bluuebunny/crossref_metadata_2025_split huggingface dataset:
Creation and implementation of an electronic health record note for quality improvement in pediatric epilepsy: Practical considerations and lessons learned
Authors: Buchhalter Jeffrey R. , Scantlebury Morris H. , D’Alfonso Sabrina , Appendino Juan Pablo , Bello Espinosa Luis , Brooks Brian L. , Claassen Curtis , Corbeil Jane , Czank David , Dean Stafford , Ho Alice W. , Jacobs Julia , Mackay Maarit , McMahon Joka , Mineyko Aleksandra , Rho Jong M. , Roberts Trina , Rothenmund Sonia , Ruta Gary , Sawchuk Tyson , Simms Brett A. , Smyth Kim , Still Tammy , Thornton Nancy 
Published: February 2021

AbstractObjectiveTo describe the development of the Pediatric Epilepsy Outcome‐Informatics Project (PEOIP) at Alberta Children's Hospital (ACH), which was created to provide standardized, point‐of‐care data entry; near‐time data analysis; and availability of outcome dashboards as a baseline on which to pursue quality improvement.MethodsStakeholders involved in the PEOIP met weekly to determine the most important outcomes for patients diagnosed with epilepsy, create a standardized electronic note with defined fields (patient demographics, seizure and syndrome type and frequency and specific outcomes‐ seizure type and frequency, adverse effects, emergency department visits, hospitalization, and care pathways for clinical decision support. These were embedded in the electronic health record from which the fields were extracted into a data display platform that provided patient‐ and population‐level dashboards updated every 36 hours. Provider satisfaction and family experience surveys were performed to assess the impact of the standardized electronic note.ResultsIn the last 5 years, 3,245 unique patients involving 13, 831 encounters had prospective, longitudinal, standardized epilepsy data accrued via point‐of‐care data entry into an electronic note as part of routine clinical care. A provider satisfaction survey of the small number of users involved indicated that the vast majority believed that the note makes documentation more efficient. A family experience survey indicated that being provided with the note was considered “valuable” or “really valuable” by 86% of respondents and facilitated communication with family members, school, and advocacy organizations.SignificanceThe PEOIP serves as a proof of principle that information obtained as part of routine clinical care can be collected in a prospective, standardized, efficient manner and be used to construct filterable process/outcome dashboards, updated in near time (36 hours). This information will provide the necessary baseline data on which multiple of QI projects to improve meaningful outcomes for children with epilepsy will be based.
Middlebox selection optimization via an intelligent framework in software‐defined networking
Authors: Zadkhosh Ehsan , Bahramgiri Hossein , Sabaei Masoud 
Published: February 2021

AbstractSoftware‐defined networking (SDN) has a vital role in network resource utilization. However, it does not provide a comprehensive view of middleboxes (MBs). In this article, we proposed an intelligent dynamic routing framework for performance optimization based on a SDN architecture with a comprehensive view of all network properties. This routing framework also uses the genetic algorithm (GA) for performance improvement. It extracts the CPU, memory, and bandwidth utilization of MBs as dynamic routing parameters. The implemented GA calculates the impact factor (IF) of these parameters to declare the impact of each parameter in network performance. The obtained results show that considering MBs status in flow forwarding improves the tested network's resource utilization by 13, 10, and 7 times compared with hop‐based shortest path first, random path selection, and Round Robin methods, respectively. The results also showed that considering IFs (IFCPU, IFRAM, and IFBW) in routing procedure would improve the network's performance. Therefore, we used the GA to calculate optimal IFs for fairness load balancing and performance optimization. The GA calculates 0.4 and 0.6, for IFCPU and IFBW, respectively. It calculates these IFs only after five iterations. It also showed that we could ignore the RAM utilization parameter in our dynamic routing as our MBs are not memory‐bounded. The simulation results declared that routing with optimal IFs not only improves the network' throughput but also improves load distribution fairness by about 25% compared with routing without the IFs.
Visual investigation of CO2 dissolution and convection in heterogeneous porous media at reservoir temperature and pressure conditions
Authors: Amarasinghe Widuramina Sameendranath , Fjelde Ingebret , Flaata Anna Maija Nørstebø 
Published: February 2021

AbstractCO2 convective mixing in saline aquifers has been widely studied numerically and experimentally. Reservoir heterogeneity is significant for CO2 convective mixing and experimental studies are still limited. In this study, we have conducted a visualization of CO2 convective mixing experiments in heterogeneous porous media at reservoir conditions using CO2 and water. We have used a two‐dimension Hele–Shaw cell, different glass beads of different permeability at porous media, and water solution with pH indicator. Glass beads were packed in a different way (horizontally and vertically) to generate the heterogeneity inside the test cell. We have studied transport velocity deviation due to the heterogeneity and effects of permeability transition zone together with the effects of boundary conditions. It was found out that having a low permeable layer below a high permeable layer restructure the flow of CO2 fingers and dampens the CO2 transport velocity. With the vertical permeability zones, having a high permeability zone accelerates CO2 gravity transport through that zone which is a good representation for a fracture or a fault in the reservoir. CO2 convection onset is governed by the vertical high‐permeable layer. Boundary conditions have been dominant with the presence of high permeable zones. It also found out that the experimental results presented in this study match with the simulation studies that are available in the literature. © 2021 The Authors. Greenhouse Gases: Science and Technology published by Society of Chemical Industry and John Wiley & Sons Ltd.
Activated microglia drive demyelination via CSF1R signaling
Authors: Marzan Dave E. , Brügger‐Verdon Valérie , West Brian L. , Liddelow Shane , Samanta Jayshree , Salzer James L. 
Published: February 2021

AbstractMicrogliosis is a prominent pathological feature in many neurological diseases including multiple sclerosis (MS), a progressive auto‐immune demyelinating disorder. The precise role of microglia, parenchymal central nervous system (CNS) macrophages, during demyelination, and the relative contributions of peripheral macrophages are incompletely understood. Classical markers used to identify microglia do not reliably discriminate between microglia and peripheral macrophages, confounding analyses. Here, we use a genetic fate mapping strategy to identify microglia as predominant responders and key effectors of demyelination in the cuprizone (CUP) model. Colony‐stimulating factor 1 (CSF1), also known as macrophage colony‐stimulating factor (M‐CSF) ‐ a secreted cytokine that regulates microglia development and survival—is upregulated in demyelinated white matter lesions. Depletion of microglia with the CSF1R inhibitor PLX3397 greatly abrogates the demyelination, loss of oligodendrocytes, and reactive astrocytosis that results from CUP treatment. Electron microscopy (EM) and serial block face imaging show myelin sheaths remain intact in CUP treated mice depleted of microglia. However, these CUP‐damaged myelin sheaths are lost and robustly phagocytosed upon‐repopulation of microglia. Direct injection of CSF1 into CNS white matter induces focal microgliosis and demyelination indicating active CSF1 signaling can promote demyelination. Finally, mice defective in adopting a toxic astrocyte phenotype that is driven by microglia nevertheless demyelinate normally upon CUP treatment implicating microglia rather than astrocytes as the primary drivers of CUP‐mediated demyelination. Together, these studies indicate activated microglia are required for and can drive demyelination directly and implicate CSF1 signaling in these events.
Effects of pipe outlet blocking on hydrological functioning in a degraded blanket peatland
Authors: Regensburg Taco H. , Chapman Pippa J. , Pilkington Michael G. , Chandler David M. , Evans Martin G. , Holden Joseph 
Published: February 2021

AbstractPeatland restoration practitioners are keen to understand the role of drainage via natural soil pipes, especially where erosion has released large quantities of fluvial carbon in stream waters. However, little is known about pipe‐to‐stream connectivity and whether blocking methods used to impede flow in open ditch networks and gullies also work on pipe networks. Two streams in a heavily degraded blanket bog (southern Pennines, UK) were used to assess whether impeding drainage from pipe networks alters the streamflow responses to storm events, and how such intervention affects the hydrological functioning of the pipe network and the surrounding peat. Pipeflow was impeded in half of the pipe outlets in one stream, either by inserting a plug‐like structure in the pipe‐end or by the insertion of a vertical screen at the pipe outlet perpendicular to the direction of the predicted pipe course. Statistical response variable η2 showed the overall effects of pipe outlet blocking on stream responses were small with η2 = 0.022 for total storm runoff, η2 = 0.097 for peak discharge, η2 = 0.014 for peak lag, and η2 = 0.207 for response index. Both trialled blocking methods either led to new pipe outlets appearing or seepage occurring around blocks within 90 days of blocking. Discharge from four individual pipe outlets was monitored for 17 months before blocking and contributed 11.3% of streamflow. Pipe outlets on streambanks with headward retreat produced significantly larger peak flows and storm contributions to streamflow compared to pipe outlets that issued onto straight streambank sections. We found a distinctive distance‐decay effect of the water table around pipe outlets, with deeper water tables around pipe outlets that issued onto straight streambanks sections. We suggest that impeding pipeflow at pipe outlets would exacerbate pipe development in the gully edge zone, and propose that future pipe blocking efforts in peatlands prioritize increasing the residence time of pipe water by forming surface storage higher up the pipe network.
Prevalence and risk factors for malignancy in hysteroscopy‐resected endometrial polyps
Authors: Wong Cheong Lung Henry , So Po Lam 
Published: February 2021

AbstractIntroductionTo determine the prevalence of malignant lesions in endometrial polyps by hysteroscopic polypectomy, and risk factors for malignant transformation. The secondary aim was to evaluate background endometrium of atypical hyperplasia in endometrial polyps, and the risk of coexisting endometrial carcinoma after hysterectomy.MethodsThis retrospective study included women who underwent hysteroscopic polypectomy between January 2015 and December 2019. Demographic characteristics, hysteroscopic findings, and histopathology results of the polyp and the uterus, in the case of a hysterectomy, were collected.ResultsIn all, 946 women were included in the study. Endometrial carcinoma in a polyp was found in 10 women (1.06%), and atypical hyperplasia was found in 11 women (1.16%). At the multivariate logistic regression model of risk factors, old age (P = 0.022) and obesity (P = 0.011) were significantly associated with (pre‐)malignant polyp. Five of the ten women (50%) with atypical hyperplasia confined to a polyp had coexisting endometrial carcinoma in the hysterectomy specimen.ConclusionWomen with risk factors should be offered hysteroscopic polypectomy to allow a reliable histologic evaluation. Furthermore, hysterectomy is recommended in women with atypical hyperplasia in endometrial polyps even after complete resection.
Clinical and CT features of ovarian torsion in infants, children and adolescents
Authors: Li Dumin , Zhang Jingwen , Kiryu Shigeru , Zhang Xiaoming , Wang Fang 
Published: February 2021

AbstractObjectiveTo investigate the clinical features and computed tomography (CT) findings of pediatric ovarian torsion.MethodsA retrospective analysis of the clinical and CT data of 61 newborns, infants, children, and adolescents with ovarian torsion confirmed by histopathology was performed.ResultsClinical features included abdominal mass, abdominal pain, nausea and vomiting, and fever. The tumor marker α‐fetoprotein was increased in five cases. Ovarian enlargement was found in 26 cases, and follicles were detected in the peripheral region of the ovary in 21 cases. Twenty‐one cases presented as solid mixed‐density masses on CT images. A total of 30 cases of ovarian torsion were associated with a benign ovarian mass. Among 27 cases of cystic or predominantly cystic masses, the mass had a thickened wall in 26 cases and showed an uneven density in 23 cases. Among all 61 patients, a torsed pedicle was detected in 47 cases. A torsed ovary or mass exhibited mild contrast enhancement in seven cases. Uterine deviation toward the involved side, blurred fat space around lesions, and pelvic free fluid were also found.ConclusionPediatric ovarian torsion presents a relatively characteristic CT appearance. Correct diagnosis can be established based on clinical and imaging features.
Phosphate foliar application increases biomass and P concentration in P deficient maize
Authors: Görlach Bruno Maximilian , Mühling Karl Hermann 
Published: February 2021

AbstractBackground: Foliar application is mainly used in agriculture as a targeted top‐up application to prevent deficiencies or during anthesis to improve quality. Hence, foliar fertilization usually occurs in plants that are in good condition and capable of uptake through the leaf. However, the extent to which plants utilize a nutrient under conditions of deficiency is also of importance.Aims: Our aim was to determine the response of P deficient maize plants to P foliar application at various concentrations and to investigate possible differences between the adaxial and abaxial sides of leaves with regard to uptake.Methods: Maize plants were grown under P deficiency in nutrient solution for two weeks followed by 2–3 foliar P treatments over a period of three weeks. Three different foliar P concentrations were compared. Older and younger shoots and roots were analyzed. In a second experiment, the influence of the leaf side on P uptake was determined by an infiltration/centrifugation method on the 5th leaf and total P in the 4th leaf, older and younger shoot, and root.Results: Foliar application significantly increased the biomass and P concentration in deficient maize, including the roots. Omission of a third application and a concomitant increase in the application concentration achieved comparable results. Uptake occurred on both sides of the leaf with no significant differences.Conclusions: Maize plants are able to absorb and utilize foliar‐applied P, even under deficient conditions and independently of leaf side. P foliar application can therefore be used as a top‐up application in deficiency situations. Moreover, the number of applications can be reduced at higher P application concentrations.
Late Quaternary record of Indian summer monsoon‐induced stratification and productivity collapse in the Andaman Sea
Authors: Sijinkumar A. V. , Nath B. Nagender , Clemens Steven , Gayathri N. M. , Miriyala P. 
Published: February 2021

ABSTRACTDuring each summer monsoon, the northeastern Indian Ocean receives a huge amount of rain and river discharge, resulting in strong stratification and prevalence of oligotrophic conditions. These water column changes impact upper ocean productivity which is reflected in the planktonic foraminifera distribution, providing an opportunity to study the effect of monsoon forcing and stratification history. Analogous to modern‐day stratification, very intense water column stratification and productivity collapse were observed associated with Indian summer monsoon (ISM) evolution. This paper reports significant stratification events during MIS 3 (37.0 to 33 and 27 to 24 cal ka), Bølling/Allerød (B/A), early Holocene (10.0 to 8.0 cal ka) and mid‐Holocene (7.0 to 5.0 cal ka) which slowly muted upwelling and productivity. The deglacial intensification of the ISM started in the early stages of the Bølling/Allerød (B/A) followed by slight weakening during the Younger Dryas and regained strength during the early Holocene, coinciding with the highest summer insolation at 30°N. A progressive decline in the abundances of productivity and salinity proxies from 4.2 to 2.0 cal ka suggests a gradual weakening of the ISM. The late Quaternary productivity variations in the Bay of Bengal and the Andaman Sea are primarily controlled by salinity‐related stratification.
The prognostic significance of lymphovascular tumor invasion in localized high‐grade osteosarcoma: Outcomes of a single institution over 10 years
Authors: Gusho Charles A. , Miller Ira , Clayton Bishir , Colman Matthew W. , Gitelis Steven , Blank Alan T. 
Published: February 2021

AbstractBackgrounds and ObjectivesLymphovascular invasion (LVI) has shown evidence of an association with worse survival in high‐grade osteosarcoma patients. The purpose of this investigation was to prognosticate LVI as a predictor of survival.MethodsThis was a retrospective review of high‐grade, localized osteosarcoma patients over a consecutive 10‐year period. Proportional hazards regression was used to identify prognostic factors. Cumulative mortality incidence was estimated with recurrence as a competing risk.ResultsForty‐two cases with a median follow‐up of 64 months (range, 6–158 months) were reviewed. LVI was present in 21.4% (n = 9) cases. The five‐ and ten‐year survivals in LVI (+) were 40% and 20%, compared to 93% and 81% in LVI (−), respectively (p < .001). After controlling for confounders, advanced age (hazards ratio [HR], 1.134; 95% confidence interval [CI], 1–1.2; p = .01) and LVI (HR, 21.768; 95% CI, 3–135; p = .001) were negative prognosticators. The cumulative incidence of recurrence was no different between LVI (+) and LVI (−) (p = .811), though the incidence of mortality was significantly higher in LVI (+) (p = .003).ConclusionThe presence of LVI in the setting of high‐grade, localized osteosarcoma is associated with greater rates of mortality and appears to portend a dismal prognosis.
Treatment plan quality control using multivariate control charts
Authors: Roy Arkajyoti , Widjaja Reisa , Wang Min , Cutright Dan , Gopalakrishnan Mahesh , Mittal Bharat B. 
Published: February 2021

PurposeStatistical process control tools such as control charts were recommended by the American Association of Physicists in Medicine (AAPM) Task Group 218 for radiotherapy quality assurance. However, the tools needed to analyze multivariate, correlated data that are often encountered in treatment plan quality measures, are lacking. In this study, we develop quality control tools that can model multivariate plan quality measures with correlations and account for patient‐specific risk factors, without adding a significant burden to clinical workflow.Methods and MaterialsA multivariate, quality control chart is developed that includes a risk‐adjustment model, Hotelling’s T2 statistic, and principal component analysis (PCA). Principal component analysis accounts for correlations among a set of organ‐at‐risk (OAR) dose‐volume histogram (DVH) points that serves as proxies for plan quality. Risk‐adjustment models estimate the principal components from PCA using a set of patient‐ and treatment‐specific risk factors. The resulting residuals from the risk‐adjustment models are used to compute the Hotelling’s T2 statistic; the corresponding multivariate control chart is then plotted based on the beta distribution followed by the statistic. Further, the box‐cox transformation is used to account for non‐normality in DVH points. We investigate the application of the proposed methodology via three multivariate control charts — a conventional chart that ignores risk‐adjustment and PCA, a risk‐adjusted chart ignoring PCA, and a PCA‐based, risk‐adjusted chart. These control charts are evaluated on 69 head‐and‐neck cases.ResultsThe conventional multivariate control chart fails to account for important patient‐specific risk factors, including volumes and cross‐sectional areas of the tumor and OARs and distances in‐between. This failure leads to a larger number of false alarms. While the multivariate risk‐adjusted control chart is able to reduce false alarms, it fails to account for correlations in DVH points. The multivariate PCA‐based, risk‐adjusted control chart can detect unusual plans after accounting for the correlations. By replanning, improvements are shown on an unusual plan identified by both risk‐adjusted methods.ConclusionsThe multivariate risk‐adjusted control chart developed here enables quality control of plans prior to delivery. This methodology is generic and can be readily applied for other radiotherapy quality assurance protocols, such as gamma analysis pass rates.
Self‐care status in patients with heart failure: Systematic review and meta‐analysis
Authors: Aghajanloo Ali , Negarandeh Reza , Janani Leila , Tanha Kiarash , Hoseini‐Esfidarjani Sara‐Sadat 
Published: February 2021

AbstractAimTo systematically review the status of self‐care in patients with heart failure through the Self‐Care of Heart Failure Index scale.DesignA systematic review and meta‐analysis.MethodsFollowing national and international databases were searched to retrieve eligible studies: PubMed, Web of Science, Embase, Google Scholar, Scientific Information Database and Magiran. The studies were screened and selected by two researchers. Data analysed through the random‐effects model, and the I2 index was used to assess heterogeneity. Stata software version 12.0 was used for analysis. The PRISMA statement was used to report systematic review and meta‐analysis.ResultsOf the 5,953 articles initially identified, 39 studies were included. The average score was estimated at 58.16 (CI: 54.39–61.94) for self‐care maintenance, 53.11 (CI: 49.17–57.05) for self‐care management and 58.66 (CI: 54.32–63.00) for self‐care confidence. Despite the high heterogeneity of the studies, the results indicated that self‐care practice is inadequate in all the three dimensions of self‐care (maintenance, management and confidence).