bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educational Informed Consent Video Equivalent to Standard Verbal Consent for Rhinologic Surgery: A Randomized Controlled Trial
Authors: Penn Joseph P. , Nallani Rohit , Dimon Erin L. , Daniels Taylor C. , Sykes Kevin J. , Chiu Alexander G. , Villwock Mark R. , Villwock Jennifer A. 
Published: February 2021

Background Informed consent is an integral part of pre-operative counseling. However, information discussed can be variable. Recent studies have explored the use of multimedia in providing informed consent for rhinologic surgery. Objective To measure impact of an educational video (Video) compared to verbal informed consent (Verbal) on knowledge gained, alleviation of concerns, and efficiency. Methods Patients undergoing endoscopic sinus surgery (ESS), septoplasty, or ESS+septoplasty were prospectively enrolled and randomized to receive Video or Verbal consent. The Video group watched an educational video; the Verbal group received standard verbal consent from an Otolaryngology resident per institutional protocol. Both groups had the opportunity to discuss questions or concerns with their attending surgeon. Prior to, and after, consent was signed, both groups completed surveys regarding knowledge of purpose, risks, and benefits of surgery as well as surgical concerns. Decision regret and patient satisfaction were also assessed post-operatively. Results 77 patients were enrolled (39 Video, 38 Verbal). Demographics were not significantly different between groups. Overall knowledge significantly improved (p < 0.005) and concerns significantly decreased (p < 0.001) following consent in both groups. Improvements in these metrics were equivalent between groups (p < 0.02). Furthermore, resident time to complete consent, patient satisfaction, and decision regret were not significantly different between groups. Conclusion Use of an educational video was equivalent to standard verbal informed consent for patients undergoing rhinologic surgery. Otolaryngologists can consider developing procedure-specific videos to allow allocation of time to other tasks, standardized education of patients, and streamlining of the informed consent process.
Survival prediction in glioblastoma on post-contrast magnetic resonance imaging using filtration based first-order texture analysis: Comparison of multiple machine learning models
Authors: Priya Sarv , Agarwal Amit , Ward Caitlin , Locke Thomas , Monga Varun , Bathla Girish 
Published: February 2021

Objective Magnetic resonance texture analysis (MRTA) is a relatively new technique that can be a valuable addition to clinical and imaging parameters in predicting prognosis. In the present study, we investigated the efficacy of MRTA for glioblastoma survival using T1 contrast-enhanced (CE) images for texture analysis. Methods We evaluated the diagnostic performance of multiple machine learning models based on first-order histogram statistical parameters derived from T1-weighted CE images in the survival stratification of glioblastoma multiforme (GBM). Retrospective evaluation of 85 patients with GBM was performed. Thirty-six first-order texture parameters at six spatial scale filters (SSF) were extracted on the T1 CE axial images for the whole tumor using commercially available research software. Several machine learning classification models (in four broad categories: linear, penalized linear, non-linear, and ensemble classifiers) were evaluated to assess the survival prediction performance using optimal features. Principal component analysis was used prior to fitting the linear classifiers in order to reduce the dimensionality of the feature inputs. Fivefold cross-validation was used to partition the data iteratively into training and testing sets. The area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic performance. Results The neural network model was the highest performing model with the highest observed AUC (0.811) and cross-validated AUC (0.71). The most important variable was the age at diagnosis, with mean and mean of positive pixels (MPP) for SSF = 0 being the second and third most important, followed by skewness for SSF = 0 and SSF = 4. Conclusions First-order texture features, when combined with age at presentation, show good accuracy in predicting GBM survival.
An Environmental Scan of Ambulatory Care Quality Indicators for Patients With Advanced Kidney Disease Currently Used in Canada
Authors: Hingwala Jay , Molnar Amber O. , Mysore Priyanka , Silver Samuel A. 
Published: February 2021

Background: Quality indicators can be used to identify gaps in care and drive frontline improvement activities. These efforts are important to prevent adverse events in the increasing number of ambulatory patients with advanced kidney disease in Canada, but it is unclear what indicators exist and the components of health care quality they measure. Objective: We sought to identify, categorize, and evaluate quality indicators currently in use across Canada for ambulatory patients with advanced kidney disease. Design: Environmental scan of quality indicators currently being collected by various organizations. Setting: We assembled a 16-member group from across Canada with expertise in nephrology and quality improvement. Patients: Our scan included indicators relevant to patients with chronic kidney disease in ambulatory care clinics. Measurements: We categorized the identified quality indicators using the Institute of Medicine and Donabedian frameworks. Methods: A 4-member panel used a modified Delphi process to evaluate the indicators found during the environmental scan using the American College of Physicians/Agency for Healthcare Research and Quality criteria. The ratings were then shared with the full panel for further comments and approval. Results: The environmental scan found 28 quality indicators across 7 provinces, with 8 (29%) rated as “necessary” to distinguish high-quality from poor-quality care. Of these 8 indicators, 3 were measured by more than 1 province (% of patients on a statin, number of patients receiving a preemptive transplant, and estimated glomerular filtration rate at dialysis start); no indicator was used by more than 2 provinces. None of the indicators rated as necessary measured timely or equitable care, nor did we identify any measures that assessed the setting in which care occurs (ie, structure measures). Limitations: Our list cannot be considered as an exhaustive list of available quality indicators at hand in Canada. Our work focused on quality indicators for nephrology providers and programs, and not indicators that can be applied across primary and specialty providers. We also focused on indicator constructs and not the detailed definitions or their application. Last, our panel does not represent the views of other important stakeholders. Conclusions: Our environmental scan provides a snapshot of the scope of quality indicators for ambulatory patients with advanced kidney disease in Canada. This catalog should inform indicator selection and the development of new indicators based on the identified gaps, as well as motivate increased pan-Canadian collaboration on quality measurement and improvement. Trial registration: Not applicable as this article is not a systematic review, nor does it report results of a health intervention on human participants.
Immunoglobulin-A Vasculitis With Renal Involvement in a Patient With COVID-19: A Case Report and Review of Acute Kidney Injury Related to SARS-CoV-2
Authors: Li Nicholas L. , Papini Adam B. , Shao Tiffany , Girard Louis 
Published: February 2021

Rationale: Acute kidney injury is a common complication of COVID-19 and is associated with significantly increased mortality. The most frequent renal biopsy finding with SARS-CoV-2 infection is acute tubular injury; however, new onset glomerular diseases have been reported. The development of persistent urinary abnormalities in patients with COVID-19 should prompt consideration for renal biopsy to rule out glomerulonephritis. Presenting Concerns: A 30-year-old man with no prior medical history presented to the emergency department with symptoms of COVID-19 and new onset painful purpuric rash, arthralgia, and abdominal pain. SARS-CoV-2 infection was confirmed with nucleic acid testing and laboratory investigations revealed preserved renal function with dysmorphic hematuria and nephrotic range proteinuria. Diagnosis: A skin biopsy of the purpuric rash was performed, which demonstrated leukocytoclastic vasculitis. Renal biopsy revealed focally crescentic and segmentally necrotizing IgA nephropathy. Overall, given the clinical syndrome of glomerulonephritis with purpuric rash, arthralgia, and abdominal pain, the presentation is most in keeping with a diagnosis of IgA vasculitis in the setting of COVID-19. Interventions: The patient was treated conservatively for COVID-19 in the community. A 7-day course of prednisone was started for the vasculitic rash. IgA nephropathy was managed conservatively with blood pressure control and RAAS blockade with losartan. Outcomes: With conservative management, the patient’s COVID-19 symptoms resolved completely and he did not require hospital admission. Following prednisone therapy, the patient’s rash, arthralgia, and abdominal pain improved. However, despite resolution of COVID-19, hematuria and proteinuria persisted. With the initiation of RAAS blockade, renal function remained stable and proteinuria improved dramatically at 6 weeks. Novel Findings: De novo glomerulonephritis is a renal manifestation of SARS-CoV-2 infection beyond acute tubular injury. IgA vasculitis appears to be a rare complication of COVID-19.
SARS-CoV-2 Seropositivity among Dental Staff and the Role of Aspirating Systems
Authors: Sarapultseva M. , Hu D. , Sarapultsev A. 
Published: February 2021

Introduction: Health care workers (HCWs) are at a high risk of infection owing to occupational exposure to patients and virus-contaminated surfaces. Objectives: The study was aimed to reveal and compare the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among patient-facing HCWs across 3 dental clinics equipped with different types of aspirating systems. Methods: This retrospective cohort study included 157 HCWs (43.58 ± 1.66 y) from 3 dental clinics in Ekaterinburg (Russian Federation) who reported to work during the coronavirus disease pandemic. All HCWs underwent serological testing once a week to detect immunoglobulin G and M antibodies against the SARS-CoV-2. The V6000 aspirating system with a vacuum controller (dry or semidry mode) and high-efficiency particulate air (HEPA) filters was used at clinics A and B, and the aspirated aerosol and air were evacuated and dissipated into the atmosphere. The VS900 aspirating vacuum pump without HEPA filters was used at clinic C. The aspirated aerosol and air were evacuated and dissipated into the operatories. All dental clinics followed the same recommendations for dental patient management and types of personal protective equipment used. Results: The estimated prevalence of SARS-CoV-2 infection was 11.5% (19 HCWs) over a 5-mo follow-up (May to August 2020). The prevalence of infection was unaffected by sex or the role of the member in the dental team (dentist/dental assistant). The prevalence of SARS-CoV-2 infection (+) was significantly higher at clinic C (equipped with an aspirating vacuum pump without HEPA filters) than at other clinics. Conclusion: The type of aspirating system used and the presence of HEPA filters could affect the prevalence of SARS-CoV-2 infection across dental clinics. Therefore, we recommend the use of aspirating systems installed with HEPA filters, which evacuate and dissipate aerosols into specialized areas. Knowledge Transfer Statement: This report confirms that dentists, being patient-facing HCWs, are at a high risk of acquiring the SARS-CoV-2 infection and identifies gaps in the protection of patients and staff in dental settings.
Assessing Medical Students’ Knowledge of the Deaf Culture and Community in Puerto Rico: A Descriptive Study
Authors: Kung Michael S , Lozano Andrea , Covas Vicente J , Rivera-González Lorena , Hernández-Blanco Yllen Y , Diaz-Algorri Yaritza , Chinapen Sandra 
Published: February 2021

Background: Effective communication between health care professionals and Deaf and Hard of Hearing (D&HH) patients remains a challenge. Literature regarding health professionals’ knowledge of the D&HH community and their barriers toward health care access is limited in Puerto Rico and suggests a need for research. Therefore, this descriptive study aims to evaluate future physician’s knowledge about the Deaf culture and community in a student cohort at San Juan Bautista School of Medicine (SJBSM), with the objective of guiding our results toward improving our curriculum. Methods: Medical students answered a survey to evaluate their knowledge of D&HH patients. The survey consisted of 3 parts testing awareness, exposure, and knowledge of the Deaf community. Responses from the Knowledge section were graded using an answer key, and correct answers were added to create an overall continuous sum score per participant, with higher scores meaning higher knowledge. Participants were also asked to write in possible issues deaf patients may face when hospitalized, apart from communication problems. All data were recorded and used for descriptive analysis. Results: 158 (68%) medical students participated. 63% reported exposure to D&HH people, and 80% were aware of the Deaf culture. 21% of students answered to have attended an American Sign Language (ASL) class, and 86% expressed interest in taking an ASL class. The overall percentage of correct answers from all the medical groups evaluated was 39%, with increasing percent knowledge as medical student year increased. The most frequently listed problem by respondents that deaf patients may face when hospitalized was dealing with an emergency in the hospital, such as the fire alarm. Conclusion: Students from clinical years (MSIII & MSIV) showed a better understanding of the Deaf culture than students in pre-clinical years (MSI & MSII). Nevertheless, the knowledge was limited in all groups. The information generated is not only valuable for our school but the healthcare community as well. The literature related to Deaf culture, particularly in the medical setting in Puerto Rico, is limited. Therefore, there exists a need to continue investigating ways to improve medical students’ education of the Deaf culture and community.
Impacts of interpersonal distancing on-board trains during the COVID-19 emergency
Authors: Coppola Pierluigi , De Fabiis Francesco 
Published: February 2021

Abstract
Introduction
The COVID-19 emergency and the cities lockdown have had a strong impact on transport and mobility. In particular, travel demand has registered an unprecedented overall contraction, dramatically dropping down with peaks of - 90%-95% passengers for public transport (PT). During the re-opening phase, demand is gradually resuming the levels before the crisis, although some structural changes are observed in travel behaviour, and containment measures to reduce the risk of contagion are still being applied, affecting transport supply.

Objective
This paper aims at assessing to what extent keeping a one-meter interpersonal distancing on-board trains is sustainable for public transport companies.

Method
The analysis is based on travel demand forecasting models applied to two case-studies in Italy: a suburban railway line and a High-speed Rail (HSR) line, differentiated by demand characteristics (e.g. urban vs. ex-urban) and train access system (free access vs. reservation required).

Results
In the suburban case, the results show the need of new urban policies, not only limited to the transport domain, in order to manage the demand peaks at the stations and on-board vehicles. In the ex-urban case, the outputs suggest the need for public subsidies in order for the railways undertakings to cope with revenue losses and, at the same time, to maintain service quality levels.
Care-giver identity impacts offspring development and performance in an annually social bumble bee
Authors: Costa Claudinéia P. , Fisher Kaleigh , Guillén Blanca M. , Yamanaka Naoki , Bloch Guy , Woodard S. Hollis 
Published: February 2021

AbstractBackgroundThe developmental fates of offspring have the potential to be influenced by the identity of their care-givers and by the nature of the care that they receive. In animals that exhibit both parental and alloparental care, such as the annually eusocial insects, the influence of care-giver identity can be directly assessed to yield mechanistic and evolutionary insights into the origins and elaboration of brood care. Here, we performed a comparative investigation of maternal and worker brood care in bumble bees, a pollinator group where mothers (queens) rear the first offspring in the nest, and then daughters (workers) assume this role upon their emergence. Specifically, we compared the effects of queen and worker brood care on offspring development and also offspring performance, for a set of traits related to sensory biology, learning, and stress resistance.ResultsWe found that queen-reared workers were smaller-bodied than worker-reared offspring, suggesting that bumble bee queens influence body size determination in their offspring. We also found that queen-reared workers were more resistant to starvation, which might be beneficial for early nesting success. These maternal influences could not be explained by feeding rate, given that we detected a similar offspring feeding frequency in both queens and workers.ConclusionBumble bee queens have a unique influence on the development of the first offspring in the nest, which they rear, relative to worker-reared workers. We propose that bumble bee brood care has been shaped by a suite of evolutionary and ecological factors, which might include a maternal influence on traits that promote survival of incipient colonies.
A validation study of the 4-variable and 8-variable kidney failure risk equation in transplant recipients in the United Kingdom
Authors: Ali Ibrahim , Kalra Philip A. 
Published: February 2021

Abstract
Background
There is emerging evidence that the 4-variable Kidney Failure Risk Equation (KFRE) can be used for risk prediction of graft failure in transplant recipients. However, geographical validation of the 4-variable KFRE in transplant patients is lacking, as is whether the more extensive 8-variable KFRE improves predictive accuracy. This study aimed to validate the 4- and 8-variable KFRE predictions of the 5-year death-censored risk of graft failure in patients in the United Kingdom.

Methods
A retrospective cohort study involved 415 transplant recipients who had their first renal transplant between 2003 and 2015 and were under follow-up at Salford Royal NHS Foundation Trust. The KFRE risk scores were calculated on variables taken 1-year post-transplant. The area under the receiver operating characteristic curves (AUC) and calibration plots were evaluated to determine discrimination and calibration of the 4- and 8-variable KFREs in the whole cohort as well as in a subgroup analysis of living and deceased donor recipients and in patients with an eGFR< 45 ml/min/1.73m2.

Results
There were 16 graft failure events (4%) in the whole cohort. The 4- and 8-variable KFREs showed good discrimination with AUC of 0.743 (95% confidence interval [CI] 0.610–0.876) and 0.751 (95% CI 0.629–0.872) respectively. In patients with an eGFR< 45 ml/min/1.73m2, the 8-variable KFRE had good discrimination with an AUC of 0.785 (95% CI 0.558–0.982) but the 4-variable provided excellent discrimination in this group with an AUC of 0.817 (0.646–0.988). Calibration plots however showed poor calibration with risk scores tending to underestimate risk of graft failure in low-risk patients and overestimate risk in high-risk patients, which was seen in the primary and subgroup analyses.

Conclusions
Despite adequate discrimination, the 4- and 8-variable KFREs are imprecise in predicting graft failure in transplant recipients using data 1-year post-transplant. Larger, international studies involving diverse patient populations should be considered to corroborate these findings.
A population-based study of preeclampsia and eclampsia in Ecuador: ethnic, geographical and altitudes differences
Authors: Tejera Eduardo , Sánchez Maria Eugenia , Henríquez-Trujillo Aquiles R. , Pérez-Castillo Yunierkis , Coral-Almeida Marco 
Published: February 2021

Abstract
Background
In Ecuador eclampsia and preeclampsia were identified as the third cause of maternal death. Like other Latin-American countries, Ecuador has human settlements living from 0 to more than 4000 m of altitude and comprising a wide ethnic-diversity across all these altitude changes. These characteristics offer the possibility to study a wide variety of possible risk factors for preeclampsia and eclampsia.

Methods
We conducted a population-based retrospective study of all deliveries in Ecuador from 2015 through 2017. The main variables analyzed were: altitude, ethnic self-identification, geographic location, and maternal age. The data comes from the Ecuadorian National Institute of Statistics and Census (INEC) and the Ecuadorian Ministry of Health. Data information regarding maternal parity and socioeconomic status was not available from official records. Logistic regression analysis was used to study the relationship between preeclampsia and eclampsia with the variable of interest. Geospatial statistical analysis was done to identify statistically significant spatial clusters of preeclampsia and eclampsia cases.

Results
The incidence of preeclampsia was estimated between 5.11 (5.05–5.18) and 6.23 (6.16–6.30), and 0.25 (0.23–0.26) for eclampsia. Native American have a lower incidence regarding preeclampsia compared to other ethnic groups. High altitude has a significant odds ratio (OR = 2.31, 1.93–2.78) of preeclampsia. Montubio residing in middle altitude (1500–3500 m) have the highest risk of preeclampsia (OR = 18.13, 9.53–34.50). Afro-Ecuadorians also have an increased risk of preeclampsia associated with altitude (OR = 2.36, 1.78–3.14). Ethnicity was not identified as a risk factor for eclampsia. Early and older maternal age was associated with an increased risk of preeclampsia and eclampsia. Women living more than 20 km from the obstetric unit have an OR = 2.61 (2.32–2.95, p-value< 0.01) and OR = 1.87 (1.82–1.92, p-value< 0.01) of developing eclampsia and preeclampsia respectively.

Conclusions
Preeclampsia is widespread across low and high-altitude areas, while eclampsia is mostly located at lower altitudes. Montubios living at middle or high altitudes represents the ethnic group with a higher risk of preeclampsia. No ethnic effect was identified as a potential risk factor for eclampsia. Moreover, in eclampsia the associated risk of young women seems to be higher than in preeclampsia.