bluuebunny/crossref_metadata_2025_split huggingface dataset:
Indirect Impact of the COVID-19 Pandemic on Activity and Outcomes of Transcatheter and Surgical Treatment of Aortic Stenosis in England
Authors: Martin Glen P. , Curzen Nick , Goodwin Andrew T. , Nolan James , Balacumaraswami Lognathen , Ludman Peter F. , Kontopantelis Evangelos , Wu Jianhua , Gale Chris P. , de Belder Mark A. , Mamas Mamas A. 
Published: May 2021

Background:
Aortic stenosis requires timely treatment with either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). This study aimed to investigate the indirect impact of coronavirus disease 2019 (COVID-19) on national SAVR and TAVR activity and outcomes.

Methods:
The UK TAVR Registry and the National Adult Cardiac Surgery Audit were used to identify all TAVR and SAVR procedures in England, between January 2017 and November 2020. The number of isolated aortic valve replacement (AVR), AVR+coronary artery bypass graft surgery, AVR+other surgery, and TAVR procedures per month was calculated. Separate negative binomial regression models were fit to monthly procedural counts, with functions of time as covariates, to estimate the expected change in activity during COVID-19.

Results:
We included 15 142 TAVR cases, 13 357 isolated AVR cases, 8550 AVR+coronary artery bypass graft cases, and 6773 AVR+other cases. Before March 2020 (UK lockdown), monthly TAVR activity was rising, with a slight decrease in the SAVR activity during 2019. We observed a rapid and significant drop in TAVR and SAVR activity during the COVID-19 pandemic, especially for elective cases. Cumulatively, over the period March to November 2020, we estimated an expected 4989 (95% CI, 4020–5959) cases of aortic stenosis who have not received treatment.

Conclusions:
This study has demonstrated a significant decrease in TAVR and SAVR activity in England following the COVID-19 outbreak. This situation should be monitored closely, to ensure that monthly activity rapidly returns to expected levels. There is potential for significant backlog in the near-to-medium term and potential for increased mortality in this population.
Association of Coronary Artery Atherosclerosis With Brain White Matter Hyperintensity
Authors: Johansen Michelle C. , Gottesman Rebecca F. , Kral Brian G. , Vaidya Dhananjay , Yanek Lisa R. , Becker Lewis C. , Becker Diane M. , Nyquist Paul 
Published: May 2021

Background and Purpose:
We aim to determine, in healthy high-risk adults, the association between subclinical coronary artery disease and white matter hyperintensity (WMH) volume and location, independent of atherosclerotic risk factors.

Methods:
Seven hundred eighty-two asymptomatic first-degree relatives of index cases with early-onset coronary artery disease (<60 years old) from GeneSTAR (Genetic Study of Atherosclerosis Risk) with contemporaneous coronary computed tomography angiography and brain magnetic resonance imaging were analyzed. Multilevel mixed-effects linear regression models, accounting for family structure, evaluated the association of total WMH volume and 3 regions (deep WMH, periventricular WMH [PVWMH], or borderzone [cuff]) with markers of coronary artery disease. Separate models were created for total WMH, deep WMH, PVWMH, and cuff volumes, each, as dependent variables, across coronary computed tomography angiography variables, adjusted for covariates.

Results:

Mean age was 51 years ±10, with 58% women and 39% African American people. Participants with any coronary plaque had 52% larger WMH volumes than those without plaque (95% CI, 0.24–0.59). Per 1% greater coronary plaque volume, total WMH volumes were 0.07% larger (95% CI, 0.04–0.10). Every 1% higher total coronary plaque volume was associated with 5.03% larger deep WMH volume (95% CI, 4.67–5.38), 5.10% PVWMH larger volume (95% CI, 4.72–5.48), and 2.74% larger cuff volume (95% CI, 2.38–3.09) with differences in this association when comparing deep WMH to PVWMH (
P
interaction, 0.001) or cuff (
P
interaction, <0.001), respectively.

Conclusions:
In healthy, high-risk individuals, the presence and volume of coronary artery plaque are associated with larger WMH volumes, appearing the strongest for PVWMH. These findings in high-risk families suggest a disease relationship in 2 different vascular beds, beyond traditional risk factors, possibly due to genetic predisposition.
‘You should tell somebody’: An evaluation of a survivor stories blog project to motivate sexual assault victims
Authors: Riggs Rachel E 
Published: May 2021

Objective: Sexual assault victims often do not disclose their assaults or seek positive health outcomes. The RAINN Survivor Stories project shares testimonials in the form of online blogs from sexual assault survivors to motivate and encourage others to come forward and disclose their assaults. This study aimed to better understand the themes present in the survivor stories to motivate victims to disclose their assaults and seek positive health outcomes. Design: A theoretical thematic analysis was conducted on blog posts created for the project to identify (a) how the posts tell survivor stories and (b) how the posts model positive health outcomes using social cognitive theory and the disclosure processes model as a guide. Setting: Online setting linked to the rainn.org website. Method: Blog posts were collected for inductive thematic analysis. Themes were identified based on their prevalence in the data and their pertinence to the research questions. Results: Emerging themes included (a) overcoming initial disclosure, (b) overcoming the lasting effects of victimisation, (c) utilising support and (d) advocating for others after assault. Conclusion: Findings offer insight to researchers and practitioners creating media messages for sexual assault victims and other stigmatised groups by expanding understanding of modelled positive health outcomes in media and the disclosure process of victims.
Public Sector Reform and the Introduction of Neoliberal Capitalism in African Socialist States: The Case of Zambia
Authors: Madimutsa Clever , Malisase Royd , Daka Evans , Chewe Moses 
Published: May 2021

Public sector reform (PSR) is believed to improve the performance of the public sector in particular and the economy in general by introducing market competition in service delivery. However, this paper shows that PSR uses a three-stage process to introduce neoliberal capitalism in African socialist states. The first stage dismantles the socialist state through strategies such as downsizing, decentralization, and privatization. The second stage introduces neoliberal capitalism in the former socialist state by removing government controls and allowing private sector actors to participate in economic activities. The third stage reconfigures the former socialist state into an agent of neoliberal capitalism. Ultimately, ordinary citizens are exploited and impoverished while private investors accumulate capital. JEL Classification: D73, P16, P33
Homecoming—Dignity Through Movement at the End of Life: A Qualitative Interview Study With Healthcare Professionals
Authors: Cameron Fiona , Janze Anna , Klarare Anna 
Published: May 2021

Aim: To describe healthcare professionals’ and volunteers’ experiences of a pathway for movement on a hospice ward. Method: This was a qualitative study with an inductive approach. Data were collected in a hospice setting through 4 focus group interviews with healthcare professionals and volunteers (n = 12). The focus group participants varied in age, profession, and length of experience in palliative care. The interviews were audio recorded, transcribed and analyzed with qualitative content analysis. Results: Dignity through movement at the end of life was the main theme, complemented by 4 sub-themes. Two descriptive sub-themes: “A practical tool to facilitate physical activity” and “Companionship and goals give meaning to the day,” and 2 interpretative sub-themes: “Regaining control and having a choice” and “Feeling normal and alive” based on participants’ views of patient experiences. Significance of Results: Indications are that the pathway for movement addresses a wide range of experiences related to different aspects of being human in a difficult situation. Experiences of movement and physical activity can promote wellbeing, dignity, and a sense of feeling “at home” for patients within hospice care. The pathway for movement is simple to set up, offers access to appropriate physical activity and seems to benefit patients both in the early and later phases of palliative care.
Biosimilar knowledge and viewpoints among Brazilian inflammatory bowel disease patients
Authors: Garcia Karoline Soares , Facas Bianca Pocopetz , Machado Marta Brenner , Teixeira Fábio Vieira , Avedano Luisa , Lönnfors Sanna , Hossne Rogério Saad , Peyrin-Biroulet Laurent , Queiroz Natália Sousa Freitas 
Published: May 2021

Background: In this analysis we aimed to describe Brazilian inflammatory bowel disease (IBD) patients’ knowledge and perceptions regarding biosimilars and compare with viewpoints from non-Brazilian patients. Methods: An online survey consisting of 19 questions was made available by the European Federation of Crohn’s and Ulcerative Colitis Associations between July 2018 and December 2018. Only respondents who had heard of biosimilars were asked to respond to all of the questions. Results: A total of 102 Brazilian IBD patients responded to the survey. The majority (78.4%) of patients had been exposed to anti-tumor-necrosis-factor drugs and 63.4% of them had heard of biosimilars. Brazilian respondents worried significantly more about biosimilars being less effective than the originator (62.5% versus 47.9%, p value 0.03) and molecular differences between biosimilars and originators (53.1% versus 31.8, p value 0.001) as compared with non-Brazilian IBD patients. The majority of Brazilian (75%) and non-Brazilian (64.1%) respondents thought that the lower cost of biosimilars should not come before their safety and efficacy ( p value 0.09). In addition, 79.1% of Brazilian respondents believed that the arrival of biosimilars will have an impact on the management of IBD. Conclusions: Brazilian patients reported higher rates of misconceptions regarding biosimilars than non-Brazilian IBD patients. Although patients still worry about different aspects regarding biosimilars, they also tend to be confident that biosimilars will have an impact on the management of their disease. With the recent approval of many biosimilars in Brazil and the imminent widespread use of these drugs, our data raise awareness for the need of providing patient education to prevent negative expectations toward switching to biosimilars.
A Comprehensive Evaluation of Township Hospitals in the Severely Cold Areas of China
Authors: Wu Yue , Zhu Lei , Yu Tingting , Zhang Shanshan 
Published: May 2021

Objective: The aims of this study are to establish an evaluation system and find the existing problems in the architectural design of township hospitals in the severely cold regions of China. Background: Due to the geographical location and economic factors, development still has some key problems, such as inadequate construction, old facilities, and backward technology, which are more prominent in the severely cold regions. Methods: First, evaluation factors have been selected and determined by literature review and on-site investigation. Evaluation rules have been determined using fuzzy membership function. Then, the analytic hierarchy process is used to determine the weights of the evaluation factors at all levels. Finally, take a township hospital as an example to calculate the comprehensive evaluation results. Results: A comprehensive evaluation index system with 28 elements and 76 factors for the township hospitals in severely cold regions including the basic health service capacity, the emergency capacity, and the climate fitness. Conclusions: The establishment of the comprehensive evaluation system of township hospitals in severely cold areas in this study aims to find out the problems through the evaluation of the existing township hospitals in the severely cold areas and provide guidance for the transformation of existing township hospitals in the severely cold areas. By comparing the scheme evaluation for building hospitals, we shall look for the optimal solution to provide reference for future development in the construction of township hospitals.
Conditional and Overall Disease-Specific Survival in Patients With Paranasal Sinus and Nasal Cavity Cancer: Improved Outcomes in the Endoscopic Era
Authors: Sharma Rahul K. , Irace Alexandria L. , Schlosser Rodney J. , Overdevest Jonathan B. , Rowan Nicholas R. , Troob Scott H. , Gudis David A. 
Published: May 2021

Background The management of paranasal sinus and nasal cavity malignancies has evolved significantly with the development of advanced endoscopic techniques and improvements in adjuvant therapy. We sought to characterize both disease-specific survival (DSS) and 5-year conditional disease-specific survival (CDSS, the change in life expectancy with increasing survivorship) for sinus malignancies diagnosed before and after the year 2000. Methods Patients diagnosed with sinus and nasal cavity cancer between 1973-2015 were extracted from the Surveillance, Epidemiology, End Results (SEER) registry. Kaplan-Meier analysis for DSS was stratified by year of diagnosis before and after 2000. Cox-proportional hazards models of DSS controlling for stage, age, and year of diagnosis were generated. CDSS was calculated using Cox-regression models stratified by stage. Results We analyzed 10,535 patients. Diagnosis after the year 2000 was independently associated with improved DSS (HR:0.81, 95% CI: 0.75-0.87, P < .001) after controlling for age and stage. After stratifying by stage, diagnosis after year 2000 was associated with improved DSS for localized (HR:0.71, 0.59-0.86, P < .001) malignancies, regional (HR: 0.86, 0.78-0.94, P = .001) and distant malignancies (HR 0.74, 0.63-0.87, P < .001). CDSS improved with increasing survivorship for all stages of sinus and nasal cavity cancer, and those diagnosed after 2000 had improved CDSS compared to those diagnosed before 2000. Descriptively, the association of year of diagnosis with CDSS diminished with increasing survivorship for localized cancers, but was consistent for other stages. Conclusion For paranasal sinus and nasal cavity malignancies, year of diagnosis independently influences both DSS and CDSS. Improved survival is likely due to advances in both surgical and adjuvant treatments. To our knowledge, this study is the first to examine CDSS for these malignancies.
Evidence and rationale for a pragmatic approach to pre-operative isolation prior to elective urological surgery during the de-escalation phase of COVID-19
Authors: Smith Rhys O , Desai Roshni S , Jones Adam 
Published: May 2021

Introduction: In response to the COVID-19 pandemic elective operating decreased to meet critical care capacity demands at the Royal Berkshire Hospital. As this demand fell elective operating subsequently increased. This saw the introduction of the ‘Cold Pathway’ at the Royal Berkshire Hospital in line with Public Health England guidelines; the first urology patients being admitted on 14 May 2020. This requires patients to undergo a 14-day self-isolation period, which many find difficult, with a negative COVID-19 swab 48 h prior to their operation. Aims: This article examines whether any differences exist in patient outcomes related to COVID-19 since implementation of the Cold Pathway and the significance of this to the 14-day self-isolation rule. Methods: Urology patients electively operated on between 23 March 2020–3 July 2020 were included. A combination of electronic records and telephone consultations were used to obtain data regarding a pre-selected set of questions. Results: One hundred and ninety-six patients were included. Seventy-eight patients were admitted prior to the introduction of the Cold Pathway and 118 after this point. Of patients analysed prior to the implementation of the Cold Pathway, one required ongoing hospital treatment as a result of potentially obtaining COVID-19 from in-patient admission. Of the 78 patients, 14 isolated prior to their procedure. Post-implementation, 118 patients were examined. Despite claiming to have complied with self-isolation instructions at admission, 45 patients admitted retrospectively to not complying at all or only partially. One patient developed COVID-19 3 weeks post-operatively. Discussion: We have shown no difference in outcomes, in relation to COVID-19, when comparing those admitted pre- and post-Cold Pathway implementation. Many patients describe difficulty in following this isolation period. In conjunction with falling national and local levels of COVID-19 positive cases, we have therefore adopted a more pragmatic approach to patient isolation with the ability to perform operations based on clinical need and individual patient circumstances. Level of evidence: This is a cohort study of patients undergoing elective urological surgery at the Royal Berkshire Hospital.
Longer Screws Can Reduce the Stress on the Upper Instrumented Vertebra With Long Spinal Fusion Surgery: A Finite Element Analysis Study
Authors: Oe Shin , Narita Kengo , Hasegawa Kazuhiro , Natarajan Raghu N. , Yamato Yu , Hasegawa Tomohiko , Yoshida Go , Banno Tomohiro , Arima Hideyuki , Mihara Yuki , Ushirozako Hiroki , Ide Koichiro , Yamada Tomohiro , Watanabe Yuh , Matsuyama Yukihiro 
Published: May 2021

Study Design: A finite element analysis study. Objective: Of proximal junctional failure, upper instrumented vertebra (UIV) fracture can causes severe spinal cord injury. Previously, we reported that higher occupancy rate of pedicle screw (ORPS) at UIV prevented UIV fracture in adult spinal deformity surgery; we had not yet tested this finding using a biomechanical study. The purpose of present study was to measure the differences in loads on the UIV according to the length of PS and ORPS. Methods: We designed an FE model of a lumbar spine (L1-S1) using FE software. The PS was set from L2 to S1 and connected the rod. The FE model simulated flexion (8 Nm) to investigate the loads at UIV (L2) according to the length of the PS. There were 5 screw lengths examined: 40 (ORPS 36.4%), 45 (48.5%), 50 (66.7%), 55 (81.8%), and 60 mm (93.9%). Results: Stress with bending motion was likely to occur at the upper front edge of the vertebral body, the pedicles, and the screw insertion point. The maximum equivalent stress according to screw lengths of 40, 45, 50, 55, and 60 mm were 45.6, 37.2, 21.6, 13.3, and 14.8 MPa, respectively. The longer screw, the less stress was applied to UIV. No remarkable change was observed between the screw lengths of 55 and 60 mm. Conclusions: Increasing ORPS to 81.8% or more reduced the load on the UIV. To prevent UIV fracture, the PS length in the UIV should be more than ORPS 81.8%.
Carotid approach to anterior circulation thromboembolectomy in an adult with failing fontan physiology: a case report
Authors: Eden Caroline , Clifford Hugo , Wang Arthur , Mohammed Asif , Yim Peter 
Published: May 2021

Abstract
Background
Anesthetic management of an adult with failing Fontan physiology is complicated given inherent anatomical and physiological alterations. Neurosurgical interventions including thromboembolectomy may be particularly challenging given importance of blood pressure control and cerebral perfusion.

Case Presentation
We describe a 29 year old patient born with double outlet right ventricle (DORV) with mitral valve atresia who after multi-staged surgeries earlier in life, presented with failing Fontan physiology. She was admitted to the hospital almost 29 years after her initial surgeries to undergo workup for a dual heart and liver transplant in the context of a failing Fontan with elevated end diastolic pressures, NYHA III heart failure symptoms, and liver cirrhosis from congestive hepatopathy. During the workup in the context of holding anticoagulation for invasive procedures, she developed a middle cerebral artery (MCA) stroke requiring a thromboembolectomy via left carotid artery approach.

Discussion and Conclusions
This case posed many challenges to the anesthesiologist including airway control, hemodynamic and cardiopulmonary monitoring, evaluation of perfusion, vascular access, and management of anticoagulation in an adult patient in heart and liver failure with Fontan physiology undergoing thromboembolectomy for MCA embolic stroke.
Accelerating diagnosis of Parkinson’s disease through risk prediction
Authors: Yuan William , Beaulieu-Jones Brett , Krolewski Richard , Palmer Nathan , Veyrat-Follet Christine , Frau Francesca , Cohen Caroline , Bozzi Sylvie , Cogswell Meaghan , Kumar Dinesh , Coulouvrat Catherine , Leroy Bruno , Fischer Tanya Z. , Sardi S. Pablo , Chandross Karen J. , Rubin Lee L. , Wills Anne-Marie , Kohane Isaac , Lipnick Scott L. 
Published: May 2021

Abstract
Background
Characterization of prediagnostic Parkinson’s Disease (PD) and early prediction of subsequent development are critical for preventive interventions, risk stratification and understanding of disease pathology. This study aims to characterize the role of the prediagnostic period in PD and, using selected features from this period as novel interception points, construct a prediction model to accelerate the diagnosis in a real-world setting.

Methods
We constructed two sets of machine learning models: a retrospective approach highlighting exposures up to 5 years prior to PD diagnosis, and an alternative model that prospectively predicted future PD diagnosis from all individuals at their first diagnosis of a gait or tremor disorder, these being features that appeared to represent the initiation of a differential diagnostic window.

Results
We found many novel features captured by the retrospective models; however, the high accuracy was primarily driven from surrogate diagnoses for PD, such as gait and tremor disorders, suggesting the presence of a distinctive differential diagnostic period when the clinician already suspected PD. The model utilizing a gait/tremor diagnosis as the interception point, achieved a validation AUC of 0.874 with potential time compression to a future PD diagnosis of more than 300 days. Comparisons of predictive diagnoses between the prospective and prediagnostic cohorts suggest the presence of distinctive trajectories of PD progression based on comorbidity profiles.

Conclusions
Overall, our machine learning approach allows for both guiding clinical decisions such as the initiation of neuroprotective interventions and importantly, the possibility of earlier diagnosis for clinical trials for disease modifying therapies.