bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical characteristics of Kawasaki disease in adolescents
Authors: Liu Xiaoliang , Wang Fang , Zhou Kaiyu , Hua Yimin , Wu Mei , Liu Lei , Shao Shuran , Wang Chuan 
Published: November 2021

Objective Studies focusing on Kawasaki disease (KD) in adolescents are lacking in Southwest China. We systematically summarized the clinical characteristics of KD in adolescents to improve pediatricians’ recognition of this condition. Methods The clinical data of patients with adolescent-onset KD in our center were retrospectively analyzed. The patients were divided into Group A (n = 7), whose first hospitalization was at our hospital, and Group B (n = 10), who were transferred from their local hospital or community health center. Results Seventeen patients with adolescent-onset KD were identified (constituent ratio of 0.8%). Seven patients had an intermittent fever for >10 days. The incidence of incomplete KD was 52.9%. These patients had a high incidence of other atypical clinical manifestations. Fifteen patients were initially misdiagnosed with other infectious diseases. Although the incidence of typical KD was higher in Group B, the overall misdiagnosis rate at the initial stages was higher and the average fever duration on arrival and before IVIG administration were much longer in Group B than A. Conclusions KD in adolescents was frequently misdiagnosed, which might be associated with its atypical, diverse clinical features and pediatricians’ poor recognition. Pediatricians must be aware of the possibility of KD in adolescents.
Erenumab versus topiramate for the prevention of migraine – a randomised, double-blind, active-controlled phase 4 trial
Authors: Reuter Uwe , Ehrlich Marc , Gendolla Astrid , Heinze Axel , Klatt Jan , Wen Shihua , Hours-Zesiger Peggy , Nickisch Jacqueline , Sieder Christian , Hentschke Christian , Maier-Peuschel Monika 
Published: November 2021

Background We compared the tolerability and efficacy of erenumab, a monoclonal antibody binding to the calcitonin gene-related peptide receptor, to topiramate for migraine prophylaxis in adults. Methods HER-MES was a 24-week, randomised, double-blind, double-dummy, controlled trial conducted in 82 sites in Germany. Patients with ≥4 migraine days per month and naïve to study drugs were randomly assigned (1:1) to either subcutaneous erenumab (70 or 140 mg/month) plus topiramate placebo (erenumab group) or oral topiramate at the individual dose with optimal efficacy (50–100 mg/day) plus erenumab placebo (topiramate group). The primary endpoint was medication discontinuation due to an adverse event during the double-blind phase. The proportion of patients that achieved ≥50% reduction from baseline in monthly migraine days during the last 3 months of the double-blind phase was a secondary endpoint. Results Seven hundred and seventy-seven patients were randomised (from 22 February 2019 to 29 July, 2020) and 95.1% completed the study. In the erenumab group, 10.6% discontinued medication due to adverse events compared to 38.9% in the topiramate group (odds ratio, 0.19; 95% confidence interval 0.13–0.27; p < 0.001). Significantly more patients achieved a ≥50% reduction in monthly migraine days from baseline with erenumab (55.4% vs. 31.2%; odds ratio 2.76; 95% confidence interval 2.06–3.71; p < 0.001). No new safety signals occurred. Conclusions Erenumab demonstrated a favourable tolerability and efficacy profile compared to topiramate. Trial registration: ClinicalTrials.gov NCT03828539, URL: https://clinicaltrials.gov/ct2/show/NCT03828539
G Vernon Davies: unsung pioneer of old age psychiatry in Victoria
Authors: Draper Brian 
Published: November 2021

Objective: To provide a biography of G Vernon Davies who took up a career in old age psychiatry in 1955 at the age of 67 at Mont Park Hospital in an era when there few psychiatrists working in the field. Conclusion: In the 1950s and 1960s, Vernon Davies worked as an old age psychiatrist and published papers containing sensible practical advice informed by contemporary research and experience, broadly applicable to both primary and secondary care, presented in a compassionate and empathetic manner. His clinical research in old age psychiatry resulted in the first doctoral degree in psychiatry awarded at the University of Melbourne at the age of 79. Before commencing old age psychiatry, he served in the Australian Army Medical Corps as a Regimental Medical Officer and received the Distinguished Service Order. He spent 3 years as a medical missionary in the New Hebrides before settling at Wangaratta where he worked as a physician for over 30 years. He contributed to his local community in a broad range of activities. Vernon Davies is an Australian pioneer of old age psychiatry.
Establishing a COVID-positive mental health ward: an Australian-first case study
Authors: Keppich-Arnold Sandra , Hopkins Liza 
Published: November 2021

Objective: Managing mental health patients during the COVID-19 pandemic has been a global challenge. Current workforce arrangements tend to separate those skilled in caring for highly infectious medical patients from those whose specialism is in managing co-morbid mental health, substance misuse and/or behaviours of concern, including potential non-compliance with community or health care directives. This paper reports an innovative service development through the emergency establishment of a temporary COVID-positive mental health ward in response to a local outbreak in Melbourne. Method: A case study of service reorientation is presented, examining barriers and enablers to effective care of co-morbid mental illness, addiction and COVID-19. Results: Establishing a skilled multidisciplinary workforce across mental health and infectious disease is the most important consideration in optimising care. Other issues included suitable physical space, security arrangements and inter-disciplinary communication. Conclusions: The paper holds insights for managing mental health care during potential future infectious disease outbreaks across the country.
Why is formulation daunting? A response to Bagster et al.’s ‘instructions’ for developing skills in formulation
Authors: Smith Graeme C 
Published: November 2021

Objective:To explore the theme identified by Bagster et al.1in their selective psychiatric literature review that formulation can appear daunting.Conclusion:Formulation is understandably daunting, even though it occurs in all human encounters. The plural nature of mental symptoms is such that anxiety-provoking intuitive judgement is required at all points in both the process and explication of formulation, a type of instinctive guessing. There are no rules for this, because the laws of vertical integration of systems are not established. Guidelines are more appropriate than ‘instructions’. Much of the wider mental health and clinical reasoning literature addresses intuitive judgement, but the current psychiatric literature tends to focus on pattern recognition as a deliberative cognitive act of Type 2 processes. Arguably this reductionism adds to the dauntingness. Anxiety detected about the intuitive judgement involved can be addressed in supervision, taking into account the psychological mindedness of the trainee.
Primary total hip arthroplasty complications and costs in liver transplant recipients: a matched analysis using a national database
Authors: Douglas Scott J , Remily Ethan A , Sax Oliver C , Pervaiz Sahir S , Mohamed Nequesha S , Kelemen Margaret N , Delanois Ronald E , Johnson Aaron J 
Published: November 2021

Background: The number of liver transplant recipients (LTR) is worldwide increasing and, as the survival is improving as well, there is an increasing number of patients needing total hip arthroplasty (THA). There might be increased risks for this specific group of patients and due to their comorbidities costs might be higher too. Using a big national database outcome and cost of THA should be compared between liver transplant recipients and the general population. Methods: The study was performed using a collection of Medicare, Medicaid, and private insurance claims. Length of stay (LOS), 30-day readmissions, complications rates up to 5 years, and 90-day total cost of care between liver transplant recipients and matched non-transplant patients should be compared. All primary THAs from 2010 to 2019 were identified. 513 patients with a liver transplant before their THA were matched to 10,759 patients without a history of solid organ transplant at a 1:20 ratio based on age, sex, Charlson Comorbidity Index, obesity, and diabetes status. Results: LTR had a longer average LOS (4.2 vs. 3.4 days, p < 0.001). There was no difference in the thirty-day readmissions (5.7% vs. 4.1%, p  = 0.117) and 90-day dislocation rates (2.9% vs. 2.4%, p  = 0.600). Total costs in the first ninety days after THA were not different between the LTR and controls ( p  = 0.756). Conclusions: These findings suggest that complications and costs are no major point of concern in patients with liver transplant that are operated with THA.
Key performance and training parameters in primary total hip arthroplasty – an expert consensus using the Delphi technique
Authors: Howgate Daniel , Garfjeld Roberts Patrick , Kendrick Ben , Rees Jonathan 
Published: November 2021

Aims: Primary total hip arthroplasty (THA) is a commonly performed and successful operation which orthopaedic trainees must demonstrate competence in prior to completion of surgical training. An assessment of agreement between surgical trainers regarding the critical steps of a primary THA has never been undertaken. The aim of this study was to define and rank the key steps of a primary THA regards ease of teaching and their importance in achieving the best patient outcome. Materials and methods: The Delphi technique with 3 iterative rounds was used to establish expert group consensus. The benchmark for consensus was set at an 80% agreement in any category for each step of a THR. The intra-class correlation coefficient (ICC) was used to report on the inter- and intra-rater reliabilities between and within participants responses respectively in rounds 2 and 3. Results: 50 consultant orthopaedic hip surgeons completed round 2, and 28 completed round 3. Overall, 27 steps (54 parameters) were identified, with 16 parameters achieving consensus agreement for their impact on patient outcome, and 17 for ease of teaching. The inter-rater ICC for patient outcome parameters was 0.89 and 0.92 in rounds 2 and 3 respectively while for teaching parameters it was 0.82 and 0.73. 50% of surgeons agreed that acetabular reaming, assessing and accurately restoring leg length, and acetabular cup anteversion were the 3 most difficult steps to teach trainees, while 90% agreed these 3 steps were substantially important to patient outcome. Another 5 steps achieved consensus for their substantial impact on patient outcome but failed to achieve consensus for ease of teaching. Conclusions: The results of this expert consensus have produced a rank-order list of the key steps in primary THA, which may be used for orthopaedic curriculum development and guiding focused improvements for surgical training in primary THR including simulation.
Ruptured Left Gastric Artery Aneurysm Associated with Fibromuscular Dysplasia
Authors: Ho Kelvin K. F. , Foo Gary , Bingley John , Redmond Kendal 
Published: November 2021

Background: Fibromuscular dysplasia is a non-inflammatory, non-atherosclerotic vascular disease that commonly affects renal and carotid arteries but involvement of virtually any vascular territory has been observed. Research Design/ Study sample: This is a case report of a ruptured left gastric artery aneurysm as the first presentation of fibromuscular dysplasia. Data collection: After written consent from the patient, relevant clinical notes and imaging were retrospectively reviewed and critically analysed. Purpose: This case reiterates the importance of considering fibromuscular dysplasia as an uncommon cause of visceral artery aneurysms. In addition, this case shows that the impact of visceral artery vasospasm on endovascular access should not be underestimated and subsequent attempts can be successful after a period of resuscitation. Results: After initial difficulty in endovascular treatment due to visceral vasospasm, the case was successfully managed with with staged open ligation and endovascular embolization after a period of resuscitation. Conclusions: FMD is an important differential diagnosis to consider in cases of visceral aneurysms.
The predictive value of disability at 2 weeks after plating of distal radial fractures: a prospective study of 101 patients
Authors: Boel Susanne , Juhl Carsten Bogh 
Published: November 2021

Assuming that some patients may benefit from early supervised rehabilitation after distal radial fractures, we investigated to what extent self-reported measures of disability, pain and performance of daily activities 2 weeks after anterior locking plating of distal radial fractures could predict long-lasting disability. We included 101 patients in a prediction study and recorded the scores of the Disability of the Arm, Shoulder and Hand questionnaire, visual analogue scales for pain and the Canadian Occupational Performance Measure. We found that the Disability of the Arm, Shoulder and Hand scores with a cut-off score of 50 were the best at predicting disability at 6 months in patients who did not receive early supervised therapy. The positive predictive value was 65% and the negative predictive value was 71%. We conclude that these scores could be used as a single measure to predict patient disability, although the predictive value was rather weak. Level of evidence: II
Factors Associated With the Mechanism of ACL Tears in the National Football League: A Video-Based Analysis
Authors: Brophy Robert H. , Wojtys Edward M. , Mack Christina D. , Hawaldar Kalyani , Herzog Mackenzie M. , Owens Brett D. 
Published: November 2021

Background: The factors associated with anterior cruciate ligament (ACL) injury mechanism in professional American football players are not well-understood. Hypothesis: It was hypothesized that football-related and player-specific factors, such as position and body mass index (BMI), are associated with ACL injury mechanism in these athletes. Study Design: Descriptive epidemiology study. Methods: Videos of ACL tears occurring in National Football League (NFL) games over 6 consecutive seasons from 2014 to 2019 were reviewed by 2 orthopaedic surgeons who specialize in sports medicine. For each injury, the role of contact ( direct contact [contact to the injured knee/lower extremity], indirect contact [contact not involving the injured knee/lower extremity], or no contact) as well as playing situation and lower extremity position were recorded. Additional player characteristics, timing of injury, and surface information were obtained from NFL game-day and injury database statistics. Results: Of the 140 ACL tears, a minority occurred via direct contact to the injured lower extremity (30%), although this varied by position. Just over two-thirds (70%) of ACL tears in offensive linemen occurred via direct contact to the injured lower extremity, while wide receivers had no direct contact ACL tears. Elevated BMI was associated with a greater likelihood of ACL tears occurring via direct contact (53% in players with BMI ≥35 kg/m2 vs 24% in players with BMI <35 kg/m2; P = <.01). Rookies had the lowest percentage of direct contact ACL tears (18%; P = .22). ACL tears that occurred during the middle 8 weeks of the regular season resulted more often from direct contact (38%; P = .06). ACL tears that occurred in the third quarter were the most likely to occur via direct contact (44%), while those that occurred in the fourth quarter were the least likely to occur via direct contact (13%; P < .01). Conclusion: Although most NFL players sustained ACL tears via a noncontact mechanism (ie, through indirect or no contact), players with an elevated BMI, especially on the offensive line, were more likely to injure their ACL through direct contact. Position-dependent variance in injury mechanism may help guide injury prevention efforts in these athletes.
Removal of oxidative stress and genotoxic activities during drinking water production by ozonation and granular activated carbon filtration
Authors: Yu Maria , Lavonen Elin , Oskarsson Agneta , Lundqvist Johan 
Published: November 2021

Abstract
Background
Bioanalytical tools have been shown to be useful in drinking water quality assessments. Here, we applied a panel of in vitro bioassays to assess the treatment efficiency of two pilot-scale treatments: ozonation and granular activated carbon (GAC) filtration at a drinking water treatment plant (DWTP). The pilot-scale systems were studied alongside a full-scale treatment process consisting of biological activated carbon (BAC) filtration, UV disinfection, and monochloramine dosing. Both systems were fed the same raw water treated with coagulation/flocculation/sedimentation and sand filtration. The endpoints studied were oxidative stress (Nrf2 activity), genotoxicity (micronuclei formations), aryl hydrocarbon receptor (AhR) activation, as well as estrogen receptor (ER) and androgen receptor (AR) activity.

Results
Nrf2, AhR, and ER activities and genotoxic effects were detected in the incoming raw water and variability was observed between the sampling events. Compared to most of the samples taken from the full-scale treatment system, lower Nrf2, AhR, and ER bioactivities as well as genotoxicity were observed in all samples from the pilot-scale systems across all sampling events. The most pronounced treatment effect was a 12-fold reduction in Nrf2 activity and a sixfold decrease in micronuclei formations following ozonation alone. GAC filtration alone resulted in sevenfold and fivefold reductions in Nrf2 activity and genotoxicity, respectively, in the same sampling event. Higher bioactivities were detected in most samples from the full-scale system suggesting a lack of treatment effect. No androgenic nor anti-androgenic activities were observed in any sample across all sampling events.

Conclusions
Using effect-based methods, we have shown the presence of bioactive chemicals in the raw water used for drinking water production, including oxidative stress, AhR and ER activities as well as genotoxicity. The currently used treatment technologies were unable to fully remove the observed bioactivities. Ozonation and GAC filtration showed a high treatment efficiency and were able to consistently remove the bioactivities observed in the incoming water. This is important knowledge for the optimization of existing drinking water treatment designs and the utilization of alternative treatment technologies.
Robust optimization of convolutional neural networks with a uniform experiment design method: a case of phonocardiogram testing in patients with heart diseases
Authors: Ho Wen-Hsien , Huang Tian-Hsiang , Yang Po-Yuan , Chou Jyh-Horng , Qu Jin-Yi , Chang Po-Chih , Chou Fu-I. , Tsai Jinn-Tsong 
Published: November 2021

Abstract
Background
Heart sound measurement is crucial for analyzing and diagnosing patients with heart diseases. This study employed phonocardiogram signals as the input signal for heart disease analysis due to the accessibility of the respective method. This study referenced preprocessing techniques proposed by other researchers for the conversion of phonocardiogram signals into characteristic images composed using frequency subband. Image recognition was then conducted through the use of convolutional neural networks (CNNs), in order to classify the predicted of phonocardiogram signals as normal or abnormal. However, CNN requires the tuning of multiple hyperparameters, which entails an optimization problem for the hyperparameters in the model. To maximize CNN robustness, the uniform experiment design method and a science-based methodical experiment design were used to optimize CNN hyperparameters in this study.

Results
An artificial intelligence prediction model was constructed using CNN, and the uniform experiment design method was proposed to acquire hyperparameters for optimal CNN robustness. The results indicate Filters ($${X}_{1}$$

X
1

), Stride ($${X}_{3}$$

X
3

), Activation functions ($${X}_{6}$$

X
6

), and Dropout ($${X}_{7}$$

X
7

) to be significant factors considerably influencing the ability of CNN to distinguish among heart sound states. Finally, the confirmation experiment was conducted, and the hyperparameter combination for optimal model robustness was Filters ($${X}_{1}$$

X
1

) = 32, Kernel Size ($${X}_{2})$$

X
2

)

= 3 × 3, Stride ($${X}_{3}$$

X
3

) = (1,1), Padding ($${X}_{4})$$

X
4

)

as same, Optimizer ($${X}_{5})$$

X
5

)

as the stochastic gradient descent, Activation functions ($${X}_{6}$$

X
6

) as relu, and Dropout ($${X}_{7}$$

X
7

) = 0.544. With this combination of parameters, the model had an average prediction accuracy rate of 0.787 and standard deviation of 0.

Conclusion
In this study, phonocardiogram signals were used for the early prediction of heart diseases. The science-based and methodical uniform experiment design was used for the optimization of CNN hyperparameters to construct a CNN with optimal robustness. The results revealed that the constructed model exhibited robustness and an acceptable accuracy rate. Other literature has failed to address hyperparameter optimization problems in CNN; a method is subsequently proposed for robust CNN optimization, thereby solving this problem.