bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resection of a Lumbar Intradural Extramedullary Schwannoma: 2-Dimensional Operative Video
Authors: Strong Michael J , Yee Timothy J , Khalsa Siri Sahib S , Saadeh Yamaan S , Muhlestein Whitney E , North Robert Y , Szerlip Nicholas J 
Published: April 2021

Abstract
Schwannomas are typically benign tumors that arise from the sheaths of nerves in the peripheral nervous system. In the spine, schwannomas usually arise from spinal nerve roots and are therefore extramedullary in nature. Surgical resection-achieving a gross total resection, is the main treatment modality and is typically curative for patients with sporadic tumors.
In this video, we present the case of a 38-yr-old male with worsening left leg radiculopathy, found to have a lumbar schwannoma. Preoperative imaging demonstrated that the tumor was at the level of L4-L5. A laminectomy at this level was performed with gross total resection of the tumor. The key points of the video include use of intraoperative fluoroscopy to confirm surgical level and help plan surgical exposure, use of ultrasound for intradural tumor localization, and advocating for maximum safe resection using neurostimulation. The patient tolerated the surgery well without any complications. He was discharged home with no additional therapy needed.
Appropriate patient consent was obtained.
WARNER MUSIC UK LTD v TUNEIN INC
Authors:   Chancery Division
Published: April 2021

Abstract
H1 Copyright – Infringement – Sound recordings – Internet radio services – Hyperlinks – Targeting – Communication to the public – Whether communication to the public in the UK – Consent – Whether the UK public was a new public – Freedom of information – Freedom of expression – Availability of a recording facility – Liability of users – Time shifting – Liability of station providers – Authorisation – Safe harbours
EVALUATION OF INTERNAL EXPOSURE TO RADIOACTIVE AEROSOL GENERATED FROM PLASMA MELTING SYSTEM USING THE BIDAS CODE
Authors: Kim S I , Lee H Y , Jung W C , Song J S 
Published: April 2021

Abstract
The radioactive aerosol generated by the Nuclear Power Plant (NPP) decommissioning process can be inhaled by workers and deposited inside the human body, resulting in internal exposure. Because internal exposure, unlike external exposure, is difficult to measure directly, it is all the more necessary to assess the dose workers receive as a result of internal exposure. Precise assessment of the internal exposure necessitates actual measurements in the work environment such as the workers’ respiration rate, kind of nuclide and amount of captured nuclide. However, in the event of difficulties in securing these measurements, the internal exposure dose can be estimated based upon the recommended values by the ICRP (International Commission on Radiological Protection) such as the intake fraction and particle size. In this study, 5 μm was selected as the particle size as recommended by the ICRP, and both heavy and light respiratory rates were used in the calculation. With respect to the nuclides contained in the radioactive aerosol and their concentrations, the data captured for the aerosol in the melting facility on the Kozloduy NPP premises in Bulgaria were applied to estimate workers’ internal exposure. As a result, each worker was found not to have received more than 20 mSv/yr, which is the maximum annual permissible dose for workers.
Brewers, Booze and Medicine: Industrial Funding of Alcoholic Liver Disease Research in 1980s Britain
Authors: Yokoe Ryosuke 
Published: April 2021

Summary
This article investigates why Britain’s brewing industry chose to sponsor a particular set of studies on liver disease during the 1980s, expounding on the nature of private-sector funding in clinical research. Through previously unexplored internal records, the article underscores how the drinks industry participated in wider debates on alcohol and public health by seeking the aid of medical expertise. Partly to minimise its own responsibility for the rise of problem drinking, the industry financed studies that looked into factors other than alcohol that contributed to the development of cirrhosis. The identification of the disease’s inborn determinants relating to heredity and sex strengthened the notion that only a minority of drinkers were at risk of developing alcohol-related illnesses, undermining the call for policies that targeted all drinking. Although driven by self-interest, the industry nevertheless supported legitimate lines of inquiry that elucidated the complex, multifactorial causation of cirrhosis.
Family Structure, Risks, and Racial Stratification in Poverty
Authors: Williams Deadric T , Baker Regina S 
Published: April 2021

Abstract
Family structure remains a dominant explanation for understanding racial inequality in poverty. Yet, empirical studies show family structure does not fully account for this association. We present racial stratification as an alternative perspective emphasizing the social construction of race and how race contributes to the unequal distribution of resources. To illustrate the link between racial stratification and poverty, we rely on risk research and conceptualize risk in terms of prevalences (the percentage of people with risks) and penalties (the probability of poverty associated with risks). We assess whether family structure and risks intersect by racialized groups, and if so, whether the penalties for risks among Black and Latinx mothers, relative to white mothers, converge (i.e., smaller gap in penalties) or diverge (i.e., larger gap in penalties). Using panel data, our results revealed Black mothers had higher risk prevalence than both Latinx and white mothers. Moreover, a dramatic divergence in the penalties for risks emerged between racialized groups whereby Black and Latinx mothers experience greater disadvantage from risks than white mothers, regardless of family structure. We conclude family structure is not only an oversimplified explanation but also contributes to obscuring structural and systemic sources of racial inequality in poverty.
Airway Microbiology in Children with Cystic Fibrosis: A Prospective Cohort Study from Northern India
Authors: Bashir Gulnaz , Bhat Javeed Iqbal , Mohammad Sozia , Fomda Bashir Ahmad , Bali Nargis K , Altaf Insha 
Published: April 2021

Abstract

Objective
The objective of this study is to find the organism profile and antimicrobial susceptibility patterns in children with cystic fibrosis (CF).

Design
Prospective cohort study.

Setting
Hospital-based study.

Intervention
Sputum cultures/throat swabs were collected from the study population. Relevant details like anthropometry, systemic examination findings and investigations were entered in a pre-designed format. Sputum culture was subjected to microbiological analysis at the hospital microbiology laboratory.

Main outcome measure
Prevalence of positive sputum/cough swab culture in CF patients, their organism profile and antibiotic sensitivity.

Results
A total of 63 patients were enrolled in the study. A total of 136 organisms were grown in our study population. Thirteen different organisms were isolated, which included five gram-positive bacteria, six gram-negative bacteria, eight Candida spp. and one filamentous. Antibiotic sensitivity profile of the Pseudomonas aeruginosa showed excellent sensitivity to all the aminoglycosides, piperacillin-tazobacteum and polymixin, similarly methicillin-sensitive Staphylococcus aureus, methicillin-resistant S. aureus and Enterococcus spp. were uniformly sensitive to vancomycin, linezolid and teicoplanin. Fungal isolates showed 100% sensitivity to all the antifungals tested including azoles and amphotericin B.

Conclusion
We observed 61% of culture positivity for different organisms in our study. Staphylococcus aureus and P. aeruginosa were the most frequently isolated organisms. Pseudomonas aeruginosa isolates were largely sensitive to aminoglycosides, carbapenems and polymixin. We found an unusually higher incidence of enterococcal infection in our study cohort with few vancomycin-resistant isolates.
Surgical Site Infection Following Neuromuscular Posterior Spinal Fusion Fell 72% After Adopting the 2013 Best Practice Guidelines
Authors: Stephan Stephen R. , Illingworth Kenneth D. , Gupta Kavish , Andras Lindsay M. , Skaggs David L. 
Published: April 2021

Study Design.
Retrospective cohort study.

Objective.
The purpose of this study is to investigate the incidence of surgical site infection in neuromuscular scoliosis (NMS) patients at a tertiary children's hospital before and after the implementation of strategies mentioned in the 2013 Best Practice Guideline.

Summary of Background Data.
Patients with NMS are at high risk for surgical site infection following spine surgery. In 2013, a Best Practice Guideline for surgical site infection prevention in high-risk pediatric spine surgery patients reported strategies to decrease incidence. To date, no studies have looked at the efficacy of these strategies.

Methods.
A retrospective review of surgical site infection in NMS patients was performed. NMS patients undergoing primary posterior spinal fusion from January 2008 to December 2012 (Group 1) and January 2014 to December 2018 (Group 2) were included, with 2013 excluded as a transition year. The primary outcome was incidence of surgical site infection within 1 year of surgery, as defined by the Centers for Disease Control and National Healthcare Safety Network. All patients had at least 1 year of documented follow-up.

Results.
One hundred ninety eight patients were included, 62 in Group 1 and 136 in Group 2. Age, BMI, sex, fusion to pelvis, preoperative Cobb angle, incontinence, drain use, blood loss, surgical time, and other perioperative values were similar (P > 0.05). Deep surgical site infection occurred in 10 (16.1%) patients in Group 1 and six (4.4%) patients in Group 2 (P = 0.005). Thirteen (59.1%) identified organisms were gram-negative, with 11 (84.6%) isolated from Group 1 (P = 0.047). Polymicrobial infections accounted for six (37.5%) infections overall.

Conclusion.
The incidence of surgical site infection in NMS patients decreased significantly (16.1% vs. 4.4%) after the implementation of the strategies mentioned in the 2013 Best Practice Guideline. Further studies are required to continue to decrease the incidence in this high-risk population.

Level of Evidence: 3
Stratifying Deterioration Risk by Acuity at Admission Offers Triage Insights for Coronavirus Disease 2019 Patients
Authors: Beals Joseph , Barnes Jaime J. , Durand Daniel J. , Rimar Joan M. , Donohue Thomas J. , Hoq S. Mahfuz , Belk Kathy W. , Amin Alpesh N. , Rothman Michael J. 
Published: April 2021

Objectives:
Triaging patients at admission to determine subsequent deterioration risk can be difficult. This is especially true of coronavirus disease 2019 patients, some of whom experience significant physiologic deterioration due to dysregulated immune response following admission. A well-established acuity measure, the Rothman Index, is evaluated for stratification of patients at admission into high or low risk of subsequent deterioration.

Design:
Multicenter retrospective study.

Setting:
One academic medical center in Connecticut, and three community hospitals in Connecticut and Maryland.

Patients:
Three thousand four hundred ninety-nine coronavirus disease 2019 and 14,658 noncoronavirus disease 2019 adult patients admitted to a medical service between January 1, 2020, and September 15, 2020.

Interventions:
None.

Measurements and Main Results:
Performance of the Rothman Index at admission to predict in-hospital mortality or ICU utilization for both general medical and coronavirus disease 2019 populations was evaluated using the area under the curve. Precision and recall for mortality prediction were calculated, high- and low-risk thresholds were determined, and patients meeting threshold criteria were characterized. The Rothman Index at admission has good to excellent discriminatory performance for in-hospital mortality in the coronavirus disease 2019 (area under the curve, 0.81–0.84) and noncoronavirus disease 2019 (area under the curve, 0.90–0.92) populations. We show that for a given admission acuity, the risk of deterioration for coronavirus disease 2019 patients is significantly higher than for noncoronavirus disease 2019 patients. At admission, Rothman Index–based thresholds segregate the majority of patients into either high- or low-risk groups; high-risk groups have mortality rates of 34–45% (coronavirus disease 2019) and 17–25% (noncoronavirus disease 2019), whereas low-risk groups have mortality rates of 2–5% (coronavirus disease 2019) and 0.2–0.4% (noncoronavirus disease 2019). Similarly large differences in ICU utilization are also found.

Conclusions:
Acuity level at admission may support rapid and effective risk triage. Notably, in-hospital mortality risk associated with a given acuity at admission is significantly higher for coronavirus disease 2019 patients than for noncoronavirus disease 2019 patients. This insight may help physicians more effectively triage coronavirus disease 2019 patients, guiding level of care decisions and resource allocation.
Circ_GRN Promotes the Proliferation, Migration, and Inflammation of Vascular Smooth Muscle Cells in Atherosclerosis Through miR-214-3p/FOXO1 Axis
Authors: Li Xiaohua , Li Li , Dong Xiaochun , Ding Junrong , Ma Hua , Han Wei 
Published: April 2021

Abstract:
Dysfunction of vascular smooth muscle cells (VSMCs) assumes a fundamental part in the pathogenesis of atherosclerosis (AS). Circular RNA granulin precursor (circ_GRN) was identified to promote the proliferation and invasion of human VSMCs (HVSMCs) in an in vitro AS model. However, the underlying mechanisms remain unclear. Levels of circ_GRN, microRNA (miR)-214-3p, and forkhead box protein O1 (FOXO1) were detected using quantitative real-time polymerase chain reaction and Western blot assays. The proliferation, migration, and inflammatory response of HVSMCs were evaluated by using flow cytometry, colony formation, Cell Counting Kit-8, Western blot, transwell assays, and enzyme-linked immunosorbent assay, respectively. The binding interaction between miR-214-3p and circ_GRN or FOXO1 was detected by dual-luciferase reporter assay. In this study, we found that circ_GRN was elevated in the serum of AS and oxidized low-density lipoprotein (ox-LDL)-induced HVSMCs. The in vitro AS model was established by exposing HVSMCs to ox-LDL, and we found circ_GRN knockdown reversed ox-LDL-evoked cell proliferation, migration, and inflammation. In a mechanical study, miR-214-3p directly bound to circ_GRN or FOXO1, and circ_GRN could regulate FOXO1 expression by competitively binding to miR-214-3p. Importantly, we demonstrated that miR-214-3p inhibition attenuated the protective effects of circ_GRN knockdown on ox-LDL-induced HVSMCs; besides that, miR-214-3p overexpression abolished ox-LDL-triggered HVSMC proliferation, migration, and inflammation, which were counteracted by FOXO1 upregulation. In conclusion, circ_GRN promoted the proliferation, migration, and inflammation of HVSMCs through miR-214-3p/FOXO1 axis in ox-LDL-induced AS model in vitro, suggesting the potential involvement in an AS process, which provided a potential candidate for future clinic intervention in AS.
Current practice of anesthetic equipment disinfection in the University of Gondar Comprehensive Specialized Hospital, 2020: a cross sectional study
Authors: Ahmed Seid A. , Fentie Demeke Y. 
Published: April 2021

Background:
Anesthetic equipments undeniably occupy prime importance in clinical practice. However, their importance falls into question if they are not appropriately prepared and handled.

Objectives:
The objective of this audit was to assess the current practice of anesthetic equipment disinfection in comprehensive specialized hospital.

Methods:
An observational study was conducted. A total of 70 patients were operated during the study period and data was analyzed using Microsoft Excel as well as descriptive statistics was used.

Results:
Around 94.2% of anesthetists followed only the first step of disinfecting laryngoscope blade and 74.2% of anesthetists stored both the laryngoscope blade and handle appropriately but the rest of the steps were performed poorly and none of the anesthetists applied alcohol for both blade and handle disinfection. All anesthetists immersed the endotracheal tube or laryngeal mask airway in high level disinfection solution and then rinse them with water. However, none of the anesthetists were applied around 6 of the process of disinfecting these equipments. Regarding face mask, only 4 (5.7%) of the anesthetists washed the anesthetic face mask with soap and 2 (2.8%) stored it safely for further use but none of them used alcohol to disinfect this equipment.

Conclusions:
Even if all of the anesthetic equipments disinfection process needs improvement, special attention should be given to laryngoscope disinfection protocol since this equipment is being used frequently between patients as well as changing the high level disinfectant solution every 24 hours because more than this hour the solution cannot be used as disinfectant and finally we recommend that all anesthetists should follow the standards of anesthetic equipment disinfection process.
Rescue of Failed XEN-45 Gel Implant by Nd:YAG Shock Wave to Anterior Chamber Tip to Dislodge Hidden Intraluminal Occlusion
Authors: Fellman Ronald L. , Grover Davinder S. , Smith Oluwatosin U. , Kornmann Helen L. 
Published: April 2021

Purpose:
The purpose of this study was to inform ophthalmic surgeons in a timely manner of the hidden problem of clear intraluminal cellular debris as a cause for XEN-45 failure and to describe low energy neodymium-doped yttrium aluminum garnet (Nd:YAG) laser revision with periluminal anterior chamber tip shockwave treatment to improve flow to the bleb.

Patients and Methods:
Six patients with visibly patent stent lumen post XEN-45 surgery. These eyes developed rising intraocular pressure (IOP) with a history of excellent prior bleb formation and were treated successfully with Nd:YAG laser shockwave therapy to disperse assumed intraluminal cellular debris. The laser was aimed just anterior and axial to the intracameral tip of the gel stent through a gonioscopy lens.

Results:
Six patients with an average age of 75 years (60 to 90 y), preoperative IOP of 30 mm Hg (16 to 52 mm Hg) on an average of 2 antiglaucoma medications (0 to 4) underwent periluminal anterior chamber tip shock wave at an average of 12 months (1 to 38 mo) from XEN-45 surgery. The IOP was immediately reduced to an average of 15 mm Hg (8 to 23 mm Hg) and last IOP averaged 15 mm Hg (10 to 23 mm Hg) on 1.5 medications (0 to 4) at 4 months post periluminal anterior chamber tip shock wave.

Conclusion:
Nd:YAG laser revision of hidden blockage of a XEN-45 gel implant with periluminal anterior chamber tip shockwave treatment can disperse invisible intraluminal cellular debris and improve flow in a failing XEN-45 microstent, especially when distal fibrosis is not excessive.
Pathway Linking Different Types of Childhood Trauma to Somatic Symptoms in a Subclinical Sample of Female College Students
Authors: Heshmati Rasoul , Azmoodeh Shahin , Caltabiano Marie L. 
Published: April 2021

Abstract
Research has shown that women are more prone to childhood trauma and this state is associated with somatic symptoms. Also, people who have been exposed to traumatic experiences use experiential avoidance to reduce negative emotions. However, the mediating role of experiential avoidance in the relationship between childhood trauma and somatic symptoms is not clear, so, the present study investigated whether the relationships among different types of childhood trauma and somatic symptoms could be explained by experiential avoidance in female college students. In a cross-sectional study, 251 Iranian female college students with somatic symptoms were recruited from the University of Tabriz. Participants completed self-report scales, including the Persian version of Child Abuse Self-Reported Scale, Acceptance and Action Questionnaire-II (AAQ-II), and the Patient-health questionnaire (PHQ-15). A path analysis was used to empirically explore the relationships. Structural equation modeling analyses confirmed a partial mediation model. Study participants who had a higher level of emotional trauma reported higher levels of somatic symptoms. Emotional and neglect trauma showed significant positive relations with experiential avoidance. Bootstrapping results showed that experiential avoidance partially mediated the relationship between emotional trauma and somatic symptoms. Moreover, the association between neglect and somatic symptoms was fully mediated by experiential avoidance. These findings suggest that experiential avoidance might be one mechanism explaining how adverse emotional and neglect experiences influence somatic symptoms. Interventions addressing experiential avoidance through methods such as emotion-focused therapy and mindfulness are discussed as potential future directions for treating somatic symptoms in females who experienced emotional and neglect trauma.
Deep-Learning-Based Diagnosis of Bedside Chest X-ray in Intensive Care and Emergency Medicine
Authors: Niehues Stefan M. , Adams Lisa C. , Gaudin Robert A. , Erxleben Christoph , Keller Sarah , Makowski Marcus R. , Vahldiek Janis L. , Bressem Keno K. 
Published: April 2021

Objectives
Validation of deep learning models should separately consider bedside chest radiographs (CXRs) as they are the most challenging to interpret, while at the same time the resulting diagnoses are important for managing critically ill patients. Therefore, we aimed to develop and evaluate deep learning models for the identification of clinically relevant abnormalities in bedside CXRs, using reference standards established by computed tomography (CT) and multiple radiologists.

Materials and Methods
In this retrospective study, a dataset consisting of 18,361 bedside CXRs of patients treated at a level 1 medical center between January 2009 and March 2019 was used. All included CXRs occurred within 24 hours before or after a chest CT. A deep learning algorithm was developed to identify 8 findings on bedside CXRs (cardiac congestion, pleural effusion, air-space opacification, pneumothorax, central venous catheter, thoracic drain, gastric tube, and tracheal tube/cannula). For the training dataset, 17,275 combined labels were extracted from the CXR and CT reports by a deep learning natural language processing (NLP) tool. In case of a disagreement between CXR and CT, human-in-the-loop annotations were used. The test dataset consisted of 583 images, evaluated by 4 radiologists. Performance was assessed by area under the receiver operating characteristic curve analysis, sensitivity, specificity, and positive predictive value.

Results
Areas under the receiver operating characteristic curve for cardiac congestion, pleural effusion, air-space opacification, pneumothorax, central venous catheter, thoracic drain, gastric tube, and tracheal tube/cannula were 0.90 (95% confidence interval [CI], 0.87–0.93; 3 radiologists on the receiver operating characteristic [ROC] curve), 0.95 (95% CI, 0.93–0.96; 3 radiologists on the ROC curve), 0.85 (95% CI, 0.82–0.89; 1 radiologist on the ROC curve), 0.92 (95% CI, 0.89–0.95; 1 radiologist on the ROC curve), 0.99 (95% CI, 0.98–0.99), 0.99 (95% CI, 0.98–0.99), 0.98 (95% CI, 0.97–0.99), and 0.99 (95% CI, 0.98–1.00), respectively.

Conclusions
A deep learning model used specifically for bedside CXRs showed similar performance to expert radiologists. It could therefore be used to detect clinically relevant findings during after-hours and help emergency and intensive care physicians to focus on patient care.