bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre-test Cortisol Levels in Predicting Short Synacthen Test Outcome: A Retrospective Analysis
Authors: Ravindran Ravikumar , Carter Joanne L , Kumar Asit , Capatana Florin , Khan Ishrat N , Adlan Mohamed A , Premawardhana Lakdasa D 
Published: May 2022

Objective: Short Synacthen tests (SSTs) are expensive, dependent on Synacthen availability, and need supervision. To reduce SST testing, we examined the utility of pre-test cortisol (Cort0) and related parameters in predicting outcome. Design and Measurements: We retrospectively examined the following in all SSTs; (i) Cort0 (ii) indications (iii) and time and place of testing. Receiver operated characteristic (ROC) curves were devised for Cort0 to obtain the best cut-off for outcome prediction in those who had SSTs between 8 and 10 am (Group 1) and at other times (Group 2). Results: Of 506 SSTs, 13 were unsuitable for analysis. 111/493 SSTs (22.5%) were abnormal. (1) ROC curves predicted – (a) SST failure with 100% specificity when Cort0 was ⩽124 nmol/L (Group 1), or ⩽47 (Group 2); (b) a normal SST with 100% sensitivity when Cort0 ⩾314 nmol/L (Group 1) and ⩾323 nmol/L (Group 2). (2) There was significant correlation between Cort0 and 30-minute cortisol ( rs = 0.65-0.78, P  < .001). (3) Median Cort0 was lower in those who failed SSTs compared to those who passed (147 vs 298 nmol/L respectively, P  < .001). (4) SST failure was commoner in Group 1 vs 2 ( P = .001). (5) There was no difference in outcome between out-patient and inpatient SSTs. (6) SST failure was most common for ‘steroid related’ indications (39.6%, P  < .001). Conclusions: This study indicates that (1) Cort0 ⩾ 323 (Group1) and ⩾314 nmol/L (Group 2) predicted a normal SST with 100% sensitivity; (2) Using these cut offs 141/493 (28.6%) tests may have been avoided; (3) supporting evidence should be considered in those with a lower pre-test predictability of failure.
Safety and Effectiveness of Excimer Laser Ablation Combined With Drug-Coated Balloon for Atherosclerotic Obliterans in the Lower Extremity
Authors: Jiang Xiaolang , Ju Shuai , Chen Bin , Jiang Junhao , Shi Yun , Ma Tao , Lin Changpo , Xu Xin , Fu Weiguo , Dong Zhihui 
Published: May 2022

Purpose: To evaluate the safety and effectiveness of excimer laser ablation (ELA) combined with drug-coated balloon (DCB) for atherosclerotic obliterans (ASO) of the lower extremities. Materials and Methods: From June 2019 to December 2020, all eligible patients were enrolled. Demographics, characteristics of lesions, complications, and follow-up information were collected and analyzed. The primary endpoint was major amputation-free survival (MAFS). Secondary endpoints included technical success, primary patency, bailout stent, distal embolization, target lesion reintervention (TLR), and ulcer healing rate. Major amputation-free survival and primary patency were calculated by Kaplan-Meier analysis. Results: A total of 71 patients were enrolled. Forty-eight (81.7%) patients presented critical limb ischemia (CLI) and 48.6% of them was calcification class 4 according to Peripheral Arterial Calcium Scoring System (PACSS). Chronic totally occluded (CTO) disease was the most common lesion in 66.0% of them and superficial femoral artery (SFA) was the most common segment in 59.6%. Technical success rate was 93.0%. One-year follow-up was finished in 25 (35.2%) patients. The primary patency and MAFS were 92.0%±27.6% and 96.0%±20.0% at 12 months, respectively. During the mean follow-up of 9.4±4.3 months, clinically-driven TLR occurred in 2 (2.8%) patients, and major and minor amputation occurred in 2 (2.8%) and 1 (1.4%) patient, respectively. Conclusion: The early results demonstrated that ELA was an effective treatment in de novo, in-stent restenosis (ISR) and CTO lesions. Meanwhile, ELA could prepare the lumen for the use of DCB and reduce the implantation of stents, especially in segments unsuitable for stenting. Mid-term and long-term results need to be awaited.
Lateral Harvest of an Osseous-Based Quadriceps Tendon Autograft Results in Thinner Remaining Patellar Bone
Authors: Perry Allison K. , Dandu Navya , Knapik Derrick M. , Inoue Nozomu , Gursoy Safa , Bush-Joseph Charles A. , Yanke Adam B. , Chahla Jorge 
Published: May 2022

Background: Patellar fracture after quadriceps tendon (QT) autograft harvest for anterior cruciate ligament reconstruction (ACLR) has been reported in up to 8.8% of patients. Purpose: To determine the thickness of the remaining patellar bone across the QT graft harvest location while providing clinical guidance for safely harvesting a patellar bone block when using a QT graft in ACLR. Study Design: Descriptive laboratory study. Methods: Medial and lateral QT graft boundaries were marked using a bone saw on 13 cadaveric patellae, and 3-dimensional computed tomography models were created. After the harvest of a virtual bone block with a maximum depth of 10 mm, the thickness of the remaining bone was measured across the graft harvest location in 9 zones. The thickness of the remaining bone was analyzed according to zone, graft harvest location, and patellar facet length. Risk zones were defined as <50% total patellar depth remaining. Results: We observed substantial variability in QT bone block harvest location, in which the distance between the lateral boundary of the harvest location and the lateral patellar cortex was from 21.2% to 49.2% of the axial patellar width. There was significantly less bone remaining in the lateral columns (mean ± SD, 7.56 ± 2.19 mm) compared with the medial columns (9.83 ± 2.10 mm) of the graft harvest location ( P = .028). The number of risk zones was significantly associated with distance to the lateral cortical edge, with an increase in 0.59 zones with every 1-mm decrease in distance to the lateral cortex edge ( b = -0.585; R 2 = 0.620; P = .001). With every 1-mm increase in the distance of the lateral cortex to the lateral graft boundary, the thickness of bone remaining in the lateral column increased by 0.412 mm ( P < .001). No risk zones were encountered when the lateral boundary of the harvest location was created 18.9 mm from the lateral edge of the patella or 43% of the total patellar width from the lateral edge. Conclusion: Harvest of a more laterally based QT autograft bone block resulted in thinner remaining patellar thickness, increasing the potential of encountering a risk zone for fracture. Clinical Relevance: Care should be taken to avoid harvesting the patellar bone block too laterally during ACLR.
Nutritional health status: association of stunted and wasted children and their mothers
Authors: Khadija Ulfat , Mahmood Shahid , Ainee Ammara , Quddoos Muhammad Yousaf , Ahmad Hajra , Khadija Afeefa , Zahra Syeda Mahvish , Hussain Ashiq 
Published: May 2022

Abstract
Background
Across the globe, 149 and 49 million children are stunted and wasted, respectively. Prevalence of stunting and wasting is 40.2 and 17.7% in children of Pakistan. Stunting and wasting are accompanied with genetics, dietary factor, lack of information, bottle feeding, illiterate parents, less birth interval, infection such as diarrhoea, low birth weight, mother suffering from malnutrition during pregnancy, breastfeeding, pharmaceutical, and hormonal, psychosocial, and low social-economic status.

Methods
Stunted and wasted children and their mothers were called on and detail discussions related to research plan were carried out. Informed consent was assured from mothers, for participation in the study. The demographics, anthropometrics, vital signs observations, body composition, clinical signs and symptoms, dietary intake and associated biomarkers (CBC, level of urea nitrogen in blood, serum albumin globulin and serum creatinine.) were tools for nutritional health status assessment. SPSS software was implied on data.

Results
The study found that 27.2% mothers were belonged to stunted children, 17.3% belonged to wasted children, and 50.9% belonged to those children who were suffering from both stunting and wasting condition.57.9% mothers who were illiterate belong to stunted and wasted children. CBC and Hb test was prominent, stunted and wasted children had Hb 9.88 mg/dL, whereas, their mothers had 10.8 mg/dL as average Hb. The average height and weight of stunted and wasted children was 68.6 cm and 7.11 kg respectively. Dietary patterns and diet quality of both mothers and children were poor, due to lack of affordability; they were not able to eat healthy food.

Conclusion
Stunting and wasting ultimately resulted in poor growth and development of children. Most of children were anemic, they height and weight less than WHO growth standards. They had less knowledge and poor intake of food diet pattern so children growth was poor.
Analysis of the cause of missed diagnosis in mpMRI/TRUS fusion-guided targeted prostate biopsy
Authors: Zhang Fan , Zhang Shun , Huang Haifeng , Zhang Qing , Zhang Shengjie , Zhang Shiwei , Guo Hongqian 
Published: May 2022

Abstract
Objectives
To investigate the causes of missed diagnosis in mpMRI/TRUS fusion-guided targeted prostate biopsy.

Methods
The clinical data of 759 patients who underwent transperineal prostate biopsy from March 2021 to June 2021 at Nanjing DrumTower Hospital were retrospectively analyzed. Twenty-one patients had MRI contraindications. Ultimately, 738 patients completed mpMRI/TRUS fusion-guided targeted prostate biopsy + 12-core transperineal systematic biopsy after mpMRI and PI-RADS scoring. The pathological diagnoses from targeted and systematic biopsy were compared to evaluate and analyze the reasons for missed diagnoses in targeted biopsy.

Results
A total of 388 prostate cancer patients were identified, including 37 (9%) missed diagnoses with targeted biopsy and 44 (11.34%) with systematic biopsy. Between the target biopsy missed diagnosis group and not missed diagnosis group, there was no significant difference in age (71.08 ± 7.11 vs. 71.80 ± 7.94), but PSA (13.63 ± 12.41 vs. 54.54 ± 177.25 ng/ml), prostate volume (61.82 ± 40.64 vs. 44.34 ± 25.07 cm3), PSAD (0.27 ± 0.28 vs. 1.07 ± 2.91), and ISUP grade [1(1) vs. 3(2)] were significantly different. The pathological results of the 37 targeted biopsy missed diagnoses were recompared with MRI: 21 prostate cancers were normal on MRI; 9 cancer areas were abnormal on MRI; and 7 cancer areas on MRI were PI-RADS 3.

Conclusions
Early prostate cancer, large prostate, effect of local anesthesia, doctor–patient cooperation, MRI diagnosis, and operator technology were possible factors for missed diagnosis in targeted biopsy. Improvements imaging technology, greater experience, and personalized biopsy may lead to an accurate pathological diagnosis.
Barriers and facilitators of access to maternal, newborn and child health services during the first wave of COVID-19 pandemic in Nigeria: findings from a qualitative study
Authors: Akaba Godwin O , Dirisu Osasuyi , Okunade Kehinde S. , Adams Eseoghene , Ohioghame Jane , Obikeze Obioma O. , Izuka Emmanuel , Sulieman Maryam , Edeh Michael 
Published: May 2022

Abstract
Background
COVID-19 pandemic may have affected the utilization of maternal and newborn child health services in Nigeria but the extent, directions, contextual factors at all the levels of healthcare service delivery in Nigeria is yet to be fully explored.
The objective of the study was to explore the barriers and facilitators of access to MNCH services during the first wave of COVID-19 pandemic in Nigeria.

Methods
A qualitative study was conducted among different stakeholder groups in 18 public health facilities in Nigeria between May and July,2020. In-depth interviews were conducted among 54 study participants (service users, service providers and policymakers) selected from across the three tiers of public health service delivery system in Nigeria (primary health centers, secondary health centers and tertiary health centers). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses.

Results
Barriers to accessing MNCH services during the first wave of COVID-19-pandemic in Nigeria include fear of contracting COVID-19 infection at health facilities, transportation difficulties, stigmatization of sick persons, lack of personal protective equipment (PPE) /medical commodities, long waiting times at hospitals, shortage of manpower, lack of preparedness by health workers, and prioritization of essential services.
Enablers to access include the COVID-19 non-pharmacological measures instituted at the health facilities, community sensitization on healthcare access during the pandemic, and alternative strategies for administering immunization service at the clinics.

Conclusion
Access to MNCH services were negatively affected by lockdown during the first wave of COVID-19 pandemic in Nigeria particularly due to challenges resulting from restrictions in movements which affected patients/healthcare providers ability to reach the hospitals as well as patients’ ability to pay for health care services. Additionally, there was fear of contracting COVID-19 infection at health facilities and the health systems inability to provide enabling conditions for sustained utilization of MNCH services. There is need for government to institute alternative measures to halt the spread of diseases instead of lockdowns so as to ensure unhindered access to MNCH services during future pandemics. This may include immediate sensitization of the general public on modes of transmission of any emergent infectious disease as well as training of health workers on emergency preparedness and alternative service delivery models.
International proficiency trial for bovine viral diarrhea virus (BVDV) antibody detection: limitations of milk serology
Authors: Wernike Kerstin , Beer Martin 
Published: May 2022

Abstract
Background
Control programs were implemented in several countries against bovine viral diarrhea (BVD), one of the most significant cattle diseases worldwide. Most of the programs rely on serological diagnostics in any phase of the program. For the detection of antibodies against BVD virus (BVDV), neutralization tests as well as a variety of (commercially available) ELISAs are used. Here, test systems applied in various laboratories were evaluated in the context of an international interlaboratory proficiency trial. A panel of standardized samples comprising five sera and five milk samples was sent to veterinary diagnostic laboratories (n=51) and test kit manufacturers (n=3).

Results
The ring trial sample panel was investigated by nine commercially available antibody ELISAs as well as by neutralization tests against diverse BVDV-1, BVDV-2 and/or border disease virus (BDV) strains. The negative serum and milk sample as well as a serum collected after BVDV-2 infection were mostly correctly tested regardless of the applied test system. A serum sample obtained from an animal immunized with an inactivated BVDV-1 vaccine tested positive by neutralization tests or by total antibody or Erns-based ELISAs, while all applied NS3-based ELISAs gave negative results. A further serum, containing antibodies against the ovine BDV, reacted positive in all applied BVDV ELISAs, a differentiation between anti-BDV and anti-BVDV antibodies was only enabled by parallel application of neutralization tests against BVDV and BDV isolates. For the BVDV antibody-positive milk samples (n=4), which mimicked prevalences of 20% (n=2) or 50% (n=2), considerable differences in the number of positive results were observed, which mainly depended on the ELISA kit and the sample incubation protocols used. These 4 milk samples tested negative in 43.6%, 50.9%, 3.6% and 56.4%, respectively, of all investigations. Overall, negative results occurred more often, when a short sample incubation protocol instead of an over-night protocol was applied.

Conclusions
While the seronegative samples were correctly evaluated in most cases, there were considerable differences in the number of correct evaluations for the seropositive samples, most notably when pooled milk samples were tested. Hence, thorough validation and careful selection of ELISA tests are necessary, especially when applied during surveillance programs in BVD-free regions.
A deep learning-based approach for the diagnosis of adrenal adenoma: a new trial using CT
Authors: Kusunoki Masaoki , Nakayama Tomohiro , Nishie Akihiro , Yamashita Yasuo , Kikuchi Kazufumi , Eto Masatoshi , Oda Yoshinao , Ishigami Kousei 
Published: May 2022

Objective: To develop and validate deep convolutional neural network (DCNN) models for the diagnosis of adrenal adenoma (AA) using CT. Methods: This retrospective study enrolled 112 patients who underwent abdominal CT (non-contrast, early, and delayed phases) with 107 adrenal lesions (83 AAs and 24 non-AAs) confirmed pathologically and with 8 lesions confirmed by follow-up as metastatic carcinomas. Three patients had adrenal lesions on both sides. We constructed six DCNN models from six types of input images for comparison: non-contrast images only (Model A), delayed phase images only (Model B), three phasic images merged into a 3-channel (Model C), relative washout rate (RWR) image maps only (Model D), non-contrast and RWR maps merged into a 2-channel (Model E), and delayed phase and RWR maps merged into a 2-channel (Model F). These input images were prepared manually with cropping and registration of CT images. Each DCNN model with six convolutional layers was trained with data augmentation and hyperparameter tuning. The optimal threshold values for binary classification were determined from the receiver-operating characteristic curve analyses. We adopted the nested cross-validation method, in which the outer fivefold cross-validation was used to assess the diagnostic performance of the models and the inner fivefold cross-validation was used to tune hyperparameters of the models. Results: The areas under the curve with 95% confidence intervals of Models A–F were 0.94 [0.90, 0.98], 0.80 [0.69, 0.89], 0.97 [0.94, 1.00], 0.92 [0.85, 0.97], 0.99 [0.97, 1.00] and 0.94 [0.86, 0.99], respectively. Model E showed high area under the curve greater than 0.95. Conclusion: DCNN models may be a useful tool for the diagnosis of AA using CT. Advances in knowledge: The current study demonstrates a deep learning-based approach could differentiate adrenal adenoma from non-adenoma using multiphasic CT.
Incontinence in palliative care: assessment to promote dignity
Authors: Jackson Debra 
Published: May 2022

This article will explore the district nurse (DN) role in caring for palliative service users and their responsibility to prepare them and their family members to understand the trajectory of their prognosis and the possible decline in urinary function and incontinence. Educating DNs to advise service users in appropriate management options and collaborating with the wider multidisciplinary team (MDT) to ensure service users' individual goals and aims are followed as closely as possible. Urinary incontinence (UI) is not a natural part of the ageing process, although the prevalence of UI is increased as people age, through multi-morbidities, polypharmacy, cognitive decline, mobility limitations or life-limiting conditions. UI affects an individual's dignity and can cause a negative impact on self-esteem, and it is often accompanied by a perceived stigma that can lead to anxiety, depression and a reluctance to ask for help and advice.
The mass knee clinic: a cost–benefit analysis
Authors: Li Lily , Ganippa Haddon Paul Lionel , Nathwani Dinesh , Bhattacharya Rajarshi 
Published: May 2022

Background/Aims Many trusts struggle to meet the government-mandated referral-to-treatment target of 18 weeks. The mass knee clinic model is an innovative approach to elective service organisation, allowing large numbers of new patients to be seen in one day in a multidisciplinary setting. This study describes a cost–benefit analysis of the mass knee clinic in an NHS trust. Methods Data were taken from trust management regarding the number of patients seen in the clinic and the staff required to deliver it. Staff and non-staff costs were calculated using data from NHS England. The costs per appointment were calculated and the average number of patient visits required were compared to data from before the implementation of the clinic to find the associated cost savings. Results The average cost per appointment at the mass knee clinic was £98.52, with an average of 152.64 patients seen per clinic day. The mean number of patient visits required fell from 4.57 to 2.41 following the implementation of the clinic. Overall, the clinic can produce cost savings £29 335.43 per clinic day and £264 018.89 per year. Conclusions The mass knee clinic model can produce substantial cost savings and increase efficiency, allowing better management of waiting times and reducing reliance on outsourcing.
Assessing media mergers and acquisitions: The power pyramids of regulatory cooperation
Authors: Afilipoaie Adelaida , Ranaivoson Heritiana 
Published: May 2022

Due to the media goods’ dual economic and cultural role, merger and acquisition (M&A) assessments are complex and differ from M&As in other sectors. An additional layer of complexity is added to the assessment when various authorities are involved. An even more complicated matter is when the authorities have different remits. These authorities mostly comprise National Competition Authorities that enforce competition law, focused on economic considerations, and National Regulatory Authorities that enforce and oversee the application of media law, focused not only on setting rules and limitations on the media market but also on considering non-economic elements such as plurality. In certain countries, ministries and government authorities can intervene in these assessments.
There have been discussions on the need for cooperation between authorities, however, mostly at the international level. Thus, little is known about the current cooperation procedures at the national level. The article proposes a typology of cooperation at the EU member states level and the United Kingdom and introduces the concept of the ‘power pyramid’ to represent the hierarchical relationships between authorities. Cooperation proves that competition policy and media-specific regulation are intertwined and are complementary. Furthermore, the article shows that having more than one authority assessing media M&As leads to media pluralism being more often explicitly one of the criteria used in the assessments, and thus providing a more holistic approach.
Digital Transformation of the Silk Industry of Assam
Authors: Hazarika Indrani 
Published: May 2022

The case study on the silk industry of Assam gives an overview of the industry, background, production process and highlights the key issues, which the industry is currently facing. In order to ensure strategic success, the traditional silk industry will have to effectively cope up with the digitalization challenge in the market for customer discovery. The raw material is locally available but limited in supply and there is no alternative source to cater the needs of the weavers. Therefore, the weavers are bound to pay high prices of raw materials. Though the cost of raw material is increasing, the weavers cannot increase the price of the products due to availability of cheap synthetic silk in the market and, they are compelled to compromise with the profit margin of the product. The entire silk industry of Assam is passing through a stagnation period not only because of the financial crisis but also due to rising prices and dearth of raw materials. This has resulted in aggravating the losses of the silk industry, as the weavers have to sell the products at the older price while procuring the raw material at the newly fixed price. The existing silk industry of Assam should go for complete digitalization through interconnected ecosystem, disrupt, and reshape the existing industry by identifying the technology associated with the business process and aligning with the business strategy. A digital culture needs to be fostered in the entire industry