bluuebunny/crossref_metadata_2025_split huggingface dataset:
Double-opposing Z-Plasty Extended with a Pedicled Buccal Fat Pad Flap for Correcting Velopharyngeal Insufficiency after Primary Palatoplasty
Authors: Park Hojin , Choi Jin Mi , Oh Tae Suk 
Published: October 2021

Introduction Furlow double-opposing Z-plasty (DOZ) lengthens the soft palate; however, this lengthening is achieved at the expense of increased mucosal flap tension. Thus, its use is limited in patients with severe tension applied on mucosal flap after DOZ. In this study, DOZ was combined with a buccal fat pad (BFP) flap to maximize palatal lengthening and muscle repositioning. Methods This study included patients who underwent surgical correction for velopharyngeal insufficiency between December 2016 and February 2019. Patients with more than moderate degree hypernasality following primary palatoplasty were included in the study. Patients younger than 4 years of age, those with a submucous cleft palate, or syndromic patients were excluded. Speech outcomes were investigated for those who underwent DOZ only (DOZ group, n = 17) and those in whom a BFP was used (BFP group, n = 15) pre- and postoperatively. The velopharyngeal gaps between the uvula and pharyngeal wall were measured before and immediately after surgery to estimate the palatal length. Results Most patients who received a BFP showed improvement in hypernasality. However, the hypernasality of the DOZ group was more severe than that of the BFP group (p = 0.023). The extent of palatal lengthening was 4.4 ± 1.7 mm and 7.5 ± 2.1 mm in the DOZ and BFP groups, respectively (p = 0.001). Conclusions BFPs reduced the tension of the DOZ mucosal flap and maximized palatal lengthening and muscle repositioning. They promoted velopharyngeal closure in patients with moderate and moderate-to-severe velopharyngeal insufficiency. Hence, our method improves the surgical outcomes of patients with velopharyngeal insufficiency after primary palatoplasty.
Recurrent arthritis as an unexpected side effect associated with azacitidine in a patient with myelodysplastic syndrome
Authors: Iltar Utku , Alhan Fadime Nurcan , Vural Ece , Ataş Ünal , Sözel Hasan , Doğan Ömer , Boduroğlu Ahmet , Yücel Orhan Kemal , Salim Ozan , Ündar Levent 
Published: October 2021

Introduction Hypomethylating agents have confirmed efficacy for myelodysplastic syndrome and acute myeloid leukemia and are widely used. Although arthralgia is common side effect associated with hypomethylating agents, arthritis has not been reported previously. Case Report We present the first recorded patient with arthritis after azacitidine treatment. The patient we presented here had severe cytopenias requiring transfusion with erythrocyte and platelet suspensions, and a complete hematological response was obtained for myelodysplastic syndrome after three cycles of azacitidine (AZA) treatment. However, interestingly, after each AZA treatment cycle, the patient had recurrent attacks of arthritis. Management and outcomes The episodes of arthritis were possibly acute flares of pre-existing crystal-induced arthritis, as exhibited with azacitidine treatments and were managed effectively with nonsteroidal anti-inflammatory drugs. Discussion Because it is a rare condition, clinicians should not overlook AZA as a possible cause of arthritis exacerbations when arthritis of unknown etiology develops in patients treated with AZA.
Rural Telehealth Visits in the Management of Type 1 Diabetes
Authors: Eiland Leslie A , Drincic Andjela 
Published: October 2021

Introduction: Despite advances in and increased adoption of technology, glycemic outcomes for individuals with type 1 diabetes (T1D) have not improved. Access to care is limited for many, in part due to a shortage of endocrinologists and their concentration in urban areas. Managing T1D via telehealth has potential to improve glycemic outcomes, as the barriers of travel-related time and cost are mitigated. Methods: Our endocrine telehealth program started in 2013 and currently provides care to nine rural community hospitals in Nebraska and Iowa. A retrospective cohort study was performed to evaluate glycemic outcomes in people with T1D who received care at these telehealth clinics from 2013-2019. Data were collected on age, race, gender, prior diabetes provider, use of diabetes technology, and A1c values over time. Results: One hundred thirty-nine individuals were followed for an average duration of 32 months (range 4-69 months). Sixty-six percent of people were previously under the care of an endocrinologist. The most common therapeutic action, in addition to insulin adjustment, was addition of a CGM (52%). Each year in telemedicine care was associated with a decline of 0.13% in A1c (95% CI: −0.20, −0.06). There was no association between A1c and age or gender. When stratifying by previous diabetes provider, all groups had a statistically significant decline in A1c, even those with a previous endocrine provider. There was no statistically significant decline in A1c based on addition of technology. Conclusion: We have shown that traditional telehealth visits are an effective way to provide care for people with T1D long-term and may provide distinct advantages to home telehealth visits.
The Effect of COVID-19 as an Economic Shock on the Gender and Ethnic Gap in Labour Market Outcomes
Authors: Milovanska-Farrington Stefani 
Published: October 2021

With more than 29 million confirmed cases of COVID-19 in the USA and 119 million cases worldwide, the pandemic has affected companies, households and the global economy. We explore the effect of the economic shock which resulted from this specific health event on labour market outcomes, and the changes in labour market disparities between ethnic groups and genders. The results provide evidence of an adverse effect of COVID-19 on labour market outcomes of all demographic groups, a widening gap between the employment prospects of minorities and whites, but no change in the earnings gaps between ethnic groups. We also do not find a deterioration of the differentials between genders, except the increase in the difference in the duration of unemployment between women and men with children. The findings have implications related to the priorities of policy decision-makers when implementing policies to combat ethnic and gender gaps in the labour market. JEL Classification: J70, J71, J01, J15, J23
Association Between Pitch Break on the 4-Seam Fastball and Slider and Shoulder Injury in Major League Baseball Pitchers: A Case-Control Study
Authors: Platt Brooks N. , Zacharias Anthony V. , Conley Caitlin , Hockensmith Lindsay , Stockwell Nicholas , Sciascia Aaron , Stone Austin V. 
Published: October 2021

Background: Few specific risk factors are known for shoulder injury in professional pitchers. New pitch-tracking data allow for risk stratification based on advanced metrics. Purpose/Hypothesis: The purpose of this study was to determine the association between shoulder injury, pitch frequency, and pitch metrics (velocity, total break, break angle, and spin rate) for the 4-seam fastball, curveball, and slider. We hypothesized that more frequent use of the 4-seam fastball would be associated with shoulder injury. Study Design: Case-control study; Level of evidence, 3. Methods: The Major League Baseball (MLB) database was queried for pitchers who had been placed on the injury list (IL) with a shoulder injury between 2015 and 2019. Injured pitchers were matched 1:1 with controls (pitchers not on the IL with a shoulder injury during the study period), based on age (±1 year), history of ulnar collateral ligament reconstruction, position (starter vs reliever), and pitches thrown during the injury season (±500). Pitch frequency, velocity, horizontal break, vertical break, total break, and spin rate for the season were collected from the Baseball Savant website for the 4-seam fastball, curveball, and slider. Univariate analysis was used to determine group differences for individual variables. Multiple logistic regression was performed to determine odds ratios (ORs) for shoulder injury associated with pitch frequency, velocity, total break, break angle, and spin rate. Covariates included age, position, ulnar collateral ligament reconstruction status, expected weighted on-base average, and total pitches thrown. Results: Overall, 233 injured pitchers were evaluated. The most common reason for IL placement was inflammation (78/233; 33.5%) followed by strain or sprain (61/233; 26.2%). Increased total pitch break was associated with an increased risk of shoulder injury for the 4-seam fastball (OR, 1.340 [95% confidence interval (CI), 1.199-1.509]; P < .001) and slider (OR, 1.360 [95% CI, 1.206-1.554]; P < .001). For the slider, a decreased spin rate (OR = 0.998 [95% CI, 0.997-0.999]; P = .026) and a more vertical break angle (OR = 1.170 [95% CI: 1.073-1.278]; P = .004) were associated with increased risk of injury. Conclusion: Increased pitch break of the 4-seam fastball and slider was associated positively with shoulder injury in MLB pitchers. These findings add to the understanding of throwing injury and ability to detect risk using ball-tracking technology.
FoldHSphere: deep hyperspherical embeddings for protein fold recognition
Authors: Villegas-Morcillo Amelia , Sanchez Victoria , Gomez Angel M. 
Published: October 2021

Abstract
Background
Current state-of-the-art deep learning approaches for protein fold recognition learn protein embeddings that improve prediction performance at the fold level. However, there still exists aperformance gap at the fold level and the (relatively easier) family level, suggesting that it might be possible to learn an embedding space that better represents the protein folds.

Results
In this paper, we propose the FoldHSphere method to learn a better fold embedding space through a two-stage training procedure. We first obtain prototype vectors for each fold class that are maximally separated in hyperspherical space. We then train a neural network by minimizing the angular large margin cosine loss to learn protein embeddings clustered around the corresponding hyperspherical fold prototypes. Our network architectures, ResCNN-GRU and ResCNN-BGRU, process the input protein sequences by applying several residual-convolutional blocks followed by a gated recurrent unit-based recurrent layer. Evaluation results on the LINDAHL dataset indicate that the use of our hyperspherical embeddings effectively bridges the performance gap at the family and fold levels. Furthermore, our FoldHSpherePro ensemble method yields an accuracy of 81.3% at the fold level, outperforming all the state-of-the-art methods.

Conclusions
Our methodology is efficient in learning discriminative and fold-representative embeddings for the protein domains. The proposed hyperspherical embeddings are effective at identifying the protein fold class by pairwise comparison, even when amino acid sequence similarities are low.
The doll therapy as a first line treatment for behavioral and psychologic symptoms of dementia in nursing homes residents: a randomized, controlled study
Authors: Santagata Francesca , Massaia Massimiliano , D’Amelio Patrizia 
Published: October 2021

Abstract
Background
Patients living with dementia are severely affected by the development of behavioral and psychologic symptoms (BPSD) which represent a burden for patients and caregivers. The use of psychotropic drugs in the control of BPSD is widely diffused, however the use of a first line non-pharmacologic approach is highly recommended.
Here we evaluate the effect of doll therapy (DT) in the management of BPSD, on the reduction of caregiver burden and delirium incidence in nursing home residents by a randomized controlled trial.

Methods
We enrolled fifty-two nursing homes residents living with dementia and BPSD. Subjects were randomized to DT (26) or standard treatment (ST, 26), we measured BPSD, caregiver burden and delirium with standard clinical scales at baseline, after 45 and 90 days.
In order to evaluate the presence of BPSD we used Neuropsychiatric Inventory (NPI) scale and the A.Di.CO scale, the caregiver burden was measured by the Greutzner scale and delirium by the Confusion Assessment Method (CAM) scale.

Results
DT was more effective in reducing agitation and aggressiveness as respect to ST. Moreover DT globally reduced the presence of BPSD as dysphoria, wandering and apathy. We observed a significant reduction of the professional caregiver burden and the incidence of delirium was significantly reduced in subjects treated with DT.

Conclusions
We show that DT is more effective that ST in the control of BSPD in patients affected by moderate to severe dementia. Moreover we suggest that DT may effective in reducing the incidence of delirium.

Trial registration
Retrospectively registered in ClinicalTrials.gov the 10th June 2, 2021 trial registration number NCT04920591.
Invasive pneumococcal disease burden in hospitalized adults in Bogota, Colombia
Authors: Narváez Paula O. , Gomez-Duque Salome , Alarcon Juan E. , Ramirez-Valbuena Paula C. , Serrano-Mayorga Cristian C. , Lozada-Arcinegas Julian , Bastidas Alirio , Gómez Sandra , Vargas Hernan , Feldman Charles , Reyes Luis Felipe 
Published: October 2021

Abstract
Background
The incidence of invasive pneumococcal disease (IPD) varies depending on a number of factors, including vaccine uptake, in both children and adults, the geographic location, and local serotype prevalence. There are limited data about the burden of Streptococcus pneumoniae (Spn), serotype distribution, and clinical characteristics of adults hospitalized due to IPD in Colombia. The objectives of this study included assessment of Spn serotype distribution, clinical characteristics, mortality, ICU admission, and the need for mechanical ventilation.

Methods
This was an observational, retrospective, a citywide study conducted between 2012 and 2019 in Bogotá, Colombia. We analyzed reported positive cases of IPD from 55 hospitals in a governmental pneumococcal surveillance program. Pneumococcal strains were isolated in each hospital and typified in a centralized laboratory. This is a descriptive study stratified by age and subtypes of IPD obtained through the analysis of medical records.

Results
A total of 310 patients with IPD were included, of whom 45.5% were female. The leading cause of IPD was pneumonia (60%, 186/310), followed by meningitis. The most frequent serotypes isolated were 19A (13.87%, 43/310) and 3 (11.94%, 37/310). The overall hospital mortality rate was 30.3% (94/310). Moreover, 52.6% (163/310 patients) were admitted to the ICU, 45.5% (141/310) required invasive mechanical ventilation and 5.1% (16/310) non-invasive mechanical ventilation.

Conclusion
Pneumococcal pneumonia is the most prevalent cause of IPD, with serotypes 19A and 3 being the leading cause of IPD in Colombian adults. Mortality due to IPD in adults continues to be very high.
Umbilical hernia repair and recurrence: need for a clinical trial?
Authors: Mannion Jennifer , Hamed Mohamed Khalid , Negi Ritu , Johnston Alison , Bucholc Magda , Sugrue Michael 
Published: October 2021

Abstract
Introduction
Umbilical hernia repair, despite its perceived simplicity, is associated with recurrence between 2.7 and 27%, in mesh repair and non mesh repair respectively. Many factors are recognized contributors to recurrence however multiple defects in the linea alba, known to occur in up to 30% of patients, appear to have been overlooked by surgeons.

Aims
This systematic review assessed reporting of second or multiple linea alba defects in patients undergoing umbilical hernia repair to establish if these anatomical variations could contribute to recurrence along with other potential factors.

Methods
A systematic review of all published English language articles was undertaken using databases PubMed, Embase, Web of Science and Cochrane Library from January 2014 to 2019. The search terms ‘Umbilical hernia’ AND ‘repair’ AND ‘recurrence’ were used across all databases. Analysis was specified in advance to avoid selection bias, was registered with PROSPERO (154173) and adhered to PRISMA statement.

Results
Six hundred and forty-six initial papers were refined to 10 following article review and grading. The presence of multiple linea alba defects as a contributor to recurrence was not reported in the literature. One paper mentioned the exclusion of six participants from their study due multiple defects. In all 11 factors were significantly associated with umbilical hernia recurrence. These included: large defect, primary closure without mesh, high BMI in 5/10 publications; smoking, diabetes mellitus, surgical site Infection (SSI) and concurrent hernia in 3/10. In addition, the type of mesh, advanced age, liver disease and non-closure of the defect were identified in individual papers.

Conclusion
This study identified many factors already known to contribute to umbilical hernia recurrence in adults, but the existence of multiple defects in the linea, despite it prevalence, has evaded investigators. Surgeons need to be consider documentation of this potential confounder which may contribute to recurrence.
Co-producing an intervention for tobacco cessation and improvement of oral health among diabetic patients in Bangladesh
Authors: Mishu Masuma Pervin , Elsey Helen , Choudhury Arup Ratan , Dastagir Shahana , Khan Saeed , Tahsin Tania , Suma Hena Moni , Karmaker Rajesh , Dogar Omara 
Published: October 2021

Abstract
Background
Tobacco consumption is a major risk factor for many diseases including diabetes and has deleterious effects on oral health. Diabetic patients are vulnerable to developing certain oral conditions. So far, no studies have attempted to co-develop a tobacco cessation intervention to be delivered in dental clinics for people with diabetes in Bangladesh.

Aim
To co-produce a tobacco cessation intervention for people with diabetes for use in dental clinics in Bangladesh.

Objectives
To assess: (1) tobacco use (patterns) and perceptions about receiving tobacco cessation support from dentists among people with diabetes attending the dental department of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) who smoke or use smokeless tobacco (ST) (2) current tobacco cessation support provision by the dentists of the dental department of BIRDEM (3) barriers and facilitators of delivering a tobacco cessation intervention at a dental clinic, and (4) to co-produce a tobacco cessation intervention with people with diabetes, and dentists to be used in the proposed context.

Methods
The study was undertaken in two stages in the dental department of BIRDEM, which is the largest diabetic hospital in Bangladesh. Stage 1 (July–August 2019) consisted of a cross-sectional survey among people with diabetes who use tobacco to address objective 1, and a survey and workshop with dentists working in BIRDEM, and consultations with patients to address objectives 2 and 3. Stage 2 (January 2020) consisted of consultations with patients attending BIRDEM, and a workshop with dentists to co-produce the intervention.

Result
All survey participants (n = 35) were interested in receiving tobacco cessation support from their dentist. We identified important barriers and facilitators to deliver tobacco cessation intervention within dental services. Barriers reported by dentists included lack of a structured support system and lack of training. As a facilitator, we identified that dentists were willing to provide support and it would be feasible to deliver tobacco cessation intervention if properly designed and embedded in the routine functioning of the dental department of BIRDEM. Through the workshops and consultations at stage 2, a tobacco cessation intervention was co-developed. The intervention included elements of brief cessation advice (using a flipbook and a short video on the harmful effects of tobacco) and pharmacotherapy.

Conclusion
Incorporation of tobacco cessation within dental care for people with diabetes was considered feasible and would provide a valuable opportunity to support this vulnerable group in quitting tobacco.
Implication and challenges of direct-fed microbial supplementation to improve ruminant production and health
Authors: Ban Yajing , Guan Le Luo 
Published: October 2021

AbstractDirect-fed microbials (DFMs) are feed additives containing live naturally existing microbes that can benefit animals’ health and production performance. Due to the banned or strictly limited prophylactic and growth promoting usage of antibiotics, DFMs have been considered as one of antimicrobial alternatives in livestock industry. Microorganisms used as DFMs for ruminants usually consist of bacteria including lactic acid producing bacteria, lactic acid utilizing bacteria and other bacterial groups, and fungi containing Saccharomyces and Aspergillus. To date, the available DFMs for ruminants have been largely based on their effects on improving the feed efficiency and ruminant productivity through enhancing the rumen function such as stabilizing ruminal pH, promoting ruminal fermentation and feed digestion. Recent research has shown emerging evidence that the DFMs may improve performance and health in young ruminants, however, these positive outcomes were not consistent among studies and the modes of action have not been clearly defined. This review summarizes the DFM studies conducted in ruminants in the last decade, aiming to provide the new knowledge on DFM supplementation strategies for various ruminant production stages, and to identify what are the potential barriers and challenges for current ruminant industry to adopt the DFMs. Overall literature research indicates that DFMs have the potential to mitigate ruminal acidosis, improve immune response and gut health, increase productivity (growth and milk production), and reduce methane emissions or fecal shedding of pathogens. More research is needed to explore the mode of action of specific DFMs in the gut of ruminants, and the optimal supplementation strategies to promote the development and efficiency of DFM products for ruminants.