bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Coins of Philip the Tetrarch and the Imperial Cult: A View from Paneas on the Fall of Sejanus
Authors: Giambrone Anthony 
Published: February 2021

Abstract
Philip the Tetrarch, son of Herod the Great, was the first Jewish ruler to depict human images on his coins. This innovation of adopting numismatic portraiture must be understood in inseparable conjunction with Philip’s aggressive cultivation of the imperial cult at Paneas. The present article, accordingly, offers the first focused study of how the development of iconography on his issues corresponds to specific political events of cultic concern. In this connection, a new interpretation is suggested for Philip’s unique undated minting, deeply implicated in the imperial drama transpiring around the year 31 CE. The tetrarch’s savvy manipulation of images, when seen against this broad background, reveals his unwavering and intensifying allegiance to the domus Augusta: to the princeps in the form of a clipeus virtutis devotion and to Livia under the aspect of Demeter.
Assessment of decadal variability in sea ice in the Community Earth System Model against a long-term regional observational record: implications for the predictability of an ice-free Arctic
Authors: Desmarais Amélie , Tremblay Bruno 
Published: February 2021

AbstractUncertainties in the timing of a seasonal ice cover in the Arctic Ocean depend on model physics and parameterizations, natural variability at decadal timescales and uncertainties in climate scenarios and forcings. We use the Gridded Monthly Sea-Ice Extent and Concentration, 1850 Onward product to assess the simulated decadal variability from the Community Earth System Model – Large Ensemble (CESM-LE) in the Pacific, Eurasian and Atlantic sector of the Arctic where a longer observational record exists. Results show that sea-ice decadal (8-16 years) variability in CESM-LE is in agreement with the observational record in the Pacific sector of the Arctic, underestimated in the Eurasian sector of the Arctic, specifically in the East-Siberian Sea, and slightly overestimated in the Atlantic sector of the Arctic, specifically in the Greenland Sea. Results also show an increase in variability at decadal timescales in the Eurasian and Pacific sectors during the transition to a seasonally ice-free Arctic, in agreement with the observational record although this increase is delayed by 10-20 years. If the current sea-ice retreat in the Arctic continues to be Pacific-centric, results from the CESM-LE suggest that uncertainty in the timing of an ice-free Arctic associated with natural variability is realistic, but that a seasonal ice cover may occur earlier than projected.
Corneal cross-linking for treatment of progressive keratoconus in a patient with Alport syndrome: A case report
Authors: Krolo Iva , Kasumović Aida , Radman Ivana , Pavić Pavao 
Published: February 2021

Purpose: Ocular features of Alport syndrome include anterior lenticonus, posterior polymorphous corneal dystrophy, and fleck-and-dot retinopathy in most cases. Keratoconus in such patients has been rarely mentioned in previous studies. To our knowledge, this is the first report of corneal cross-linking for halting the progression of keratoconus in a patient with Alport syndrome. Case report: A 22-year-old male was referred for his initial corneal topography, after he was already prescribed with rigid gas-permeable contact lenses. Alport syndrome was diagnosed in his infancy and gene COL4A5 mutation was confirmed. Ophthalmological evaluation confirmed keratoconus. One-year follow-up showed a progression on his right eye and standard corneal cross-linking was performed. Stabilization of the disease marked by normalization in visual function and corneal tomography values was noticed 1 year after the procedure. Conclusions: When diagnosing ocular clinical findings of Alport syndrome, keratoconus should be considered. Standard corneal cross-linking protocol can halt its progression.
A quality analysis of the YouTube video content on meniscus repair surgery
Authors: Sigonney François , Steltzlen Camille , Bouché Pierre Alban , Pujol Nicolas 
Published: February 2021

Objectives: The Internet, especially YouTube, is an important and growing source of medical information. The content of this information is poorly evaluated. The objective of this study was to analyze the quality of YouTube video content on meniscus repair. The hypothesis was that this source of information is not relevant for patients. Methods: A YouTube search was carried out using the keywords "meniscus repair". Videos had to have had more than 10,000 views to be included. The videos were analyzed by two evaluators. Various features of the videos were recorded (number of views, date of publication, "likes", "don’t likes", number of comments, source, type of content and the origin of the video). The quality of the video content was analyzed by two validated information system scores: the JAMA benchmark score (0 to 4) and the Modified DISCERN score (0 to 5). A specific meniscus repair score (MRSS scored out of 22) was developed for this study, in the same way that a specific score has been developed for other similar studies (anterior cruciate ligament, spine, etc.). Results: Forty-four (44) videos were included in the study. The average number of views per video was 180,100 (± 222,000) for a total number of views of 7,924,095. The majority of the videos were from North America (90.9%). In most cases, the source (uploader) that published the video was a doctor (59.1%). A manufacturer, an institution and a non-medical source were the other sources. The content actually contained information on meniscus repair in only 50% of the cases. The mean scores for the JAMA benchmark, MD score and MRSS were 1.6/4± 0.75, 1.2/5 ± 1.02 and 4.5/22 (± 4.01) respectively. No correlation was found between the number of views and the quality of the videos. The quality of videos from medical sources was not superior to those from other sources. Conclusion: The content of YouTube videos on meniscus repair is of very low quality. Physicians should inform patients and, more importantly, contribute to the improvement of these contents.
Statewide implementation of high-fidelity recovery-oriented ACT: A case study
Authors: Herinckx Heidi , Kerlinger Alyssa , Cellarius Karen 
Published: February 2021

Background: Assertive Community Treatment (ACT) is a recognized evidence-based practice, but the use of Translation Science to ensure the broad implementation of high quality ACT services has not yet been fully explored. This single intrinsic case study explores how Oregon uses strategies identified through Translation Science to achieve statewide implementation of high-fidelity recovery-oriented ACT. Method: Multiple data sources were used to evaluate this implementation process, including ACT fidelity review reports, programmatic outcome data, a national ACT taskforce survey, and focus groups with program participants. Findings: In 2013, the Oregon Health Authority funded the creation of the Oregon Center of Excellence for Assertive Community Treatment to support the implementation of ACT. It also implemented administrative rules requiring an annual re-certification process with a minimum level of fidelity to the evidence-based model. Other implementation strategies included establishing an ACT Advisory Committee, quarterly reviews of implementation and outcome data, and trainings promoting the role of peer providers and related evidence-based practices. Conclusion: High-fidelity recovery-oriented ACT services in Oregon are maintained through multiple strategies, including codifying the minimum level of ACT implementation into state administrative rule, linking fidelity benchmarks scores to Medicaid reimbursements, and funding ongoing oversight, training and technical assistance through a statewide technical assistance center. Strict adherence to the ACT model has been a key to ensuring a uniform level of high-quality care across Oregon while incorporating additional evidence-based practices without compromising the integrity of the original model. Plain language abstract: Assertive Community Treatment (ACT) is a mental health program serving individuals with the most severe mental illness in the community. While ACT is an evidence-based practice, there is more research needed to explore how ACT is implemented and maintained in different settings. In 2013, Oregon implemented ACT statewide. The Oregon Center of Excellence for ACT was created to provide training and technical assistance to ACT teams and conduct yearly fidelity reviews. Oregon is among the few states who have attached funding to yearly ACT certification, uses community sizes to determine the size of the ACT teams, and the technical assistance center not only provides training but also conducts yearly review of fidelity to the ACT model. This case study will review the steps Oregon took to implement ACT, how it continues to monitor fidelity to the model and provide training and support, and focus on recovery orientation and integrating evidence-based practices. Continued support, training, and the linking of fidelity benchmark scores to program funding are the ways that Oregon makes sure that ACT teams are successfully implementing the ACT model to fidelity with recovery-oriented care.
Accurate and fast mitotic detection using an anchor-free method based on full-scale connection with recurrent deep layer aggregation in 4D microscopy images
Authors: Kitrungrotsakul Titinunt , Iwamoto Yutaro , Takemoto Satoko , Yokota Hideo , Ipponjima Sari , Nemoto Tomomi , Lin Lanfen , Tong Ruofeng , Li Jingsong , Chen Yen-Wei 
Published: February 2021

Abstract
Background
To effectively detect and investigate various cell-related diseases, it is essential to understand cell behaviour. The ability to detection mitotic cells is a fundamental step in diagnosing cell-related diseases. Convolutional neural networks (CNNs) have been successfully applied to object detection tasks, however, when applied to mitotic cell detection, most existing methods generate high false-positive rates due to the complex characteristics that differentiate normal cells from mitotic cells. Cell size and orientation variations in each stage make detecting mitotic cells difficult in 2D approaches. Therefore, effective extraction of the spatial and temporal features from mitotic data is an important and challenging task. The computational time required for detection is another major concern for mitotic detection in 4D microscopic images.

Results
In this paper, we propose a backbone feature extraction network named full scale connected recurrent deep layer aggregation (RDLA++) for anchor-free mitotic detection. We utilize a 2.5D method that includes 3D spatial information extracted from several 2D images from neighbouring slices that form a multi-stream input.

Conclusions
Our proposed technique addresses the scale variation problem and can efficiently extract spatial and temporal features from 4D microscopic images, resulting in improved detection accuracy and reduced computation time compared with those of other state-of-the-art methods.
Andersen’s utilization model for cataract surgical rate and empirical evidence from economically-developing areas
Authors: Lin Senlin , Ma Yingyan , Hou Zhiyuan , Congdon Nathan , Lu Lina , Zou Haidong 
Published: February 2021

Abstract
Background
Un-operated cataract is the leading cause of vision loss worldwide, responsible for 33% of visual impairment, and half of global blindness. The study aimed to build a fast evaluation method utilizing Andersen’s utilization framework and identify predictors of cataract surgical rate in sub-Saharan Africa and China.

Methods
The study was a cross-over ecological epidemiology study with a total of 19 countries in sub-Saharan Africa, and 31 provinces in China. Information was extracted from public data and published studies. Linear regression and structural equation modeling with Bootstrap were used to analyze predictors of CSR and their pathways to impact in sub-Saharan Africa and China separately.

Results
Cataract surgical resources in sub-Saharan Africa were linearly correlated with CSR (β = 0.74, 95% CI: 0.09, 0.91), while GDP/P didn’t impact cataract surgical resources (β = 0.29, 95% CI: − 0.12, 0.75). In China, residents’ average ability to pay was confirmed as the mediator between GDP/P and CSR (p = 0.32, RMSEA = 0.07; βCSR-paying = 0.77, 95% CI: 0.25, 0.90; βpaying-GDP/P = 0.89, 95% CI: 0.82, 0.93).

Conclusions
In sub-Saharan Africa, CSR is determined by health care provision. Local economic development may not directly influence CSR. Therefore, international assistance aimed to providing free cataract surgery directly is crucial. In China, CSR is determined principally by health care demand (ability to pay). To increase CSR in underserved areas of China, ability to pay must be enhanced through social insurance, and reduced surgical fees.
Awareness of obstetric danger signs among pregnant women in the Democratic Republic of Congo: evidence from a nationwide cross-sectional study
Authors: Nkamba Dalau Mukadi , Wembodinga Gilbert , Bernard Pierre , Ditekemena John , Robert Annie 
Published: February 2021

Abstract
Background
Poor awareness of obstetric danger signs is a major contributing factor to delays in seeking obstetric care and hence to high maternal mortality and morbidity worldwide. We conducted the current study to assess the level of agreement on receipt of counseling on obstetric danger signs between direct observations of antenatal care (ANC) consultation and women’s recall in the exit interview. We also identified factors associated with pregnant women’s awareness of obstetric danger signs during pregnancy in the Democratic Republic of Congo (DRC)

Methods
We used data from the 2017–2018 DRC Service Provision Assessment survey. Agreement between the observation and woman’s recall was measured using Cohen’s kappa statistic and percent agreement. Multivariable Zero-Inflated Poisson (ZIP) regression was used to identify factors associated with the number of danger signs during pregnancy the woman knew.

Results
On average, women were aware of 1.5 ± 1.34 danger signs in pregnancy (range: 0 to 8). Agreement between observation and woman’s recall was 70.7%, with a positive agreement of 16.9% at the country level but ranging from 2.1% in Bandundu to 39.7% in Sud Kivu. Using multivariable ZIP analysis, the number of obstetric danger signs the women mentioned was significantly higher in multigravida women (Adj.IRR = 1.38; 95% CI: 1.23–1.55), in women attending a private facility (Adj.IRR = 1.15; 95% CI: 1.01–1.31), in women attending a subsequent ANC visit (Adj.IRR = 1.11; 95% CI: 1.01–1.21), and in women counseled on danger signs during the ANC visit (Adj.IRR = 1.19; 95% CI: 1.05–1.35). There was a regional variation in the awareness of danger signs, with the least mentioned signs in the middle and the most in the eastern provinces.

Conclusions
Our findings indicated poor agreement between directly observed counseling and women’s reports that counseling on obstetric danger signs occurred during the current ANC visit. We found that province of residence, provision of counseling on obstetric danger signs, facility ownership, gravidity and the number of ANC visits were predictors of the awareness of obstetric danger signs among pregnant women. These factors should be considered when developing strategies aim at improving women’s awareness about obstetric danger signs in the DRC
The scale and structure of government financial investment in traditional medicine based on optimal efficiency: evidence from public traditional Chinese medicine hospitals (PTHs) of Henan province, China
Authors: Ren Weicun , Fu Xiaoli , Tarimo Clifford Silver , Kasanga Maisa , Wang Yanqing , Wu Jian 
Published: February 2021

AbstractBackgroundTraditional medicine has been widely used to address relatively common illnesses. In this regard, Chinese government has been continually topping up its investments on public Traditional Chinese Medicine hospitals (PTHs) in recent years. This study aimed to assess the optimal scales and structure of the investments in Henan province by analyzing the contribution of Government Financial Investment (GFI) to the efficiency and revenue growth of PTHs as well as recommending proper investment strategies for implementation to policy-makers.MethodsThis study was a panel data study, conducted in Henan Province, China. By collecting 143 PTHs’ operational data from the year 2005 to 2017, Barro Economic Growth (BEG) model, Stochastic Frontier Analysis (SFA) and Vector Autoregressive (VAR) model were used to assess the efficiency and PTHs revenue.ResultsThe study observed the positive contribution of GFI to PTHs’ revenue growth (average MPG = 2.84), indicating that the GFI had not reached the required optimal level of “Barro Law”. In order to maximize the input-output efficiency, the scales of GFI on Grade III, Grade II A, Grade II B PTHs need to be increased by − 5.96, 4.88 and 11.51%, respectively. The third year following the first investment may be a more essential period for conducting an effective GFI evaluation in Henan Province.ConclusionsGFI on PTHs usually has a long-term impact on PTHs. Governments can adjust its GFI policy so as to maximize the input-output efficiency.
Genetic spectrum and clinical early natural history of glucose-6-phosphate dehydrogenase deficiency in Mexican children detected through newborn screening
Authors: Vela-Amieva Marcela , Alcántara-Ortigoza Miguel Angel , González-del Angel Ariadna , Belmont-Martínez Leticia , López-Candiani Carlos , Ibarra-González Isabel 
Published: February 2021

Abstract
Background
Glucose-6-phosphate dehydrogenase deficiency (G6PDd) newborn screening is still a matter of debate due to its highly heterogeneous birth prevalence and clinical expression, as well as, the lack of enough knowledge on its natural history. Herein, we describe the early natural clinical course and the underlying GDPD genotypes in infants with G6PDd detected by newborn screening and later studied in a single follow-up center. G6PDd newborns were categorized into three groups: group 1: hospitalized with or without neonatal jaundice (NNJ); group 2: non-hospitalized with NNJ; and group 3: asymptomatic. Frequencies of homozygous UGT1A1*28 (rs34983651) genotypes among G6PDd patients with or without NNJ were also explored.

Results
A total of 81 newborns (80 males, one female) were included. Most individuals (46.9%) had NNJ without other symptoms, followed by asymptomatic (42.0%) and hospitalized (11.1%) patients, although the hospitalization of only 3 of these patients was related to G6PDd, including NNJ or acute hemolytic anemia (AHA). Nine different G6PDd genotypes were found; the G6PD A−202A/376G genotype was the most frequent (60.5%), followed by the G6PD A−376G/968C (22.2%) and the Union-Maewo (rs398123546, 7.4%) genotypes. These genotypes produce a wide range of clinical and biochemical phenotypes with significant overlapping residual enzymatic activity values among class I, II or III variants. Some G6PD A−202A/376G individuals had enzymatic values that were close to the cutoff value (5.3 U/g Hb, 4.6 and 4.8 U/g Hb in the groups with and without NNJ, respectively), while others showed extremely low enzymatic values (1.1 U/g Hb and 1.4 U/g Hb in the groups with and without NNJ, respectively). Homozygosity for UGT1A1*28 among G6PDd patients with (11.9%, N = 5/42) or without (10.3%, N = 4/39) NNJ did not shown significant statistical difference (p = 0.611).

Conclusion
Wide variability in residual enzymatic activity was noted in G6PDd individuals with the same G6PD genotype. This feature, along with a documented heterogeneous mutational spectrum, makes it difficult to categorize G6PD variants according to current WHO classification and precludes the prediction of complications such as AHA, which can occur even with > 10% of residual enzymatic activity and/or be associated with the common and mild G6PD A−376G/968C and G6PD A−202A/376G haplotypes.
Contraceptive method use, discontinuation and failure rates among women aged 15–49 years: evidence from selected low income settings in Kumasi, Ghana
Authors: Bawah Ayaga A. , Sato Ryoko , Asuming Patrick , Henry Elizabeth G. , Agula Caesar , Agyei-Asabere Charles , Canning David , Shah Iqbal 
Published: February 2021

Abstract
Background
This paper provides estimates of contraceptive discontinuation and failure rates in a poor urban setting in Ghana. Contraceptive use is for the purposes of preventing unintended or mistimed pregnancies. Unfortunately, evidence abounds in many parts of the world where there is considerable levels of contraceptive failure and high levels of discontinuation resulting in unintended pregnancies.

Methods
We estimated discontinuation rates during a 12-month period since starting use by applying single and multiple decrement life table methods to the contraceptive calendar data collected in a survey of women in reproductive age of 15–49 years.

Results
Modern contraceptive method use was estimated to be 13.7% at the time of the survey. The results show that contraceptive method discontinuation vary markedly by type of contraceptive method but are high for almost all methods, except for implants (23.7%). Discontinuation rate for emergency contraception was estimated at 88.5%, withdrawal 87.6%, and male condom use 80.9%. However, discontinuation rates were moderately high for rhythm (63.6%), pills (65.6%) and injectables (56%). In terms of failure rates, overall contraceptive failure for all methods was estimated at 7.9%. The factors significantly associated with method failure include being within age bracket 40–44 years (OR = 0.3, p < 0.05), having secondary/higher education (OR = 0.4, p < 0.01), belonging to the richest household wealth scale (OR = 3.3, p < 0.01), currently in union with a partner (OR = 2.2, p < 0.01), and using contraceptive methods such as rhythm (OR = 5.6, p < 0.01) and withdrawal (OR = 3.7, p < 0.01). On the flip side, the odds for method discontinuation were significantly higher for women in their 20s and mid 30s, formerly in union (OR = 1.9, p < 0.05) and use of withdrawal method (OR = 1.4, p < 0.05) and lower for women formerly in union (OR = 0.4, p < 0.01) and use of implants (OR = 0.2, p < 0.01) and injectables (OR = 0.6, p < 0.01).

Conclusion
While contraceptives use is low, both discontinuation and failure rates are high and variable among different methods. Failure and discontinuation rates are lowest for long-acting methods such as implants while higher failure rates are more prevalent among women who rely on withdrawal and the rhythm methods.