bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anticonvulsant Primary and Secondary Prophylaxis for Acute Ischemic Stroke Patients: A Decision Analysis
Authors: Jones Felipe J.S. , Sanches Paula R. , Smith Jason R. , Zafar Sahar F. , Hernandez-Diaz Sonia , Blacker Deborah , Hsu John , Schwamm Lee H. , Westover Michael B. , Moura Lidia M.V.R. 
Published: June 2021

Background and Purpose:
We examined the impact of 3 anticonvulsant prophylaxis strategies on quality-adjusted life-years (QALYs) among patients with an incident acute ischemic stroke.

Methods:
We created a decision tree to evaluate 3 strategies: (1) long-term primary prophylaxis; (2) short-term secondary prophylaxis after an early seizure with lifetime prophylaxis if persistent or late seizures (LSs) developed; and (3) long-term secondary prophylaxis if either early, late, or persistent seizures developed. The outcome was quality-adjusted life expectancy (QALY). We created 4 base cases to simulate common clinical scenarios: (1) female patient aged 40 years with a 2% or 11% lifetime risk of an LS and a 33% lifetime risk of an adverse drug reaction (ADR); (2) male patient aged 65 years with a 6% or 29% LS risk and 60% ADR risk; (3) male patient aged 50 years with an 18% or 65% LS risk and 33% ADR risk; and (4) female patient aged 80 years with a 29% or 83% LS risk and 80% ADR risk. In sensitivity analyses, we altered the parameters and assumptions.

Results:
Across all 4 base cases, primary prophylaxis yielded the fewest QALYs when compared with secondary prophylaxis. For example, under scenario 1, strategies 2 and 3 resulted in 7.17 QALYs each, but strategy 1 yielded only 6.91 QALYs. Under scenario 4, strategies 2 and 3 yielded 2.85 QALYs compared with 1.40 QALYs for strategy 1. Under scenarios in which patients had higher ADR risks, strategy 2 led to the most QALYs.

Conclusions:
Short-term therapy with continued anticonvulsant prophylaxis only after postischemic stroke seizures arise dominates lifetime primary prophylaxis in all scenarios examined. Our findings reinforce the necessity of close follow-up and discontinuation of anticonvulsant seizure prophylaxis started during acute ischemic stroke hospitalization.
Light microscopy of wood using sanded surface instead of slides
Authors: Kitin Peter , Hermanson John C. , Abe Hisashi , Nakaba Satoshi , Funada Ryo 
Published: June 2021

Abstract
Xylem anatomy is fundamental in studies of the evolution of terrestrial plants, tree ecophysiology, forestry, and wood science. Traditional xylem anatomical studies by light microscopy utilize wood sections. However, the procedures are laborious, and high-quality histological sections have been particularly challenging to achieve from recalcitrant wood species and dry wood material. Modern microscopy offers opportunities for speeding up the xylem anatomical preparations. In this regard, the merits of using a sanded surface for wood anatomical research have been largely overlooked. Sanding of wood surfaces is practiced in dendrochronology and wood identification studies exclusively for the investigation of macro features, such as tree rings, wood porosity, or parenchyma patterns. We conducted microscopic level investigations of sanded surfaces of difficult-to-section high-density woods such as Dalbergia and Quercus species by reflected white light and epifluorescence microscopy. Reflected white light or combinations of reflected light and fluorescence could clearly show xylem micro-features in sanded wood surfaces. The resolution of cell types after sanding with 1000-grit was similar to the resolution obtained by transmitted light microscopy in histological slides. The advantages of sanded wood surfaces compared to traditional wood sections can be summarized as cost- and time-effective sample preparation, large sample area, intact cell walls and tissue structure, preservation of chemical content and extractives, and even focus of the field of view. A simple procedure of wood sanding instead of microscopic slides can be used for xylem microscopy and automatic image analysis of xylem structure.
Variability and Sources of the Internal Wave Continuum Examined from Global Moored Velocity Records
Authors: Le Boyer Arnaud , Alford Matthew H. 
Published: June 2021

AbstractEnergy for ocean turbulence is thought to be transferred from its presumed sources (viz., the mesoscale eddy field, near-inertial internal waves, and internal tides) to the internal wave continuum, and through the continuum via resonant triad interactions to breaking scales. To test these ideas, the level and variability of the oceanic internal gravity wave continuum spectrum are examined by computing time-dependent rotary spectra from a global database of 2260 current meter records deployed on 1362 separate moorings. Time series of energy in the continuum and the three “source bands” (near-inertial, tidal, and mesoscale) are computed, and their variability and covariability examined. Seasonal modulation of the continuum by factors of up to 5 is seen in the upper ocean, implicating wind-driven near-inertial waves as an important source. The time series of the continuum is found to correlate more strongly with the near-inertial peak than with the semidiurnal or mesoscale. The use of moored internal-wave kinetic energy frequency spectra as an alternate input to the traditional shear or strain wavenumber spectra in the Gregg–Henyey–Polzin finescale parameterization is explored and compared to traditional strain-based estimates.
Continuous hemadsorption with cytokine adsorber for severe COVID-19: A case series of 15 patients
Authors: Paisey Christopher , Patvardhan Chinmay , Mackay Michael , Vuylsteke Alain , Bhagra Sai Kiran 
Published: June 2021

Background: Hyperinflammation and cytokine release has been associated with severe Covid-19. Hemadsorption cartridges may have a potential role in treatment of cytokine storm associated with the development of severe Covid-19. Methods: We retrospectively examined the case records of patients with severe Covid-19 receiving adjunctive hemadsorption (HA) in our ICU. We analyzed inflammatory biomarkers pre- and post- HA. Results: Fifteen patients received HA during the study period. All were intubated, ventilated and required renal replacement therapy. 11/15 were supported on ECMO. Mean ferritin 2652 (±3286) ng/ml, mean CRP 154 (±92) mg/ml, median D-dimer 3071 (±2689) ng/ml, mean troponin 236 (±461) ng/L. We found significant difference in pre-and post- treatment ferritin 3622 ng/ml versus 1682 ng/ml ( p = 0.022), CRP 222 mg/ml versus 103 mg/ml ( p = 0.008, 95% CI 22.4–126.5), lactate 2 mmol/L versus 1.3 mmol/L ( p = 0.017), and procalcitonin 15.3 ng/ml versus 4.2 ng/ml ( p = 0.023). No significant difference in pre- and post- treatment IL-6 14 pg/ml versus 43 pg/ml ( p = 0.32), IL-10 3.4 pg/ml versus 2.6 pg/ml ( p = 0.31), IL1 β 0.37 pg/ml versus 0.77 pg/ml ( p = 0.75), TNF α 12.77 pg/ml versus 12.49 pg/ml ( p = 0.75), VIS 10.04 versus 6.01 ( p = 0.31, 95% CI 5.98–17.16) was seen. Conclusions: The use of HA as adjunctive treatment in a critically unwell group of COVID-19 patients lead to a reduction in ferritin, CRP, procalcitonin and lactate with no significant change in other parameters. The use of HA in the treatment of severe COVID-19 requires further larger randomized studies.
Hepatitis and tuberculosis testing are much less common than HIV testing among adults in Kisumu, Kenya: results from a cross-sectional assessment
Authors: Tunnage Joshua , Yates Adam , Nwoga Chiaka , Sing’oei Valentine , Owuoth John , Polyak Christina S. , Crowell Trevor A. ,   for the RV393 Study Group, Adongo Rachel , Aguttu Rachel , Akala Hosea , Ake Julie , Bondo Michael , Broach Erica , Busisa Christine , Copeland Nate , Cowden Jessica , de Souza Mark , Eller Leigh Anne , Gogo Milicent , Hassen Zebiba , Hu Dale , Imbach Michelle , Juma Anne , Kasera Oscar , Li Qun , Mbuchi Margaret , Milazzo Mark , Modjarrad Kayvon , Ngonda Eric , Nyariro Jacob , Ochola Jew , Ohore Roseline , Okumu Thomas , Omondi Mary , Omondi Timothy , Ooro Linnah , Orando Beatrice , Otieno June , Owira Victorine , Oyugi Roselyn , Robb Merlin , Rono Eric , Tran Chi , Turley Hannah 
Published: June 2021

Abstract
Background
Kenya has a high burden of HIV, viral hepatitis, and tuberculosis. Screening is necessary for early diagnosis and treatment, which reduces morbidity and mortality across all three illnesses. We evaluated testing uptake for HIV, viral hepatitis, and tuberculosis in Kisumu, Kenya.

Methods
Cross-sectional data from adults aged 18–35 years who enrolled in a prospective HIV incidence cohort study from February 2017 to May 2018 were analyzed. A questionnaire was administered to each participant at screening for study eligibility to collect behavioral characteristics and to assess prior testing practices. Among participants without a history of previously-diagnosed HIV, multivariable robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV testing in the 12 months prior to enrollment. A hierarchical model was used to test for differential access to testing due to spatial location.

Results
Of 671 participants, 52 (7.7%) were living with HIV, 308 (45.9%) were female, and the median age was 24 (interquartile range 21–28) years. Among 651 (97.0%) who had ever been tested for HIV, 400 (61.2%) reported HIV testing in the past 6 months, 129 (19.7%) in the past 6–12 months, and 125 (19.1%) more than one year prior to enrollment. Any prior testing for viral hepatitis was reported by 8 (1.2%) participants and for tuberculosis by 51 (7.6%). In unadjusted models, HIV testing in the past year was more common among females (PR 1.08 [95% CI 1.01, 1.17]) and participants with secondary education or higher (PR 1.10 [95% CI 1.02, 1.19]). In the multivariable model, only secondary education or higher was associated with recent HIV testing (adjusted PR 1.10 [95% CI 1.02, 1.20]). Hierarchical models showed no geographic differences in HIV testing across Kisumu subcounties.

Conclusions
Prior HIV testing was common among study participants and most had been tested within the past year but testing for tuberculosis and viral hepatitis was far less common. HIV testing gaps exist for males and those with lower levels of education. HIV testing infrastructure could be leveraged to increase access to testing for other endemic infectious diseases.
Factors affecting healthcare pathways for chronic lung disease management in Vietnam: a qualitative study on patients’ perspectives
Authors: Nguyen Thu-Anh , Pham Yen Ngoc , Doan Nhung Phuong , Nguyen Thao Huong , Do Toan Thanh , Van Vu Giap , Marks Guy B. , McKinn Shannon , Negin Joel , Bernays Sarah , Fox Greg J. 
Published: June 2021

AbstractBackgroundChronic obstructive pulmonary disease (COPD) and asthma rank among the leading causes of respiratory morbidity, particularly in low- and middle-income countries. This qualitative study aimed to explore the healthcare pathways of patients with chronic respiratory disease, and factors influencing their ability to access healthcare in Vietnam, where COPD and asthma are prevalent.MethodsWe conducted 41 in-depth interviews among patients, including 31 people with COPD, eight with asthma and two with asthma-COPD overlap syndrome. Participants were recruited at provincial- or national-level health facilities in two urban and two rural provinces in Vietnam. The interviews were audio-recorded, transcribed, and analysed using thematic analysis.ResultsPatients’ healthcare pathways were complex and involved visits to multiple health facilities before finally obtaining a definitive diagnosis at a provincial- or national-level hospital. Access to healthcare was affected considerably by participants’ limited knowledge of their respiratory conditions, the availability of social support, especially from family members, the costs of healthcare as well as health system factors (including the coverage of public health insurance, the distance to health facilities, and attitude of healthcare providers).ConclusionThe study demonstrated the need for improved access to timely diagnosis and treatment of chronic lung disease within the lower level of the health system. This can be achieved by enhancing the communication skills and diagnostic capacity of local healthcare workers. Health education programmes for patients and caregivers will contribute to improved control of lung disease.
The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care
Authors: Yu Xinyan , Wu Yingying , Ning Rende 
Published: June 2021

Abstract
Background
Deep vein thrombosis (DVT) of lower limb is one of the common complications after total hip arthroplasty(THA), we aimed to evaluate the potential risk factors of DVT of lower limb in patients with THA, to provide insights into the management of THA.

Methods
Patients who underwent THA in our hospital from January 1, 2017 to November 30, 2020 were included. The personal characteristics and clinical data of DVT and no-DVT patients were compared and analyzed. Logistic regression analyses were perfomed to identify the potential risk factors of DVT in patients with THA.

Results
A total of 182 THA patients were included, the incidence of DVT of lower limb in patients with THA was 19.78 %. There were significant differences in the age, BMI, diabetes, number of replacement, duration of surgery, type of prosthesis and duration of days in bed between DVT and no-DVT patients(all P < 0.05). And there were no significant differences in the gender, hypertension, hyperlipidemia, preoperative D-dimer, type of anesthesia and anticoagulant drugs use(all P > 0.05). Logistic regression analysis indicated that age > 70y(OR4.406, 95 %CI1.744 ~ 6.134), BMI ≥ 28(OR2.275, 95 %CI1.181 ~ 4.531), diabetes(OR3.949, 95 %CI1.284 ~ 5.279), bilateral joint replacements(OR2.272, 95 %CI1.402 ~ 4.423), duration of surgery ≥ 120 min(OR3.081, 95 %CI1.293 ~ 5.308), cemented prosthesis(OR2.435, 95 %CI1.104 ~ 4.315), and duration of days in bed > 3 days(OR1.566, 95 %CI1.182 ~ 1.994) were the risk factors of DVT of lower limb in patients with THA.

Conclusions
DVT in the lower limb after THA is common, and its onset is affected by many factors. In clinical work, attention should be paid to identify the risk factors for DVT and targeted interventions are highlighted to prevent the postoperative DVT.
Advancing discussion of ethics in mixed methods health services research
Authors: Stadnick Nicole A. , Poth Cheryl N. , Guetterman Timothy C. , Gallo Joseph J. 
Published: June 2021

Abstract
Background
To describe the ethical issues and experiences of scientists conducting mixed methods health services research and to advance empirical and conceptual discussion on ethical integrity in mixed methods health research.

Methods
The study was conducted with 64 scholars, faculty and consultants from the NIH-funded Mixed Methods Research Training Program (MMRTP) for the Health Sciences. This was a cross-sectional study. Survey results were analyzed using descriptive statistics to characterize responses and open coding to summarize strategies about eight ethical mixed methods research issues. Respondents completed an online survey to elicit experiences related to eight ethical issues (informed consent, confidentiality, data management, burden, safety, equitable recruitment, communication, and dissemination) and strategies for addressing them.

Results
Only about one-third of respondents thought their research ethics training helped them plan, conduct, or report mixed methods research. The most frequently occurring ethical issues were participant burden, dissemination and equitable recruitment (> 70% endorsement). Despite occurring frequently, < 50% of respondents rated each ethical issue as challenging. The most challenging ethical issues were related to managing participant burden, communication, and dissemination. Strategies reported to address ethical issues were largely not specific or unique to mixed methods with the exception of strategies to mitigate participant burden and, to a lesser degree, to facilitate equitable recruitment and promote dissemination of project results.

Conclusions
Mixed methods health researchers reported encountering ethical issues often yet varying levels of difficulty and effectiveness in the strategies used to mitigate ethical issues. This study highlights some of the unique challenges faced by mixed methods researchers to plan for and appropriately respond to arising ethical issues such as managing participant burden and confidentiality across data sources and utilizing effective communication and dissemination strategies particularly when working with a multidisciplinary research team. As one of the first empirical studies to examine mixed methods research ethics, our findings highlight the need for greater attention to ethics in health services mixed methods research and training.
Comparison of SDSG and CARDS classifications for L5/S1 lumbar degenerative spondylolisthesis: an independent inter- and intra-observer agreement study
Authors: Sun Zhengwang , Xu Chongqing , Yin Mengchen , Yan Wangjun 
Published: June 2021

Abstract
Background
Lumbar degenerative spondylolisthesis (DS) has been a common disease that makes increasing patients to suffer from different degrees of low back pain and radicular symptoms. The Spinal Deformity Study Group (SDSG) and the Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) systems are commonly used to classify the disease, and help to make a more detailed treatment plan. The objective of this study is to compare the reliability and reproducibility of SDSG and CARDS classifications, and to explore their clinical application value.

Methods/design
All 117 patients with L5/S1 lumbar DS were enrolled. Five experienced spine surgeons were selected to assess DS with SDSG and CARDS systems. Kappa (K) value was used to check the coefficient consistency for multi-factor and assess the inter- and intra-observer agreement. After 12 weeks, the analysis was repeated.

Results
The inter-observer reliability and intra-observer reproducibility of SDSG system were substantial with K values of 0.704 and 0.861, while those of CARDS system were substantial with values of 0.620 and 0.878.

Conclusion
SDSG system had better inter-observer reliability in comparison with CARDS system, and though CARDS system is more intuitive and simpler, it is more likely to produce deviations when using it. Both SDSG and CARDS systems show substantial agreement and have great significance in surgical strategy of L5/S1 lumbar DS, they can be widely used in clinical practice.
Convergence in public health expenditure across the Sub-Saharan African countries: does club convergence matter?
Authors: Traoré Ousmane 
Published: June 2021

Abstract
Background
Sub-Saharan African (SSA) countries that currently face enormous healthcare challenges have implemented national health policies focusing on regional or international health commitments. These health commitments generally promote new healthcare financing policies (e.g., health insurance, user fee exemption and results-based financing) with the objective of providing ever-larger population cohorts with human capital and better health in particular. To achieve this, governments must involve themselves more fully in their respective healthcare sectors through the mobilisation of public funding.

Objective
This paper aims to examine convergence in health expenditure throughout SSA. The findings of club convergence will allow a robust comparison of health indicators between countries and will be suitable for the adjustment of health policies to foster the efficiency of such policies at the regional and/or country level. Such findings could also help with the conception and implementation of health policies at the regional level.

Methods
We used the methodology of convergence analysis based on dynamic factor modelling leading to the logt regression to test for full convergence, club convergence and club clustering of health expenditure on a balanced panel of 44 countries in Sub-Saharan Africa spanning the period from 2000 to 2016.

Results
Overall, our results do not support the hypothesis that all SSA countries converge to a single equilibrium state regarding public health expenditure. When testing for club convergence, the results highlight eight convergence clubs and one group of diverging countries. Indeed, performing the club clustering algorithm reveals the existence of three convergence clubs and the diverging group. The three clubs consist of 12, 14 and 14 members, respectively, where convergence is found to occur among different regional economic organisations.

Conclusion
Our findings indicate that SSA governments should increase spending on healthcare in order to align their healthcare systems with a global convergence model. To foster the convergence to a single equilibrium state in public health expenditure, attention could be paid to strengthening integration within the various regional economic organisations and to the coordination and integration of healthcare policies within and across convergence clubs throughout SSA.
The spike glycoprotein genes of porcine epidemic diarrhea viruses isolated in China
Authors: Wang Pei-Hua , Li Ya-Qian , Pan Yuan-Qing , Guo Yan-Yan , Guo Fan , Shi Rui-Zhu , Xing Li 
Published: June 2021

AbstractThe porcine epidemic diarrhea virus (PEDV) causes a highly contagious disease in pigs, which is one of the most devastating viral diseases of swine in the world. In China, PEDV was first confirmed in 1984 and PEDV infections occurred sporadically from 1984 to early 2010. From late 2010 until present, PEDV infections have swept every province or region in China. In this study, we analyzed a total of 186 full-length spike genes and deduced proteins of all available complete genomes of PEDVs isolated in China during 2007–2019. A total of 28 potential recombination events were identified in the spike genes of PEDVs in China. Spike gene recombination not only expanded the genetic diversity of PEDVs in the GII genogroup, but also resulted in the emergence of a new evolutional branch GI-c during 2016–2018. In addition, comparative analysis of spike proteins between GI-a prototype virulent CV777 and GII strain AJ1102 reveals that the amino acid variations could affect 20 potential linear B cell epitopes, demonstrating a dramatic antigen drift in the spike protein. These results provide a thorough view of the information about the genetic and antigenic diversity of PEDVs circulating in China and therefore could benefit the development of suitable strategies for disease control.
Throughput of distributed queueing-based LoRa for long-distance communication
Authors: Wu Wei , Wang Wennai , Wang Bin , Song Rongfang 
Published: June 2021

AbstractLoRa, due to its advantage of long-range communication capability, is promising for Internet of Things (IoT) and space-air-ground communications. However, the conventional MAC protocol used with LoRa is classified as an Aloha-based algorithm, which leads to drastic decrease in throughput when a huge amount of end-devices try to access the network. To achieve stable and high throughput of LoRa, we propose a design to combine the distributed queueing (DQ) and in-band-full-duplex (IBFD) technologies. The usage of DQ mechanism is benefit for fast collision resolution, while the IBFD-enabled gateway helps to reduce the heavy control overhead of DQ. The designs of access procedure and frame structure are discussed in detail. The outage probability and average throughput are evaluated under imperfect self-interference cancelation. Also, a mathematical programming method is developed to optimize the spreading factor and code rate. Numerical results show that our proposal gains an extra enhancement of 1.83-fold in throughput.