bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time Trends in Episiotomy and Severe Perineal Tears in Portugal: A Nationwide Register-based Study
Authors: Teixeira Cristina , Lorthe Elsa , Barros Henrique 
Published: August 2022

Abstract
Introduction: Rates of episiotomy and severe perineal tears (SPT) are indicators of the quality of obstetric care. Time-trends in the reported occurrence of episiotomy and SPT can contribute to understand both, changes in care and in the frequency of risk factors. Therefore, the aim of this research was to estimate time trends in the frequency of SPT in Portugal and its relationship with episiotomy. Methods: Nationwide register-based study by using data on singleton vaginal deliveries from the national inpatient database of all Portuguese public hospitals between 2000 and 2015. Time-trend analysis using joinpoint regression models was performed to identify trends (joinpoints) and compare time changes in the prevalence of SPT and risk factors expressed as annual percentage change (APC) with 95% Confidence Interval (95% CI). Poisson regression models were fitted to know whether time-trends in SPT rates were explained by changes in risk factors and to assess the association between episiotomy and SPT. Adjusted relative risk (RR) and respective 95% CI were obtained.Results: From 908 999 singleton vaginal deliveries, 20.6% were instrumental deliveries, 76.7% with episiotomy and 0.56% were complicated by SPT. SPT decreased among women with non-instrumental deliveries and no episiotomy from 2009 onwards (1.3% to 0.7%), whereas SPT kept increasing in women with episiotomy for both non-instrumental (0.1% in 2000 to 0.4% in 2015) and instrumental deliveries (0.7% in 2005 to 2.3% in 2015). Episiotomy was associated with a decrease in SPT with adjusted RR varying between 2000 and 2015 from 0.18 (95%CI:0.13-0.25) to 0.59 (95%CI:0.44-0.79) for non-instrumental deliveries and from 0.45 (95%CI:0.25-0.81) to 0.50 (95%CI:0.40-0.72) for instrumental deliveries. Conclusions: Episiotomy rate could safely further decrease as the main factor driving SPT rates seems to be an increase in awareness and reporting of SPT particularly among women who underwent an episiotomy.
Sleep Movements and Respiratory Coupling as a Biobehavioral Marker for Early Alzheimer’s Disease in Independently Dwelling Adults
Authors: Khosroazad Somayeh , Gilbert Christopher , Aronis Jessica A. , Daigle Katrina M. , Esfahani Masoumeh , Almaghasilah Ahmed , Elias Merrill F. , Meuser Thomas M. , Kaye Lenard , Singer Clifford M. , Abedi Ali , Hayes Marie J. , Ahmed Fayeza S. 
Published: August 2022

Abstract
INTRODUCTION: Sleep disorder is often the first symptom of age-related cognitive decline in Mild Cognitive Impairment (MCI), or early Alzheimer’s disease. Patient or family sleep complaints in primary care do not reliably lead to screening for sleep or cognitive loss. In this study, poor sleep and arousability were examined using movement arousals, a novel biobehavioral marker of cumulative sleep loss, identified by periodic (circa 4 min) sleep movements (SM). We report that SM events trigger respiratory upregulation (RR) in healthy, but not in MCI-related, sleep. Time latency (TL) between SM-RR events is proposed as a marker of sleep loss and potentially of neurodegeneration associated with cognitive loss in MCI.METHOD. Community-dwelling older adults (N=95; 62-90 years) were tested in the home bed for two days on an “under the sheets” mattress overlay with high sensitivity for respiration and all movement, including micro-movements of SM. Wrist actigraphy (7 days) and standard sleep self-reports were collected as well. A suite of neurocognitive testing identified three groups: Normal Cognition (NC; n=45); clinic diagnosed MCI (MCI-DX; n= 17); and MCI-Consensus determined by an expert panel (MCI-CON; n=33 consensus or pre-clinical MCI) groups.RESULTS: In adjusted cohort analyses, sleep fragmentation (SF) and WASO predicted poorer memory performance selectively. Actigraphy revealed greater sleep latency (SL; p<.008), sleep duration (p<.01) and SF (p=.008) in MCI-DX compared to NC groups. Longer SL and poor sleep were associated with depression which was more prevalent in both MCI groups than NC. Neural Networks AI methods were applied to discriminate MCI and NC cases using the TL metric between SM-RR coupling events. ROC diagnostics were applied which identified MCI vs. NC cases with 87% sensitivity; 89% specificity; and 88% positive predictive value. DISCUSSION: MCI cognitive phenotype was detected with a novel sleep biomarker TL, associated with the tight gap between SM-RR coupling, which is proposed as a corollary of sleep quality/loss that affects the autonomic regulation of respiration during sleep. Movement arousals are less effective in initiating respiratory upregulation in MCI which suggests a potential mechanism for neurodegenerative changes and cognitive loss in early MCI.
Chronic heart failure hampers regulatory T cell homeostasis which is not restored by cardiac resynchronization therapy
Authors: Martins Silvia , António Natália , Carvalheiro Tiago , Laranjeira Paula , Rodrigues Ricardo , Gonçalves Lino , Tomaz Cândida , Paiva Artur 
Published: August 2022

Abstract
Background: T cells have been implicated in the development and progression of inflammatory process in chronic heart failure (CHF). Cardiac resynchronization therapy (CRT) has beneficial effects on symptoms and cardiac remodeling in CHF. However, its impact on the inflammatory immune response remains controversial. We aimed to study the impact of CRT on T cells in heart failure patients (HFP). Methods: Thirty-nine HFP were evaluated before CRT (T0) and 6 months later (T6). Quantification of T cells, their subsets, and their functional characterization, after in vitro stimulation, were evaluated by flow cytometry. Results: T regulatory (Treg) cells were decreased in CHF patients (healthy group (HG): 1.08±0.50 versus HFP-T0: 0.69±0.40, P=0.022) and remaining diminished after CRT (HFP-T6: 0.61±0.29, P=0.003). Responders (R) to CRT presented a higher frequency of T cytotoxic (Tc) cells producing IL-2 at T0 compared with non-responders (NR) (R: 36.52±12.55 versus NR: 24.71±11.66, P=0.006). After CRT, HFP presented a higher percentage of Tc cells expressing TNF-α and IFN-γ (HG: 44.50±16.62 versus R: 61.47±20.54, P=0.014; and HG: 40.62±15.36 versus R: 52.39±18.66, P=0.049, respectively). Conclusion: The dynamic of different functional T cell subpopulations is significantly altered in CHF, which results in an exacerbated pro-inflammatory response, which could be due, at least in part, to the inability of CRT to restore Treg cells levels or inhibit Tc1 cell-mediated pro-inflammatory pathway.Trial registration: Retrospectively registered.
A Focus Module based Lightweight End-to-End CNN framework for Voiceprint Recognition
Authors: Velayuthapandian Karthikeyan , S Suja Priyadharsini 
Published: August 2022

Abstract
Speaker identification is a recognition problem that entails identifying a spokesperson from a set of consecutive time-series information. Because voice is a continuous one-dimensional time-stream, the majority of recent experimental techniques use convolutional neural networks (CNNs) or deep neural networks (DNNs). Because of the spectrogram in audio, the spatial attributes of utterances (which correlates to the speech spectra) and CNN are appropriate for spatial characteristic extraction. Simultaneously, the signal is time-series data, and DNN can better capture extended speeches than deep models. This work presents a DNN model for speaker identification using a jump-connected one-dimensional convolutional neural network (1-D CNN) with a focus module (FM). The 1-D convolutional layer integrated with FM is employed in the presented model for speaker characteristic extraction and lessens heterogeneity in the temporal and spatial domains, allowing for quicker layer processing. Furthermore, the layered CNN hopping interconnection is employed to overcome the connectivity glitches, and a solution based on softmax loss and smooth L1-norm combined regulation is presented to increase efficiency. The ELSDSR, TIMIT, NIST, 16000PCM, and experimental audio datasets were used to test the suggested network model. The Equal Error Rate (EER) of end-to-end CNN for voiceprint identification is enhanced by 9.02% when assessed to baseline approaches, according to the experimental data. Our proposed DNN model, which we term the deep FM-1D CNN, had a high recognition accuracy of 99.21 percent in the experiments. At the same time, the observations show that the suggested network model outperforms other models in terms of robustness. This method could be used for other types of research, such as language modelling, with further optimization.
The Localization, development and validation of a survey instrument to assess attitudes toward professionalism based on the opinions of clinical teachers
Authors: hosseinizadeh Adeleh , Shakour Mahsa , Afshar Leila 
Published: August 2022

Abstract
Background: This study examined the validation of a survey instrument to assess attitudes toward professionalism based on the opinions of clinical teachers in Iran and localized it.Methods: The research is applied-descriptive, that is conducted in two stages: qualitative and quantitative. Fifteen expert professors in the field of professionalism from Iranian universities of medical sciences participated in qualitative stage by Delphi. sampling method was purposive. In the quantitative stage, using simple and quota sampling method, 82 samples were collected from all clinical professors of first ranked universities of medical sciences. We used “The Penn State College of Medicine Professionalism Questionnaire” as a basic questionnaire. Its validity assessed by Delphi and survey. Some items changed, deleted and added. Then it confirmed by confirmatory factor analysis.Data analysis was performed using one-sample t-test and SmartPLS software. Results: 7 dimensions and 48 final indicators were approved and all 7 dimensions were in good condition. Among the approved dimensions, “the enrichment” with a factor load of 0.238, was the biggest factor in measuring the variable of professionalism. The dimensions of “respect”, “responsibility”, “altruism”, “duty”, “honor, honesty and justice”, “respectively” with factor loads of 0.215, 0.212, 0.163, 0.146, 0.106 and 0.047 are ranked in order.
Indian Ocean influence on the ENSO-monsoon teleconnection is mostly apparent
Authors: Bódai Tamás , Aneesh Sundaresan , Lee June-Yi , Lee Sun-Seon 
Published: August 2022

Abstract
“Decadal influence” on the El Nino–Southern Oscillation-Indian summer monsoon (ENSO-ISM) teleconnection has been much studied but with plurality and ambiguity about the concept of influence. Here we provide formal definitions of the apparent influence of a specific factor which enable us to test them as null-hypotheses. Using the recently released Community Earth System Model v2 (CESM2) Large Ensemble (LE) data, we show that a 50% chance for the detection of the apparent Indian Ocean (IO) influence under stationary conditions might take 2000 years of data. However, we find that this influence is mostly apparent indeed, as it originates from fluctuations of the decadal apparent – as opposed to climatological – ENSO variability, which causally influences an IO dipole-like apparent mean state. We also show that no unattributed so-called “decadal influence”, reflected in a deviation from a linear regression model of the teleconnection as a null-hypothesis, can be detected in 20th c. observations even regionally. However, as a new insight, we find our new influence concept to be possibly consistent with such a null-hypothesis.
Size-specific Dose Estimate for Lower-limb CT
Authors: Kobayashi Masanao , Nishihara Yusei , Haba Tomonobu , Matsunaga Yuta , Asada Yasuki , Kobayashi Shigeki 
Published: August 2022

Abstract
The Computed Tomography Dose Index (CTDI) is an indicator for dose management in computed tomography (CT), but has limited use for patient dosimetry. To evaluate the patient dose, the size-specific dose estimate (SSDE), reported by the American Association of Physics in Medicine task groups 204, 220, and 293, must be calculated by the CTDIvol(z) displayed on the CT console and the conversion factor f(D(z)) from the effective diameter (DEff) or water equivalent diameter (Dw). However, no reports have verified the appropriateness of using the 320-mm diameter phantom for dose assessment in CT examinations involving the lower limbs. Therefore, we validated a new method for evaluating the SSDE(z) of the lower limbs, using two 160-mm diameter phantoms instead of the 320-mm diameter phantom. The CTDIvol(z) obtained from Monte Carlo (MC) simulation study was reliable because they were almost the same as obtained in a dosimetry study. The conversion factor f (D (zl.l.)) for the lower limbs was evaluated based on the CTDIvol(z) obtained by MC simulation performed using two polymethyl methacrylate cylinder phantoms of 160-mm diameter. The MC simulation was performed by the International Commission on Radiological Protection publication 135 reference adult phantom and was used to evaluate the absorbed dose of the pelvis, lower limbs, knees, and ankles. The dose showing the greatest difference was the lower limbs, which was 8.3 mGy (16%) lower than the absorbed dose. Thus, the SSDE (zl.l.) could be estimated from the \({\text{C}\text{T}\text{D}\text{I}}_{\text{v}\text{o}\text{l}}^{320}\left(\text{z}\right)\) displayed on the CT scanner console.
Synthesis of axially silicon phthalocyanine substituted with bis- (3,4-dimethoxyphenethoxy) groups and energy features, charge density analysis and molecular docking studies
Authors: Solgun Derya Gungordu , Tanriverdi Aslihan Aycan , Yildiko Umit , Ağırtaş Mehmet Salih 
Published: August 2022

Abstract
Axially bis-substituted silicon phthalocyanine was synthesized from the reaction of 2-(3,4-dimethoxy phenyl) ethanol and SiPcCl2. The structure of the compound was justified by FT-IR, 1H NMR, 13C NMR, UV-Vis, and mass spectra. The conglomeration action of the phthalocyanine compound was determined by UV-visible spectra at different concentrations and in different solvents. Some parameters of this axial silicon phthalocyanine compound were investigated by computational chemistry. Structural optimization of axial silicon phthalocyanine substituted with compound, HOMO-LUMO energies and MEP maps was performed by density functional theory (DFT) studies. In addition, a chemical bond analysis of the molecule was performed with quantum theory atom in molecules (QTAIM). Finally, a molecular docking study was applied to this new phthalocyanine molecule in its binding mechanism.
Bayesian deep learning for error estimation in the analysis of
anomalous diffusion
Authors: Seckler Henrik , Metzler Ralf 
Published: August 2022

Abstract
Modern single-particle-tracking techniques produce extensive time-series of diffusive motion in a wide variety of systems, from single-molecule motion in living-cells to movement ecology. The quest is to decipher the physical mechanisms encoded in the data and thus to better understand the probed systems. We here augment recently proposed machine-learning techniques for decoding anomalous-diffusion data to include an uncertainty estimate in addition to the predicted output. To avoid the Black-Box-Problem a Bayesian-Deep-Learning technique named Stochastic-Weight-Averaging-Gaussian is used to train models for both the classification of the diffusion model and the regression of the anomalous diffusion exponent of single-particle-trajectories. Evaluating their performance, we find that these models can achieve a well-calibrated error estimate while maintaining high prediction accuracies. In the analysis of the output uncertainty predictions we relate these to properties of the underlying diffusion models, thus providing insights into the learning process of the machine and the relevance of the output.
Are platelet concentrate scaffolds superior to traditional blood clot scaffolds in regeneration therapy? A systematic review and meta-analysis
Authors: Tang Qianwei , Jin Hua , Lin Song , Ma Long , Tian Tingyu , Qin Xiurong 
Published: August 2022

Abstract
Background
The effectiveness of platelet concentrates in promoting root development of necrotic immature permanent teeth is unclear. The present study evaluated whether the platelet concentrate protocol was superior to the traditional blood clot protocol in regeneration therapy.
Methods
Electronic databases, such as PubMed, Cochrane Library, ClinicalTrials and EMBASE, were searched for studies comparing these protocols, with identified studies manually searched for relevant references. Clinical case-control studies were included, in which platelet-rich concentrates were tested for pulp regeneration and radicular development, with the blood clot treatment protocol as the control group. Clinical and radiographic outcomes were considered.Selected articles were assessed for risk of bias. Pooled Risk ratios were calculated for clinical success, responses to cold and electric pulp tests, periapical lesions, apex closure, root lengthening, and thickening of the dentin walls. Heterogeneity was assessed using I2 statistics and Cochrane’s Q test.
Results
Of the 1272 screened studies, 16 were selected, 14 case-control and two split-mouth studies, in which 465 immature necrotic permanent teeth, particularly incisors and premolars, were treated. Of these 465 teeth, 457 (98.2%) in both the control and experimental groups remained clinically asymptomatic for the entire study duration, whereas eight (1.8%) showed signs and symptoms of failure, including spontaneous pain, sensitivity to percussion or reinfection. Compared with control teeth, teeth treated with platelet-rich plasma or platelet-rich fibrin showed improved periapical healing (RR 1.09, 95% CI 1.00–1.20, P = 0.05), apical closure (RR 1.04, 95% CI 0.86–1.25, P = 0.69), root lengthening (RR 1.01, 95% CI 0.74–1.39, P = 0.93), and thickening of the dentin walls (RR 1.32, 95% CI 0.96–1.81, P = 0.08), although these differences were not statistically significant.
Conclusions
Platelet concentrates can act as successful scaffolds for regenerative endodontic treatment, although they did not differ significantly from conventional blood clot scaffolds.
Effect of grit blasting on fatigue life of aged 18Ni(300) maraging steel
Authors: PALAU JOSE CARLOS FORTES , Travessa Dilermando Nagle 
Published: August 2022

Abstract
The fatigue life of aged 18Ni300 maraging steel was investigated in two different surface conditions: polished and grit-blasted. Axial fatigue tests results, plotted in the form of S-N curves were used to correlate the fatigue performance and the surface characteristics, carefully characterized using a combination of experimental techniques, including X-ray diffraction (XRD), contact profilometry, microhardness testing, scanning electron microscopy (SEM), and stereo optical microscopy (S-OM). The results show that turn-machining of round fatigue samples forms a thin recrystallized layer over the steel surface, which remains after polishing. Roughness increases significantly after grit-blasting, but strain hardening and compressive residual stresses developed after blasting outweigh the deleterious increase of roughness and the fatigue life increases in comparison to the polished condition. Both crack initiation and propagation are retarded under the effects of blasting.
Blood Urea Nitrogen to Serum Albumin Ratio: A Good Predictor of in-Hospital and 90-Day All-Cause Mortality in AECOPD Patients
Authors: Zeng Zixiong , Ke Xiaocui , Gong Shan , Huang Xin , Liu Qin , Huang Xiaoying , Cheng Juan , Li Yuqun , Wei Liping 
Published: August 2022

Abstract
Background: Compared with survivors,previous studies of AECOPD have found that those died in hospital had higher blood urea nitrogen levels and poorer nutritional status.Nevertheless,the association between blood urea nitrogen to serum albumin ratio (BUN/ALB ratio) and in-hospital and short-term prognosis in AECOPD patients remains unclear.The aim of this study was to explore the usefulness of BUN/ALB ratio in AECOPD as an objective predictor for in-hospital and 90-day all-cause mortality.Methods: BUN/ALB ratio levels were measured in AECOPD patients on admission.By drawing the ROC curve of the patients,we obtained the cut-point of the BUN/ALB ratio level for in-hospital death.Multivariate logistic regression was used for analyses of the factors of in-hospital mortality and multivariate Cox regression was used to analyse the factors of 90-day all-cause mortality.Results: A total of 362 patients were recruited and 319 patients were finally analyzed,23 patients died during hospitalization and the fatality rate was 7.2%. Furthermore,14 patients died during 90-day follow-up.Compared with those in-hospital survivors,patients who died in hospital were older(80.78±6.58vs.75.09±9.73 years old, P =0.001),had a higher percentage of congestive heart failure(69.6% vs.27.4%, P<0.001),had higher BUN/ALB ratio levels(0.329(0.250,0.399)vs.0.145(0.111,0.210), P<0.001),had higher neutrophil counts(10.27(7.21，14.04)vs.6.58(4.58，9.04), P<0.001),higher blood urea nitrogen levels(10.86(7.10,12.25) vs.5.35(4.14,7.40), P<0.001),a lower albumin level(32.58±3.72vs.36.26±4.53, P<0.001) and had a lower lymphocyte count(0.85(0.58,1.21) vs.1.22(0.86,1.72), P=0.001).The ROC curve showed that the area under the curve (AUC) of BUN/ALB ratio for in-hospital death was 0.87, (95%CI: 0.81-0.93, P< 0.001), the best cut-point value to discriminate survivors from nonsurvivors in hospital was 0.249, the sensitivity was 78.3%, the specificity was 86.5%, and the youden’s index was 0.648.Having an BUN/ALB ratio ≥0.249 was an independent risk factor for both in-hospital and 90-day all-cause mortality after adjustment for relative risk(RR)(RR=15.08,95% CI:3.80-59.78, P< 0.001 for the multivariate logistic regression analysis) and hazard ratio (HR)(HR=5.34,95% CI:1.62-17.57, P=0.006 for the multivariate cox regression analysis).Conclusion: An elevated BUN/ALB ratio level was a strong and independent predictor of in-hospital and 90-day all-cause mortality in AECOPD patients.
Addressing Scalability Issues in Blockchain: A Use case from Healthcare
Authors: Sadath Lipsa , Mehrotra Deepti , Kumar Anand 
Published: August 2022

Abstract
The opportunities with blockchain technology has grown immensely especially with its unique features such as immutability, transparency, decentralization etc. It is also important that the basic features such as privacy, security and scalability co-exists. Our novel study proposes a framework named ERSB (Enhanced Reliability of a Scalable Blockchain) implemented with Hyperledger fabric as a solution to address scalability issues. Multiple records are generated and processed during a patient’s hospital visits/stays, laboratory tests and insurance claims. When there are networks of hospitals under one umbrella (a group of hospitals), it is critical to address maintenance of this complex system in context of the afore-mentioned unique features. Our proposed framework uses a hierarchical model at hospital networks, laboratory and insurance company that has multiple levels. Stages are evaluated with nodes added along with smart contracts. Smart contracts are also amended with more changes to observe performance, reliability and latency of the model at the first level of hierarchy.
Material Flow Optimisation of Multistage, Multiproduct Parallel Lines
Authors: BHOSALE KAILASH 
Published: August 2022

Abstract
In the production planning phase, long-term decision problems are addressed. In this phase, the demand of the products is fulfilled by considering the production capacity, available time and available manpower. The demand of the products is determined by Monte-Carlo simulation method. The objective function is considered to minimise material flow time. A case study based on soap finishing line which is related to multistage, multiproduct parallel line is selected. The mathematical model is formulated as mixed integer nonlinear programming. The CPLEX optimisation solver is used to find the optimum solution.