bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Inter-Agency Expert Panel's Prioritisation of Clinical Quality Improvement Topics in a Paramedic System
Authors: Campeau Anthony , Huiskamp Maud , Sykes Nicole , Kriening Susan , Bourn Scott , VanAarsen Kritine 
Published: June 2021

Introduction Quality improvement (QI) programs have become common in paramedic systems, but they are often limited to individual agencies. Modern paramedicine involves many different agencies and inter-agency QI programs would better reflect their co-operative efforts. Similarly, inter-agency use of clinical outcome measurements can offer system level performance data. This study's intent was to explore the feasibility of planning an inter-agency QI program that uses outcome measures. Methods This study used a modified Delphi methodology. A 49-member panel of inter-agency representatives was convened to identify and prioritise clinical outcome-based topics. Over a 3-month period, two online surveys were conducted followed by a 1-day face-to-face meeting. Results The study demonstrated very high participation rates. Results progressed from an initial wide range of 38 topics to a final consensus of two: infection/sepsis and patient safety/care pathways, complete with outcome measures. Conclusion Inter-agency quality improvement planning is an under investigated area, but this study demonstrates that it is feasible. Additionally, this planning can incorporate clinical outcome measures that inform system level discussions about quality. Other paramedic agencies may draw on the study's processes when planning their own quality improvement programs.
Prognostic Value of Coronary Artery Calcification Identified by the Semi-quantitative Weston Method in the Emergency Room or Other Hospitalized Patients
Authors: Chen Lu , Vavrenyuk Andrey , Ren Jun Hong , Desai Pankil , Bahgat Joseph , Bernstein Michael A. , Ebright Michael I. , Gowda Mamatha , Rose Suzanne , Fallahi Arzhang , Stainken Brian , Hsi David H. 
Published: June 2021

Background: Coronary artery calcification (CAC) may provide insight to the patients' coronary artery disease (CAD) risks and influence early intervention. With increasing use of non-gated CT scans in clinical practice, the visual coronary artery scoring system (Weston Method) could quickly provide clinicians with important information of CAC for patient triage and management.Methods: We retrospectively studied the available CT imaging data and estimated CAC burden using the Weston method in 493 emergency room or other hospitalized patients. The Weston scores were calculated by the sum of the score for each vessel including the left main, left anterior descending, left circumflex artery and right coronary artery (range 0–12). The primary endpoint was a composite of the major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, stroke, and coronary revascularization.Results: During a median follow-up of 85 months, a total of 25 (5.1%) MACE were recorded and 57 (11.2%) patients died from any causes. Detectable CAC was most common (96%) in the left anterior descending coronary arteries. Multivariable analysis showed that CAC total scores were independent predictors for MACE and all-cause mortality. Receiver operating characteristic analysis showed that CAC total score ≥5 was the optimal cutoff value for predicting MACEs.Conclusions: In the emergency room and hospitalized patients, the semi-quantitation of CAC burden using the Weston score system was related to the long-term cardiovascular outcomes including mortality. Clinicians and radiologists should maximize the value of non-contrast chest CT images by reporting CAC details.
Success Factors of Artificial Intelligence Implementation in Healthcare
Authors: Wolff Justus , Pauling Josch , Keck Andreas , Baumbach Jan 
Published: June 2021

Background: Artificial Intelligence (AI) in healthcare has demonstrated high efficiency in academic research, while only few, and predominantly small, real-world AI applications exist in the preventive, diagnostic and therapeutic contexts. Our identification and analysis of success factors for the implementation of AI aims to close the gap between recent years' significant academic AI advancements and the comparably low level of practical application in healthcare.Methods: A literature and real life cases analysis was conducted in Scopus and OpacPlus as well as the Google advanced search database. The according search queries have been defined based on success factor categories for AI implementation derived from a prior World Health Organization survey about barriers of adoption of Big Data within 125 countries. The eligible publications and real life cases were identified through a catalog of in- and exclusion criteria focused on concrete AI application cases. These were then analyzed to deduct and discuss success factors that facilitate or inhibit a broad-scale implementation of AI in healthcare.Results: The analysis revealed three categories of success factors, namely (1) policy setting, (2) technological implementation, and (3) medical and economic impact measurement. For each of them a set of recommendations has been deducted: First, a risk adjusted policy frame is required that distinguishes between precautionary and permissionless principles, and differentiates among accountability, liability, and culpability. Second, a “privacy by design” centered technology infrastructure shall be applied that enables practical and legally compliant data access. Third, the medical and economic impact need to be quantified, e.g., through the measurement of quality-adjusted life years while applying the CHEERS and PRISMA reporting criteria.Conclusions: Private and public institutions can already today leverage AI implementation based on the identified results and thus drive the translation from scientific development to real world application. Additional success factors could include trust-building measures, data categorization guidelines, and risk level assessments and as the success factors are interlinked, future research should elaborate on their optimal interaction to utilize the full potential of AI in real world application.
Association Between Pre-Pregnancy Body Mass Index and Miscarriage in an Assisted Reproductive Technology Population: A 10-Year Cohort Study
Authors: Qu Pengfei , Yan Mingxin , Zhao Doudou , Wang Dongyang , Dang Shaonong , Shi Wenhao , Shi Juanzi , Zhang Chunli 
Published: June 2021

ObjectiveTo investigate the association between pre-pregnancy body mass index (BMI) and miscarriages in women who required assisted reproductive technology (ART) for conception.MethodsA retrospective cohort study was conducted using a 10-year (2006–2015) sample of 14,994 pregnancy cycles with ART treatment in Northwest Women’s and Children’s Hospital, Xi’an, China. The effects of women’s BMI before pregnancy on early miscarriage and miscarriage were assessed using generalized estimating equation models.ResultsThe risks of early miscarriage and miscarriage were higher in the obese group than in the normal weight group [early miscarriage: relative risk (RR) = 1.36, confidence interval (CI): 1.12–1.65; miscarriage: RR = 1.40, 95% CI: 1.17–1.68]. Pre-pregnancy underweight was not associated with an increased risk of early miscarriage or miscarriage. We observed interactions between pre-pregnancy BMI and singleton or twin pregnancy in early miscarriage and miscarriage (P = 0.017 and P = 0.003, respectively). Twin pregnancy increased the effects of pre-pregnancy BMI on early miscarriage and miscarriage (early miscarriage: a. singleton pregnancy: RR = 1.02, 95% CI: 1.01–1.04; b. twin pregnancy: RR = 1.08, 95% CI: 1.03–1.13; miscarriage: a. singleton pregnancy: RR = 1.02, 95% CI: 1.01–1.04; b. twin pregnancy: RR = 1.08, 95% CI: 1.05–1.13).ConclusionsPre-pregnancy obesity was associated with higher risks of early miscarriage and miscarriage in the ART population, and twin pregnancy increased the effects of pre-pregnancy BMI on early miscarriage and miscarriage. Women should maintain a normal BMI before ART initiation to prevent adverse pregnancy outcomes.
Tomography Imaging of Lithium Electrodeposits Using Neutron, Synchrotron X-Ray, and Laboratory X-Ray Sources: A Comparison
Authors: Magnier Lucile , Lecarme Lauréline , Alloin Fannie , Maire Eric , King Andrew , Bouchet Renaud , Tengattini Alessandro , Devaux Didier 
Published: June 2021

X-ray and neutron imaging are widely employed for battery materials, thanks to the possibility to perform noninvasive in situ and in operando analyses. X-ray tomography can be performed either in synchrotron or in laboratory facilities and is particularly well-suited to analyze bulk materials and electrode/electrolyte interfaces. Several post-lithium-ion (Li-ion) devices, such as Li–sulfur, Li–O2, or all-solid-state Li batteries, have an anode made of metallic Li in common. The main failure mode of Li batteries is the inhomogeneity of the Li electrodeposits onto the Li anode during charge steps, leading to dendrite growth and low Coulombic efficiency. X-ray tomography is a powerful tool for studying dendrites as it provides useful information about their locations, dynamics, and microstructures. So far, the use of neutron tomography is scarcely reported for Li deposit analysis due to the difficulty in reaching sufficient image resolution to capture the deposit microstructure, that is, typically below 10–20 µm. The very different interactions of X-rays and neutrons with Li, which has significantly different opacity in the two cases, make the two techniques highly complementary. Notably, the capacity of neutrons to discern different Li isotopes is pivotal to getting an insight into the composition of Li deposits by distinguishing between Li originating from an electrode (6Li in this study) and Li originating from the Li salt electrolyte (mainly in 7Li here). Indeed, the theoretical linear neutron attenuation coefficient of 6Li is about 15 and 2,000 times larger than that of natural Li and 7Li, respectively. Therefore, a high imaging contrast difference is obtained between 6Li (high attenuation) and natural Li and 7Li (lower attenuations), which could allow a better understanding of the origin of the Li comprising the electrodeposits. In this work, we report, as a proof of concept, an in situ neutron tomography imaging of Li electrodeposits in a cycled Li symmetric cell. The electrochemical cell comprises a natural Li electrode, a 6Li electrode, and a deuterated liquid electrolyte. The neutron tomographies are compared with X-ray tomography images of the same electrochemical cell acquired both at an X-ray synchrotron beamline and at a laboratory X-ray tomograph. Neutron tomography is shown to be compatible with in situ analysis and capable of capturing the overall morphology of the Li deposits in good accordance with X-ray tomography analyses.
Immune Tolerance-Adjusted Personalized Immunogenicity Prediction for Pompe Disease
Authors: De Groot Anne S. , Desai Ankit K. , Lelias Sandra , Miah S. M. Shahjahan , Terry Frances E. , Khan Sundos , Li Cindy , Yi John S. , Ardito Matt , Martin William D. , Kishnani Priya S. 
Published: June 2021

Infantile-onset Pompe disease (IOPD) is a glycogen storage disease caused by a deficiency of acid alpha-glucosidase (GAA). Treatment with recombinant human GAA (rhGAA, alglucosidase alfa) enzyme replacement therapy (ERT) significantly improves clinical outcomes; however, many IOPD children treated with rhGAA develop anti-drug antibodies (ADA) that render the therapy ineffective. Antibodies to rhGAA are driven by T cell responses to sequences in rhGAA that differ from the individuals’ nativeGAA(nGAA). The goal of this study was to develop a tool forpersonalizedimmunogenicity riskassessment (PIMA) that quantifies T cell epitopes that differ between nGAA and rhGAA using information about an individual’s native GAA gene and their HLA DR haplotype, and to use this information to predict the risk of developing ADA. Four versions of PIMA have been developed. They use EpiMatrix, a computational tool for T cell epitope identification, combined with an HLA-restricted epitope-specific scoring feature (iTEM), to assess ADA risk. One version of PIMA also integrates JanusMatrix, a Treg epitope prediction tool to identify putative immunomodulatory (regulatory) T cell epitopes in self-proteins. Using the JanusMatrix-adjusted version of PIMA in a logistic regression model with data from 48 cross-reactive immunological material (CRIM)-positive IOPD subjects, those with scores greater than 10 were 4-fold more likely to develop ADA (p&lt;0.03) than those that had scores less than 10. We also confirmed the hypothesis that some GAA epitopes are immunomodulatory. Twenty-one epitopes were tested, of which four were determined to have an immunomodulatory effect on T effector responsein vitro. The implementation of PIMA V3J on a secure-access website would allow clinicians to input the individual HLA DR haplotype of their IOPD patient and the GAA pathogenic variants associated with each GAA allele to calculate the patient’s relative risk of developing ADA, enhancing clinical decision-making prior to initiating treatment with ERT. A better understanding of immunogenicity risk will allow the implementation of targeted immunomodulatory approaches in ERT-naïve settings, especially in CRIM-positive patients, which may in turn improve the overall clinical outcomes by minimizing the development of ADA. The PIMA approach may also be useful for other types of enzyme or factor replacement therapies.
High Antibodies to VAR2CSA in Response to Malaria Infection Are Associated With Improved Birthweight in a Longitudinal Study of Pregnant Women
Authors: McLean Alistair R. D. , Opi D. Herbert , Stanisic Danielle I. , Cutts Julia C. , Feng Gaoqian , Ura Alice , Mueller Ivo , Rogerson Stephen J. , Beeson James G. , Fowkes Freya J. I. 
Published: June 2021

IntroductionPregnant women have an increased risk of P. falciparum infection, which is associated with low birth weight and preterm delivery. VAR2CSA, a variant surface antigen expressed on the parasitized erythrocyte surface, enables sequestration in the placenta. Few studies have prospectively examined relationships between antibody responses during pregnancy and subsequent adverse birth outcomes, and there are limited data outside Africa.MethodsLevels of IgG against VAR2CSA domains (DBL3; DBL5) and a VAR2CSA-expressing placental-binding P. falciparum isolate (PfCS2-IE) were measured in 301 women enrolled at their first visit to antenatal care which occurred mid-pregnancy (median = 26 weeks, lower and upper quartiles = 22, 28). Associations between antibody levels at enrolment and placental infection, birthweight and estimated gestational age at delivery were assessed by linear and logistic regression with adjustment for confounders. For all outcomes, effect modification by gravidity and peripheral blood P. falciparum infection at enrolment was assessed.ResultsAmong women who had acquired P. falciparum infection at enrolment, those with higher levels of VAR2CSA antibodies (75th percentile) had infants with higher mean birthweight (estimates varied from +35g to +149g depending on antibody response) and reduced adjusted odds of placental infection (aOR estimates varied from 0.17 to 0.80), relative to women with lower levels (25th percentile) of VAR2CSA antibodies. However, among women who had not acquired an infection at enrolment, higher VAR2CSA antibodies were associated with increased odds of placental infection (aOR estimates varied from 1.10 to 2.24).ConclusionsWhen infected by mid-pregnancy, a better immune response to VAR2CSA-expressing parasites may contribute to protecting against adverse pregnancy outcomes.
Significance of PD1 Alternative Splicing in Celiac Disease as a Novel Source for Diagnostic and Therapeutic Target
Authors: Ponce de León Candelaria , Lorite Pedro , López-Casado Miguel Ángel , Barro Francisco , Palomeque Teresa , Torres María Isabel 
Published: June 2021

BackgroundWe have focused on the alteration of the PD-1/PD-L1 pathway in celiac disease and discussed the roles of the PD1 pathway in regulating the immune response. We explored the idea that the altered mRNA splicing process in key regulatory proteins could represent a novel source to identify diagnostic, prognostic, and therapeutic targets in celiac disease.MethodsWe characterized the PD1 mRNA variants’ profile in CD patients and in response to gluten peptides’ incubation after in vitro experiments. Total RNA from whole blood was isolated, and the coding region of the human PD-1 mRNA was amplified by cDNA PCR.ResultsPCR amplification of the human PD-1 coding sequence revealed an association between the over-expression of the sPD-1 protein and the PD-1Δex3 transcript in celiac disease. Thus, we have found three novel alternative spliced isoforms, two of which result in a truncated protein and the other isoform with a loss of 14 aa of exon 2 and complete exon 3 (Δ3) which could encode a new soluble form of PD1 (sPD-1).ConclusionsOur study provides evidence that dietary gluten can modulate processes required for cell homeostasis through the splicing of pre-mRNAs encoding key regulatory proteins, which represents an adaptive mechanism in response to different nutritional conditions.
Regulatory T Cells Increase After rh-MOG Stimulation in Non-Relapsing but Decrease in Relapsing MOG Antibody-Associated Disease at Onset in Children
Authors: Horellou Philippe , de Chalus Aliénor , Giorgi Laetitia , Leroy Carole , Chrétien Pascale , Hacein-Bey-Abina Salima , Bourgeois Christine , Mariette Xavier , Serguera Ché , Le Grand Roger , Deiva Kumaran 
Published: June 2021

BackgroundMyelin oligodendrocytes glycoprotein (MOG) antibody-associated disease (MOGAD) represent 25% of pediatric acquired demyelinating syndrome (ADS); 40% of them may relapse, mimicking multiple sclerosis (MS), a recurrent and neurodegenerative ADS, which is MOG-Abs negative.AimsTo identify MOG antigenic immunological response differences between MOGAD, MS and control patients, and between relapsing versus non-relapsing subgroups of MOGAD.MethodsThree groups of patients were selected: MOGAD (n=12 among which 5 relapsing (MOGR) and 7 non-relapsing (MOGNR)), MS (n=10) and control patients (n=7). Peripheral blood mononuclear cells (PBMC) collected at the time of the first demyelinating event were cultured for 48 h with recombinant human (rh)-MOG protein (10 μg/ml) for a specific stimulation or without stimulation as a negative control. The T cells immunophenotypes were analyzed by flow cytometry. CD4+ T cells, T helper (Th) cells including Th1, Th2, and Th17 were analyzed by intracellular staining of cytokines. Regulatory T cells (Tregs, Foxp3+), CD45RA-Foxp3+ Tregs and subpopulation naive Tregs (CD45RA+Foxp3int), effector Tregs (CD45RA-Foxp3high) and non-suppressive Tregs (CD45RA-Foxp3int) proportions were determined.ResultsThe mean onset age of each group, ranging from 9.9 to 13.8, and sex ratio, were similar between MOGR, MOGNR, MS and control patients as analyzed by one-way ANOVA and Chi-square test. When comparing unstimulated to rh-MOG stimulated T cells, a significant increase in the proportion of Th2 and Th17 cells was observed in MOGAD. Increase of Th17 cells was significant in MOGNR (means: 0.63 ± 0.15 vs. 1.36 ± 0.43; Wilcoxon-test p = 0.03) but not in MOGR. CD4+ Tregs were significantly increased in MOGNR (means: 3.51 ± 0.7 vs. 4.59 ± 1.33; Wilcoxon-test p = 0.046) while they decreased in MOGR. CD45RA-Foxp3+ Tregs were significantly decreased in MOGR (means: 2.37 ± 0.23 vs. 1.99 ± 0.17; paired t-test p = 0.021), but not in MOGNR. MOGR showed the highest ratio of effector Tregs/non suppressive-Tregs, which was significantly higher than in MOGNR.ConclusionsOur findings suggest that CD4+ Th2 and Th17 cells are involved in the pathophysiology of MOGAD in children. The opposite response of Tregs to rh-MOG in MOGNR, where CD4+ Tregs increased, and in MOGR, where CD45RA-Foxp3+ Tregs decreased, suggests a probable loss of tolerance toward MOG autoantigen in MOGR which may explain relapses in this recurrent pediatric autoimmune disease.
Dynamical Downscaling of Coastal Dynamics for Two Extreme Storm Surge Events in Japan
Authors: Trošelj Joško , Ninomiya Junichi , Takewaka Satoshi , Mori Nobuhito 
Published: June 2021

Graphical AbstractStudy domains and model setup (up-left), Sea Surface Height results validation (up-right), Sea Surface Salinity results validation (down-left) and impact of the two storm surge events to the associated coastal dynamics variables (down-right).
Prediction of Left Double-Lumen Tube Size by Measurement of Cricoid Cartilage Transverse Diameter by Ultrasound and CT Multi-Planar Reconstruction
Authors: Zhang Chengchao , Qin Xinlei , Zhou Wenyi , He Shuaijie , Liu Ao , Zhang Yu , Dai Zhigang , Yin Jiangwen 
Published: June 2021

Background: Currently, there is no uniform standard for selecting the left double lumen tubes (LDLT). Advantages, such as safety and convenience of the ultrasonic technology, and measurement accuracy, make it more widely applied in the clinical anesthesia, and computed tomography (CT) multi-planar reconstruction (MPR) technology will certainly provide a more accurate measurement. For better application for thoracic surgery choice LDLT, relieving the injury to patients, and reducing the complications, this study will compare the two approaches.Methods: The first part, 120 cases of patients were selected according to the height and gender; recording the patient's optimum LDLT and measurement the transverse diameter of the cricoid cartilage (TD-C) by ultrasound and CT MPR, and then obtained the TD-C range measurement by ultrasound and CT MPR corresponding to different types of LDLT. The second part, total of 102 patients were divided into the ultrasound group and the CT MPR group. In the ultrasound group, TD-C was measured by ultrasound, the corresponding size for intubation was selected based on the conclusions derived from the first part. In the CT MPR group, TD-C was measured by CT MPR, the corresponding size of LDLT based on the conclusions derived from the first part.Results: In the first part, 120 patients were no significant difference in the basic characteristics (P &gt; 0.05). The accuracy of selecting the LDLT by conventional experience, namely height and gender was 58.3%. Ultrasonic measurement TD-C range was as follows: 32 Fr &lt;15.88, 35 Fr: 15.88–16.80, 37 Fr: 16.75–17.81, and 39 Fr &gt; 17.80. CT MPR measurement TD-C range was as follows: 32 Fr &lt;15.74, 35 Fr: 15.74–16.65, 37 Fr: 16.56–17.68, and 39 Fr &gt; 17.65. In the second part, there was no significant difference in the basic characteristics between the two groups (P &gt; 0.05). The accuracy of intubation in the ultrasound group was 90.2% and the corresponding in the CT MPR group was 94.1% (P &gt; 0.05).Conclusions: The accuracy of selecting the LDLT based on TD-C is significantly higher than conventional experience; it can significantly reduce the post-operative complications and there was no statistical significance in the accuracy of LDLT selected for TD-C measurement by ultrasound vs. CT, and both of them could be safely used for the evaluation before intubation under anesthesia in thoracic surgery.