bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and validation of machine learning models to predict postoperative infarction in moyamoya disease
Authors: Fuse Yutaro , Ishii Kazuki , Kanamori Fumiaki , Oyama Shintaro , Imaizumi Takahiro , Araki Yoshio , Yokoyama Kinya , Takasu Syuntaro , Seki Yukio , Saito Ryuta 
Published: April 2024

OBJECTIVE
Cerebral infarction is a common complication in patients undergoing revascularization surgery for moyamoya disease (MMD). Although previous statistical evaluations have identified several risk factors for postoperative brain ischemia, the ability to predict its occurrence based on these limited predictors remains inadequately explored. This study aimed to assess the feasibility of machine learning algorithms for predicting cerebral infarction after revascularization surgery in patients with MMD.

METHODS
This retrospective study was conducted across two centers and harnessed data from 512 patients with MMD who had undergone revascularization surgery. The patient cohort was partitioned into internal and external datasets. Using perioperative clinical data from the internal cohort, three distinct machine learning algorithms—namely the support vector machine, random forest, and light gradient-boosting machine models—were trained and cross-validated to predict the occurrence of postoperative cerebral infarction. Predictive performance validity was subsequently assessed using an external dataset. Shapley additive explanations (SHAP) analysis was conducted to augment the prediction model’s transparency and to quantify the impact of each input variable on shaping both the aggregate and individual patient predictions.

RESULTS
In the cohort of 512 patients, 33 (6.4%) experienced postrevascularization cerebral infarction. The cross-validation outcomes revealed that, among the three models, the support vector machine model achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at mean ± SD 0.785 ± 0.052. Notably, during external validation, the light gradient-boosting machine model exhibited the highest accuracy at 0.903 and the largest ROC-AUC at 0.710. The top-performing prediction model utilized five input variables: postoperative serum gamma-glutamyl transpeptidase value, positive posterior cerebral artery (PCA) involvement on preoperative MRA, infarction as the rationale for surgery, presence of an infarction scar on preoperative MRI, and preoperative modified Rankin Scale score. Furthermore, the SHAP analysis identified presence of PCA involvement, infarction as the rationale for surgery, and presence of an infarction scar on preoperative MRI as positive influences on postoperative cerebral infarction.

CONCLUSIONS
This study indicates the usefulness of employing machine learning techniques with routine perioperative data to predict the occurrence of cerebral infarction after revascularization procedures in patients with MMD.
Efficacy and safety of tranexamic acid in the management of chronic subdural hematoma: a systematic review and meta-analysis
Authors: Musmar Basel , Orscelik Atakan , Salim Hamza , Adeeb Nimer , Spellicy Samantha , Abdelgadir Jihad , Azar Jehad , Cuellar-Saenz Hugo H. , Guthikonda Bharat , Jabbour Pascal , Hasan David 
Published: April 2024

OBJECTIVE
Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition, particularly among the elderly. Various treatment options exist, but recurrence rates remain high. This systematic review and meta-analysis aims to assess the efficacy and safety of tranexamic acid (TXA) in the management of CSDH.

METHODS
The authors conducted a comprehensive literature search adhering to the 2020 PRISMA guidelines, involving three primary databases (Scopus, PubMed, and Web of Science) that were searched for articles compiled from inception until October 20, 2023. The primary outcome was recurrence of CSDH, and secondary outcomes included complications and SDH volume following TXA treatment. The mean difference and odds ratios with 95% confidence intervals were calculated using the random-effects model.

RESULTS
A total of 5 studies, involving 643 patients in the TXA group and 736 patients in the non-TXA group, met the inclusion criteria. The meta-analysis revealed that TXA use led to a significantly lower CSDH recurrence (OR 0.35, 95% CI 0.23–0.53; p < 0.01) without increasing complications (OR 1.84, 95% CI 0.43–7.95; p = 0.42). Additionally, TXA users had a significantly lower CSDH volume compared to the non-TXA group at 3-month follow-up (mean difference −4.56, 95% CI −8.76 to −0.36; p = 0.03).

CONCLUSIONS
The findings suggest that TXA might be a promising agent for reducing the risk of CSDH recurrence without elevating the risk of complications. However, these results should be interpreted cautiously due to the limited number of studies included and the methodological heterogeneity. Further large-scale randomized controlled trials are needed to confirm these findings.
The intersection of race and social determinants of health on clinical outcome of glioblastoma patients
Authors: Asfaw Zerubabbel K. , Hernandez-Marquez Gianina C. , Naik Anant , Young Tirone , Vega Perez Ruben , Bickell Nina , Germano Isabelle M. 
Published: April 2024

OBJECTIVE
Resection, chemotherapy, radiation therapy, and tumor treating fields significantly increase the overall survival (OS) of glioblastoma (GBM) patients. Yet, cost and healthcare disparities might limit access. Multiple studies have attributed more than 80% of the GBM disease burden to White patients. The aim of this study was to explore the intersections of race and social determinants of health (SDoH) with healthcare access and outcomes of GBM patients in a large metropolitan area.

METHODS
In this retrospective single-center study, the tumor registry at the authors’ institution (2011–2019) was queried to identify a GBM cohort according to the updated WHO criteria. Data were supplemented by electronic health records to include demographics, outcome, National Cancer Institute Comorbidity Index (NCI-CI), and the Agency for Healthcare Research and Quality (AHRQ) socioeconomic status (SES) index.

RESULTS
A total of 276 unique patients met the study inclusion criteria; 46% of the cohort was female, and 45% was non-White. This racial proportion differs from previous reports indicating that 80% of patients with GBM are White. The proportion of non-White patients in this study was similar to that of the general US population and significantly lower than that of New York City (p < 0.05). Non-White patients predominantly composed the lowest AHRQ SES index quartile, while White patients constituted the highest quartile (p < 0.001). White patients were older at diagnosis compared with non-White patients (63 vs 58 years, p = 0.001). Older age (p = 0.03), higher NCI-CI (p = 0.0006), and lack of insurance (p = 0.03) reduced the odds of a home discharge. Private insurance (p = 0.005), younger age (p = 0.02), and the highest ("wealthiest") AHRQ SES index quartile (p = 0.02) predicted a lower hospital length of stay (LOS). Patients who underwent gross-total resection had greater OS than those who received a subtotal resection or biopsy, independent of race and SDoH (1.68 vs 1.4 years, p = 0.022).

CONCLUSIONS
This study is the first to report on race and SDoH of a cohort using the latest WHO criteria for GBM classification. In contrast to previous literature, the study cohort exhibits a higher proportion of non-White patients with GBM, similar to the representation of non-White individuals in the general US population. This study corroborates the impact of SDoH and not race on LOS and discharge location. Initiatives to identify and address these barriers are crucial for enhancing the care of all GBM patients.
Factors associated with increased length of stay in degenerative cervical spine surgery: a cohort analysis from the Canadian Spine Outcomes and Research Network
Authors: Moskven Eryck , McIntosh Greg , Nataraj Andrew , Christie Sean D. , Kumar Rajesh , Phan Philippe , Wang Zhi , Tarabay Bilal , Weber Michael H. , Singh Supriya , Bailey Christopher S. , Manson Neil A. , Abraham Edward , Paquet Jérôme , Wilson Jefferson R. , Rampersaud Y. Raja , Fisher Charles G. , Dea Nicolas , Charest-Morin Raphaële 
Published: April 2024

OBJECTIVE
Postoperative length of stay (LOS) significantly contributes to healthcare costs and resource utilization. The primary goal of this study was to identify patient, clinical, surgical, and institutional variables that influence LOS after elective surgery for degenerative conditions of the cervical spine. The secondary objectives were to examine the variability in LOS and institutional practices used to decrease LOS.

METHODS
This was a multicenter observational retrospective cohort study of patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) between January 2015 and October 2020 who underwent elective anterior cervical discectomy and fusion (ACDF) (1–3 levels) or posterior cervical fusion (PCF) (between C2 and T2) with/without decompression for degenerative conditions of the cervical spine. Prolonged LOS was defined as LOS greater than the median for the ACDF and PCF populations. The principal investigators at each participating CSORN healthcare institution completed a survey to capture institutional practices implemented to reduce postoperative LOS.

RESULTS
In total, 1228 patients were included (729 ACDF and 499 PCF patients). The median (IQR) LOS for ACDF and PCF were 1.0 (1.0) day and 5.0 (4.0) days, respectively. Predictors of prolonged LOS after ACDF were female sex, myelopathy diagnosis, lower baseline SF-12 mental component summary score, multilevel ACDF, and perioperative adverse events (AEs) (p < 0.05). Predictors of prolonged LOS after PCF were nonsmoking status, education less than high school, lower baseline numeric rating scale score for neck pain and EQ5D score, higher baseline Neck Disability Index score, and perioperative AEs (p < 0.05). Myelopathy did not significantly predict prolonged LOS within the PCF cohort after multivariate analysis. Of the 8 institutions (57.1%) with an enhanced recovery after surgery (ERAS) protocol or standardized protocol, only 3 reported using an ERAS protocol specific to patients undergoing ACDF or PCF.

CONCLUSIONS
Patient and clinical factors predictive of prolonged LOS after ACDF and PCF are highly variable, warranting individual consideration for possible mitigation. Perioperative AEs remained a consistent independent predictor of prolonged LOS in both cohorts, highlighting the importance of preventing intra- and postoperative complications.
Impact of bilateral facet joint violation on radiographic degeneration of superior adjacent segments and clinical outcomes
Authors: Ding Zhiguo , Di Derun , Wang Lianlei , Liu Xinyu 
Published: April 2024

OBJECTIVE
Facet joint violation (FJV) is associated with postoperative low-back pain and is a confirmed risk factor for adjacent-segment degeneration, a long-term complication of lumbar fusion surgery. The authors’ knowledge of its mechanisms comes from in vitro biomechanical research only; there is a lack of radiographic evidence of the effects of violation on the superior adjacent-segment facet joint, intervertebral disc, and other local radiographic parameters. Furthermore, any differences between unilateral and bilateral violation remain relatively unclear. The authors therefore aimed to explore the effects of nonviolation and unilateral and bilateral violation on radiographic degeneration of the facet joint and intervertebral disc at the fusion and superior adjacent segment. Patient-reported clinical outcomes were compared at the 2-year follow-up.

METHODS
The authors retrospectively analyzed data from 148 patients with lumbar degenerative diseases who underwent single-segment minimally invasive transforaminal lumbar interbody fusion between 2016 and 2020. FJV and facet joint degeneration were evaluated and graded using Shah’s method and Pathria’s standard, respectively. Radiographic parameters, including disc height and intervertebral Cobb angle at the fusion and superior adjacent segment, were measured. Clinical outcomes were evaluated using visual analog scale (VAS) and Japanese Orthopaedic Association scores.

RESULTS
Preoperative data were comparable among the 3 groups (nonviolation, unilateral violation, and bilateral violation) (p > 0.05). Patient-reported clinical outcomes were followed up for at least 2 years (average duration 28.17 ± 6.17 months). At the last follow-up, facet joint degeneration grades were sequentially increased in the nonviolation, unilateral violation, and bilateral violation groups (p = 0.006). The unilateral (2.45 ± 2.17 mm) and bilateral (2.70 ± 1.94 mm) violation groups had more severe losses of disc height in the superior adjacent segment than did the nonviolation group (1.31 ± 2.01 mm). The VAS low-back pain and Japanese Orthopaedic Association scores in the bilateral (2.57 ± 1.44 and 19.83 ± 2.84, respectively) and unilateral (2.26 ± 0.79 and 20.43 ± 3.85, respectively) violation groups were significantly worse than in the nonviolation group (1.69 ± 1.12 and 21.80 ± 3.36, respectively) (p < 0.05). By contrast, there were no significant between-group differences in disc height, intervertebral Cobb angle in the fusion segment, or VAS leg pain scores (p > 0.05).

CONCLUSIONS
FJV was associated with postoperative low-back pain and worse functional outcomes. It also aggravated facet joint and intervertebral disc changes in the superior adjacent segment, especially when bilateral violation occurred; this may be part of the mechanisms of adjacent-segment degeneration.
Understanding proficiency-oriented silence in the context of EAL
Authors: Ekici Gail 
Published: April 2024

This mixed methods, case study focuses on adult second language learning and their silences in a pre-intermediate level class, where they experience a potentially difficult time reaching the point of Target language proficiency. The findings of this study respond to the paucity of research on the problem adult student silence in a pre-intermediate language classroom by investigating the pre-intermediate language learning experiences of competent bilingual adults reflecting back on learning English as a second language (EAL) in Australia. The findings give reason for why students are silent in class. Analysis of student reflections combined with the EAL teachers’ interviews identified a pedagogical barrier. These barriers caused them to be silent because most of the teachers teaching content at this level were not trained to teach students who approximately break their silence at this level, and need a particular teaching approach to help them. The findings show that there needs to be a reform in approach during adult silent period which happens to be approximately at pre-intermediate level (Ekici, 2022). The need for teacher professional development on being able to adapt their English language classroom talk to foster spoken interactions was seen as priority. Finings have shown that the nuanced dynamic between what teachers think they are doing and what students know they are trying to achieve in many cases fail to match. Teacher and learner confusion about each other’s' styles, the struggle to teach and learner in which both pedagogy and silence are mutually problematic, and above all else, the need for empathy for student learning and the need to customise a pedagogy to suit it to avoid untreated proficiency silence which can be detrimental (Ekici, 2022).
Faktor-Faktor Yang Mempengaruhi Prediksi Arus Kas Operasi Masa Depan Pada Perusahaan Subsektor Pertambangan Batu Bara Yang Terdaftar di BEI Tahun 2016-2021
Authors: Amalia Riski , Valianti Reva Maria , Arifin Mohammad Aryo 
Published: April 2024

ABSTRACT

This study aims to determine the factors that influence the prediction of future operating cash flows. The variables used are operating profit, net income and operating cash flow. The population of this research is coal mining sub-sector companies listed on the Indonesia Stock Exchange, totaling 24 companies. The sampling technique is purposive samplin. The number of samples is 10 companies. This research is a quantitative research. The data collection technique is the financial report in the Coal Mining Sub-sector on the IDX in 2016-2021. The data used is secondary data. This study uses multiple linear regression analysis method, which is to find out how much influence operating profit and net income have on operating cash flows in the future, and data testing is carried out with the help of the SPSS (Statistical Product And Service Solution) program.The results of the research that have been carried out partially show that there is an effect of operating profit on operating cash flow while net income has no effect on operating cash flow and the results simultaneously show that operating profit and net income have an influence on operating cash flow in predicting for the following year.

Keywords: Operating Profit, Net Income, Operating Cash Flow.

ABSTRAK

Penelitian ini bertujuan untuk mengetahui faktor-faktor yang mempengaruhi prediksi arus kas operasi masa depan. Variabel yang digunakan adalah laba operasi, laba bersih dan arus kas operasi. Populasi penelitian ini perusahaan subsektor pertambangan batu bara yang terdaftar di BEI yang berjumlah 24 perusahaan. Teknik pengambilan sampel adalah purposive sampling. Jumlah sampel sebanyak 10 perusahaan. Penelitian ini merupakan penelitian kuantitatif. Teknik pengumpulan data adalah laporan keuangan di Subsektor Pertambangan Batu Bara di BEI tahun 2016-2021. Data yang digunakan adalah data sekunder. Penelitian ini menggunakan metode analisis regresi linear berganda yaitu mengetahui seberapa besar pengaruh laba operasi dan laba bersih terhadap arus kas operasi di masa depan, dan pengujian data dilakukan dengan dibantu program SPSS (Statistical Product And Service Solution) 22.
Hasil uji hipotesis menyimpulkan bahwa secara parsial variabel laba operasi berpengaruh signifikan terhadap arus kas operasi sebesar 0,000 < 0,05, variabel laba bersih tidak berpengaruh signifikan terhadap arus kas operasi sebesar 0,770 > 0,05, dan dapat disimpulkan secara simultan yaitu terdapat pengaruh antara variabel laba operasi dan laba bersih terhadap arus kas operasi sebesar 0,000.

Kata kunci: Laba Operasi, Laba Bersih, Arus Kas Operasi
Analisis Pajak Penghasilan Pasal 21 Atas Gaji Pegawai Dinas Kesehatan Puskesmas Gunung Kemala di Kota Prabumulih
Authors: Novianti Serli , Valianti Reva Maria , Nurmala Nurmala 
Published: April 2024

ABSTRACT

Income Tax Article 21 is a tax in the form of wages,honorarium,allowances,other payments obtained by domestic taxpayers related to work and position.The purpose of this research was to find out how the mechanism for calculating, withholding Article 21 Income Tax on the Salaries of Health Office Employees at the Gunung Kemala Health Center in the City of Prabumulih. The type of data used in this study is secondary data in the form of Salaries for the Health Office of the Gunung Kemala Public Health Center in the city of Prabumulih in 2023, the method used is a qualitative method, the data collection technique used is documentation and interviews, the population in this study are Civil Servants, while the sample used is the Salary of Civil Servants. The data analysis used in this research is descriptive analysis. the research results of the calculation of Article 21 PPh deductions are in accordance with the provisions of the tax law where seen in the conclusions and suggestions in the calculation of Article 21 PPh already using the latest PTKP rates with the results of the calculation there is a difference in overpayment when reporting such as employees of the Mount Kemala Public Health Center in the city of Prabumulih.

Keywords: Income Tax, Income Tax Article 21, PTKP

ABSTRAK

Pajak Penghasilan 21 adalah pajak berkaitan dengan gaji,honorarium, tunjangan, dan pembayaran lainnya yang didapatkan Wajib Pajak dan berkaitan dengan pekerjaan maupun jabatan.Tujuan penelitian ini untuk mengetahui bagaimana mekanisme perhitungan, pemotongan Pajak Penghasilan Pasal 21 atas Gaji Pegawai Dinas Kesehatan Puskesmas Gunung Kemala Dikota Prabumulih, data yang digunakan dalam penelitian ini adalah data sekunder berupa Gaji Pegawai Dinas Kesehatan Puskesmas Gunung Kemala dikota Prabumulih tahun 2023, metode yang digunakan yaitu metode kualitatif, teknik pengumpulan data dengan cara dokumentasi dan wawancara, populasi dalam penelitian ini adalah Pegawai Negeri Sipil, sedangkan sampel yang dipakai adalah Gaji Pegawai Negeri Sipil. Analisis data yang digunakan dalam penelitian ini adalah Analisis Deskriptif.Hasil penelitian perhitungan pemotongan PPh Pasal 21 sudah sesuai dengan ketentuan undang-undang perpajakan dimana dilihat pada kesimpulan dan saran dalam perhitungan PPh Pasal 21 sudah menggunakan tarif PTKP terbaru dengan hasil perhitungan terdapat selisih lebih bayar saat pelaporan SPT Pegawai Dinas Kesehatan Puskesmas Gunung Kemala dikota Prabumulih.

Kata kunci: Pajak Penghasilan, PPh Pasal 21, PTKP.
DDA-SSNets: Dual decoder attention-based semantic segmentation networks for COVID-19 infection segmentation and classification using chest X-Ray images
Authors: Gopatoti Anandbabu , Jayakumar Ramya , Billa Poornaiah , Patteeswaran Vijayalakshmi 
Published: April 2024

BACKGROUND: COVID-19 needs to be diagnosed and staged to be treated accurately. However, prior studies’ diagnostic and staging abilities for COVID-19 infection needed to be improved. Therefore, new deep learning-based approaches are required to aid radiologists in detecting and quantifying COVID-19-related lung infections. OBJECTIVE: To develop deep learning-based models to classify and quantify COVID-19-related lung infections. METHODS: Initially, Dual Decoder Attention-based Semantic Segmentation Networks (DDA-SSNets) such as Dual Decoder Attention-UNet (DDA-UNet) and Dual Decoder Attention-SegNet (DDA-SegNet) are proposed to facilitate the dual segmentation tasks such as lung lobes and infection segmentation in chest X-ray (CXR) images. The lung lobe and infection segmentations are mapped to grade the severity of COVID-19 infection in both the lungs of CXRs. Later, a Genetic algorithm-based Deep Convolutional Neural Network classifier with the optimum number of layers, namely GADCNet, is proposed to classify the extracted regions of interest (ROI) from the CXR lung lobes into COVID-19 and non-COVID-19. RESULTS: The DDA-SegNet shows better segmentation with an average BCSSDC of 99.53% and 99.97% for lung lobes and infection segmentations, respectively, compared with DDA-UNet with an average BCSSDC of 99.14% and 99.92%. The proposed DDA-SegNet with GADCNet classifier offered excellent classification results with an average BCCAC of 99.98%, followed by the GADCNet with DDA-UNet with an average BCCAC of 99.92% after extensive testing and analysis. CONCLUSIONS: The results show that the proposed DDA-SegNet has superior performance in the segmentation of lung lobes and COVID-19-infected regions in CXRs, along with improved severity grading compared to the DDA-UNet and improved accuracy of the GADCNet classifier in classifying the CXRs into COVID-19, and non-COVID-19.