bluuebunny/crossref_metadata_2025_split huggingface dataset:
Automated multidimensional deep learning platform for referable diabetic retinopathy detection: a multicentre, retrospective study
Authors: Zhang Guihua , Lin Jian-Wei , Wang Ji , Ji Jie , Cen Ling-Ping , Chen Weiqi , Xie Peiwen , Zheng Yi , Xiong Yongqun , Wu Hanfu , Li Dongjie , Ng Tsz Kin , Pang Chi Pui , Zhang Mingzhi 
Published: July 2022

ObjectiveTo develop and validate a real-world screening, guideline-based deep learning (DL) system for referable diabetic retinopathy (DR) detection.DesignThis is a multicentre platform development study based on retrospective, cross-sectional data sets. Images were labelled by two-level certificated graders as the ground truth. According to the UK DR screening guideline, a DL model based on colour retinal images with five-dimensional classifiers, namely image quality, retinopathy, maculopathy gradability, maculopathy and photocoagulation, was developed. Referable decisions were generated by integrating the output of all classifiers and reported at the image, eye and patient level. The performance of the DL was compared with DR experts.SettingDR screening programmes from three hospitals and the Lifeline Express Diabetic Retinopathy Screening Program in China.Participants83 465 images of 39 836 eyes from 21 716 patients were annotated, of which 53 211 images were used as the development set and 30 254 images were used as the external validation set, split based on centre and period.Main outcomesAccuracy, F1 score, sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), Cohen’s unweighted κ and Gwet’s AC1 were calculated to evaluate the performance of the DL algorithm.ResultsIn the external validation set, the five classifiers achieved an accuracy of 0.915–0.980, F1 score of 0.682–0.966, sensitivity of 0.917–0.978, specificity of 0.907–0.981, AUROC of 0.9639–0.9944 and AUPRC of 0.7504–0.9949. Referable DR at three levels was detected with an accuracy of 0.918–0.967, F1 score of 0.822–0.918, sensitivity of 0.970–0.971, specificity of 0.905–0.967, AUROC of 0.9848–0.9931 and AUPRC of 0.9527–0.9760. With reference to the ground truth, the DL system showed comparable performance (Cohen’s κ: 0.86–0.93; Gwet’s AC1: 0.89–0.94) with three DR experts (Cohen’s κ: 0.89–0.96; Gwet’s AC1: 0.91–0.97) in detecting referable lesions.ConclusionsThe automatic DL system for detection of referable DR based on the UK guideline could achieve high accuracy in multidimensional classifications. It is suitable for large-scale, real-world DR screening.
Self-Harm in Eating Disorders (SHINE): a mixed-methods exploratory study
Authors: Lavis Anna , McNeil Sheryllin , Bould Helen , Winston Anthony , Reid Kalen , Easter Christina L , Pendrous Rosina , Michail Maria 
Published: July 2022

IntroductionSelf-harm is highly prevalent among young people with eating disorders. However, why a young person may develop and continue to experience both an eating disorder and self-harm is unclear. This study will investigate the frequency, intensity, duration, function, context and processes of self-harm among people aged 16–25 diagnosed with an eating disorder. It will explore participants’ perspectives on the genesis and functions of both their self-harm and eating disorder, as well as their support needs. The study was designed with the input of members of a Young Persons’ Advisory Group, who will be key to study delivery and dissemination.Methods and analysisThis exploratory study has a sequential mixed-methods explanatory design. Between 70 and 100 young people aged 16–25 with both an eating disorder diagnosis and self-harm thoughts and/or behaviours will be recruited from three NHS Eating Disorder outpatient services in England. Phase 1: a 14-day (six prompts per day) ecological momentary assessment (EMA) of participants’ feelings, thoughts, motivations, behaviours and experiences of self-harm. Phase 2: 20–30 participants from phase 1 will be reapproached to take part in an in-depth qualitative interview on the psychological, emotional and social factors that underlie their self-harm and eating disorder as well as their support needs. EMA data from phase 1 will be analysed using descriptive and multilevel statistics. Qualitative interview data from phase 2 will be analysed using inductive and deductive thematic analysis. Results from both phases will be integrated using a mixed-methods matrix, with each participant’s data from both phases compared alongside comparative analysis of the datasets as a whole.Ethics and disseminationThe study gained ethical approval from the NHS HRA West Midlands–Black Country Research Ethics Committee (number: 296032). We anticipate disseminating findings to clinical, academic and lived experience audiences, at academic conferences, through peer-reviewed articles, and through various public engagement activities (eg, infographics, podcasts).
How to measure mental pain: a systematic review assessing measures of mental pain
Authors: Charvet Camille , Boutron Isabelle , Morvan Yannick , Le Berre Catherine , Touboul Suzanne , Gaillard Raphaël , Fried Eiko , Chevance Astrid 
Published: July 2022

QuestionAlthough mental pain is present in many mental disorders and is a predictor of suicide, it is rarely investigated in research or treated in care. A valid tool to measure it is a necessary first step towards better understanding, predicting and ultimately relieving this pain.Study selection and analysisFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic review to identify all published standardised measures of mental pain. We used qualitative content analysis to evaluate the similarity of each measure, quantified via Jaccard Index scores ranging from no similarity (0) to full similarity (1). Finally, using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, we evaluated each measure’s development (assessing 35 features), its content validity (31 features) and if the latter was rated at least adequate, its other psychometric properties.FindingsWe identified 10 self-reported scales of mental pain in 2658 screened studies relying on diverse definitions of this construct. The highest average similarity coefficient for any given measure was 0.24, indicative of weak similarity (individual pairwise coefficients from 0 to 0.5). Little to no information was provided regarding the development and the content validity of all 10 scales. Therefore, their development and content validity were rated ‘inadequate’ or ‘doubtful’.Conclusions and clinical implicationsThere is not enough evidence of validity to recommend using one measure over others in research or clinical practice. Heterogeneous use of disparate measures across studies limits comparison and combination of their results in meta-analyses. Development by all stakeholders (especially patients) of a consensual patient-reported measure for mental pain is needed.PROSPERO registration numberCRD42021242679.
Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial
Authors: Zwaans Juliette J M , Raven Wouter , Rosendaal Arthur V , Van Lieshout Esther M M , Van Woerden Geesje , Patka Peter , Haagsma Juanita A , Rood Pleunie P M 
Published: July 2022

BackgroundPatients with traumatic wounds frequently present to the ED. Literature on whether to treat these wounds sterile or non-sterile is sparse. Non-sterile treatment has the advantage of saving resources and costs, and could be of value in health settings where sterile materials are not readily available. Our objective was to compare the rate of wound infection after suturing traumatic lacerations with non-sterile gloves and dressings versus sterile gloves, dressings and drapes in the ED. We hypothesised that non-sterile gloves and dressings would be non-inferior to sterile gloves, dressings and drapes. The non-inferiority margin was set at 2%.MethodsA multicentre single-blinded randomised controlled trial testing for non-inferiority of non-sterile gloves and dressings versus sterile gloves, dressings and drapes for suturing of traumatic wounds was performed in 3 EDs in The Netherlands. Adults with uncomplicated wounds were included from July 2012 to December 2016. At the time of treatment, patient and wound characteristics and management were documented. The outcome was wound infection, which was identified during follow-up in the treating ED at 5–14 days postprocedure.ResultsFrom 2468 eligible patients, 1480 were randomised in a sterile (n=747) or non-sterile (n=733) protocol. Baseline characteristics were similar in both study arms. The observed wound infection rate in the non-sterile group was 5.7% (95% CI 4.0% to 7.5%) vs 6.8% (95% CI 5.1% to 8.8%) in the sterile group. The mean difference of the wound infection rate of the two groups was −1.1% (95% CI −3.7% to 1.5%).ConclusionAlthough recruitment ceased prior to reaching our planned sample size, the findings suggest that there is unlikely to be a large difference between the non-sterile gloves, dressings and sterile gloves, dressings and drapes for suturing of traumatic wounds in the ED.Trial registration numberNL 34798.078.11, NTR3541.
Transitioning out of work and metabolic syndrome incidence: a longitudinal study among 13 303 older workers from the Lifelines Cohort Study and Biobank
Authors: Runge Katharina , van Zon Sander K. R. , Bültmann Ute , Henkens Kène 
Published: July 2022

BackgroundThis study investigates (1) whether different employment transition types (ie, unemployment, work disability, early retirement and regular retirement) are associated with metabolic syndrome (MetS) incidence among older workers (50–64 years) and (2) whether occupational group moderates the association between employment transition type and MetS incidence.MethodsA sample of 13 303 older Dutch workers from the Lifelines Cohort Study and Biobank was examined using longitudinal data from two comprehensive measurement waves with a mean follow-up time of 3.7 years. MetS components were based on physical measures, blood markers and medication use. Employment transitions were determined using questionnaires. Logistic regression analysis was performed to examine the association between employment transition type and MetS incidence.ResultsOlder workers who transitioned from employment to unemployment (adjusted OR 1.39, 95% CI 1.05 to 1.82) or work disability (adjusted OR 1.89, 95% CI 1.15 to 3.10) had a significantly higher MetS incidence than the working control group. No association between early retirement or regular retirement with MetS incidence was found after adjusting for sociodemographic, educational and occupational factors. Occupational group did not moderate the association between employment transition type and MetS incidence.ConclusionThe results suggest that older workers who transition from employment to unemployment or work disability are at risk for developing MetS. More awareness among occupational physicians and general practitioners about MetS incidence in late working life is needed in general and more specific among older workers who transition into unemployment or work disability.
Non-contrast enhanced silent MR angiography to evaluate hemodynamics and morphology of unruptured intracranial aneurysms: a comparative computational fluid dynamics study
Authors: Lu Yuzhao , Leng Xiaochang , Zou Rong , Chen Qi , Li Wenqiang , Zhou Xiaobing , Tan Song , Huang Xiaofei , Ding Cong , Gong Feixiang , Xiang Jianping , Wang Yang 
Published: July 2022

BackgroundSilent MR angiography (silent MRA) is a new generation of non-contrast enhanced angiography with outstanding advantages in visualizing cerebrovascular lesions and the follow-up after endovascular treatment for intracranial aneurysms (IAs). This study aims to investigate the reliability of silent MRA-based three-dimensional (3D) geometric description and hemodynamic calculation of IAs.Methods19 patients with 23 unruptured IAs, who underwent both silent MRA and 3D rotational angiography (3DRA), were included in this study. Computational fluid dynamics simulations were performed on all patient-specific 3D reconstruction images to compare the morphology and hemodynamics of the two different imaging models for IAs.ResultsSilent MRA models had smaller maximum and perpendicular height (mm), aneurysmal surface area (mm2), and aneurysmal volume (mm3) than 3DRA (p<0.05); the differences of the above parameters between the two models were 9.0±6.2%, 7.7±7.4%, 15.9±13.0%, and 21.4±17.5%, respectively. However, correlation analysis of morphological parameters in various dimensions and model comparison showed good overall consistency in geometrical characteristics between the two models. Moderate coherence was observed between models in time-averaged wall shear stress of aneurysm and parent vessel (TAWSS, PAWSS), aneurysm velocity (AV), parent vessel velocity, and oscillatory shear index (OSI). However, strong correlations were observed among normalized aneurysm wall shear stress (NWSS), low shear area (LSA), inflow concentration index (ICI), and normalized aneurysm velocity (NAV).ConclusionBoth morphological and hemodynamic assessments of IAs for silent MRA are comparable to 3DRA. Additionally, normalized indicators such as NWSS, LSA, ICI, and NAV were better than TAWSS, AV, and OSI in silent MRA-related hemodynamic evaluation.
Thalamic atrophy measured by artificial intelligence in a multicentre clinical routine real-world study is associated with disability progression
Authors: Zivadinov Robert , Bergsland Niels , Jakimovski Dejan , Weinstock-Guttman Bianca , Benedict Ralph H B , Riolo Jon , Silva Diego , Dwyer Michael G 
Published: July 2022

BackgroundThe thalamus is a key grey matter structure, and sensitive marker of neurodegeneration in multiple sclerosis (MS). Previous reports indicated that thalamic volumetry using artificial intelligence (AI) on clinical-quality T2-fluid-attenuated inversion recovery (FLAIR) images alone is fast and reliable.ObjectiveTo investigate whether thalamic volume (TV) loss, measured longitudinally by AI, is associated with disability progression (DP) in patients with MS, participating in a large multicentre study.MethodsThe DeepGRAI (Deep Grey Rating via Artificial Intelligence) Registry is a multicentre (30 USA sites), longitudinal, observational, retrospective, real-world study of relapsing-remitting (RR) MS patients. Each centre enrolled between 30 and 35 patients. Brain MRI exams acquired at baseline and follow-up on 1.5T or 3T scanners with no prior standardisation were collected. TV measurement was performed on T2-FLAIR using DeepGRAI, and on two dimensional (D)-weighted and 3D T1-weighted images (WI) by using FMRIB’s Integrated Registration and Segmentation Tool software where possible.Results1002 RRMS patients were followed for an average of 2.6 years. Longitudinal TV analysis was more readily available on T2-FLAIR (96.1%), compared with 2D-T1-WI (61.8%) or 3D-T1-WI (33.2%). Over the follow-up, DeepGRAI TV loss was significantly higher in patients with DP, compared with those with disability improvement (DI) or disease stability (−1.35% in DP, −0.87% in DI and −0.57% in Stable, p=0.045, Bonferroni-adjusted, age-adjusted and follow-up time-adjusted analysis of covariance). In a regression model including MRI scanner change, age, sex, disease duration and follow-up time, DP was associated with DeepGRAI TV loss (p=0.022).ConclusionsThalamic atrophy measured by AI in a multicentre clinical routine real-world setting is associated with DP over mid-term follow-up.
Risk of Parkinson’s disease in multiple sclerosis and neuromyelitis optica spectrum disorder: a nationwide cohort study in South Korea
Authors: Kwon Soonwook , Jung Se Young , Han Kyung-do , Jung Jin Hyung , Yeo Yohwan , Cho Eun Bin , Ahn Jong Hyeon , Shin Dong Wook , Min Ju-Hong 
Published: July 2022

BackgroundNeurodegeneration is associated with pathogenesis of both multiple sclerosis (MS) and neuromyelitis optica (NMOSD). Parkinson’s disease (PD) is a representative neurodegenerative disease, however, whether MS or NMOSD is associated with risk of PD is not known.MethodsMS and NMOSD cohorts were collected from the Korean National Health Insurance Service between 1 January 2010 and 31 December 2017, using International Classification of Diseases 10th revision diagnosis codes and information in the Rare Intractable Disease management programme. The PD incidence rate that occurred after a 1-year lag period was calculated and compared with that of a control cohort matched for age, sex, hypertension, diabetes and dyslipidaemia in a 1:5 ratio.ResultsThe incidence rates of PD in patients with MS and NMOSD were 3.38 and 1.27 per 1000 person-years, respectively, and were higher than that of their matched control groups. The adjusted HR of PD was 7.73 (95% CI, 3.87 to 15.47) in patients with MS and 2.61 (95% CI, 1.13 to 6.02) in patients with NMOSD compared with matched controls. In both patients with MS and NMOSD, there were no significant differences in relative risk when stratified by sex, age, diabetes, hypertension and dyslipidaemia.ConclusionThe PD risk was higher in patients with MS and NMOSD compared with healthy controls and was particularly high in patients with MS. Further investigations should be performed to determine the pathophysiology and occurrence of PD in patients with MS and NMOSD.
Six versus 2 weeks treatment with doxycycline in European Lyme neuroborreliosis: a multicentre, non-inferiority, double-blinded, randomised and placebo-controlled trial
Authors: Solheim Anne Marit , Lorentzen Åslaug Rudjord , Dahlberg Audun Olav , Flemmen Heidi Øyen , Brune Synne , Forselv Kristine Johanne Nordstrøm , Pripp Are Hugo , Bø Margrete Halvorsen , Eikeland Randi , Reiso Harald , Mygland Åse , Ljøstad Unn 
Published: July 2022

BackgroundThere is limited evidence regarding optimal duration of antibiotic treatment in neuroborreliosis. We aimed to compare efficacy and safety of oral doxycycline for 2 and 6 weeks in European Lyme neuroborreliosis (LNB).MethodsThe trial had a randomised, double-blinded, placebo-controlled, non-inferiority design. Patients with LNB were recruited from eight Norwegian hospitals and randomised to doxycycline 200 mg once daily for 2 weeks, followed by 4 weeks of placebo, or doxycycline 200 mg once daily for 6 weeks. The primary endpoint was clinical improvement as measured by difference in a Composite Clinical Score (0–64 points) from baseline to 6 months. The non-inferiority margin was predetermined to 0.5 points.ResultsOne hundred and twenty-one patients were included. Fifty-two treated for 2 weeks and 53 for 6 weeks were included in the intention-to-treat analyses, and 52 and 51 in per-protocol analysis. Mean difference in clinical improvement between the groups was 0.06, 95% CI −1.2 to 1.2, p=0.99 in the intention-to-treat population, and −0.4, 95% CI −1.4 to 0.7, p=0.51 in the per-protocol population and non-inferiority could not be established. There were no treatment failures and no serious adverse events. The groups did not differ in secondary outcomes including clinical scores at 10 weeks and 12 months, cerebrospinal fluid data and patient-reported outcome measures. Patients receiving 6 weeks doxycycline reported slightly more side effects in week 5.ConclusionOur results strongly indicate that there are no benefits of doxycycline treatment beyond 2 weeks in European LNB.Trial registration number2015-001481-25.
Bubbles and lockdown in Aotearoa New Zealand: the language of self-isolation in #Covid19NZ tweets
Authors: Burnette Jessie , Long Maebh 
Published: July 2022

In March 2020, as cases of COVID-19 were found in Aotearoa New Zealand, the government moved to eliminate community transmission of the virus through self-isolation. During this month, as the population discussed if, when and how households would be asked to stay at home, terms such as lockdown—the state of (national) closure—and bubble—the household isolating together—became common parts of everyday conversation.In this article, we blend quantitative and qualitative research methodologies from corpus linguistics, literary studies and the medical humanities to compare the affective range of the terms lockdown and bubble as they were used in tweets containing the hashtag #Covid19NZ. Both lockdown and bubble are metaphors of containment that provided different ways of understanding and engaging with government stay-at-home measures by highlighting and minimising different aspects of the event. We found that while the strong, prison connotations of lockdown were reflected in discussions of the measure as a tough form of control exercised from above, the lighter associations of the term bubble led to the perception of this measure as more malleable and conducive to exertion of individual control. Yet, although the seemingly restrictive range of lockdown made it a useful term for the expression of negative affect, the term was actually more frequently used with neutral or unclear affect to share information. Conversely, while bubble tweets expressed more positive sentiment, humour and support towards government stay-at-home measures, this rendered the term surprisingly restrictive in its potential uses: its lightness makes it an effective way to limit the expression of antilockdown sentiment. As Kiwi Twitter users faced the uncertainty of the first COVID-19 lockdown, the pre-existing connotations of the metaphors used to frame stay-at-home measures also helped frame their own experiences of these measures.
Coccygeoplasty: preliminary experience with this new alternative treatment of refractory coccydynia in patients with coccyx hypermobility
Authors: Manfre Luigi , Gil Inês , Baptista Tiago , Calvão Pires Pedro , de Vivo Aldo Eros , Masala Salvador , Chandra Ronil V , D'Anna Gennaro , Hirsch Joshua A 
Published: July 2022

BackgroundCoccydynia has many causes, including fracture, subluxation, and hypermobility of sacrococcygeal segments. Existing treatments are limited in their effectiveness. Coccygeoplasty (CP) is a relatively new, minimally invasive treatment that appears to address this difficult clinical challenge.ObjectiveTo describe clinical results at the time of the procedure and at 3- and 12-months' follow-up of patients with coccydynia related to subluxation and coccyx hypermobility treated with the CP technique. Additionally, to determine if there is any correlation between the final imaging and clinical results at 3- and 12-months' follow-up.MethodsA prospectively maintained database was used, and all patients who underwent CP for chronic coccydynia between January 2005 and October 2018 were retrospectively reviewed. All the patients had painful hypermobility (greater than 25°) with anterior flexion confirmed on radiological imaging. Alternative causes of coccydynia were excluded using CT and MRI. Procedures were performed under local anesthesia with combined fluoroscopic and CT guidance. Clinical follow-up was performed at two time points: 3 and 12 months after treatment using the Visual Analogue Scale (VAS).ResultsTwelve patients were treated in a single center. No procedural complications occurred. At 3- and 12-months' follow-up, the majority (75%) of patients had significantly lower VAS scores than at baseline, with mean changes of 3.5 and 4.9, respectively. There was no pain recurrence at 12 months and just one patient had no improvement of the pain. Follow-up CT images confirmed fixation of the sacrococcygeal bone segments in nine patients; however, no correlation was found between final imaging results and clinical outcome (p=0.1).ConclusionsPatients with refractory painful coccyx subluxation and hypermobility undergoing CP have a favorable clinical response at 3- and 12-months' follow-up. Further studies are required to validate this technique and to identify predictors of treatment response. Coccygeoplasty may be considered a reasonable alternative to coccygectomy.