bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical treatment of proximal humeral fractures with the transosseous suture fixation
Authors: Miquel J. , Martínez R. , Santana F. , Marimon P. , Torrens C. 
Published: June 2021

Abstract
Background
The surgical treatment of displaced proximal humeral fractures is commonly affected by implant-related complications. We evaluated the functional and radiographic results of transosseous suture fixation in a series of displaced proximal humeral fractures (PHF).

Methods
Sixty-four patients were retrospectively classified by age, sex, and the Neer fracture classification. Two-part greater tuberosity (2pGT) displaced fractures and 3-part (varus and valgus) and 4-part valgus impacted fractures were managed with fragment reduction and transosseous suture fixation. Patients with minimum follow-up of 24 months and assessed with the Constant-Murley score (CMS) were included. Radiological and medical complications, as well as reinterventions were also recorded.

Results
Forty-six patients with a mean follow-up of 58 (24–132) and a mean age of 58 years old were analyzed. Patients with 2pGT (n = 10) fractures had a CMS of 76 points (59–89); patients with 3-part fractures (n = 22) had a score of 67 points (13–91); and those with 4-part fractures (n = 14) had a score of 64 (24–76) points. The overall complication rate was 6 out of 46, and 4 patients required reintervention for different reasons. Patients presenting with 3-part varus fractures had significantly lower functional outcomes scores (p = 0.007). Humeral head osteonecrosis was present in 9 patients and significantly affected the functional outcomes (p < 0.05). However, only three out of nine patients with osteonecrosis required subsequent surgery at the indicated follow-up.

Conclusions
The fracture reduction and transosseous fixation technique represents a safe technique with low complication and reintervention rates. The presence of humeral head necrosis did not lead to subsequent surgical intervention because no hardware had protruded.

Level of evidence
Level IV, retrospective study
Effect of cannulation site on emboli travel during cardiac surgery
Authors: Puthettu Mira , Vandenberghe Stijn , Demertzis Stefanos 
Published: June 2021

AbstractBackgroundDuring cardiac surgery, micro-air emboli regularly enter the blood stream and can cause cognitive impairment or stroke. It is not clearly understood whether the most threatening air emboli are generated by the heart-lung machine (HLM) or by the blood-air contact when opening the heart. We performed an in vitro study to assess, for the two sources, air emboli distribution in the arterial tree, especially in the brain region, during cardiac surgery with different cannulation sites.MethodsA model of the arterial tree was 3D printed and included in a hydraulic circuit, divided such that flow going to the brain was separated from the rest of the circuit. Air micro-emboli were injected either in the HLM (“ECC Bubbles”) or in the mock left ventricle (“Heart Bubbles”) to simulate the two sources. Emboli distribution was measured with an ultrasonic bubble counter. Five repetitions were performed for each combination of injection site and cannulation site, where air bubble counts and volumes were recorded. Air bubbles were separated in three categories based on size.ResultsFor both injection sites, it was possible to identify statistically significant differences between cannulation sites. For ECC Bubbles, axillary cannulation led to a higher amount of air bubbles in the brain with medium-sized bubbles. For Heart Bubbles, aortic cannulation showed a significantly bigger embolic load in the brain with large bubbles.ConclusionsThese preliminary in vitro findings showed that air embolic load in the brain may be dependent on the cannulation site, which deserves further in vivo exploration.
The impact of childhood diagnosed ADHD versus controls without ADHD diagnoses on later labour market attachment—a systematic review of longitudinal studies
Authors: Christiansen Marie Sturesson , Labriola Merete , Kirkeskov Lilli , Lund Thomas 
Published: June 2021

AbstractPrevious studies have suggested that Attention Deficit Hyperactive Disorder (ADHD) affect individuals across their lifespan, especially in relation to employment. The purpose of this review was to synthesize the results from studies examining the prospective association of ADHD diagnosis in childhood and later education, earnings and employment, compared to children without an ADHD diagnosis. A review protocol was prospectively registered with PROSPERO (ID = CRD42019131634). The findings were reported according to the PRISMA guidelines. The systematic review is based on a structured and preplanned analysis of original prospective longitudinal studies. A total of 2505 potential records were identified, two through backward search. Six papers met the inclusion criteria. One paper was assessed as good, four as fair and one as poor quality. The studies indicated that ADHD diagnosis affected the nature of the individual’s attachment to the labour market across different labour market attachment outcomes. Adults with persisting symptoms, had significantly more problems at work. Even if ADHD symptoms desist in adulthood, the negative impact of earlier ADHD symptoms can still be seen on occupational outcomes. Significantly fewer probands had a Bachelor’s degree compared to controls. Based on one good quality study and four fair quality studies, it is indicated that patients with childhood diagnosed ADHD, generally experience employment of lower quality compared with peers, in relation to income, education and occupational attainment. The overall level of evidence is rated as poor.
Role of the intestinal microbiome and microbial-derived metabolites in immune checkpoint blockade immunotherapy of cancer
Authors: Hayase Eiko , Jenq Robert R. 
Published: June 2021

AbstractImmune checkpoint inhibitors (ICIs) are monoclonal antibodies that block immune inhibitory pathways. Administration of ICIs augments T cell-mediated immune responses against tumor, resulting in improved overall survival in cancer patients. It has emerged that the intestinal microbiome can modulate responses to ICIs via the host immune system and that the use of antibiotics can lead to reduced efficacy of ICIs. Recently, reports that fecal microbiota transplantation can lead to ICI therapy responses in patients previously refractory to therapy suggest that targeting the microbiome may be a viable strategy to reprogram the tumor microenvironment and augment ICI therapy. Intestinal microbial metabolites may also be linked to response rates to ICIs. In addition to response rates, certain toxicities that can arise during ICI therapy have also been found to be associated with the intestinal microbiome, including in particular colitis. A key mechanistic question is how certain microbes can enhance anti-tumor responses or, alternatively, predispose to ICI-associated colitis. Evidence has emerged that the intestinal microbiome can modulate outcomes to ICI therapies via two major mechanisms, including those that are antigen-specific and those that are antigen-independent. Antigen-specific mechanisms occur when epitopes are shared between microbial and tumor antigens that could enhance, or, alternatively, reduce anti-tumor immune responses via cross-reactive adaptive immune cells. Antigen-independent mechanisms include modulation of responses to ICIs by engaging innate and/or adaptive immune cells. To establish microbiome-based biomarkers of outcomes and specifically modulate the intestinal microbiome to enhance efficacy of ICIs in cancer immunotherapy, further prospective interventional studies will be required.
RETRACTED ARTICLE: Application research of perception data fusion system of agricultural product supply chain based on Internet of things
Authors: Sun Xu , Shu Kunliang 
Published: June 2021

AbstractThere are often agricultural product quality problems in the production and circulation of agricultural products. Therefore, there are more and more people on the agricultural product supply chain based on the Internet of things. This article mainly introduces the research on the perception data fusion of agricultural product supply chain in the context of the Internet of things. This is a simple research result based on the Internet of things technology platform, which analyzes the current status of the product according to market demand. After analysis and comparison, a sensory data fusion model suitable for the supply chain of agricultural products is obtained, and information technology based on the Internet of things is used to transform and optimize the Internet of things in the circulation of agricultural products. The experimental results of this article show that data fusion technology based on the Internet of things can solve and track 69.45% of the problem of unknown sources of agricultural products, improve the supply efficiency of agricultural products by 43%, reduce the health problems of agricultural products by 31.24%, and reduce the prices of agricultural products by 13–20%. Improving logistics efficiency can save 5 million tons of agricultural products.
Cause of death for patients with breast cancer: discordance between death certificates and medical files, and impact on survival estimates
Authors: Izci Hava , Tambuyzer Tim , Vandeven Jessica , Xicluna Jérôme , Wildiers Hans , Punie Kevin , Willers Nynke , Oldenburger Eva , Van Nieuwenhuysen Els , Berteloot Patrick , Smeets Ann , Nevelsteen Ines , Deblander Anne , De Schutter Harlinde , Neven Patrick , Silversmit Geert , Verdoodt Freija 
Published: June 2021

AbstractBackgroundRegistration and coding of cause of death is prone to error since determining the exact underlying condition leading directly to death is challenging. In this study, causes of death from the death certificates were compared to patients’ medical files interpreted by experts at University Hospitals Leuven (UHL), to assess concordance between sources and its impact on cancer survival assessment.MethodsBreast cancer patients treated at UHL (2009–2014) (follow-up until December 31st 2016) were included in this study. Cause of death was obtained from death certificates and expert-reviewed medical files at UHL. Agreement was calculated using Cohen’s kappa coefficient. Cause-specific survival (CSS) was calculated using the Kaplan-Meier method and the relative survival probability (RS) using the Ederer II and Pohar Perme method.ResultsA total of 2862 patients, of whom 354 died, were included. We found an agreement of 84.7% (kappa-value of 0.69 (95% C.I.: 0.62–0.77)) between death certificates and medical files. Death certificates had 10.7% false positive and 4.5% false negative rates. However, five-year CSS and RS measures were comparable for both sources.ConclusionFor breast cancer patients included in our study, fair agreement of cause of death was seen between death certificates and medical files with similar CSS and RS estimations.
Explaining Waldorf students’ high motivation but moderate achievement in science: is inquiry-based science education the key?
Authors: Salchegger Silvia , Wallner-Paschon Christina , Bertsch Christian 
Published: June 2021

AbstractBackgroundEvidence so far shows that Waldorf students are characterized by average science achievement but at the same time high socioeconomic status and high science motivation. Moreover, Waldorf education is characterized by high emphasis on inquiry-based science education (IBSE). The present study investigates if the specific attitude-achievement constellation of Waldorf students in science may be explained by the high level of IBSE.MethodsPropensity score matching was applied to control for Waldorf students’ more advantageous social background using the Austrian PISA 2015 sample (N = 7007 15-year old students). After propensity score matching, 1107 matched controls were included alongside all 149 Waldorf students.ResultsThe results show that Waldorf students report higher enjoyment in learning science and more interest in broad science topics than matched controls. On the other hand, they demonstrate lower science achievement. Mediation analyses show that, although Waldorf students’ more positive attitudes towards science can be almost entirely attributed to their higher exposure to IBSE, their underperformance in science cannot.ConclusionsThese results indicate that attending a school type with a high level of IBSE (Waldorf) may have positive effects on attitudinal outcomes (enjoyment and interest in science) whereas it does not seem to have notable effects on science achievement. This indicates that IBSE could be applied in educational contexts aiming to increase students’ scientific attitudes.
Assessing the feasibility and acceptability of a financial versus behavioural incentive-based intervention for community health workers in rural Indonesia
Authors: Gadsden Thomas , Jan Stephen , Sujarwoto Sujarwoto , Kusumo Budiarto Eko , Palagyi Anna 
Published: June 2021

Abstract
Background
The World Health Organization recommends that community health workers (CHWs) receive a mix of financial and non-financial incentives, yet notes that there is limited evidence to support the use of one type of incentive (i.e. financial or non-financial) over another. In preparation for a larger scale trial, we investigated the acceptability and feasibility of two different forms of incentives for CHWs in Malang District, Indonesia.

Methods
CHWs working on a cardiovascular disease (CVD) risk screening and management programme in two villages were assigned to receive either a financial or non-financial incentive for 6 months. In the financial incentives village, CHWs (n = 20) received 16,000 IDR (USD 1.1) per patient followed up or 500,000 IDR (USD 34.1) if they followed up 100% of their assigned high-risk CVD patients each month. In the non-financial incentive village, CHWs (n = 20) were eligible to receive a Quality Care Certificate for following up the highest number of high-risk CVD patients each month, awarded in a public ceremony. At the end of the 6-month intervention period, focus group discussions were conducted with CHWs and semi-structured interviews with programme administrators to investigate acceptability, facilitators and barriers to implementation and feasibility of the incentive models. Data on monthly CHW follow-up activity were analysed using descriptive statistics to assess the preliminary impact of each incentive on service delivery outcomes, and CHW motivation levels were assessed pre- and post-implementation.

Results
Factors beyond the control of the study significantly interrupted the implementation of the financial incentive, particularly the threat of violence towards CHWs due to village government elections. Despite CHWs reporting that both the financial and non-financial incentives were acceptable, programme administrators questioned the sustainability of the non-financial incentive and reported CHWs were ambivalent towards them. CHW service delivery outcomes increased 17% for CHWs eligible for the non-financial incentive and 21% for CHWs eligible for the financial incentive. There was a statistically significant increase (p < 0.0001) in motivation scores for the performance domain in both villages.

Conclusion
It was feasible to deliver both a performance-based financial and non-financial incentive to CHWs in Malang District, Indonesia, and both incentive types were acceptable to CHWs and programme administrators. Evidence of preliminary effectiveness also suggests that both the financial and non-financial incentives were associated with improved motivation and service delivery outcomes. These findings will inform the next phase of incentive design, in which incentive feasibility and preliminary effectiveness will need to be considered alongside their longer-term sustainability within the health system.
The use of antibiotics in COVID-19 management: a rapid review of national treatment guidelines in 10 African countries
Authors: Adebisi Yusuff Adebayo , Jimoh Nafisat Dasola , Ogunkola Isaac Olushola , Uwizeyimana Theogene , Olayemi Alaka Hassan , Ukor Nelson Ashinedu , Lucero-Prisno Don Eliseo 
Published: June 2021

AbstractAntimicrobial resistance is a hidden threat lurking behind the COVID-19 pandemic which has claimed thousands of lives prior to the emergence of the global outbreak. With a pandemic on the scale of COVID-19, antimicrobial resistance has the potential to become a double-edged sword with the overuse of antibiotics having the potential of taking us back to the pre-antibiotic era. Antimicrobial resistance is majorly attributed to widespread and unnecessary use of antibiotics, among other causes, which has facilitated the emergence and spread of resistant pathogens. Our study aimed to conduct a rapid review of national treatment guidelines for COVID-19 in 10 African countries (Ghana, Kenya, Uganda, Nigeria, South Africa, Zimbabwe, Botswana, Liberia, Ethiopia, and Rwanda) and examined its implication for antimicrobial resistance response on the continent. Our findings revealed that various antibiotics, such as azithromycin, doxycycline, clarithromycin, ceftriaxone, erythromycin, amoxicillin, amoxicillin-clavulanic acid, ampicillin, gentamicin, benzylpenicillin, piperacillin/tazobactam, ciprofloxacin, ceftazidime, cefepime, vancomycin, meropenem, and cefuroxime among others, were recommended for use in the management of COVID-19. This is worrisome in that COVID-19 is a viral disease and only a few COVID-19 patients would have bacterial co-infection. Our study highlighted the need to emphasize prudent and judicious use of antibiotics in the management of COVID-19 in Africa.
Recognition of phrenic paralysis as atypical presentation during CT chest examination of COVID-19 infection and its correlation with CT severity scoring: a local experience during pandemic era
Authors: Abdeldayem Emad H. , Abdelrahman Ahmed S. , Mansour Mohamed G. 
Published: June 2021

Abstract
Background
Coronavirus disease 2019 (COVID-19) was declared a global pandemic by the World Health Organization on March 11, 2020. COVID-19 infection is considered a multi-system disease with neurological, digestive, and cardiovascular symptoms and complications. It can trigger acute and diffuse endothelial dysfunction, resulting in a cytokine storm, most likely induced by the interleukin-6 (IL-6) amplifier. The peripheral and central neurological complications may explain some clinical manifestations such as vagus nerve palsy. The known main CT chest findings of COVID-19 pneumonia include ground glass patches, pulmonary consolidations, inter-lobar septal thickening, crazy paving appearance, and others. We presented our experience in the incidental discovery of phrenic nerve paralysis as atypical chest finding in patients with a known history of COVID-19-associated pneumonia, proved by RT-PCR and coming for evaluation of the lung changes. Patients with evidence of diaphragmatic paralysis underwent close follow-up with a re-evaluation of the phrenic nerve palsy at their routine follow-up for COVID-19 pneumonia. The association of the phrenic nerve palsy was correlated with the CT chest severity score.

Results
Among 1527 scanned patients with known COVID-19 pneumonia, we had recognized 23 patients (1.5%) with unilateral diaphragmatic paralysis, accidentally discovered during CT chest examination. Twenty-one patients had shown complete recovery of the associated diaphragmatic paralysis during their follow-up CT chest with regression or the near-total resolution of the pulmonary changes of COVID-19- pneumonia. No significant correlation between the incidence of unilateral diaphragmatic paralysis and CT severity score with p value = 0.28.

Conclusion
Phrenic paralysis is considered a serious but rare neurological complication of COVID-19 pneumonia. No significant correlation between the CT severity score and the incidental discovery of unilateral diaphragmatic paralysis. The majority of the cases show spontaneous recovery together with the improvement of the pulmonary changes of COVID-19 pneumonia. The association of phrenic paralysis with anosmia and dysgeusia could suggest a direct viral attack on the nerve cells.
Association Between Smoking Behavior and Insulin Resistance Using Triglyceride–Glucose Index Among South Korean Adults
Authors: Jeong Sung Hoon , Joo Hye Jin , Kwon Junhyun , Park Eun-Cheol 
Published: June 2021

Abstract

Context
Insulin resistance is a determinant of diabetes. With the increasing popularity of electronic smoking, the number of dual smokers (smoking both cigarettes and electronic cigarettes [e-cigarettes]) is increasing. However, few studies have assessed the association between insulin resistance and smoking behavior, including dual smoking.

Objective
This work aims to investigate the association between smoking behaviors and insulin resistance.

Methods
This prospective, cross-sectional study took place among the general community. A total of 11 653 participants (4721 male and 6932 female) aged 19 years or older from the 2016 to 2018 Korea National Health and Nutrition Examination Survey were divided based on their smoking behaviors: dual smokers (both cigarettes and e-cigarettes), single smokers (cigarette smokers), previous smokers, and nonsmokers. Insulin resistance was determined based on the triglyceride-glucose index. Multiple logistic regression analysis was performed to investigate the association between smoking behavior and insulin resistance.

Results
Among the participants, 164 males (3.5%) and 33 females (0.5%) were dual-smokers, and 1,428 males (30.2%) and 308 females (4.4%) were single-smokers. Male and female smokers (dual and single) both had higher odds of being in a group with higher insulin resistance than nonsmokers (male, dual: OR = 2.19; 95% CI, 1.39-3.44; single: OR = 1.78; 95% CI, 1.43-2.22; female, dual: OR = 2.32; 95% CI, 1.01-5.34; single: OR = 1.76; 95% CI, 1.28-2.42).

Conclusion
This study suggests that single and dual smoking both may increase the risk of insulin resistance in the general population. Education on the adverse effects of smoking behaviors may be an important strategy to improve the health of the population.
Predicting Malignancy in Pediatric Thyroid Nodules: Early Experience With Machine Learning for Clinical Decision Support
Authors: Radebe Lebohang , van der Kaay Daniëlle C M , Wasserman Jonathan D , Goldenberg Anna 
Published: June 2021

Abstract

Objective
To develop a machine learning tool to integrate clinical data for the prediction of non-benign thyroid cytology and histology.

Context
Papillary thyroid carcinoma is the most common endocrine malignancy. Since most nodules are benign, the challenge for the clinician is to identify those most likely to harbor malignancy while limiting exposure to surgical risks among those with benign nodules.

Methods
Random forests (augmented to select features based on our clinical measure of interest), in conjunction with interpretable rule sets, were used on demographic, ultrasound, and biopsy data of thyroid nodules from children younger than 18 years at a tertiary pediatric hospital. Accuracy, false-positive rate (FPR), false-negative rate (FNR), and area under the receiver operator curve (AUROC) are reported.

Results
Our models predict nonbenign cytology and malignant histology better than historical outcomes. Specifically, we expect a 68.04% improvement in the FPR, 11.90% increase in accuracy, and 24.85% increase in AUROC for biopsy predictions in 67 patients (28 with benign and 39 with nonbenign histology). We expect a 23.22% decrease in FPR, 32.19% increase in accuracy, and 3.84% decrease in AUROC for surgery prediction in 53 patients (42 with benign and 11 with nonbenign histology). This improvement comes at the expense of the FNR, for which we expect 10.27% with malignancy would be discouraged from performing biopsy, and 11.67% from surgery. Given the small number of patients, these improvements are estimates and are not tested on an independent test set.

Conclusion
This work presents a first attempt at developing an interpretable machine learning based clinical tool to aid clinicians. Future work will involve sourcing more data and developing probabilistic estimates for predictions.