bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differentiating Biliary Atresia From Idiopathic Neonatal Hepatitis: A Novel Keratin 7 Based Mathematical Approach on Liver Biopsies
Authors: Misra Sunayana , Majumdar Kaushik , Sakhuja Puja , Jain Priyanka , Singh Lavleen , Kumar Praveen , Dubey AP 
Published: January 2021

Background and Aims Differentiating biliary atresia (BA) from idiopathic neonatal hepatitis (INH) is vital in routine pediatric practice. However, on liver biopsy, few cases offer a diagnostic challenge to discriminate these entities with certainty. Bile ductular reaction (DR), intermediate hepatobiliary cells (IHBC) and extra-portal ductules (EPD) indicate progenitor cell activation, as a response to various hepatic insults. The present study aims to quantify DR, IHBC and EPD by Keratin 7 (CK7) immunohistochemistry (IHC) in BA and INH and to devise a mathematical approach to better differentiate the two, especially in histologically equivocal cases. Methods A total of 98 cases were categorized on biopsy as BA, INH or equivocal histology, favoring BA or INH. CK7 DR mean, IHBC mean and EPD mean values were compared between BA and INH. A formula was derived to help distinguish these two entities, the cut-off value, sensitivity and specificity of which were determined by receiver operating characteristic (ROC) curve. This formula was applied and validated on histologically equivocal cases. Results Univariate logistic regression revealed significant difference between BA and INH with respect to CK7 DR and CK7 EPD mean (p < 0.001 in both); however, CK7 IHBC mean was not significant (p = 0.08). On multivariate logistic regression, only CK7 DR had significant impact on diagnosis (p < 0.001). A formula: (CK7 DR) 2  + (CK7 EPD)/(CK7 IHBC) was derived to help distinguish BA from INH. Cut off value of 10.5 and above, determined by ROC curve, favored a diagnosis of BA (sensitivity= 93.4%, specificity= 94.6%). Histologically equivocal and discrepant cases could be correctly categorized using this formula. Conclusions Formula using CK7 IHC parameters may aid pathologists better distinguish BA from INH, especially in histologically equivocal cases.
Biphasic Postnatal Umbilical Cord Shortening
Authors: Manci Elizabeth A , Alvarez Sejal Shah , McClellan Steven B , Campbell Pamela Moore , Dasaraju Sandhya , Winkler Carey L , Shah Arvind K 
Published: January 2021

Introduction Variations in postnatal length of refrigerated, unfixed umbilical cords were studied over time to elucidate natural changes and times of stability. Methods Length was measured in 132 cords following severance, repeated at varying timed intervals and studied by analysis of variance and regression analysis. Results Data show immediate rapid initial phase shortening (mean 4.2+/-3.9 cm SD); an interval of lengthening; stable length at hours 3-4 following severance, a slower second phase shortening (mean 1.5+/-0.7 cm SD) beginning at 5 hours and peaking at 12 hours; and gradual lengthening to stable length after 23 hours. Overall, there was a significant net mean decrease of 3.49+/-2.29 cm SD. Shortening was greatest for intact long cord segments (p=0.0001), as much as 11 cm. Two highly significant models for predicting umbilical cord length at delivery (OL) were determined using the post-delivery lengths (Length) measured at different times following delivery (Hours), as follows: At ≤ 3 hours following delivery: OL=1.02xLength cm+1.11xHours At >3 hours following delivery: OL=1.07xLength+0.44xHours-0.01x(Hours)2 Conclusion Cord lengths stabilized between hours 3-4 and after 23 hours following severance. Phase one shortening resembles vasoconstriction; phase two resembles rigor mortis. The models allow prediction of the original umbilical cord length at delivery, regardless of the time of measurement.
Comparison of the effect of isopropyl alcohol and chlorhexidine solution rinses on body temperature of female cats undergoing sterilization surgery
Authors: Kreisler Rachael E , Douglas Michelle L , Harder Karissa N 
Published: January 2021

Objectives Isopropyl alcohol 70% as a rinse agent for chlorhexidine scrub has been shown to decrease body temperature more quickly than chlorhexidine solution in mice prepared aseptically prior to surgery. For this reason, some high-quality, high-volume (HQHV) surgical sterilization clinics use chlorhexidine solution rather than alcohol. We sought to determine if temperature upon entry to recovery, heat loss per kg and rate of temperature decline during surgery were different between cats rinsed with chlorhexidine solution vs 70% isopropyl alcohol following surgical scrub, and if there were significant predictors of recovery temperature. Methods Female cats admitted for surgery to trap–neuter–return (TNR) clinics at a veterinary college were assigned chlorhexidine solution or alcohol rinse agents via block randomization. Veterinary students and veterinarians performed spay surgeries using HQHV techniques. In recovery, heat support and reversal agents were available for cats with a low body temperature or that were slow to recover. Baseline values, outcome variables and duration of each stage (preparation, surgery, recovery) were assessed using Wilcoxon rank-sum and t-tests. Recovery temperature was evaluated using random effects multiple linear regression. Results The recovery temperature, heat loss per kg, heat loss per min, need for reversal and need for heat support in recovery were not significantly different between rinse groups. Weight <2.3 kg, body condition score <4, duration of surgery and postinduction temperature were predictors of recovery temperature. The rate of heat loss in the first 30 mins of surgery was slightly lower for cats in the alcohol rinse group and the recovery duration was shorter for cats weighing less <2.3 kg in the alcohol rinse group. Conclusions and relevance There were no clinically meaningful differences in body temperature between chlorhexidine and alcohol rinses. Both chlorhexidine solution and isopropyl alcohol 70% are appropriate rinse agents for aseptic preparation of feline spay surgeries.
Surgical management of consecutive exotropia: Long-term outcomes
Authors: Ceylan Osman Melih , Oğuz Yeşim Gedik , Ayyıldız Önder , Köksal Serkan , Yumuşak Erhan , Mutlu Fatih Mehmet 
Published: January 2021

Purpose: To compare lateral rectus recession (LRc) and medial rectus advancement (MRadv) for correction of consecutive exotropia (CXT). Methods: Of the 43 exotropic patients 20 of them underwent LRc (group 1) and 23 of them underwent MRadv (group 2). Postoperative exodrift, strabismic angle, dose effect relationship were compared with minimum 2 years follow‑up. Results: An average dose-effect in group 2 is higher than group 1 in the early postoperative period, however there was no significant difference at the second year follow-up (p=0,109). An average exodrift after 2 year follow-up was 6,6±7,12 PD in group 1, and 8,13±7,45 PD in group 2. Postoperative overall success rate was 50% in group 1 and 65% in group 2 at the last follow-up. The success rates were not significantly different between the groups (chi-square, p =0.31). Conclusion: Although there was no statistically significant difference at the last follow-up, better results were obtained with MRadv than LRc in the treatment of CXT.
Diagnosis of optic nerve head drusen using enhanced depth imaging optical coherence tomography
Authors: Gili Pablo , Kim-Yeon Naon , de Manuel-Triantafilo Sofía , Modamio-Gardeta Laura , Leal-González Mercedes , Yangüela Julio 
Published: January 2021

Purpose: To evaluate the efficacy of Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT) in differentiating between optic nerve head drusen (ONHD) and optic disc oedema (ODE). Methods: This was a cross-sectional study of 140 patients: 83 patients with ONHD (49 hidden and 34 visible), 20 patients with pseudopapilloedema (without drusen), and 37 patients with ODE. EDI-OCT of the optic nerve was performed, selecting one high-resolution line from the HD 5-line raster protocol. Two observers blindly evaluated the presence of a hyporeflective core surrounded by a hyperreflective margin or border. The sensitivity, specificity, predictive values and posttest probability were evaluated as well as the inter-observer agreement (k). Results: EDI-OCT demonstrated a sensitivity of 92% (95% CI: 83%–96%), a specificity of 96% (95% CI: 87%–99%), with a positive predictive value of 97% and a negative predictive value of 89%. The inter-observer agreement was as remarkable as k = 0.8985 (95% CI 0.8252–0.9718). A positive EDI OCT increases the posttest probability to 97% (95% CI: 91%–99%); when negative, the posttest probability is reduced to 12% (95% CI: 6%–21%). Conclusion: EDI-OCT allowed for differentiation between ONHD and ODE with high sensitivity and specificity.
Breaking the logic of neoliberal victimhood: Vulnerability, interdependence and memory in Captain Marvel (Anna Boden and Ryan Fleck, 2019)
Authors: Gámez Fuentes María José 
Published: January 2021

The contemporary visibility of women’s accomplishments and popular outcry in the face of injustice and/or violence might suggest that women have achieved their aim of putting long-fought feminist principles in the spotlight and have finally earned equality. However, let us not forget that, in the face of violence, the hegemonic matrix of intelligibility has also historically defined women victims by their ‘injurability’, so, intrinsically vulnerable, thus justifying the need of the system to assist them. It is not surprising, then, that, as a response to vulnerability, empowerment is celebrated. In this context, one would think that a blockbuster, such as Captain Marvel (2019), would reproduce the hegemonic economy of recognition where the subjects of violence are either treated as devoid of agency or offered empowerment through a neoliberal individualizing logic. However, the controversy that the film and its female protagonist raised (for adopting explicit feminist language to challenge patriarchy), along with the outcry of white angry men (symptomatized in male film critics) and the Internet nerd-culture (members of which considered themselves aggrieved by the film), provide a fruitful ground to look into the communicative logic of victimhood. Captain Marvel can help us to explore not only the chiaroscuros and phallacy of the victim versus empowered subject script but also the implicit logic that obscures the divisions that this logic perpetuates. In this respect, we are interested in analyzing how the movie stages: 1. The assignation and construction of female vulnerability in a hegemonic shared cultural narrative that privileges the construction of the empowered subject obscuring the politics of emotions; 2. The possibilities of empowerment before such a narrative and in relation to reclaiming historical and personal memories; 3. The sharing of the condition of vulnerability across gender and geographical boundaries and its relation with the criminalization of other vulnerable others such as aliens.
Smoking and snus use among Norwegian students: Demographic, personality and substance use characteristics
Authors: Sæther Solbjørg Makalani Myrtveit , Askeland Kristin Gärtner , Pallesen Ståle , Erevik Eilin Kristine 
Published: January 2021

Background and aim: Smoking rates are decreasing in Norway while the use of snus has increased. We aimed to investigate the co-occurrence of, and the socio-demographics, personality and substance use characteristics associated with, student smoking and snus use. Methods: Survey data were collected among students in higher education in Bergen, Norway in 2015 ( N = 11,236, response rate 39.4%). Multinomial regression analyses comparing snus users and smokers to non-users and non-smokers, respectively, on demographic, personality and substance use variables were conducted. Regression analyses comparing current dual users to current smokers and current snus users and comparing daily smokers to daily snus users, on demographic, personality and substance use variables were also conducted. Results: In total 67.9% of ever snus users identified themselves as non-smokers (past and current). Several demographic, personality and substance use characteristics associated with smoking and snus use were identified (all = p < .05), some of which were common for both (e.g., use of cannabis) and some which were exclusively associated with either smoking (e.g., neuroticism) or snus use (e.g., extroversion). Conclusion: The current study contributes with several novel findings regarding traits associated with smoking and snus use. Though limited by a cross-sectional design, the current findings may suggest that the group of students using snus consists of a combination of previous smokers, students who would have smoked if snus was not available and a new segment who may not have used nicotine if snus was not available.
Critical limb ischemia patients clinically improving with medical treatment have lower neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios
Authors: Erdoğan Sevinç B , Selçuk Ümmühan N , Baştopçu Murat , Arslanhan Gökhan , Çakmak Arif Y , Kuplay Hüseyin , Mete Evren MT , Aka Serap A 
Published: January 2021

Objectives Inflammation is a component in the pathogenesis of critical limb ischemia. We aimed to assess how inflammation affects response to treatment in patients treated for critical limb ischemia using neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocytes ratios (PLR) as markers of inflammation. Methods Patients in a single tertiary cardiovascular center with critical limb ischemia unsuitable for surgical or interventional revascularization were retrospectively identified. Data were collected on medical history for risk factors, previous surgical or endovascular revascularization, and outcome. A standard regimen of low molecular weight heparin, aspirin, statins, iloprost infusions, and a standard pain medication protocol were applied to each patient per hospital protocol. Patients with improvement in ischemic pain and healed ulcers made up the responders group and cases with no worsening pain or ulcer size or progression to minor or major amputations made up the non-responders group. Responders and Non-responders were compared for risk factors including pretreatment NLR and PLR. Results 268 included patients who were not candidates for surgical or endovascular revascularization were identified. Responders had significantly lower pretreatment NLR (4.48 vs 8.47, p < 0.001) and PLR (162.19 vs 225.43, p = 0.001) values. After controlling for associated risk factors NLR ≥ 4.63 (p < 0.001) and PLR ≥ 151.24 (p = 0.016) were independently associated with no response to treatment. Conclusions Neutrophil-to-lymphocyte ratio and platelet-to-lymphocytes ratio are markers of inflammation that are reduced in patients improving with medical treatment suggesting a decreased state of inflammation before treatment in responding patients.
Importance of incorporating quantitative imaging biomarker technical performance characteristics when estimating treatment effects
Authors: Obuchowski Nancy A , Remer Erick M , Sakaie Ken , Schneider Erika , Fox Robert J , Nakamura Kunio , Avila Ricardo , Guimaraes Alexander 
Published: January 2021

Background/aims Quantitative imaging biomarkers have the potential to detect change in disease early and noninvasively, providing information about the diagnosis and prognosis of a patient, aiding in monitoring disease, and informing when therapy is effective. In clinical trials testing new therapies, there has been a tendency to ignore the variability and bias in quantitative imaging biomarker measurements. Unfortunately, this can lead to underpowered studies and incorrect estimates of the treatment effect. We illustrate the problem when non-constant measurement bias is ignored and show how treatment effect estimates can be corrected. Methods Monte Carlo simulation was used to assess the coverage of 95% confidence intervals for the treatment effect when non-constant bias is ignored versus when the bias is corrected for. Three examples are presented to illustrate the methods: doubling times of lung nodules, rates of change in brain atrophy in progressive multiple sclerosis clinical trials, and changes in proton-density fat fraction in trials for patients with nonalcoholic fatty liver disease. Results Incorrectly assuming that the measurement bias is constant leads to 95% confidence intervals for the treatment effect with reduced coverage (<95%); the coverage is especially reduced when the quantitative imaging biomarker measurements have good precision and/or there is a large treatment effect. Estimates of the measurement bias from technical performance validation studies can be used to correct the confidence intervals for the treatment effect. Conclusion Technical performance validation studies of quantitative imaging biomarkers are needed to supplement clinical trial data to provide unbiased estimates of the treatment effect.
Agreement in the CARTaGENE cohort between self-reported medication use and claim data
Authors: Moura Cristiano S , Payette Yves , Boileau Catherine , Abrahamowicz Michal , Pilote Louise , Bernatsky Sasha 
Published: January 2021

Objectives To describe the agreement of self-reported medication use with claim prescription records and to ascertain factors associated with agreement between the two data sources. Methods Baseline data on self-reported medication use was extracted from CARTaGENE, a cohort study in Quebec, Canada, and from the provincial health insurance records (dispensation database) of the same individuals. Kappa statistics were used to estimate concordance beyond chance between the two data sources. Logistic regression models were adjusted to estimate the association between agreement and selected individual’s characteristics (sex, age, education, region, income, utilization of health care system, and comorbidities). Results Agreement between self-reported medication use and administrative data varied considerably across medication classes (kappa 0.54 for respiratory system and 0.91 for systemic hormonal preparations). Overall, agreement improved when a fixed time window of 90 days was used for exposure measurement. Sex, education level, frequency of health care use and the number of reported medications were associated with agreement. Discussion Overall, there was a reasonable agreement between the two data sources, but important variations were found for the different drug classes. These results could be used by researchers to more accurately assess drug exposures using real-world data, which are increasingly important to regulators.
Exploring nurses’ experiences of value congruence and the perceived relationship with wellbeing and patient care and safety: a qualitative study
Authors: Dunning Alice , Louch Gemma , Grange Angela , Spilsbury Karen , Johnson Judith 
Published: January 2021

Background Values are of high importance to the nursing profession. Value congruence is the extent to which an individual’s values align with the values of their organisation. Value congruence has important implications for job satisfaction. Aim This study explored nurse values, value congruence and potential implications for individual nurses and organisations in terms of wellbeing and patient care and safety. Method Fifteen nurses who worked in acute hospital settings within the UK participated in semi-structured telephone interviews. Thematic analysis was utilised to analyse the data. Results Four themes were identified: organisational values incongruent with the work environment; personal and professional value alignment; nurse and supervisor values in conflict; nurses’ values at odds with the work environment. Perceived value incongruence was related to poorer wellbeing, increased burnout and poorer perceived patient care and safety. The barriers identified for nurses being able to work in line with their values are described. Conclusions Value congruence is important for nurse wellbeing and patient care and safety. Improving the alignment between the values that organisations state they hold, and the values implied by the work environment may help improve patient care and safety and support nurses in practice.
Diabetic Retinopathy Screening Using Artificial Intelligence and Handheld Smartphone-Based Retinal Camera
Authors: Malerbi Fernando Korn , Andrade Rafael Ernane , Morales Paulo Henrique , Stuchi José Augusto , Lencione Diego , de Paulo Jean Vitor , Carvalho Mayana Pereira , Nunes Fabrícia Silva , Rocha Roseanne Montargil , Ferraz Daniel A. , Belfort Rubens 
Published: January 2021

Background: Portable retinal cameras and deep learning (DL) algorithms are novel tools adopted by diabetic retinopathy (DR) screening programs. Our objective is to evaluate the diagnostic accuracy of a DL algorithm and the performance of portable handheld retinal cameras in the detection of DR in a large and heterogenous type 2 diabetes population in a real-world, high burden setting. Method: Participants underwent fundus photographs of both eyes with a portable retinal camera (Phelcom Eyer). Classification of DR was performed by human reading and a DL algorithm (PhelcomNet), consisting of a convolutional neural network trained on a dataset of fundus images captured exclusively with the portable device; both methods were compared. We calculated the area under the curve (AUC), sensitivity, and specificity for more than mild DR. Results: A total of 824 individuals with type 2 diabetes were enrolled at Itabuna Diabetes Campaign, a subset of 679 (82.4%) of whom could be fully assessed. The algorithm sensitivity/specificity was 97.8 % (95% CI 96.7-98.9)/61.4 % (95% CI 57.7-65.1); AUC was 0·89. All false negative cases were classified as moderate non-proliferative diabetic retinopathy (NPDR) by human grading. Conclusions: The DL algorithm reached a good diagnostic accuracy for more than mild DR in a real-world, high burden setting. The performance of the handheld portable retinal camera was adequate, with over 80% of individuals presenting with images of sufficient quality. Portable devices and artificial intelligence tools may increase coverage of DR screening programs.