on two databases STARE and DRIVE, show that the average vascular accuracy rates obtained by the algorithm reach 96.62% and 96.45%, and the average true positive rates reach 75.52% and 83.07%, respectively.
Conclusion: The segmentation accuracy is high, and better blood vessel segmentation results can be obtained.
doi: https://doi.org/10.12669/pjms.37.6-WIT.4848
How to cite this:Hao Y, Xie H, Qiu R. Construction and application of color fundus image segmentation algorithm based on Multi-Scale local combined global enhancement. Pak J Med Sci. 2021;37(6):1595-1599. doi: https://doi.org/10.12669/pjms.37.6-WIT.4848
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Exploring the NT-proBNP expression in Premature Infants with Patent Ductus Arteriosus (PDA) by Echocardiography
Authors: Shi Yunlong , Ji Jianwei , Wang Chunying 
Published: September 2021

Objectives: To investigate the correlation between echocardiographic indicators and the expression level of N-terminal pro-brain natriuretic peptide (NT-proBNP) in premature infants (PIs) with patent ductus arteriosus (PDA) and the value of NT-proBNP in diagnosing symptomatic PDA (sPDA) in PIs whose gestational age (GA) was less than 32 weeks.
Methods: Ninty premature infants were selected as the research objects, including 52 in the non-PDA group and 38 in the PDA group (26 sPDA cases and 12 cases with asymptomatic PDA (asPDA)) from February 2019 to March 2020. The general information of these infants was recorded, including gender, delivery method, maternal infection, and serum NT-proBNP level on the 3rd day after birth. They were screened by echocardiographic indicators under an artificial intelligence convolutional neural network (AI-CNN). The Receiver Operating Characteristic (ROC) curves were illustrated to decide serum NT-proBNP expression levels, thereby determining specificity and sensitivity of sPDA and the correlation between serum sPDA NT-proBNP expression and echocardiographic indicators.
Results: The expression level of serum NT-proBNP in the sPDA group was greater than that in the asPDA group and the non-PDA group (P<0.001). The serum NT-proBNP expression level was positively correlated with the diameter of the ductus arteriosus in the sPDA group (r=0.462, P<0.001); it was also positively correlated with the ratio of left atrium/aorta (LA/AO) (r=0.573, P<0.001), but was not correlated with left ventricular ejection fraction (LVEF) (r=-0.015, P=0.747).
Conclusion: The combination of serum NT-proBNP expression and echocardiography had clinical values in early diagnosis of PDA.
doi: https://doi.org/10.12669/pjms.37.6-WIT.4853
How to cite this:Shi Y, Ji J, Wang C. Exploring the NT-proBNP expression in Premature Infants with Patent Ductus Arteriosus (PDA) by Echocardiography. Pak J Med Sci. 2021;37(6):1615-1619. doi: https://doi.org/10.12669/pjms.37.6-WIT.4853
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.