bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey
Authors: Sattui Sebastian Eduardo , Liew Jean W , Kennedy Kevin , Sirotich Emily , Putman Michael , Moni Tarin T , Akpabio Akpabio , Alpízar-Rodríguez Deshiré , Berenbaum Francis , Bulina Inita , Conway Richard , Singh Aman Dev , Duff Eimear , Durrant Karen L , Gheita Tamer A , Hill Catherine L , Howard Richard A , Hoyer Bimba F , Hsieh Evelyn , El Kibbi Lina , Kilian Adam , Kim Alfred Hyoungju , Liew David F L , Lo Chieh , Miller Bruce , Mingolla Serena , Nudel Michal , Palmerlee Candace A , Singh Jasvinder A , Singh Namrata , Ugarte-Gil Manuel Francisco , Wallace John , Young Kristen J , Bhana Suleman , Costello Wendy , Grainger Rebecca , Machado Pedro M , Robinson Philip C , Sufka Paul , Wallace Zachary S , Yazdany Jinoos , Harrison Carly , Larché Maggie , Levine Mitchell , Foster Gary , Thabane Lehana , Rider Lisa G , Hausmann Jonathan S , Simard Julia F , Sparks Jeffrey A 
Published: September 2021

BackgroundWe describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine.MethodsFrom 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, beliefs and intent about discontinuing disease-modifying antirheumatic drugs (DMARDs) around the time of vaccination, and patient-reported adverse events after vaccination.ResultsWe analysed 2860 adults with systemic rheumatic diseases who received COVID-19 vaccination (mean age 55.3 years, 86.7% female, 86.3% white). Types of COVID-19 vaccines were Pfizer-BioNTech (53.2%), Oxford/AstraZeneca (22.6%), Moderna (21.3%), Janssen/Johnson & Johnson (1.7%) and others (1.2%). The most common rheumatic disease was rheumatoid arthritis (42.3%), and 81.2% of respondents were on a DMARD. The majority (81.9%) reported communicating with clinicians about vaccination. Most (66.9%) were willing to temporarily discontinue DMARDs to improve vaccine efficacy, although many (44.3%) were concerned about rheumatic disease flares. After vaccination, the most reported patient-reported adverse events were fatigue/somnolence (33.4%), headache (27.7%), muscle/joint pains (22.8%) and fever/chills (19.9%). Rheumatic disease flares that required medication changes occurred in 4.6%.ConclusionAmong adults with systemic rheumatic disease who received COVID-19 vaccination, patient-reported adverse events were typical of those reported in the general population. Most patients were willing to temporarily discontinue DMARDs to improve vaccine efficacy. The relatively low frequency of rheumatic disease flare requiring medications was reassuring.
The Role of Testosterone in Menopause Management: A Review of Literature
Authors: Manalo Eileen M. , Irabon Ina S. , Fajutagana Shayne S. 
Published: September 2021

Background: Despite the lack of approved testosterone formulations for women in most countries, testosterone therapy is still being offered to women worldwide. Aging and loss of ovarian or adrenal function, among others, can lower testosterone levels in women. However, international guidelines currently do not routinely recommend androgen replacement therapy due to lack of long-term safety data. Evidence on its benefits and risks still remains uncertain. Objectives: The aim of this literature review is to present current studies and guidelines that examined the effects of testosterone therapy for postmenopausal women, including its role on cognition and mood; breast and endometrial cancer risks; musculoskeletal, cardiovascular, and genitourinary health; and sexual function. Methodology: A review of literature was done using PubMed, EMBASE, Science Direct, OVID, and Google scholar, with the following key words: androgen, testosterone, menopause, and hypoactive sexual desire dysfunction. We identified reviews, clinical trials, and guidelines. The population was limited to postmenopausal women. Results: There is no evidence from current published literature to support the use of testosterone therapy for female well-being, mood and cognition, bone and cardiovascular health. Intravaginal testosterone appears to be a promising alternative for the treatment of genitourinary symptoms of menopause (GSM) but efficacy and safety are yet to be confirmed. Well-designed, randomized, and placebo-controlled trials are needed to establish long-term safety, efficacy, and appropriate dosing and route of testosterone therapy in postmenopausal women. The only evidence-based indication for testosterone therapy in women is for the treatment of postmenopausal hypoactive sexual desire disorder (HSDD). Should a trial of testosterone therapy be given for HSDD, the transdermal route is the preferred method of delivery. Baseline total testosterone concentration should be determined before starting treatment, and repeated after 3–6 months. Serum testosterone levels should be monitored at regular intervals to avoid supraphysiologic dosing. Conclusion: Currently, there is no robust evidence to support the use of exogenous testosterone to improve female well-being, musculoskeletal health, mood and cognition, as well as bone and cardiovascular health among postmenopausal women. The only evidence-based indication for testosterone therapy in women is the treatment of postmenopausal hypoactive sexual desire disorder, but only after all other causes of sexual dysfunction have been ruled out. To date, testosterone therapy has no US Food and Drug Administration (US FDA) approval due to the lack of long-term efficacy and safety data.
Putting On the Gas and Taking Off the Brakes: A Novel Combinatorial Strategy to Enhance Tumor-Infiltrating Lymphocytes
Authors: Felices Martin , Miller Jeffrey S. 
Published: September 2021

Abstract
The advent of checkpoint blockade and use of cytokines to enhance immune responses have changed the field of immunotherapy. Yet, these approaches are not without drawbacks including systemic toxicities and acquired therapeutic resistance. In this issue, Xu and colleagues describe a novel biological molecule composed of a PD-1–targeting antibody linked to a mutated IL15 that induces better targeting of IL15 to tumor-infiltrating lymphocytes (TIL) to decrease systemic toxicities and enhance antitumor responses.
See related article by Xu et al., p. 1141 (1).
Author, Author: A Short Story of the Rise, reign and ruine of the late Antinomians, Familists, and Libertines (1644) Reappraised
Authors: Hall David D. 
Published: September 2021

Abstract
When the great nineteenth-century antiquarian James Savage disputed the assumption that John Winthrop wrote A Short Story (London 1644), he was on to something, although the evidence he adduced was incorrect. Taking as a starting point two facts about the book-it is a compilation of documents and bears numerous marks of being an intentional text-this essay describes how the Short Story came into being and suggests who may be the "I" who mysteriously (and unidentified) speaks in the text.
Fleshy scoli removed without detriment: structure and potential anti-predation function in a slug caterpillar (Limacodidae)
Authors: Dong Bing , Wang Yirong , Li Qin , Chen Zhanqi 
Published: September 2021

Abstract
Anti-predator outgrowths are found prevalent in animals such as stinging spines of caterpillars. However, an encounter with a predator is usually fatal as caterpillars would die easily even if just small body parts were taken. Here, we showed the larvae of Phrixolepia sp. did not get injured when the fleshy but not urticating scoli were removed. By showing the morphologic traits, we assume these particular scoli function as enlarged warning signals and substitute to be attacked so that caterpillars can warn multiple predators, with a lower chance of getting injured when encountering natural enemies, such as birds and carabid beetles.
Does recent experience affect large male advantage in a sequentially-mating fish?
Authors: Allen Emily R. , Weir Laura K. 
Published: September 2021

Abstract
In many mating systems, large male body size is associated with dominance in direct contests with rivals and females may exhibit preference for larger males. As such, body size is often positively associated with mating success. However, mating experience can influence the potential advantage of large body size through alterations in behaviour and depletion of sperm reserves. In Japanese medaka (Oryzias latipes), males mate with many females each day, and larger males mate more frequently than smaller males. In an observational experiment, we tested the following alternate predictions: (1) recent mating experience may enhance mating success through a carry-over effect of prior mating, whereby small experienced males gain an advantage over large inexperienced rivals in mating contests; or (2) recent mating experience decreases mating success through a reduction in fertilization due to sperm limitation, effectively dampening the large-male advantage against a small inexperienced rival. We examined the interactive effect of size and recent experience on mating behaviour and success. While mating contests were monopolized by large males, recent experience enhanced mating success, especially in small male winners. Experienced males courted more readily than those without recent experience, suggesting that recent prior mating enhances this behaviour. Furthermore, males who had copulated recently did not exhibit sperm depletion when in the presence of a competitor, nor did female behaviour indicate a preference for inexperienced males. This suggests that males can use sexual experience to increase their reproductive success in future mating situations, which may influence the action of sexual selection and alternative tactics in shaping mating systems.
Regulating Vessel Discharges on the International and EU Level
Authors: Proelss Alexander , Schatz Valentin J. 
Published: September 2021

Abstract
This study analyzes the legal requirements concerning discharges from ships, a matter that is characterized by a considerable degree of complexity. This complexity results, inter alia, from the highly technical nature of the applicable norms, but also from the fact that the relevant rules and principles are prescribed in a wide and often overlapping variety of instruments on different levels of law, namely public international law, European Union law (where applicable) and domestic law. Taking into account that the individual legal instruments within these sub-systems of law significantly differ in their spatial and substantive scopes and regulatory approaches, a risk of conflicts of norms exists both from a vertical (i.e., between different levels of law) and horizontal (i.e., between different instruments on the same level of law) perspective. This situation gives rise to legal uncertainties, which may ultimately threaten the lawful and effective application and implementation of the relevant norms. This study attempts to clarify the existing uncertainties and to suggest harmonized interpretations and applications of the pertinent rules and principles. It does not address the issue of pollution from ships in general, but focuses on three specific categories of vessel discharges, namely scrubber washwater, sewage and ballast water.
Risk Factors of Difficult Pharyngeal Accidental Fishbones Ingestion
Authors: Huang Yi-Bo , Zhang Fan , Chen Hui-Ju , Ren Dong-Dong , Yu Hua-Peng , Du Qiang , Gao Chun-Li , Shi Yong , Liang Yu-Fang , Xu Chen-Mei , Wang Wei-Hua , Hu Hua , Sun Qin , Zhang Ru , Zhang Ji-Feng , Wu Hai-Tao , Shao Jun , He Pei-Jie 
Published: September 2021

Objective: Accidental pharyngeal fishbone ingestion is a common complaint in ear, nose, and throat clinics. Approximately two-thirds of the accidentally ingested fishbones can be removed using tongue depressors and indirect laryngoscopy. However, the remaining third is challenging to identify and remove using these methods. These difficult fishbones require identification and removal via more advanced approaches. Video-guided laryngoscope is used to deal with difficult fishbones in our center. This study aimed to explore the risk factors for difficult fishbones. Methods: A prospective study was performed at a teaching hospital on 2080 patients. Univariate and multivariate analyses were performed to identify the risk factors. Results: The common fishbone locations were the tonsils (39.8%; defined as STEP-I), tongue base (37.1%), vallecula (13.3%; STEP-II), and hypopharynx (9.8%; STEP-III). With increasing STEP level, the ratio of difficult fishbones correspondingly increased (Z = 13.919, P < .001), and the proportions were 21.1%, 41.9%, and 70% in STEP-I, II, and III, respectively. In particular, fishbones in STEP-III (vs STEP-I) had a higher risk of difficult fishbones (odds ratio [OR]: 11.573, 95% CI: 7.987-16.769). Complaints of neck pain (yes vs no), foreign body sensation (yes vs no), and shorter length of fishbones always had a lower risk of difficult fishbones (OR: 0.455, 95% CI: 0.367-0.564; OR: 0.284, 95% CI: 0.191-0.422; OR: 0.727, 95% CI: 0.622-0.85). Missing teeth (yes vs no), swallowing behavior after fishbone ingestion (yes vs no), and male patients (vs female) had a higher risk of difficult fishbones (OR: 1.9, 95% CI: 1.47-2.456; OR: 1.631, 95% CI: 1.293-2.059; OR: 1.278, 95% CI: 1.047-1.56). Conclusions: Neck pain, foreign body sensation, fishbone length, patient age and sex, tooth status, and swallowing behavior after fishbone ingestion are independent risk factors for difficult fishbones.
Outcomes of Salvage Resection and Radiosurgery Following Failed Primary Treatment of Vestibular Schwannomas
Authors: Kay‐Rivest Emily , Golfinos John G. , McMenomey Sean O. , Friedmann David R. , Jethanamest Daniel , Kondziolka Douglas , Roland J. Thomas 
Published: September 2021

ObjectiveTo evaluate outcomes following salvage microsurgery (MS) and salvage stereotactic radiosurgery (SRS) after failure of primary treatment for vestibular schwannomas (VS).Study DesignRetrospective chart review.SettingTertiary referral center.MethodsPatients with more than 1 intervention for their VS were divided into 4 groups: MS followed by SRS (n = 61), MS followed by MS (n = 9), SRS followed by MS (n = 7), and SRS followed by SRS (n = 7), and outcomes were evaluated.ResultsA total of 77 patients were included (84 procedures). In group 1 (MS then SRS), 3% developed a decline in facial function, 3% developed trigeminal sensory loss, and 13% patients had gradual improvement of facial nerve function following SRS. Group 2 (MS then MS) had the highest rates of facial nerve deterioration, although all but 1 patient achieved a House‐Brackmann score of II or III. Gross‐total resection (GTR) was achieved in 56% of patients. When a different approach was used for salvage resection, GTR occurred more commonly, and facial nerve outcomes were similar. In group 3 (SRS then MS), GTR occurred in 43% of cases, and 2 of 7 patients developed worsened facial function. In group 4 (SRS then SRS), no patient developed facial weakness after reirradiation, and 1 developed a trigeminal nerve deficit.ConclusionsFor MS recurrences/residuals, SRS is the mainstay of treatment and does not preclude facial function recovery. If salvage microsurgery is required, an alternate approach should be considered. For SRS failures, when MS is required, less‐than GTR may be preferable, and reirradiation is a potential safe alternative.
Young Adolescents’ Endorsement of Restrictive Gender Norms: Evidence From a Community-Based Intervention in Côte d’Ivoire and Sierra Leone
Authors: Leer Jane , Gassman-Pines Anna , Djé Blé Eric , Kainessie Josephine , Kennedy Catherine , Press Sarah , Schubert Heidi 
Published: September 2021

This study investigated attitudes toward restrictive gender norms among adolescents in Côte d’Ivoire and Sierra Leone (pooled N = 1,793, M age(baseline) = 10.3, M age(follow-up) = 11.6, 50% boys/girls). We examined individual and contextual predictors of gender attitudes, assessed change in gender attitudes over 2 years, and estimated the effect of a community-based norms diffusion intervention. Multiple regression analyses revealed that being a boy, exposure to violence against women, and restrictive norms among same-gender peers predicted support for a patriarchal division of adult roles, lower educational status for girls, and acceptance of gender-based violence. In contrast to evidence from Western contexts, we found limited evidence of increased flexibility in gender attitudes during early adolescence. However, the intervention significantly reduced support for restrictive gender norms, especially among boys. Findings reveal novel pathways through which young adolescents acquire beliefs about gender, and provide encouraging evidence regarding community-based approaches to shifting adolescents’ gender attitudes.
The importance of motivational postures to mental health regulators: Lessons for Victoria’s mental health system in reducing the use of force
Authors: Katterl Simon 
Published: September 2021

Objective: To consider whether research into “motivational postures” can assist the Victorian Government and the forthcoming Mental Health and Wellbeing Commission to regulate and implement forthcoming mental health laws. Conclusion: Although no research explicitly uses a motivational postures framework, there is evidence of a diverse set of postures amongst the mental health workforce. Some practitioners and disciplines reflect positive motivational postures towards mental health laws and consumer rights, while others show resistance, and others disengagement altogether. More research explicitly built on motivational postures is required to inform appropriate regulatory responses.
Development and Implementation of a Multicomponent Protocol to Promote Sleep and Reduce Delirium in a Medical Intensive Care Unit
Authors: Darby Adrienne , Northam Kalynn , Austin C. Adrian , Chang Lydia , Campbell-Bright Stacy 
Published: September 2021

Background: Evidence suggests that poor sleep increases risk of delirium. Because delirium is associated with poor outcomes, institutions have developed protocols to improve sleep in critically ill patients. Objective: To assess the impact of implementing a multicomponent sleep protocol. Methods: In this prospective, preimplementation and postimplementation evaluation, adult patients admitted to the medical intensive care unit (ICU) over 42 days were included. Outcomes evaluated included median delirium-free days, median Richards-Campbell Sleep Questionnaire (RCSQ) score, median optimal sleep nights, duration of mechanical ventilation (MV), ICU and hospital length of stay (LOS), and in-hospital mortality. Results: The preimplementation group included 78 patients and postimplementation group, 84 patients. There was no difference in median delirium-free days (1 day [interquartile range, IQR, = 0-2.5] vs 1 day [IQR = 0-2]; P = 0.48), median RCSQ score (59.4 [IQR = 43.2-71.6] vs 61.2 [IQR = 49.9-75.5]; P = 0.20), median optimal sleep nights (1 night [IQR = 0-2] vs 1 night [IQR = 0-2]; P = 0.95), and in-hospital mortality (16.7% vs 17.9%, P = 1.00). Duration of MV (8 days [IQR = 4-10] vs 4 days [IQR = 2-7]; P = 0.03) and hospital LOS (13 days [IQR = 7-22.3] vs 8 days [IQR = 6-17]; P = 0.05) were shorter in the postimplementation group, but both were similar between groups after adjusting for age and severity of illness. Conclusions and Relevance: This report demonstrates that implementation of a multicomponent sleep protocol in everyday ICU care is feasible, but limitations exist when evaluating impact on measurable outcomes. Additional evaluations are needed to identify the most meaningful interventions and best practices for quantifying impact on patient outcomes.
MRI-based brain tumor segmentation using FPGA-accelerated neural network
Authors: Xiong Siyu , Wu Guoqing , Fan Xitian , Feng Xuan , Huang Zhongcheng , Cao Wei , Zhou Xuegong , Ding Shijin , Yu Jinhua , Wang Lingli , Shi Zhifeng 
Published: September 2021

Abstract
Background
Brain tumor segmentation is a challenging problem in medical image processing and analysis. It is a very time-consuming and error-prone task. In order to reduce the burden on physicians and improve the segmentation accuracy, the computer-aided detection (CAD) systems need to be developed. Due to the powerful feature learning ability of the deep learning technology, many deep learning-based methods have been applied to the brain tumor segmentation CAD systems and achieved satisfactory accuracy. However, deep learning neural networks have high computational complexity, and the brain tumor segmentation process consumes significant time. Therefore, in order to achieve the high segmentation accuracy of brain tumors and obtain the segmentation results efficiently, it is very demanding to speed up the segmentation process of brain tumors.

Results
Compared with traditional computing platforms, the proposed FPGA accelerator has greatly improved the speed and the power consumption. Based on the BraTS19 and BraTS20 dataset, our FPGA-based brain tumor segmentation accelerator is 5.21 and 44.47 times faster than the TITAN V GPU and the Xeon CPU. In addition, by comparing energy efficiency, our design can achieve 11.22 and 82.33 times energy efficiency than GPU and CPU, respectively.

Conclusion
We quantize and retrain the neural network for brain tumor segmentation and merge batch normalization layers to reduce the parameter size and computational complexity. The FPGA-based brain tumor segmentation accelerator is designed to map the quantized neural network model. The accelerator can increase the segmentation speed and reduce the power consumption on the basis of ensuring high accuracy which provides a new direction for the automatic segmentation and remote diagnosis of brain tumors.