bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistent swallowing disorders after extubation in mechanically ventilated patients in ICU: a two-center prospective study
Authors: Beduneau G. , Souday V. , Richard J. C. , Hamel J. F. , Carpentier D. , Chretien J. M. , Bouchetemble P. , Laccoureye L. , Astier A. , Tanguy V. , Mercat A. , Beloncle F. , Tamion F. 
Published: October 2020

Abstract
Background
Persistent swallowing disorders (SD) are non-pulmonary complications of mechanical ventilation (MV). However, there are few clinical studies on persistent SD in critically ill patients undergoing tracheal intubation for MV. The aim of the present study was to assess the incidence and characteristics of clinical manifestations associated with persistent SD.

Methods
We prospectively evaluated in patients requiring more than 7 days of invasive MV the incidence and characteristics of clinical manifestations related to persistent SD. For this purpose, quality of swallowing was assessed within 24 h after extubation by an experienced physical therapist not directly involved in patient management. Swallowing assessment consisted in a specific standardized test combining a swallowing test and a full clinical evaluation of the cranial nerves involved in swallowing. In patients with SD on the first test, a second test was done within 48 h in order to discriminate between transient and persistent SD.

Results
Among the 482 patients mechanically ventilated more than 7 days, 138 were enrolled in this study. The first test performed 24 h after extubation revealed SD in 35 patients (25%). According to the second test performed 48 h later, SD were considered transient in 21 (15%) and persistent in 14 (10%) cases. Patients with persistent SD were older (66 ± 16 vs 58 ± 15 years), had lower bodyweight at admission (76 ± 15 vs 87 ± 23 kg) and received less often neuromuscular blocking agents (36% vs 66%) compared to patients without or with only transient SD. Patients with persistent SD had longer duration of Intensive Care Unit (ICU) stay after first extubation and longer delay to oral feeding than patients without or with only transient SD, respectively, 11 ± 9 vs 7 ± 6 days and 23 ± 33 vs 5 ± 7 days.

Conclusions
Based on a specific standardized clinical test, 25% of patients mechanically ventilated more than 7 days exhibited clinical manifestations of SD. However, SD were considered as persistent after extubation in only 10% of them. Persistent SD were associated with longer duration of ICU stay after extubation and longer time of enteral feeding.
Trial registration: The study is registered with Clinical Trials (NCT01360580).
Existence-uniqueness of positive solutions to nonlinear impulsive fractional differential systems and optimal control
Authors: Song Shu , Zhang Lingling , Zhou Bibo , Zhang Nan 
Published: October 2020

AbstractIn this thesis, we investigate a kind of impulsive fractional order differential systems involving control terms. By using a class ofφ-concave-convex mixed monotone operator fixed point theorem, we obtain a theorem on the existence and uniqueness of positive solutions for the impulsive fractional differential equation, and the optimal control problem of positive solutions is also studied. As applications, an example is offered to illustrate our main results.
Extra-pair paternity and antiparasitic defence
Authors: Møller Anders Pape , Søraker Jørgen Skavdal , Soler Juan José 
Published: October 2020

AbstractBackgroundExtra-pair paternity (EPP) in birds provides benefits in terms of more offspring, and characteristics for maintenance of this behaviour have been the subject of investigation. Microorganisms are known to be transmitted during mating, especially when mating with multiple partners, and factors reducing this cost of multiple mating are expected. Further, plumage brightness and colour intensity have been shown to be important traits to benefits from multiple mating as predicted by sexual selection. The aim of this study was to investigate the relationship between the rate of extra-pair paternity and the relative size of the uropygial gland at the interspecific level, as the uropygial gland is an exocrine gland hypothesized to produce antiparasitic substances and further identified to affect plumage brightness. Because of the expected benefits of large uropygial gland in scenarios of sexual selection, we predicted a positive correlation with EPP.MethodsWe collected information from the literature of uropygial gland size and frequency of extra-pair paternity of 60 avian species of different families and explored the predicted positive correlation between them. We did so with means of comparative analyses that considered phylogenetic relationship as random factor and included body mass as covariate. We used Markov chain Monte Carlo generalized linear mixed models that were weighted by number of nests used to estimate extra-pair paternity.ResultsWe detected a positive relationship between level of extra-pair paternity and uropygial gland size at an interspecific level. This finding is consistent with the prediction.ConclusionsWe discuss the importance of this result in scenarios of sexual selection and argue that the detected relationship may have arisen by utilizing antiparasitic secretions through secondary sexual characters indicating parasite resistance.
Non-adherence to inhaled medications among adult asthmatic patients in Ethiopia: a systematic review and meta-analysis
Authors: Aberhe Woldu , Hailay Abrha , Zereabruk Kidane , Mebrahtom Guesh , Haile Teklehaimanot 
Published: October 2020

Abstract
Background
Medication non-adherence is one of a common problem in asthma management and it is the main factor for uncontrolled asthma. It can result in poor asthma control, which leads to decreased quality of life, increase hospital admission, increased health care utilization, lost productivity, and mortality. To date, there have been no studies and protocols that estimated the pooled national prevalence of non-adherence to inhaled anti-asthmatic medications in Ethiopia. Therefore, the primary purpose of this systematic review and meta-analysis is to determine the pooled national prevalence of non-adherence to inhaled medications among asthmatic patients in Ethiopia.

Methods
Different database searching engines including PubMed, Scopus, Google Scholar, Africa journal online, World Health Organization afro library, and Cochrane review were systematically searched by using keywords such as “prevalence, non-adherence to inhaled medications, inhaled corticosteroids, and asthmatic patients” and their combinations. Six published observational studies that report the prevalence of non-adherence to inhaled medications were finally selected. The Preferred Reporting Items for Systematic Review and Meta-Analysis guideline was followed. Heterogeneity across the included studies was evaluated by the inconsistency index (I2). The random-effect model was fitted to estimate the pooled prevalence of non-adherence to inhale anti-asthmatic medications. All statistical analysis was done using R version 3.5.3 and R Studio version 1.2.5033 software for windows.

Results
The pooled national prevalence of non-adherence to inhaled medications among asthmatic patients was 29.95% (95% CI, 19.1, 40.8%). The result of this meta-analysis using the random-effects model revealed that there is high heterogeneity across the included studies. The result of subgroup analysis indicates that one out of three in the Oromia region and one out of five in the Amhara region asthmatic patients was non-adherent to their inhaled anti-asthmatic medications.

Conclusion
the prevalence of non-adherence to inhaled anti-asthmatic medications was high. Thus, our finding suggests that one out of four asthmatic patients were non-adherent to inhaled medications. The ministry of health, health policymakers, clinicians, and other health care providers should pay attention to strengthening the adherence levels to inhaled anti-asthmatic medications, and country-based interventions should be developed to reduce the burden of non-adherence to inhaled anti-asthmatic medications.
Does synbiotic supplementation affect the quality of life in children with cystic fibrosis? A pilot randomized controlled clinical trial
Authors: Bilan Nemat , Marefat Effat , Nikniaz Leila , Abbasalizad Farhangi Mahdieh , Nikniaz Zeinab 
Published: October 2020

Abstract
Background
There is no clinical trial that assesses the effect synbiotic supplementation on HRQOL in CF children. Considering the importance of HRQOL as an essential primary outcome and determinant of therapeutic benefit in chronic diseases like cystic fibrosis, the present clinical trial aimed to determine the efficacy of synbiotic supplementation on HRQOL in children with CF.

Methods
In the present double-blind randomized clinical trial, 40 CF children were randomly allocated to the two groups. The intervention group was supplemented with synbiotics supplements and the patients in the placebo group received maltodextrin for 6 months. Demographic data and information about antibiotic use were recorded using the questionnaire. The health-related quality of life was assessed using the Persian version of quality of life inventory questionnaires. Paired t-test and ANCOVA were used for statistical analysis.

Results
Totally, 36 participants completed the trial. The mean score of HRQOL was 76.34 ± 17.33. There were no significant differences between synbiotic and placebo groups regarding baseline demographic and quality of life characteristics. Compared with baseline values, the mean total score and subscores of quality of life did not change significantly after synbiotic and placebo supplementation (p > 0.05). Moreover, the results of ANCOVA showed that there were no significant differences between the two groups regarding the post-trial value of HRQOL total score and subscores.

Conclusion
According to results, six-month supplementation with synbiotic did not have a significant effect on the HRQOL in children with CF. However, further studies with larger sample sizes and using more disease-specific questionnaires are needed for a more precise conclusion.
The protocol of the study was registered at Iranian registry clinical trials (Registration code: IRCT2017011732004N1; Registration date: 2017-02-14).
Save the hearing, an ear surgery training project program to combat deafness in developing countries
Authors: El-Begermy Mohamed A. , Deghady Hany A. , El-Seidy Nasr , Ezzat Abdelrahman , El-Begermy Marwa M. , AlAqel Abdul Wasa , Mosleh Mohmed Saleh , Nafie Yasser ,   Many Others
Published: October 2020

AbstractBackgroundHearing loss is one of the most common health problems affecting people in the developing countries so our aim of the “Save The Hearing Project” was to combat deafness by training local doctors for ear surgery in order to treat their local patients with low cost as possible. The project was done as ear surgery campaigns in peripheral areas in Egypt, Yemen, and other countries, to train young ENT specialists and to treat patients there. Our plan was put according to the frequency of different causes of deafness as shown by previous surveys. We used the previous local and evidence-based researches to make our protocols of management of different diseases. These protocols were further evaluated during our work.The project has five stages. The first stage included management of sudden sensory neural hearing loss (SSNHL), otitis media with effusion (OME), and local anesthesia for the ear surgery—cartilage tympanoplasty and ossiculoplasty. The second stage included mastoidectomy cholesteatoma surgery and otoendoscopy. The third stage included more advanced surgery as stapedectomy and tympanosclerosis. The fourth stage included combating SNHL mainly through audiology and rehabilitation program, beside referral for cochlear implants to specialized centers. The fifth stage was only a plan for doing stem cell research in management of hearing loss.ResultsOur teams did about 42 campaigns only and the data of 31 were recorded. There were 259 attendants, 70 had hands on training, and 35 were well trained and became trainers. We did 270 tympanoplasties, 52 mastoidectomies, and cholesteatoma surgery beside 16 operations of stage III.ConclusionTraining an ear surgeon is a tedious and long process, but it is at the end very fruitful and useful for the community. Most causes of HL are preventable. We think that our project plan to combat HL is very suitable to be applied in developing countries in Africa and the Middle East.
Integrated geophysical imaging of rare earth element-bearing iron oxide-apatite deposits in the Eastern Adirondack Highlands, New York
Authors: Shah Anjana K. , Taylor Ryan D. , Walsh Gregory J. , Phillips Jeffrey D. 
Published: October 2020

The eastern Adirondack Highlands of northern New York host dozens of iron oxide-apatite (IOA) deposits containing magnetite and rare earth element (REE)-bearing apatite. We use new aeromagnetic, aeroradiometric, ground gravity, and sample petrophysical and geochemical data to image and understand these deposits and their geologic framework. Aeromagnetic total field data reflect highly magnetic leucogranite host rock and major structures that likely served as fluid conduits for the hydrothermal system. Band-pass filtering of the aeromagnetic data reveals locations of individual deposits that were verified in the field or from historical records. A 3D inversion for magnetic susceptibility images these deposits at depth, allowing the inference of plunge directions and relative size. Radiometric data highlight variations in the surface geology and several large tailings piles that contain REE-bearing apatite. Within the host rock, eTh (equivalent Th), K, and the eTh/K ratio are variable with high eTh/K near several of the IOA deposits. Areas with elevated K or low eTh/K representing potassic alteration appear to be rare; instead, elevated eTh/K ratios likely reflect widespread sodic alteration that overprinted potassic alteration. Bouguer gravity anomalies show limited correspondence to the surface geology, radiometric data, or magnetic data, but they do exhibit approximately 10 km wide highs in areas where deposits are observed. Some 2D forward models of the gravity and magnetic data show that deeper dense material beneath the leucogranite is quantitatively feasible. If these dense rocks represent intrusions that were emplaced or still cooling at the time of mineralization, they may have served as a heat source that helped to drive the hydrothermal system. Combining data sets, we find that deposits occur toward the distal ends of major structures within the host leucogranite and mostly above gravity highs. The geophysical modeling thus suggests that IOA deposits formed in structural, thermal, and chemical traps near the distal ends of the hydrothermal system.
Relational and affective neuroscience: a quiet revolution in psychiatric and psychotherapeutic practice
Authors: Mizen C. Susan , Hook John 
Published: October 2020

SUMMARYWe consider some advances in relational and affective neuroscience and related disciplines that attempt to resolve some fundamental aspects of the mind–brain problem. We consider the key role of affect in generating consciousness and in meeting our essential survival needs; the neural correlates of relating; how self and other are represented in the brain and awareness of self and other is generated through interoceptive predictive processes. We describe some leading models of the generation and purpose of consciousness, linking theories of affective and cognitive consciousness. We discuss psychiatric and psychotherapeutic innovations arising from this research, new integrated biopsychosocial interventions and the obstacles to be overcome in applying these models in practice.
Adjuvant Sorafenib for Renal Cell Carcinoma at Intermediate or High Risk of Relapse: Results From the SORCE Randomized Phase III Intergroup Trial
Authors: Eisen Tim , Frangou Eleni , Oza Bhavna , Ritchie Alastair W.S. , Smith Benjamin , Kaplan Rick , Davis Ian D. , Stockler Martin R. , Albiges Laurence , Escudier Bernard , Larkin James , Bex Axel , Joniau Steven , Hancock Barry , Hermann Gregers G. , Bellmunt Joaquim , Hodgkinson Elizabeth , Stewart Grant D. , Barber Jim , Brown Janet , McMenemin Rhona , Nathan Paul , Pickering Lisa M. , Parmar Mahesh K.B. , Meade Angela 
Published: October 2020

PURPOSE SORCE is an international, randomized, double-blind, three-arm trial of sorafenib after surgical excision of primary renal cell carcinoma (RCC) found to be at intermediate or high risk of recurrence. PATIENTS AND METHODS We randomly assigned participants (2:3:3) to 3 years of placebo (arm A), 1 year of sorafenib followed by 2 years of placebo (arm B), or 3 years of sorafenib (arm C). The initial sorafenib dose was 400 mg twice per day orally, amended to 400 mg daily. The primary outcome analysis, which was revised as a result of external results, was investigator-reported disease-free survival (DFS) comparing 3 years of sorafenib versus placebo. RESULTS Between July 2007 and April 2013, we randomly assigned 1,711 participants (430, 642, and 639 participants in arms A, B, and C, respectively). Median age was 58 years, 71% of patients were men, 84% had clear cell histology, 53% were at intermediate risk of recurrence, and 47% were at high risk of recurrence. We observed no differences in DFS or overall survival in all randomly assigned patients, patients with high risk of recurrence, or patients with clear cell RCC only. Median DFS was not reached for 3 years of sorafenib or for placebo (hazard ratio, 1.01; 95% CI, 0.83 to 1.23; P = .95). We observed nonproportional hazards; the restricted mean survival time (RMST) was 6.81 years for 3 years of sorafenib and 6.82 years for placebo (RMST difference, 0.01 year; 95% CI, −0.49 to 0.48 year; P = .99). Despite offering treatment adaptations, more than half of participants stopped treatment by 12 months. Grade 3 hand-foot skin reaction was reported in 24% of participants on sorafenib. CONCLUSION Sorafenib should not be used as adjuvant therapy for RCC. Active surveillance remains the standard of care for patients at intermediate or high risk of recurrence after nephrectomy and is the appropriate control of our current international adjuvant RCC trial, RAMPART.
ARTSCAN III: A Randomized Phase III Study Comparing Chemoradiotherapy With Cisplatin Versus Cetuximab in Patients With Locoregionally Advanced Head and Neck Squamous Cell Cancer
Authors: Gebre-Medhin Maria , Brun Eva , Engström Per , Haugen Cange Hedda , Hammarstedt-Nordenvall Lalle , Reizenstein Johan , Nyman Jan , Abel Edvard , Friesland Signe , Sjödin Helena , Carlsson Henrik , Söderkvist Karin , Thomasson Marcus , Zackrisson Björn , Nilsson Per 
Published: October 2020

PURPOSE We performed an open-label randomized controlled phase III study comparing treatment outcome and toxicity between radiotherapy (RT) with concomitant cisplatin versus concomitant cetuximab in patients with locoregionally advanced head and neck squamous cell carcinoma (HNSCC; stage III-IV according to the Union for International Cancer Control TNM classification, 7th edition). MATERIALS AND METHODS Eligible patients were randomly assigned 1:1 to receive either intravenous cetuximab 400 mg/m2 1 week before start of RT followed by 250 mg/m2/wk, or weekly intravenous cisplatin 40 mg/m2, during RT. RT was conventionally fractionated. Patients with T3-T4 tumors underwent a second random assignment 1:1 between standard RT dose 68.0 Gy to the primary tumor or dose escalation to 73.1 Gy. Primary end point was overall survival (OS) evaluated using adjusted Cox regression analysis. Secondary end points were locoregional control, local control with dose-escalated RT, pattern of failure, and adverse effects. RESULTS Study inclusion was prematurely closed after an unplanned interim analysis when 298 patients had been randomly assigned. At 3 years, OS was 88% (95% CI, 83% to 94%) and 78% (95% CI, 71% to 85%) in the cisplatin and cetuximab groups, respectively (adjusted hazard ratio, 1.63; 95% CI, 0.93 to 2.86; P = .086). The cumulative incidence of locoregional failures at 3 years was 23% (95% CI, 16% to 31%) compared with 9% (95% CI, 4% to 14%) in the cetuximab versus the cisplatin group (Gray’s test P = .0036). The cumulative incidence of distant failures did not differ between the treatment groups. Dose escalation in T3-T4 tumors did not increase local control. CONCLUSION Cetuximab is inferior to cisplatin regarding locoregional control for concomitant treatment with RT in patients with locoregionally advanced HNSCC. Additional studies are needed to identify possible subgroups that still may benefit from concomitant cetuximab treatment.
Glycemic Control and Variability of Diabetes Secondary to Total Pancreatectomy Assessed by Continuous Glucose Monitoring
Authors: Juel Caroline T B , Dejgaard Thomas F , Hansen Carsten P , Storkholm Jan H , Vilsbøll Tina , Lund Asger , Knop Filip K 
Published: October 2020

Abstract

Context
The extent of the glycemic variability in diabetes secondary to total pancreatectomy is not fully understood.

Objective
To evaluate glycemic variability in totally pancreatectomized (PX) patients and compare it to glycemic variability in hemoglobin A1c (HbA1c)-matched patients with long-standing type 1 diabetes (T1D).

Design
A case-control study was performed.

Setting
Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.

Patients or Other Participants
Ten PX patients (mean [SD]: age 64.3 [9.8] years; body mass index (BMI) 23.4 [5.0] kg/m2; duration of diabetes 3 [2.8] years), 10 HbA1c-matched patients with T1D (63.9 [8.6] years; 24.6 [3.1] kg/m2; 22 [4] years), and 10 gender-, age-, and BMI-matched healthy controls. All patients were managed on multiple daily injections of insulin.

Intervention
Continuous glucose monitoring (CGM) (Medtronic MiniMed iPro 2) during 12 consecutive days.

Main Outcome Measures
Glycemic variability.

Results
HbA1c levels were similar in the PX group and the T1D group. The PX group had greater continuous overall net glycemic action per 60 minutes (CONGA60 min) compared with the T1D group (mean [SEM]: 9.5 [0.3] vs 8.3 [0.2] mmol/L, P &lt; 0.003) and mean plasma glucose values were higher in the PX group (10.6 [0.9] vs 9.0 [0.9] mmol/L, P &lt; 0.001), whereas coefficient of variation for plasma glucose and standard deviation of mean plasma glucose, respectively, were similar in the 2 groups. Time spent below range was not different between the PX and the T1D group (2.3 [0.8] vs 4.5 [0.8]%, P = 0.065), whereas time spent above range was higher in the PX group (51.4 [3.3] vs 37.6 [1.9]%, P &lt; 0.001).

Conclusions
CGM-assessed glycemic variability showed higher CONGA60 min and time spent above range in our PX patients compared with HbA1c-matched T1D patients. This study is registered at www.ClinicalTrials.gov (NCT02944110).