bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validating International Classification of Disease 10th Revision algorithms for identifying influenza and respiratory syncytial virus hospitalizations
Authors: Hamilton Mackenzie A. , Calzavara Andrew , Emerson Scott D. , Djebli Mohamed , Sundaram Maria E. , Chan Adrienne K. , Kustra Rafal , Baral Stefan D. , Mishra Sharmistha , Kwong Jeffrey C. 
Published: January 2021

Objective
Routinely collected health administrative data can be used to efficiently assess disease burden in large populations, but it is important to evaluate the validity of these data. The objective of this study was to develop and validate International Classification of Disease 10th revision (ICD -10) algorithms that identify laboratory-confirmed influenza or laboratory-confirmed respiratory syncytial virus (RSV) hospitalizations using population-based health administrative data from Ontario, Canada.

Study design and setting
Influenza and RSV laboratory data from the 2014–15, 2015–16, 2016–17 and 2017–18 respiratory virus seasons were obtained from the Ontario Laboratories Information System (OLIS) and were linked to hospital discharge abstract data to generate influenza and RSV reference cohorts. These reference cohorts were used to assess the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ICD-10 algorithms. To minimize misclassification in future studies, we prioritized specificity and PPV in selecting top-performing algorithms.

Results
83,638 and 61,117 hospitalized patients were included in the influenza and RSV reference cohorts, respectively. The best influenza algorithm had a sensitivity of 73% (95% CI 72% to 74%), specificity of 99% (95% CI 99% to 99%), PPV of 94% (95% CI 94% to 95%), and NPV of 94% (95% CI 94% to 95%). The best RSV algorithm had a sensitivity of 69% (95% CI 68% to 70%), specificity of 99% (95% CI 99% to 99%), PPV of 91% (95% CI 90% to 91%) and NPV of 97% (95% CI 97% to 97%).

Conclusion
We identified two highly specific algorithms that best ascertain patients hospitalized with influenza or RSV. These algorithms may be applied to hospitalized patients if data on laboratory tests are not available, and will thereby improve the power of future epidemiologic studies of influenza, RSV, and potentially other severe acute respiratory infections.
Variation in hospital admission in febrile children evaluated at the Emergency Department (ED) in Europe: PERFORM, a multicentre prospective observational study
Authors: Borensztajn Dorine M. , Hagedoorn Nienke N. , Rivero Calle Irene , Maconochie Ian K. , von Both Ulrich , Carrol Enitan D. , Dewez Juan Emmanuel , Emonts Marieke , van der Flier Michiel , de Groot Ronald , Herberg Jethro , Kohlmaier Benno , Lim Emma , Martinon-Torres Federico , Nieboer Daan , Nijman Ruud G. , Pokorn Marko , Strle Franc , Tsolia Maria , Vermont Clementien , Yeung Shunmay , Zavadska Dace , Zenz Werner , Levin Michael , Moll Henriette A. ,   on behalf of PERFORM consortium: Personalised Risk assessment in febrile children to optimise Real-life Management across the European Union
Published: January 2021

Objectives
Hospitalisation is frequently used as a marker of disease severity in observational Emergency Department (ED) studies. The comparison of ED admission rates is complex in potentially being influenced by the characteristics of the region, ED, physician and patient. We aimed to study variation in ED admission rates of febrile children, to assess whether variation could be explained by disease severity and to identify patient groups with large variation, in order to use this to reduce unnecessary health care utilization that is often due to practice variation.

Design
MOFICHE (Management and Outcome of Fever in children in Europe, part of the PERFORM study, www.perform2020.org), is a prospective cohort study using routinely collected data on febrile children regarding patient characteristics (age, referral, vital signs and clinical alarming signs), diagnostic tests, therapy, diagnosis and hospital admission.

Setting and participants
Data were collected on febrile children aged 0–18 years presenting to 12 European EDs (2017–2018).

Main outcome measures
We compared admission rates between EDs by using standardised admission rates after adjusting for patient characteristics and initiated tests at the ED, where standardised rates >1 demonstrate higher admission rates than expected and rates <1 indicate lower rates than expected based on the ED patient population.

Results
We included 38,120 children. Of those, 9.695 (25.4%) were admitted to a general ward (range EDs 5.1–54.5%). Adjusted standardised admission rates ranged between 0.6 and 1.5. The largest variation was seen in short admission rates (0.1–5.0), PICU admission rates (0.2–2.2), upper respiratory tract infections (0.4–1.7) and fever without focus (0.5–2.7). Variation was small in sepsis/meningitis (0.9–1.1).

Conclusions
Large variation exists in admission rates of febrile children evaluated at European EDs, however, this variation is largely reduced after correcting for patient characteristics and therefore overall admission rates seem to adequately reflect disease severity or a potential for a severe disease course. However, for certain patient groups variation remains high even after adjusting for patient characteristics.
Content comparison and person-centeredness of standards for quality improvement in cardiovascular health care
Authors: Algurén Beatrix , Jernberg Tomas , Vasko Peter , Selb Melissa , Coenen Michaela 
Published: January 2021

Background
Quality standards are important for improving health care by providing compelling evidence for best practice. High quality person-centered health care requires information on patients' experience of disease and of functioning in daily life.

Objective
To analyze and compare the content of five Swedish National Quality Registries (NQRs) and two standard sets of the International Consortium of Health Outcomes Measurement (ICHOM) related to cardiovascular diseases.

Materials and methods
An analysis of 2588 variables (= data items) of five NQRs—the Swedish Registry of Congenital Heart Disease, Swedish Cardiac Arrest Registry, Swedish Catheter Ablation Registry, Swedish Heart Failure Registry, SWEDEHEART (including four sub-registries) and two ICHOM standard sets–the Heart Failure Standard Set and the Coronary Artery Disease Standard Set. According to the name and definition of each variable, the variables were mapped to Donabedian’s quality criteria, whereby identifying whether they capture health care processes or structures or patients’ health outcomes. Health outcomes were further analyzed whether they were clinician- or patient-reported and whether they capture patients’ physiological functions, anatomical structures or activities and participation.

Results
In total, 606 variables addressed process quality criteria (31%), 58 structure quality criteria (3%) and 760 outcome quality criteria (38%). Of the outcomes reported, 85% were reported by clinicians and 15% by patients. Outcome variables addressed mainly ‘Body functions’ (n = 392, 55%) or diseases (n = 209, 29%). Two percent of all documented data captured patients’ lived experience of disease and their daily activities and participation (n = 51, 3% of all variables).

Conclusions
Quality standards in the cardiovascular field focus predominately on processes (e.g. treatment) and on body functions-related outcomes. Less attention is given to patients’ lived experience of disease and their daily activities and participation. The results can serve as a starting-point for harmonizing data and developing a common person-centered quality indicator set.
A multi-mechanism approach reduces length of stay in the ICU for severe COVID-19 patients
Authors: Valerio Pascua Fernando , Diaz Oscar , Medina Rina , Contreras Brian , Mistroff Jeff , Espinosa Daniel , Sekhon Anupamjeet , Paz Handal Diego , Pineda Estela , Vargas Pineda Miguel , Pineda Hector , Diaz Maribel , Lewis Anita S. , Hesse Heike , Castro Lainez Miriams T. , Stevens Mark L. , Sierra- Hoffman Miguel , Ontai Sidney C. , VanBuren Vincent 
Published: January 2021

PurposeCOVID-19 pandemic has multifaceted presentations with rising evidence of immune-mediated mechanisms underplay. We sought to explore the outcomes of severe COVID-19 patients treated with a multi-mechanism approach (MMA) in addition to standard-of-care (SC) versus patients who only received SC treatment.Materials and methodsData were collected retrospectively for patients admitted to the intensive care unit (ICU). This observational cohort study was performed at five institutions, 3 in the United States and 2 in Honduras. Patients were stratified for MMA vs. SC treatment during ICU stay. MMA treatment consists of widely available medications started immediately upon hospitalization. These interventions target immunomodulation, anticoagulation, viral suppression, and oxygenation. Primary outcomes included in-hospital mortality and length of stay (LOS) for the index hospitalization and were measured using logistic regression.ResultsOf 86 patients admitted, 65 (76%) who had severe COVID-19 were included in the study; 30 (46%) patients were in SC group, compared with 35 (54%) patients treated with MMA group. Twelve (40%) patients in the SC group died, compared with 5 (14%) in the MMA group (p-value = 0.01, Chi squared test). After adjustment for gender, age, treatment group, Q-SOFA score, the MMA group had a mean length of stay 8.15 days, when compared with SC group with 13.55 days. ICU length of stay was reduced by a mean of 5.4 days (adjusted for a mean age of 54 years, p-value 0.03) and up to 9 days (unadjusted for mean age), with no significant reduction in overall adjusted mortality rate, where the strongest predictor of mortality was the use of mechanical ventilation.ConclusionThe finding that MMA decreases the average ICU length of stay by 5.4 days and up to 9 days in older patients suggests that implementation of this treatment protocol could allow a healthcare system to manage 60% more COVID-19 patients with the same number of ICU beds.
Quantitative analysis of dynamic computed tomography angiography for the detection of endoleaks after abdominal aorta aneurysm endovascular repair: A feasibility study
Authors: Apfaltrer Georg , Lavra Francesco , Schoepf U. Joseph , Scarabello Marco , Yamada Ricardo , van Assen Marly , Varga-Szemes Akos , Jacobs Brian E. , Bauer Maximilian J. , Greenberg William T. , Guimaraes Marcelo , Saba Luca , De Cecco Carlo N. 
Published: January 2021

Objectives
To assess the feasibility of quantitative analysis of dynamic computed tomography angiography (dCTA) for the detection of endoleaks in patients who underwent endovascular repair of abdominal aortic aneurysms (EVAR).

Material and methods
Twenty patients scheduled for contrast-enhanced CT angiography (CTA) of the abdominal aorta post-EVAR were prospectively enrolled. All patients received a standard triphasic CTA protocol, followed by an additional dCTA. The dCTA acquisition enabled reconstruction of color-coded maps depicting blood perfusion and a dCTA dataset of the aneurysm sac. Observers assessed the dCTA and dynamic CT perfusion (dCTP) images for the detection of endoleaks, establishing diagnostic confidence based on a modified 5-point Likert scale. An index was calculated for the ratio between the endoleak and aneurysm sac using blood flow for dCTP and Hounsfield units (HU) for dCTA. The Wilcoxon test compared the endoleak index and the diagnostic confidence of the observers.

Results
In total, 19 patients (18 males, median age 74 years [70.5–75.7]) were included for analysis. Nine endoleaks were detected in 7 patients using triphasic CTA as the reference standard. There was complete agreement for endoleak detection between the two techniques on a per-patient basis. Both dCTA and dCTP identified an additional endoleak in one patient. The diagnostic confidence using dCTP for detection of endoleaks was not significantly superior to dCTA (5.0 [5–5] vs. 4.5 [4–5], respectively; p = 0.11); however, dCTP demonstrated superior diagnostic confidence for endoleak exclusion compared to dCTA (1.0 [1–1] vs 1.5 [1.5–1.5], respectively; p <0.01). Moreover, the dCTP endoleak index was significantly higher than the dCTA index (18.5 [10.8–20.5] vs. 3.5 [5–2.7], respectively; p = 0.02).

Conclusions
Quantitative analysis of dCTP imaging can aid in the detection of endoleaks and demonstrates a higher endoleak detection rate than triphasic CTA, as well as a strong correlation with visual assessment of dCTA images.
Clinicopathological characteristics and outcomes of gastrointestinal stromal tumors with high progranulin expression
Authors: Do In-Gu , Jung Kyung Uk , Koo Dong-Hoe , Lee Yun-Gyoo , Oh Sukjoong , Kim Kyungeun , Kim Dong-Hoon , Sohn Jin Hee , Son Byung Ho , Lee Sung Ryol , Shin Jun Ho , Kim Hyung Ook , Kim Hungdai , Chun Ho-Kyung , Serrero Ginette , Yoo Chang Hak 
Published: January 2021

Background & aims
Progranulin (PGRN) is known to promote tumorigenesis and proliferation of several types of cancer cells. However, little is known about the clinicopathological features of patients with gastrointestinal stromal tumors (GISTs) with regard to PGRN expression.

Methods
A retrospective analysis was performed on patients with GISTs who underwent curative surgical resection between 2007 and 2017. PGRN expression was evaluated by immunohistochemical (IHC) analysis and semi-quantitatively categorized (no expression, 0; weak, 1+; moderate, 2+; strong, 3+). Tumors with a staining intensity of 2+ or 3+ were considered high PGRN expression.

Results
Fifty-four patients were analyzed; 31 patients (57%) were male. The median age at surgery was 60 years (range, 33–79), and the most common primary site was the stomach (67%). Thirty-five patients (65%) had spindle histology; 42 patients (78%) were separated as a high-risk group according to the modified National Institutes of Health (NIH) classification. High PGRN-expressing tumors were observed in 27 patients (50%), had more epithelioid/mixed histology (68% vs. 32%; p = 0.046), and KIT exon 11 mutations (76% vs. 24%; p = 0.037). Patients with high PGRN-expressing tumors had a worse recurrence-free survival (RFS) (36% of 5-year RFS) compared to those with low PGRN-expressing tumors (96%; p<0.001). Multivariate analysis showed that high PGRN expression and old age (>60 years) were independent prognostic factors for poor RFS.

Conclusions
High PGRN-expressing GISTs showed more epithelioid/mixed histology and KIT exon 11 mutations. PGRN overexpression was significantly associated with poor RFS in patients with GISTs who underwent curative resection.
Neuromarkers and neurological outcome in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia–experience from the HAnnover COoling REgistry (HACORE)
Authors: Akin Muharrem , Garcheva Vera , Sieweke Jan-Thorben , Adel John , Flierl Ulrike , Bauersachs Johann , Schäfer Andreas 
Published: January 2021

Background
Neuron-specific enolase (NSE) and S-100b have been used to assess neurological damage following out-of-hospital cardiac arrest (OHCA). Cut-offs were derived from small normothermic cohorts. Whether similar cut-offs apply to patients treated with hypothermia remained undetermined.

Methods
We investigated 251 patients with OHCA treated with hypothermia but without routine prognostication. Neuromarkers were determined at day 3, neurological outcome was assessed after hospital discharge by cerebral performance category (CPC).

Results
Good neurological outcome (CPC≤2) was achieved in 41%. Elevated neuromarkers, older age and absence of ST-segment elevation after ROSC were associated with increased mortality. Poor neurological outcome in survivors was additionally associated with history of cerebrovascular events, sepsis and higher admission lactate. Mean NSE was 33μg/l [16–94] vs. 119μg/l [25–406]; p<0.001, for survivors vs. non-survivors, and 21μg/l [16–29] vs. 40μg/l [23–98], p<0.001 for good vs. poor neurological outcome. S-100b was 0.127μg/l [0.063–0.360] vs. 0.772μg/l [0.121–2.710], p<0.001 and 0.086μg/l [0.061–0.122] vs. 0.138μg/l [0.090–0.271], p = 0.009, respectively. For mortality, thresholds of 36μg/l for NSE and 0.128μg/l for S-100b could be determined; for poor neurological outcome 33μg/l (NSE) and 0.123μg/l (S-100b), respectively. Positive predictive value for NSE was 81% (74–88) and 79% (71–85) for S-100b.

Conclusions
Thresholds for NSE and S-100b predicting mortality and poor neurological outcome are similar in OHCA patients receiving therapeutic hypothermia as in those reported before the era of hypothermia. However, both biomarkers do not have enough specificity to predict mortality or poor neurological outcome on their own and should only be additively used in clinical decision making.
Critical Care Nurses’ Experiences of End-of-Life Care: A Qualitative Study
Authors: Utami Reni Sulung , Pujianto Ahmat , Setyawan Dody , Naviati Elsa , Rochana Nana 
Published: January 2021

Background: Patients admitted to the intensive care unit (ICU) may face terminal illness situations, which may lead to death. In this case, the role of critical care nurses shifts from life-sustaining to end-of-life care (EOLC). Nurses’ involvement in EOLC varies between countries, even in one country due to differences in religion, culture, organization, laws, cases and patient quality. In Indonesia, research on EOLC in ICU has not been carried out.Purpose: This study aimed to explore the experiences of critical care nurses in providing EOLC.Methods: A qualitative study with a phenomenological approach was conducted. Ten critical care nurses having the experiences of caring for dying patients were recruited through a purposive sampling technique for in-depth interviews. Manual content analysis was used to identify themes.Results: The results of the study found five themes, including the challenge of communication with the family, support for the family, support for the patient, discussion and decision making, and nurses’ emotions. Conclusion: Most of EOLC provided by critical care nurses was focused on the family. They had some challenges in communication and decision making. Nurses need to get training and education about how to care for patients towards the end of life.
Technical and Economic Analysis of Ship Launching with Slipway and Airbag KM. Sabuk Nusantara 72 in PT. Janata Marina Indah Shipyard Semarang
Authors: Sugeng Sunarso , Ridwan Mohammad , Suharto Suharto , Khristyson Samuel Febriary 
Published: January 2021

In a ship planning can not be separated from the planning of the ship launching process. A ship can glide perfectly if it has a high enough planning time and costs. The launch process itself is divided into several ways. The choice of this method needs to be considered because it relates to the budget and preparations made. The method used is the calculation according to the numerical approach assisted by computational software. In the first calculation it is planned with the slipway launch, and then the next one is planned with the airbags that have been implemented previously. The purpose of this study is to provide analysis results as a consideration in implementing the slipway and airbag ship launching method on KM ships. Belt Nusantara 72 measuring 2000 DWT. In steps 5 to 6, both the slipway and the airbags experience a stern lift condition with a value (yVd) of 1396.97 ton. Based on the economic analysis of the hours of people using airbags, there is a decrease in working hours by 44% when compared to the launch using a slipway. This also happened to work productivity where it was 84% more time effective. When viewed from an investment point of view, the use of slipways is actually more economical than airbag, the difference is 43% more economical using slipways. Both types of launch can be applied by looking at the economical side and the ability of each shipyard in carrying out the launching process and seeing the main size of the ship to be launched.
Timing of Co-occurring Chronic Conditions in Children With Neurologic Impairment
Authors: Thomson Joanna , Hall Matt , Nelson Katherine , Flores Juan Carlos , Garrity Brigid , DeCourcey Danielle D. , Agrawal Rishi , Goodman Denise M. , Feinstein James A. , Coller Ryan J. , Cohen Eyal , Kuo Dennis Z. , Antoon James W. , Houtrow Amy J , Bastianelli Lucia , Berry Jay G. 
Published: January 2021

BACKGROUND:
Children with neurologic impairment (NI) are at risk for developing co-occurring chronic conditions, increasing their medical complexity and morbidity. We assessed the prevalence and timing of onset for those conditions in children with NI.

METHODS:
This longitudinal analysis included 6229 children born in 2009 and continuously enrolled in Medicaid through 2015 with a diagnosis of NI by age 3 in the IBM Watson Medicaid MarketScan Database. NI was defined with an existing diagnostic code set encompassing neurologic, genetic, and metabolic conditions that result in substantial functional impairments requiring subspecialty medical care. The prevalence and timing of co-occurring chronic conditions was assessed with the Agency for Healthcare Research and Quality Chronic Condition Indicator system. Mean cumulative function was used to measure age trends in multimorbidity.

RESULTS:
The most common type of NI was static (56.3%), with cerebral palsy (10.0%) being the most common NI diagnosis. Respiratory (86.5%) and digestive (49.4%) organ systems were most frequently affected by co-occurring chronic conditions. By ages 2, 4, and 6 years, the mean (95% confidence interval [CI]) numbers of co-occurring chronic conditions were 3.7 (95% CI 3.7–3.8), 4.6 (95% CI 4.5–4.7), and 5.1 (95% CI 5.1–5.2). An increasing percentage of children had ≥9 co-occurring chronic conditions as they aged: 5.3% by 2 years, 10.0% by 4 years, and 12.8% by 6 years.

CONCLUSIONS:
Children with NI enrolled in Medicaid have substantial multimorbidity that develops early in life. Increased attention to the timing and types of multimorbidity in children with NI may help optimize their preventive care and case management health services.
Pérdida de suelo en el sistema ancestral wachado en el trópico alto de Nariño, Colombia
Authors: Volveras-Mambuscay Belisario , Merchancano-Rosero José Domingo , López-Rendón Juan Fernando , Campo-Quesada José Manuel 
Published: January 2021

Introducción. El sistema ancestral wachado (surco o camellón), usado en laderas de Nariño para la producción de papa y leche, no utiliza maquinaria pesada y genera menor impacto sobre la productividad del suelo. Objetivo. Evaluar el ajuste de la inclinación del surcado para papa y su efecto sobre la pérdida de suelo en la zona alto andina de Nariño. Materiales y métodos. El trabajo se desarrolló en las localidades de Pasto, Potosí y Pupiales, entre mayo y octubre del 2014. Se utilizó un diseño de bloques completos al azar con tres repeticiones y cuatro tratamientos (wachado a 90°, 70°, 60° y labranza comercial). En la base de cada unidad experimental se construyeron canaletas para recoger el suelo desplazado. Se evaluó la pérdida del suelo y rendimiento de tubérculos. Resultados. Se observó efecto significativo de la inclinación de los surcos sobre la pérdida de suelo; la mayor pérdida total de suelo se obtuvo en surcos en sentido de la pendiente (90°), con promedio de 69,29 t ha-1 para labranza comercial y 63,51 t ha-1 para wachado; la menor pérdida fue 45,76 t ha-1 en wachado a 60°. De la pérdida total de suelo, la mayor proporción se presentó en los primeros dos meses del cultivo que incluyó siembra y aporques; en estas labores se perdió el 90%, 60% y 67% en las localidades de Pasto, Potosí y Pupiales, respectivamente. No se observó efecto de los tratamientos de inclinación del surcado sobre el rendimiento de papa, que alcanzó un promedio de 44,94 t ha-1. Conclusión. La reducción de la inclinación de los surcos disminuyó la pérdida de suelo durante el ciclo de cultivo sin afectar el rendimiento y se sugiere validarla a nivel comercial, ya que podría contribuir a la disminución de la degradación del suelo en las laderas andinas de Nariño.