bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early HER2-positive breast cancer arising from a fibroadenoma: a case report
Authors: Fujimoto Akihiro , Matsuura Kazuo , Kawasaki Tomonori , Ichinose Yuki , Nukui Asami , Hiratsuka Miyuki , Asano Aya , Shimada Hiroko , Osaki Akihiko , Saeki Toshiaki 
Published: September 2021

ABSTRACT
Breast cancer arising from fibroadenoma (FA) is rare, in which almost all reported cases are human epidermal growth factor receptor 2 (HER2)-negative. This is the first report to describe a case of HER2-positive breast cancer arising from FA that was treated with chemotherapy plus anti-HER2 therapy. In this early case, upfront surgery outcomes guided the selection of appropriate systemic therapy. A 31-year-old woman previously diagnosed with FA experienced tumor growth. Core needle biopsy and imaging studies confirmed a diagnosis of stage IIA HER2-positive invasive ductal carcinoma (IDC) with no evidence of lymph node metastasis (cT2N0M0). Breast-conserving surgery was performed. Pathological diagnosis revealed stage IA IDC with a predominant intraductal component (pT1aN0M0), arising from FA. In conclusion, we encountered an extremely rare case of HER2-positive breast cancer arising from FA in which pathological infiltration was difficult to predict based on preoperative imaging.
Takotsubo syndrome during surgery for pheochromocytoma: an unexpected complication
Authors: Paraschiv Catalina , Trasca Livia F , Enciu Octavian , Balanescu Serban M , Miron Adrian 
Published: September 2021

ABSTRACT
Takotsubo syndrome is a rare cause of systolic dysfunction and can be found as a clinical manifestation of pheochromocytoma. We present a case of rapid onset of systolic dysfunction with cardiogenic shock, which developed after the surgical excision of an adrenal gland tumor in a 60-year-old male. Coronary angiography excluded coronary artery disease. The echocardiography and ventriculography images suggested Takotsubo cardiomyopathy pattern. Following 2 weeks of inotropic and vasopressor therapy, the left ventricular function gradually improved, until complete resolution.
Exploring remission concept in axial spondyloarthritis through the perception of rheumatologists using vignettes and priority ratings
Authors: Aouad Krystel , Wendling Daniel , Breban Maxime , Dadoun Sabrina , Hudry Christophe , Moltó Anna , Pertuiset Edouard , Gossec Laure 
Published: September 2021

Abstract

Objectives
The optimal treatment target in axial spondyloarthritis (axSpA) is remission; however, a consensual definition of remission is lacking. Our objective was to explore rheumatologists’ perception of remission using vignette cases and a priority exercise.

Methods
A cross-sectional survey of rheumatologists’ perceptions of remission in axSpA was performed in 2020 using (i) 36 vignette cases, with a single clinical picture and three varying parameters [axial pain (ranging from 2 to 5 on a 0–10 scale)], fatigue (2–8), and morning stiffness (&lt;15 min, 30 min or 1 h), assessed as remission yes/no; and (ii) prioritization of elements to consider for remission from a list of 12 items: BASDAI, ASDAS, elements of BASDAI and ASDAS including CRP, NSAID use, extra-articular manifestations (EAMs), and other explanations of symptoms, e.g. fibromyalgia. Analyses were descriptive.

Results
Overall, 200 French rheumatologists participated in 2400 vignette evaluations. Of these, 463 (19%) were classified as remission. The six vignette cases representing 56% of all remission cases had &lt;15 min duration of morning stiffness and axial pain ≤3/10, regardless of fatigue levels. Prioritized items for remission were: morning stiffness (75%), EAMs (75%), NSAID use (71%), axial pain (68%) and CRP (66%).

Conclusions
When conceptualizing remission in axSpA, rheumatologists took into account morning stiffness and axial pain as expected; the link between remission and fatigue was much weaker. Furthermore, rheumatologists also included EAMs and NSAID use in the concept of remission. Consensus is needed for definition of remission in axSpA.
UTERINE ARTERY EMBOLISATION: CONTINUOUS QUALITY IMPROVEMENT REDUCES RADIATION DOSE WHILE MAINTAINING IMAGE QUALITY
Authors: Nocum Don J , Robinson John , Halaki Mark , Båth Magnus , Mekiš Nejc , Liang Eisen , Thompson Nadine , Moscova Michelle , Reed Warren 
Published: September 2021

Abstract
The purpose of this study was to introduce a continuous quality improvement (CQI) program for radiation dose optimisation during uterine artery embolisation (UAE) and assess its impact on dose reduction and image quality. The CQI program investigated the effects of optimising radiation dose parameters on the kerma-area product (KAP) and image quality when comparing a ‘CQI intervention’ group (n = 50) and ‘Control’ group (n = 50). Visual grading characteristics (VGC) analysis was used to assess image quality, using the ‘Control’ group as a reference. A significant reduction in KAP by 17% (P = 0.041, d = 0.2) and reference air kerma (Ka, r) by 20% (P = 0.027, d = 0.2) was shown between the two groups. The VGC analysis resulted in an area under the VGC curve (AUCVGC) of 0.54, indicating no significant difference in image quality between the two groups (P = 0.670). The implementation of the CQI program and optimisation of radiation dose parameters improved the UAE radiation dose practices at our centre. The dose reduction demonstrated no detrimental effects on image quality.
Managing expectations in financial markets: voluntary accountability practices of capital market regulators in Spain and Turkey
Authors: Apaydin Fulya , Jordana Jacint 
Published: September 2021

AbstractIn recent decades, independent regulatory agencies (IRAs) have been introduced as part of public administration reforms around the world. Unlike traditional administrative agencies, most IRAs are not accountable to the executive and their accountability relationship to the legislative tends to be weak. Nevertheless, these agencies often engage in acts of voluntary explanation and justification of their decisions to stakeholders. Based on a comparative study of financial regulation agencies, this article shows that these IRAs resort more actively to voluntary accountability when the expectations of actors interacting with the agency are at conflict. Specifically, we argue that the agency’s ability to manage expectations is shaped by the level of agency independence and the degree of organizational capacity. Our findings contribute to the existing debates by conceptualizing voluntary accountability as a mechanism for managing stakeholders’ conflicting expectations through the lens of financial regulation based on original evidence from Spain and Turkey.
Comparison of self-reported and observed water contact measures in Schistosoma japonicum–endemic villages in Leyte, The Philippines
Authors: Falcone Bianca , Park Sangshin , Wu Hannah W , Leenstra Tjalling , Jiz Mario A , Jarilla Blanca , McGarvey Stephen T , Kurtis Jonathan D , Friedman Jennifer F 
Published: September 2021

Abstract

Background
We compared individuals’ self-reported water contact from a questionnaire to direct observation of water contact. Questionnaires that accurately capture water contact are necessary to risk-stratify individuals and communities at high risk for schistosomiasis.

Methods
Individuals (N=677) ages 7–30 y were included from three Schistosoma japonicum–endemic villages in Leyte, The Philippines. Each individual was observed for 12 d over the course of the 18-month study and the questionnaire was administered six times. A questionnaire index was derived that captured the number of self-reported contacts with water bodies for any purpose. An exposure index was created based on the sum of contacts that was weighted by the percentage of body surface area (BSA) exposed and exposure duration.

Results
Of 16 water contact activities, only bathing and washing clothes exhibited a significant, positive correlation between self-reported contacts and the observed exposure index related to those contacts.

Conclusions
We found that only the reported frequencies of bathing and washing clothes were significantly related to an individual's overall observed exposure index, while use of all reported contacts was not related to the observed exposure. This study further supports the need for questionnaires to be augmented by some measure of how much BSA is exposed and/or time is spent in the water on average for a specific activity.
The Epidemiology of Adult Tracheostomy in the United States 2002–2017: A Serial Cross-Sectional Study
Authors: Abril Maria K. , Berkowitz David M. , Chen Yunyun , Waller Lance A. , Martin Greg S. , Kempker Jordan A. 
Published: September 2021

Objectives:
Describe the longitudinal national epidemiology of tracheostomies performed in acute care hospitals and describe the annual rate of tracheostomy performed for patients with respiratory failure with invasive mechanical ventilation.

DESIGN:
Serial cross-sectional study.

Setting:
The 2002–2014 and 2016–2017 Healthcare Utilization Project’s National Inpatient Sample datasets.

Patients:
Discharges greater than or equal to 18 years old, excluding those with head and neck cancer or transferred from another hospital. We used diagnostic and procedure codes from the International Classification of Diseases, 9th and 10th revisions to define cases of respiratory failure, invasive mechanical ventilation, and tracheostomy.

Interventions:
None.

Measurements and Main Results:
There were an estimated 80,612 tracheostomies performed in 2002, a peak of 89,545 tracheostomies in 2008, and a nadir of 58,840 tracheostomies in 2017. The annual occurrence rate was 37.5 (95% CI, 34.7–40.4) tracheostomies per 100,000 U.S. adults in 2002, with a peak of 39.7 (95% CI, 36.5–42.9) in 2003, and with a nadir of 28.4 (95% CI, 27.2–29.6) in 2017. Specifically, among the subgroup of hospital discharges with respiratory failure with invasive mechanical ventilation, an annual average of 9.6% received tracheostomy in the hospital. This changed over the study period from 10.4% in 2002, with a peak of 10.9% in 2004, and with a nadir of 7.4% in 2017. Among respiratory failure with invasive mechanical ventilation discharges with tracheostomy, the annual proportion of patients 50–59 and 60–69 years old increased, whereas patients from 70 to 79 and greater than or equal to 80 years old decreased. The mean hospital length of stay decreased, and in-hospital mortality decreased, whereas discharge to intermediate care facilities increased.

Conclusions:
Over the study period, there were decreases in the annual total case volume and adult occurrence rate of tracheostomy as well as decreases in the rate of tracheostomy among the subgroup with respiratory failure with invasive mechanical ventilation. There is some evidence of changing patterns of patient selection for in-hospital tracheostomy among those with respiratory failure with invasive mechanical ventilation with decreasing proportions of patients with advanced age.
Explainable Machine Learning on AmsterdamUMCdb for ICU Discharge Decision Support: Uniting Intensivists and Data Scientists
Authors: Thoral Patrick J. , Fornasa Mattia , de Bruin Daan P. , Tonutti Michele , Hovenkamp Hidde , Driessen Ronald H. , Girbes Armand R. J. , Hoogendoorn Mark , Elbers Paul W. G. 
Published: September 2021

Objectives:
Unexpected ICU readmission is associated with longer length of stay and increased mortality. To prevent ICU readmission and death after ICU discharge, our team of intensivists and data scientists aimed to use AmsterdamUMCdb to develop an explainable machine learning–based real-time bedside decision support tool.

Derivation Cohort:
Data from patients admitted to a mixed surgical-medical academic medical center ICU from 2004 to 2016.

Validation Cohort:
Data from 2016 to 2019 from the same center.

Prediction Model:
Patient characteristics, clinical observations, physiologic measurements, laboratory studies, and treatment data were considered as model features. Different supervised learning algorithms were trained to predict ICU readmission and/or death, both within 7 days from ICU discharge, using 10-fold cross-validation. Feature importance was determined using SHapley Additive exPlanations, and readmission probability-time curves were constructed to identify subgroups. Explainability was established by presenting individualized risk trends and feature importance.

Results:
Our final derivation dataset included 14,105 admissions. The combined readmission/mortality rate within 7 days of ICU discharge was 5.3%. Using Gradient Boosting, the model achieved an area under the receiver operating characteristic curve of 0.78 (95% CI, 0.75–0.81) and an area under the precision-recall curve of 0.19 on the validation cohort (n = 3,929). The most predictive features included common physiologic parameters but also less apparent variables like nutritional support. At a 6% risk threshold, the model showed a sensitivity (recall) of 0.72, specificity of 0.70, and a positive predictive value (precision) of 0.15. Impact analysis using probability-time curves and the 6% risk threshold identified specific patient groups at risk and the potential of a change in discharge management to reduce relative risk by 14%.

Conclusions:
We developed an explainable machine learning model that may aid in identifying patients at high risk for readmission and mortality after ICU discharge using the first freely available European critical care database, AmsterdamUMCdb. Impact analysis showed that a relative risk reduction of 14% could be achievable, which might have significant impact on patients and society. ICU data sharing facilitates collaboration between intensivists and data scientists to accelerate model development.
A reliable diagnostic method of surgical site infection after posterior lumbar surgery based on serial C-reactive protein
Authors: Kim Min Hyung , Park Jong-Hyeok , Kim Jong Tae 
Published: September 2021

Study design:
A observational study.

Purpose:
To evaluate the detection of surgical site infection (SSI) after posterior lumbar surgery by the laboratory parameters.

Materials and methods:
The study included 189 patients undergoing posterior lumbar fusion or decompression between January 2018 and December 2019. Patients with chronic renal disease, rheumatoid arthritis, hepatic disease were excluded. Patients with tumor, trauma, cervical and thoracic lesions were also excluded. Leukocyte counts, segmented neutrophils, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were evaluated preoperatively and on postoperative days 1 (POD1), 3 (POD3), 7 (POD7), 14 (POD14), and 30 (POD30). Surgical site infection was defined as (1) purulent discharge at incision site, (2) organisms isolated aseptically from the incision site, and (3) evidence of infection based on MRI. Increasing CRP (ICRP) and decreasing CRP (DCRP) groups were classified according to the value of CRP on POD7. The change rate in CRP was calculated using the formula: (Late value−Previous value/Previous value)×100. Receiver operating characteristic curves were used to validate laboratory data involving SSI.

Results:
The mean age was 64.5±12.5 years. Male to female ratio was 91–98. The incidence of SSI was 8.8%. Leukocyte count, segmented neutrophil, and ESR were not specific. ICRP group were 43 patients. SSI was found in 14% of ICRP group and 18.6% was associated with secondary infection. Even 7.7% of the infection in DCRP group was identified as SSI. Based on the change rate of CRP, −50% of decreasing rate of CRP in ICRP group between POD7 and POD14 showed the validity that sensitivity was 90.9% and specificity was 68.1%. In DCRP group, −43.3% of decreasing rate of CRP in DCRP group between POD7 and POD14 showed the validity that sensitivity and specificity were 83.3% and 82.4%, respectively. Only 43% of all patients showed normalization of CRP can rule out the SSI.

Conclusion:
The serial change rate of CRP is a reliable method for detecting SSI more than the criteria of normal value. Nevertheless, close monitoring of patient’s signs and symptoms is important to detect early SSI.
Chemical upcycling of polymers
Authors: Stadler Bernhard M. , de Vries Johannes G. 
Published: September 2021

As the production volume of polymers increases, so does the amount of plastic waste. Plastic recycling is one of the concepts to address in this issue. Unfortunately, only a small fraction of plastic waste is recycled. Even with the development of polymers for closed loop recycling that can be in theory reprocessed infinitely the inherent dilemma is that because of collection, cleaning and separation processes the obtained materials simply are not cost competitive with virgin materials. Chemical upcycling, the conversion of polymers to higher valuable products, either polymeric or monomeric, could mitigate this issue. In the following article, we highlight recent examples in this young but fast-growing field.This article is part of the theme issue 'Bio-derived and bioinspired sustainable advanced materials for emerging technologies (part 2)'.
The tiered restrictions enforced in November 2020 did not impact the epidemiology of the second wave of COVID-19 in Italy
Authors: Rainisio Maurizio 
Published: September 2021

AbstractIn the attempt to counter the second COVID-19 wave in autumn 2020, the Italian government introduced a unique countrywide system of physical distancing measures organized in progressively restrictive tiers (coded as yellow, orange, and red) imposed on a regional basis according to epidemiological risk assessments. This followed a set of other scattered or limited measures described in full detail by Manica et al.1.This paper concerns the introduction of the tiered restrictions. The data used to evaluate the impact of the restriction system on SARS-CoV-2 transmissibility and hospitalization burden in Italy is from the Italian COVID-19 integrated surveillance system.The reproduction number R(t) estimated on the onset of COViD-19 symptoms constantly decreased during most of the observation period 04 October 2020 - 06 December 2020 than is centered on the date of introduction of the measures and includes the expected latency to reach an effect. The fastest decrease of R(t) occurred in the period preceding the introduction of the tiered restrictions. There was no evidence that introducing the tiered restrictions determined the reduction of R(t). An alternative analysis using the daily growth rate of the epidemic curve confirms these conclusions. Similar considerations are made concerning the health system burden, analyzing hospitalizations at country level.The trend of R(t) tending to increase shortly after the measures became effective does not allow to exclude that the enforcement of such restrictions might have been counterproductive.These results are instrumental in informing public health efforts aimed at attempting to manage the epidemic efficiently. Planning further use of the tiered restrictions and the associated containment measures should be carefully and critically revised to avoid a useless burden to the population with no advantage for the containment of the epidemic or a possible worsening.
The efficiency of dynamic regional lockdown approach in controlling the COVID-19 epidemic. Insights from the agent-based epidemiological model for Poland
Authors: Zieliński Jakub , Gruziel-Słomka Magdalena , Nowosielski Jȩdrzej M. , Bartczuk Rafał P. , Niedzielewski Karol , Semeniuk Marcin , Górski Łukasz , Kisielewski Jan , Moszyński Antoni , Radwan Maciej , Kaczorek Artur , Rakowski Franciszek 
Published: September 2021

ABSTRACTIn this work properties of the dynamic regional lockdown approach to suppress the COVID-19 epidemic spread in Poland were investigated. In particular, an agent based model was used with the aim to indicate an optimal lockdown strategy, defined here as the one which minimizes mean lockdown time over regional unit provided health service is not overwhelmed. With this approach the lockdown extent was also considered by varying restrictions between complete regional school closure and/or significant social distancing in semi-public spaces. In result, a cooperative effect was discovered in the case when closure of schools was accompanied by severe restrictions of social contacts in semi-public spaces. Moreover, the regional lockdown approach implemented here on the level of counties (units of population around 100k) proofed to be successful, that is allowed to identify optimal entrance and release thresholds for lockdown. The authors believe that until significant portion of population is vaccinated such a strategy might be applied.
The 1st year of the COVID-19 epidemic in Estonia: an interrupted time series of population based nationwide cross-sectional studies
Authors: Uusküla Anneli , Kalda Ruth , Solvak Mihkel , Jürisson Mikk , Käärik Meelis , Fischer Krista , Keis Aime , Raudvere Uku , Vilo Jaak , Peterson Hedi , Käärik Ene , Metspalu Mait , Jürgenson Tuuli , Milani Lili , Kolberg Liis , Tiit Ene-Margit , Vassil Kristjan 
Published: September 2021

AbstractBackgroundDecisions about the continued need for control measures and the effect of introducing COVID-19 vaccinations rely on accurate and population-based data on SARS-CoV-2 positivity and risk factors for testing positive.MethodsIn this interrupted time series of population-based nationwide cross-sectional studies, data from nasopharyngeal testing and questionnaires were used to estimate the SARS-CoV-2 RNA prevalence and factors associated with test positivity over the 1st year of the COVID-19 epidemic.The study is registered with the ISRCTN Registry, ISRCTN10182320.ResultsBetween April 23, 2020 and February 2, 2021, results were available from 34,915 individuals and 27,870 samples from 11 consecutive studies. The percentage of people testing positive for SARS-CoV-2 decreased from 0.27% (95% CI 0.10% - 0.59%) in April to 0.04% (95% CI 0.00% - 0.22%) by the end of May and remained very low (0.01%, 95% CI 0.00% - 0.17%) until the end of August, followed by an increase since November (0.37%, 95% CI 0.18% - 0.68%) that escalated to 2.69% (95% CI 2.08% - 2.69%) in January 2021. In addition to substantial change in time, an increasing number of household members (for one additional OR 1.15, 95% CI 1.02-1.29), reporting current symptoms of COVID-19 (OR 2.21, 95% CI 1.59-3.09), and completing questionnaire in the Russian language (OR 1.85, 95% CI 1.15-2.99) were associated with increased odds for SARS-CoV-2 RNA positivity.ConclusionsSARS-CoV-2 population prevalence needs to be carefully monitored as vaccine programmes are rolled out in order to inform containment decisions.Strengths and limitations of this studyOur study relies upon nation-wide and population-based data on SARS-CoV-2 prevalence, and presents changes in prevalence over the whole 1st year of the Covid-19 epidemic.Our analysis of SARS-CoV-2 infection risk factors is not limited to notification or health care-based case data.Selection bias may have been introduced as a result of low response rate. The direction of bias is unclear, but most likely operates rather uniformly over the period of observation, though this presents less of a threat to the SARS-CoV-2 prevalence trend analysis.Our data could be used to adequately project the future course of the SARS-CoV-2 epidemic and the effect of control measures.