bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of an artificial intelligence system for bone age assessment in Tibet
Authors: Wang Fengdan , Cidan Wangjiu , Gu Xiao , Chen Shi , Yin Wu , Liu Yongliang , Shi Lei , Pan Hui , Jin Zhengyu 
Published: February 2021

Objective:
To investigate whether bone age (BA) of children living in Tibet Highland could be accurately assessed using a fully automated artificial intelligence (AI) system.

Methods：
Left hand radiographs of 385 children (300 Tibetan and 85 immigrant Han) aged 4–18 years who presented to the largest medical center of Tibet between September 2013 and November 2019 were consecutively collected. From these radiographs, BA was determined using the Greulich and Pyle (GP) method by experts in a consensus manner; furthermore, BA was estimated by a previously reported artificial intelligence (AI) BA system based on Han children from southern China. The performance of the AI system was compared with that of experts by using statistical analysis.

Results:
Compared with the experts’ results, the accuracy of the AI system for Tibetan and Han children within 1 year was 84.67 and 89.41%, respectively, and its mean absolute difference (MAD) was 0.65 and 0.56 years, respectively. The discrepancy in hand-wrist bone maturation was the main cause of low accuracy of the system in the 4- to 6-year-old group.

Conclusion:
The AI BA system developed for Han Chinese children living in flat regions could enable to assess BA accurately in Tibet where medical resources are limited.

Advances in knowledge:
AI-based BA system may serve as an effective and efficient solution to assess BA in Tibet.
Human erythrocyte surface fucose expression increases with age and hyperglycemia
Authors: Cao Huan , Bagchi Ananyo , Tampakis Dimitrios , Laidvee Irina , Williams Maria , Minter Beverley , Wright Sonja , Antonopoulos Aristotelis , Haslam Stuart M. , Barker Robert N. , Vickers Mark A. 
Published: February 2021

Background: Reactive oxygen species and other free radicals, together with glucose and its metabolites are believed to play important roles in the aging process. The carbohydrate components of glycosylated proteins are important in mediating cell-cell interactions and a role has been suggested for them in the aging process. Erythrocytes are critical cells in the human body, heavily glycosylated and relatively easily available and so are good candidates to yield insights into how patterns of glycosylation change with age and disease. It has been claimed, based on a periodic acid Schiff assay, that human aging is associated with a decline of erythrocyte surface sialic acids. Plant lectins allow for more specific assays for glycans, including determining the linkage of sialic acids and analysis of single cells by flow cytometry. Methods: Plant lectins, including Maackia amurensis lectin II (MAL), binding to α-2,3 linked sialic acids and Sambucus nigra (SNA), α-2,6 sialic acids, were used in flow cytometry and western blot of erythrocyte surface membrane. N-glycomics mass spectrometry determines glycan structures. Donors varying in age and hyperglycemia, as indicated by HbA1c were analysed. Results: Erythrocyte surface sialic acids have no significant associations with donor age. A combination of storage and cellular aging produces a specific loss of α-2,6 sialic acids. By contrast, erythrocyte surface terminal fucoses increase significantly with donor age. In order to determine which aspects of aging are important in determining this change, we investigated whether this novel human aging biomarker is associated with higher plasma glucose values, assessed by glycated hemoglobin (HbA1c) and reactive oxygen species (ROS) generation. Fucose levels were associated with HbA1c levels, but not ROS generation. Conclusion: Our study identifies novel glycan-based biomarkers for human aging and disease. The simplicity of lectin-based assays provide an attractive cellular tool to study aging and disease processes.
An Objective Structured Clinical Exam As a Tool for Assessing the Communicative Skills of Residents in Simulated Conditions
Authors: Vasil'eva E. , Tomilova M. 
Published: February 2021

The relevance of the research problem is due to the need to update theoretical views and practical actions to create new methods for an objective and structured assessment of the communication skills of students at a medical university.
The purpose of the article is to prove the suitability, reliability, feasibility of an objective structured clinical examination (OSKE) as a tool for assessing the communication skills of residents in simulated conditions during the intermediate certification of students.
The leading research method was an experiment on the development and implementation of three stations within the framework of the OSKE to assess the communication skills of 77 residents who completed the training course in the discipline "Communication skills" necessary information and resistance to doctor's recommendations.
The article shows that experts highly assess the level of formation of general communication skills and skills of explaining information to the patient among the majority of examinees. It was revealed that communication skills associated with persuading the patient to follow the doctor's recommendations require improvement. Based on the methods of oral questioning and questioning, as well as psychometric analysis of the exam results, it has been proven that the developed OSKE is a reliable and valid tool for assessing the communication skills of residents in simulated conditions.
The materials presented in the article can be used for intermediate and final certification of students in residency, as well as in the process of teaching future doctors the skills of communicating with patients at clinical departments. The technology of the exam, developed by the authors, will make it possible to fairly objectively assess communication skills, to cause the examinees to experience a sense of fairness in assessment, which is one of the factors in the emergence of a positive attitude towards improving the activity of professional communication.
Analysis of the efficacy and safety of electroconvulsive therapy in elderly patients: a retrospective study in the Polish population
Authors: Antosik-Wójcińska Anna , Dominiak Monika , Goetz Zuzanna , Gędek Adam , Braniecka Anna , Święcicki Łukasz , Mierzejewski Paweł 
Published: February 2021

Cel pracyCelem badania była ocena skuteczności i bezpieczeństwa leczenia elektrowstrząsowego w populacji pacjentów ≥ 65 latMetodaOmawiane badanie miało charakter naturalistyczny, retrospektywny. Do badania włączono 65 pacjentów, kobiety i mężczyzn hospitalizowanych w oddziałach Instytutu Psychiatrii i Neurologii i poddawanych terapii EW. Analizowano przebieg 615 zabiegów przeprowadzonych w latach 2015-2019. Skuteczność EW oceniano z wykorzystaniem skali CGI-S. Bezpieczeństwo oceniano analizując działania niepożądane terapii, uwzględniając obciążenia somatyczne grupy badanych.WynikiAż 94 % pacjentów wyjściowo spełniało kryteria lekooporności. W badanej grupie nie odnotowano poważnych powikłań takich jak zgon, stan zagrożenia życia, konieczność hospitalizacji na innym oddziale czy trwały uszczerbek na zdrowiu. Łącznie w całej grupie działania niepożądane odnotowano u 47,7% starszych pacjentów, w większości przypadków (88%) miały one niewielkie nasilenie i ustępowały bez stosowania żadnego specyficznego postępowania. Najczęściej obserwowanym działaniem niepożądanym EW były wzrosty ciśnienia tętniczego (55,4%). Czterech pacjentów nie ukończyło terapii EW z powodu działań niepożądanych. U większości badanych (86,2%) wykonano co najmniej 8 zabiegów w serii. Zabiegi EW okazały się być skuteczną metodą leczenia w populacji pacjentów po 65 roku życia - reakcję na leczenie stwierdzono u 76,92% chorych, a remisję u 49, 23% leczonych osób. Wyjściowe nasilenie choroby w skali CGI-S wyniosło średnio 5,54, po leczeniu EW 2,67.WnioskiTolerancja zabiegów jest po 65 r.ż gorsza niż u młodszych pacjentów, większość działań niepożądanych jest związana z wyjściowymi obciążeniami somatycznymi, głównie dotyczącymi układu sercowo-naczyniowego. Nie zmienia to faktu, że terapia EW jest w tej populacji wysoce skuteczna i może stanowić bardzo dobrą alternatywę dla często nieskutecznej lub powodującej uboczne działania farmakoterapii.
Improved Computational Approaches and Heuristics for Zero Forcing
Authors: Brimkov Boris , Mikesell Derek , Hicks Illya V. 
Published: February 2021

Zero forcing is a graph coloring process based on the following color change rule: all vertices of a graph [Formula: see text] are initially colored either blue or white; in each timestep, a white vertex turns blue if it is the only white neighbor of some blue vertex. A zero forcing set of [Formula: see text] is a set of blue vertices such that all vertices eventually become blue after iteratively applying the color change rule. The zero forcing number [Formula: see text] is the cardinality of a minimum zero forcing set. In this paper, we propose novel exact algorithms for computing [Formula: see text] based on formulating the zero forcing problem as a two-stage Boolean satisfiability problem. We also propose several heuristics for zero forcing based on iteratively adding blue vertices which color a large part of the remaining white vertices. These heuristics are used to speed up the exact algorithms and can also be of independent interest in approximating [Formula: see text]. Computational results on various types of graphs show that, in many cases, our algorithms offer a significant improvement on the state-of-the-art algorithms for zero forcing. Summary of Contribution: This paper proposes novel algorithms and heuristics for an NP-hard graph coloring problem that has numerous applications. Our exact methods combine Boolean satisfiability modeling with a constraint generation framework commonly used in operations research. The paper also includes an analysis of the facets of the polytope associated with this problem and decomposition techniques which can reduce the size of the problem. Our computational approaches are implemented and tested on a wide variety of graphs and are compared with the state-of-the-art algorithms from the literature. We show that our proposed algorithms based on Boolean satisfiability, in conjunction with the heuristics and order-reduction techniques, yield a significant speedup in some cases.
Evidence-based review of safe theatre practice during the COVID-19 pandemic beyond personal protective equipment
Authors: Khalefa MA , Khadabadi NA , Moores TS , Hossain FS 
Published: February 2021

Introduction COVID-19 remains a threat for a fear of a second pandemic. Emergency orthopaedic operations are still among the most commonly performed procedures with increased risk of transmission of SARS CoV-2 to the patients and the healthcare workers. The aim of this study was to present the evidence available into best practices limiting the spread of COVID-19 in healthcare setting during current and future pandemics. Methods A review of the literature was performed in multiple databases (PubMed, the Cochrane Library, Google Scholar, World Health Organization and Centers for Disease Control), using ‘COVID-19’ with other relevant keywords in different combinations. Owing to the limited and heterogenous evidence available, data were presented in a narrative manner. Findings From the evidence gathered it was noted that a multimodal approach to minimising pathogen transmission is required. This primarily comprises the wider engineering and administrative controls to reduce the concentration of the pathogen and to separate staff and patients from it. Theatre isolation and traffic control bundling, theatre flow and logistics, ventilation and waste management form a pivotal role in the environmental/engineering controls. Administrative measures include policies for both patients and staff. For patients, isolation and preoperative screening are of utmost value. For staff, testing for COVID-19, risk assessment, redeployment and provision of persona; protective equipment, together with the necessary training are important administrative controls. Conclusion We believe these measures are likely to improve the sustainability of resources and can be carried to elective settings in order to return to some form of normality and help to mitigate the effects of future pandemics.
Getting it right first time: implementation of laparoscopic pyloromyotomy without a learning curve
Authors: Arul GS , Moni-Nwinia W , Soccorso G , Pachl M , Singh M , Jester I 
Published: February 2021

Introduction Laparoscopic pyloromyotomy is now an accepted procedure for the treatment of pyloric stenosis. However, it is clear that during the implementation period there are significantly higher incidences of mucosal perforation and incomplete pyloromyotomy. We describe how we introduced a new laparoscopic procedure without the complications associated with the learning curve. Materials and methods Five consultants tasked one surgeon to pilot and establish laparoscopic pyloromyotomy before mentoring the others until they were performing the procedure independently; all agreed to use exactly the same instruments and operative technique. This involved a 5mm 30-degree infra-umbilical telescope with two 3mm instruments. Data were collected prospectively. Results Between 1 January 2013 and 31 December 2017, 140 laparoscopic pyloromyotomies were performed (median age 27 days, range 13–133 days, male to female ratio 121:19). Fifty-five per cent of procedures were performed by trainees. Complications were one mucosal perforation and one inadequate pyloromyotomy. There were no injuries to other organs, problems with wound dehiscence or other significant complications. The median time of discharge was one day (range one to six days). Conclusion Our rate of perforation and incomplete pyloromyotomy was 1.4%, which is equivalent to the best published series of either open or laparoscopic pyloromyotomy. We believe that this resulted from the coordinated implementation of the procedure using a single technique to reduce clinical variability, increase mentoring and improve training. This approach appears self-evident but is rarely described in the literature of learning curves. In this age of increased accountability, new technologies should be incorporated into routine practice without an increase in morbidity to patients.
Treatment of cutaneous basal cell carcinoma with combined laser extirpation and methyl aminolevulinic acid: five-year success rates
Authors: Azzopardi EA , Abdelrahman W , Azzopardi E , O’Leary B , Yarrow J , Miles N , Barbara C , Camilleri L , Clementoni MT , Murison M 
Published: February 2021

Introduction Basal cell carcinoma is the most common cancer. Excisional surgery is associated with a high clearance rate, at the expense of significant functional and aesthetic morbidity, especially within the T-zone or for extensive lesions. We report five-year follow-up outcomes for carbon dioxide laser extirpation of cutaneous basal cell carcinoma, assisted by immediate methyl aminolevulinate photodynamic therapy and cost–benefit considerations. Materials and methods Retrospective cohort database analysis of adult patients with biopsy-proven primary cutaneous basal cell carcinoma, completing five years of follow-up. Direct per-lesion cost was compared with conventional wide local excision. Patients with morphoeic basal cell carcinoma were excluded. Results Treated lesions were up to 1% total body surface area and up to 3.8mm (1.38 ± 0.695cm, mean ± standard deviation) in biopsy-proven depth. At the five-year follow-up mark, 93.6% of treated areas remained free of recurrence. Nodular basal cell carcinoma was the most common subtype (41.5%). A mean tumour depth greater than 2 ± 0.872mm was significantly associated with recurrence (Mann–Whitney, p = 0.0487). For a service delivered through the NHS at 2015 prices, we report a 43% saving, equating to a saving of £235 per basal cell carcinoma or a national annualised saving of £70 million by 2025 for the NHS. Conclusion Our results suggest that CO2-assisted photodynamic therapy is non-inferior to excision but may offer better functional and cosmetic preservation at a fraction of the direct like for like cost of operative surgery. Investigation of this method by randomised controlled methodology is warranted.
Rechtliche Fallstricke des Einsatzes von Open Source Software und freier Software – Hinweise für die Praxis
Authors: Wilmer Thomas 
Published: February 2021

ZusammenfassungDer folgende Artikel bietet einen Überblick über die häufigsten Anwendungsprobleme beim Einsatz und der Integration von freier und Open Source Software in der Praxis. Ein Schwerpunkt liegt dabei auf den Herausforderungen für Softwarehersteller, welche freie Software in ihre Produkte integrieren und vertreiben. Hingewiesen wird auf die unterschiedlichen freien Lizenzarten, Best Practice-Lösungsmöglichkeiten und Compliancefragen sowie die Grenzen der Auslegung der Lizenzen.
Structural validity of the Chronic Pain Coping Inventory—Brazilian version
Authors: Souza Layz Alves Ferreira , Pereira Lilian Varanda , de Moura Louise Amália , Díaz Leidy-Johanna Rueda , da Cruz Diná de Almeida Lopes Monteiro , Aparecido Da Silva José 
Published: February 2021

Background
The Chronic Pain Coping Inventory (CPCI) has been widely used to measure coping with pain, however, the psychometric properties of the Brazilian CPCI are unknown.

Aim
To verify the validity and reliability of the CPCI-Brazilian version.

Materials and methods
A sample of 705 outpatients with chronic pain participated in the study. Cronbach’s alpha, corrected item-total correlations, and confirmatory factor analysis were performed, using the method of Diagonally Weighted Least Squares.

Results
Construct validity was supported with a factor loading range of 0.36–0.90 (9 factors) corroborating original loads. The final model had adequate fit with items 42 and 54 excluded, D.F = 2174, TLI = 0.96; CFI = 0.96 and RMSEA = 0.051(p = 0.067). Eight of the nine CPCI scales showed satisfactory reliability (Cronbach’s alpha ranged from 0.70 to 0.92). The Relaxation scale obtained a low alpha value (0.53).

Conclusion
The CPCI-Brazilian version, after exclusion of items 42 and 54, is valid to measure chronic pain coping in Brazilian adults.
Extracorporeal cytokine adsorption: Significant reduction of catecholamine requirement in patients with AKI and septic shock after cardiac surgery
Authors: Boss Kristina , Jahn Michael , Wendt Daniel , Haidari Zaki , Demircioglu Ender , Thielmann Matthias , Ruhparwar Arjang , Kribben Andreas , Tyczynski Bartosz 
Published: February 2021

Background
Extracorporeal cytokine adsorption is an option in septic shock as an additional measure to treat a pathological immune response. Purpose of this study was to investigate the effects of extracorporeal cytokine adsorption on hemodynamic parameters in patients with acute kidney injury (AKI) on continuous renal replacement therapy (CRRT) and septic shock after cardiac surgery.

Methods
In this retrospective study, a total of 98 patients were evaluated. Hemoadsorption was performed by the CytoSorb® adsorber. In all patients cytokine adsorption was applied for at least 15 hours and at least one adsorber was used per patient. To compare cumulative inotrope need in order to maintain a mean arterial pressure (MAP) of ≥ 65 mmHg, we applied vasoactive score (VAS) for each patient before and after cytokine adsorption. A paired t-test has been performed to determine statistical significance.

Results
Before cytokine adsorption the mean VAS was 56.7 points. This was statistically significant decreased after cytokine adsorption (27.7 points, p< 0.0001). Before cytokine adsorption, the mean noradrenalin dose to reach a MAP of ≥ 65 mmHg was 0.49 μg/kg bw/min, the mean adrenalin dose was 0.12 μg/kg bw/min. After cytokine adsorption, significantly reduced catecholamine doses were necessary to maintain a MAP of ≥ 65 mmHg (0.24 μg/kg bw/min noradrenalin; p< 0.0001 and 0.07 μg/kg bw/min adrenalin; p < 0.0001). Moreover, there was a significant reduction of serum lactate levels after treatment (p< 0.0001). The mean SOFA-score for these patients with septic shock and AKI before cytokine adsorption was 16.7 points, the mean APACHE II-score was 30.2 points. The mean predicted in-hospital mortality rate based on this SOFA-score of 16.7 points was 77,0%, respectively 73,0% on APACHE II-score, while the all-cause in-hospital mortality rate of the patients in this study was 59.2%.

Conclusion
In patients with septic shock and AKI undergoing cardiac surgery, extracorporeal cytokine adsorption could significantly lower the need for postoperative inotropes. Additionally, observed versus SOFA- and APACHE II-score predicted in-hospital mortality rate was decreased.
Physical inactivity in healthy, obese, and diabetic adults in Germany: An analysis of related socio-demographic variables
Authors: Linder Stephanie , Abu-Omar Karim , Geidl Wolfgang , Messing Sven , Sarshar Mustafa , Reimers Anne K. , Ziemainz Heiko 
Published: February 2021

Background
Adults with diabetes or obesity are more likely to be physically inactive than healthy adults. Physical activity is essential in the management of both diseases, necessitating targeted interventions in these groups. This study analysed physical inactivity (defined as not taking part in leisure-time physical activity) in over 100,000 adults in Germany considering their body mass index and the presence of diabetes. Furthermore, the relationship between specific socio-demographic factors with physical inactivity was investigated, particularly focussing diabetic and obese people, to refine the identification of risk-groups for targeted interventions on physical activity promotion.

Methods
Data from 13 population-based health surveys conducted in Germany from 1997 to 2018 were used. The relevant variables extracted from these datasets were merged and employed in the analyses. We included data from 129,886 individuals in the BMI analyses and 58,311 individuals in the diabetes analyses. Logistic regression analyses were performed to identify the importance of six socio-demographic variables (age, sex/gender, education, income, employment, and migration) for the risk of physical inactivity.

Results
Obese and diabetic people reported a higher prevalence of physical inactivity than those who were not affected. Logistic regression analyses revealed advanced age, low education level, and low household income as risk factors for physical inactivity in all groups. A two-sided migration background and unemployment also indicated a higher probability of physical inactivity.

Conclusion
Similar socio-demographic barriers appear to be important determinants of physical inactivity, regardless of BMI status or the presence of diabetes. However, physical activity promoting interventions in obese and diabetic adults should consider the specific disease-related characteristics of these groups. A special need for target group specific physical activity programmes in adults from ethnic minorities or of advanced age was further identified.