bluuebunny/crossref_metadata_2025_split huggingface dataset:
RESPONSE OF CURRENT PHOTON PERSONAL DOSEMETERS TO NEW OPERATIONAL QUANTITIES
Authors: Ekendahl Daniela , Čemusová Zina , Kurková Dana , Kapuciánová Michaela 
Published: May 2020

Abstract
The ICRU proposed new operational quantities, which are defined in close relation to effective dose and absorbed dose. Most of the current personal dosemeters were designed to measure personal dose equivalents. Because of differences between the new and old quantities, the existing dosemeters may not be ideal for measurements of the new quantities, personal dose, Hp, and absorbed dose in local skin, Dp local skin. For photon radiation sources, we investigated relative responses of the current personal dosemeters with respect to the measurement of the new quantities. Introduction of the new quantities into practice will require some changes in practical radiation protection. A recalibration of the current dosemeters will be essential for Hp measurements in higher photon energy region (&gt;50 keV). For lower photon energies, a redesign of specific evaluation algorithms will be necessary. For purposes of Dp local skin measurements the dosemeters do not require any fundamental changes.
Reforms to the Legal Framework of Child Sexual Abuse in India: Legislative Band-Aids on Systemic Wounds
Authors: Chaudhary Shraddha 
Published: May 2020

Abstract
The Criminal Law (Amendment) Act, 2018 and the Protection of Children from Sexual Offences (Amendment) Act, 2019 were purportedly aimed at strengthening the criminal justice system and deterring child sexual abuse. The article demonstrates how both legislations were reactionary, enacted without considering the evidence available on the lacunae in the system they sought to reform. It problematizes and critiques the new offences and enhanced sentences anchored in age-categorizations, the increased mandatory minimum sentences, the unenforceable timelines for investigation and trial, and the reinforcement of the link between fines imposed on the offender and compensation for the victim. It argues that the new legal framework will only exacerbate the implementation hurdles of the old framework, leading to poorer prosecution outcomes. The article also critiques the introduction of the death penalty for child rape. It is argued that the move could expose victims to mortal danger and will create a baffling situation for Special Courts adjudicating de facto consensual cases. While the government touts these legislations as proof of its hard stance on child sexual abuse, this article demonstrates that they were nothing more than political gimmicks, meant to distract from the conspicuous absence of any effort towards systemic change.
Therapeutic drug monitoring in patients on biologics: lessons from gastroenterology
Authors: Papamichael Konstantinos , Cheifetz Adam S. 
Published: May 2020

Purpose of review
To give an overview on the role of therapeutic drug monitoring (TDM) of biologics in patients with inflammatory bowel disease (IBD).

Recent findings
Numerous prospective exposure–response relationship studies and post-hoc analyses of randomized controlled trials (RCTs) show a positive correlation between biologic drug concentrations and favorable clinical outcomes in IBD. These studies also demonstrate that higher drug concentrations appear to be needed to achieve more stringent objective therapeutic outcomes. Reactive TDM rationalizes the management of primary nonresponse and secondary loss of response to antitumor necrosis factor (anti-TNF) therapy and is more cost-effective when compared with empiric dose optimization. Furthermore, recent data suggest that proactive TDM, with the goal of targeting a threshold drug concentration, is associated with better therapeutic outcomes when compared with empiric dose escalation and/or reactive TDM of infliximab or adalimumab. Finally, proactive TDM can also efficiently guide infliximab de-escalation or discontinuation in patients with IBD in remission.

Summary
Reactive TDM is currently considered as standard of care, whereas proactive TDM is emerging as a new therapeutic strategy for better optimizing anti-TNF therapy in IBD. However, more data from prospective studies are needed before a wide implementation of TDM-based algorithms in real life clinical practice for newer biologics.
The management of enthesitis in clinical practice
Authors: Koppikar Sahil , Eder Lihi 
Published: May 2020

Purpose of reviewEnthesitis is a hallmark feature of the spondyloarthropathies (SpA). This review provides an overview of recent insights on diagnosis and management of enthesitis.Recent findingsRecent studies support the use of imaging for diagnosis because of its higher sensitivity and specificity compared with clinical examination. Several new MRI and ultrasound scoring systems have been developed for enthesitis, which may facilitate the use of imaging in research. Enthesitis has been evaluated as a primary study outcome mainly in psoriatic arthritis (PsA); however, the use of different indices and definitions of improvement limits comparison across studies. There is very limited information about the efficacy of synthetic disease modifying antirheumatic drugs (DMARDs) for the treatment of enthesitis. In contrast, targeted and biologic DMARDs have all shown efficacy in treating enthesitis compared with placebo. There have been only a few head-to-head trials that compared two different cytokine inhibitors for the treatment of enthesitis. Preliminary data suggest that targeting IL-17 or IL12/23 may be more efficacious for controlling enthesitis than TNF inhibition.SummaryEmerging data suggest interleukin-17 and 12/23 inhibitors may be the first choice in PsA patients with enthesitis. Further head-to-head studies are needed before making definitive recommendations.
Barrier lymphocytes in spondyloarthritis
Authors: Berlinberg Adam , Kuhn Kristine A. 
Published: May 2020

Purpose of review
The clinical overlap between spondyloarthritis (SpA) and inflammation of barrier tissues such as the intestine and skin indicates a role of barrier tissue immunity in the development of SpA. Herein, we review the recent advances in understanding lymphocyte populations and functions within the intestine and skin implicated in the pathophysiology of SpA.

Recent findings
A number of unique lymphocyte populations have been identified to be expanded within the gut and skin of patients with SpA, including γδ T cells, mucosa-associated invariant T (MAIT) cells, innate lymphoid cells (ILCs) and T resident memory (TRM) cells. These cells respond to microbial cues at their barrier surface causing cellular activation and generation of interleukin (IL)-17, which is hypothesized to be the mechanism by which they contribute to SpA pathogenesis.

Summary
Understanding how unique lymphocyte populations expand and produce IL-17 in the development of SpA provides insights into the pathophysiology of this disease as well as potential future therapeutic avenues.
The IL-23/IL-17A axis in spondyloarthritis: therapeutics informing pathogenesis?
Authors: Siebert Stefan , McGucken Andrew , McInnes Iain B. 
Published: May 2020

Purpose of review
To give an overview of the recently published trials relating to IL-23/IL-17 pathway in spondyloarthritis (SpA).

Recent findings
Recent studies in psoriasis confirmed the efficacy of targeting the IL-23/IL-17 pathway, with emerging evidence from head-to-head studies suggesting functional hierarchy of these inhibitors. In psoriatic arthritis (PsA), recent studies have indicated the efficacy of inhibiting IL-23p19, in addition to IL-23p40 and IL-17A, albeit all with lower hurdle results than those seen in psoriasis. The first head-to-head study of an IL-17A and tumour necrosis factor inhibitor in PsA has also recently been published. Recent studies have demonstrated the efficacy of the IL-17A inhibitor, ixekizumab, across the axial SpA spectrum. In contrast, inhibition of IL-12/IL-23p40 and IL-23p19 both failed in axial SpA. In inflammatory bowel disease (IBD), recent studies indicate efficacy of IL-23p40 and IL-23p19 inhibition, in contrast to the previous failed studies of IL-17 inhibition.

Summary
Clinical trials of IL-23/IL-17 inhibition have been transformative in psoriasis, with more mixed results in PsA and differential responses in axial SpA and IBD. These results pose challenges to our fundamental understanding of SpA pathogenesis and further head-to-head studies and more subtle evaluation of the local tissue-specific aspects will be required.
MHC class I associations beyond HLA-B27: the peptide binding hypothesis of psoriatic arthritis and its implications for disease pathogenesis
Authors: Winchester Robert , FitzGerald Oliver 
Published: May 2020

Purpose of review
To provide an overview of the heterogeneous human leucocyte antigen (HLA) associations of psoriatic arthritis, their relationship to particular clinical features of the disease, and how a hypothesis of binding specific peptides could provide a unifying basis for this heterogeneity.

Recent findings
There have been substantive advances in understanding the role of HLA molecules in binding self-peptides that select our repertoire of T cells, the specific peptide-binding properties of these HLA allotypes, and their crystallographic structure. These advances provide a means to envision the significance of the heterogeneous psoriatic arthritis HLA associations. The clinical relevance of these allotypes if heightened by emerging knowledge of their relationship to particular clinical features of the disease that serve as subphenotypes.

Summary
We propose a peptide binding hypothesis of psoriatic arthritis based on a shared pattern of negative charge in the ‘B’ pocket of the HLA-B and HLA-C molecules encoded by the susceptibility allotypes. This hypothesis suggests that peptides characterized by the presence of arginine at position 2 or 3 are bound to the susceptibility allotypes and drive the T-cell clones selected on them to attack molecules containing these peptides located in sites of psoriatic arthritis inflammation.
Biosimilars in supportive care
Authors: Foreman Emma 
Published: May 2020

Purpose of review
This review covers recent publications relating to the use of biosimilar medicines in the supportive care of cancer patients, and broader publications focussed on the benefits and challenges of implementing biosimilars into clinical practice.

Recent findings
A metaanalysis and a number of systematic literature reviews have confirmed that the safety and efficacy of biosimilar versions of epoetin-α, filgrastim and infliximab are equivalent to those of their corresponding reference biologics. New guidelines have been issued concerning the interchangeability of biosimilars and the practice of substituting a biosimilar in place of a prescribed reference product. The introduction of biosimilars into a health system has been shown to improve patient access to treatment while also delivering cost savings, however, there are a number of barriers that can prevent or delay the adoption of biosimilars into clinical practice which must be overcome for the potential benefits of biosimilars to be realized.

Summary
There is a large amount of data to demonstrate that supportive care biosimilars are well tolerated and effective, with over 10 years of experience in Europe. We can learn from the challenges faced when introducing biosimilars into supportive care to facilitate the introduction of newer biosimilars into the treatment setting.
Techniques of noncircular corneal transplantation
Authors: Deshmukh Rashmi , Stevenson Louis J. , Vajpayee Rasik B. 
Published: May 2020

Purpose of review
The management of peripheral corneal diseases, including Mooren's ulcer, Terrien's marginal degeneration, peripheral ulcerative keratitis and pellucid marginal degeneration is challenging. Circular grafts must either be very large, resulting in the excision of healthy tissue, or eccentric, leading to high levels of astigmatism. This review summarizes the range of noncircular keratoplasty procedures available to surgeons, in addition to their indications, and surgical techniques.

Recent findings
Noncircular grafts have been demonstrated to be useful in the management of peripheral corneal diseases. They are effective at providing tectonic support and also facilitate visual rehabilitation. Specifically, they produce favourable postoperative visual and astigmatic outcomes. The evidence relating to these procedures is largely limited to case reports and case series, with no large-scale studies available.

Summary
Noncircular keratoplasty procedures are useful in the management of peripheral corneal diseases, which is typically difficult. There is a need for larger studies to investigate the relative advantages and disadvantages of these procedures and further characterize their outcomes.
Immunodeficiency and inborn disorders of vitamin B12 and folate metabolism
Authors: Watkins David , Rosenblatt David S. 
Published: May 2020

Purpose of review
Immune dysfunction, including severe combined immunodeficiency, has been described in genetic disorders affecting the metabolism of the vitamins cobalamin (vitamin B12) and folate. We have reviewed reports of clinical findings in patients with a number of inborn errors of cobalamin or folate metabolism, specifically looking for immune problems.

Recent findings
There is little evidence that immune function is affected in most of the disorders. Exceptions are Imerslund–Gräsbeck syndrome and hereditary folate malabsorption (affecting intestinal absorption of cobalamin and folate, respectively), transcobalamin deficiency (affecting transport of cobalamin in blood and cellular cobalamin uptake), and methylenetetrahydrofolate dehydrogenase 1 deficiency (catalyzing cytoplasmic interconversion of reduced folate coenzyme derivatives).

Summary
Although some inborn errors of cobalamin or folate can be associated with immune dysfunction, the degree and type of immune dysfunction vary with no obvious pattern.
The Early Impact of the Centers for Medicare & Medicaid Services State Innovation Models Initiative on 30-Day Hospital Readmissions Among Adults With Diabetes
Authors: Rodríguez Hector P. , Fulton Brent D. , Phillips Aryn Z. 
Published: May 2020

Background:
The Centers for Medicare & Medicaid Services (CMS) State Innovation Models (SIM) Initiative funds states to accelerate delivery system and payment reforms. All SIM states focus on improving diabetes care, but SIM’s effect on 30-day readmissions among adults with diabetes remains unclear.

Methods:
A quasi-experimental research design estimated the impact of SIM on 30-day hospital readmissions among adults with diabetes in 3 round 1 SIM states (N=671,996) and 3 comparison states (N=2,719,603) from 2010 to 2015. Difference-in-differences multivariable logistic regression models that incorporated 4-group propensity score weighting were estimated. Heterogeneity of SIM effects by grantee state and for CMS populations were assessed.

Results:
In adjusted difference-in-difference analyses, SIM was associated with an increase in odds of 30-day hospital readmission among patients in SIM states in the post-SIM versus pre-SIM period relative to the ratio in odds of readmission among patients in the comparison states post-SIM versus pre-SIM (ratio of adjusted odds ratio=1.057, P=0.01). Restricting the analyses to CMS populations (Medicare and Medicaid beneficiaries), resulted in consistent findings (ratio of adjusted odds ratio=1.057, P=0.034). SIM did not have different effects on 30-day readmissions by state.

Conclusions:
We found no evidence that SIM reduced 30-day readmission rates among adults with diabetes during the first 2 years of round 1 implementation, even among CMS beneficiaries. It may be difficult to reduce readmissions statewide without greater investment in health information exchange and more intensive use of payment models that promote interorganizational coordination.
Reduced Cost-sharing for Preventive Drugs Preferentially Benefits Low-income Patients With Diabetes in High Deductible Health Plans With Health Savings Accounts
Authors: Ross-Degnan Dennis , Wallace Jamie , Zhang Fang , Soumerai Stephen B. , Garabedian Laura , Wharam J. Frank 
Published: May 2020

Background:High deductible health plans linked to Health Savings Accounts (HSA-HDHPs) must include all care under the deductible except for select preventive services. Some employers and insurers have adopted Preventive Drug Lists (PDLs) that exempt specific classes of medications from deductibles.Objective:The objective of this study was to examine the association between shifts to PDL coverage and medication utilization among patients with diabetes in HSA-HDHPs.Research Design:A natural experiment comparing pre-post changes in monthly and annual outcomes in matched study groups.Subjects:The intervention group included 1744 commercially-insured HSA-HDHP patients with diabetes age 12–64 years switched by employers to PDL coverage; the control group included 3349 propensity-matched HSA-HDHP patients whose employers offered no PDL.Measures:Outcomes were out-of-pocket (OOP) costs for medications and the number of pharmacy fills converted to 30-day equivalents.Results:Transition to the PDL was associated with a relative pre-post decrease of $612 (−35%,P<0.001) per member OOP medication expenditures; OOP reductions were higher for key classes of antidiabetic and cardiovascular medicines listed on the PDL; the policy did not affect unlisted classes. The PDL group experienced relative increases in medication use of 6.0 30-day fills per person during the year (+11.2%,P<0.001); the increase was more than twice as large for lower-income (+6.6 fills, +12.6%,P<0.001) than higher-income (+3.0 fills, +5.1%,P=0.024) patients.Conclusion:Transition to a PDL which covers important classes of medication to manage diabetes and cardiovascular conditions is associated with substantial annual OOP cost savings for patients with diabetes and increased utilization of important classes of medications, especially for lower-income patients.
“Not Alone Anymore”
Authors: Mayer Victoria L. , Siscovick David , Goytia Crispin , Brown Daphne , Hanlen Emily , Flory James , McKee M. Diane , Horowitz Carol R. 
Published: May 2020

Background:
New York State Medicaid’s Health Home program is an example of a natural experiment that could affect individuals with diabetes. While evaluations of interventions such as the Health Home program are generally based solely on clinical and administrative data and rarely examine patients’ experience, patients may add to the understanding of the intervention’s implementation and mechanisms of impact.

Objective:
The objective of this study was to qualitatively examine the health and nonmedical challenges faced by Medicaid-insured patients with diabetes and their experiences with the services provided by New York’s Health Homes to address these challenges.

Research Design:
We performed 10 focus groups and 23 individual interviews using a guide developed in collaboration with a stakeholder board. We performed a thematic analysis to identify cross-cutting themes.

Subjects:
A total of 63 Medicaid-insured individuals with diabetes, 31 of whom were enrolled in New York’s Health Home program.

Results:
While participants were not generally familiar with the term “Health Home,” they described and appreciated services consistent with Health Home enrollment delivered by care managers. Services addressed challenges in access to care, especially by facilitating and reminding participants about appointments, and nonmedical needs, such as transportation, housing, and help at home. Participants valued their personal relationships with care managers and the psychosocial support they provided.

Conclusions:
From the perspective of its enrollees, the Health Home program primarily addressed access to care, but also addressed material and psychosocial needs. These findings have implications for Health Home entities and for research assessing their impact.
Using Electronic Health Records in Longitudinal Studies
Authors: Huguet Nathalie , Kaufmann Jorge , O’Malley Jean , Angier Heather , Hoopes Megan , DeVoe Jennifer E. , Marino Miguel 
Published: May 2020

Background:
Electronic health records (EHRs) provide rich data on many domains not routinely available in other data, as such, they are a promising source to study changes in health outcomes using longitudinal study designs (eg, cohort studies, natural experiments, etc.). Yet, patient attrition rates in these data are unknown.

Objective:
The objective of this study was to estimate overall and among adults with diabetes or hypertension: (1) patient attrition over a 3-year period at community health centers; and (2) the likelihood that patients with Medicaid permanently switched their source of primary care.

Research Design:
A retrospective cohort study of 2012–2017 data from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Data Research Network of community health centers were used to assess EHR data attrition. Oregon Medicaid enrollment and claims data were used to estimate the likelihood of changing the source of primary care.

Subjects:
A total of 827,657 patients aged 19–64 with ≥1 ambulatory visit from 76 community health center systems across 20 states. In all, 232,891 Oregon Medicaid enrollees (aged 19–64) with a gap of ≥6 months following a claim for a visit billed to a primary care source.

Measures:
Percentage of patients not returning within 3 years of their qualifying visit (attrition). The probability that a patient with Medicaid permanently changed their primary care source.

Results:
Attrition over the 3 years averaged 33.5%; attrition rates were lower (<25%) among patients with diabetes and/or hypertension. Among Medicaid enrollees, the percentage of provider change after a 6-month gap between visits was 12% for community health center patients compared with 39% for single-provider practice patients. Over 3 years, the likelihood of a patient changing to a new provider increased with length of time since their last visit but remained lowest among community health center patients.

Conclusion:
This study demonstrates the use of the EHR dataset is a reliable source of data to support longitudinal studies while highlighting variability in attrition by primary care source and chronic conditions.