bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergence of racial/ethnic and socioeconomic differences in objectively measured sleep–wake patterns in early infancy: results of the Rise & SHINE study
Authors: Yu Xinting , Quante Mirja , Rueschman Michael , Ash Tayla , Kaplan Emily R , Guo Na , Horan Christine M , Haneuse Sebastien , Davison Kirsten , Taveras Elsie M , Redline Susan 
Published: October 2020

AbstractStudy ObjectivesTo characterize objectively assessed sleep–wake patterns in infants at approximately 1 month and 6 months and examine the differences among infants with different racial/ethnic backgrounds and household socioeconomic status (SES).MethodsFull-term healthy singletons wore an ankle-placed actigraph at approximately 1 month and 6 months and parents completed sleep diaries. Associations of racial/ethnic and socioeconomic indices with sleep outcomes were examined using multivariable analyses. Covariates included sex, birth weight for gestational age z-score, age at assessment, maternal education, household income, bed-sharing, and breastfeeding.ResultsThe sample included 306 infants, of whom 51% were female, 42.5% non-Hispanic white, 32.7% Hispanic, 17.3% Asian, and 7.5% black. Between 1 month and 6 months, night sleep duration increased by 65.7 minutes (95% CI: 55.4, 76.0), night awakenings decreased by 2.2 episodes (2.0, 2.4), and daytime sleep duration decreased by 73.3 minutes (66.4, 80.2). Compared to change in night sleep duration over this development period for white infants (82.3 minutes [66.5, 98.0]), night sleep increased less for Hispanic (48.9 minutes [30.8, 66.9]) and black infants (31.6 minutes [−5.9, 69.1]). Night sleep duration also increased less for infants with lower maternal education and household income. Asian infants had more frequent night awakenings. Adjustment for maternal education and household income attenuated all observed day and night sleep duration differences other than in Asians, where persistently reduced nighttime sleep at 6 months was observed.ConclusionsRacial/ethnic differences in sleep emerge in early infancy. Night and 24-hour sleep durations increase less in Hispanic and black infants compared to white infants, with differences largely explained by SES.
Algorithm for automatic detection of self-similarity and prediction of residual central respiratory events during continuous positive airway pressure
Authors: Oppersma Eline , Ganglberger Wolfgang , Sun Haoqi , Thomas Robert J , Westover M Brandon 
Published: October 2020

Abstract

Study Objectives
Sleep-disordered breathing is a significant risk factor for cardiometabolic and neurodegenerative diseases. High loop gain (HLG) is a driving mechanism of central sleep apnea or periodic breathing. This study presents a computational approach that identifies “expressed/manifest” HLG via a cyclical self-similarity feature in effort-based respiration signals.

Methods
Working under the assumption that HLG increases the risk of residual central respiratory events during continuous positive airway pressure (CPAP), the full night similarity, computed during diagnostic non-CPAP polysomnography (PSG), was used to predict residual central events during CPAP (REC), which we defined as central apnea index (CAI) higher than 10. Central apnea labels are obtained both from manual scoring by sleep technologists and from an automated algorithm developed for this study. The Massachusetts General Hospital sleep database was used, including 2466 PSG pairs of diagnostic and CPAP titration PSG recordings.

Results
Diagnostic CAI based on technologist labels predicted REC with an area under the curve (AUC) of 0.82 ± 0.03. Based on automatically generated labels, the combination of full night similarity and automatically generated CAI resulted in an AUC of 0.85 ± 0.02. A subanalysis was performed on a population with technologist-labeled diagnostic CAI higher than 5. Full night similarity predicted REC with an AUC of 0.57 ± 0.07 for manual and 0.65 ± 0.06 for automated labels.

Conclusions
The proposed self-similarity feature, as a surrogate estimate of expressed respiratory HLG and computed from easily accessible effort signals, can detect periodic breathing regardless of admixed obstructive features such as flow limitation and can aid the prediction of REC.
Evolution of macroglands and defensive mechanisms in Leiuperinae (Anura: Leptodactylidae)
Authors: Ferraro Daiana Paola , Pereyra Martín Oscar , Topa Pascual Emilio , Faivovich Julián 
Published: October 2020

AbstractAnurans show a wide variety of anti-predator mechanisms, and the species of the Neotropical clade Leiuperinae display several of them. Most species of Edalorhina, Physalaemus and Pleurodema show eyespots, hidden bright colours, macroglands in a inguinal/lumbar position, defensive behaviours and/or chemical defence. We conducted a histological analysis of dorsal and lumbar skin and revised the colour patterns, defensive behaviours and glandular secretions to study the diversity and evolution of anti-predator mechanisms associated with macroglands. We describe 17 characters and optimize these in a phylogenetic hypothesis of Leiuperinae. In the most recent common ancestor of Edalorhina + Engystomops + Physalaemus + Pleurodema, a particular type of serous gland (the main component of macroglands) evolved in the lumbar skin, along with the absence of the Eberth–Katschenko layer. A defensive behaviour observed in leiuperines with macroglands includes four displays (‘crouching down’ behaviour, rear elevation, body inflation and eye protection), all present in the same ancestor. The two elements associated with aposematism (hidden bright colours and eyespots) evolved independently in several species. Our results provide phylogenetic evidence for the startle-first hypothesis, which suggests that behavioural displays arise as sudden movements in camouflaged individuals to avoid predatory attacks, before the origin of bright coloration.
Obstetric Perineal Lacerations in Women With Female Genital Mutilation (FGM) [11G]
Authors: Hickman Holly Anne , Pagidas Kelly , Gaskins Jeremy , O'Leary Katherine , Hodge Taylor 
Published: October 2020

INTRODUCTION:
To evaluate whether or not women, who have undergone FGM III, have an increased rate of second degree and higher obstetric perineal lacerations than a control group of similar patients.

METHODS:
For this retrospective chart review, we searched the electronic medical record (EMR) for patients speaking Somali, Arabic, Kurdish, Swahili, and French, who delivered at the University of Louisville Hospital from April 10, 2016 through August 10, 2017. We then entered baseline characteristics and delivery details into a secure database. A total of 110 patients were included. We looked at type of FGM, mode of delivery, rates of assisted delivery and primary cesarean section, types of perineal lacerations, and whether or not defibulation was performed.

RESULTS:
The baseline characteristics had several significant differences between the controls (n=84), FGM II (n=11), and FMG III (n=15) patients. Most strikingly, the FGM III population was 93% nulliparous. We controlled for this in our analysis with logistic regression models. The odds ratios (OR) of a second degree or higher perineal laceration comparing FGM III to controls (OR 5.06, 0.87-53.84) was not significant (p=0.0687). After logistic regression was applied controlling for body mass index, nulliparity, and assisted delivery, there was no increased risk of laceration in women with FGM III (AOR 1.06, CI 0.11-10.35, p=0.9571). We found that we correctly followed the standard of care and defibulated 89% (8/9) of women with FGM III that underwent vaginal delivery.

CONCLUSION:
Women with FGM III did not appear to have an increased risk of second degree and higher perineal lacerations.
Association of Class II Obesity and Hypertension With Perinatal Outcomes in ART Conceived Twin Pregnancies [21P]
Authors: Mulhall J. Connor , Arkfeld Christopher K. , Shea Ashley , Dahlke Joshua D. 
Published: October 2020

INTRODUCTION:
Obesity and hypertensive disorders (chronic hypertension, gestational hypertension, preeclampsia) have an associated increased risk of adverse perinatal outcomes in singleton and twin gestations. These associations are less defined when both occur in twin gestations conceived through artificial reproductive technology (ART). Our objective was to evaluate the impact of preconception concurrent Class II obesity (BMI ≥35 kg/m2) and hypertension on perinatal outcomes from twin gestations conceived through ART.

METHODS:
IRB approval was obtained. We performed a retrospective cohort study of twin gestations delivered at one tertiary care center and had ultrasonography in our MFM clinic between January 1, 2013 and September 1, 2017. Women with spontaneous conception, unknown contraceptive method, missing maternal/neonatal data, and monochorionic-monoamniotic twins were excluded. Our primary outcome was neonatal and maternal morbidity in twin pregnancies conceived by ART among two groups: 1) preconception BMI ≥-35 kg/m2 with a hypertensive condition and 2) preconception BMI <35 kg/m2 without hypertension.

RESULTS:
Of 587 twin pregnancies identified, 229 met inclusion criteria. 213 patients had preconception BMI <35 kg/m2 without hypertension; 16 patients had preconception BMI ≥-35 kg/m2 with a hypertensive condition. Compared to preconception BMI <35 kg/m2 without hypertension, the preconception BMI ≥35 kg/m2 with hypertension group were more likely to have a 5 minute Apgar score <5 (P=.008), intrauterine fetal demise (P=.025), maternal gestational diabetes mellitus (P=.007), and cesarean delivery (P=.003).

CONCLUSION:
ART conceived twin gestations in women with preconception Class II obesity and hypertension have an associated increased risk of 5 minute Apgar score <5, IUFD, maternal gestational diabetes, and cesarean section compared to women without these conditions.
Provider Perspectives on Sterilization: The Complexities and Challenges of Sterilization Counseling [5R]
Authors: Monaco Alexandra , Rangnekar Niyati , Hamm Megan E. , Maples Jill , Borrero Sonya , Zite Nikki B. 
Published: October 2020

INTRODUCTION:
The purpose of this project was to explore provider perspectives regarding women's informational and decision support needs around sterilization decision making, the complexities and challenges of sterilization counseling, and how these factors may differ for low-income women.

METHODS:
Semi-structured, 30-45 minute telephone interviews with 15 obstetrician-gynecologists in 3 different geographic regions were audio-recorded and transcribed verbatim. A codebook was inductively developed through review of the interview transcripts, and then applied to all transcripts by two coders with the assistance of NVivo qualitative data analysis software. Coding differences were adjudicated to full agreement. This finalized coding was used to assist in a thematic analysis of the transcripts.

RESULTS:
Obstetrician-gynecologists described several challenges to providing high-quality sterilization counseling. Providers discussed inherent tensions between respecting women's reproductive autonomy and concern for future regret. Specifically, they wanted to support women's desire for sterilization but were often concerned that women did not have the information they needed or the foresight to make high-quality decisions. They identified significant barriers to counseling including lack of time in the visit, lack of continuity over the course of prenatal care, and significant baseline misinformation among patients. They also identified barriers to postpartum sterilization after a decision was made, including lack of timely OR availability and maternal factors like obesity. Providers felt that low-income women faced more challenges in sterilization decision-making, including significant baseline knowledge gaps and sterilization consent regulations required by Medicaid federally.

CONCLUSION:
Efforts are needed to support providers and women with regard to sterilization counseling and decision-making.
Unmonitored Labor Episodes in Obese Parturients With Wireless Versus Conventional Fetal Heart Rate Monitoring [16S]
Authors: Blitz Matthew J. , Sharma Ruchira , Gerber Rachel , Lal Tara N. , Rabin Jill M. , Meirowitz Natalie 
Published: October 2020

INTRODUCTION:
To determine the frequency and duration of unmonitored labor (UL) episodes in obese parturients exposed to wireless fetal heart rate (FHR) monitoring compared to exclusively conventional wired FHR monitoring.

METHODS:
Retrospective cohort of obese gravidas with non-anomalous, term singleton gestations admitted for induction or early labor at a tertiary hospital. Patients were excluded for initial cervical dilation ≥5 cm or prior cesarean delivery. Groups were defined by whether any exposure to wireless FHR monitoring (Monica Novii Wireless Patch System, GE Healthcare) occurred during admission for delivery. Each subject's complete FHR tracing was reviewed. Outcomes were UL episodes/hour and minutes/hour of FHR monitoring. UL is defined as ≥2 minutes of absent or discontinuous FHR tracing, excluding intentional interruptions exceeding 30 minutes.

RESULTS:
A total of 1,350 hours of FHR monitoring were reviewed for 52 deliveries (24 wireless, 28 wired). BMI was higher in the wireless compared to the wired group (38.1 vs. 34.7 kg/m2); no other demographic differences were observed. In the wireless group, 54.2% of FHR monitoring time was wireless. No differences in UL were observed between the wireless and wired groups. However, within the wired group, which was exposed to both forms of FHR monitoring, there were fewer UL episodes/hour (0.41 vs. 0.85; P<0.005) and UL minutes/hour (2.8 vs. 7.5; P<0.001) during the wireless FHR monitoring period compared with the wired FHR monitoring period.

CONCLUSION:
Wireless FHR monitoring may reduce periods of UL, particularly in high BMI patients. Future studies should evaluate whether this affects obstetrical outcomes.
Broad Utility of a Minimally Invasive Technique for Pediatric Wound Care: Simple and Effective
Authors: Steen Emily H. , Tuley Jill M. , King Alice , Lee Timothy C. , Keswani Sundeep G. 
Published: October 2020

ABSTRACT

OBJECTIVE
Infected or contaminated wound sites have historically been managed with incision and drainage. Here, the authors review their experience with skin closure over vessel loops and assess the results of this technique in a variety of clinical situations, hypothesizing that minimally invasive drainage strategies are associated with a decrease in common postoperative complications.

METHODS
Investigators retrospectively reviewed the data of all children with infected or contaminated wound sites operated on by a single surgeon with skin closure over vessel loops from September 2016 to September 2018. Demographics, indications for surgery, complications, and follow-up were assessed.

RESULTS
Over a 2-year period, 33 children underwent skin closure over vessel loops. The majority were female (82%), Hispanic/Latino (40%), and younger than 5 years (58%; range, 4 months to 16 years). One-third were obese. Reasons for intervention included skin and soft tissue infection (64%), trauma (15%), and ostomy closure (6%). Median postoperative length of stay was 1 day. Three-quarters (76%) of the patients returned to the clinic for follow-up and/or vessel loop removal. At 30 days after operation, no patients in this cohort returned to the ED with recurrent infection or wound dehiscence.

CONCLUSIONS
This minimally invasive technique for contaminated wound management demonstrates no evidence of subsequent infection in standard follow-up. These results are indicative of specific advantages related to vessel loop drainage, including shorter lengths of stay and ease of wound maintenance, in a variety of challenging clinical scenarios.
Treatment of Superficial Incision Dehiscence after Abdominal Surgery by Z-Plasty: A Retrospective Case Series
Authors: Cao Zilong , Zhang Fan , Liu Xujin , Zhang Min , Ma Yuntao 
Published: October 2020

ABSTRACT

OBJECTIVE
To explore the treatment of superficial incision dehiscence after abdominal surgery by Z-plasty combined with negative-pressure wound therapy.

METHODS
A retrospective study was performed on seven patients with superficial abdominal incision dehiscence from October 2018 to February 2019. All patients were given systemic antibiotics and nutrition support. During the first stage, surgical debridement with negative-pressure wound therapy was performed. Local Z-plasty was performed in the second stage.

RESULTS
The incision healed well in all patients, and no infection or necrosis occurred in the flaps. During the follow-up of 7.3 months (range, 5-10 months), no incision rupture or redehiscence occurred.

CONCLUSIONS
Surgical debridement, negative-pressure wound therapy, and Z-plasty can be used to treat superficial abdominal incision dehiscence and achieve good therapeutic effect and prognosis. Z-plasty can be used as an alternative to direct suture of incisions because of its simplicity and excellent results.
Efficacy of Surgical Excision and Brachytherapy in the Treatment of Keloids: A Retrospective Cohort Study
Authors: Daurade Mathieu , Breton Pierre , Rouard Nathalie , Lorchel Fabrice , Ibrahim Badr , Sigaux Nicolas 
Published: October 2020

ABSTRACT

OBJECTIVE
To demonstrate the efficacy of a protocol combining surgical excision and high-dose-rate brachytherapy for treatment of keloids.

METHODS
The authors performed a unicentric retrospective cohort study between 2013 and 2018. The minimum follow-up was 12 months. All patients treated for keloids at the authors’ institution were included. Extralesional excision was performed with placement of a brachytherapy sheath under the skin. The total dose of irradiation was 18 Gy. The postoperative results were evaluated for aesthetic and functional outcomes with a validated scale, as well as the presence or absence of recurrence.

RESULTS
Fifteen patients were lost to follow-up. Thirty-eight patients with 67 keloids were included. The control rate was 94%. The aesthetic and functional outcomes were considered good in 62% of cases. The main limitation of the study was the small patient population.

CONCLUSIONS
Extralesional excision combined with postoperative high-dose-rate brachytherapy seems to be one of the most effective invasive protocols to treat and prevent keloids.
Life on Call: Perspectives of Junior and Senior Internal Medicine Residents
Authors: Cygler Jeremy , Page Andrea V. , Ginsburg Shiphra 
Published: October 2020

Purpose
Models of daytime and nighttime on-call responsibilities for residents vary across internal medicine training programs, but there are few data regarding residents’ perceptions of their on-call experiences. The authors sought to understand what residents perceive as the benefits and detriments of 24-hour, in-house call, a perspective instrumental to informing change.

Method
The authors conducted in-depth individual interviews and focus groups between December 2018 and March 2019 with 17 internal medicine residents from postgraduate years 1, 2, and 3 at the University of Toronto about their on-call experiences. Using constructivist grounded theory, the authors developed a framework to understand the residents’ perceived benefits and drawbacks of 24-hour in-house call.

Results
Residents’ experiences on call were grouped into 7 themes regarding negative and positive aspects of call. Participants reported multidimensional fatigue related to call, including decision fatigue, emotional fragility and lability, and loss of empathy, and also reported that call adversely affected their personal lives. Residents expressed conflicting opinions as to whether prolonged duty hours affected patient outcomes. In contrast, residents also expressed benefits to call, including that overnight call led to increased autonomy and decision-making skills and provided preparation for future careers as independent internists. They described developing camaraderie and a sense of belonging to a team with coresidents overnight. Lastly, residents described occupying different roles during regular duty hours and while on call—daytime roles revolved around follow-up of previously admitted patients and administrative tasks, while overnight duties centered on initial workup and medical stabilization of referred patients.

Conclusions
Understanding the nuanced phenomenon of being on call from the perspective of those who live through it is a critical step in creating evidence-based educational policies. New call models should emphasize resident autonomy and decision making and should include a consideration of residents’ perceived differences between daytime and on-call roles.
A Method to Improve Continuous Renal Replacement Therapy Circuit Survival Time in Critically Ill Coronavirus Disease 2019 Patients With Acute Kidney Injury
Authors: Volbeda Meint , Londema Mark , van Meurs Matijs , Stegeman Coen A. , Gansevoort Ron T. , Berger Stefan P. , van der Voort Peter H. J. , Franssen Casper F. M. 
Published: October 2020

Objectives:
Optimizing continuous renal replacement therapy circuit survival in coronavirus disease 2019 patients admitted to the ICU.

Design:
Single-center prospective observational cohort study.

Setting:
Tertiary academic teaching ICU.

Patients:
Between March 19, 2020, and May 18, 2020, 11 out of 101 coronavirus disease 2019 patients were treated with continuous renal replacement therapy comprising 127 continuous renal replacement therapy days.

Interventions:
A nonrandomized observational comparison of circuit anticoagulation modalities using standard regional citrate anticoagulation, continuous IV heparin anticoagulation, or the combination of regional citrate anticoagulation with either continuous IV heparin or therapeutic dose nadroparin.

Measurements and Main Results:
Circuit patency was shorter than 24 hours using standard regional citrate anticoagulation or continuous IV heparin anticoagulation. Median circuit survival increased with at least 165% when the combination of regional citrate anticoagulation with either continuous IV heparin or therapeutic dose nadroparin was applied.

Conclusions:
Continuous renal replacement therapy circuit patency is diminished in coronavirus disease 2019 ICU patients. Combining regional citrate anticoagulation with either continuous IV heparin or therapeutic dose nadroparin increases filter survival as compared with regional citrate anticoagulation alone in this nonrandomized observational study.
Multikinase inhibitors for the treatment of radioiodine refractory thyroid cancer: what have we learned from the ‘real-world’ experience?
Authors: Costante Giuseppe 
Published: October 2020

Purpose of review
Several molecularly targeted drugs for treating radioiodine resistant differentiated thyroid carcinomas (RAIR-DTC) have been identified. Among these, sorafenib and lenvatinib have been approved for clinical use in many countries. The present review will analyze efficacy and safety ‘real-world’ data (RWD) emerging after their commercialization.

Recent findings
RWDs confirmed sorafenib and lenvatinib efficacy in terms of progression-free survival and, perhaps, overall survival improvement in patients with RAIR-DTC. Lenvatinib performance in RWDs appeared somehow lower than in randomized clinical trials (RCT), probably because the decision to start treatment in ‘real life’ was made when patients were in worse clinical conditions than in RCTs. Concerning safety, RWD studies corroborated RCT evidence of elevated overall and serious adverse event incidence. Notably, adverse events were manageable in most cases with appropriate treatment or dose reduction/interruption, so that the need for definitive withdrawal was limited. The suitability of multikinase inhibitors (MKI) as salvage therapy in RAIR-DTCs was also confirmed by RWD experience, at least for lenvatinib in the second-line setting.

Summary
RWD analysis has corroborated RCT results in terms of MKI efficacy for both first-line and salvage treatment in patients with RAIR-DTC. The safety profiles emerging from RWDs seem to justify the caution recommended by most scientific guidelines.