bluuebunny/crossref_metadata_2025_split huggingface dataset:
The minimum effective concentration (MEC90) of ropivacaine for ultrasound-guided caudal block in anorectal surgery. A dose finding study
Authors: Li Xuehan , Li Jun , Zhang Pei , Deng Huifei , Yang Mingan , He Hongbo , Wang Rurong 
Published: September 2021

BackgroundCaudal epidural block (CEB) provides reliable anesthesia for adults undergoing anorectal surgery. Despite the widely utilization, the minimum effective concentration for 90% patients (MEC90) of ropivacaine for CEB remains unknown.ObjectiveTo estimate MEC of ropivacaine for CEB in anorectal surgery.DesignA prospective dose-finding study using biased coin design up-and-down sequential method.SettingOperating room and postoperative recovery area of Chengdu Shangjin Nanfu Hospital, from October 2019 to January 2020.Patients50 males and 51 females scheduled for anorectal surgery.InterventionsWe conducted two independent biased coin design up-and down trials by genders. The concentration of ropivacaine administered to the first patient of male and female were 0.25% with fixed volume of 14ml for male and 12ml for female patients based on our previous study. In case of failure, the concentration was increased by 0.05% in the next subject. Otherwise, the next subject was randomized to a concentration 0.05% less with a probability of 0.11, or the same concentration with a probability of 0.89. Success was defined as complete sensory blockade of perineal area 15 min after the block evidenced by the presence of a lax anal sphincter and pain-free surgery.Main outcome measuresThe MEC of ropivacaine to achieve a successful CEB in 90%(MEC90) of the patients.ResultsThe MEC90of ropivacaine for CEB were estimated to be 0.35% (95% CI 0.29 to 0.4%) for male and 0.353% (95%CI 0.22 to 0.4%) for female. By extrapolation to MEC in 99% of subjects (MEC99) and pooled adjacent violators algorithm (PAVA) adjusted responses, it would be optimal to choose 0.4% ropivacaine with a volume of 14ml for male and 12ml for female.ConclusionsA concentration of 0.35% ropivacaine with a volume of 14ml provided a successful CEB in 90% of the male patients, while 0.353% ropivacaine with a volume of 12ml provided a successful CEB in 90% of the female patients. A concentration of 0.4% and a volume of 14ml for male and 12 ml for female would be successful in 99% of the patients.Trial registrationChictr.org.cnidentifier: No. ChiCTR 1900024315.
Estimating the cost and value of functional changes in communication ability following telepractice treatment for aphasia
Authors: Jacobs Molly , Ellis Charles 
Published: September 2021

Context
Aphasia is a post-stroke condition that can dramatically impact a person with aphasia’s (PWA) communication abilities. To date, few if any studies have considered the cost and cost-effectiveness of functional change in aphasia nor considered measures of patient’s value for aphasia treatment.

Objective
To assess the cost, cost-effectiveness, and perceived value associated with improved functional communication in individuals receiving telerehabilitation treatment for aphasia.

Design
Twenty PWA completed between 5 and 12 telehealth rehabilitation sessions of 45–60 minutes within a 6-week time frame using a Language-Oriented Treatment (LOT) designed to address a range of language issues among individuals with aphasia. National Outcomes Measures (NOMS) comprehension and verbal expression and the ASHA Quality of Communication Life (QCL) were completed prior to and at the completion of rehabilitation to obtain baseline and treatment measures.

Results
Age, education, and race are significantly correlated with improvement in the NOMS verbal expression. African Americans (OR = 2.0917) are twice as likely as Whites to experience improvement after treatment. The likelihood of improvement also increases with each additional year of education (OR = 1.002) but decrease with age (OR = 0.9463). A total of 15 PWA showed improvement in NOMS comprehension and nine patients showed improvement in NOMS verbal expression. Improving patients attended between five and 12 treatment sessions. The average cost of improvement in NOMS comprehension was $1,152 per patient and NOMS verbal expression was $1,128 per patient with individual treatment costs varying between $540 and $1,296. However, on average, the monetary equivalent in patient’s improved QCL was between $1,790.39 to $3,912,54—far exceeding the financial cost of treatment.

Conclusions
When measuring the functional improvement of patients with aphasia, patient’s quality of communication life received from treatment exceeded financial cost of services provided.
Spatiotemporal analysis and the characteristics of the case transmission network of 2019 novel coronavirus disease (COVID-19) in Zhejiang Province, China
Authors: Wu Haocheng , Wu Chen , Lu Qinbao , Ding Zheyuan , Xue Ming , Lin Junfen 
Published: September 2021

Background
Zhejiang Province is one of the five provinces in China that had the highest incidence of novel coronavirus disease (COVID-19). Zhejiang, ranked fourth highest in COVID-19 incidence, is located in the Yangtze River Delta region of southeast China. This study was undertaken to identify the space-time characteristics of COVID-19 in Zhejiang.

Methods
Data on COVID-19 cases in Zhejiang Province from January to July 2020 were obtained from this network system. Individual information on cases and deaths was imported, and surveillance information, including demographic characteristics and geographic and temporal distributions, was computed by the system. The Knox test was used to identify possible space-time interactions to test whether cases that are close in distance were also close in time. Network analysis was performed to determine the relationship among the cases in a transmission community and to try to identify the key nodes.

Results
In total, 1475 COVID-19 cases and 1 fatal case were reported from January to July 2020 in Zhejiang Province, China. Most of the cases occurred before February 15th, which accounted for 90.10%. The imported cases increased and became the main risk in Zhejiang Province after February 2020. The risk areas showed strong heterogeneity according to the Knox test. The areas at short distances within 1 kilometer and at brief periods within 5 days presented relatively high risk. The numbers of subcommunities for the four clusters were 12, 9, 6 and 4. There was obvious heterogeneity in the modularity of subcommunities. The maximum values of the node centrality for the four clusters were 2.9474, 4.3706, 4.1080 and 2.7500.

Conclusions
COVID-19 was brought under control over a short period in Zhejiang Province. Imported infections from outside of mainland China then became a new challenge. The effects of spatiotemporal interaction exhibited interval heterogeneity. The characteristics of transmission showed short range and short term risks. The importance to the cluster of each case was detected, and the key patients were identified. It is suggested that we should focus on key patients in complex conditions and in situations with limited control resources.
Racial disparities in the SOFA score among patients hospitalized with COVID-19
Authors: Tolchin Benjamin , Oladele Carol , Galusha Deron , Kashyap Nitu , Showstark Mary , Bonito Jennifer , Salazar Michelle C. , Herbst Jennifer L. , Martino Steve , Kim Nancy , Nash Katherine A. , Nguemeni Tiako Max Jordan , Roy Shireen , Vergara Greeno Rebeca , Jubanyik Karen 
Published: September 2021

BackgroundSequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic.Research questionAre SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients?Study design and methodsRetrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29thto August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6.ResultsOf 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11–1.99).InterpretationGiven current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.
Implementation of the new EU IVD regulation – urgent initiatives are needed to avert impending crisis
Authors: Cobbaert Christa , Capoluongo Ettore D. , Vanstapel Florent J.L.A. , Bossuyt Patrick M.M. , Bhattoa Harjit Pal , Nissen Peter Henrik , Orth Matthias , Streichert Thomas , Young Ian S. , Macintyre Elizabeth , Fraser Alan G. , Neumaier Michael 
Published: September 2021

Abstract
Laboratory medicine in the European Union is at the dawn of a regulatory revolution as it reaches the end of the transition from IVDD 98/79/EC (https://eur-lex.eur-opa.eu/legal-content/EN/TXT/?uri=CELEX%3A31998L0079&qid=1628781352814) to IVDR 2017/746 https://eur-lex.europa.eu/eli/reg/2017/746. Without amendments and contingency plans, implementation of the IVDR in May 2022 will lead the healthcare sector into uncharted waters due to unpreparedness of the EU regulatory infrastructure. Prospective risk analyses were not made by the European Commission, and if nothing happens it can be anticipated that the consequences will impact all stakeholders of the medical test pipeline, may seriously harm patients and may prevent caregivers from making appropriate clinical decisions due to non-availability of medical tests. Finally, it also may discourage manufacturers and academia from developing specialty tests, thereby hampering innovation in medical diagnostic care. We hereby inform laboratory professionals about the imminent diagnostic collapse using testimonies from representative stakeholders of the diagnostic supply chain and from academia developing innovative in-house tests in domains of unmet clinical needs. Steps taken by the EFLM Task Force on European Regulatory Affairs, under the umbrella of the Biomedical Alliance in Europe, will be highlighted, as well as the search for solutions through dialogue with the European Commission. Although we recognize that the IVDR promotes positive goals such as increased clinical evidence, surveillance, and transparency, we need to ensure that the capabilities of the diagnostic sector are not damaged by infrastructural unpreparedness, while at the same time being forced to submit to a growing bureaucratic and unsupportive structure that will not support its “droit d’exister”.
Stress degree demonstrated in mothers with phenylketonuria or hyperphenylalaninemia infant when requested for total or partial breastfeeding replacement
Authors: Schulpis Kleopatra , Iakovou Kostas 
Published: September 2021

Abstract

Obejctives
Phenylketonuria (PKU) and hyperphenylalaninemia (HPHE) are metabolic disorders of phenylalanine (phe) metabolism due to the liver enzyme phe hydroxylase deficiency resulting in mental retardation. The only treatment of these disorders is the total or the partial breastfeeding replacement with special formula, respectively.

Case presentation
We aimed to evaluate the maternal stress degree in the two groups of mothers and compare the stress degree between mothers who were obliged to replace breastfeeding completely with those who replaced it partially. Mothers (n=50) were divided into two groups: n=25 with PKU and n=25 with HPHE infants. Mothers with PKU newborns were obliged to replace breastfeeding completely and feed their newborns with a common formula plus phe free medical food, whereas mothers with HPHE infants partially replaced breastfeeding with phe free medical food. Stress degrees were calculated using special questionnaire checklist by Bourne E. Psychological support was provided for both groups of mothers with stress.

Conclusions
Most mothers with PKU infants experienced high or severe stress, whereas mothers with HPHE newborns suffered from low and moderate symptoms and signs of stress. After psychological support most mothers with PKU newborns were ameliorated from stress symptoms; mothers with HPHE neonates experienced almost no stress symptoms. Mothers with PKU infants obliged to complete breastfeeding replacement experienced high and/or severe stress degrees as compared to mothers with HPHE newborns with partial breastfeeding replacement. Psychological support resulted in amelioration of both tested groups.
Acquisition of morphology by L2 children in naturalistic environments: a case of Japanese case markers
Authors: Nishikawa Tomomi 
Published: September 2021

Abstract
This study investigated the second language (L2) acquisition of Japanese case markers among children in naturalistic environments. L2 Japanese children with Chinese backgrounds (n = 187) and monolingual Japanese children (n = 280) were tested on their productive knowledge of four case markers: ga, o, ni, and de. Test scores correlated more strongly with length of residence (LOR) than age of acquisition in the current L2 group (LOR mean = 4.98 years). Most L2 children reached age-matched monolingual norms after an LOR of 2–5 years, although some did not reach the norms within this time frame. The nominative and accusative case markers, ga and o, were generally easier than the other two case markers, even though there are no equivalent morphological markers in Chinese. This indicates that the absence of these markers in the first language is not always a determining factor for the difficulty in naturalistic child L2 acquisition.
The Muting of the Other: The Technological Reconfiguration of Our Auditory Experience of Others
Authors: Gutierrez Ivan 
Published: September 2021

Abstract
Increasingly privatized auditory spaces resulting from the mutual engendering of auditory cultural practices and sound technologies that separated the sense of hearing and segmented acoustic spaces have had a muting effect on our experience of Others that has intensified since the advent of mobile listening devices. In Section 1 of the article, I outline features of the social realm of the nineteenth to twentieth centuries that made modern sound technologies possible and then features of the technological realm that have shaped today’s social realm – all with an eye toward our experience of other people. Then, in Section 2, I reach for a few phenomenological tools from the work of Jean-Paul Sartre, Emmanuel Levinas, and Don Ihde to draw out the phenomenological vectors that have taken shape within the enmeshed sociotechnological context described in Section 1. Specifically, I show how technologically mediated auditory experience has been individualized and how the use of sound technologies on the go – whether wearing earphones or in a car – has had a muting effect on our experience of others.
impacto del disfrute y la ansiedad en la voluntad de comunicarse de los estudiantes del idioma inglés
Authors: Bensalem Elias 
Published: September 2021

La voluntad de comunicarse (WTC por sus siglas en inglés) juega un rol fundamental en el aprendizaje de una segunda lengua (Clément et al., 2003; Kang, 2005; Yashima et al., 2004) porque un alto nivel de WTC puede ayudar a los estudiantes a lograr el dominio del idioma (MacIntyre et al., 2003; Yashima et al., 2004). Por tanto, MacIntyre et al. (1998, p. 547) afirmó que el objetivo principal del aprendizaje de idiomas debería ser el WTC. La voluntad de comunicarse en un idioma extranjero está vinculada a una variedad de emociones negativas (es decir, ansiedad y aburrimiento) y emociones positivas (es decir, disfrute y orgullo). Inspirado por el cambio de la psicología negativa a la psicología positiva en el campo del aprendizaje de una segunda lengua, el presente estudio tuvo como objetivo investigar si el disfrute del lenguaje y la ansiedad son predictores potenciales del WTC. Se encuestó a un grupo de 349 estudiantes de pregrado de Inglés como Lengua Extranjera (EFL por sus siglas en inglés) (mujeres = 226, hombres = 123) matriculados en universidades públicas de Arabia Saudita. Se recogieron datos cuantitativos durante un mes. Los análisis descriptivos revelaron niveles superiores a la media de WTC de los participantes. Los análisis de regresión múltiple revelaron que el disfrute del idioma extranjero (FLE por sus siglas en inglés) era un predictor del WTC, pero la ansiedad hacia el idioma extranjero en el aula (FLA por sus siglas en inglés) no se correlacionó significativamente con el WTC de los estudiantes. Estos resultados sugieren que los niveles más altos de disfrute pueden haber neutralizado los efectos de la ansiedad en el WTC, lo que indica el rol de las emociones positivas. Se discuten las implicaciones para los profesores de lenguas extranjeras.
The Female Sublime: Domesticating Luigia Todi’s Voice
Authors: Peritz Jessica Gabriel 
Published: September 2021

Abstract
This article delves into the puzzling reception of opera singer Luigia Todi (1753–1833) in order to explore how the traces left by pre-phonographic voices contain long-forgotten cultural histories. Operagoers in 1790s Venice claimed that Todi’s moral qualities allowed her to overcome her “vocal defects,” and, in turn, taught her listeners to become good citizens. Hearing vocal difficulties as a manifestation of interiority, rather than as poor training, marked a significant departure from what were then the predominant aesthetics of operatic voice. In attempting to smooth over this gap, listeners pieced together narratives about Todi’s subjectivity based on the unstable, fragmented sounds of her voice. This article argues that such remediations of Todi’s singing were subtended by two seemingly irreconcilable ontologies of female voice, one of them rooted in ancient myths of sublime song and the other born of Enlightenment ideologies of domesticity. I thus read inscriptions of Todi’s voice through a network of late eighteenth-century Italian cultural anxieties, drawing on literary reimaginings of Sappho, debates over the nature of musical skill, discourses on women’s education, and more. By interrogating the narratives about one woman’s unusual voice, I offer a new origin story for still resonant assumptions about the relationships between gender and disability, politics and domestic labor, and, fundamentally, bodies and voices.
Rare Earth Extraction using Solvent Extraction: Which Factor Has the Most Significant Impact?
Authors: Ismail Nurul Ain 
Published: September 2021

Using a two-level factorial design, a study was undertaken to change the parameters impacting the recovery of rare earth from rare earth mixture. The experimental design was used to screen and identify the major contributing aspects to rare earth recovery. The experiment aims to isolate samarium from a mixture of samarium, europium, and gadolinium. Factors involved consist of pH (pH 1 and pH 6), acid type (nitric acid and hydrochloric acid) and concentration (1.0M and 5.0M), mixing duration (30 min and 120 min), feed composition (20% samarium and 80% samarium), type of diluent (hexane and chloroform), temperature (room temperature and 60°C) and organic to aqueous phase ratio (1:1 and 2:1). The results showed that the samarium recovery was in the range of 0.98% to 90.88%. Based on analysis variance (ANOVA), five factors significantly affect the samarium recovery out of eight factors explored. The five factors according to the most significant order are pH> feed composition> organic to aqueous phase ratio>acid concentration>acid type>mixing duration>type of diluent> temperature. Statistical analysis shows that the linear model is significant, with the value of R2 is 0.9886. Based on the statistical data, five significant variables influence the separation of samarium. This research shows that two-level factorial design can anticipate significant variables impacting rare earth separation, particularly samarium, in the solvent extraction process.
Childhood reproductive hormone levels after pediatric hematopoietic stem cell transplantation in relation to adult testicular function
Authors: Mathiesen Sidsel , Sørensen Kaspar , Ifversen Marianne , Hagen Casper P , Holm Petersen Jørgen , Juul Anders , Müller Klaus 
Published: September 2021

Objectives
Longitudinal assessment of testicular function after pediatric hematopoietic stem cell transplantation (HSCT) is needed to guide clinical follow-up. We investigated dynamics in male reproductive hormones after pediatric HSCT, focusing on pubertal timing and associations with testosterone deficiency and azoospermia in adulthood.

Methods
This retrospective, longitudinal study included 39 survivors median 19 years after pediatric HSCT. Serum concentrations of LH, testosterone, FSH, and inhibin B from the time of HSCT, during puberty, and into adulthood were analyzed. Pubertal timing (rise in LH and testosterone) was compared to a reference cohort of 112 healthy boys. Associations between reproductive hormone levels during puberty and adult testicular function (including semen quality) were investigated.

Results
Pubertal induction with testosterone was needed in 6/26 patients who were prepubertal at HSCT. In the remaining patients, pubertal timing was comparable to the reference cohort. However, 9/33 patients (without pubertal induction) developed testosterone deficiency in early adulthood, which was associated with higher LH levels from age 14 to 16 years. Azoospermia in adulthood was found in 18/26 patients without testosterone substitution. Higher FSH and lower inhibin B levels from mid-pubertal age were associated with azoospermia in adulthood, in patients being prepubertal at HSCT.

Conclusion
Our results indicate a substantial risk of deterioration in testicular function after pediatric HSCT, despite normal pubertal timing. Although reproductive hormone levels from mid-puberty indicated adult testicular function, prolonged follow-up into adulthood is needed in these patients, including clinical examination, reproductive hormone analysis, and semen sample for patients interested in their fertility potential.