bluuebunny/crossref_metadata_2025_split huggingface dataset:
Troponin least significant change (z-score) is associated with poor clinical outcomes in patients presenting to the emergency department
Authors: Smith Joel D , Leong Kai'En , Fazio Timothy , Chiang Cherie 
Published: February 2021

Background A rise and/or fall in high sensitivity cardiac troponin (hs-Tn) is critical in defining acute myocardial injury and therefore the diagnosis of acute myocardial infarction. A significant rise in hs-Tn is not well defined in current guidelines. Calculation of a z-score for two consecutive hs-Tn measurements is a method-independent measure of dynamic troponin elevation. However, the association of hs-Tn z-score with outcomes for unselected emergency department admissions is unknown. Moreover, the association of non-dynamic troponin elevations, as defined by a normal z-score, with clinical outcomes remains to be assessed. Methods We retrospectively calculated z-scores for patients presenting to emergency department over 18 months who had serial troponin measurements with at least one result >99th percentile using the Abbott hs-TnI assay. We assessed the association of z-score with discharge diagnosis, cardiac interventions, inpatient mortality, length of stay and readmission rates. Results There were 2062 presentations for 1830 patients where a z-score was calculated. Z-score was elevated in 1080 presentations. Dynamic troponin elevation (z-score ≥ 2) was associated with acute myocardial infarction (OR = 9.1, P < 0.01), admission to an inpatient unit (95 vs. 88%, P < 0.01), increased inpatient length of stay (97 vs. 65 days, P < 0.01), inpatient coronary intervention (21 vs. 6%, P < 0.01) and mortality (4.4 vs. 2.4%, P < 0.05) compared with myocardial injury with a static troponin elevation. Conclusions Z-score is an assay-independent tool to alert clinicians of significant, dynamic troponin elevation and acute myocardial injury. It is associated with poorer clinical outcomes.
Effect of Hearing and Head Protection on the Localization of Tonal and Broadband Reverse Alarms
Authors: Laroche Chantal , Giguère Christian , Vaillancourt Véronique , Marleau Claudia , Cadieux Marie-France , Laprise-Girard Karina , Gula Emily , Carroll Véronique , Bibeau Manuelle , Nélisse Hugues 
Published: February 2021

Objective This study explored the effects of hearing protection devices (HPDs) and head protection on the ability of normal-hearing individuals to localize reverse alarms in background noise. Background Among factors potentially contributing to accidents involving heavy vehicles, reverse alarms can be difficult to localize in space, leading to errors in identifying the source of danger. Previous studies have shown that traditional tonal alarms are more difficult to localize than broadband alarms. In addition, HPDs and safety helmets may further impair localization. Method Standing in the middle of an array of eight loudspeakers, participants with and without HPDs (passive and level-dependent) had to identify the loudspeaker emitting a single cycle of the alarm while performing a task on a tablet computer. Results The broadband alarm was easier to localize than the tonal alarm. Passive HPDs had a significant impact on sound localization (earmuffs generally more so than earplugs), particularly double hearing protection, and level-dependent HPDs did not fully restore sound localization abilities. The safety helmet had a much lesser impact on performance than HPDs. Conclusion Where good sound localization abilities are essential in noisy workplaces, the broadband alarm should be used, double hearing protection should be avoided, and earplug-style passive or level-dependent devices may be a better choice than earmuff-style devices. Construction safety helmets, however, seem to have only a minimal effect on sound localization. Application Results of this study will help stakeholders make decisions that are more informed in promoting safer workplaces.
Third molar maturity index and legal age in different ethnic populations: Accuracy of Cameriere’s method
Authors: De Micco Francesco , Martino Federica , Velandia Palacio Luz Andrea , Cingolani Mariano , Campobasso Carlo Pietro 
Published: February 2021

Molar development is widely accepted as a reliable indicator of chronological age in a forensic context. A quantitative method for age estimation has been proposed by Cameriere et al. based on the relationship between chronological age and the third molar maturity index (I3M), which is the ratio between the two apical pulp widths and the total tooth length. Cameriere’s cut off value of 0.08 was found to be a reliable tool in assessing the threshold of 18 years of age. The aim of this study was to evaluate the accuracy of the I3M in different ethnic populations focusing on its specificity (subjects correctly classified as <18 years based on I3M >0.08) and sensitivity (subjects correctly classified as ≥18 years based on I3M <0.08). A review of 22 scientific articles was performed, representing data from panoramic radiographs of 12,286 individuals (5723 males and 6563 females) from all over the world, including some ethnical subgroups. The I3M showed an overall sensitivity for both sexes ranging from 51.8% to 93.4% and a specificity ranging from 86.2% to 100%. The proportion of correctly classified individuals ranged from 74% to 95%. These results can be useful to refer the age estimation with the margin of error of subjects correctly classified as minors (specificity) or adults (sensitivity), according to sex, ethnicity and geographical distribution. The I3M can be considered a suitable method for estimating adulthood in forensic settings, regardless of sex. However, ethnic group can affect the accuracy.
The Relationships Between State Health Department Practitioners’ Perceptions of Organizational Supports and Evidence-Based Decision-Making Skills
Authors: Mazzucca Stephanie , Jacob Rebekah R. , Valko Cheryl A. , Macchi Marti , Brownson Ross C. 
Published: February 2021

Objectives Evidence-based decision making (EBDM) allows public health practitioners to implement effective programs and policies fitting the preferences of their communities. To engage in EBDM, practitioners must have skills themselves, their agencies must engage in administrative evidence-based practices (A-EBPs), and leaders must encourage the use of EBDM. We conducted this longitudinal study to quantify perceptions of individual EBDM skills and A-EBPs, as well as the longitudinal associations between the 2. Methods An online survey completed among US state health department practitioners in 2016 and 2018 assessed perceptions of respondents’ skills in EBDM and A-EBPs. We used χ2 tests, t tests, and linear regressions to quantify changes over time, differences by demographic characteristics, and longitudinal associations between individual skills and A-EBPs among respondents who completed both surveys (N = 336). Results Means of most individual EBDM skills and A-EBPs did not change significantly from 2016 to 2018. We found significant positive associations between changes in A-EBPs and changes in EBDM skill gaps: for example, a 1-point increase in the relationships and partnerships score was associated with a narrowing of the EBDM skill gap (β estimate = 0.38; 95% CI, 0.15-0.61). At both time points, perceived skills and A-EBPs related to financial practices were low. Conclusions Findings from this study can guide the development and dissemination of initiatives designed to simultaneously improve individual and organizational capacity for EBDM in public health settings. Future studies should focus on types of strategies most effective to build capacity in particular types of agencies and practitioners, to ultimately improve public health practice.
Impact of University Website Usability on Satisfaction: A Structural Equation Modelling Approach
Authors: Karani Anushree , Thanki Heena , Achuthan Sarla 
Published: February 2021

One of the many ways through which the universities can communicate with students is through their website, which is considered as the face of the organization. It also represents the organization as a whole, its culture, value and vision. The current study aimed to check the usability of Gujarat Technological University’s website from students’ perspective and to find its association with satisfaction. The current study tried to address the gap in the literature, wherein in the Indian context, the majority studies were conducted in the context of library website only. The current study has adopted a quantitative approach, where a single cross-sectional research design has been used with convenience sampling. The present study had adapted the Website Usability Evaluation (WEBUSE) scale. A total of 577 students from the fields of management, computer science, and engineering have responded to the structured questionnaire. The structural equation model of the study revealed that all the four dimensions of website usability were positively associated with satisfaction, whereas content, organization and readability criterion had the most influence on satisfaction followed by user interface design, performance and effectiveness and navigation and links. The study strongly recommends the university to maintain up-to-date content, organize it well and it should be readable for the students in order to maximize the satisfaction with the website. JEL Codes: I230, M150
ECMO in COVID-19—prolonged therapy needed? A retrospective analysis of outcome and prognostic factors
Authors: Dreier Esther , Malfertheiner Maximilian Valentin , Dienemann Thomas , Fisser Christoph , Foltan Maik , Geismann Florian , Graf Bernhard , Lunz Dirk , Maier Lars Siegfried , Müller Thomas , Offner Robert , Peterhoff David , Philipp Alois , Salzberger Bernd , Schmidt Barbara , Sinner Barbara , Lubnow Matthias 
Published: February 2021

Background: The role of venovenous extracorporeal membrane oxygenation (VV ECMO) in patients with COVID-19-induced acute respiratory distress syndrome (ARDS) still remains unclear. Our aim was to investigate the clinical course and outcome of those patients and to identify factors associated with the need for prolonged ECMO therapy. Methods: A retrospective single-center study on patients with VV ECMO for COVID-19-associated ARDS was performed. Baseline characteristics, ventilatory and ECMO parameters, and laboratory and virological results were evaluated over time. Six months follow-up was assessed. Results: Eleven of 16 patients (68.8%) survived to 6 months follow-up with four patients requiring short-term (<28 days) and seven requiring prolonged (⩾28 days) ECMO support. Lung compliance before ECMO was higher in the prolonged than in the short-term group (28.1 (28.8–32.1) ml/cmH2O vs 18.7 (17.7–25.0) ml/cmH2O, p = 0.030). Mechanical ventilation before ECMO was longer (19 (16–23) days vs 5 (5–9) days, p = 0.002) and SOFA score was higher (12.0 (10.5–17.0) vs 10.0 (9.0–10.0), p = 0.002) in non-survivors compared to survivors. Low viral load during the first days on ECMO tended to indicate worse outcomes. Seroconversion against SARS-CoV-2 occurred in all patients, but did not affect outcome. Conclusions: VV ECMO support for COVID-19-induced ARDS is justified if initiated early and at an experienced ECMO center. Prolonged ECMO therapy might be required in those patients. Although no relevant predictive factors for the duration of ECMO support were found, the decision to stop therapy should not be made dependent of the length of ECMO treatment.
Numerical modeling of blood flow in the internal jugular vein with the use of computational fluid mechanics software
Authors: Simka Marian , Latacz Paweł 
Published: February 2021

Objectives To determine the site and nature of altered hemodynamics in pathological internal jugular veins. Method With the use of computational fluid mechanics software we simulated blood flow in 3 D models of the internal jugular veins that exhibited different morphologies, including nozzle-like strictures in their upper parts and valves in the lower parts. Results In a majority of models with nozzle-like strictures, especially those positioned asymmetrically, abnormal flow pattern was revealed, with significant flow separation and regions with reversed flow. Abnormal valves had no significant impact on flow in a case of already altered flow evoked by stricture in upper part of the vein. Conclusions In our jugular model, cranially-located stenoses, which in clinical practice are primarily caused by external compression, cause more significant outflow impact respect to endoluminal defects and pathological valves located more caudally.
Dexmedetomidine for hyperactive delirium at the end of life: An open-label single arm pilot study with dose escalation in adult patients admitted to an inpatient palliative care unit
Authors: Thomas Benjamin , Lo Wing-Shan Angela , Nangati Zivai , Barclay Greg 
Published: February 2021

Background: Terminal delirium, specifically the hyperactive delirium subtype at the end of life, is common in palliative care patients. Standard care often involves sedation to alleviate distress. The alpha2-adrenoreceptor agonist dexmedetomidine may have promise in terminal delirium, due to its properties of decreasing delirium and permitting rousable sedation. Aim: This study aimed to describe the effect of dexmedetomidine on delirium and sedation, when delivered via continuous subcutaneous infusion (CSCI) in patients with terminal delirium. Design: The trial was prospectively registered in the ANZCTR database (ACTRN12618000658213) and conducted in accordance with CONSORT (pilot study extension). Twenty-two adult patients were treated with a CSCI of dexmedetomidine with a two-tier dose schedule, low and high dose. Delirium severity was measured by the Memorial Delirium Assessment Scale (MDAS, target <13), and sedation by the Richmond Agitation-Sedation Scale, Palliative Version (RASS-PAL, target −1 to −3). Results: All patients had a response to dexmedetomidine as measured by decrease in MDAS after initiation; 59% required escalation to high dose to maintain control of delirium. All responses to high dose were sustained. RASS-PAL scores showed significant variability, however mean scores remained within target range on both doses, and the majority of patients were rousable. Fifty percent of patients treated crossed over to standard care; no patients who crossed over were experiencing moderate-severe delirium. Predominant reason for crossover was family request for deeper sedation. Conclusion: Dexmedetomidine shows potential for the management of terminal delirium with improved interactivity. Further research is needed to determine efficacy compared to current standard care.
Selective effects of serotonin on choices to gather more information
Authors: Livermore James JA , Holmes Clare L , Cutler Jo , Levstek Maruša , Moga Gyorgy , Brittain James RC , Campbell-Meiklejohn Daniel 
Published: February 2021

Background: Gathering and evaluating information leads to better decisions, but often at cost. The balance between information seeking and exploitation features in neurodevelopmental, mood, psychotic and substance-related disorders. Serotonin’s role has been highlighted by experimental reduction of its precursor, tryptophan. Aims: We tested the boundaries and applicability of this role by asking whether changes to information sampling would be observed following acute doses of serotonergic and catecholaminergic clinical treatments. We used a variant of the Information Sampling Task (IST) to measure how much information a person requires before they make a decision. This task allows participants to sample information until satisfied to make a choice. Methods: In separate double-blind placebo-controlled experiments, we tested 27 healthy participants on/off 20 mg of the serotonin reuptake inhibitor (SRI) citalopram, and 22 participants on/off 40 mg of the noradrenergic reuptake inhibitor atomoxetine. The IST variant minimised effects of temporal impulsivity and loss aversion. Analyses used a variety of participant prior expectations of sampling spaces in the IST, including a new prior that accounts for learning of likely states across trials. We analysed behaviour by a new method that also accounts for baseline individual differences of risk preference. Results: Baseline preferences demonstrated risk aversion. Citalopram decreased the expected utility of choices and probability of being correct based on informational content of samples collected, suggesting participants collected less useful information before making a choice. Atomoxetine did not influence information seeking. Conclusion: Acute changes of serotonin activity by way of a single SRI dose alter information-seeking behaviour.
Evaluating intracranial artery dissection by using three-dimensional simultaneous non-contrast angiography and intra-plaque hemorrhage high-resolution magnetic resonance imaging: a retrospective study
Authors: Tang Min , Gao Jinglong , Gao Jie , Yan Xuejiao , Zhang Xin , Li Longchao , Xia Zhe , Lei Xiaoyan , Zhang Xiaoling 
Published: February 2021

Background There was no previous report on the three-dimensional simultaneous non-contrast angiography and intra-plaque hemorrhage (3D-SNAP) magnetic resonance imaging (MRI) sequence to diagnose intracranial artery dissection (IAD). Purpose To improve the diagnostic accuracy and guide the clinical treatment for IAD by elucidating its pathological features using 3D-SNAP MRI. Material and Methods From January 2015 to September 2018, 113 patients with suspected IAD were analyzed. They were divided into IAD and non-IAD groups according to the spontaneous coronary artery dissection (SCAD) criteria. All patients underwent 3D-SNAP, 3D-TOF, T2W imaging, 3D-PD, 3D-T1W-VISTA, and 3D-T1WCE) using 3.0-T MRI; clinical data were collected. The IAD imaging findings (intramural hematoma, double lumen, intimal flap, aneurysmal dilatation, stenosis, or occlusion) in every sequence were analyzed. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficiency of each sequence. Results There was a significant difference in the probability of intramural hematoma, relative signal intensity of intramural hematoma, double lumen, stenosis, or occlusion signs on 3D-TOF, T2W, 3D-PD, 3D-T1W-VISTA, 3D-SNAP, and 3D-T1WCE sequences ( P<0.05). The 3D-SNAP and 3D-T1WCE sequences were most sensitive for diagnosing intramural hematoma and displaying double-lumen signs, respectively. The diagnostic efficiency of the 3D-SNAP sequence combined with 3D-T1WCE was the highest (area under the curve [AUC] 0.966). The AUC value of the 3D-SNAP sequence (AUC 0.897) was slightly inferior to that of 3D-T1W enhancement (AUC 0.903). Conclusion 3D-SNAP MRI is a non-invasive and effective method and had the greatest potential among those methods tested for improving the diagnostic accuracy for IAD.
Pirarubicin-loaded CalliSpheres® drug-eluting beads for the treatment of patients with stage III–IV lung cancer
Authors: Bi Yonghua , Shi Xiaonan , Yi Mengfei , Han Xinwei , Ren Jianzhuang 
Published: February 2021

Background CalliSpheres® beads (CB) have been used recently for patients with hepatocellular carcinoma. However, the safety and effect of drug-eluting bead transarterial chemoembolization (DEB-TACE) in patients with stage III–IV lung cancer are still unknown. Purpose To evaluate the safety and efficacy of DEB-TACE with pirarubicin-loaded CB for the treatment of stage III–IV lung cancer. Material and Methods From July 2016 to April 2020, 29 patients with stage III–IV primary lung cancer underwent DEB-TACE with pirarubicin-loaded CB. The objective response rate (ORR) was the primary endpoint; the secondary endpoints were progression-free survival (PFS) and overall survival (OS). Results Twenty-nine patients received DEB-TACE with pirarubicin-loaded (median 60 mg) CB, with no severe adverse events or treatment-related deaths. After DEB-TACE, hemoptysis disappeared within 1–3 days in all patients, and the symptoms of cough or expectoration were significantly improved in 12 patients. ORR and disease control rate at one, three, and six months after DEB-TACE were 39.3% and 96.4%, 26.1% and 69.6%, and 29.4% and 58.8%, respectively. The median PFS was 6.3 months (range 1.1–30.1 months), and the three-, six-, and 12-month PFS rates were 70.2%, 50.1%, and 27.1%, respectively. The median OS was 10.2 months (range 1.1–44.6 months), and the three-, six, and 12-month OS rates were 87.9%, 68.6%, and 39.8%, respectively. Conclusion DEB-TACE with pirarubicin-loaded CB is safe, feasible, and well-tolerated for patients with stage III–IV lung cancer, and symptom control was a potential benefit of treatment.
Association between metabolic syndrome and calcium oxalate stone risk in Chinese individuals: a nomogram prediction model
Authors: Wu Baisuo , Xie Junhao , Guo Junyi , Wang Jinbo , Lang Hongjuan 
Published: February 2021

Objective This retrospective study explored the association between calcium oxalate (CaOx) stones and metabolic syndrome. It also developed and validated a nomogram to aid in the prediction of CaOx stones. Methods This case-control study enrolled 150 patients with CaOx stones and 635 individuals without urolithiasis from October 2016 to October 2018. Student’s t-test, the chi-squared test, and logistic univariate and multivariate regression analyses were used. A nomogram for prediction of CaOx stones was established based on independent associated factors. The concordance index and calibration curves were plotted to determine nomogram accuracy. Results Female sex, age ≥66 years, blood pressure (systolic pressure ≥130 mmHg and/or diastolic pressure ≥85 mmHg), and blood uric acid level independently influenced the risk of CaOx stones, according to multivariate logistic regression analysis; these factors were included in the nomogram. The concordance index was 0.701 (95% confidence interval: 0.658–0.737). The standard curve showed a robust fit with the calibrated predictive curve. Conclusions Female sex, age ≥66 years, elevated blood pressure, and blood uric acid level independently influenced the risk of CaOx stones. Our nomogram for the prediction of CaOx stones may provide a clinical basis for the assessment of CaOx stone and facilitate early prevention efforts.
Noninvasive radiomics-based method for evaluating idiopathic central precocious puberty in girls
Authors: Jiang Hongyang , Shu Zhenyu , Luo Xiaoming , Wu Meizhen , Wang Mei , Feng Qi , Chen Junfa , Lin Chunmiao , Ding Zhongxiang 
Published: February 2021

Objective Traditional approaches that involve measuring the height and volume of the pituitary by magnetic resonance imaging (MRI) are unreliable. We investigated the use of a more accurate method using texture analysis to evaluate idiopathic central precocious puberty (ICPP) by MRI. Methods In total, 352 texture features of the pituitary were extracted from 12 healthy girls and 18 girls with ICPP. A LASSO regression model and linear regression model were used to create the prediction model. Pearson’s correlation analysis and receiver operating characteristic curves were used to evaluate the predictive performance. Results The radiomics score had a significant linear relationship with the luteinizing hormone concentration and the luteinizing hormone/follicle-stimulating hormone ratio. The radiomics score showed better predictive performance than traditional pituitary measurements. The area under the curve of the radiomics score, pituitary height, and variable combinations was 0.759 (95% confidence interval [CI], 0.583–0.936), 0.681 (95% CI, 0.483–0.878), and 0.829 (95% CI, 0.681–0.976), respectively. Conclusion Combination of the radiomics score with pituitary height measurements allows for better evaluation of the pituitary during diagnostic imaging, indicating satisfactory potential for efficacy assessments.