bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intermediate-term results and risk factors analysis of tumor endoprosthesis in paediatric patients after the resection of lower extremity bone sarcoma
Authors: Moses Li Man Lung , Wong Kwok Chuen , Chiu Wang Kei , Kumta Shekhar-madhukar 
Published: October 2022

Background Mechanical failure of the endoprostheses is a concern in paediatric patients with primary bone sarcoma. Their long-term results are variable in the Asian population, thus we aim to investigate the outcome by assessing the mechanical failure, its risk factors and the functional results. Methods We retrospectively reviewed 38 paediatric patients (mean 13.29, range 6–18) with primary bone sarcoma of lower extremity undergone chemotherapy and limb salvage surgery with tumor endoprosthesis between 2003 and 2016. All hospital notes were reviewed for any type of failures. Risk factors for implant loosening like stem size, remaining bone length, stem length, extracortical bone bridge ingrowth (EBBI), the ratio of resected bone length to whole bone length, bone stem ratio and custom-made versus modular were analyzed. The limb function was recorded by Musculoskeletal Tumor Society (MSTS) score. Median follow-up time was 7.42 years (3.0–15.4 years) and minimum follow-up for surviving patients was 2 years. Results Endoprosthesis survivorship, according to Kaplan Meier was 94.7%, 85.4% and 66.2% at 2, 5 and 10 years respectively. Type II failure occurred in three patients (7.9%). Type III failure occurred in four patients (10.5%). Type IV failure occured in two patients (5.2%). Only EBBI independently predicted implant loosening ( p = .007). Risk factors like stem size, remaining bone length, stem length, the ratio of resected bone length to whole bone length and custom-made versus modular were not associated with increase in implant loosening ( p > .05). The mean stem size was 9.41 mm in asymptomatic group, comparable with 9.22 mm in the failure group ( p = .79). The MSTS score was 29.62. Conclusions Our data suggests that paediatric Chinese patients with small body built had good and excellent mid-term results in implant survival and limb function respectively. EBBI is important in preventing loosening in tumor endoprosthesis. In contrast to the reported higher failure risk with stem size <12 mm, we found no increased loosening rate with smaller stem size endoprosthesis. Level of evidence Class III
The Impact of Cultural Embeddedness on the Implementation of an Artificial Intelligence Program at Triage: A Qualitative Study
Authors: Jordan Michael , Hauser Jacob , Cota Stephanie , Li Hong , Wolf Lisa 
Published: October 2022

Introduction: Triage requires rapid determination of acuity and resources. Current modalities allow for individual judgment, with varied application of algorithmic rules. Although artificial intelligence can improve triage accuracy, gaps remain in understanding implementation facilitators and barriers, especially those related to the cultural understandings by nurses of emergency department presentations. The purpose of this study was to explore the cultural and technological elements of the implementation of an artificial intelligence clinical decision support aid (i.e., KATE) in an emergency nursing triage process in an urban community hospital on the West Coast of the United States. Method: An exploratory qualitative study using semi-structured small group and individual interviews and constant comparison analysis strategies. The sample comprised 13 emergency department triage nurses at one site. Campinha-Bacote’s theory of cultural competence framed the study. Results: Responses yielded the overall theme of We know these people and we know these things. Supporting categories included the problem of aire; just another checkbox; gut trumps data; higher acuity with no resources; and technology as a safety net. Participants reported reliance on clinical experience and cultural knowledge to assign acuity. Discussion: The implementation of an artificial intelligence program was initially received skeptically due to the acontextual nature of AI, but grew to be perceived as a safety net for triage decision making among emergency nurses.
Predicted mean vote model for thermal comfort evaluation of pregnant women considering the effects of metabolic rate
Authors: Wu Weilan , Fang Zhaosong , Ji Xiangfei , Zheng Zhimin 
Published: October 2022

In this study, on-site measurements of the summer air-conditioning environment in obstetric clinics of six hospitals in Guangzhou, China, and subjective questionnaire surveys of pregnant women regarding hot and humid environments were carried out. A total of 723 valid questionnaires were obtained. In order to determine the appropriate metabolic rate, three methods were used in this study to obtain three different metabolic rate values, including ASHRAE 55-2020 for healthy adults in a sedentary state 1.0 met, pregnant women after 5 months of pregnancy 1.2 met based on medical tests and the resting metabolic rate of pregnant women 0.66 met. Linear fitting was performed with three predicted mean votes (PMVs) and thermal sensation vote (TSV). The mean TSV (MTSV) and PMV models were established to estimate the actual thermal neutral value (25.3°C) and the predicted thermal neutral value (26.1°C) for pregnant women. The PMV model for pregnant women was linearly corrected, and the corrected PMV model coincided with the actual thermal sensory MTSV model. The corrected PMV estimate was 0.60 PMV + 0.17, and the corrected thermal neutral estimate was 25.3°C. Finally, a simplified model of the relationship between the PMV for pregnant women and the relative humidity, mean radiant temperature, wind speed and air temperature was obtained.
Tidal volume expandability affected by flow, dynamic hyperinflation, and quasi-fixed inspiratory time in patients with COPD and healthy individuals
Authors: Chuang Ming-Lung 
Published: October 2022

Exertional dyspnea (ED) and impaired exercise performance (EP) are mainly caused by dynamic hyperinflation (DH) in chronic obstructive pulmonary disease (COPD) patients by constraining tidal volume expansion at peak exercise (VTpeak). As VTpeak is the product of inspiratory time (TIpeak) and flow (VT/TIpeak), it was hypothesized that VTpeak and VTpeak/total lung capacity (VTpeak/TLC) may be affected by TIpeak and VT/TIpeak. Hence, the study investigated the (1) effect of TIpeak and VT/TIpeak on VTpeak expansion, (2) factors associated with TIpeak, expiratory time (TEpeak), VT/TIpeak, and VTpeak/TLC, and (3) relationships between VT/TIpeak and VTpeak/TLC with ED and EP in COPD patients and controls. The study enrolled 126 male stable COPD patients and 33 sex-matched controls. At peak exercise, TIpeak was similar in all subjects (COPD versus controls, mean ± SD: 0.78 ± 0.17 s versus 0.81 ± 0.20 s, p = NS), whereas the COPD group had lower VT/TIpeak (1.71 ± 0.49 L/s versus 2.58 ± 0.69 L/s, p < .0001) and thus the COPD group had smaller VTpeak (1.31 ± 0.34 L versus 2.01 ± 0.45 L, p < .0001) and VTpeak/TLC (0.22 ± 0.06 vs 0.33 ± 0.05, p < .0001). TIpeak, TEpeak, and VT/TIpeak were mainly affected by exercise effort, whereas VTpeak/TLC was not. TEpeak, VT/TIpeak, and VTpeak/TLC were inversely changed by impaired lung function. TIpeak was not affected by lung function. Dynamic hyperinflation did not occur in the controls, however, VTpeak/TLC was strongly inversely related to DH (r = −0.79) and moderately to strongly related to lung function, ED, and EP in the COPD group. There was a slightly stronger correlation between VTpeak/TLC with ED and EP than VT/TIpeak in the COPD group (|r| = 0.55–0.56 vs 0.38–0.43). In summary, TIpeak was similar in both groups and the key to understanding how flow affects lung expansion. However, the DH volume effect was more important than the flow effect on ED and EP in the COPD group.
Functional Connectivity in Patients With Parkinson’s Disease and Freezing of Gait Using Resting-State EEG and Graph Theory
Authors: Bosch Taylor J. , Espinoza Arturo I. , Mancini Martina , Horak Fay B. , Singh Arun 
Published: October 2022

Background Although many studies have shown abnormalities in brain structure and function in people with Parkinson’s disease (PD), we still have a poor understanding of how brain structure and function relates to freezing of gait (FOG). Graph theory analysis of electroencephalography (EEG) can explore the relationship between brain network structure and gait function in PD. Methods Scalp EEG signals of 83 PD (42 PDFOG+ and 41 PDFOG−) and 42 healthy controls were recorded in an eyes-opened resting-state. The phase lag index was calculated for each electrode pair in different frequency bands, but we focused our analysis on the theta-band and performed global analyses along with nodal analyses over a midfrontal channel. The resulting connectivity matrices were converted to weighted graphs, whose structure was characterized using strength and clustering coefficient measurements, our main outcomes. Results We observed increased global strength and increased global clustering coefficient in people with PD compared to healthy controls in the theta-band, though no differences were observed in midfrontal nodal strength and midfrontal clustering coefficient. Furthermore, no differences in global nor midfrontal nodal strength nor global clustering coefficients were observed between PDFOG+ and PDFOG− in the theta-band. However, PDFOG+ exhibited a significantly diminished midfrontal nodal clustering coefficient in the theta-band compared to PDFOG−. Furthermore, FOG scores were negatively correlated with midfrontal nodal clustering coefficient in the theta-band. Conclusion The present findings support the involvement of midfrontal theta oscillations in FOG symptoms in PD and the sensitivity of graph metrics to characterize functional networks in PDFOG+.
Machine learning prediction of symptomatic intracerebral hemorrhage after stroke thrombolysis: a cross-cultural validation in Caucasian and Han Chinese cohort
Authors: Liu Junfeng , Chen Xinyue , Guo Xiaonan , Xu Renjie , Wang Yanan , Liu Ming 
Published: October 2022

Background: Previous studies found that Asians seemed to have higher risk of HT after thrombolysis than Caucasians due to its race differences in genetic polymorphism. Whether the model developed by Caucasians could predict risk of symptomatic intracerebral hemorrhage (sICH) in Asians was unknown. Objectives: To develop a machine learning–based model for predicting sICH after stroke thrombolysis in Caucasians and externally validate it in an independent Han Chinese cohort. Design: The derivation Caucasian sample included 1738 ischemic stroke (IS) patients from the Virtual International Stroke Trials Archive (VISTA) data set, and the external validation Han Chinese cohort included 296 IS patients who were treated with intravenous thrombolysis. Methods: Twenty-eight variables were collected across both samples. According to their properties, we classified them into six distinct clusters (ie, demographic variables, medical history, previous medication, baseline blood biomarkers, neuroimaging markers on initial CT scan and clinical characteristics). A support vector machine (SVM) model, which consisted of data processing, model training, testing and a 10-fold cross-validation, was developed to predict the risk of sICH after stroke thrombolysis. The receiving operating characteristic (ROC) was used to assess the prediction performance of the SVM model. A domain contribution analysis was then performed to test which cluster had the highest influence on the performance of the model. Results: In total, 85 (4.9%) patients developed sICH in the Caucasians, and 29 (9.8%) patients developed sICH in the Han Chinese cohort. Eight features including age, NIHSS score, SBP (systolic blood pressure), DBP (diastolic blood pressure), ALP (alkaline phosphatase), ALT (alanine transaminase), glucose, and creatine level were included in the final model, all of which were from demographic, clinical characteristics, and blood biomarkers clusters, respectively. The SVM model showed a good predictive performance in both Caucasians (AUC = 0.87) and Han Chinese patients (AUC = 0.74). Domain contribution analysis showed that inclusion/exclusion of clinical characteristic cluster (NIHSS score, SBP, and DBP), had the highest influence on the performance of predicting sICH in both Caucasian and Han Chinese cohorts. Conclusion: The established SVM model is feasible for predicting the risk of sICH after thrombolysis quickly and efficiently in both Caucasian and Han Chinese cohort.
Non-emergent Conditions of the Ankle, Hindfoot, and Midfoot in Elderly Patients Are as Mobility Limiting as Congestive Heart Failure
Authors: Manz Wesley J. , Nash Amalie E. , Novak Jack , Fink Juliet , Kadakia Rishin , Coleman Michelle M. , Bariteau Jason T. 
Published: October 2022

Background Mobility limitations are well linked to increased morbidity and mortality. Older patients with chronic pathologies of the foot and ankle can suffer from significant mobility limitations; however, the magnitude of limitation experienced by this cohort is not well characterized. Conversely, the effects of congestive heart failure (CHF) on patient mobility are routinely assessed via the New York Heart Association (NYHA) classification. New York Heart Association classification is determined by a patient’s physical activity limitation and is strongly correlated to functional status. We hypothesized that non-emergent conditions of the foot and ankle would be as mobility limiting as CHF. Methods Life-Space Mobility Assessments (LSAs) were prospectively collected from orthopaedic patients at their preoperative visits and from CHF patients at a cardiology clinic. Patients over the age of 50 years were included in this study. Congestive heart failure patients NYHA class II or greater were included. The non-emergent foot and ankle cohort included Achilles tendonitis, ankle joint cartilage defects, ankle arthritis, subtalar arthritis, and midfoot arthritis. Patient demographics and LSA scores were analyzed using Mann-Whitney U and chi-squared tests. Results A total of 96 elderly, non-emergent foot and ankle operative patients and 45 CHF patients met inclusion criteria. All medical comorbidities, except smoking status, were significantly more prevalent in the CHF cohort. No statistical difference was observed between CHF and preoperative foot and ankle LSA scores (56.1 vs 62.4, P = .320). Life-Space Mobility Assessment scores in the foot and ankle cohort were significantly improved relative to CHF patients, at 6-month and 1-year postoperative visits (P = .028, P < .0001, respectively). Conclusion Non-emergent ankle, hindfoot, and midfoot pathology is associated with similar mobility limitation to that of NYHA class II and III CHF. Older patients undergoing elective foot and ankle procedures exceeded the mobility of CHF patients at 6 months post-operation, and the mobility gains persisted at 1-year post-operation. Levels of Evidence: Level II: Prospective cohort study
Effect of long-acting injectable antipsychotics on hospitalizations and global functioning in schizophrenia: a naturalistic mirror-image study
Authors: Montemagni Cristiana , Del Favero Elisa , Cocuzza Elena , Vischia Flavio , Rocca Paola 
Published: October 2022

Background: Partial adherence to antipsychotics is the most common cause of relapses and rehospitalization in patients with schizophrenia (SZ), leading to higher health care costs and psychosocial disability. The use of long-acting injectable (LAI) antipsychotics may improve therapeutic continuity and adherence to treatment. Objective: To assess the effectiveness of switching from oral antipsychotics (OAs) to long-acting antipsychotics. Methods: This 1-year mirror-image study evaluated the effect of switching from OAs to LAIs on the reduction of psychiatric hospitalizations and the improvement of global functioning in patients with schizophrenia. Differences in outcomes between second-generation (SGA) LAIs and first-generation (FGA) LAIs were also analyzed. Results: In all, 166 patients were included: 32.5% treated by FGA-LAIs and 67.5% by SGA-LAIs. There was an overall reduction of 71% in the average number of hospital admissions and an overall improvement of 29.3% in the Global Assessment of Functioning (GAF) score between the previous 12 months and the 12 months following the switching to LAIs. Patients who switched to SGA-LAIs had no significant differences in hospitalization occurrences but a significant improvement in GAF scores when compared with patients who switched to FGA-LAIs. Conclusion: Our results suggest that using LAIs could be the most adequate treatment choice for SZ patients with a high risk of relapse and low adherence rate. Patients with poorer social functioning may be ideal candidates for SGA-LAIs treatment. Our findings may be of particular interest from a clinical and health care management perspective.
A survey of local diagnostic reference levels for the head, thorax, abdomen and pelvis computed tomography in Norway and Canada
Authors: Tonkopi Elena , Wikan Eline Jahre , Hovland Tor Olav , Høgset Sivert , Kofod Thomas Alexander , Sefenu Selasi K , Hughes-Ryan Emily , d´Entremont-O´Connell Dakota , Gunn Catherine , Holter Tanja , Johansen Safora 
Published: October 2022

Background Computed tomography (CT) contributes to 60% of the collective dose in medical imaging. Literature has demonstrated that patient dose varies across regions and countries. Establishing diagnostic reference levels (DRLs) contributes to the optimization of clinical practices and radiation protection. Purpose To survey the dose indices (CTDIvol and dose-length product) for frequently performed CT examinations from the chosen hospitals in Norway and Canada and to determine local DRLs (LDRLs) based on the collected data. Material and Methods The survey included eight scanners from two Norwegian hospitals and four scanners from four Canadian hospitals. Dosimetry data were collected for the following routine CT examinations: head, contrast-enhanced thorax, and abdomen and pelvis. Overall 480 adult average-sized patients from Norway and 360 from Canada were included in the survey. The LDRLs were determined as the 75th percentile of distributions of median values of dose indicators from different CT scanners. The differences in dose between scanners were determined using single-factor ANOVA. Results The LDRLs determined in Norway were higher overall than in Canada. The obtained values were compared to the national DRLs. The dose from several scanners in Norway exceeded national Norwegian DRLs, while Canadian LDRLs were below the Canadian reference levels. The differences between the means of the dose distributions from each scanner were statistically significant ( p < 0.05) for all examinations with exception of identical scanners located in the same hospital and using the same protocols. Conclusion Observed dose variations even in the same hospital, or from the same scanner model confirmed the need for CT protocol optimization.
Integrating a Patient Decision Aid into the Electronic Health Record: A Case Report on the Implementation of BREASTChoice at 2 Sites
Authors: Lee Clara N. , Sullivan Janessa , Foraker Randi , Myckatyn Terence M. , Olsen Margaret A. , Phommasathit Crystal , Boateng Jessica , Parrish Katelyn L. , Rizer Milisa , Huerta Tim , Politi Mary C. 
Published: October 2022

Patient decision aids can support shared decision making and improve decision quality. However, decision aids are not widely used in clinical practice due to multiple barriers. Integrating patient decision aids into the electronic health record (EHR) can increase their use by making them more clinically relevant, personalized, and actionable. In this article, we describe the procedures and considerations for integrating a patient decision aid into the EHR, based on the example of BREASTChoice, a decision aid for breast reconstruction after mastectomy. BREASTChoice’s unique features include 1) personalized risk prediction using clinical data from the EHR, 2) clinician- and patient-facing components, and 3) an interactive format. Integrating a decision aid with patient- and clinician-facing components plus interactive sections presents unique deployment issues. Based on this experience, we outline 5 key implementation recommendations: 1) engage all relevant stakeholders, including patients, clinicians, and informatics experts; 2) explicitly and continually map all persons and processes; 3) actively seek out pertinent institutional policies and procedures; 4) plan for integration to take longer than development of a stand-alone decision aid or one with static components; and 5) transfer knowledge about the software programming from one institution to another but expect local and context-specific changes. Integration of patient decision aids into the EHR is feasible and scalable but requires preparation for specific challenges and a flexible mindset focused on implementation. Highlights Integrating an interactive decision aid with patient- and clinician-facing components into the electronic health record could advance shared decision making but presents unique implementation challenges. We successfully integrated a decision aid for breast reconstruction after mastectomy called BREASTChoice into the electronic health record. Based on this experience, we offer these implementation recommendations: 1) engage relevant stakeholders, 2) explicitly and continually map persons and processes, 3) seek out institutional policies and procedures, 4) plan for it to take longer than for a stand-alone decision aid, and 5) transfer software programming from one site to another but expect local changes.