bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-effectiveness of direct discharge from the emergency department of patients with simple stable injuries in the Netherlands
Authors: Geerdink Thijs H , Geerdink Niek J , van Dongen Johanna M , Haverlag Robert , Goslings J Carel , van Veen Ruben N 
Published: October 2021

BackgroundApproximately one-third of musculoskeletal injuries are simple stable injuries (SSIs). Direct discharge (DD) from the emergency department (ED) of patients with SSIs reduces healthcare utilization, without compromising patient outcome and experience, when compared with “traditional” care with routine follow-up. This study aimed to determine the cost-effectiveness of DD compared with traditional care from a societal perspective.MethodsSocietal costs, including healthcare, work absenteeism, and travel costs, were calculated for patients with an SSI, 6 months before (pre-DD cohort) and after implementation of DD (DD cohort). The pre-DD cohort was treated according to local protocols. The DD cohort was treated using orthoses, discharge leaflet, smartphone application, and telephone helpline, without scheduling routine follow-up. Effect measures included generic health-related quality of life (HR-QoL; EuroQol Five-Dimensional Questionnaire); disease-specific HR-QoL (functional outcome, different validated questionnaires, converted to 0–100 scale); treatment satisfaction (Visual Analog Scale (VAS), 1–10); and pain (VAS, 1–10). All data were assessed using a 3-month postinjury survey and electronic patient records. Incremental cost-effectiveness ratios were calculated and uncertainty was assessed using bootstrapping techniques.ResultsBefore DD, 144 of 348 participants completed the survey versus 153 of 371 patients thereafter. There were no statistically significant differences between the pre-DD cohort and the DD cohort for generic HR-QoL (0.03; 95% CI −0.01 to 0.08), disease-specific HR-QoL (4.4; 95% CI −1.1 to 9.9), pain (0.08; 95% CI −0.37 to 0.52) and treatment satisfaction (−0.16; 95% CI −0.53 to 0.21). Total societal costs were lowest in the DD cohort (−€822; 95% CI −€1719 to −€67), including healthcare costs (−€168; 95% CI −€205 to −€131) and absenteeism costs (−€645; 95% CI −€1535 to €100). The probability of DD being cost-effective was 0.98 at a willingness-to-pay of €0 for all effect measures, remaining high with increasing willingness-to-pay for generic HR-QoL, disease-specific HR-QoL, and pain, and decreasing with increasing willingness-to-pay for treatment satisfaction.DiscussionDD from the ED of patients with SSI seems cost-effective from a societal perspective. Future studies should test generalizability in other healthcare systems and strengthen findings in larger injury-specific cohorts.Level of evidenceII.
Prevalence of Three-Rooted Deciduous Mandibular Molars in the Children of Northwestern Iran
Authors: Khosrozadeh Maryam , Mostafavi Maryam , Hamrah Mohammad Hassan , Niknejad Elham 
Published: October 2021

Introduction. Although primary teeth have a determinative role in development of normal occlusion, few studies about anomalies related to deciduous dentition have been conducted so far. Regarding recent improvements in common knowledge and the importance of maintaining primary teeth until eruption of succedaneous teeth, identifying the morphology of primary teeth and probable variations is of great importance to achieve optimal therapeutic outcome. This study aims to determine the prevalence of three-rooted mandibular primary molars in a population of northwestern Iran. Materials and Methods. In this descriptive cross-sectional study, periapical radiographs of patients attending private oral and maxillofacial radiology offices in the northwestern region of Iran from 2017 to 2019 were retrospectively reviewed. A total of

300

cases in the 3–

10

-year age range having bilateral periapical radiographs from mandibular primary molars were screened. First and second primary molars were observed meticulously. Gender, side of the mandible (right or left), symmetry, overall prevalence, and prevalence considering the type of molar (D or E) were recorded and analyzed. Results. Overall prevalence of three-rooted mandibular primary molars was

9.33
%

(

28
/
300

),

92.9
%

of which were unilateral. The prevalence of teeth showing supernumerary roots among all teeth examined was

2.5
%

(

30
/
1200

). Considering symmetry and gender, the occurrence of these three-rooted primary molars did not differ significantly (respectively,

p
=
0.832

and

p
=
0.541

). However, there was a significant relationship between the occurrence of supernumerary roots and left side for three-rooted first molars and right side for three-rooted second molars (

p
=
0.021

). Conclusion. Obtained data show that three-rooted mandibular primary molars in children of northwest region of Iran have a prevalence of approximately

10

% which urges some specific considerations in exodontic and endodontic procedures.
Predictors of postoperative hospital length of stay after total knee arthroplasty
Authors: Tornese Davide , Robustelli Alessandro , Ricci Gabriele , Rancoita Paola Maria Vittoria , Maffulli Nicola , Peretti Giuseppe Michele 
Published: October 2021

Introduction:
We aimed to collect and analyse clinical and functional variables of patients undergoing rehabilitation after total knee arthroplasty (TKA), to identify the variables that influence the postoperative hospital length of stay (LOS).

Methods:
We conducted a retrospective analysis of prospectively collected data of 1,082 consecutive patients (746 females and 336 males) who underwent primary TKA and rehabilitation in our orthopaedic institute between January 2013 and July 2017. Clinical and anthropometric data were analysed using a multivariate linear regression model.

Results:
The average LOS was 5.08 ± 2.52 days in the Department of Orthopaedic Surgery and 12.67 ± 5.54 days in the Sports Rehabilitation Unit. Factors such as age, female sex and the presence of comorbidities were predictive of a longer stay. The presence of caregiver assistance at home was associated with shorter LOS. There was no evidence of a statistically significant positive association between body mass index and LOS.

Conclusion:
An in-depth and early knowledge of factors that influence LOS may enable the multidisciplinary team to plan a patient-tailored rehabilitation path and better allocate resources to maximise patients’ functional recovery, while reducing LOS and the overall cost of the procedure.
Time to intubation with McGrath™ videolaryngoscope versus direct laryngoscope in powered air-purifying respirator: a randomised controlled trial
Authors: Goh Qing Yuan , Lie Sui An , Tan Zihui , Tan Pei Yi Brenda , Ng Shin Yi , Abdullah Hairil Rizal 
Published: October 2021

Abstract

Introduction:
During the coronavirus disease 2019 (COVID-19) pandemic, multiple guidelines have recommended videolaryngoscope (VL) for tracheal intubation. However, there is no evidence that VL reduces time to tracheal intubation, and this is important for COVID-19 patients with respiratory failure.

Methods:
To simulate intubation of COVID-19 patients, we randomly assigned 28 elective surgical patients to be intubated with either McGrath™ MAC VL or direct laryngoscope (DL) by specialist anaesthetists who donned 3M™ Jupiter™ powered air-purifying respirators (PAPR) and N95 masks. The primary outcome was time to intubation.

Results:
The median time to intubation was 61 s (interquartile range [IQR] 37–63 s) and 41.5 s (IQR 37–56 s) in the VL and DL groups, respectively (P = 0.35). The closest mean distance between the anaesthetist and patient during intubation was 21.6 ± 4.8 cm and 17.6 ± 5.3 cm in the VL and DL groups, respectively (P = 0.045). There were no significant differences in the median intubation difficulty scale scores, proportion of successful intubations at the first laryngoscopic attempt and proportion of intubations requiring adjuncts. All the patients underwent successful intubation with no adverse event.

Conclusion:
There was no significant difference in the time to intubation of elective surgical patients with either McGrath™ VL or DL by specialist anaesthetists who donned PAPR and N95 masks. The distance between the anaesthetist and patient was significantly greater with VL. When resources are limited or disrupted during a pandemic, DL could be a viable alternative to VL for specialist anaesthetists.
Image quality, contrast enhancement and radiation dose of electrocardiograph- versus non-electrocardiograph-triggered computed tomography angiography of the aorta
Authors: Wong Ying Mei , Ong Ching Ching , Liang Chong Ri , Tan Choon Ann , Teo Lynette Li San 
Published: October 2021

Introduction:
Computed tomography angiography of the aorta (CTAA) is the modality of choice for investigating aortic disease. Our aim was to evaluate the image quality, contrast enhancement and radiation dose of electrocardiograph (ECG)-triggered and non-ECG-triggered CTAA on a 256-slice single-source CT scanner. This allows the requesting clinician and the radiologist to balance radiation risk and image quality.

Methods:
We retrospectively assessed the data of 126 patients who had undergone CTAA on a single-source CT scanner using ECG-triggered (group 1, n = 77) or non-ECG-triggered (group 2, n = 49) protocols. Radiation doses were compared. Qualitative (4-point scale) and quantitative image quality assessments were performed.

Results:
The mean volume CT dose index, dose length product and effective dose in group 1 were 12.4 ± 1.9 mGy, 765.8 ± 112.4 mGy cm and 13.0 ± 1.9 mSv, respectively. These were significantly higher compared to group 2 values (9.1 ± 2.6 mGy, 624.1 ± 174.8 mGy cm and 10.6 ± 3.0 mSv, respectively) (P < 0.001). Qualitative assessment showed the image quality at the aortic root–proximal ascending aorta was significantly higher in group 1 (median 3) than in group 2 (median 2, P < 0.001). Quantitative assessment showed significantly better mean arterial attenuation, signal-to-noise ratio and contrast-to-noise ratio in ECG-triggered CTAA compared to non-ECG-triggered CTAA.

Conclusion:
ECG-triggered CTAA in a single-source scanner has superior image quality and vessel attenuation of aortic root/ascending aorta, but a higher radiation dose of approximately 23%. Its use should be considered specifically when assessing aortic root/ascending aorta pathology.
Islam Is Not a “Religion” – Global Religious History and Early Twentieth-Century Debates in British Malaya
Authors: Maltese Giovanni 
Published: October 2021

Abstract
Lately, Islamicists have called to discard “religion” as a conceptual tool and/or to use the “Qurʾānic term” dīn instead, arguing that “religion” entails Eurocentric bias. Analyzing how Fazl-ur-Rahman Ansari conceptualized Islam and religion in the late 1930s and early 1940s, this article presents a threefold argument. Firstly, I argue that a global history approach which examines in a poststructuralist framework how “Islam” and “religion” are used in concrete contexts is better suited to address the problem of Eurocentrism in both Religious Studies and Islamic Studies. Secondly, I challenge the scholarly thesis that twentieth-century Southeast Asian intellectual debates which referred to Islam as religion were mere emulators of debates conducted in the “West.” Instead of assuming isolated histories and ignoring Southeast Asian debates, I contend that the current use of and debates about conceptualizations of Islam as/and religion are the product of one and the same discourse – a result of global negotiation processes in which Europeans were as involved as Southeast Asia-based non-Europeans, even if they did not speak from the same position of power. Finally, I submit that the approach of global religious history opens new perspectives on contemporary Malaysian politics.
Increased plasma disequilibrium between pro- and anti-oxidants during the early phase resuscitation after cardiac arrest is associated with increased levels of oxidative stress end-products
Authors: Shoaib Muhammad , Kim Nancy , Choudhary Rishabh C. , Yin Tai , Shinozaki Koichiro , Becker Lance B. , Kim Junhwan 
Published: October 2021

AbstractBackgroundCardiac arrest (CA) results in loss of blood circulation to all tissues leading to oxygen and metabolite dysfunction. Return of blood flow and oxygen during resuscitative efforts is the beginning of reperfusion injury and is marked by the generation of reactive oxygen species (ROS) that can directly damage tissues. The plasma serves as a reservoir and transportation medium for oxygen and metabolites critical for survival as well as ROS that are generated. However, the complicated interplay among various ROS species and antioxidant counterparts, particularly after CA, in the plasma have not been evaluated. In this study, we assessed the equilibrium between pro- and anti-oxidants within the plasma to assess the oxidative status of plasma post-CA.MethodsIn male Sprague–Dawley rats, 10 min asphyxial-CA was induced followed by cardiopulmonary resuscitation (CPR). Plasma was drawn immediately after achieving return of spontaneous circulation (ROSC) and after 2 h post-ROSC. Plasma was isolated and analyzed for prooxidant capacity (Amplex Red and dihydroethidium oxidation, total nitrate and nitrite concentration, xanthine oxidase activity, and iron concentration) and antioxidant capacity (catalase and superoxide dismutase activities, Total Antioxidant Capacity, and Iron Reducing Antioxidant Power Assay). The consequent oxidative products, such as 4-Hydroxyl-2-noneal, malondialdehyde, protein carbonyl, and nitrotyrosine were evaluated to determine the degree of oxidative damage.ResultsAfter CA and resuscitation, two trends were observed: (1) plasma prooxidant capacity was lower during ischemia, but rapidly increased post-ROSC as compared to control, and (2) plasma antioxidant capacity was increased during ischemia, but either decreased or did not increase substantially post-ROSC as compared to control. Consequently, oxidation products were increased post-ROSC.ConclusionOur study evaluated the disbalance of pro- and anti-oxidants after CA in the plasma during the early phase after resuscitation. This disequilibrium favors the prooxidants and is associated with increased levels of downstream oxidative stress-induced end-products, which the body’s antioxidant capacity is unable to directly mitigate. Here, we suggest that circulating plasma is a major contributor to oxidative stress post-CA and its management requires substantial early intervention for favorable outcomes.
KDM6A mutations promote acute cytoplasmic DNA release, DNA damage response and mitosis defects
Authors: Koch J. , Lang A. , Whongsiri P. , Schulz W. A. , Hoffmann M. J. , Greife A. 
Published: October 2021

Abstract
Background
KDM6A, encoding a histone demethylase, is one of the top ten mutated epigenetic cancer genes. The effect of mutations on its structure and function are however poorly characterized.

Methods
Database search identified nonsense and missense mutations in the N-terminal TPR motifs and the C-terminal, catalytic JmjC domain, but also in the intrinsically disordered region connecting both these two well-structured domains. KDM6A variants with cancer-derived mutations were generated using site directed mutagenesis and fused to eGFP serving as an all-in-one affinity and fluorescence tag to study demethylase activity by an ELISA-based assay in vitro, apoptosis by FACS, complex assembly by Co-immunoprecipitation and localization by microscopy in urothelial cells and apoptosis by FACS.

Results
Independent of the mutation and demethylase activity, all KDM6A variants were detectable in the nucleus. Truncated KDM6A variants displayed changes in complex assemblies affecting (1) known interactions with the COMPASS complex component RBBP5 and (2) KDM6A-DNA associated assemblies with the nuclear protein Nucleophosmin. Some KDM6A variants induced a severe cellular phenotype characterized by multiple acute effects on nuclear integrity, namely, release of nuclear DNA into the cytoplasm, increased level of DNA damage indicators RAD51 and p-γH2A.X, and mitosis defects. These damaging effects were correlated with increased cell death.

Conclusion
These observations reveal novel effects of pathogenic variants pointing at new specific functions of KDM6A variants. The underlying mechanisms and affected pathways have to be investigated in future research to understand how tumor cells cope with and benefit from KDM6A truncations.
Landscape and climatic features drive genetic differentiation processes in a South American coastal plant
Authors: Silva-Arias Gustavo A. , Caballero-Villalobos Lina , Giudicelli Giovanna C. , Freitas Loreta B. 
Published: October 2021

Abstract
Background
Historical and ecological processes shape patterns of genetic diversity in plant species. Colonization to new environments and geographical landscape features determine, amongst other factors, genetic diversity within- and differentiation between-populations. We analyse the genetic diversity and population structure of Calibrachoa heterophylla to infer the influence of abiotic landscape features on the level of gene flow in this coastal species of the South Atlantic Coastal Plain.

Results
The C. heterophylla populations located on early-deposited coastal plain regions show higher genetic diversity than those closer to the sea. The genetic differentiation follows a pattern of isolation-by-distance. Landscape features, such as water bodies and wind corridors, and geographical distances equally explain the observed genetic differentiation, whereas the precipitation seasonality exhibits a strong signal for isolation-by-environment in marginal populations. The estimated levels of gene flow suggest that marginal populations had restricted immigration rates enhancing differentiation.

Conclusions
Topographical features related to coastal plain deposition history influence population differentiation in C. heterophylla. Gene flow is mainly restricted to nearby populations and facilitated by wind fields, albeit without any apparent influence of large water bodies. Furthermore, differential rainfall regimes in marginal populations seem to promote genetic differentiation.
Ultrasonic biomechanics method for vortex and wall motion of left ventricle: a phantom and in vivo study
Authors: Zhang Aohua , Pan Min , Meng Long , Zhang Fengshu , Zhou Wei , Zhang Yaonan , Zheng Rongqin , Niu Lili , Zhang Yanling 
Published: October 2021

Abstract
Background
The non-invasive quantitative evaluation of left ventricle (LV) function plays a critical role in clinical cardiology. This study proposes a novel ultrasonic biomechanics method by integrating both LV vortex and wall motion to fully assess and understand the LV structure and function. The purpose of this study was to validate the ultrasonic biomechanics method as a quantifiable approach to evaluate LV function.

Methods
Firstly, B-mode ultrasound images were acquired and processed, which were utilized to implement parameters for quantifying the LV vortex and wall motion respectively. Next, the parameters were compared in polyvinyl alcohol cryogen (PVA) phantoms with different degree of stiffness corresponding to different freezing and thawing cycles in vitro. Finally, the parameters were computed in vivo during one cardiac cycle to assess the LV function in normal and abnormal subjects in vivo.

Results
In vitro study, the velocity field of PVA phantom differed with stiffness (varied elasticity modulus). The peak of strain for wall motion decreases with the increase of elasticity modulus, and periodically changed values. Statistical analysis for parameters of vortex dynamics (energy dissipation index, DI; kinetic energy fluctuations, KEF; relative strength, RS; and vorticity, W) based on different elasticity (E) of phantom depicted the good viability of this algorithm. In vivo study, the results confirmed that subjects with LV dysfunction had lower vorticity and strain (S) compared to the normal group.

Conclusion
Ultrasonic biomechanics method can obtain the vortex and wall motion of left ventricle. The method may have potential clinical value in evaluation of LV dysfunction.
Utility of conventional clinical risk scores in a low-risk COVID-19 cohort
Authors: Ngiam Jinghao Nicholas , Chew Nicholas W. S. , Tham Sai Meng , Lim Zhen Yu , Li Tony Y. W. , Cen Shuyun , Tambyah Paul Anantharajah , Santosa Amelia , Sia Ching-Hui , Cross Gail Brenda 
Published: October 2021

Abstract
Background
Several specific risk scores for Coronavirus disease 2019 (COVID-19) involving clinical and biochemical parameters have been developed from higher-risk patients, in addition to validating well-established pneumonia risk scores. We compared multiple risk scores in predicting more severe disease in a cohort of young patients with few comorbid illnesses. Accurately predicting the progression of COVID-19 may guide triage and therapy.

Methods
We retrospectively examined 554 hospitalised COVID-19 patients in Singapore. The CURB-65 score, Pneumonia Severity Index (PSI), ISARIC 4C prognostic score (4C), CHA2DS2-VASc score, COVID-GRAM Critical Illness risk score (COVID-GRAM), Veterans Health Administration COVID-19 index for COVID-19 Mortality (VACO), and the “rule-of-6” score were compared for three performance characteristics: the need for supplemental oxygen, intensive care admission and mechanical ventilation.

Results
A majority of patients were young (≤ 40 years, n = 372, 67.1%). 57 (10.3%) developed pneumonia, with 16 (2.9% of study population) requiring supplemental oxygen. 19 patients (3.4%) required intensive care and 2 patients (0.5%) died. The clinical risk scores predicted patients who required supplemental oxygenation and intensive care well. Adding the presence of fever to the CHA2DS2-VASc score and 4C score improved the ability to predict patients who required supplemental oxygen (c-statistic 0.81, 95% CI 0.68–0.94; and 0.84, 95% CI 0.75–0.94 respectively).

Conclusion
Simple scores including well established pneumonia risk scores can help predict progression of COVID-19. Adding the presence of fever as a parameter to the CHA2DS2-VASc or the 4C score improved the performance of these scores in a young population with few comorbidities.
Seasonal variations in use and outcome of rapid antigen detection tests and cultures in pharyngotonsillitis: a register study in primary care
Authors: Andersson Martin , Pallon Jon , Cronberg Olof , Sundqvist Martin , Hedin Katarina 
Published: October 2021

Abstract
Background
Diagnosis and treatment of pharyngotonsillitis are commonly focused on group A streptococci (GAS), although the disease is often associated with other pathogens. While the incidence of pharyngotonsillitis is known to vary with season, seasonal variations in the prevalence of potential pathogens are sparsely explored. The aim of this study was to explore any seasonal variations in the use and outcome of rapid antigen detection tests (RADTs) for GAS and throat cultures among patients diagnosed with pharyngotonsillitis in primary care.

Methods
We retrieved and combined retrospective data from the electronic medical record system and the laboratory information system in Kronoberg County, Sweden. Primary care visits resulting in a diagnosis of tonsillitis or pharyngitis were included, covering the period 2013–2016. The monthly rate of visits was measured, along with the use and outcome of RADTs for GAS and throat cultures obtained on the date of diagnosis. The variations between calendar months were then analysed.

Results
We found variations between calendar months, not only in the mean rate of visits resulting in a diagnosis of pharyngotonsillitis (p < 0.001), but in the mean proportion of RADTs being positive for GAS among the diagnosed (p < 0.001), and in the mean proportion of visits associated with a throat culture (p < 0.001). A lower mean rate of visits in August and September coincided with a lower proportion of RADTs being positive for GAS among them, which correlated with a higher proportion of visits associated with a throat culture.

Conclusions
This study suggests that the role of GAS in pharyngotonsillitis in Sweden is less prominent in August and September than during the rest of the year.