bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midshaft Clavicle Fractures: Surgery Provides Better Results as Compared With Nonoperative Treatment: A Meta-analysis
Authors: Guerra Enrico , Previtali Davide , Tamborini Simone , Filardo Giuseppe , Zaffagnini Stefano , Candrian Christian 
Published: March 2019

Background: There is no agreement on the best treatment for displaced midshaft clavicle fractures (MCFs), which are currently addressed by nonoperative or surgical approaches. Purpose: To compare fracture healing and functional outcome after surgical versus nonsurgical treatment of MCFs, to help specialists in deciding between these different strategies by providing a synthesis of the best literature evidence. Study Design: Meta-analysis. Methods: A systematic research of the literature was performed in different online databases: PubMed, Web of Science, Cochrane library, and grey literature. PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines were used. The risk of bias was evaluated with the Cochrane Collaboration’s “risk of bias” tool, and the quality of evidence was graded according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Randomized controlled trials investigating differences between surgery and nonoperative treatment for displaced MCFs were included. The primary outcome was the nonunion rate. Other outcomes analyzed were time to union and to return to activities, Constant score, and Disabilities of the Arm, Shoulder and Hand (DASH) index. Patients’ satisfaction, secondary operations, and complications were also recorded. Results: Out of 832 records found, 14 randomized controlled trials with 1546 patients were included. A significantly lower risk ratio was found for nonunion (10%; 95% CI, 6%-18%, P < .001) favoring surgery. Time to union was 5.1 weeks shorter with surgery ( P = .007). The complication rate (including the number of reinterventions) was higher in the surgical group (31.3% vs 20.5%, P < .001). Shoulder function at short-term follow-up was significantly better in the surgical group (DASH index mean difference = 4.0 points), while no statistical difference was found in the Constant score and in the DASH index at midterm follow-up ( P = .41 and .80, respectively). At long-term follow-up, both shoulder functional scores were significantly better in the surgery group: the overall Constant score mean difference was 5.3 points (95% CI, 2.3-8.4 points; P < .001), and the DASH index mean difference was 4.3 points (95% CI, 0.2-8.4 points; P = .04). Conclusion: Surgical treatment of MCFs significantly reduces the nonunion rate and shortens the time to union as compared with the nonoperative approach and, despite a slightly higher incidence of complications, leads to better shoulder functional scores at short- and long-term follow-up. Further studies should address the clinical significance of the documented improvement.
Can Exchange Rate Volatility Influence the Export Positively? Evidence from Turkey Under the Regime Shifts
Authors: Bilgili Faik , Ulucak Recep , Soykan Mehmet Erkan , Erdog˘an Selma 
Published: March 2019

One might claim that a researcher can estimate the impact of exchange rate volatility on exports, considering the regime shifts. Otherwise, the relevant estimation output might be biased. This article examines the possible impact of exchange rate volatility on export in Turkey by employing the monthly data for the period 2003M1 and 2015M4. To this end, the article develops a model based on the demand for the traditional long-term aggregate export in which the influences of volatility of exchange rate, domestic income level, foreign income level and ratio of foreign price to domestic price on the real export level are observed. The article (a) first reviews the relevant literature evidence, (b) then follows the preliminary methodologies of unit root test with structural breaks or break point tests through regime shifts (c) and later, estimates the cointegration coefficients of Hatemi-J regime switching models, dynamic ordinary least square (DOLS) and fully modified ordinary least square models to understand the behaviour of Turkish export in detail. The motivation of this article lies in two points. First, the article considers mainly the effect of exchange rate volatility on Turkish export by observing the possible existence of structural breaks and/or regime shifts. Second, the article follows both (C/S) regime switching model and (C/T) regime switching model, where (C/S) represents the model in which regime changes are observed in constant and in all regressors and where (C/T) denotes the model in which the regime shifts are estimated in constant along with trend of the Turkish export equation. The regime switching model (C/S) exhibits the positive effects of volatility, domestic income and price ratio (W/Tr) and negative impact of World income on Turkish export. The DOLS estimations support the (C/S) model outputs except the sign of price ratio. Eventually the article reveals that (a) the Turkish exporters appear to be risk lovers rather than risk-averse and (b) Turkish export should give more weight to MENA countries.
Blockchain and Trust in a Smart City
Authors: Kundu Debasish 
Published: March 2019

Trust in a smart city is fundamental to its transparency, the participation of its people in governance, entrepreneurial initiatives, trade, commerce and hence the growth of its economy. A city gets smart by transforming itself to a digital city, and a digital city runs on data, analytics, internet of things, artificial intelligence and machine learning. This inevitable transformation creates the fundamental need for trust. How does data remain sacrosanct and verifiable? How do people trust institutions? How do institutions trust each other? How do devices trust each other? This article explores blockchain as an essential layer of trust in a smart city. It explains the technology by drawing real-life examples to the ‘memory game’ that operates in an ecosystem of ‘trust and consensus.’ The article provides further insight into institutions that can be governed on blockchain through ‘smart contracts’ in a sovereign and human independent manner. The use cases of blockchain have been corroborated with examples of successful blockchain implementation. The value for blockchain, in general, and smart cities, in particular, has been presented across four categories: (a) the network effect on trust on society, governments and industries; (b) empowering the individual and strengthening the economy; (c) the liquid economy and (d) the shareable economy. Given the current topology of technology innovations, there is no solution better than blockchain that embodies trust. It is a hope and expectation that this article will help smart city planners, developers, architects and thinkers implement blockchain as the embodiment of trust in smart cities that are increasingly becoming digital.
Gaming in Virtual Reality: What Changes in Terms of Usability, Emotional Response and Sense of Presence Compared to Non-Immersive Video Games?
Authors: Pallavicini Federica , Pepe Alessandro , Minissi Maria Eleonora 
Published: March 2019

Background. Virtual reality can provide innovative gaming experiences for present and future game players. However, scientific knowledge is still limited about differences between player’s experience in video games played in immersive modalities and games played in non-immersive modalities (i.e., on a desktop display). Materials and method. Smash Hit was played by 24 young adults in immersive (virtual reality) and non-immersive (desktop) condition. Self-report questionnaires (VAS-A, VAS-HP, VAS-SP, SUS, SUS-II) and psycho-physiological measures (heart rate and skin conductance) were used to assess usability, emotional response and the reported sense of presence. Results. No statistical differences emerged between the immersive and the non-immersive condition regarding usability and performance scores. The general linear model for repeated measures conducted on VAS-A, VAS-HP, VAS-SP scores for the virtual reality condition supported the idea that playing in the immersive display modality was associated with higher self-reported happiness and surprise; analysis on SUS-II revealed that the perceived sense of presence was higher in the virtual reality condition Discussion and conclusion. The proposed study provides evidence that (a) playing a video game in virtual reality was not more difficult than playing through a desktop display; (b) players showed a more intense emotional response, as assessed by self-report questionnaires and with psycho-physiological indexes (heart rate and skin conductance), after playing in virtual reality versus after playing through the desktop display; (c) the perceived sense of presence was found to be greater in virtual reality as opposed to the non-immersive condition.
First-line pembrolizumab therapy in a cisplatin-ineligible patient with plasmacytoid urothelial carcinoma: A case report
Authors: Hunter Lindsay , Moser Justin , Sturge Caleb , Barraza Gonzalo , Colonna Sarah 
Published: March 2019

Background Plasmacytoid urothelial carcinoma (PUC) is a rare but aggressive variant of transitional cell carcinoma. In patients with unresectable disease, cisplatin-based combination chemotherapy is the most commonly used treatment. However, many patients are cisplatin-ineligible due to poor performance status or other comorbidities. We report a case of a cisplatin-ineligible patient with metastatic PUC who was treated with pembrolizumab. Case report A 71-year-old man with 30 pack-year smoking history and schizoaffective disorder was found to have multiple right-sided lung nodules after presenting with atypical chest pain. Staging CT showed bilateral adrenal masses and a large soft tissue mass in the right iliac fossa. Tissue pathology and immunohistochemical staining was consistent with PUC. As the patient was cisplatin-ineligible due to poor performance status and multiple medical comorbidities, the decision was made to treat with pembrolizumab. Repeat CT chest and abdomen showed partial response at three months and stable disease at six months. Discussion The KEYNOTE-052 study found that first-line pembrolizumab in cisplatin-ineligible patients with urothelial cancer resulted in complete or partial response in 24% of patients with few adverse effects. However, it is unclear if patients with plasmacytoid variant were included. To our knowledge, this is the first case report of a patient with metastatic PUC not only treated with pembrolizumab but shown to have clinical response. Conclusion Given our patient’s clinical response, pembrolizumab is a promising first-line agent for treating cisplatin-ineligible patients with metastatic PUC. Further evaluation is warranted to confirm the benefit of treating this patient population with pembrolizumab.
Orbital metastasis as presenting symptom from a prostatic adenocarcinoma
Authors: Pastore Marco R , D’Aloisio Rossella , Cirigliano Gabriella , De Giacinto Chiara , Tognetto Daniele 
Published: March 2019

Purpose: To report a 72-year-old man with orbital metastasis as presenting symptoms from a prostatic adenocarcinoma. Methods: A complete ophthalmological evaluation with ultrasonography examination, kinetic perimetry, fluorescein angiography, and visually evoked potentials were performed. The patient underwent computed tomography, magnetic resonance imaging of the orbit, and blood test for confirmation of the diagnosis. Bone infiltration rate of the cancer was evaluated with bone scintigraphy. Type of the tumor was assessed with orbital incision biopsy and histological analysis. The patient received systemic chemotherapy. Due to poor patient compliance, radiotherapy was not performed. Results: Ultrasonography showed a hypoechoic retrobulbar lesion. At computed tomography examination of the orbit an expansive oval intraconical solid lesion with enhancement after medium contrast was found. Biopsy findings revealed a moderately differentiated adenocarcinoma with immunohistochemical profile supporting prostate as the primary tumor site: negative for cytokeratin-7 and cytokeratin-20 and positive for prostate-specific antigen, prostate-specific acid phosphatase, and alpha-methylacyl-CoA-racemase. Conclusions: Ocular signs and symptoms as first clinical presentation of a prostate cancer are relatively rare. Despite its very poor prognosis, a correct management and therapy can improve visual acuity, ocular symptoms, and median survival of cancer patients.
Contrast Enhancement and Image Quality Influence Two- and Three-dimensional Echocardiographic Determination of Left Ventricular Volumes: Comparison With Magnetic Resonance Imaging
Authors: Jenner Jonas , Sörensson Peder , Pernow John , Caidahl Kenneth , Eriksson Maria J 
Published: March 2019

Purpose: To evaluate the effect of image quality and contrast enhancement (CE) on left ventricular (LV) volume determination by two- (2D) and three-dimensional (3D) echocardiography (2DE/3DE). Methods: We studied 32 post-myocardial infarction (MI) patients without (2DE/3DE) and with CE (CE2DE/CE3DE), in comparison with cardiac magnetic resonance imaging (CMR). Results: Two-dimensional echocardiography showed the largest negative bias versus CMR for diastolic and systolic volumes (−59, −28 mL, respectively) with lower biases for CE2DE (−37, −22 mL), 3DE (−31, −17 mL), and CE3DE (−17, −11 mL). Bias for ejection fraction (EF) ranged from −2.1% for 2DE to +1.4% for CE3DE. Agreement (intraclass correlation coefficient, ICC) for EF between CMR and 3DE (0.86 without and 0.85 with contrast) was better than for 2DE (0.73 without and 0.69 with contrast). The inter-/intra-observer coefficients of variation for EF varied from 16%/10% (2DE) to 6.9%/6.6% (CE2DE), and 8.3%/4.8% (3DE) to 6.7%/6.8% (CE3DE), respectively. The agreement (ICC) with CMR for EF measured by 2DE/3DE changed from 0.64/0.84 with poor image quality to 0.81/0.87 with moderate to good image quality. Conclusions: Three-dimensional echocardiography was more accurate than 2DE for estimating LV volumes, with less inter-/intra-observer variability in EF values. Contrast enhancement improved accuracy for both 2DE and 3DE and improved the inter-observer variability of EF estimates for 2DE and 3DE. Image quality had more impact on the agreement of EF values with CMR for 2DE than for 3DE. Our results emphasize the importance of using the same technique for longitudinal studies of LV EF and specially LV volumes.
Male–Female Wage Gap and Informal Employment in Bangladesh: A Quantile Regression Approach
Authors: Rahman Mustafizur , Al-Hasan Md. 
Published: March 2019

This article undertakes an examination of Bangladesh’s latest available Quarterly Labour Force Survey 2015–2016 data to draw in-depth insights on gender wage gap and wage discrimination in Bangladesh labour market. The mean wage decomposition shows that on average a woman in Bangladesh earns 12.2 per cent lower wage than a man, and about half of the wage gap can be explained by labour market discrimination against women. Quantile counterfactual decomposition shows that women are subject to higher wage penalty at the lower deciles of the wage distribution with the wage gap varying between 8.3 per cent and 19.4 per cent at different deciles. We have found that at lower deciles, a significant part of the gender wage gap is on account of the relatively larger presence of informal employment. Conditional quantile estimates further reveal that formally employed female workers earn higher wage than their male counterparts at the first decile but suffer from wage penalty at the top deciles. JEL: C21, J31, J46, J70
Impact of 99mTc-GSA SPECT Image-Guided Inverse Planning on Dose–Function Histogram Parameters for Stereotactic Body Radiation Therapy Planning for Patients With Hepatocellular Carcinoma: A Dosimetric Comparison Study
Authors: Toya Ryo , Saito Tetsuo , Kai Yudai , Shiraishi Shinya , Matsuyama Tomohiko , Watakabe Takahiro , Sakamoto Fumi , Tsuda Noriko , Shimohigashi Yoshinobu , Yamashita Yasuyuki , Oya Natsuo 
Published: March 2019

Purpose: To evaluate the impact of 99mTc-labeled diethylene triamine pentaacetate-galactosyl human serum albumin (99mTc-GSA) single-photon emission computed tomography (SPECT) image-guided inverse planning on the dose–function histogram (DFH) parameters for stereotactic body radiation therapy planning in patients with hepatocellular carcinoma (HCC). Methods: Eleven patients were enrolled in this study. The functional liver structure (FLS) was derived from SPECT thresholds of 60% to 80% of the maximum pixel value. Two treatment plans optimized without FLS (plan C) and with FLS (plan F) were designed for 50 Gy to the planning target volume (PTV). The DFH parameters were calculated as follows: Fx = (sum of the counts within the liver volume receiving a dose > x Gy/sum of the counts within the whole liver volume) × 100. Other parameters for the PTV included D95, mean dose, conformity index (CI), and homogeneity index (HI). Results: Compared with plan C, plan F significantly reduced DFH parameters of F5 to F40 ( P < .05). There were no significant differences in the parameters of the PTV of D95, mean dose, CI, and HI and organs at risks (stomach, duodenum, spinal cord, and kidneys) between plans C and F. Conclusion: DFH analyses revealed that 99mTc-GSA SPECT image-guided inverse planning provided dosimetric benefits related to sparing of liver function and may reduce hepatic toxicities.
Positioning of longest axis of the radial head in neutral forearm rotation
Authors: Deschrijver Miguel , Lamquet Simon , Planckaert Guillaume , Vermue Hannes , De Wilde Lieven , Van Tongel Alexander 
Published: March 2019

Introduction The radial head has an ellipsoid shape so that a longest and a shortest axis can be defined. The aim of this study is to evaluate the position of the longest axis of the radial head (LARH) in relation to proximal radioulnar joint (PRUJ) and to the forearm in neutral position using 3D computed tomography (CT). Materials and methods 3D CT reconstructions of the distal humerus, the radius and the ulna of 27 healthy volunteers (average age 27.65 ± 9.25; 24 males, 3 females) were created. First an evaluation of the elliptic form of the radial head and the location of its longest axis was performed. Next, three planes were defined: the PRUJ plane, the forearm plane and a neutral plane. Based on the angle between the forearm plane and the neutral plane, the rotation of the scanned forearm was measured. Taking this rotation into account, the position of the LARH compared to PRUJ plane and forearm plane in neutral position is recalculated. Results The shape of the radial head is determined to be non-circular based on this study population (p < .001). In neutral position, the angle between the LARH and the forearm plane is 5.28° (SD: 15.09) and between the LARH and the PRUJ is 33.46° (SD: 13.91). Conclusions The position of the LARH is found to be approximately perpendicular to the forearm plane when the forearm is in neutral position and perpendicular to the PRUJ plane when the forearm is on average in 30° of pronation.
Safety Culture and Attitudes Among Spine Professionals: Results of an International Survey
Authors: Gadjradj Pravesh S. , Harhangi Biswadjiet S. 
Published: March 2019

Study Design: International survey. Objective: A positive safety culture has been linked to better surgical outcomes, less hospital costs and less patient harm and severity-adjusted mortality, making safety attitudes relevant for society and both patient and health care provider. The aim of the current study is to assess attitudes toward safety culture among spinal care professionals. Methods: An online survey was distributed to members of AOSpine International in 2016. The survey consisted out of 3 parts: (1) demographics, (2) the Safety Attitude Questionnaire (SAQ), and (3) expectations of responsibility for improving the safety culture. The SAQ measured job satisfaction, teamwork, and safety climate, perceptions of management, stress recognition, and working conditions. Multivariate logistic regression was performed to identify factors associated with safety attitudes. Results: A total of 356 respondents replied. The SAQ showed that respondents in Africa have a significant lower score (odds ratio [OR] 0.19, P < .05) on working conditions, compared with spine professionals in Asia. Respondents in North America had the highest odds of having a higher score (OR 4.04, P < .05) compared with respondents in Asia. Gender, continent, occupation, tenure, and the number of employees in the clinic were not associated with the dimensions of safety culture ( P > .05). The majority expected the surgeon to be mainly responsible for improving the safety culture in the operating room and at management level. Conclusions: There was a lot of variety among different respondents worldwide albeit respondents in Africa scored significantly lower on working conditions, compared with spine professionals in Asia and North America, suggesting that wealthier countries have better working conditions which may lead toward better safety attitudes. Closer collaboration between hospital management and clinicians seems to be a target for improvement in safety culture. Furthermore, to show clinical relevance in this field, studies correlating safety attitudes with outcomes after spine surgery are warranted.
Gasless laparoendoscopic single-site surgery with intraoperative autologous blood transfusion for management of ectopic pregnancy with significant hemoperitoneum: a retrospective observational study
Authors: Takeda Akihiro , Tsuge Shiori , Shibata Mayu , Shinone Sanae , Nakamura Hiromi 
Published: March 2019

Abstract
Background
With advances in diagnostic and therapeutic modalities, earlier detection of ectopic pregnancy with minimal symptoms makes laparoscopic management more common. However, if diagnostic delay occurs, significant hemoperitoneum associated with ectopic pregnancy is still a potentially life-threatening condition, which presents a therapeutic challenge especially when minimally invasive surgical approach is a significant concern. Herein, retrospective observational study in 18 consecutive cases of ectopic pregnancy with significant hemoperitoneum ≥ 800 mL was performed to assess the feasibility and efficacy of gasless laparoendoscopic single-site (LESS) surgery with intraoperative autologous blood cell salvage and donation for management.

Results
At triage, median shock index was 0.95, median hemoglobin value was 6.5 g/dL, and median serum β-hCG value was 13,651 U/L. Surgical diagnosis included 7 ampullary (including 5 abortions and 2 ruptures), 5 ruptured isthmic (including 1 heterotopic pregnancy in remnant tube after salpingectomy and 1 remnant tube pregnancy after salpingo-oophorectomy), 4 ruptured interstitial (including 1 case after salpingectomy), and 2 ruptured ovarian pregnancies. Among these cases, 16 cases were successfully managed by LESS surgery, while, in 2 cases with interstitial pregnancy, conversion to multi-port laparoscopic surgery along with transfusion of bank blood were required. Laparotomic conversion was not experienced. Surgical procedures in 16 cases successfully completed by LESS surgery with intraoperative autologous blood transfusion included unilateral salpingectomy for 7 ampullary and 5 isthmic pregnancies, cornuotomy and cornual resection for each 1 case with interstitial pregnancy, and unilateral salpingo-oophorectomy and partial ovarian resection for each 1 case with ovarian pregnancy. Median surgical duration was 57.5 min, median amounts of salvaged peritoneal blood were 950 mL (range 800–2000 mL), and median amounts of transfused autologous blood were 540 mL (range 450–1300 mL). Major complications associated with LESS surgery and intraoperative autologous blood transfusion were not experienced.

Conclusion
Gasless LESS surgery with intraoperative autologous blood transfusion is a feasible minimally invasive surgical option with avoidance to use homologous blood for management of selected cases of ectopic pregnancy even with significant hemoperitoneum.