bluuebunny/crossref_metadata_2025_split huggingface dataset:
Usefulness of Defined Daily Dose and Days of Therapy in Pediatrics and Obstetrics-Gynecology: A Comparative Analysis of Antifungal Drugs (2000–2001, 2005–2006, and 2010–2011)
Authors: Guillot Justine , Lebel Denis , Roy Hélène , Ovetchkine Philippe , Bussières Jean-François 
Published: October 2020

OBJECTIVES: The objective was to describe antifungal drug use by using the number of defined daily doses (DDD)/1000 patient-days per antifungal, the number of days of therapy (DOT)/1000 patient-days per antifungal, and the mean dose in mg/kg/day per antifungal during a 10-year period.
METHODS: Retrospective, cross-sectional, descriptive study, in a mother-child university hospital center, with 400 pediatric beds and 100 obstetrics-gynecology beds. All inpatients who received 1 of the 7 authorized antifungals on the institution’s local formulary in 2000–2001, 2005–2006, or 2010–2011 were included. Prescriptions for emergency department and outpatient clinics were excluded. The data were extracted from the patients’ computerized medication profiles linked to patient admission, discharge, and transfer data. The DDD, DOT, and the mean dose in mg/kg/day were calculated for each antifungal and overall.
RESULTS: There was a 2.97-fold increase in the overall number of DDD/1000 patient-days, from 14.8 in 2000–2001 to 37.5 in 2005–2006 and 43.9 in 2010–2011. There was a 2.97-fold increase in the overall number of DOT/1000 patient-days, from 22.8 in 2000–2001 to 50.3 in 2005–2006 and 67.8 in 2010–2011.
CONCLUSIONS: It can be difficult to compare the use of antifungal drugs among institutions, owing to numerous factors, but it gives an idea about the consumption outside the studied center. Moreover, these ratios help to evaluate the use of antifungals within a same institution. These data could be correlated among others, with resistance patterns, in order to improve our daily practice concerning antifungal prescription.
Evaluation of Enoxaparin Dosing and Monitoring in Pediatric Patients at Children's Teaching Hospital
Authors: McCormick Elizabeth W. , Parbuoni Kristine A. , Huynh Donna , Morgan Jill A. 
Published: October 2020

OBJECTIVES: The primary objective of this study was to evaluate whether empirical enoxaparin doses according to Chest guidelines resulted in therapeutic antifactor Xa concentrations in pediatric patients. Secondary objectives were to determine the median enoxaparin dose that resulted in therapeutic anticoagulation, the median time to therapeutic concentrations, and the percentage of patients who experienced major bleeding.
METHODS: Patients in a tertiary medical center who were &lt;18 years of age and received treatment doses of enoxaparin between July 2007 and June 2010 were included. Patients with &lt;2 antifactor Xa concentrations or with only supratherapeutic concentrations and doses that were higher than recommended by the guidelines were excluded. Subgroup analysis was conducted by dividing children into 4 age groups: &lt;2 months of age, 2 months to &lt;1 year of age, 1 year to &lt;3 years of age, and 3 to 17 years of age.
RESULTS: Thirty-two patients were included in the study. Thirty-seven percent of the patients achieved a therapeutic drug level with empirical dosing. The therapeutic dose ranged from 1 to 1.9 mg/kg in patients &lt;1 year old, and 0.6 to 1.5 mg/kg in those =1 year of age. Comparison of the median therapeutic doses for patients 2 months to &lt;1 year to that for patients =1 year old using the Mann-Whitney U test showed the median doses to be significantly difierent between the 2 groups (p=0.01). The antifactor Xa level became therapeutic on day 5 (median). There were no major bleeding events.
CONCLUSION: Less than 40% of patients were therapeutic with empirical dosing, which supports findings from other studies that suggest a need for modification of empirical treatment dosing of enoxaparin in children.
Injectable Dexamethasone Sodium Phosphate Administered Orally? A Pharmacokinetic Analysis of a Common Emergency Department Practice
Authors: Toledo Alexander , Amato Christopher S. , Clarke Nigel , Reitz Richard E. , Salo David 
Published: October 2020

BACKGROUND: The injectable formulation of dexamethasone has been administered orally, for the treatment of pediatric asthma and croup. The practice is followed in emergency departments around the country, but pharmacokinetic data supporting this practice are lacking.OBJECTIVES: This study evaluated the relative bioavailability and pharmacokinetics of dexamethasone sodium phosphate for injection (DSPI) administered orally compared to dexamethasone oral concentrate (DOC) in healthy adults.METHODS: This was an open label, crossover study of 11 healthy adults 18 to 45 years of age. All subjects received 8 mg of dexamethasone oral concentrate initially. After a 1-week wash-out period, subjects received 8 mg of DSPI administered orally. Dexamethasone levels were measured by liquid chromatography in tandem mass spectrometry. Cmax and area under the curve (AUC (0-t) and AUC (0-∞)) were calculated and compared between groups using the paired t test.RESULTS: The mean ± SD AUC(0-t) for dexamethasone oral concentrate and DSPI were 5497.23 ± 1649 and 4807.82 ± 1971) ng/dL/hr, respectively; 90% confidence interval (CI) was 78.8%–96.9%. The mean ± SD AUC(0-∞) for dexamethasone oral concentrate and DSPI were 6136.43 ± 2577 and 5591.48 ± 3075 ng/dL/hr, respectively; 90% CI was 79.0% –105.2%. Mean Cmax ± SD for DOC and DSPI were 942.94 ± 151 and 790.92 ± 229 ng/dL, respectively; 90% CI 76.8%–91.7%. The relative bioavailability of DSPI administered orally was 87.4% when using AUC(0-t) and 91.1% when using AUC(0-∞). The calculated absolute bioavailability was 75.9%.CONCLUSIONS: DSPI is not bioequivalent to dexamethasone oral concentrate when administered orally. The existing literature supports the efficacy of DSPI despite this. Dosing adjustments may be considered.
Extended-Interval Gentamicin Dosing in Achieving Therapeutic Concentrations in Malaysian Neonates
Authors: Low Yee Shan , Tan Sin Li , Wan Angeline SL 
Published: October 2020

OBJECTIVE: To evaluate the usefulness of extended-interval gentamicin dosing practiced in neonatal intensive care unit (NICU) and special care nursery (SCN) of a Malaysian hospital.
METHODS: Cross-sectional observational study with pharmacokinetic analysis of all patients aged ≤28 days who received gentamicin treatment in NICU/SCN. Subjects received dosing according to a regimen modified from an Australian-based pediatric guideline. During a study period of 3 months, subjects were evaluated for gestational age, body weight, serum creatinine concentration, gentamicin dose/interval, serum peak and trough concentrations, and pharmacokinetic parameters. Descriptive percentages were used to determine the overall dosing accuracy, while analysis of variance (ANOVA) was conducted to compare the accuracy rates among different gestational ages. Pharmacokinetic profile among different gestational age and body weight groups were compared by using ANOVA.
RESULTS: Of the 113 subjects included, 82.3% (n = 93) achieved therapeutic concentrations at the first drug-monitoring assessment. There was no significant difference found between the percentage of term neonates who achieved therapeutic concentrations and the premature group (87.1% vs. 74.4%), p = 0.085. A total of 112 subjects (99.1%) achieved desired therapeutic trough concentration of &lt;2 mg/L. Mean gentamicin peak concentration was 8.52 mg/L (95% confidence interval [Cl], 8.13–8.90 mg/L) and trough concentration was 0.54 mg/L (95% CI, 0.48–0.60 mg/L). Mean volume of distribution, half-life, and elimination rate were 0.65 L/kg (95% CI, 0.62–0.68 L/kg), 6.96 hours (95% CI, 6.52–7.40 hours), and 0.11 hour−1 (95% CI, 0.10–0.11 hour−1), respectively.
CONCLUSION: The larger percentage of subjects attaining therapeutic range with extended-interval gentamicin dosing suggests that this regimen is appropriate and can be safely used among Malaysian neonates.
Reported Rates of Diarrhea Following Oral Penicillin Therapy in Pediatric Clinical Trials
Authors: Kuehn Jemima , Ismael Zareen , Long Paul F. , Barker Charlotte I.S. , Sharland Mike 
Published: October 2020

OBJECTIVES: Antibiotic-associated diarrhea (AAD) is a well-recognized adverse reaction to oral penicillins. This review analyzed the literature to determine the incidence of AAD following amoxicillin, amoxicillin/clavulanate, and penicillin V oral therapy in pediatric clinical trials.
METHODS: An advanced search was conducted in MEDLINE and Embase databases for articles in any language reporting the incidence of AAD following oral penicillin therapy for any indicated infection in children (0–17 years). The search was limited to clinical trials. Articles were excluded if treatment was related to chronic conditions, involved concomitant antimicrobials, or if the dose or number of patients was not specified.
RESULTS: Four hundred thirty-five articles relating to clinical trials were identified (307 from Embase; 128 from MEDLINE). Thirty-five articles reporting on 42 studies were included for analysis. The indications included acute otitis media, sinusitis, pharyngitis, and pneumonia. Thirty-three trials reported on amoxicillin/clavulanate, 6 on amoxicillin, and 3 on penicillin V. In total, the 42 trials included 7729 children who were treated with an oral penicillin. On average, 17.2% had AAD. Data were pooled for each penicillin. The AAD incidence was 19.8% for amoxicillin/clavulanate, 8.1% for amoxicillin, and 1.2% for penicillin V. The amoxicillin/clavulanate data were analyzed according to formulation: pooled-average. The incidence of ADD was 24.6% for the 4:1 formulation, 12.8% for the 7:1 formulation, 19.0% for the 8:1 formulation, and 20.2% for the 14:1 formulation.
CONCLUSIONS: These results demonstrate substantially increased incidence of AAD following use of amoxicillin/clavulanate, compared to use of amoxicillin and penicillin V, as well as varying AAD rates with diffierent amoxicillin/clavulanate formulations. These findings warrant consideration when prescribing. The underlying mechanisms of AAD in children remain unclear.
Patterns of Off-Label Prescribing in the Pediatric Intensive Care Unit and Prioritizing Future Research
Authors: Czaja Angela S. , Reiter Pamela D. , Schultz M. Lynn , Valuck Robert J. 
Published: October 2020

OBJECTIVES: To characterize off-label prescribing among US pediatric intensive care units (PICUs), determine characteristics associated with off-label use, and identify medications in highest need for additional study.METHODS: Medications prescribed for ≥1% PICU patients (age &lt; 18 years) in 2010 were identified from 39 children's hospitals. Use in a patient younger than the Food and Drug Administration (FDA)-approved age for any indication was considered off-label. Hierarchical multivariable modeling was used to identify characteristics associated with off-label use, accounting for center effects. Highest-impact drugs were defined by: 1) high off-label use (off-label use in at least 5% of the PICU cohort), 2) high risk medication, and 3) high priority status by the FDA or Best Pharmaceuticals for Children Act (BPCA).RESULTS: A total of 66,896 patients received ≥1 medication of interest (n = 162) during their PICU stay. A median of 3 (interquartile range, 2–6) unique drugs per patient were used off-label. Those who received ≥1 drug off-label (85% of the cohort) had longer median PICU (2 days vs 1 day) and hospital (6 days vs 3 days) lengths of stay and higher mortality (3.6% vs 0.7%), p &lt; 0.001. Factors independently associated with off-label drug use included: age 1 to 5 years, chronic conditions, acute organ failures, mechanical ventilation, arterial or venous catheters, dialysis, and blood products. Half of prescribed medications (n = 84) had been used off-label: 26 with significant off-label use, 30 high-risk medications, and 47 with high FDA/BPCA priority. The highest impact medications identified were: dexmedetomidine, dopamine, hydromorphone, ketamine, lorazepam, methadone, milrinone, and oxycodone.CONCLUSIONS: Most PICU patients are exposed to off-label medication use, with uncertain evidence. Future medication research in this population should focus on medications with high impact potential.
Premixed Parenteral Nutrition Solution Use in Children
Authors: Chhim Rebecca F. , Crill Catherine M. 
Published: October 2020

OBJECTIVES: In response to national drug shortages, our institution established criteria for the use of commercial premixed parenteral nutrition (PN) solutions in select pediatric patients. Although these solutions have been marketed for use in children, there are no data in this patient population. The objective of this study was to review our use of commercial premixed PN solutions in children.METHODS: This was a retrospective review of patients ≤18 years of age who received a premixed PN solution from October 2010 to April 2012. All premixed PN courses were assessed for incidence of premixed PN discontinuation due to laboratory abnormalities. Estimated goal and actual protein and total caloric intake were evaluated for premixed PN courses that were continued for &gt;48 hours.RESULTS: Sixty-nine patients received 74 courses of premixed PN solutions for a mean duration of 5.6 ± 6.2 (range, 1–31) days. Fifteen courses (20%) required discontinuation of premixed PN as a result of mild laboratory abnormalities. No changes in clinical status were observed in patients and all abnormalities were corrected after switching to individualized PN. In patients receiving PN for &gt;48 hours, premixed PN solutions provided goal protein in 48/49 (98%) courses and goal calories in 33/49 (67%) courses.CONCLUSIONS: Premixed PN solutions were used in a wide range of pediatric patients and provide a potential option for PN support in pediatric patients when drug shortages limit PN product supply. Close monitoring for electrolyte abnormalities and protein and caloric intake is recommended when using premixed PN solutions in children.
Grænsearbejde blandt grænsependlere
Authors: Andersen Dorte Jagetic , Winkler Ingo 
Published: October 2020

Inspireret af Chris Rumfords teori om grænsearbejde fokuserer artiklen på måden, hvorpå den dansk-tyske grænse praktiseres og derigennem udleves af grænsependlere, der bor og arbejder på forskellige sider af den. I vores etnografiske studier har det vist sig, at måden, grænsependlere praktiserer og lever med grænser i deres hverdag på, udtrykker en mangfoldighed af grænser, der er i konstant dialog i pendlernes hverdagsliv. Særligt betydningen af mobilitet og det at være mobil, og af bevægelse mere generelt, er et væsentligt fundament for at udleve grænsen, men også nationale forskelle og identitetsdannelse og ikke mindst sproglig praksis danner grundlag for særlige måder at udleve grænser på. Det er vores indtryk at grænser og deres konsekvenser først forstås i lyset af den praksis, i hvilken de virkeliggøres, og at denne praksis aldrig er entydigt geopolitisk determineret, men nærmere åbner op for en konstant forhandling af, hvad grænser er.
An International Standardized Magnetic Resonance Imaging Protocol for Diagnosis and Follow-up of Patients with Multiple Sclerosis
Authors: Saslow Lori , Li David K.B. , Halper June , Banwell Brenda , Barkhof Frederik , Barlow Laura , Costello Kathleen , Damiri Peter , Dunn Jeffrey , Giri Shivraman , Maes Micki , Morrow Sarah A. , Newsome Scott D. , Oh Jiwon , Paul Friedemann , Quarterman Patrick , Reich Daniel S. , Shewchuk Jason R. , Shinohara Russell Takeshi , Van Hecke Wim , van de Ven Kim , Wallin Mitchell T. , Wolinsky Jerry S. , Traboulsee Anthony 
Published: October 2020

Abstract
Standardized magnetic resonance imaging (MRI) protocols are important for the diagnosis and monitoring of patients with multiple sclerosis (MS). The Consortium of Multiple Sclerosis Centers (CMSC) convened an international panel of MRI experts to review and update the current guidelines. The objective was to update the standardized MRI protocol and clinical guidelines for diagnosis and follow-up of MS and develop strategies for advocacy, dissemination, and implementation. Conference attendees included neurologists, radiologists, technologists, and imaging scientists with expertise in MS. Representatives from the CMSC, Magnetic Resonance Imaging in MS (MAGNIMS), North American Imaging in Multiple Sclerosis Cooperative, US Department of Veteran Affairs, National Multiple Sclerosis Society, Multiple Sclerosis Association of America, MRI manufacturers, and commercial image analysis companies were present. Before the meeting, CMSC members were surveyed about standardized MRI protocols, gadolinium use, need for diffusion-weighted imaging, and the central vein sign. The panel worked to make the CMSC and MAGNIMS MRI protocols similar so that the updated guidelines could ultimately be accepted by international consensus. Advocacy efforts will promote the importance of standardized MS MRI protocols. Dissemination will include publications, meeting abstracts, educational programming, webinars, “meet the expert” teleconferences, and examination cards. Implementation will require comprehensive and coordinated efforts to make the protocol easy to access and use. The ultimate vision, and goal, is for the guidelines to be universally useful, usable, and used as the standard of care for patients with MS.
The Use of Osteopathic Manipulative Medicine in the Management of Recurrent Mastitis
Authors: Jackson Caitlin , Loveless Brian 
Published: October 2020

Abstract
Mastitis affects breastfeeding mothers everywhere and management obstacles often lead to cessation of breastfeeding. Breastfeeding mastitis is commonly managed with antibiotics despite lack of clear infectious etiology. With the emerging problem of antibiotic resistance, novel managements are required. We present the case of a 34-year-old woman with 6 pregnancies and 3 children (gravida 6, parity 3) who had 5 cases of mastitis within 6 months treated with multiple courses of antibiotics. The patient underwent with osteopathic manipulative treatment (OMT) to the affected breast over 2 sessions and was taught how to perform self-myofascial release. Techniques are shown in an accompanying Supplemental Video. As of this report, the patient had been symptom free for 1 year. Future research, including a clinical trial of OMT, is required to determine whether osteopathic physicians can effectively manage recurrent lactational mastitis.
Virulence Attributes of Clinical Candida glabrata (Sensu Stricto) Isolates in the West Region of Cameroon
Authors: Nangwat Claude , Ngouana Thierry Kammalac , Dougue Aude Ngueguim , Kountchou Cyrille Levis , Ekpo Alfred Itor , Dzoyem Jean Paul , Tume Christopher Bonglavnyuy 
Published: October 2020

Background: Studies on the assessment of the virulence factors of C. glabrata sensu stricto strains are on the rise. This is partly due to the increase in recurrent C. glabrata infections that have contributed to increased mortality rates. Published data on the virulence characteristics of C. glabrata strains in Cameroon are very rare.
Aims: This study aimed at assessing some virulence characteristics, including the capacity to form biofilms and hydrolytic enzymes (protease, esterase and phospholipase).
Methods: Fifty-four (54) molecularly (MALDI-TOF) identified non-duplicate C. glabrata sensu stricto clinical isolates initially collected in a previous study, were used in the present study. These isolates were obtained from stool (S), urine (U), oro-pharyngeal (OPS) and cervico-vaginal (CVS) swabs of pregnant women, diabetic patients (both types 1 and 2 diabetes mellitus), HIV/AIDS and other patients who had neither of these diseases. Phospholipase, protease, esterase and biofilm activities were assessed using previously described methods.
Results: Our results revealed that our isolates were more able to produce phospholipase (37.04%) than they were able to produce protease (1.85%) and esterase (0%). The high producers of phospholipase (Pz < 0.7) originated mostly from oro-pharyngeal swabs (41.17%) of some diabetic patients and pregnant women. Also, all our isolates were formers of biofilm, most (74.42%) of which had lower (< 100%) biofilm formation activity compared to our reference strain. To be able to give a significant conclusion about the virulence characteristics of C. glabrata strains in the west region, we recommend that more studies be carried on a larger number of strains.
A Review and Revisit of Newton’s Law and Gravitational Constant Derivations
Authors: Forsythe Curtis J. 
Published: October 2020

This paper is a review of, and complement to, my original papers previously published in Physics Essays [1] and ViXra [2]. While the derivations and results pertinent to this review are unchanged, a possible extension of the proposed model as it relates to the derivation of G and to G-experimental is explored and presented in the attached addendum.
Herein, as proposed in my previous papers, is a theoretical model of Universal Gravitation based upon hypothetical mass/energy resonance waves, the intensities of which I propose to be casually analogous with those of electromagnetic waves. Using said model, I derive the expressed Newtonian law of gravitation from which an apparent Newtonian gravitational constant factors as a combination of other physical constants, yielding a primary G-value of 6.662936 x 10-11m3/kg s2, shown by extension to yield a secondary result that correlates well with the 2018 recommended value. A second resultant of the proposal is a demonstration that the quantum energy states of the hydrogen atom appear related to the length of these waves, shown equal to twice the ground state orbital radius in a Bohr hydrogen atom. Additionally determined, independently of any experimental G-value, are values for the Planck mass, length, and time.
Comprehensive cross‐platform comparison of methods for non‐invasive EGFR mutation testing: results of the RING observational trial
Authors: Romero Atocha , Jantus‐Lewintre Eloisa , García‐Peláez Beatriz , Royuela Ana , Insa Amelia , Cruz Patricia , Collazo Ana , Pérez Altozano Javier , Vidal Oscar Juan , Diz Pilar , Cobo Manuel , Hernández Berta , Vázquez Estevez Sergio , Benítez Gretel , Guirado Maria , Majem Margarita , Bernabé Reyes , Ortega Ana Laura , Blasco Ana , Bosch‐Barrera Joaquim , Jurado Jose M. , García González Jorge , Viteri Santiago , Garcia Giron Carlos , Massutí Bartomeu , Lopez Martín Ana , Rodriguez‐Festa Alejandro , Calabuig‐Fariñas Silvia , Molina‐Vila Miguel Ángel , Provencio Mariano 
Published: October 2020

Several platforms for noninvasive EGFR testing are currently used in the clinical setting with sensitivities ranging from 30% to 100%. Prospective studies evaluating agreement and sources for discordant results remain lacking. Herein, seven methodologies including two next‐generation sequencing (NGS)‐based methods, three high‐sensitivity PCR‐based platforms, and two FDA‐approved methods were compared using 72 plasma samples, from EGFR‐mutant non‐small‐cell lung cancer (NSCLC) patients progressing on a first‐line tyrosine kinase inhibitor (TKI). NGS platforms as well as high‐sensitivity PCR‐based methodologies showed excellent agreement for EGFR‐sensitizing mutations (K = 0.80–0.89) and substantial agreement for T790M testing (K = 0.77 and 0.68, respectively). Mutant allele frequencies (MAFs) obtained by different quantitative methods showed an excellent reproducibility (intraclass correlation coefficients 0.86–0.98). Among other technical factors, discordant calls mostly occurred at mutant allele frequencies (MAFs) ≤ 0.5%. Agreement significantly improved when discarding samples with MAF ≤ 0.5%. EGFR mutations were detected at significantly lower MAFs in patients with brain metastases, suggesting that these patients risk for a false‐positive result. Our results support the use of liquid biopsies for noninvasive EGFR testing and highlight the need to systematically report MAFs.