bluuebunny/crossref_metadata_2025_split huggingface dataset:
Limitations in representative sampling of unpaid caregivers from minority ethnocultural backgrounds in a population-based survey
Authors: Marani Husayn 
Published: September 2021

AbstractObjectiveHistorically, persons from minority ethnic, religious and linguistic backgrounds have been un- or under-represented in population-based research studies. Emerging scholarship suggests challenges in representative sampling, particularly of minority ethnocultural groups, has been exacerbated by the COVID-19 pandemic. This research note offers additional insights concerning these challenges in the context of a population-based survey of unpaid caregivers conducted in Ontario, Canada, between August and December, 2020, the analysis of which is currently underway.ResultsBeyond limitations intrinsic to study design, including time and budget constraints, the study sample underrepresents unpaid caregivers from minority ethnocultural backgrounds due to differences in conceptions of caregiving across minority cultures, the time-consuming nature of caregiving that disproportionately affects minority groups, and a propensity to avoid research which is rooted in tokenism. These hypotheses are non-exhaustive, speculative and warrant further empirical investigation.
The addition of neoadjuvant pertuzumab for the treatment of HER2+ breast cancer: a cost estimate with real-world data
Authors: Borges Andreia , Pereira Filipa , Redondo Patrícia , Antunes Luís , Vieira Cláudia , Antunes Pedro , Bento Maria José , Sousa Susana , Lopes José Machado , Rocha-Gonçalves Francisco , de Sousa Joaquim Abreu , Pereira Deolinda Sousa , Borges Marina 
Published: September 2021

Abstract
Background
Breast cancer (BC) is largely prevalent worldwide. HER2-positive BC account for roughly 20–25% of all BC cases and has an overall survival lower than other BC. Innovation on BC therapeutics is a constant, but novel therapies have higher costs. Therefore, cost-effectiveness research is essential to provide healthcare decision-makers with solid foundations for a resource allocation. This study aims to estimate the average direct medical costs/patient and cost-effectiveness of adding pertuzumab in neoadjuvant treatment (NeoT) for HER2-positive breast cancer (BC).

Methods
Two retrospective real-world consecutive cohorts of ≥18yo female patients diagnosed with HER2-positive BC treated with NeoT at the Breast Clinic of IPO-Porto were studied. The AC-DH regimen (2012–2015) comprised 8 cycles of neoadjuvant therapy (4 cycles of doxorubicin + cyclosphosphamide followed by 4 cycles ofdocetaxel + trastuzumab), while the AC-DHP regimen (2015–2017) included also pertuzumab as NeoT. NeoT was followed by surgery and adjuvant trastuzumab. Micro-costing technique and a bottom-up approach was used comprising all medical direct costs from the hospital perspective. Unit costs were obtained from government official prices or from IPO-Porto costing system. Costs were adjusted to 2017 and are expressed in euros. Multivariable logistic regression models were used for effectiveness assessment, while generalized linear models with gamma distribution were used for costs. ICER was calculated using the pathological complete response (pCR) as the preferential measure of effectiveness. Sensitivity analysis was also performed.

Results
AC-DHP (n = 40) and AC-DH (n = 54) cohorts had heterogenous patient profiles (median age 43y/53y; 67.5%/59.3% positive HR; 60.0%/27.8% operable; 25.0%/24.1% inflammatory, respectively). The AC-DHP average total cost/patient was 56,375€, with pertuzumab accounting for 13,978€ (24.79%) and increasing in 15,982€ the average cost/patient (p < 0.001). Clinical staging and hormone receptors (HR) were significantly associated with pCR. ICER was 1.370€ per percentage point of pCR.

Conclusions
ICER was more favourable in stage III HR negative BC patients compared to other patient profiles. Innovative treatments access is critical to deliver high-quality healthcare, but sustainability must be considered. These results suggest the importance of establishing a cost-effectiveness profile of Pertuzumab in NeoT for HER2-positive BC.
Player Tracking Technology and Data for Injury Prevention in the National Football League
Authors: Ghasem Wesley , Valenzuela Joshua , Saxon Leslie A. 
Published: September 2021

Abstract
The recent partnership of NFL’s Next Gen Stats with Amazon Web Services has created a buzz among media and fans, yet the full scope and utility of digital biosensors has yet to be determined. We review current uses of Global Positioning System technology and digital biosensors in the NFL and discuss the future role of this technology in injury prevention. A complete literature review was conducted, along with review of the NFL web site and news outlet articles, to obtain a comprehensive assessment of all prior and current uses of biosensor technology in the NFL. Limited data exist on successful injury prevention and return to play, and utilization of this emerging technology has mostly been for fan experience. While ethical and legal challenges exist, the integration of digital biosensor and GPS technology in the NFL has enormous potential and is an invaluable tool in the comprehensive assessment of player health.
The Application Value of Magnetic Resonance Imaging (MRI)in the Clinical Diagnosis in Hospital Management
Authors: Chen Yan , Zhou Hong-Mei , Jiang Qijie 
Published: September 2021

Background & Objective: To evaluate the application value of dynamic enhanced magnetic resonance imaging (DCE-MRI) in the clinical diagnosis in hospital based on the fuzzy C-means clustering algorithm and conduct its cost-benefit analysis in practice.
Methods: This study was conducted from October 11th 2020 to November 25, 2020. Eighteen patients with lung cancer confirmed by pathology were collected and examined by DCE-MRI one day before and one month after surgery using a fuzzy C-means clustering algorithm. And then, taking Guang’an District People’s Hospital as an example, the present paper conducts the cost-benefit analysis with the utilization of net present value (NPV).
Results: After 1-month review, eleven patients with effective treatment, four numerical Ktrans, Kep, Ve, Vp compared with preoperative decreased, which Ktrans, Kep, the change of the Ve was statistically significant (P < 0.05), the Vp of decline has no statistical significance (P > 0.05), the experimental and ineffective group after an operation, compared to four numerical Ktrans and Vp difference was statistically significant (P < 0.05), the corresponding AUC (area under the curve) to 1 and 0.818, the sensitivity of 100% and 85.7%, a specific degree of 100% and 72.7%. The NPV analysis results showed that the hospital could achieve profit and loss balance in the third year after purchasing MRI equipment and then gradually obtain positive cash inflow.
Conclusion: The application of MRI in the Clinical Diagnosis helps hospital promote the therapeutic effect, thus having great practical value, and also contributes to increasing benefits in the long run.
Abbreviations: DCE-MRI: Dynamic enhanced magnetic resonance imaging. NPV: Net Present Value. RECIST: Reliable Tumor Evaluation Criteria. CR: Complete Response.
doi: https://doi.org/10.12669/pjms.37.6-WIT.4791
How to cite this:Chen Y, Zhou HM, Jiang QJ. The Application Value of Magnetic Resonance Imaging (MRI) in the Clinical Diagnosis in Hospital Management. Pak J Med Sci. 2021;37(6):1710-1713. doi: https://doi.org/10.12669/pjms.37.6-WIT.4791
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Diagnosis and analysis of primary central nervous system lymphoma based on MRI segmentation algorithm
Authors: Lu Guanping , Li Ying , Liang Xinqiang , Zhao Zhengjun 
Published: September 2021

Objective: This paper summarizes the MRI imaging findings of primary central nervous system lymphoma (PCNSL) in the posterior cranial fossa to improve the accuracy of PCNSL diagnosis in the posterior cranial fossa.
Methods: This study retrospectively analyzed the MRI imaging manifestations of 15 PCNSL posterior cranial fossa cases confirmed by puncture or surgical pathology from June 2017 to May 2018, including their occurrence sites, the number of lesions, MRI plain and enhanced manifestations, and diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy. Imaging (MRS) performance.
Results: A total of 15 cases were enrolled, including 10 cases of single lesion and five cases of multiple lesions. The total number of lesions was 25, which were in the cerebellar hemisphere and cerebellar vermis, midbrain, fourth ventricle, and pontine cerebellum. The lesions were round, irregular, nodular, patchy, with low or medium signals on T1WI, equal or slightly higher signals on T2WI, and enhanced with 25 meningiomas-like gray matter signals. All of them were significantly strengthened. “Acupoint sign” and “umbilical depression sign” were seen in eight lesions. There were 17 massive and nodular enhancements, four striped enhancements, three patchy enhancements, and one circular enhancement. five cases of DWI showed homogeneous high signal, two cases showed uneven high signal, and 3 cases showed medium signal. The ADC value of tumor parenchyma in 10 patients was (0.62±0.095)×10-3mm2/s. MRS examination showed obvious Lip peak in two cases.
Conclusion: PCNSL in posterior cranial fossa has certain characteristics. DWI, ADC value and MRS are helpful to improve the correct diagnosis rate of PCNSL.
doi: https://doi.org/10.12669/pjms.37.6-WIT.4843
How to cite this:Lu G, Li Y, Liang X, Zhao Z. Diagnosis and analysis of primary central nervous system lymphoma based on MRI segmentation algorithm. Pak J Med Sci. 2021;37(6):1585-1589. doi: https://doi.org/10.12669/pjms.37.6-WIT.4843
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Adjunctive postoperative course of dexamethasone in chronic subdural hematoma: Effect on surgical outcome
Authors: Tariq Jibran , Bhatti Sajid Nazir 
Published: September 2021

Objectives: To compare the effect of burrhole craniostomy with and without a postoperative course of dexamethasone on recurrence rate of chronic subdural hematoma (CSDH).
Methods: The study was conducted at the Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, from September 2017 till May 2018. Adult patients diagnosed with CSDH and advised burrhole craniostomy were enrolled in this prospective randomized controlled trial. Participants were randomized into Group-1 (receiving two weeks dexamethasone), and Group-2 (no dexamethasone). Clinical assessment and Brain CT were done preoperatively, second postoperative day, sixth and twelfth postoperative week, with outcome assessed at twelfth postoperative week. Complications of treatment and recurrence rate were recorded.
Results: Ninety-two (n=92, 46 in each group) patients were enrolled. Improvement in neurological (95.7% vs 93.5%; P=0.646) and radiological outcome (95.7% vs 93.5%; P=0.646) was similar in both groups. Complication rate was higher in Group-1 but not significantly different (58.7% vs 43.5%; P=0.535). Most frequent complication was pneumocephalus, with mortality rate equal (n=one). Recurrence was observed in 2.2% (n=1/46) patients in Group-1 and 4.3% (n=2/46) in Group-2 (P=0.557), which was not statistically significant.
Conclusions: Neurological and radiological outcome, and mortality rates were similar in both groups. The recurrence rate was lower and complications slightly higher in Group-1 but these were not statistically significant.
doi: https://doi.org/10.12669/pjms.37.7.3374
How to cite this:Tariq J, Bhatti SN. Adjunctive postoperative course of dexamethasone in chronic subdural hematoma: Effect on surgical outcome. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.3374
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Lymphopenia: A useful predictor of COVID-19 disease severity and mortality
Authors: Toori Kaleem Ullah , Qureshi Muhammad Arsalan , Chaudhry Asma 
Published: September 2021

Objective: To detect association of lymphopenia with disease severity and mortality.
Methods: Total 874 COVID RT-PCR positive patients admitted to KRL Hospital Islamabad from April 2020 to August 2020 were included in this cross-sectional study. Lymphopenia was defined as <1100 cells/micro–L. WHO categories for disease severity were used. Demographic profile, absolute lymphocyte counts and co-morbidities were recorded. Pearson’s Chi Square test was used to see association between lymphopenia and disease severity as well as disease outcome. Regression analysis was used to see whether lymphopenia would predict disease severity. Comparison of means of absolute lymphocyte count in different disease categories was done by ANOVA. Tukey’s test range was then used to find the means different from each other. P-value ≤ 0.05 was considered statistically significant
Results: The mean age of patients was 40±12.3 years. Majority patients (73.9%) were asymptomatic. Lymphopenia was present in 6.9% of total patients. Significant association was found between lymphopenia and disease severity as well as lymphopenia and mortality (< 0.001). Lymphopenia was found to be a predictor of disease severity using regression analysis (< 0.001). Comparison of mean absolute lymphocyte count was significant among disease severity categories (< 0.001). On post-hoc analysis, difference in absolute lymphocyte count was significant moving from asymptomatic to mild and then moderate disease category. However no significant difference was seen in absolute lymphocyte count between moderate and severe categories.
Conclusion: Results are compatible with worldwide studies and lymphopenia is valid as a marker of disease severity and mortality
doi: https://doi.org/10.12669/pjms.37.7.4085
How to cite this:Toori KU, Qureshi MA, Chaudhry A. Lymphopenia: A useful predictor of COVID-19 disease severity and mortality. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4085
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Effects of HBeAg Status on cellular immune function of patients with Hepatitis B virus/Treponema Pallidum Co-infection
Authors: Luo Wei , Xin Hanxiao , Zhao Pengyun , Jiang Shasha 
Published: September 2021

Objectives: This study was aimed at exploring the effects of hepatitis B envelope antigen (HBeAg) status on the cellular immune function of patients with hepatitis B virus/treponema pallidum (HBV/TP) co-infection.
Methods: The clinical data of 79 patients with HBV/TP co-infection admitted to our hospital from January 2019 to January 2020 were retrospectively analyzed. These patients were divided into two groups according to the different HBeAg statuses before the treatment: 41 HBeAg+ patients were included in the HBeAg+ group, while 38 HBeAg- patients were included in the HBeAg- group. The levels of HBV-DNA, T lymphocyte subsets represented by NK cells and cytokines associated with T cells in the peripheral blood (PB) of the patients were compared between both groups.
Results: The HBV-DNA levels in the HBeAg+ group were significantly higher than those in the HBeAg- group (P < 0.05). The levels of CD3+, CD4+, CD4+/CD8+ and natural killer (NK) cells in the HBeAg+ group were higher than those in the HBeAg- group (P < 0.05), while the levels of CD8+ cells were lower than those in the HBeAg- group (P < 0.05). Moreover, the levels of interferon-γ (IFN-γ), tumor necrosis factor (TNF-α), interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-17 (IL-17), transforming growth factor-β (TGF-β) in the HBeAg+ group were all significantly higher than those in the HBeAg- group (P < 0.05), but there was no significant difference in the levels of interleukin-4 (IL-4) and interleukin-10 (IL-10) between the HBeAg+ group and the HBeAg- group (P > 0.05).
Conclusion: HBeAg+ can increase the HBV-DNA levels in the PB of patients with HBV/TP co-infection, in turn triggering the body to initiate cellular immunity, increasing the levels of T lymphocyte subsets, and promote the secretion of cytokines.
doi: https://doi.org/10.12669/pjms.37.7.4253
How to cite this:Luo W, Xin H, Zhao P, Jiang S. Effects of HBeAg Status on cellular immune function of patients with Hepatitis B virus/Treponema Pallidum Co-infection. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4253
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Predicting Human Discretion to Adjust Algorithmic Prescription: A Large-Scale Field Experiment in Warehouse Operations
Authors: Sun Jiankun , Zhang Dennis J. , Hu Haoyuan , Van Mieghem Jan A. 
Published: September 2021

Conventional optimization algorithms that prescribe order packing instructions (which items to pack in which sequence in which box) focus on box volume utilization yet tend to overlook human behavioral deviations. We observe that packing workers at the warehouses of the Alibaba Group deviate from algorithmic prescriptions for 5.8% of packages, and these deviations increase packing time and reduce operational efficiency. We posit two mechanisms and demonstrate that they result in two types of deviations: (1) information deviations stem from workers having more information and in turn better solutions than the algorithm; and (2) complexity deviations result from workers’ aversion, inability, or discretion to precisely implement algorithmic prescriptions. We propose a new “human-centric bin packing algorithm” that anticipates and incorporates human deviations to reduce deviations and improve performance. It predicts when workers are more likely to switch to larger boxes using machine learning techniques and then proactively adjusts the algorithmic prescriptions of those “targeted packages.” We conducted a large-scale randomized field experiment with the Alibaba Group. Orders were randomly assigned to either the new algorithm (treatment group) or Alibaba’s original algorithm (control group). Our field experiment results show that our new algorithm lowers the rate of switching to larger boxes from 29.5% to 23.8% for targeted packages and reduces the average packing time of targeted packages by 4.5%. This idea of incorporating human deviations to improve optimization algorithms could also be generalized to other processes in logistics and operations. This paper was accepted by Charles Corbett, operations management.
Direct bandwidth measurement of multimode waveguides based on an optical sampling technique
Authors: Shi Ying , Xu Bingxin , Ma Lin , Xiong Junjie , Fan Xinyu , Zhuang Yudi , He Zuyuan 
Published: September 2021

We demonstrate direct bandwidth measurement of 11-cm-long multimode polymer waveguides based on an optical sampling technique for the first time, to our knowledge. The pulse shape can be recovered after transmission due to the advantages such as high bandwidth and high refresh rate of optical sampling technology. A reduction in averaged bandwidth (bandwidth-length product) from 241 GHz (27 GHz·m) to 180 GHz (20 GHz·m) of straight waveguides is observed when using mode scramblers to fully stimulate the higher-order modes. The effects such as bending and crossing structure of the waveguides on the bandwidth are also investigated. The proposed method is effective for measuring the bandwidth and dispersion of meter- and centimeter-long waveguides, fibers, and optical devices.
Multilevel factor analysis of flipped classroom in dental education: A 3-year randomized controlled trial
Authors: Wang Zuo , Kohno Eiko Yoshida , Fueki Kenji , Ueno Takeshi , Inamochi Yuka , Takada Kazuki , Wakabayashi Noriyuki 
Published: September 2021

PurposePrevious studies have rarely attempted to test the confounding factors that may affect learning outcomes of the flipped classroom. The purpose of this study was to assess how flipped classrooms affect the acquisition of knowledge in clinical dental education based on multilevel factor analysis.MethodThe authors conducted a 3-year (2017, 2018, and 2019) randomized controlled trial in a series of introductory prosthodontics courses in dental education. A total of 137 participants were randomly assigned to flipped classroom (n = 70, 51%) or lecture (n = 67, 49%) formats. The flipped group was instructed to self-learn knowledge-based content through online preparation materials, including videos and text, while the lecture group was given text only. Both groups were provided with the same study content and opportunities for different styles of learning. The session attendance rate and number of times the materials were accessed were monitored. Individual and team readiness assurance tests (IRAT/TRAT) were conducted to evaluate knowledge acquisition. A multilevel linear regression analysis was conducted on both instructional styles (flipped vs. lecture) as an intervention factor, and confounding factors that could affect the outcomes were implemented.ResultsThe average number of online accesses was 2.5 times per session in the flipped group and 1.2 in the lecture group, with a significant difference (p < .05). The average IRAT score was significantly higher in the flipped than in the lecture group (effect size [ES] 0.58, p < .001). The number of online accesses was significantly and positively correlated with IRAT scores (0.6 [0.4, 0.8]). The instructional style was significantly and positively correlated with TRAT scores (coefficient [95% confidence interval]: 4.6 [2.0, 7.3]), but it was not correlated with IRAT (4.3 [-0.45, 9.0]).ConclusionsThe flipped classroom was more effective than the lecture format regarding knowledge acquisition; however, the decisive factor was not the instructional style but the number of individual learning occasions. The employment of the flipped classroom was the decisive factor for team-based learning outcomes.