bluuebunny/crossref_metadata_2025_split huggingface dataset:
Teaching limited compression ultrasound to general practitioners reduces referrals of suspected DVT to a hospital: a retrospective cross-sectional study
Authors: Hannula Ossi , Vanninen Ritva , Rautiainen Suvi , Mattila Kalle , Hyppölä Harri 
Published: February 2021

Abstract
Background
The aim of this study was to retrospectively determine whether teaching limited compression ultrasound (LCUS) to general practitioners (GP) would reduce the number of patients with a suspected lower extremity DVT referred to a hospital for ultrasound (US) examination. According to the current literature, an LCUS protocol is a safe way to diagnose or exclude lower extremity deep venous thrombosis (DVT) and a good option to radiologist-performed whole-leg ultrasound (US), especially in remote health care units where there may be a limited availability of radiological services.

Methods
Between 2015 and 2016, altogether 13 GPs working in the same primary care unit were trained in LCUS for DVT diagnostics. The number of annual referrals due to a suspected DVT from Saarikka primary care unit to the closest hospital was evaluated before and after training. The incidence of DVT was considered to be constant. Thus, the reduction of referrals was attributed to the fact that these patients were diagnosed and treated in primary health care. Incidence rate ratio of hospital referrals was calculated. As a measure of safety, all patients diagnosed with a pulmonary embolism in the nearest hospital were evaluated to determine if they had undergone LCUS by a GP in primary care.

Results
Before training in 2014, there were 60 annual referrals due to a suspected DVT; in 2017, after training, the number was reduced to 16, i.e., a 73.3% decrease. The incidence of referrals decreased from 3.21 to 0.89 per 1000 person-years. (IRR 3.58, 95% CI 2.04–6.66, p < 0.001). No patient with a pulmonary embolism diagnosis had LCUS performed previously, indicating that there were no false negatives, resulting in pulmonary embolism.

Conclusions
Teaching LCUS to GPs can safely reduce the number of patients with a suspected DVT referred to a hospital substantially.
Pharmaceutical portfolio optimization under cost uncertainty via chance constrained-type method
Authors: Farid Maboubeh , Chaudhry Abraar , Ytterstad Magnus , Wiklund Stig Johan 
Published: February 2021

AbstractProject selection for a portfolio is a pivotal decision in the pharmaceutical industry. In this paper, we study a portfolio optimization problem for pharmaceutical companies considering the uncertainty of the cost of each phase of drug development and the specific value of the annual budget. The presented optimization model is suitable to make investment decisions for multi-phase drug development projects and a stochastic approach is applied to handle the uncertainty in the model. Post-optimality analysis for annual budget is studied. An illustrative example is included to demonstrate the presented approach.
Some results on the filter method for nonlinear complementary problems
Authors: Wang Jueyu , Gu Chao , Wang Guoqiang 
Published: February 2021

AbstractRecent studies show that the filter method has good numerical performance for nonlinear complementary problems (NCPs). Their approach is to reformulate an NCP as a constrained optimization solved by filter algorithms. However, they can only prove that the iterative sequence converges to the KKT point of the constrained optimization. In this paper, we investigate the relation between the KKT point of the constrained optimization and the solution of the NCP. First, we give several sufficient conditions under which the KKT point of the constrained optimization is the solution of the NCP; second, we define regular conditions and regular point which include and generalize the previous results; third, we prove that the level sets of the objective function of the constrained optimization are bounded for a strongly monotone function or a uniformP-function; finally, we present some examples to verify the previous results.
Transnational sustainability certification for the bioeconomy? Patterns and discourse coalitions of resistance and alternatives in biomass exporting regions
Authors: Vogelpohl Thomas 
Published: February 2021

AbstractThe bioeconomy is nowadays widely proclaimed by governments and corporations around the world as a new paradigm for a sustainable economy. Essentially, it broadly denotes the promotion, development and establishment of the use of biogenic resources in diverse kinds of industrial technologies, production processes and products. Yet, in order for the bioeconomy to be sustainable, it has to be assured that these biogenic resources are sourced sustainably. In the last 30 years, transnational sustainability certification (TSC) has established itself as a popular instrument in this context, for example in the case of European biofuels sustainability regulation. In the last decade or so, however, TSC initiatives in several biomass production sectors like palm oil, soy, fruits, aquaculture or fisheries—mostly initiated by non-governmental organizations (NGOs) and corporations from the Global North—are increasingly met with resistance from actors from the resource-producing countries, mostly located in the Global South. Issues brought up in this context concern their lack of legitimacy and respect for national regulatory sovereignty and conflicting priorities in terms of sustainable development. Consequently, governmental and corporate actors from the resource-producing countries have developed sustainability standards that now at least partly compete with TSC. Against this background, this contribution investigates this apparent dilemma of biomass certification by taking stock of existing TSC initiatives and territorial responses to them in several sectors of the bioeconomy in order to discover general patterns and dynamics of transnational biomass sustainability certification. This analysis is based on a review of existing empirical studies on these issues as well as on conceptual literature on discourse coalitions and transnational hybrid governance for the classification of the different aspects and developments in the individual sectors. Results show that TSC is indeed challenged in all sectors around story lines of sovereignty and sustainability, employed by closely associated state and industry actors in the specific context of the prevalent state-industry relations and the practices and institutions of the respective international political economies. Beyond this general pattern, these alternative systems take on different shapes and complex relations between transnational and territorial sustainability governance emerge that are not always antagonistic, but also exist in parallel or even complementarily and involve various hybrid configurations of public and private actors. Overall, this casts some doubt on the potential of TSC as an instrument to safeguard the sustainability of the bioeconomy and shows one of its potential pitfalls, which is reflected upon in the conclusion.
Nitrous oxide emissions and maize yield as influenced by nitrogen fertilization and tillage operations in upland soil
Authors: Kim Sung Un , Lee Hyun Ho , Moon Sung Min , Han Hae Ri , Hong Chang Oh 
Published: February 2021

AbstractPrevious studies simply focused on determining nitrous oxide (N2O) emissions from the soil under different tillage operations and nitrogen (N) fertilizations without considering crop yield. Therefore, the objective of this study was to determine the effects of different tillage operations and N fertilizations on N2O emissions and crop yield from upland soil. Two different tillage operations [conventional tillage (CT) and no-tillage (NT)] and N fertilizations [without urea (WOU) and with 186 kg N ha−1 of urea (WU)] were established in a randomized block design with three replications on upland soil. Maize (Zea mays) was cultivated from 6th July to 4th October, 2018 (year 1), and from 15th April to 26th July, 2019 (year 2). The daily N2O flux did not peak soon after tillage operation and N fertilization, but it was more related to the change in water-filled pore space (WFPS). The mean value of WFPS across N fertilizations and seasons (years) was higher in CT than in NT. The changes of nitrification and denitrification rates could be attributed to the differences in WFPS between CT and NT. Nitrification was the predominant process producing N2O with CT, but denitrification was with NT. The application of urea increased cumulative N2O emissions, while CT also increased it compared with NT. The order of the mean values of cumulative N2O emissions across seasons from the highest to the lowest was as follows: CT + WU (7.12 kg N2O ha−1 year−1) > NT + WU (5.69 kg N2O ha−1 year−1) ≥ CT + WOU (5.02 kg N2O ha−1 year−1) > NT + WOU (4.24 kg N2O ha−1 year−1). Tillage operation did not affect the grain yield of maize or yield-scaled N2O emissions (YSNE). However, the application of urea increased the grain yield of maize and decreased YSNE, implying it could reduce N2O emission per unit of maize grain production. No-tillage management did not decrease YSNE value compared to CT operation, but N fertilization significantly decreased YSNE in the current study.
Blast Response Simulation of the Alfred Murrah Building Reinforced by Use of HPFRCC
Authors: Jung Jae-Wook , Hong Jung-Wuk 
Published: February 2021

AbstractStructural behavior against the blast load is evaluated for a structure reinforced by high-performance fiber-reinforced cementitious composites (HPFRCC). The Alfred P. Murrah Federal Building, which experienced a terrorist attack in 1995 is taken into consideration for the blast analysis using the finite element method. The continuous surface cap model (CSCM) is used to simulate the behavior of normal concrete and HPFRCC. By reinforcing normal concrete with HPFRCC, damage, and deformation of the structure are significantly reduced. This study presents an efficient reinforcement method by performing an explosion simulation on the structure using HPFRCC and evaluating the behavior according to various reinforcement methods. Specific reinforcements according to the types of members are required to enhance the efficiency of reinforcement. With the optimized reinforcement using high-performance fiber-reinforced cementitious composites (HPFRCC), the resistance to blast load is significantly improved.
Does the gap between health workers’ expectations and the realities of implementing a performance-based financing project in Mali create frustration?
Authors: Zitti Tony , Fillol Amandine , Lohmann Julia , Coulibaly Abdourahmane , Ridde Valéry 
Published: February 2021

AbstractBackgroundPerformance-Based Financing (PBF), an innovative health financing initiative, was recently implemented in Mali. PBF aims to improve quality of care by motivating health workers. The purpose of this research was to identify and understand how health workers’ expectations related to their experiences of the first cycle of payment of PBF subsidies, and how this experience affected their motivation and sentiments towards the intervention. We pose the research question, “how does the process of PBF subsidies impact the motivation of health workers in Mali?”MethodsWe adopted a qualitative approach using multiple case studies. We chose three district hospitals (DH 1, 2 and 3) in three health districts (district 1, 2 and 3) among the ten in the Koulikoro region. Our cases correspond to the three DHs. We followed the principle of data source triangulation; we used 53 semi-directive interviews conducted with health workers (to follow the principle of saturuation), field notes, and documents relating to the distribution grids of subsidies for each DH. We analyzed data in a mixed deductive and inductive manner.ResultsThe results show that the PBF subsidies led to health workers feeling more motivated to perform their tasks overall. Beyond financial motivation, this was primarily due to PBF allowing them to work more efficiently. However, respondents perceived a discrepancy between the efforts made and the subsidies received. The fact that their expectations were not met led to a sense of frustration and disappointment. Similarly, the way in which the subsidies were distributed and the lack of transparency in the distribution process led to feelings of unfairness among the vast majority of respondents. The results show that frustrations can build up in the early days of the intervention.ConclusionThe PBF implementation in Mali left health workers frustrated. The short overall implementation period did not allow actors to adjust their initial expectations and motivational responses, neither positive nor negative. This underlines how short-term interventions might not just lack impact, but instil negative sentiments likely to carry on into the future.
Rationale and design of an interventional study of cross-sectoral, coordinated treatment of stroke patients with patient-orientated outcome measurement (StroCare)
Authors: Rimmele David Leander , Schrage Theresa , Brettschneider Christian , Engels Alexander , Gerloff Christian , Härter Martin , Rosenkranz Michael , Schmidt Holger , Kriston Levente , Thomalla Götz 
Published: February 2021

Abstract
Introduction
Stroke has a long-term impact on functional status and quality of life in multiple health domains. A well-coordinated managed care program for stroke patients is crucial for ameliorating patients’ health and cost-efficient use of resources. The aim of this study is the implementation and evaluation of an optimised cross-sectoral, coordinated and managed care program for stroke patients bridging secondary and tertiary care.

Methods
In this multi-center mixed method sequentially controlled intervention study, stroke patients with ischemic stroke (I63), transient ischemic attack and related syndromes (G45), or intracerebral haermorrhage (I64) will be invited to participate. For a 12-months period, 235 consecutive patients are expected to be enrolled and assigned standard of care treatment as an active control group. During the following 12 months, 235 consecutive patients will be enrolled and assigned to a post stroke intervention program. The StroCare intervention consists of repeated outpatient visits with specialized stroke teams, the implementation of a case manager, the use of an electronical tool for communication between acute care, rehabilitation facilities, and out-patient care, and the definition of individualized treatment targets. Patients will be followed up for 24 months. The primary outcome is health-related quality of life measured by the Patient-Reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10) at 12 months after the index event, i.e. stroke or TIA. For the qualitative survey of the implementation process, 21 patients in the intervention group will be interviewed after implementation of the interventions. In addition, 20 health care providers and staff members will be interviewed before and after implementation. Additionally, economic outcomes will be evaluated after 6 and 12 months.

Perspective
The study will not only provide information about the tested intervention but is likely to be helpful for clinicians, suppliers of reimbursement, and researchers in implementing and evaluating complex interventions in stroke care in general. With this program, the health care system will have a reference model at its disposal for transfer to other regions and settings.

Trial registration
The trial is registered at ClinicalTrials.gov (NCT04159324). Approval of the local ethics committee (Ethik-Kommission der Ärztekammer Hamburg, Niedersachsen, Schleswig-Holstein) has been obtained.
Infected hip prosthesis in patient with suspected Covid-19 infection
Authors: Cosentino A. , Odorizzi G. , Berger W. 
Published: February 2021

Abstract
Background
Infections following arthroplasty are one of the major risks during this type of surgery. Moreover, the outbreak of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus Disease 2), has developed into an unprecedented pandemic, posing enormous pressure on health-care providers around the world.

Case presentation
Four and half years after right hip arthroplasty, the patient came back to our attention with pain at the same hip. The instrumental examinations showed signs of cup detachment. After carefully analyzing the case, we decided to perform a sterile aspiration of the hip in the operating room under C-arm fluoroscopy. Microbiological examinations showed positivity for E. coli. The patient underwent surgery by which the prosthesis was removed and a spacer was implanted. A therapy with Cefotaxim 2 g three times a day for 6 weeks was then set, and then a total arthroplasty was performed. During this period, the COVID-19 pandemic occurred and therefore the patient received nasal-throat swabbing two times, and both yielded negative results. However, 1 week after the final surgery, his respiratory conditions deteriorated and chest X-ray and CT scan showed images of ground-glass opacification patterns (GGO). Due to the clinical symptoms and the characteristic images of the instrumental examinations, the patient was transferred to an observation ward. Thereafter, two more swab tests gave negative results. The patient was then transferred to the ward for patients with typical symptoms of COVID-19 but with negative swab tests for 2 weeks and was subsequently discharged home.

Conclusion
The purpose of this case report was to point out the correct treatment of a PJI after the outbreak of COVID-19. Despite the ongoing COVID-19 pandemic, the guidelines in the case of periprosthetic hip infection further confirmed the correct management of the patient.
The value of the added diffusion-weighted images to multiparametric MRI in the early diagnosis of uterine cervix cancers and nodal assessment
Authors: Osman Nasr Mohamed , Mourad Mohamed Aboul-fotouh 
Published: February 2021

Abstract
Background
Cervical cancer still one of the most common causes of tumor-related death in developing countries presented in younger women. In this study, we aimed to evaluate the value of diffusion-weighted MRI in early diagnosis of malignant cervical lesions, to assess metastatic adenopathy, peritoneal dissemination, and possible tumor recurrence, and determine treatment response. This study included 60 patients with abnormal vaginal bleeding and suspected cervical lesion by US. A histopathological biopsy was done. Pelvic MR with DWI and dynamic contrast-enhanced MRI were done for all patients.

Results
According to the histopathological findings, we divided our studied 60 patents into two groups: group I, malignant lesions (46 lesions; 76.7%), and group II, benign lesions (14 lesions; 23.3%). Multiparametric MRI could detect all cervical lesions but with poor pathologic characterization, achieving 72.37% sensitivity, 37.50% specificity, 63.33% accuracy, 76.19% PPV, and 33.33% NPV. When compared with DWI with ADC value measurements at high b value (b = 800) to MRI exam, it showed a higher diagnostic accuracy with good lesion pathological characterization that achieved 95.65% sensitivity, 71.43% specificity, 90% accuracy, 91.67 PPV, and 83.33% NPV. The mean ADC value for malignant lesions was 0.86–1.1, mean = 0.92 ± 0.71 × 10−3 mm2/s, while the mean ADC value in the benign lesion group was 1.18 ± 0.1 × 10–3 mm2/s.

Conclusion
Comparing DWI with ADC values measurements at high b value to the multiparametric MRI examination of the female pelvis increases the sensitivity, specificity, and diagnostic accuracy of characterization and early diagnosis of cervical malignant focal lesions and reduces the need for intravenous contrast administration.
Comparing the diagnostic efficacy of digital breast tomosynthesis with full-field digital mammography using BI-RADS scoring
Authors: Naeim Rana M. , Marouf Rania A. , Nasr Merhan A. , Abd El-Rahman Marwa E. 
Published: February 2021

Abstract
Background
Mammography has been the mainstay for the detection of breast cancer over decades. It has gradually advanced from screen film to full-field digital mammography. Tomosynthesis has evolved as advanced imaging for early diagnosis of breast lesions with a promising role in both diagnostic and screening settings, particularly in dense and treated breasts.

Results
This study included 90 female patients according to our inclusion criteria. All patients perform full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) and were classified according to breast density and age groups. Breast imaging reporting and data system (BI-RADS) scoring was assigned for each case. This was correlated with the final diagnosis; the diagnostic indices of mammography were a sensitivity of 64.44%, a specificity of 77.78%, a positive predictive value (PPV) 74.63%, a negative predictive value (NPV) of 68.63%, and a diagnostic accuracy of 71.11%. Diagnostic indices of DBT were a sensitivity of 100%, a specificity of 97.77%, PPV 97.78%, NPV 100%, and diagnostic accuracy of 97.7%.
In patients with dense breasts American College of Radiology (ACR) (c and d), 61% of cases had changed their BIRADS scoring with the addition of tomosynthesis. Yet, in non-dense breast ACR (a and b), 45% of cases had changed BIRADS scoring with the addition of DBT to FFDM.

Conclusion
DBT is a promising imaging modality offering better detection and characterization of different breast abnormalities, especially in young females, and those with dense breasts with an increase of sensitivity and specificity than FFDM. This leads to a reduction in the recalled cases, negative biopsies, and assessing the efficacy of therapy as it enables improving detection of breast cancer and different breast lesions not visualized by conventional mammography
Diogenes syndrome in dementia: a case report
Authors: Sacchi Luca , Rotondo Emanuela , Pozzoli Sara , Fiorentini Alessio , Schinco Giuseppina , Mandelli Clara , Coppola Carlotta , Fumagalli Giorgio G. , Carandini Tiziana , Pietroboni Anna M. , Galimberti Daniela , Triulzi Fabio , Marotta Giorgio , Scarpini Elio , Cesari Matteo , Brambilla Paolo , Arighi Andrea 
Published: February 2021

Background
Diogenes syndrome is a neurobehavioural syndrome characterised by domestic squalor, hoarding and lack of insight. It is an uncommon but high-mortality condition, often associated with dementia.

Aims
To describe the clinical features and treatment of Diogenes syndrome secondary to behavioural variant frontotemporal dementia (bvFTD).

Method
We describe a case of bvFTD in a 77-year-old man presenting with Diogenes syndrome.

Results
The patient's medical and psychiatric histories were unremarkable, but in recent years he had begun packing his flat with ‘art pieces’. Mental state examination revealed confabulation and more structured delusions. Neuropsychological evaluation outlined an impairment in selective attention and letter verbal fluency, but no semantic impairment, in the context of an overall preserved mental functioning. Brain magnetic resonance imaging and positron emission tomography (PET) with fluorodeoxyglucose showed mild bilateral temporo-insular atrophy and hypometabolism in the left-superior temporal gyrus respectively. An amyloid PET scan and genetic analysis covering the dementia spectrum were normal. A diagnosis of bvFTD was made.

Conclusions
The clinical framing of behavioural symptoms of dementia such as hoarding poses a diagnostic challenge. This case illustrates the importance of a deeper understanding of Diogenes syndrome, leading to timelier diagnosis and effective therapeutic strategies.