bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk prediction of 30-day mortality after stroke using machine learning: a nationwide registry-based cohort study
Authors: Wang Wenjuan , Rudd Anthony G. , Wang Yanzhong , Curcin Vasa , Wolfe Charles D. , Peek Niels , Bray Benjamin 
Published: May 2022

Abstract
Backgrounds
We aimed to develop and validate machine learning (ML) models for 30-day stroke mortality for mortality risk stratification and as benchmarking models for quality improvement in stroke care.

Methods
Data from the UK Sentinel Stroke National Audit Program between 2013 to 2019 were used. Models were developed using XGBoost, Logistic Regression (LR), LR with elastic net with/without interaction terms using 80% randomly selected admissions from 2013 to 2018, validated on the 20% remaining admissions, and temporally validated on 2019 admissions. The models were developed with 30 variables. A reference model was developed using LR and 4 variables. Performances of all models was evaluated in terms of discrimination, calibration, reclassification, Brier scores and Decision-curves.

Results
In total, 488,497 stroke patients with a 12.3% 30-day mortality rate were included in the analysis. In 2019 temporal validation set, XGBoost model obtained the lowest Brier score (0.069 (95% CI: 0.068–0.071)) and the highest area under the ROC curve (AUC) (0.895 (95% CI: 0.891–0.900)) which outperformed LR reference model by 0.04 AUC (p < 0.001) and LR with elastic net and interaction term model by 0.003 AUC (p < 0.001). All models were perfectly calibrated for low (< 5%) and moderate risk groups (5–15%) and ≈1% underestimation for high-risk groups (> 15%). The XGBoost model reclassified 1648 (8.1%) low-risk cases by the LR reference model as being moderate or high-risk and gained the most net benefit in decision curve analysis.

Conclusions
All models with 30 variables are potentially useful as benchmarking models in stroke-care quality improvement with ML slightly outperforming others.
Clinical significance and correlation of PD-L1, B7-H3, B7-H4, and TILs in pancreatic cancer
Authors: Yang Jiayue , Tian Zhen , Gao Han , Xiong Fan , Cao Cuiping , Yu Jiaojiao , Shi Wei , Zhan Qiang , Yang Cheng 
Published: May 2022

Abstract
Background
B7 molecules play significant roles in regulating tumor immunity, but their expression patterns and immuno-biological correlations in pancreatic cancer (PaCa) have not been fully discussed.

Methods
RNA-sequencing data of B7 molecules of PaCa samples in the Cancer Genome Atlas (TCGA) dataset was downloaded from the UCSC Xena to assess the expression, correlation, and mutation of the B7 family in PaCa. Next, two PaCa tissue microarrays (TMAs, Cat. HPanA150CS02 and HPanA120Su02) were obtained from Outdo BioTech (Shanghai, China). To detect the expression levels of PD-L1, B7-H3 and B7-H4, immunohistochemistry (IHC) staining was performed on these TMAs.

Results
Most B7 molecules, including B7–1, B7–2, PD-L1, B7-DC, B7-H2, and B7-H5 exhibited similar expression patterns, but B7-H3, B7-H4, B7-H6, and B7-H7 showed outlier expression patterns compared with other B7 molecules. Besides, B7 molecules were genetically stable and exhibited low alteration frequency. IHC staining indicated PD-L1, B7-H3, and B7-H4 were up-regulated in PaCa tissues and showed uncorrelated expression patterns. Furthermore, high expression of PD-L1 and B7-H3 indicated poor-differentiated grades in PaCa. PD-L1 was positively, but B7-H4 was negatively correlated with CD8+ TILs infiltration in PaCa. Moreover, combined PD-L1 and B7-H4 expression was a novel subtyping strategy in PaCa, namely patients with both high PD-L1 and B7-H4 expression exhibited decreased CD8+ TILs infiltration in tumor tissues.

Conclusion
Overall, we systemically analyzed the expression patterns of B7 molecules and proposed a novel subtyping strategy in PaCa. Patients with both high PD-L1 and B7-H4 expression exhibited the immuno-cold phenotype, which may be not suitable for immunotherapy.
Prevalence of diabetic retinopathy and self-reported barriers to eye care among patients with diabetes in the emergency department: the diabetic retinopathy screening in the emergency department (DRS-ED) study
Authors: Williams Andrew M. , Weed Jared M. , Commiskey Patrick W. , Kalra Gagan , Waxman Evan L. 
Published: May 2022

Abstract
Background
Screening for diabetic retinopathy (DR) is suboptimal, and patients with diabetes who present to the emergency department (ED) may be at particularly high risk of undiagnosed DR. The purpose of this study is to determine the prevalence of DR among diabetic patients who present to the ED of our tertiary medical center using teleophthalmology and to assess self-reported barriers to eye care.

Methods
This cross-sectional, single-institution study recruited clinically stable diabetic patients who presented to the ED during daytime hours over 29 total weekdays across 2 months in 2018 and 2019. Participants had nonmydriatic, 45-degree, single-field digital retinal photographs taken on site (Digital Retinal System, Centervue). Following retinal imaging, participants then completed a survey about barriers to regular eye care and their acceptance of potential interventions to promote screening. Digital retinal photographs were interpreted remotely by a board-certified ophthalmologist and communicated to participants’ primary care physician and/or endocrinologist.

Results
Over the study period, 275 ED patients had a documented diagnosis of diabetes, of whom 167 were deemed clinically stable for the study and 141 were invited to participate. Sixty-four were enrolled, of whom 50 had gradable-quality fundus images (78%). Of these 50 patients, almost all had type 2 diabetes (47, 94%), with an average disease duration of 12 ± 9 years and mean hemoglobin A1c of 8.1 ± 2.0% (mmol/mol). Based on fundus photography, 14 patients (28%) were diagnosed with DR, which was newly diagnosed for 10 (20% of the total study population). Severity was most commonly mild or moderate (12/14, 86%), with 1 case of severe nonproliferative DR and 1 proliferative DR. The majority (26, 52%) reported at least one barrier to routine eye care in our self-administered survey, of which having too many appointments (6, 12%) and cost (5, 10%) were frequently cited as most important. The majority were receptive to interventions to promote DR screening, including reminder phone calls (29, 58%) and text messages (28, 56%).

Conclusions
Digital fundus photography in the ED detected a high rate of undiagnosed DR. Half of participants reported barriers to routine care, and most were receptive to messaging interventions to schedule an eye exam. Future studies are warranted to assess scalability of ED-based screening programs and their follow-through rates.
Early neonatal mortality is modulated by gestational age, birthweight and fetal heart rate abnormalities in the low resource setting in Tanzania – a five year review 2015–2019
Authors: Shayo Aisa , Mlay Pendo , Ahn Emily , Kidanto Hussein , Espiritu Michael , Perlman Jeffrey 
Published: May 2022

Abstract
Background
Early Neonatal mortality (ENM) (< 7 days) remains a significant problem in low resource settings. Birth asphyxia (BA), prematurity and presumed infection contribute significantly to ENM. The study objectives were to determine: first, the overall ENM rate as well as yearly ENM rate (ENMR) from 2015 to 2019; second, the influence of decreasing GA (< 37 weeks) and BW (< 2500 g) on ENM; third, the contribution of intrapartum and delivery room factors and in particular fetal heart rate abnormalities (FHRT) to ENM; and fourth, the Fresh Still Birth Rates (FSB) rates over the same time period.

Methods
Retrospective cohort study undertaken in a zonal referral teaching hospital located in Northern Tanzania. Labor and delivery room data were obtained from 2015 to 2019 and included BW, GA, fetal heart rate (FHRT) abnormalities, bag mask ventilation (BMV) during resuscitation, initial temperature, and antenatal steroids use. Abnormal outcome was ENM < 7 days. Analysis included t tests, odds ratios (OR), and multivariate regression analysis.

Results
The overall early neonatal mortality rate (ENMR) was 18/1000 livebirths over the 5 years and did not change significantly comparing 2015 to 2019. Comparing year 2018 to 2019, the overall ENMR decreased significantly (OR 0.62; 95% confidence interval (CI) 0.45–0.85) as well as infants ≥37 weeks (OR 0.45) (CI 0.23–0.87) and infants < 37 weeks (OR 0.57) (CI 0.39–0.84). ENMR was significantly higher for newborns < 37 versus ≥37 weeks, OR 10.5 (p < 0.0001) and BW < 2500 versus ≥2500 g OR 9.9. For infants < 1000 g / < 28 weeks, the ENMR was ~ 588/1000 livebirths. Variables associated with ENM included BW - odds of death decreased by 0.55 for every 500 g increase in weight, by 0.89 for every week increase in GA, ENMR increased 6.8-fold with BMV, 2.6-fold with abnormal FHRT, 2.2-fold with no antenatal steroids (ANS), 2.6-fold with moderate hypothermia (all < 0.0001). The overall FSB rate was 14.7/1000 births and decreased significantly in 2019 when compared to 2015 i.e., 11.3 versus 17.3/1000 live births respectively (p = 0.02).

Conclusion
ENM rates were predominantly modulated by decreasing BW and GA, with smaller/ less mature newborns 10-fold more likely to die. ENM in term newborns was strongly associated with FHRT abnormalities and when coupled with respiratory depression and BMV suggests BA. In smaller newborns, lack of ACS exposure and moderate hypothermia were additional associated factors. A composite perinatal approach is essential to achieve a sustained reduction in ENMR.
Time perception of individuals with subthreshold autistic traits: the regulation of interpersonal information associations
Authors: Xuan Bin , Li Shuo , Li Peng , Yang Lu 
Published: May 2022

Abstract
Background
People with high subthreshold autistic traits usually share behavioral patterns similar to those of individuals on the autism spectrum, but with fewer social and cognitive changes. The effect of autistic traits on time perception and the role of interpersonal information in this effect remain unexplored.

Methods
This study used a temporal bisection task between 400 and 1600 ms to compare the time perception of individuals with higher and lower autistic traits, and to explore the regulation of interpersonal information on their time perception by establishing associations between identities and geometric shapes. Thirty-two participants with high autistic traits and thirty-one participants with low autistic traits participated in this study.

Results
In the absence of identity information, people with high autistic traits tended to judge short durations as longer. Their subjective bisection point was lower, and the Weber ratio was higher than for those with low autistic traits, suggesting that their overestimation of short duration was due to decreased temporal sensitivity. With the involvement of interpersonal information, the proportion of long responses for no identity was significantly lower than for self, friends, and strangers, which seemed more obvious in individuals with low autistic traits although there was no significant interaction between identity and group. The Weber ratio of no identity was lower than that for other identities.

Conclusion
The results suggest that individuals with high autistic traits have more conservative responses that are relatively shorter in duration, and this change is related to a decline in perceptual sensitivity. Compared to individuals with high autistic traits, the time perception of individuals with low autistic traits seemed more susceptible to interpersonal information.
Physical therapy of patients undergoing first-time lumbar discectomy: a survey of current UK practice
Authors: Alsiaf Hanan , O’Neill Terence W. , Callaghan Michael J. , Goodwin Peter C. 
Published: May 2022

Abstract
Background
The type, timing, and extent of provision of rehabilitation for lumbar discectomy patients in the UK are currently unknown. The aim of this study was to determine the provision and type of rehabilitation for patients undergoing lumbar discectomy in UK neurosurgical centers.

Method
Physical therapists involved in treating lumbar discectomy patients in UK neurosurgery centers were invited to complete an online survey that asked about the type, timing (preop, postop), and rehabilitation content for patients undergoing lumbar discectomy.

Results
Seventeen UK neurosurgery centers completed the survey. Twelve (36%) responded from the 33 centers targeted as well as an additional five private centers. All participating centers provided a rehabilitation service for lumbar discectomy patients. Rehabilitation was provided preoperatively in n = 6 (35%) centers, postoperatively as an inpatient in all centers, and postoperatively as an outpatient in n = 14 (82%) centers. Factors that influenced the decision to provide rehabilitation included both external and internal or patient-related factors. Preoperative rehabilitation focused mainly on education, whilst postoperative outpatient rehabilitation focused more on exercises. Rehabilitation consistently included mobility, functional task training, and exercise prescription.

Conclusions
Whilst all neurosurgical centers in this survey provided some form of rehabilitation for patients undergoing LD surgery, the approach remains inconsistent. Rehabilitation was delivered most frequently postoperatively, with one in three centers providing it preoperatively. Rehabilitation content also varied depending on when it was provided. Further research is needed to determine the optimum timing, contents, and target of rehabilitation for patients undergoing LD surgery.
Distal interphalangeal joint arthrodesis with nonaxial multiple small screws: a biomechanical analysis with axial headless compression screw and clinical result of 15 consecutive cases
Authors: Woo Seung Hun , Kwak Sang Ho , Jang Hyo Seok , Kim Dong Hee , Seo Jang Hyeon , Lee Sang Hyun 
Published: May 2022

Abstract
Background
The axial headless compression screw (AHCS) technique is a widely used method for distal interphalangeal joint (DIPJ) and thumb IPJ arthrodesis. However, it might not be suitable for cases over 10° flexion of fusion angle and extremely small-sized phalanx. Here, the authors describe the nonaxial multiple small screws (NMSS) technique, compare the mechanical strength of the NMSS technique with the AHCS technique, and suggest clinical outcomes of the NMSS technique.

Methods
DIPJ and thumb IPJ arthrodesis models were simulated in the 4th generation composite bone hand. Fixation with three 1.5 mm cortical screws (NMSS) or one HCS (AHCS) was performed in each pair of the phalanx. The bending stiffness and load to failure were tested in 10 pairs of each specimen, and the torsional stiffness and torque to failure were tested in seven pairs of each specimen. Moreover, 15 consecutive clinical DIPJ and thumb IPJ arthrodesis cases were reviewed retrospectively.

Results
The NMSS specimens showed significantly higher bending load to failure, torsional stiffness, and torque to failure than the AHCS specimens. All 15 arthrodesis cases were united without severe complications. The mean fusion angle was 16.3° for the nine cases of the flexed target position.

Conclusions
The NMSS technique showed biomechanical stability comparable to that of the AHCS technique in DIPJ and thumb IPJ arthrodesis. Thus, the NMSS technique could be used as a feasible option in DIPJ and thumb IPJ arthrodesis, especially when a small finger is indicated and a significant flexion angle is required.
Rheumatic heart disease knowledge and associated factors among nurses working in cardiac centers at public and private hospitals of Addis Ababa: cross sectional study
Authors: Techane Tesfaye , Legesse Bethlehem , Ayalew Yohannes , Hailu Aklil 
Published: May 2022

Abstract
Background
It is proposed that the biggest gap in control of rheumatic heart disease is in implementing of ineffective primary and secondary preventive measures. These measures are supposed to be well addressed by nurses. For prevention and proper management, nurses are expected to have full knowledge about rheumatic heart disease. Therefor the main objective of the study was to assess the level of nurse’s knowledge and factors behind regarding RHD in the current study.

Method
Institution based cross sectional study was conducted on nurses working in cardiac centers of public and private hospitals at Addis Ababa from April 1 to 30, 2021. Total sample size is 163 selected by purposive sampling method. Data was entered in to Epi-data version 4.5 and exported to SPSS version 25.0 and was checked for missing values. Data was cleaned. Descriptive statistics such as frequency, mean and percentages were calculated, described and displayed in tables, graphs and charts. Binary logistic regression was done to see the crude significant relation of each independent variable with nurse’s good knowledge score. Significant factors were identified based on multivariate logistics regression in 95% confidence level at P-value less than 0.05.

Result
In the present study about 154 participants were participated. The mean correct answer response of the nurses for knowledge of RHD questions is 12.2 ± 5.2. Only 48.7% of the nurses have good knowledge towards RHD. Being male in gender, having history of sore throat, taking formal education in university or collage, taking in-service training on RHD, having higher wok experience, have found significantly associated with higher odds of nurses’ good knowledge towards RHD.

Conclusion and recommendation
Regular training regarding RHD management should be given to nurses who are working in cardiac centers. Rheumatic heart disease early treatment and prevention should be incorporated and reinforced in to nursing and other health related professions curriculums.
Mindfulness, empathy and moral sensitivity in nurses: a structural equation modeling analysis
Authors: Rezapour-Mirsaleh Yasser , Aghabagheri Mahdi , Choobforoushzadeh Azadeh , Mohammadpanah Ardakan Azra 
Published: May 2022

Abstract
Background
Ethical issues may pose challenges to nurses; moral sensitivity can help them to overcome these challenges. Identifying variables related to moral sensitivity can help in planning to increase nurses’ moral sensitivity. This study aimed to investigate the relationship among mindfulness, empathy, and moral sensitivity in a sample of nurses.

Methods
In the present study, a cross-sectional design utilizing Structural Equation Modeling (SEM) was conducted. The nurses in a private hospital in Yazd, Iran, were invited to participate in the study (n=162) using simple random sampling. In order to gather the data, the Freiburg’s mindfulness inventory, moral sensitivity questionnaire, and revised Jefferson’s empathy scale were used. The hypothesized model was analyzed by SEM.

Results
The results show that Mindfulness (β=0.41, t=5.53, p<0.01) and empathy (β=0.52, t=6.77, p<0.01) had a significant direct effect on moral sensitivity. However, mindfulness had an indirect effect on nurses’ moral sensitivity via empathy improvement (z= 6.25, p<.01).

Conclusion
Empathy played a significant mediating role in the relationship between mindfulness and moral sensitivity, so mindfulness-based interventions with an emphasis on empathy may provide an opportunity to increase moral sensitivity in nurses.
Brucella spp. distribution, hosting ruminants from Greece, applying various molecular identification techniques
Authors: Katsiolis Aristomenis , Papadopoulos Dimitrios K. , Giantsis Ioannis A. , Papageorgiou Konstantinos , Zdragas Antonis , Giadinis Nektarios D. , Petridou Evanthia 
Published: May 2022

AbstractBackgroundBrucellosis still remains an endemic disease for both livestock and human in Greece, influencing the primary sector and national economy in general. Although farm animals and particularly ruminants constitute the natural hosts of the disease, transmission to humans is not uncommon, thus representing a serious occupational disease as well. Under this prism, knowledge concerningBrucellaspecies distribution in ruminants is considered a high priority. There are various molecular methodologies forBrucelladetection with however differential discriminant capacity. Hence, the aim of this survey was to achieve nationallyBrucellaepidemiology baseline genotyping data at species and subtype level, as well as to evaluate the pros and cons of different molecular techniques utilized for detection ofBrucellaspecies. Thirty-nine tissue samples from 30 domestic ruminants, which were found positive applying a screening PCR, were tested by four different molecular techniques i.e. sequencing of the 16S rRNA, the BP26 and the OMP31 regions, and the MLVA typing panel 1 assay of minisatellite markers.ResultsOnly one haplotype was revealed from the 16S rRNA sequencing analysis, indicating that molecular identification ofBrucellabacteria based on this marker might be feasible solely up to genus level. BP26 sequencing analysis and MLVA were in complete agreement detecting bothB. melitensisandB. abortus.An interesting exception was observed in 11 samples, of lower quality extracted DNA, in which not all expected MLVA amplicons were produced and identification was based on the remaining ones as well as on BP26. On the contrary OMP31 failed to provide a clear band in any of the examined samples.ConclusionsThe present study reveals the constant circulation ofBrucellabacteria in ruminants throughout Greece. Further, according to our results, BP26 gene represents a very good alternative to MLVA minisatellite assay, particularly in lower quality DNA samples.
Risk of sharing resistant bacteria and/or resistance elements between dogs and their owners
Authors: Naziri Zahra , Poormaleknia Meisam , Ghaedi Oliyaei Azar 
Published: May 2022

Abstract
Background
The indiscriminate use and the similarity of prescribed antibiotics especially beta-lactams in human and small animal medicine, along with the close communication between pets and humans, increases the risk of the transfer of antibiotic-resistant bacteria and/or resistance elements especially integrons, between them. Therefore, we aimed to compare the frequencies of extended spectrum beta-lactamase (ESBL)-producing strains, major ESBL genes, classes 1 and 2 integrons, and antibiotic resistance patterns of fecal Escherichia coli (E. coli) isolates from dogs and their owners.

Methods
The present study was conducted on 144 commensal E. coli isolates from the feces of 28 healthy dog-owner pairs and 16 healthy humans who did not own pets. Phenotypic confirmatory test was used to identify the frequencies of ESBL-producing E. coli. Frequencies of blaCTX-M, blaSHV, and blaTEM genes, and also classes 1 and 2 integrons were determined by polymerase chain reaction. Resistance against 16 conventional antibiotics was determined by disk diffusion technique.

Results
ESBL-production status was similar between the E. coli isolates of 71.4% of dog-owner pairs. The E. coli isolates of 75, 60.7, and 85.7% of dog-owner pairs were similar in terms of the presence or absence of blaCTX-M, blaTEM, and blaSHV genes, respectively. The presence or absence of class 1 and class 2 integrons was the same in E. coli isolates of 57.1% of dog-owner pairs. Prevalence of resistance to chloramphenicol and tetracycline was significantly higher in E. coli isolates of dogs than owners, but for other 10 (83.3%) tested antibiotics, no statistically significant difference was found in prevalence of antibiotic resistance between dogs and owners isolates. Furthermore, the antibiotic-resistance profile was the same in the E. coli isolates of 14.3% of dog-owner pairs.

Conclusions
The results of current research highlight the seriousness of the drug-resistance problem and the need to prevent further increases and spread of antibiotic-resistance to reduce treatment failure. Moreover, relatively similar characteristics of the E. coli isolates of dogs and their owners can show the risk of sharing resistant bacteria and/or resistance elements between them.