bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Validation of an Assessment Tool for Technical Skills in Handheld Otoscopy
Authors: Guldager Mads J. , Melchiors Jacob , Andersen Steven Arild Wuyts 
Published: February 2020

Objective: Handheld otoscopy requires both technical and diagnostic skills, and is often reported to be insufficient after medical training. We aimed to develop and gather validity evidence for an assessment tool for handheld otoscopy using contemporary medical educational standards. Study Design: Educational study. Setting: University/teaching hospital. Subjects and Methods: A structured Delphi methodology was used to develop the assessment tool: nine key opinion leaders (otologists) in undergraduate training of otoscopy iteratively achieved consensus on the content. Next, validity evidence was gathered by the videotaped assessment of two handheld otoscopy performances of 15 medical students (novices) and 11 specialists in otorhinolaryngology using two raters. Standard setting (pass/fail criteria) was explored using the contrasting groups and Angoff methods. Results: The developed Copenhagen Assessment Tool of Handheld Otoscopy Skills (CATHOS) consists 10 items rated using a 5-point Likert scale with descriptive anchors. Validity evidence was collected and structured according to Messick’s framework: for example the CATHOS had excellent discriminative validity (mean difference in performance between novices and experts 20.4 out of 50 points, P < .001); and high internal consistency (Cronbach’s alpha = 0.94). Finally, a pass/fail score was established at 30 points for medical students and 42 points for specialists in ORL. Conclusion: We have developed and gathered validity evidence for an assessment tool of technical skills of handheld otoscopy and set standards of performance. Standardized assessment allows for individualized learning to the level of proficiency and could be implemented in under- and postgraduate handheld otoscopy training curricula, and is also useful in evaluating training interventions. Level of evidence: NA
Oscillation free robust adaptive synchronization of chaotic systems with parametric uncertainties
Authors: Ahmad Israr , Shafiq Muhammad 
Published: February 2020

The complexity of the closed-loop system, short transient response time, and fast synchronization error convergence rates are the three basic parameters that limit hacking in the data encryption and secure the communication systems. This paper addresses the following two challenges: The full-order synchronization (FOS) of two parametrically excited second-order nonlinear pendulum (PENP) chaotic systems with uncertain parameters. The reduced-order synchronization (ROS) between the canonical projection part of an uncertain third-order chaotic Rossler and the uncertain PENP systems. This article designs a new robust adaptive synchronization control (RASC) algorithm to address the above two challenges. The proposed controller achieves the FOS and ROS in a shorter transient time, and the synchronization error signals converge to the origin with faster rates in the presence of bounded unknown state-dependent and time-dependent disturbances. The Lyapunov direct method verifies this convergence behavior. The paper provides parameters updated laws that confirm the convergence of the uncertain parameters to some fixed values. The controller does not cancel the nonlinear terms of the plant; this property of the controller keeps the nonlinear terms in the closed-loop that results in the enhanced complexity of the dynamical system. The proposed RASC strategy is successful in synthesizing oscillation free convergence of the synchronization error signals to the origin for reducing the transient time and guarantees the asymptotic stability at the origin. The simulation results endorse the theoretical findings.
HLA-DQB genetic susceptibility and rheumatic heart disease: a case-control study
Authors: Sharma Neha , Toor Devinder , Baro Lokajeet , Chaliha Mriganka S , Kusre Giriraj , Baruah Sreemanta M , Das Sangeeta 
Published: February 2020

Background Rheumatic heart disease is a major global health concern, especially in low- and middle-income countries. The pathogenesis is attributable to an aberrant immune response, host genetic factors, and socioeconomic status. The objective of this study was to screen HLA-DQB1 alleles as genetic susceptibility markers in rheumatic heart disease patients in Assam, North East India, and to correlate the predominant allele with socioeconomic status and clinical profile. Methods A case-control study of 100 echocardiography-confirmed rheumatic heart disease patients and age- and sex-matched healthy controls from Assam Medical College and Hospital was conducted. Human leukocyte antigen typing was performed using HLA-DQ typing kit. A questionnaire was designed to study the socioeconomic status and clinical profile of rheumatic heart disease patients. Results Among the 9 alleles studied, HLA-DRBQ1*03:01 was found to be the statistically significant predominant allele in this population, especially in the Ahom ethnic group. In the HLA-DRBQ1*03:01-positive population, rural dwelling was found to be a significantly increased risk factor for rheumatic heart disease. Among severe cases, 90% of mitral stenosis, 40% of mitral regurgitation, and 33.3% of aortic regurgitation cases were HLA-DRBQ1*03:01-positive. Also, 50% of aortic valve thickening and 36.8% of mitral valve thickening cases were found in this population. Conclusion Our data suggest that HLA-DRBQ1*03:01 is a significant susceptibility marker in this population, and predominant in the rural population. Furthermore, it may play an important role in determining the pattern of valve damage in rheumatic heart disease patients.
Safety and efficacy of embolotherapy for severe hemorrhage after partial nephrectomy
Authors: Gieraerts Christopher , Vanhoutte Els , Laenen Annouschka , Bonne Lawrence , De Wever Liesbeth , Joniau Steven , Oyen Raymond , Maleux Geert 
Published: February 2020

Background Partial nephrectomy may be complicated by postoperative hemorrhage, which may be treated by transcatheter embolization. Purpose To assess the safety and efficacy of embolotherapy for hemorrhagic complications of partial nephrectomy and to analyze the potential correlation between multiple bleeding sites on angiography and surgical complexity Material and Methods A cohort of 25 patients presenting with severe, postoperative bleeding after partial nephrectomy and treated with catheter-directed superselective embolization was included. Patients’ demographics, radiological investigations before the embolization, and clinical outcome after embolization were analyzed. Mann–Whitney U test was used to analyze the potential difference in the RENAL score between patients with one or more bleeding sites in the resection area. Results Selective renal angiography revealed multiple bleeding sites at the resection bed in 8 (32%) patients with amorphous contrast extravasation in 10 (40%) patients. Embolization with use of a microcatheter and microcoils was effective to stop the bleeding in all but one patient, the latter requiring a second embolization two days later. Transient decrease in renal function was noted in 3/25 (12%) patients with full recovery in two of the three. Patients with multiple bleeding sites did not show significantly different RENAL scores compared to patients with a single bleeding site ( P = 0.148). Conclusion Embolotherapy for postoperative partial nephrectomy-related bleeding is safe and effective with a low rate of recurrent bleeding. The number of bleeding sites at the resection area did not correlate to the RENAL score.
Persistent post-traumatic headache attributed to mild traumatic brain injury: Deep phenotyping and treatment patterns
Authors: Ashina Håkan , Iljazi Afrim , Al-Khazali Haidar Muhsen , Ashina Sait , Jensen Rigmor Højland , Amin Faisal Mohammad , Ashina Messoud , Schytz Henrik Winther 
Published: February 2020

Objective To investigate clinical characteristics and treatment patterns in persistent post-traumatic headache attributed to mild traumatic brain injury. Methods A total of 100 individuals with persistent post-traumatic headache attributed to mild traumatic brain injury were enrolled between July 2018 and June 2019. Deep phenotyping was performed using a semi-structured interview while allodynia was assessed using the 12-item Allodynia Symptom Checklist. Results In 100 subjects with persistent post-traumatic headache, the mean headache frequency was 25.4 ± 7.1 days per month. The most common headache phenotype was chronic migraine-like headache (n = 61) followed by combined episodic migraine-like and tension-type-like headache (n = 29) while nine subjects reported “pure” chronic tension-type-like headache. The most frequent trigger factors were stress, lack of sleep, and bright lights. A history of preventive medication use was reported by 63 subjects, of which 79% reported failure of at least one preventive drug, while 19% reported failure of at least four preventive drugs. Cutaneous allodynia was absent in 54% of the subjects, mild in 23%, moderate in 17%, and severe in 6%. Conclusions The headache profile of individuals with persistent post-traumatic headache most often resembled a chronic migraine-like phenotype or a combined episodic migraine-like and tension-type-like headache phenotype. Migraine-specific preventive medications were largely reported to be ineffective. Therefore, there is a pressing need for pathophysiological insights and disease-specific therapies.
Solidarity or self-interest? Public opinion in relation to alcohol policies in Sweden
Authors: Karlsson David , Holmberg Sören , Weibull Lennart 
Published: February 2020

Aim: The aim of this article is to study how people sometimes accept policies that could in a narrow sense be seen as in conflict with their own self-interest. Design: The study is based on survey data relating to public opinion on alcohol policy in Sweden targeted at people aged 16–85 years 2016–2017. Among the 3400 people questioned, the response rate was 52%. Results: The results show that people’s perception of the problematic societal consequences of alcohol, in combination with ideological norms regarding the responsibility of individuals, is much more important in explaining public opinion than self-interest factors. It is the view that there is a problem at the societal level, rather than at the personal level, that is most essential for explaining opinions on alcohol restrictions. General knowledge of alcohol-related matters has some effect, whereas personal experiences of close affiliates excessive drinking does not seem to color the opinions expressed. Conclusion: Support for restrictive alcohol policies in Swedish public opinion is mainly founded on norms of solidarity and astute problem analyses at the societal level, and to a much lesser extent on egoism and personal experiences.
Biomarker testing for personalized, first-line therapy in advanced nonsquamous non-small cell lung cancer patients in the real world setting in Japan: a retrospective, multicenter, observational study (the BRAVE study)
Authors: Shimizu Junichi , Masago Katsuhiro , Saito Haruhiro , Nishino Kazumi , Kurata Takayasu , Itoh Yohji , Yoshimura Yoko , Yabuki Yutaka , Dosaka-Akita Hirotoshi 
Published: February 2020

Background: Molecular diagnostic testing is necessary to guide optimal first-line treatment. The number of patients who receive first-line treatment based on biomarker analysis in Japan is unknown. We aimed to determine the proportion of nonsquamous non-small cell lung cancer (NSCLC) patients for whom first-line treatment was selected based on biomarker testing. Methods: This retrospective, multicenter, observational study registered patients aged ⩾20 years with locally advanced or metastatic nonsquamous NSCLC who started first-line treatment between August and December 2017 in Japan. Data were collected from medical records between January and May 2018. The primary endpoint was the proportion of patients with confirmed biomarker status for first-line treatment decision. Results: Among 202 patients enrolled from 11 centers, 161 (79.7%; 95% confidence interval, 74.2–85.2%) had confirmed biomarker status. The testing rate was highest for epidermal growth factor receptor ( EGFR; 97.5%), followed by anaplastic lymphoma kinase ( ALK; 88.1%), programmed death ligand-1 (PD-L1; 87.1%), and ROS1 (67.3%). For first-line treatment, 70/75 patients with EGFR-positive tumors were administered an EGFR-TKI; 14/15 patients with ALK-positive tumors received an ALK inhibitor; 2/2 patients with ROS1-positive tumors received a ROS1 inhibitor; and 29/36 driver mutation-negative patients with a PD-L1 tumor proportion score ⩾50% were administered an anti-PD-1 monoclonal antibody. Median times from confirmed diagnosis date to first-line treatment initiation, and from first biomarker test order to last biomarker test result were 19 and 11 days, respectively. Conclusions: The proportion of nonsquamous NSCLC patients with confirmed biomarker status for first-line treatment was considered insufficient and in need of improvement.
Qualitative Assessment of the Effect of Continuous Positive Airway Pressure on the Nasal Cavity
Authors: Reilly Erin K. , Huntley Colin T. , Boon Maurits S. , Epps Gregory , Vimawala Swar , Chitguppi Chandala , Patel Jena , Murphy Kira , Nyquist Gurston G. , Rosen Marc R. , Evans James J. , Rabinowitz Mindy R. 
Published: February 2020

Background For patients with obstructive sleep apnea (OSA), there is a lack of knowledge regarding the impact of continuous positive airway pressure (CPAP) on the nasal cavity. There is a significant need for evidence-based recommendations regarding the appropriate use of CPAP following endoscopic sinus and skull base surgery. Objective The goal of this study is to translate a previously developed cadaveric model for evaluating CPAP pressures in the sinonasal cavity by showing safety in vivo and quantifying the effect of positive pressurized air flow on the nasal cavity of healthy individuals where physiologic effects are at play. Methods A previously validated cadaveric model using intracranial sensor catheters has proved to be a reliable technique for measuring sinonasal pressures. These sensors were placed in the nasal cavity of 18 healthy individuals. Pressure within the nose was recorded at increasing levels of CPAP. Results Overall, nasal cavity pressure was on average 85% of delivered CPAP. The amount of pressure delivered to the nasal cavity increased as the CPAP increased. The percentage of CPAP delivered was 77% for 5 cmH2O and increased to 89% at 20 cmH2O. There was a significant difference in mean intranasal pressures between all the levels of CPAP except 5 cmH2O and 8 cmH2O ( P < .001). Conclusion On average, only 85% of the pressure delivered by CPAP is transmitted to the nasal cavity. Higher CPAP pressures delivered a greater percentage of pressurized air to the nasal cavity floor. Our results are comparable to the cadaver model, which demonstrated similar pressure delivery even in the absence of anatomic factors such as lung compliance, nasal secretions, and edema. This study demonstrates the safety of using sensors in the human nasal cavity. This technology can also be utilized to evaluate the resiliency of various repair techniques for endoscopic skull base surgery with CPAP administration.
Machine learning in prediction of individual patient readmissions for elective carotid endarterectomy, aortofemoral bypass/aortic aneurysm repair, and femoral-distal arterial bypass
Authors: Amato Alexandre Campos Moraes , Santos Ricardo Virgínio dos , Saucedo Dumitriu Zunino , Amato Salvador José de Toledo Arruda 
Published: February 2020

Objective: Early hospital readmissions have been rising and are increasingly used for public reporting and pay-for-performance. The readmission problem is fundamentally different in surgical patients compared with medical patients. There is an opportunity to intervene preoperatively to decrease the risk of readmission postoperatively. Methods: A predictive model of 90-day hospital readmission for patients undergoing elective carotid endarterectomy, aortofemoral bypass/aortic aneurysm repair, and femoral-distal arterial bypass was developed using data from the Healthcare Cost and Utilization Project State Inpatient Database for Florida State. The model training followed a nested resampling method with subsampling to increase execution speed and reduce overfitting. The following predictors were used: age, gender, race, median household income, primary expected payer, patient location, admission type, Elixhauser–van Walraven Comorbidity Index, Charlson comorbidity score, main surgical procedure, length of stay, disposition of the patient at discharge, period of the year, hospital volume, and surgeon volume. Results: Our sample comprised data on 246,405 patients, of whom 30.3% were readmitted within 90 days. Readmitted patients were more likely to be admitted via emergency (47.2% vs 30%), included a higher percentage with a Charlson score greater than 3 (35.8% vs 18.7%), had a higher mean van Walraven score (8.32 vs 5.34), and had a higher mean length of hospital stay (6.59 vs 3.51). Endarterectomy was the most common procedure, accounting for 19.9% of all procedures. When predicting 90-day readmission, Shrinkage Discriminant Analysis was the best performing model (area under the curve = 0.68). Important variables for the best predictive model included length of stay in the hospital, comorbidity scores, endarterectomy procedure, and elective admission type. The survival analysis for the time to readmission after the surgical procedures demonstrated that the hazard ratios were higher for subjects who presented Charlson comorbidity score above three (2.29 (2.26, 2.33)), patients transferred to a short-term hospital (2.4 (2.23, 2.59)), home healthcare (1.64 (1.61, 1.68)), other type of facility (2.59 (2.54, 2.63)) or discharged against medical advice (2.06 (1.88, 2.26)), and those with greater length of stay (1.89 (1.86, 1.91)). Conclusion: The model stratifies readmission risk on the basis of vascular procedure type, which suggests that attempts to decrease vascular readmission should focus on emergency procedures. Given the current focus on readmissions and increasing pressure to prevent unplanned readmissions, this score stratifies patients by readmission risk, providing an additional resource to identify and prevent unnecessary readmissions.
Pharmacologic Therapies for Aortic Stiffness in End-Stage Renal Disease: A Systematic Review and Meta-Analysis
Authors: Rodriguez Rosendo A. , Spence Matthew , Hae Richard , Agharazii Mohsen , Burns Kevin D. 
Published: February 2020

Background: Increased carotid-femoral pulse wave velocity (cf-PWV), a surrogate of increased aortic stiffness, is a risk factor for cardiovascular events and all-cause mortality in end-stage renal disease (ESRD). To minimize the deleterious effects of an increased aortic stiffness in ESRD patients, several interventions have been developed and cf-PWV has been used to monitor responses. Objective: The aim of this study was to determine the effects of pharmacologic interventions that target aortic stiffness on cf-PWV and systolic blood pressure (SBP) in adults with ESRD. Study design: This study implements a systematic review and meta-analysis. Data sources: MEDLINE, EMBASE, Cochrane Central, Health Technology Assessment, and EBM databases were searched. Study eligibility, participants, and interventions: Randomized and non-randomized studies involving adults (>18 years) with ESRD of any duration, receiving or not renal replacement therapy (hemodialysis, peritoneal dialysis) and exposed to a pharmacologic intervention whose effects were assessed by cf-PWV. Methods: Study screening, selection, data extraction, and quality assessments were performed by 2 independent reviewers. Narrative synthesis and quantitative data analysis summarized the review. Results: We included 1027 ESRD participants from 13 randomized and 5 non-randomized studies. Most pharmacologic interventions targeted bone mineral metabolism disorder or hypertension. Treatment with vitamin D analogues or cinacalcet did not decrease cf-PWV or SBP over placebo or matched controls ( P > .05). Calcium-channel blockers (CCB) decreased cf-PWV and SBP compared with placebo or standard care ( P < .05). Renin-angiotensin system inhibitors did not show any advantage over placebo in decreasing cf-PWV ( P > .05). Limitations: Quality of evidence ranged from very low to moderate. Overall evidence was limited by the low number of studies, small sample sizes, and methodological inconsistencies. Conclusions: Pharmacologic interventions targeting aortic stiffness in ESRD have mixed effects on reducing cf-PWV, with some strategies suggesting potential benefit. The quality of evidence, however, is insufficient to draw definitive conclusions on their use to slow progression of aortic stiffness in ESRD. Further well-designed studies are needed to confirm these associations and their impact on cardiovascular outcomes in ESRD. Registered in PROSPERO (CRD42016033463)
Eremostachys laciniata as effective as rectal diclofenac suppository in cesarean section pain relief: A triple-blind controlled clinical trial
Authors: Mohammad Pour Shabnam , Hakimi Sevil , Delazar Abbas , Javad Zadeh Yousef , Mallah Fatemeh 
Published: February 2020

Background: Pain and distress are two common complications of cesarean section. Among complementary therapies, Eremostachys was introduced as a pain mitigator. This study aimed at investigating the effect of Eremostachys laciniata on cesarean section pain and distress. Materials and methods: This randomized clinical trial was conducted on 86 women who gave childbirth by cesarean section. The control group received 50 mg rectal diclofenac suppository every 8 h for 3 days, and the intervention group received 35 mg E. laciniata total extract suppository every 8 h up to three doses. Pain was measured with the Visual Analogue Scale at 8, 16, and 24 h after cesarean section. The Symptom Distress Scale was completed at 8 and 24 h after cesarean section. The Redness, Edema, Ecchymosis, Discharge, Approximation scale was completed 5 days after cesarean section. Findings: Pain score at 8, 16, and 24 h after surgery (15 min after intervention) was not significantly different between the intervention and control groups. The distress score 24 h after cesarean section showed a significant difference in favor of the control group according to Friedman’s test. There was a significant difference between the two groups in wound healing score, which indicated better efficacy of rectal diclofenac suppository than E. laciniata suppository. We assessed nausea, vomiting, headache, massive hemorrhage, and any type of anaphylactic reaction. No side events were observed in two groups. Conclusion: Rectal E. laciniata suppository could be introduced as a low-complication, appropriate, and effective medication in controlling pain and distress after cesarean section; more studies should be conducted on this matter.