bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Evaluation of Readability of Information on the Internet Regarding Total Ankle Replacement
Authors: carthy andrea mc , Flavin Robert 
Published: January 2021

Abstract
Background:Health literacy is defined as the ability to understand basic health information with such competence as to be able to use this information to enhance health. Lower health literacy is associated with increased post-operative complications, reduced satisfaction and compliance. To ensure accessibility and comprehension by the general public, many international health organisations suggest that health literature has a reading grade level equivalent to the American sixth grade. However, previous studies show that this rarely occurs.Total ankle replacement (TAR) technology has rapidly progressed with new prosthesis showing increasingly improving outcomes. However, TAR remains a complex procedure which may be challenging to explain to the patient. Thus, many patients will turn to the internet for more information and as a ‘quasi-second opinion’. If the health education materials provided on the internet is not accessible to patients, it can leave them overwhelmed and confused. The aim of the study is to evaluate the readability of information on the internet with regards to Total Ankle ReplacementMethods: 110 websites from the two main search engines (Google and Bing) were assessed using the terms ‘total ankle replacement’ and ‘total ankle arthroplasty’. Once duplicates had been removed and exclusion criteria were applied, 36 unique websites were categorised and underwent analysis using readability software (WEB FX readability tool). The websites were assessed for readability using the Fleisch Reading Ease Score (FRES) and the Reading Grade Level (RGL). A score of greater than 65 for FRES and an RGL of six or less were considered acceptable. Differential and Inferential statistical analysis was performed using SPSS.Results:The mean FRES score was 54.95 (SD: ± 13.2); this was significantly below the recognised acceptable standard score of 65 (P<.0001). An ANOVA conducted showed significant difference between FRES scores based on categories (P=.041) with post-hoc testing showing that the difference between commercial and non-physician scores was the most significant (P=.016; CI:3.84-61.66).The mean RGL was 8.31 (SD: ± 1.95). One-way t-tests showed that these scores were significantly higher than the acceptable standard (P<.0001; CI: 1.64-2.97). ANOVA testing showed a significant difference based on category (P=.028) with post hoc testing showing significant difference between non physician and commercial scores (P=.012, CI: 0.71-9.33).Conclusion:The majority of the websites pertaining to total ankle replacement are significantly beyond the comprehension levels of the general public. This will affect the patient’s ability to discern the complexities and potential complications of total ankle arthroplasty, with serious ramifications for consent as well as post-operative rehabilitation and compliance.Level of Evidence: not applicable
Assessing the integrity of auditory processing and sensory memory in adults with cystinosis (CTNS gene mutations)
Authors: Francisco Ana A. , Berruti Alaina S. , Kaskel Frederick J. , Foxe John J. , Molholm Sophie 
Published: January 2021

Abstract
Background
Cystinosis, a rare lysosomal storage disease, is characterized by cystine crystallization and accumulation within tissues and organs, including the kidneys and brain. Its impact on neural function appears mild relative to its effects on other organs, but therapeutic advances have led to substantially increased life expectancy, necessitating deeper understanding of its impact on neurocognitive function in adulthood. We previously demonstrated intact auditory sensory processing, accompanied by mild sensory memory difficulties, in children and adolescents with cystinosis.
Methods
We investigated whether further progressive decrements in these processes would be observed in adults with cystinosis, comparing high-density auditory-evoked potential (AEP) recordings from adults with cystinosis (N = 15; ages: 19–38 years) to those of age-matched controls (N = 17). We employed a duration oddball paradigm with different stimulation rates, in which participants passively listened to regularly occurring standard tones interspersed with infrequently occurring deviant tones. Analyses focused on AEP components reflecting auditory sensory-perceptual processing (N1 and P2), sensory memory (mismatch negativity, MMN), and attentional orienting (P3a).
Results
Overall, adults with cystinosis produced highly similar sensory-perceptual AEP responses to those observed in controls suggesting intact early auditory cortical processing. However, significantly increased P2 and P3a amplitudes and reduced MMN at slower stimulation rates were observed, suggesting mild-to-moderate changes in auditory sensory memory and attentional processing. While cognitive testing revealed lower scores on verbal IQ and perceptual reasoning in cystinosis, these did not correlate with the AEP measures.
Conclusions
These neurophysiological data point to the emergence of subtle auditory processing deficits in early adulthood in cystinosis, warranting further investigation of memory and attentional processes in this population, and of their consequences for perceptual and cognitive function.
Increased Symptoms of Posttraumatic Stress in School Students Soon After the Start of the COVID-19 Outbreak in China
Authors: Xu Hanmei , Zhang Hang , Huang Lijuan , Wang Xiaolan , Tang Xiaowei , Wang Yanping , Xiao Qingqing , Xiong Ping , Jiang Rongqiu , Zhan Jie , Deng Fang , Yu Mingya , Liu Dong , Liu Xuejun , Zhang Chunli , Wang Wenjun , Li Lu , Cao Hongmei , Zhang Wenchao , Zhou Hongping , Wang Wo , Yin Li 
Published: January 2021

Abstract
Background: The outbreak of Coronavirus Disease 2019(COVID-19) caused psychological stress in Chinese adults population. But we are unaware of whether the pandemic causes psychological stress on children.Methods: We used the Children’s Impact of Event Scale questionnaire (CRIES-13) to investigate the degree of Post-traumatic Stress (PTSD) symptoms caused by the pandemic in students selected from schools in Sichuan, Jiangsu, Henan, Yunnan, and Chongqing provinces of China.Results: A total of 7769 students(3692 male and 4077 female), aged 8-18 years, were enrolled in the study, comprising 1214 in primary schools, 2799 in junior high schools and 3756 in senior high schools. A total of 1639 students (21.1%) had severe psychological stress reactions. A large proportion of senior high school students (23.3%) experienced severe psychological stress, and they had the highest median total CRIES-13 score. Female students were more likely to experience severe psychological stress and had higher median CRIES-13 total scores than males. Conclusion: COVID-19 has placed psychological stresses on primary and secondary school students in China. These stresses are more likely to reach severe levels among female students and senior high school students.
Career aspirations among specialty residents in France: a cross-sectional gender-based comparison
Authors: Cathelain Alice , Jourdain Mercedes , Cordonnier Charlotte , Jonard Sophie Catteau , Sebbane Deborah , Copin Marie-Christine , Berlingo Laura , Rubod Chrystele , Garabedian Charles 
Published: January 2021

Abstract
Background: Most studies evaluating career aspirations among gender are performed in Anglo-Saxon countries. Two recent French studies looked at the career choice of residents in obstetrics & gynecology. It seemed useful to us to broaden this questioning to other specialties, by proposing a study to all residents in the same Faculty. The objective of our study was to describe residents’ career aspirations and possible barriers according to gender.Methods: Declarative cross-sectional survey, using questionnaires sent by email to the specialty residents of the Faculty of Medicine of Lille (France). An analysis by specialty group (i.e., medicine, surgery, obstetrics & gynecology, and anesthesia & resuscitation) and a comparison of the results according to gender were performed.Results: Of the 1,384 specialty residents currently in training, 462 answered the questionnaire (33.38%), among whom 289 women and 173 men (average age = 27.08 ± 0.091 years). Seventeen women (5.9%) were currently considering a university hospital career versus 37 men (21.4%) (p = 0.001).Gender analysis made it possible to identify obstacles to engaging in a university career: lacking a female model, more frequent doubting the ability to undertake this type of career among women (61.6%) than men (35.3%) (p < 0.001), and gender discrimination felt in the workplace for 51.6% of women (versus 7.5% of men, p < 0.001). Subgroup analysis showed specificities related to each specialty.Conclusions: Few residents plan to embark upon a university hospital career, let alone female residents. There are considerations specific to each specialty and marked gender differences regarding career aspirations. Many features have been identified as obstacles to access to university hospital positions for women. It is important to develop strategies to remove these barriers and enable women to pursue such university careers.
ECOG-ACRIN 2399: Analysis of Patient Related Outcomes after Chemoradiation for Locally Advanced Head and Neck Cancer
Authors: Cmelak Anthony J. , Dietrich Mary S. , Li Shuli , Ridner Sheila , Forastiere Arlene A , Burtness Barbara A. , Cella David , Murphy Barbara A. 
Published: January 2021

Abstract
Background

We conducted a correlative study for E2399, a function preservation trial for resectable locally advanced oropharynx and larynx cancer, to prospectively assess effects of chemoradiation (CCR) on quality of life (QOL), swallowing and voice. We correlated the results of swallow assessments done via questionnaires and objective assessments.

Methods

The Functional Assessment of Cancer-HN (FACT-HN), the Performance Status Scale – Head and Neck (PSS-HN), swallow assessments (including modified barium swallow studies), and voice assessments (Voice Handicap Index and the Voice Disability Assessment) were conducted at baseline and periodically post-treatment for 2 years.

Results

Baseline QOL and swallowing function predicted overall survival. Patients experienced a marked decrease in QOL, swallowing, and speech post CCR although the decrease in vocal function was modest. Function and QOL returned towards baseline in the majority of patients by 12 months post treatment. Less than 10% of patients had severe dysphagia and were PEG dependent at 12 months post treatment. There was a high degree of correlation between the FACT-HN and PSS-HN swallow items. Statistically significant correlations were found between subjective and objective measures of swallow function.

Conclusions

Patients experience marked loss in swallowing function post CCR which returned to baseline in the majority of patients. The correlations between the FCM and self-report swallow items on the PSS and FACT-HN appear to be sufficiently strong to justify their use as a surrogate marker for swallowing disability in large therapeutic trials.
Socio-demographic associations of HIV among women attending antenatal care in selected rural primary care facilities in South Africa's Eastern Cape province.
Authors: Mabunda Sikhumbuzo A , Sigovana Khuthala , Chitha Wezile , Apalata Teke , Nomatshila Sibusiso 
Published: January 2021

Abstract
Background: To effectively reduce vertical HIV transmission requires a reduction of HIV prevalence and incidence among pregnant women and a full understanding of its epidemiology. The study aimed to determine the prevalence of HIV among women attending antenatal care and further determine spousal support during antenatal care attendance in rural areas in Eastern Cape province, South Africa.Methods: A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted using an interviewer-administered questionnaire which collected information on socio-demographic characteristics and medical history. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (95%CI) is used for precision of estimates; p≤0.05 for statistical significance.Results: A total of 343 participants were included in the final analysis. The antenatal HIV prevalence was 38.2% (95%CI: 33.2 – 43.9). For 75% of the women, the HIV diagnosis was made 141 days before the date of the interview (median=77 days, interquartile range=42-141 days). Participants between the age of 30 to 39 years were 50% more likely to be HIV positive compared to those who were between the age of 20 to 29, these differences were statistically significant (PR=1.5; p-value=0.001). Furthermore, self-employed women were 30% less likely to be HIV positive when compared to unemployed participants, this was also statistically significant (PR=0.7; p-value<0.0001).Conclusion: Despite a 100% antenatal HIV testing rate, the antenatal HIV prevalence remains high in this population, coupled with no spousal attendance in antenatal care. It is important to move beyond awareness about the HIV status to actionable strategies of reducing the HIV incident cases. It is therefore important to remain vigilant and monitor mother-to-child transmission that could be associated with this increased prevalence.
Reliability of Simulation-based Assessment for Practicing Physicians: Performance is Context-Specific
Authors: Sinz Elizabeth , Banerjee Arna , Steadman Randolph , Shotwell Matthew S , Slagle Jason , McIvor William R , Torsher Laurence , Burden Amanda , Cooper Jeffrey , DeMaria Samuel , Levine Adam I , Park Christine , Gaba David M , Weinger Matthew B , Boulet John R 
Published: January 2021

Abstract
Introduction: Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established.Methods: Standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities. A subset of the study population agreed to participate as the primary responder in a second scenario for this study. The physicians were assessed independently by trained raters on both teamwork/behavioural and technical performance measures. Analysis using Generalisability and Decision studies were completed for the two scenarios with two raters.Results: The behavioural score was not more reliable than the technical score. With two raters > 20 scenarios would be required to achieve a reliability estimate of 0.7. Increasing the number of raters for a given scenario would have little effect on reliability.Conclusions: The performance of practicing physicians on simulated critical events may be highly context-specific. Realistic simulation-based assessment for practicing physicians is resource-intensive and may be best-suited for individualized formative feedback. More importantly, aggregate data from a population of participants may have an even higher impact if used to identify skill or knowledge gaps to be addressed by training programs and inform continuing education improvements across the profession.
Investigation of the relationship between Community-acquired respiratory distress syndrome toxin and the High-mobility group box protein 1-Toll-like receptors-Myeloid differentiation factor 88 signaling pathway in Mycoplasma pneumoniae pneumonia
Authors: Fan Yujie , Ding Ying , Li Yuqin , Zhang Dandan , Yu Min , Zhou Wei-fang , Kong Xiaoxing 
Published: January 2021

Abstract
Background: In recent years, reports of refractory Mycoplasma pneumoniae pneumonia (RMPP) have gradually increased, including reports on how these conditions threaten the lives of children. However, the specific mechanism of Mycoplasma pneumoniae pneumonia (MPP) remains unclear. This study aimed to investigate the relationship between community-acquired respiratory distress syndrome toxin (CARDS TX) and High-mobility group box protein 1-Toll-like receptors-Myeloid differentiation factor 88 (HMGB1-TLRs-MyD88) in MPP and to examine the immune pathogenesis of Mycoplasma pneumoniae infection. Methods: Children who were diagnosed with MPP and examined by bronchoscopy were included in the MPP group. Additionally, children who underwent bronchoscopy because of bronchial foreign bodies in the same period were included in the control group. Gene expression of CARDS TX, HMGB1, Toll-like receptor 2 (TLR2), Toll-like receptor 4 (TLR4), MyD88, and cluster of differentiation 14 (CD14) in bronchoalveolar lavage fluid (BALF) were detected using real-time reverse transcription-polymerase chain reaction. Correlations between CARDS TX and HMGB1-TLRs-MyD88 were analyzed. Results: CARDS TX, HMGB1, TLR2, MyD88, and CD14 mRNA expression in BALF in the MPP group was significantly higher than that in the control group (all P< 0.05). CARDS TX mRNA expression was positively correlated with HMGB1, TLR2, MyD88, and CD14 mRNA expression (all P< 0.05). Furthermore, HMGB1 mRNA expression was positively correlated with TLR2, MyD88, and CD14 mRNA expression (all P< 0.05). Conclusions: CARDS TX may participate in the immune pathogenesis of MPP through the HMGB1-TLRs/CD14-MyD88 pathway.
A minimally invasive approach for chronic pancreatitis: combination of Frey procedure and laparoscopic distal pancreatectomy
Authors: Saito Kenta , Matsuo Yoichi , Ueda Goro , Omi Kan , Hayashi Yuichi , Imafuji Hiroyuki , Tsuboi Ken , Morimoto Mamoru , Ogawa Ryo , Takahashi Hiroki , Naitoh Itaru , Hayashi Kazuki , Kataoka Hiromi , Takiguchi Shuji 
Published: January 2021

Abstract
Background: The treatment of chronic pancreatitis requires a surgical approach in patients refractory to medical therapy. During surgical treatment, ductal decompression is required, but a pancreatectomy is necessary for some patients, such as those with severe stenosis of the pancreatic duct. Importantly, inadequate procedures lead to recurrent pancreatitis. We used a minimally invasive approach for patients with severe stenosis of the pancreatic duct. In this report, we aim to present the feasibility and outcomes of our approach. Methods: We selected a laparoscopic approach for the distal pancreatectomy because these parts are relatively safe and the effect of reducing the length of the wound is substantial. We selected an open approach for parts of the Frey procedure because complete ductal compression has a high risk for injury to the vessels posterior to the pancreas. We examined operative outcomes, postoperative complications and recurrence of pancreatitis.Results: Our approach was performed in three patients from January 2018 to December 2018. No intraoperative complications occurred and the postoperative course was uneventful in all patients. There were no recurrence of pancreatitis and no postoperative pain in all patients in the over two years follow-up. Conclusion: Our hybrid method focusing on complete ductal compression with safety and minimal invasiveness is the optimal approach for the surgical treatment of chronic pancreatitis which requires a pancreatectomy with the Frey procedure.
Wind and Gravity in Shaping Picea Trunks
Authors: Larjavaara Markku , Auvinen Mikko , Kantola Anu , Mäkelä Annikki 
Published: January 2021

Abstract
Understanding why trunks (tree stems) are the size that they are is important. However, this understanding is fragmented into isolated schools of thought and has been far from complete. Realistic calculations on minimum trunk diameters needed to resist bending moments caused by wind and gravity would be a significant step forward. However, advancements using this biomechanical approach have been delayed by difficulties in modelling bending of trunks and wind gusts. We felled and measured five Norway spruces (Picea abies) in an unthinned monoculture in southeastern Finland planted 67 years earlier. We focused on forces working on storm-bent (maximally bent) trees caused by gravity and the strongest gust in a one-hour simulation with a large-eddy simulation model. The weakest points along the trunks of the three largest trees resisted mean above-canopy wind speeds ranging from 10.2 m s-1 to 12.7 m s-1 (3.3-fold in the strongest gust), but the two smallest were well protected by a dense layer of leaves from the bending tops of larger trees, and could have resisted stronger winds. Gravity caused approximately one quarter of the critical bending moments. The wind that breaks the trunks in their weakest points is close to breaking them in other points, supporting importance of bending moments caused by wind and gravity in evolution of trunk taper. This approach could also be used to model tree biomasses and how those may change with changing climate.
Clinical characteristics and predictive value of lower CD4+T cell level in patients with moderate and severe COVID-19: A multicenter retrospective study
Authors: Wen Xue-song , Jiang Dan , Gao Lei , Zhou Jian zhong , Xiao Jun , Cheng Xiao-cheng , He Bin , Chen Yue , Lei Peng , Tan Xiao-wei , Qin Shu , Zhang Dongying 
Published: January 2021

Abstract
BackgroundIn December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei, China. Moreover, it has become a global pandemic. This is of great value in describing the clinical symptoms of COVID-19 patients in detail and looking for markers which are significant to predict the prognosis of COVID-19 patients.MethodsIn this multicenter, retrospective study, 476 patients with COVID-19 were enrolled from a consecutive series. After screening, a total of 395 patients were included in this study. All-cause death was the primary endpoint. All patients were followed up from admission till discharge or death.ResultsThe main symptoms observed in the study included fever on admission, cough, fatigue, and shortness of breath. The most common comorbidities were hypertension and diabetes mellitus. Patients with lower CD4+T cell level were older and more often male compared to those with higher CD4+T cell level. Reduced CD8+T cell level was an indicator of the severity of COVID-19. Both decreased CD4+T [HR:13.659; 95%CI: 3.235-57.671] and CD8+T [HR: 10.883; 95%CI: 3.277-36.145] cell levels were associated with in-hospital death in COVID-19 patients, but only the decrease of CD4+T cell level was an independent predictor of in-hospital death in COVID-19 patients.ConclusionsReductions in lymphocytes and lymphocyte subsets were common in COVID-19 patients, especially in severe cases of COVID-19. It was the CD8+T cell level, not the CD4+T cell level, that reflected the severity of the patient’s disease. Only reduced CD4+T cell level was independently associated with increased in-hospital death in COVID-19 patients.Trial registration: Prognostic Factors of Patients With COVID-19, NCT04292964. Registered 03 March 2020. https://clinicaltrials.gov/ct2/show/NCT04292964. Retrospectively registered.