bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association of polypharmacy and high-risk drug classes with adverse health outcomes in the Scottish population with type 1 diabetes
Authors:   on behalf of the Scottish Diabetes Research Network (SDRN) Epidemiology Group, Höhn Andreas , Jeyam Anita , Caparrotta Thomas M. , McGurnaghan Stuart J. , O’Reilly Joseph E. , Blackbourn Luke A. K. , McCrimmon Rory J. , Leese Graham P. , McKnight John A. , Kennon Brian , Lindsay Robert S. , Sattar Naveed , Wild Sarah H. , McKeigue Paul M. , Colhoun Helen M. 
Published: February 2021

Abstract
Aims/hypothesis
The aim of this work was to map the number of prescribed drugs over age, sex and area-based socioeconomic deprivation, and to examine the association between the number of drugs and particular high-risk drug classes with adverse health outcomes among a national cohort of individuals with type 1 diabetes.

Methods
Utilising linked healthcare records from the population-based diabetes register of Scotland, we identified 28,245 individuals with a diagnosis of type 1 diabetes on 1 January 2017. For this population, we obtained information on health status, predominantly reflecting diabetes-related complications, and information on the total number of drugs and particular high-risk drug classes prescribed. We then studied the association of these baseline-level features with hospital admissions for falls, diabetic ketoacidosis (DKA), and hypoglycaemia or death within the subsequent year using multivariate Cox proportional hazards models.

Results
Not considering insulin and treatment for hypoglycaemia, the mean number of prescribed drugs was 4.00 (SD 4.35). The proportion of individuals being prescribed five or more drugs at baseline consistently increased with age (proportion [95% CI]: 0–19 years 2.04% [1.60, 2.49]; 40–49 years 28.50% [27.08, 29.93]; 80+ years 76.04% [67.73, 84.84]). Controlling for age, sex, area-based socioeconomic deprivation and health status, each additional drug at baseline was associated with an increase in the hazard for hospitalisation for falls, hypoglycaemia and death but not for DKA admissions (HR [95% CI]: falls 1.03 [1.01, 1.06]; DKA 1.01 [1.00, 1.03]; hypoglycaemia 1.05 [1.02, 1.07]; death 1.04 [1.02, 1.06]). We found a number of drug classes to be associated with an increased hazard of one or more of these adverse health outcomes, including antithrombotic/anticoagulant agents, corticosteroids, opioids, antiepileptics, antipsychotics, hypnotics and sedatives, and antidepressants.

Conclusions
Polypharmacy is common among the Scottish population with type 1 diabetes and is strongly patterned by sociodemographic factors. The number of prescribed drugs and the prescription of particular high-risk drug classes are strong markers of an increased risk of adverse health outcomes, including acute complications of diabetes.

Graphical abstract
The ethics of algorithms: key problems and solutions
Authors: Tsamados Andreas , Aggarwal Nikita , Cowls Josh , Morley Jessica , Roberts Huw , Taddeo Mariarosaria , Floridi Luciano 
Published: February 2021

AbstractResearch on the ethics of algorithms has grown substantially over the past decade. Alongside the exponential development and application of machine learning algorithms, new ethical problems and solutions relating to their ubiquitous use in society have been proposed. This article builds on a review of the ethics of algorithms published in 2016 (Mittelstadt et al. Big Data Soc 3(2), 2016). The goals are to contribute to the debate on the identification and analysis of the ethical implications of algorithms, to provide an updated analysis of epistemic and normative concerns, and to offer actionable guidance for the governance of the design, development and deployment of algorithms.
Baer sums for a natural class of monoid extensions
Authors: Faul Peter F. 
Published: February 2021

AbstractIt is well known that the set of isomorphism classes of extensions of groups with abelian kernel is characterized by the second cohomology group. In this paper we generalise this characterization of extensions to a natural class of extensions of monoids, the cosetal extensions. An extension "Equation missing" is cosetal if for all $$g,g' \in G$$

g
,

g
′

∈
G

in which $$e(g) = e(g')$$

e

(
g
)

=
e

(

g
′

)

, there exists a (not necessarily unique) $$n \in N$$

n
∈
N

such that $$g = k(n)g'$$

g
=
k

(
n
)

g
′

. These extensions generalise the notion of special Schreier extensions, which are themselves examples of Schreier extensions. Just as in the group case where a semidirect product could be associated to each extension with abelian kernel, we show that to each cosetal extension (with abelian group kernel), we can uniquely associate a weakly Schreier split extension. The characterization of weakly Schreier split extensions is combined with a suitable notion of a factor set to provide a cohomology group granting a full characterization of cosetal extensions, as well as supplying a Baer sum.
Weakly supervised deep learning for determining the prognostic value of 18F-FDG PET/CT in extranodal natural killer/T cell lymphoma, nasal type
Authors: Guo Rui , Hu Xiaobin , Song Haoming , Xu Pengpeng , Xu Haoping , Rominger Axel , Lin Xiaozhu , Menze Bjoern , Li Biao , Shi Kuangyu 
Published: February 2021

Abstract
Purpose
To develop a weakly supervised deep learning (WSDL) method that could utilize incomplete/missing survival data to predict the prognosis of extranodal natural killer/T cell lymphoma, nasal type (ENKTL) based on pretreatment 18F-FDG PET/CT results.

Methods
One hundred and sixty-seven patients with ENKTL who underwent pretreatment 18F-FDG PET/CT were retrospectively collected. Eighty-four patients were followed up for at least 2 years (training set = 64, test set = 20). A WSDL method was developed to enable the integration of the remaining 83 patients with incomplete/missing follow-up information in the training set. To test generalization, these data were derived from three types of scanners. Prediction similarity index (PSI) was derived from deep learning features of images. Its discriminative ability was calculated and compared with that of a conventional deep learning (CDL) method. Univariate and multivariate analyses helped explore the significance of PSI and clinical features.

Results
PSI achieved area under the curve scores of 0.9858 and 0.9946 (training set) and 0.8750 and 0.7344 (test set) in the prediction of progression-free survival (PFS) with the WSDL and CDL methods, respectively. PSI threshold of 1.0 could significantly differentiate the prognosis. In the test set, WSDL and CDL achieved prediction sensitivity, specificity, and accuracy of 87.50% and 62.50%, 83.33% and 83.33%, and 85.00% and 75.00%, respectively. Multivariate analysis confirmed PSI to be an independent significant predictor of PFS in both the methods.

Conclusion
The WSDL-based framework was more effective for extracting 18F-FDG PET/CT features and predicting the prognosis of ENKTL than the CDL method.
Geometric Analysis to Determine Kinking and Shortening of Bridging Stents After Branched Endovascular Aortic Repair
Authors: Finotello Alice , Spinella Giovanni , Notini Giulia , Palombo Domenico , Pratesi Giovanni , Mambrini Simone , Auricchio Ferdinando , Conti Michele , Pane Bianca 
Published: February 2021

Abstract
Purpose
To evaluate bridging stent geometry in patients who underwent branched endovascular aortic repair (B-EVAR) and to correlate the outcomes with intrinsic bridging stent characteristics aiming to identify the stent(s) that guarantees the best performance.

Methods
Pre-operative and post-operative computed tomography images of all patients undergoing B-EVAR between September 2016 and April 2019 were retrospectively analyzed. Following geometrical features were measured: target vessel take-off angle (TOA); longitudinal stent shortening; shape index (SI), intended as ratio between minimum and maximum diameter of the lumen cross sections, averaged on three segments: zone 1 (proximal stented zone), zone 2 (intermediate), and zone 3 (distal).

Results
Thirty-eight branches (8 right (RRA) and 8 left renal arteries (LRA), 11 superior mesenteric arteries (SMA), 11 celiac trunks (CTR)) were treated. Fluency (Bard Peripheral Vascular), COVERA (Bard Peripheral Vascular), and VBX (WLGore&Assoc) stent-grafts were implanted in 10, 12, and 16 branches, respectively. Pre-operative TOA was more acute in RRA and LRA when compared to CTR and SMA, and straightened in post-operative configuration (109.86 ± 28.65° to 150.27 ± 21.0°; P < 0.001). Comparable values of SI among the stent types were found in zone 1 (P = 0.08), whereas higher SI in VBX group was detected in zones 2 (P < 0.001) and 3 (P < 0.001). The VBX group was also the most affected by stent shortening (11.12 ± 5.65%; P = 0.001).

Conclusion
Our early experience showed that the VBX stent offers greater stent circularity than the other devices even if a greater shortening has been observed drawing attention with regards to the decision of the nominal stent length.
The effect of vitamin D supplementation and nutritional intake on skeletal maturity and bone health in socio-economically deprived children
Authors: Uday Suma , Manaseki-Holland Semira , Bowie Jessica , Mughal Mohamed Zulf , Crowe Francesca , Högler Wolfgang 
Published: February 2021

Abstract
Purpose
1. To determine the effect of vitamin D supplementation on bone age (BA), a marker of skeletal maturity, and Bone Health Index (BHI), a surrogate marker of bone density. 2. To characterise the differences in nutritional intake and anthropometry between children with advanced vs. delayed BA.

Methods
The current study is a post hoc analysis of radiographs obtained as part of a randomised controlled trial. In this double-blind, placebo-controlled trial, deprived Afghan children (n = 3046) aged 1–11 months were randomised to receive six doses of oral placebo or vitamin D3 (100,000 IU) every 3 months for 18 months. Dietary intake was assessed through semi-quantitative food frequency questionnaires at two time points. Anthropometric measurements were undertaken at baseline and 18 months. Serum 25OHD was measured at five time points on a random subset of 632 children. Knee and wrist radiographs were obtained from a random subset (n = 641), of which 565 wrist radiographs were digitised for post-hoc analysis of BA and BHI using BoneXpert version 3.1.

Results
Nearly 93% (522, male = 291) of the images were analysable. The placebo (n = 258) and vitamin D (n = 264) groups were comparable at baseline. The mean (± SD) age of the cohort was 2 (± 0.3) years. At study completion, there was no difference in mean 25-hydroxy vitamin D concentrations [47 (95% CI 41, 56) vs. 55 (95% CI 45, 57) nmol/L, p = 0.2], mean (± SD) BA SDS [− 1.04 (1.36) vs. − 1.14 (1.26) years, p = 0.3] or mean (± SD) BHI SDS [− 0.30 (0.86) vs. − 0.31 (0.80), p = 0.8] between the placebo and vitamin D groups, respectively. Children with advanced skeletal maturity (BA SDS ≥ 0) when compared to children with delayed skeletal maturity (BA SDS < 0), had consumed more calories [mean (± SD) calories 805 (± 346) vs 723 (± 327) kcal/day, respectively, p < 0.05], were significantly less stunted (height SDS − 1.43 vs. − 2.32, p < 0.001) and underweight (weight SDS − 0.82 vs. − 1.45, p < 0.001), with greater growth velocity (11.57 vs 10.47 cm/ year, p < 0.05).

Conclusion
Deprived children have significant delay in skeletal maturation but no substantial impairment in bone health as assessed by BHI. BA delay was influenced by total calorie intake, but not bolus vitamin D supplementation.
Solid Swallow Examination During High Resolution Manometry and EGJ-Distensibility Help Identify Esophageal Outflow Obstruction in Non-obstructive Dysphagia
Authors: Murray Fritz Ruprecht , Fischbach Lara Maria , Schindler Valeria , Schnurre Larissa , Hente Juliane Marie , Tatu Aurora , Pohl Daniel 
Published: February 2021

AbstractSingle water swallow (SWS) high-resolution manometry (HRM) may miss relevant esophageal motility disorders. Solid test meal (STM) during HRM and lately the functional lumen imaging probe (FLIP) have been shown to be of diagnostic value in the assessment of motility disorders. We aimed to assess the diagnostic yield of STM and FLIP in non-obstructive dysphagia (NOD). Patients assessed for dysphagia with both HRM and FLIP between April 2016 and August 2019 were analyzed for signs of non-obstructive EGJ outflow obstruction (EGJOO) according to Chicago Classification 3.0 (CCv3) and CC adapted for the use with solid swallows (CC-S), followed by an individual group-specific analysis. Five subjects without dysphagia served as control group. Standard HRM- and FLIP-values as well as esophagograms and Eckardt Scores were analyzed. Forty-two patients were identified (male/female, 14/36, median age 62). Twenty-five (59.5%) were diagnosed with EGJOO during STM only (= SWS-negative patients; CC-S). The EGJ distensibility index (EGJ-DI) of symptomatic patients was significantly lower compared to the control group (p = 0.006). EGJ-DI was < 3mm2/mmHg in 67% and 88% of patients diagnosed according to CC-S and CCv3, respectively. The IRP during STM showed a significant association to the corresponding EGJ-DI values (p < 0.001). Seventy-six percent of patients received treatment because of additional STM evaluation with a favorable clinical response rate of 89%. STM and FLIP identify EGJOO in symptomatic patients with normal SWS during HRM. STM resembles an inexpensive and clinically meaningful option to diagnose motility disorders and helps to select patients for interventional treatment.
Web-based self-help intervention for partners of cancer patients based on acceptance and commitment therapy and self-compassion training: a randomized controlled trial with automated versus personal feedback
Authors: Köhle Nadine , Drossaert Constance H. C. , ten Klooster Peter M. , Schreurs Karlein M. G. , Hagedoorn Mariët , Van Uden-Kraan Cornelia F. , Verdonck-de Leeuw Irma M. , Bohlmeijer Ernst T. 
Published: February 2021

Abstract
Purpose
To evaluate the effectiveness of two versions (personal or automated feedback) of a psychological Web-based self-help intervention targeting partners of cancer patients. The intervention was based on acceptance and commitment therapy (ACT) and self-compassion training. Participants’ adherence and their satisfaction were also studied.

Methods
Two hundred three partners of patients with heterogeneous entities of cancer were randomized into three conditions: personal feedback (PF) (n = 67), automated feedback (AF) (n = 70), or waiting list (WL) control (n = 66). Participants completed measures at baseline (T0) and post-intervention (T1; 3 months after baseline) to assess psychological distress (HADS; primary outcome), positive mental health, caregiver strain, general health (secondary outcomes), posttraumatic growth, resilience, self-compassion, psychological flexibility, sense of mastery, and relational communication style (process measures). Participants in the two experimental conditions also completed these measures at follow-up (T2; 6 months after baseline).

Results
There was no significant difference in change in psychological distress, positive mental health, caregiver strain and general health from T0 to T1 for either of the experimental conditions compared with the WL-condition. However, when compared to a WL-condition, the PF-condition was effective in increasing psychological flexibility (effect size d = 0.49) and resilience (d = 0.12) and decreasing overprotection (d = 0.25), and the AF-condition was effective in reducing overprotection (d = 0.36) and improving protective buffering (d = 0.36). At follow-up, the PF-condition was more effective than the AF-condition for improving mental health (d = 0.36), psychological flexibility (d = 0.60), mastery (d = 0.48), and protective buffering (d = 0.24). Participants positively appreciated the intervention and 69% participants were adherent.

Conclusion
This study demonstrates that a Web-based intervention based on ACT and self-compassion training with automated or personal feedback does not seem to improve psychological distress; however, it may have the potential to support partners of cancer patients to cope with the difficult situation they are facing. The condition with personal feedback seemed to be more beneficial.
Age-related decline in the taurine content of the skin in rodents
Authors: Yoshimura Tomohisa , Inokuchi Yuki , Mutou Chikako , Sakurai Takanobu , Nagahama Tohru , Murakami Shigeru 
Published: February 2021

AbstractTaurine, a sulfur-containing amino acid, occurs at high concentrations in the skin, and plays a role in maintaining the homeostasis of the skin. We investigated the effects of aging on the content and localization of taurine in the skin of mice and rats. Taurine was extracted from the skin samples of hairless mice and Sprague Dawley rats, and the taurine content of the skin was determined by high-performance liquid chromatography (HPLC). The results of the investigation revealed that the taurine content in both the dermis and epidermis of hairless mice declined significantly with age. Similar age-related decline in the skin taurine content was also observed in rats. In contrast, the taurine content in the sole remained unchanged with age. An immunohistochemical analysis also revealed a decreased skin taurine content in aged animals compared with younger animals, although no significant differences in the localization of taurine were observed between the two age groups. Supplementation of the drinking water of aged mice with 3% (w/v) taurine for 4 weeks increased the taurine content of the epidermis, but not the dermis. The present study showed for the first time that the taurine content of the skin decreased with age in mice and rats, which may be related to the impairment of the skin homeostasis observed with aging. The decreased taurine content of the epidermis in aged animals was able to be rescued by taurine supplementation.
Comparing symptoms, treatment patterns, and quality of life of ankylosing spondylitis and non-radiographic axial spondyloarthritis patients in the USA: findings from a patient and rheumatologist Survey
Authors: Hunter Theresa , Sandoval David , Booth Nicola , Holdsworth Elizabeth , Deodhar Atul 
Published: February 2021

Abstract
Objectives
The aim of this study was to compare the symptoms, treatment patterns, and quality of life (QoL) of ankylosing spondylitis (AS) patients to non-radiographic axial spondyloarthritis (nr-axSpA) patients in the USA.

Method
A cross-sectional survey was conducted with rheumatologists and their consulting patients in the USA from June through August 2018. Patients who had a rheumatologist confirmed diagnosis of AS and nr-axSpA were eligible to participate. Patient demographics, symptoms, and medication use were reported by the rheumatologist, while work disability and QoL measures were reported by the patient. Patient demographics, symptoms, QoL and treatment patterns of AS and nr-axSpA patients were compared using parametric tests and non-parametric tests when appropriate.

Results
A total of 515 AS patients and 495 nr-axSpA patients were included in this analysis. A higher proportion of AS patients were male (p < 0.001), older (p = 0.014), and more likely to be prescribed a biologic (p < 0.0001). On average, AS patients experienced slightly more symptoms at diagnosis (p = 0.023); however, nr-axSpA patients were more likely to experience enthesitis (p = 0.048) and synovitis (p = 0.003). Patient reported outcomes such as the ASAS Health Index (p = 0.171), ASQoL (p = 0.296), BASDAI (p = 0.124), and WPAI (p = 0.183) were similar between AS and nr-axSpA patients after adjusting for confounding variables such as medication use.

Conclusions
AS and nr-axSpA patients share the same clinical features. The burden of the disease, as assessed by QoL measurements, is also similar in AS and nr-axSpA patients; however, despite these similarities, patients with nr-axSpA are less likely to be treated with a biologic.

Key Points

• Ankylosing spondylitis and non• radiographic axial spondyloarthritis patients share similar clinical features and burden of disease.• Quality of life is similar among ankylosing spondylitis and non• radiographic axial spondyloarthritis after adjusting for current treatment patterns.
The impact of preoperative anxiety on patients undergoing brain surgery: a systematic review
Authors: Oteri Vittorio , Martinelli Anna , Crivellaro Elisa , Gigli Francesca 
Published: February 2021

AbstractPreoperative anxiety is a common reaction exhibited by up to 80% of patients who are scheduled for surgical procedures and characterized by psychological and physical changes which may affect their perioperative period. Our aim is to report the most up-to-date evidence on preoperative anxiety in brain surgery patients through a systematic analysis of the studies produced in the last decades. We performed a systematic review of literature by searching PubMed, Embase, and Cochrane Library databases. Data were extracted using the Population, Intervention, Comparison, Outcome framework and critically analyzed. PRISMA guidelines were applied, and the risk of bias of the included studies was assessed using the Risk of bias (RoB) 2 and ROBINS tools, as was the methodological quality, following GRADE criteria. We included 27 articles, accounting for 2558 patients in twelve different countries. The prevalence of preoperative anxiety ranged from 17 up to 89%, higher in female patients. Preoperative anxiety was associated with lower quality of life and cognitive performance, higher need for information, poorer memory and attention, longer hospitalization, depressive symptoms, and increase of physical disability; no correlation with survival rate was found. Seven randomized controlled trials attested the efficacy of acupuncture, music therapy, virtual reality, and pharmacological support in lowering anxiety levels. Preoperative anxiety is a common phenomenon that could negatively affect the perioperative period of brain surgery patients: this is something that should not be neglected to achieve better care through early prevention and optimal management.
Perspektiven für die Haushaltspolitik der Europäischen Union
Authors:   Überblick
Published: February 2021

ZusammenfassungDie Europäische Union hat mit „NextGenerationEU“ (NGEU) einen Fonds aufgelegt, um die wirtschaftliche Erholung ihrer Mitgliedstaaten während und nach der Corona-Pandemie zu unterstützen. Mit dem Fonds sollen die Kohäsion sowie der grüne und digitale Wandel in Europa befördert werden. Gleichzeitig hat die EU ihre Haushaltsmittel im Rahmen des Mehrjährigen Finanzrahmens 2021 bis 2027 nur leicht erhöht. Die finanzielle Unterstützung durch die EU wird positiv bewertet. Allerdings bleibt fraglich, wo die nationalen Prioritäten liegen und ob die gesteckten Ziele tatsächlich strukturelle Veränderungen im Sinne der EU ermöglichen. In jedem Fall verändert NGEU die Finanzarchitektur der EU, da der Fonds über gemeinsame Anleihen finanziert werden soll. Welche Folgen dies für die Struktur der EU-Finanzen langfristig haben kann und welche Reformansätze sinnvoll sind, ist Gegenstand der Debatte.
Responsibility and the ‘Pie Fallacy’
Authors: Kaiserman Alex 
Published: February 2021

AbstractMuch of our ordinary thought and talk about responsibility exhibits what I call the ‘pie fallacy’—the fallacy of thinking that there is a fixed amount of responsibility for every outcome, to be distributed among all those, if any, who are responsible for it. The pie fallacy is a fallacy, I argue, because how responsible an agent is for some outcome is fully grounded in facts about the agent, the outcome and the relationships between them; it does not depend, in particular, on how responsible anyone else is for that same outcome. In this paper, I explore how the pie fallacy can arise by considering several different kinds of case in which two or more agents are responsible for the same outcome. I’ll end with some brief remarks on the potential consequences of my arguments for how to think about responsibility in war.