bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why a Propofol Infusion Should Be the Anesthetic of Choice for Auditory Brainstem Response Testing in Children
Authors: Kandil Ali I. , Ok Michale S. , Baroch Kelly A. , Subramanyam Rajeev , Mahmoud Mohamed A. , McAuliffe John J. 
Published: February 2022

BACKGROUND:
Auditory brainstem response (ABR) testing is considered to be relatively resistant to effects of volatile anesthetics. The impact of newer anesthetics on interpretability of ABR testing is unknown. This study compared sevoflurane versus propofol anesthesia on qualitative interpretability of ABR click-testing in children.

METHODS:
This prospective double-blind crossover study enrolled children (≤18 years old) receiving general anesthesia for elective ABR testing. All subjects received both sevoflurane and propofol anesthesias in the same ABR testing session. Deidentified ABR data were reviewed by 5 audiologists (blinded to anesthetic and patient) to determine threshold levels for hearing loss. The primary outcome was qualitative interpretability (false positive) of ABR click-testing.

RESULTS:
Each patient was tested at 4 different intensities in each ear: generating 624 records under each anesthetic, for a total of 1248 records. A few patients were tested at 5 different intensities in a single ear accounting for the additional 11 records, yielding 1259 records. Under sevoflurane anesthesia, 21 of the same patients (37 ears) were identified with abnormal ABR levels consistent with hearing loss (one or both ears). The probability of a patient being diagnosed with hearing “loss” in one or both ears was significantly less with propofol versus sevoflurane anesthesia (mid P =.0312). If patients with bilateral loss are compared, the mid P value is 0.0098. The effect size based on patients was medium to large, with a minimum value of Cohen w = 0.320.

CONCLUSIONS:
Sevoflurane produced more false positives for hearing loss and suggested more severe hearing loss than propofol. False-positive ABR tests, produced by certain anesthetic agents, can have significant life-long impact and negative psychosocial and developmental implications. Use of the intravenous anesthetic propofol is superior to sevoflurane for ABR testing in children.
External Validation of a Neural Network Model in Aneurysmal Subarachnoid Hemorrhage: A Comparison With Conventional Logistic Regression Models
Authors: Feghali James , Sattari Shahab Aldin , Wicks Elizabeth E. , Gami Abhishek , Rapaport Sarah , Azad Tej D. , Yang Wuyang , Xu Risheng , Tamargo Rafael J. , Huang Judy 
Published: February 2022

BACKGROUND:
Interest in machine learning (ML)–based predictive modeling has led to the development of models predicting outcomes after aneurysmal subarachnoid hemorrhage (aSAH), including the Nijmegen acute subarachnoid hemorrhage calculator (Nutshell). Generalizability of such models to external data remains unclear.

OBJECTIVE:
To externally validate the performance of the Nutshell tool while comparing it with the conventional Subarachnoid Hemorrhage International Trialists (SAHIT) models and to review the ML literature on outcome prediction after aSAH and aneurysm treatment.

METHODS:
A prospectively maintained database of patients with aSAH presenting consecutively to our institution in the 2013 to 2018 period was used. The web-based Nutshell and SAHIT calculators were used to derive the risks of poor long-term (12-18 months) outcomes and 30-day mortality. Discrimination was evaluated using the area under the curve (AUC), and calibration was investigated using calibration plots. The literature on relevant ML models was surveyed for a synopsis.

RESULTS:
In 269 patients with aSAH, the SAHIT models outperformed the Nutshell tool (AUC: 0.786 vs 0.689, P = .025) in predicting long-term functional outcomes. A logistic regression model of the Nutshell variables derived from our data achieved adequate discrimination (AUC = 0.759) of poor outcomes. The SAHIT models outperformed the Nutshell tool in predicting 30-day mortality (AUC: 0.810 vs 0.636, P < .001). Calibration properties were more favorable for the SAHIT models. Most published aneurysm-related ML-based outcome models lack external validation and usable testing platforms.

CONCLUSION:
The Nutshell tool demonstrated limited performance on external validation in comparison with the SAHIT models. External validation and the dissemination of testing platforms for ML models must be emphasized.
Frailty in Very Elderly Patients is Not Associated with Adverse Surgical or Oncological Outcomes in Extremity Surgery for Soft Tissue Sarcoma
Authors: Sivarajah Gausihi , Davies Emma , Hurley Anna , Strauss Dirk C. , Smith Myles J. F. , Hayes Andrew J. 
Published: February 2022

Abstract
Background
While surgery remains the mainstay of treatment for limb sarcoma, extreme old age is a relative contraindication to oncological surgery.

Methods
Patients >80 years referred with primary extremity soft-tissue sarcoma (ESTS) between 2007 and 2016 were retrospectively reviewed. Prognostic variables, including ASA status and Clinical Frailty Scores, were collected. Endpoints were perioperative morbidity, locoregional (LRR) and distant recurrence (DR), disease-specific survival (DSS) adjusted using competing risk modelling, and overall survival (OS).

Results
A total of 141 primary tumours were identified, with 116 undergoing resections. Main motives for nonoperative management were severe frailty or significant comorbidity (56.0%). The operative group had a median age of 84 (range 80-96) years and median follow-up of 16 months (range 0-95). 45.7% of patients received radiotherapy. Median hospital stay was 7 (range 0-40) days, with frailty (p = 0.25) and ASA (p = 0.28) not associated with prolonged admission. 12.9% developed significant complications, with one perioperative mortality.
24.1% had LRR, occurring at a median of 14.5 months. All patients with reported DR (28.4%), except one, died of their disease. Frailty did not confer a significant difference in adjusted LRFS (p = 0.95) and DMFS (p = 0.84). One- and 5-year adjusted DSS and OS was 87.0% versus 74.9% and 62.3% versus 27.4%, respectively. Frailty (CFS ≥4) was associated with worse OS (hazard ratio [HR] 2.49; 95% confidence interval [CI] 1.51-4.12; p < 0.001), however not with adjusted DSS (p = 0.16). Nonoperative management conferred a 1- and 5-year adjusted DSS was 58.3% and 44.4%, respectively.

Conclusions
Extremity surgery for sarcoma is well tolerated in the frail very elderly population with low morbidity and comparable oncological outcomes.
Facile Post-synthesis and Redox Behavior of π-Expanded Ferrocene and ansa-Ferrocene
Authors: Morimoto Hirofumi , Matsuo Kyohei , Hayashi Hironobu , Yamada Hiroko , Aratani Naoki 
Published: February 2022

Abstract
A new π-extended ferrocene and a transannular ansa-ferrocene have been successfully synthesized by post-synthesis via one-pot reaction of a 1,1′-diborylferrocene with 1,8-dibromonaphthalene under Suzuki-Miyaura-Heck coupling conditions. Both compounds in the neutral and one-electron oxidized forms characterized by single-crystal X-ray analysis and UV-vis-NIR absorption revealed the structure-property relationships.
Corporate governance and shareholders’ confidence in cooperative corporations: a systematic literature review
Authors: Thangaveloo Arasu , Dorasamy Magiswary , Bin Ahmad Abdul Aziz , Marimuthu Siva Barathi , Jayabalan Jayamalathi 
Published: February 2022

Background: The confidence of Bottom 40 (B40) shareholders is crucial for cooperative corporation’s sustenance within wider corporate governance. An in-depth study on cooperatives is needed, as they play a crucial role in the Malaysian economic system and contribute greatly to the country’s social development. However, in the current landscape, confidence among shareholders is at stake. This study aims to identify the research gap into corporate governance for cooperative corporations in relation to B40 shareholder confidence, as well as identify current study challenges and develop a conceptual framework for future research. Methods: We conducted a systematic literature review, with the use of agency theory to assess shareholders’ confidence. Emerald, ProQuest, InderScience, Scopus and Science Direct were the online databases used in this study to search five keyword phrases: corporate governance, confidence, cooperative, agency theory and Bottom 40% (B40) household. Tranfield’s five stages were used to conduct the systematic review. Results: Only 5 of the 324 studies assess shareholders’ confidence in cooperatives, as well as one paper on B40 and two papers on agency theory. Our review presents three major findings. First, research in the context of B40 shareholder’s confidence in cooperative corporations is limited. Second, the challenges related to shareholders’ confidence in B40 are major issues in the context. Third, research on agency theory in the context of shareholders’ confidence within cooperative corporations and corporate governance is still scant. Conclusions: This review urges the research community to conduct more studies based on the highlighted research gaps.
Effectiveness and safety profile of mesenchymal stem cell secretome as a treatment for severe cases of COVID-19: a randomized controlled trial
Authors: Abdullah Murdani , Pawitan Jeanne Adiwinata , Irawan Cosphiadi , - Rahyussalim , Aditianingsih Dita , Liem Isabella Kurnia , Sinto Robert , Susilo Adityo , Yulianti Mira , Handayani Raden Rara Diah , Pratomo Irandi Putra , Burhan Erlina , Damayanti Triya , Wibowo Heri , Dilogo Ismail Hadisoebroto 
Published: February 2022

Background: Mesenchymal stem cells (MSCs) are known to have immunomodulatory, anti-inflammatory, anti-apoptotic, and angiogenesis effects that are useful for relieving inflammation, recovery, and protection of lung tissues in COVID-19 patients. Secretome, a secretory product of MSCs, has several advantages over MSCs. We conducted a study to investigate secretomes’ effectiveness and safety profile as a treatment for severe COVID-19. Methods: A double-blind, multicenter, randomized, placebo-controlled trial was conducted between February 2021 and July 2021 in three top COVID-19 referral hospitals in the Greater Jakarta area, Indonesia. Eligible subjects (n=40) were randomized in a 1:1 ratio to an intervention group (n=20) and a control group (n=20). The primary outcome of this study was the changes in inflammatory markers and the ratio of inflammatory to anti-inflammatory markers. The secondary outcomes of this study included clinical outcome, laboratory outcome, radiological outcome, RT-PCR result conversion, and safety profile of MSC secretome. Results: Our analysis showed that on the 14th day after placebo administration, IL-6 level in the control group was significantly increased [4.110 (2.403–12.820) at baseline to 13.320 (2.958–33.285) on the 14th day after intervention, p=0.017]. The IL-6/IL-10 ratio in the control group was significantly increased (p=0.036) on the 14th day after placebo administration. We also found that most of the subjects who received placebo had high levels of IL-6 and ferritin (p=0.043) on the seventh day after the intervention. However, we found no significant differences in inflammatory marker levels on the seventh day and 14th day after intervention between both groups. There was no adverse event reported. There were no significant differences in the laboratory outcome, radiology outcome, RT-PCR result conversion, and safety profiles between both groups. Conclusions: MSC secretome can control inflammation in patients with severe COVID-19 and has a good safety profile. MSC secretome is a promising treatment modality for severe COVID-19.
A STUDY OF CATASTROPHIC HEALTH EXPENDITURES IN INDIA - EVIDENCE FROM NATIONALLY REPRESENTATIVE SURVEY DATA: 2014-2018
Authors: Sriram Shyamkumar , Albadrani Muayad 
Published: February 2022

Abstract Background: India is taking steps to provide Universal Health Coverage (UHC). Out-of-pocket (OOP) health care payment is the most important mechanism for health care payment in India. This study aims to investigate the effect of OOP health care payments on catastrophic health expenditures (CHE). Methods: Data from the National Sample Survey Organization, Social Consumption in Health 2014 and 2018 are used to investigate the effect of OOP health expenditure on household welfare in India. Three aspects of catastrophic expenditure were analyzed in this paper: (i) incidence and intensity of ‘catastrophic’ health expenditure, (ii) socioeconomic inequality in catastrophic health expenditures, and (iii) factors affecting catastrophic health expenditures. Results: The odds of incidence and intensity of CHE were higher for the poorer households. Using the logistic regression model, it was observed that the odds of incidence of CHE was higher among the households with at least one child aged less than 5 years, one elderly person, one secondary educated female member, and if at least one member in the household used a private healthcare facility for treatment. The multiple regression model showed that the intensity of CHE was higher among households with members having chronic illness, and if members had higher duration of stay in the hospital. Subsidizing healthcare to the households having elderly members and children is necessary to reduce CHE. Conclusion: Expanding health insurance coverage, increasing coverage limits, and inclusion of coverage for outpatient and preventive services are vital to protect households. Strengthening public primary health infrastructure and setting up a regulatory organization to establish policies and conduct regular audits to ensure that private hospitals do not increase hospitalizations and the duration of stay is necessary.
Case Report: Glans penile necrosis in a patient with SARS-CoV-2 and leprosy infection
Authors: Ismy Jufriady , Khalilullah Said Alfin , Bahagianto Aditya Fajar 
Published: February 2022

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was firstly identified in China and has been declared a global pandemic. Several serious extrapulmonary manifestations due to SARS-CoV-2 infection have also been reported and associated with hypercoagulability thrombotic vasculopathy. In addition, cases of Mycobacterium-leprae infection have also been known associated with blood coagulation abnormality. Methods: Here, we report a 56-year-old male with coronavirus disease-19 (COVID-19) with concomitant leprosy infection with manifestation of glans penile necrosis, presented to the emergency department with acute penile pain. This case is unique because no occlusion blood flow to the penile was observed in the radiographic imaging. We described the potential pathophysiology in this case through a literature review. Results: The patient received treatment according to the COVID-19 protocol and was given low molecular weight heparin (LMWH) therapy for 4 days. During the follow up, the clinical and functional condition of the penis showed significant improvement. Conclusions: Microthrombus involvement, platelet abnormalities and impaired hemostasis due to SARS-CoV-2 and leprosy co-infection are the hypothesis in this case report.
How psychiatrists’ attitudes towards multi-source feedback including patient feedback influenced the educational value: a qualitative study
Authors: Murton Claudia , Spowart Lucy , Anderson Merryn 
Published: February 2022

Background: Multi-source feedback (MSF) is well-established in psychiatric training. However, evidence on the educational impact is not definitive and there is scanty evidence exploring its value for professional development of psychiatry trainees in the United Kingdom (UK). Evidence suggests the MSF tool currently used is not suitable for specialist trainees. This qualitative research project explored psychiatric doctors’ attitudes towards MSF with patient feedback, to determine how this influenced the feedback’s educational usefulness. Methods: A qualitative study using a phenomenological approach based on a constructivist approach. Purposive sampling identified trainee psychiatrists who completed a more extensive MSF, including patient feedback, than they currently use. They discussed their results in supervised sessions to plan how to use the feedback. Semi-structured interviews were conducted separately with trainees and their supervisors following completion of MSF. The data was analysed thematically. The study was completed in 2020. Results: Seven trainees and five supervisors participated. Four themes were identified. Most had positive opinions about the educational usefulness of MSF, including patient feedback, and made changes to their behaviour following the feedback. Interviewees valued patient feedback and identified it as important in psychiatry. Most valued their patient feedback over their colleague feedback. The complexities of patient feedback in psychiatry and how this may influence the educational usefulness of the feedback were discussed in detail. Conclusions: Findings suggest a need to review the current system of MSF in psychiatry in order to maximise educational benefits. In particular, this research points to the benefits of psychiatric trainees engaging with patient feedback.
A culturally competent approach to teach humanities in international medical school: potential frameworks and lessons learned
Authors: Daher-Nashif Suhad , Kane Tanya 
Published: February 2022

Background: This paper describes the development of a culturally competent medical humanities course for second and third-year medical students at the ethnically diverse College of Medicine at Qatar University. First taught in 2016, the elective seminar “Medicine and the Arts” was restructured in 2017 to cultivate an appreciation of the symbiotic relationship between medicine, art, and humanities, and to foster cultural competence among the students.Methods: Results and tips are based on our experiences and past reports.Results: In designing a course for students immersed in an Arab-Muslim context, we encountered two challenges: the discipline’s privileging of a predominantly Western canon of arts and humanities, and the largely Euro-American-centric and unilateral framing of concepts e.g., the doctor-patient relationship, patient-centered approach, patient experiences, and meanings of health and illness. To circumvent these challenges, we followed the Purnell Model for Cultural Competence, adopted the interdisciplinary approach, and employed an intersectionality framework to build and deliver a culturally competent course exploring the nexus of arts, humanities, and medicine.In addition to these tips on which frameworks to adopt and how to structure the course, we recommend a visual literacy workshop to help them develop the ability to recognize and understand ideas conveyed through art. Furthermore, we recommend deep conversations about artistic portrayals of medicine from different cultural contexts as tools for developing cultural awareness. Lastly, we recommend that these discussions adopt a student-centered approach, where students inform about their experiences and their own health and illness determinants, in order to develop their knowledge and practice of holism and patient centered approach, and other issues related to humanities and social sciences. Conclusions:Adopting and implementing a culturally competent approach to medical education, alongside interdisciplinary and intersectionality concepts, are potential conceptual frameworks to structure a course that uses art to inform about medical humanities.
Life cycle analysis of the solar thermochemical energy storage scheme SOCRATCES
Authors: Hritz Sara , Eusha Muhammad , Mir Faraz Rasheed , Schories Gerhard 
Published: February 2022

Background: SOCRATCES is an environment-friendly thermochemical solar energy storage scheme based on calcium-looping [1]. It involves capturing of solar energy using an endothermic splitting of calcium carbonator into calcium oxide and carbon dioxide, and a subsequent exothermic combination of these two products to reproduce calcium carbonate in a cyclic process [2]. The life cycle analysis of this concept, which has generated substantial interest in recent years, is extremely important in its holistic assessment [3]. Methods: The methodology followed was based on the international standards ISO 14040:2006 and 14044:2006, considering three different scales – the pilot plant in Seville, Spain [1] and two industrial-scale sizes with 10 and 100 MW. The data for calculating the environmental impact was compiled by the consortium involved in the project SOCRATCES (EU GA 727348) and the previously developed deliverables [4] in the project. Additional information that was not covered during the work of the project was taken from different literature resources. For the calculation of the LCA, the software Umberto® LCA+ was utilized. Results: The results showed that the technology is comparable to alternative energy storage approaches in terms of the environmental impact assessment. It is located in the lower region of CO2-Eq output per kWh produced electricity and has significantly lower toxicity impact. When the eco-efficiency factor is brought into consideration, it emerged that the technology is considerably superior to competing alternatives, which comes from the higher storage time compared to other technologies. Conclusions: The Stirling engine appears to be a sound choice, in terms of conversion efficiency, at comparatively low temperatures, to be integrated with an exothermic reactor, at least at small-scale applications.
Ambulatory blood pressure monitoring using telemedicine: proof-of-concept cohort and failure modes and effects analyses
Authors: Armitage Laura C. , Lawson Beth K. , Roman Cristian , Thompson Beth , Biggs Christopher , Rutter Heather , Lewis-Jones Martin , Ede Jody , Tarassenko Lionel , Farmer Andrew , Watkinson Peter 
Published: February 2022

Background: The COVID-19 pandemic has accelerated adoption of remote consulting in healthcare. Despite opportunities posed by telemedicine, most hypertension services in Europe have suspended ambulatory blood pressure monitoring (ABPM). Methods: We examined the process and performance of remotely delivered ABPM using two methodologies: firstly, a Failure Modes and Effects Analysis (FMEA) and secondly, a quantitative analysis comparing ABPM data from a subgroup of 65 participants of the Screening for Hypertension in the INpatient Environment (SHINE) diagnostic accuracy study. The FMEA was performed over seven sessions from February to March 2021, with a multidisciplinary team comprising a patient representative, a research coordinator with technical expertise and four research clinicians. Results: The FMEA identified a single high-risk step in the remote ABPM process. This was cleaning of monitoring equipment in the context of the COVID-19 pandemic, unrelated to the remote setting. A total of 14 participants were scheduled for face-to-face ABPM appointments, before the UK March 2020 COVID-19 lockdown; 62 were scheduled for remote ABPM appointments since emergence of the COVID-19 pandemic between November 2020 and August 2021. A total of 65 (88%) participants completed ABPMs; all obtained sufficient successful measurements for interpretation. For the 10 participants who completed face-to-face ABPM, there were 402 attempted ABPM measurements and 361 (89%) were successful. For the 55 participants who completed remote ABPM, there were 2516 attempted measurements and 2114 (88%) were successful. There was no significant difference in the mean per-participant error rate between face-to-face (0.100, SD 0.009) and remote (0.143, SD 0.132) cohorts (95% CI for the difference -0.125 to 0.045 and two-tailed P-value 0.353). Conclusions: We have demonstrated that ABPM can be safely and appropriately provided in the community remotely and without face-to-face contact, using video technology for remote fitting appointments, alongside courier services for delivery of equipment to participants.