bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetic retinopathy classification using deep convolutional neural network
Authors: L. Akshita , Singhal Harshul , Dwivedi Ishita , Ghuli Poonam 
Published: October 2021

<span>Diabetic retinopathy (DR) is a diabetic impairment that affects the eyes and if not treated could lead to permanent vision impairment. Traditionally, Ophthalmologists perform diagnosis of DR by checking for existence and any seriousness of some subtle features in the fundus images. This process is not very efficient as it takes a lot of time and resources. DR testing of all the patients, a lot of which are undiagnosed or untreated, is a big task due to the inefficiency of the traditional method. This paper was written with the aim to propose a classification system based on an efficient deep convolution neural network (DCNN) model which is computationally efficient. Amongst other supervised algorithms involved, proposed solution is to find a way to efficiently classify the fundus images into 5 different levels of severity. Application of segmentation after the pre-processing and then use of deep convolutional neural networks on the dataset results in a high accuracy of 91.52%. The result achieved is high given the limitations of the dataset and computational powers.</span>
Falling Through the Cracks: The Current Gap in the Health Care Transition of Patients With Kawasaki Disease
Authors: Dahdah Nagib , Kung Samuel C. , Friedman Kevin G. , Marelli Ariane , Gordon John B. , Belay Ermias D. , Baker Annette L. , Kazi Dhruv S. , White Patience H. , Tremoulet Adriana H. ,   the American Heart Association Rheumatic Fever, Endocarditis, Kawasaki Disease Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young, and the Council on Arteriosclerosis, Thrombosis and Vascular Biology
Published: October 2021

Background
Health care transition (HCT) is a period of high vulnerability for patients with chronic childhood diseases, particularly when patients shift from a pediatric to an adult care setting. An increasing number of patients with Kawasaki disease (KD) who develop medium and large coronary artery aneurysms (classified by the American Heart Association according to maximal internal coronary artery diameter Z‐scores ≥5 and ≥10, respectively) are becoming adults and thus undergoing an HCT. However, a poor transition to an adult provider represents a risk of loss to follow‐up, which can result in increasing morbidity and mortality.

Methods and Results
This scientific statement provides a summary of available literature and expert opinion pertaining to KD and HCT of children as they reach adulthood. The statement reviews the existing life‐long risks for patients with KD, explains current guidelines for long‐term care of patients with KD, and offers guidance on assessment and preparation of patients with KD for HCT. The key element to a successful HCT, enabling successful transition outcomes, is having a structured intervention that incorporates the components of planning, transfer, and integration into adult care. This structured intervention can be accomplished by using the Six Core Elements approach that is recommended by the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians.

Conclusions
Formal HCT programs for patients with KD who develop aneurysms should be established to ensure a smooth transition with uninterrupted medical care as these youths become adults.
Knowledge, attitudes and practices towards COVID-19 among multiethnic elderly Asian residents in Singapore: a mixed-methods study
Authors: Aravindhan Amudha , Gan Alfred Tau Liang , Lee Ester Pei Xuan , Gupta Preeti , Man Ryan , Ho Kam Chun , Sung Sharon Cohan , Cheng Ching-Yu , Ling Moi Lin , Tan Hiang Khoon , Wong Tien Yin , Fenwick Eva Katie , Lamoureux Ecosse Luc 
Published: October 2021

Abstract

Introduction:
We investigated the knowledge, attitudes and practice (KAP) towards coronavirus disease 2019 (COVID-19) and its related preventive measures in Singaporeans aged ≥60 years.

Methods:
This was a population-based, cross-sectional, mixed-methods study (13 May 2020–9 June 2020) of participants aged ≥ 60 years. Self-reported KAP about ten symptoms and six government-endorsed preventive measures related to COVID-19 were evaluated. Multivariable regression models were used to identify sociodemographic and health-related factors associated with KAP in our sample. Associations between knowledge/attitude scores and practice categories were determined using logistic regression. Seventy-eight participants were interviewed qualitatively about the practice of additional preventive measures and data were analysed thematically.

Results:
Mean awareness score of COVID-19 symptoms was 7.2/10. The most known symptom was fever (93.0%) and the least known was diarrhoea (33.5%). Most participants knew all six preventive measures (90.4%), perceived them as effective (78.7%) and practised ‘wear a mask’ (97.2%). Indians, Malays and participants living in smaller housing had poorer mean scores for knowledge of COVID-19 symptoms. Older participants had poorer attitudes towards preventive measures. Compared to Chinese, Indians had lower odds of practising three out of six recommendations. A one-point increase in score for knowledge and attitudes regarding preventive measures resulted in higher odds of always practising three of six and two of six measures, respectively. Qualitative interviews revealed use of other preventive measures, for example, maintaining a healthy lifestyle.

Conclusions:
Elderly Singaporeans displayed high levels of KAP about COVID-19 and its related preventive measures, with a positive association between levels of knowledge/attitude and practice. However, important ethnic and socioeconomic disparities were evident, indicating that key vulnerabilities remain, which require immediate attention.
A qualitative study of motivations for non-suicidal self-injury in a sample of psychiatric outpatients in Singapore
Authors: Shahwan Shazana , Zhang Yunjue , Sambasivam Rajeswari , Ong Say How , Chong Siow Ann , Subramaniam Mythily 
Published: October 2021

Introduction:
The popular notion that the need for attention drives non-suicidal self-injury (NSSI) serves to stigmatise rather than understand this warning sign of underlying psychological/psychiatric disorder. Despite the pervasiveness of NSSI in clinical and community settings, effective treatments for this behaviour are lacking. This qualitative research aims to understand the motivations of NSSI in adolescents/young adults in a mental health facility in Singapore.

Methods:
Semi-structured interviews were conducted with 20 outpatients (6 males, 14 females) of the Institute of Mental Health aged 17–29 years who had reported NSSI as part of an earlier survey. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data. The main themes and sub-themes were identified and described.

Results:
A preponderance of motivations served intrapersonal emotion-regulating purposes, which were categorised as to: (a) release bottled-up feelings; (b) self-punish; (c) turn aggression inwards; (d) sensitise oneself; and (e) attain a sense of control and mastery. By contrast, a small subset of motivations served the interpersonal motivation of signaling one's distress, especially when the capacity for verbal expression was limited or attempts to verbalise distress were futile.

Conclusion:
Committing NSSI solely for attention-seeking is a myth that perpetuates the stigma and hinders those in need of psychological care from seeking appropriate treatment. NSSIs may be warning signs that indicate not only intrapersonal conflicts but external environments that are perceived unsafe to deal with these intrapersonal conflicts. An understanding of the underlying motives will facilitate better treatment of individuals presenting with NSSI.
Buddhist Ritual as “Connectionwork”: Aesthetics and Technologies of Mediating Religious Belonging
Authors: Williams-Oerberg Elizabeth 
Published: October 2021

Abstract
In September 2016, the Himalayan Buddhist festival Naropa 2016 took place in the Northwest Himalayan region of Ladakh, India. This article analyzes the spectacular aesthetics of the Naro Gyen Druk ritual, the focus of Naropa 2016. Drawing on ethnographic documentation of this ritual, I consider the role of ritual aesthetics in provoking affective, emotional, and bodily experiences among participants and their felt connections to the 12th Gyalwang Drukpa, the charismatic leader of the Drukpa Kagyü organization. I introduce the term “connectionwork” to emphasize how Buddhist conceptualizations of connections, drelwa (‘brel ba), bring to light how ritual and performances of charisma either work or fail to work in establishing religious belonging among Himalayan and international participants. Connectionwork helps to emphasize not only the work to organize and orchestrate religious rituals with the intention to institute religious belonging, but also the agential role that participants play in charismatic ritual performances.
Ottomans: Unwanted Immigrants in Brazil at the Beginning of the Twentieth Century
Authors: Genç Hamdi , Bozkurt İbrahim Murat 
Published: October 2021

Abstract
This article addresses the Ottoman migration to Brazil from current Lebanon and Syria. The article explores reasons for the migration, the Ottoman State’s attitude towards this migration and the measures taken to control it. It also analyses the socio-economic and political relations between the Ottoman State and Brazil, and the socio-economic situation of the Lebanese and Syrians who migrated to Brazil as well as the attitude of the Brazilian government. In addition, the article highlights the attitude of the Brazilian government to Lebanese and Syrian migrants. The article is mostly based on Ottoman archives accessed through the State Archives Department of the Turkish Presidency. These documents give a distinctive character to the article compared with other studies in this field, namely that it is one of very few focusing on migration from Lebanon and Syria to Brazil in the Ottoman period that uses archival resources of the country of emigration.
Revisiting the Pancreatic Fistula Risk Score: Clinical Nomogram Accurately Assesses Risk
Authors: Mohamed Abdimajid , Nicolais Laura , Fitzgerald Timothy L. 
Published: October 2021

Objectives Surgeons have created numerous iterations of the pancreatic fistula risk score (FRS) to predict risk for clinically relevant postoperative pancreatic fistula (CR-POPF). The multitude of often conflicting models makes it difficult for surgeons to apply data in clinical practice. Methods We conducted a retrospective cohort study utilizing National Surgical Quality Improvement Program data from 2015 to 2018. The study included patients undergoing pancreaticoduodenectomy. Missing data were resolved with multiple imputations. Results The study included 5975 patients; 1018 (17%) had a CR-POPF. On multivariate analysis, male sex (odds ratio (OR) 1.60 CI: 1.29-1.98 P < .001), obesity (OR 1.65 CI: 1.31-2.08 P < .001), and soft gland texture (OR 3.21 CI: 2.45-4.23 P < .001) were all associated with increased odds of a CR-POPF. Variables not associated with CR-POPF included diabetes, preoperative bilirubin, preoperative albumin, and American Society of Anesthesiologists (ASA) classification. On multivariate analysis, duct diameter >6 mm (OR .52 CI: .34-.77 P = .001), pancreatic adenocarcinoma pathology (OR .67 CI: .53-.84 P < .001), and neoadjuvant treatment (OR .71 CI: .51-.98 P = .042) were all associated with decreased odds of a CR-POPF. We constructed a clinically relevant nomogram from this model known as the Portland FRS. Model characteristics were superior to previously published FRS models. The area under the curve (AUC) for the Portland FRS was .72 (CI: .704-.737). In comparison, AUCs for the Alternative and Seoul FRS were .70 and .64, respectively. Conclusion Utilizing readily available clinical data, the Portland FRS can accurately predict the risk for pancreatic fistula. The nomogram may assist surgeons in patient counseling and perioperative management.
The Audiometric Assessment of the Effectiveness of Surgical Treatment of Otosclerosis Depending on the Preoperative Incidence of Carhart’s Notch
Authors: Job Katarzyna , Wiatr Agnieszka , Skladzien Jacek , Wiatr Maciej 
Published: October 2021

Objective: The presence of Carhart’s notch at 2000 Hz in otosclerosis links the changed bone conduction for this frequency with the otosclerotic process occurring in the oval window. The aim of this study is to perform an audiometric assessment of the effectiveness of surgical treatment of otosclerosis depending on the incidence of Carhart’s notch. Methods: The analysis included 116 patients treated surgically for the first time due to otosclerosis. Patients were divided into 4 groups depending on the occurrence of Carhart’s notch, determined by pure-tone audiometry (PTA) before the surgery and 36 months afterward. The mean value of bone conduction thresholds was calculated for 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz in the groups in which the Cahart’s notch was observed. This value of bone conduction (BC) was a reference point for further analysis in patients who had no preoperative or postoperative Carhart’s notch. Results: The analysis indicated that Cahart’s notch in preoperative PTA is a statistically significant improvement factor for average BC. It was found that over a longer observation period, the presence of Carhart’s notch has adverse effects on the size of the postoperative air-bone gap, and consequently on hearing improvement after surgical treatment. A comparison between patients from the two groups without preoperative Carhart’s notch found that no beneficial effects of the surgery on speech comprehension were observed regarding high-level sensorineural hearing loss (SNHL). Conclusions: (1) In a long-term observation post-stapedotomy, average BC values were found to improve. Nevertheless, the improvement is less evident in patients with preoperative Carhart’s notch. (2) Disappearance of Cahart’s notch after surgical treatment of otosclerosis is a good prognosis of improvement in speech audiometry. (3) Deep SNHL in the absence of Carhart’s notch in PTA constitutes a bad prognostic factor for improvement in speech audiometry in patients qualified for surgical treatment of otosclerosis.
Physical fitness changes induced by thermal aquatic standardized exercise in chronic venous disease patients
Authors: Menegatti Erica , Mandini Simona , Chi Yung-Wei , Mazzoni Gianni , Pagani Anselmo , Malagoni Anna Maria , Tessari Mirko , Costa Alfio Luca , Avruscio Giampiero , Zamboni Paolo , Gianesini Sergio 
Published: October 2021

Background Lack of physical activity represents a risk factor for both cardiovascular and chronic venous diseases (CVD), nevertheless a specific exercise protocol for CVD patient is still missing. This investigation was aimed to assess the impact of a standardized exercise protocol in a thermal water environment on physical fitness and quality-of-life (QoL) in CVD patients. Methods Sixteen (16) CVD patients performed 5 standardized exercise sessions in a thermal water pool. Before starting the exercise protocol, the cohort filled International Physical Activity Questionnaire (IPAQ) to determine their physical activity level. At baseline and at the end of the exercise program, leg volume, QoL, musculoskeletal and cardiovascular physical fitness were assessed by means of water plethysmography, validated questionnaire and functional test, blood pressure and heart rate at rest were also reported. Results All the patients were categorized as physically inactive: average activity time 235.6 (155.2) MET-minutes per week. At the end of the study, a significant leg volume reduction was found (−16%; p < .002). Significant improvement in lower limb strength (p < .0001), endurance (p < .006), rapidity and balance (p < .05) together with decrease in resting heart rate (−1.8%, p < .0001) and systolic blood pressure (−1.1%, p < .04) were reported, significant improvement in bodily pain (p < .0005) and social function (p < .002) QoL items were observed. Conclusions The proposed exercise protocol in thermal aquatic environment demonstrated to be an effective treatment modality improving both cardiovascular and musculoskeletal outcomes and QoL in sedentary CVD patients. Aquatic environment investigations require proper analysis of the various factors involved, in a standardized and reproducible way. The herein report can be a reference for further studies on different health related conditions.
Opioid-sparing effects of ketorolac in palliative care patients receiving opioids for chronic cancer-related pain: A systematic literature review
Authors: Butcher Belinda , Hutchings Elizabeth , Fazekas Belinda , Clark Katherine , Rowett Debra , Currow David 
Published: October 2021

Background: Standard of care in treatment of cancer-related pain involves opioids in combination with non-steroidal anti-inflammatory drugs (NSAID). Ketorolac, a NSAID, has demonstrated opioid-sparing effects in other clinical settings. Aim: This systematic literature review investigated ketorolac’s opioid-sparing effects in patients receiving opioids for chronic, cancer-related pain. Design: The primary outcome was total daily dose of opioids. Secondary outcomes included frequency of opioid use, use and frequency of ‘rescue’ medication and adverse events. Outcomes were described, and meta-analysed where possible. PROSPERO registration CRD42019130894. Data sources: Articles included original research, from any study phase or methodology, published in English in a peer-reviewed journal or conference between 1990 and 2020; included subjects >18 years; had chronic cancer-related pain and described the use of opioid-sparing effect of ketorolac. Results: Nine articles were included. While there was significant heterogeneity, ketorolac may have an opioid-sparing effect, with significant reductions in total daily dose of morphine observed in a single randomised controlled trial (SMD −4.30 mg, 95% CI −5.36 to −3.25), but the changes in the before and after studies were not statistically significant −0.46 mg (95% CI −1.14 to 0.22). Ketorolac was associated with greater likelihood of complete pain relief, but the data were heterogeneous. Insufficient data were available to analyse frequency of opioid use, or rescue medication requirements. Conclusions: Given the heterogeneity of the data, adequately powered, randomised controlled trials are required to establish any opioid-sparing effect of ketorolac. For patients not responding to conventional pain management, ketorolac may have a role in treatment augmentation.
Development and Validation of a Discrete Event Simulation Model to Evaluate the Cardiovascular Impact of Population Policies for Obesity
Authors: Arrospide Arantzazu , Ibarrondo Oliver , Castilla Iván , Larrañaga Igor , Mar Javier 
Published: October 2021

Introduction Our aim was to describe the development and validation of an obesity model representing the cardiovascular risks associated with different body mass index (BMI) categories, through simulation, designed to evaluate the epidemiological and economic impact of population policies for obesity. Methods A discrete event simulation model was built in R considering the risk of cardiovascular events (heart failure, stroke, coronary heart disease, and diabetes) associated with BMI categories in the Spanish population. The main parameters included in the model were estimated from Spanish hospital discharge records and the Spanish Health Survey and allowed both first-order and second-order (probabilistic sensitivity analysis) uncertainty to be programmed into the model. The simulation yielded the incidence and prevalence of cardiovascular events as validation outputs. To illustrate the capacity of the model, we estimated the reduction in cardiovascular events and cost-utility (incremental cost/incremental quality-adjusted life-years [QALYs]) of a hypothetical intervention that fully eliminated the cardiovascular risks associated with obesity and overweight. Results The Validation Status of Health-Economic decision models (AdViSHE) tool was applied. Internal validation plots showed adequate goodness of fit for the Spanish population. External validation was achieved by comparing the simulated and real incidence by age group for stroke, acute myocardial infarction, and heart failure. The intervention reduced the population hazard ratios of stroke, acute myocardial infarction, and heart failure to 0.81, 0.74, and 0.78, respectively, and added 0.74 QALYs to the whole population. Conclusions This obesity simulation model evidenced good properties for estimating the long-term epidemiological and economic impact of policies to tackle obesity in Spain. The conceptual model could be implemented for other counties using country-specific input data.
Contrast-enhanced digital mammography and magnetic resonance imaging: reproducibility compared to pathologic anatomy
Authors: Liguori Alessandro , Depretto Catherine , Ciniselli Chiara Maura , Citterio Andrea , Boffelli Giulia , Verderio Paolo , Scaperrotta Gianfranco Paride 
Published: October 2021

Purpose: To compare the reproducibility between contrast-enhanced digital mammography (CEDM) and magnetic resonance imaging (MRI) with the postsurgical pathologic examination. In addition, the applicability of the Breast Imaging–Reporting and Data System (BI-RADS) lexicon of MRI to CEDM was evaluated for mass lesions. Methods: A total of 62 patients with a histologically proven diagnosis of breast cancer were included in this study, for a total of 67 lesions. Fifty-nine patients underwent both methods. The reproducibility between MRI vs CEDM and the reference standard (postoperative pathology) was assessed by considering the lesion and breast size as pivotal variables. Reproducibility was evaluated by computing the concordance correlation coefficient (CCC). Bland-Altman plots were used to depict the observed pattern of agreement as well as to estimate the associated bias. Furthermore, the pattern of agreement between the investigated methods with regard to the breast lesion characterization (i.e. mass/nonmass; shape; margins; internal enhanced characteristics) was assessed by computing the Cohen kappa and its 95% confidence interval (CI). Results: The reproducibility between MRI and the reference standard and between CEDM and the reference standard showed substantial agreement, with a CCC value of 0.956 (95% CI, 0.931–0.972) and 0.950 (95% CI, 0.920–0.969), respectively. By looking at the Bland-Altman analysis, bias values of 2.344 and 1.875 mm were observed for MRI and CEDM vs reference evaluation, respectively. The agreement between MRI and CEDM is substantial with a CCC value of 0.969 (95% CI, 0.949–0.981). The Bland-Altman analysis showed bias values of −0.469 mm when comparing CEDM vs MRI. Following the Landis and Koch classification criteria, moderate agreement was observed between the two methods in describing BI-RADS descriptors of mass lesions. Conclusion: CEDM is able to measure and describe tumor masses comparably to MRI and can be used for surgical planning.