bluuebunny/crossref_metadata_2025_split huggingface dataset:
1123. Specificity of Diagnosis Codes and Adequacy of Supportive Documentation for Common Acute Pediatric Infections: Implications for Ambulatory Stewardship
Authors: Willis Zachary , Walters Elizabeth 
Published: July 2020

Abstract

Background
Assessing the appropriateness of antibiotic prescribing in ambulatory care generally relies on the accuracy of diagnosis codes, which is uncertain. It is also uncertain if documented history and physical findings support antibiotic indications (AI). We completed a retrospective study of pediatric primary care (PPC) encounters to determine: A) if documented findings supported documented AI; and B) whether diagnosis codes captured documented AI (figure).

Methods
We conducted point-prevalence audits of the 9 PPC clinics in our healthcare system, randomly selecting one weekday per month to review all visits between 9/2017 and 4/2018. We included only encounters with antibiotic prescribing. We reviewed clinician notes, orders, laboratory results, and ICD-10 diagnosis codes. We recorded demographics; visit date/location; AI as documented in notes; history, examination, and laboratory findings; and diagnosis codes. We used national guidelines to determine whether documentation supported AI. We calculated the sensitivity of diagnosis codes using documented AI as the gold standard.

Results
The sample included 452 encounters. The most common AI were acute otitis media (AOM), pharyngitis, and sinusitis. For AOM, 163 of 168 encounters (97.0%) had an appropriate diagnosis code; for pharyngitis, 127 of 138 (92.0%); and for sinusitis, 68 of 75 (90.7%). For AOM, 160 of 168 encounters (95.2%) had adequate documentation of supportive findings. For sinusitis, 44 of 75 encounters had adequate supporting history and/or examination findings (58.7%). For pharyngitis, while 135 of 139 (97.1%) had a positive streptococcal test, 104 of 139 (74.8%) had history and examination findings to support testing.

Conclusion
By chart review, we identified each AI and evaluated whether findings supported those AI. The sensitivity of diagnosis codes for AI ranged from 90.7–97.0% for common conditions; this result can inform the design of ambulatory stewardship programs. Only 74.8% of children treated for pharyngitis and 58.7% of children treated for sinusitis had sufficient supporting documentation. Use of discrete data elements alone (Figure 1) may result in overestimates of the proportion of children for whom antibiotics are appropriate. Further research is needed across healthcare settings.

Disclosures
All authors: No reported disclosures
Operative Adjuncts and Technique for En Bloc Removal of Lumbar Intradural-Extramedullary Tumor: 2-Dimensional Operative Video
Authors: Clifton William , Quinones-Hinojosa Alfredo , Chen Selby 
Published: July 2020

Abstract
We present a surgical video illustrating the technique for en bloc resection of an intradural-extramedullary lumbar tumor. The patient is a 63-yr-old woman presenting with worsening bilateral leg pain. Imaging of her lumbar spine showed an enhancing, circumscribed intradural-extramedullary tumor compressing her cauda equina at the L2 level. With informed patient consent, an L1-L3 laminectomy was performed, and intraoperative ultrasound provided the tumor location in order to plan the dural opening as well as define the tumor boundaries with respect to the surrounding nerve roots. The nerve roots were found to be dorsal to the tumor on the ultrasound and appeared to be separate from the tumor capsule. After the dura was opened, the nerve roots were dissected from the tumor capsule and the filum was identified at its proximal and distal portions relative to the mass. The tumor appeared to be arising from the filum itself. Intraoperative electromyography monitoring and stimulation identified the motor roots around the filum and were dissected away. The filum was isolated and cut proximally in order to prevent upward displacement of the mass above the dural opening. The distal portion was then cut and the tumor was removed en bloc. The patient had good postoperative relief of her leg pain and no new neurologic or genitourinary complications. This case highlights the preoperative and intraoperative surgical planning as well as detailed technical aspects of en bloc intradural-extramedullary lumbar tumor resection with preservation of the tumor capsule in order to achieve gross total resection.
Temporal and spatial variation of synchrotron X-ray stripes in Tycho’s supernova remnant
Authors: Matsuda Masamune , Tanaka Takaaki , Uchida Hiroyuki , Amano Yuki , Tsuru Takeshi Go 
Published: July 2020

Abstract
The synchrotron X-ray “stripes” discovered in Tycho’s supernova remnant (SNR) have been attracting attention as they may be evidence for proton acceleration up to PeV. We analyzed Chandra data taken in 2003, 2007, 2009, and 2015 for imaging and spectroscopy of the stripes in the southwestern region of the SNR. Comparing images obtained at different epochs, we find that time variability of synchrotron X-rays is not limited to two structures previously reported but is more common in the region. Spectral analysis of nine bright stripes reveals not only their time variabilities but also a strong anti-correlation between the surface brightness and photon indices. The spectra of the nine stripes have photon indices of Γ = 2.1–2.6 and are significantly harder than those of the outer rim of the SNR in the same region with Γ = 2.7–2.9. Based on these findings, we indicate that the magnetic field is substantially amplified, and suggest that particle acceleration through a stochastic process may be at work in the stripes.
Break Risk
Authors: Smith Simon C , Timmermann Allan 
Published: July 2020

AbstractWe develop a new approach to modeling and predicting stock returns in the presence of breaks that simultaneously affect a large cross-section of stocks. Exploiting information in the cross-section enables us to detect breaks in return prediction models with little delay and to generate out-of-sample return forecasts that are significantly more accurate than those from existing approaches. To identify the economic sources of breaks, we explore the asset pricing restrictions implied by a present value model which links breaks in return predictability to breaks in the cash flow growth and discount rate processes.
Testing the feasibility of a system-based approach to deliver a smoking cessation and food nudging intervention at food pantry sites
Authors: Patterson Freda , Robson Shannon , McGarry Charlotte , Taylor Denise , Halvorsen Samantha , Rex Samantha , Landgraf Rita 
Published: July 2020

Abstract
Food-insecure adults disproportionately experience high cardiovascular risk. Guided by the Feeding America recommendations, we tested the feasibly of a system-based approach to address the cardiovascular risk behaviors of current smoking and dietary choice at food distribution sites. Food pantries affiliated with the Food Bank of Delaware organization (N = 14) were invited to take part. Pantries who agreed solicited personnel within the pantry (i.e., staff, active volunteers) to become trained as quit-smoking coaches and/or food environment “nudging” interventionists. After training, trained personnel implemented the evidence-based treatments. Across a 6-month observation period, quit coaches reported each month on the number of (a) enrolled food pantry clients, (b) total quit-smoking sessions scheduled and attended, and (c) the smoking status of clients who attended the final, third session. Trained evaluators visited participating pantries once per month across the observation period to assess adherence to nudging guidelines. One in five (21%; 3/14) invited pantries participated in the study, and five personnel were trained to deliver intervention components. Across the observation period, quit coaches reported that 86 new smoking cessation clients were enrolled, 228 quit coaching sessions were scheduled, and 187 attended (82% attendance rate). Smoking cessation rates were estimated at 19%–36%. A 100% adherence to the food nudging approach was observed. These data demonstrate the feasibility of a system-based approach to build the capacity of food distribution sites and personnel to deliver smoking cessation quit-coaching and food nudging interventions on-site.
Multi-omics analysis of cellular pathways involved in different rapid growth stages of moso bamboo
Authors: Tao Gui-Yun , Ramakrishnan Muthusamy , Vinod Kunnummal Kurungara , Yrjälä Kim , Satheesh Viswanathan , Cho Jungnam , Fu Ying , Zhou Mingbing 
Published: July 2020

Abstract
Moso bamboo (Phyllostachys edulis (Carriere) J. Houzeau) is a rapidly growing grass of industrial and ecological importance. However, the molecular mechanisms of its remarkable growth are not well understood. In this study, we investigated the early-stage growth of moso bamboo shoots and defined three different growth stages based on histological and biochemical analyses, namely, starting of cell division (SD), rapid division (RD) and rapid elongation (RE). Further analyses on potentially relevant cellular pathways in these growth stages using multi-omics approaches such as transcriptomics and proteomics revealed the involvement of multiple cellular pathways, including DNA replication, repair and ribosome biogenesis. A total of 8045 differentially expressed genes (DEGs) and 1053 differentially expressed proteins (DEPs) were identified in our analyses. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses of detected DEGs identified several key biological pathways such as phytohormone metabolism, signal transduction, cell wall development and carbohydrate metabolism. The comparative analysis of proteins displayed that a total of 213 DEPs corresponded with DEGs and 3 significant expression profiles that could be promoting the fast growth of bamboo internodes. Moreover, protein–protein interaction network prediction analysis is suggestive of the involvement of five major proteins of signal transduction, DNA synthesis and RNA transcription, and may act as key elements responsible for the rapid shoot growth. Our work exploits multi-omics and bioinformatic approaches to unfurl the complexity of molecular networks involved in the rapid growth of moso bamboo and opens up questions related to the interactions between the functions played by individual molecular pathway.
Assessment of anesthetic gases in a central hospital
Authors: Norton Pedro , Pinho Paulo , Xará Daniela , Pina Fátima , Norton Maria 
Published: July 2020

Abstract

Introduction:
Adverse health effects related with chronic exposure to waste anesthetic gases remain controversial. Strict threshold values are recommended to minimize possible health risks. The objective of our study was to measure the concentration of waste anesthetic gases in different hospital settings in an 11-year period.

Materials and methods:
Six-monthly assessment of nitrous oxide, sevoflurane, and desflurane was made between 2005 and 2016 in different hospital departments. Trace gas analysis was performed by infrared spectroscopy.

Results:
An anesthetic gas concentration above the upper limit of the threshold value was found in computed tomography/magnetic resonance imaging (CT/MRI) (45.5%), ambulatory operating room (34.5%), and in the burn unit (31.6%). Desflurane assessment was more frequently above the upper limit of threshold value (12.37%).

Discussion:
In the CT/MRI department, the small number of air cycling per hour and the frequent use of a face mask with the associated risk of leakage may explain the results. In burn unit patients inhalatory route is also frequent. Desflurane is widely used for its rapid elimination and rapid recovery, which is compatible with the results. Being odorless, it may be connected to undetected escape.

Conclusion:
The places with more anesthetic agents exposure were the CT/MRI, the ambulatory operating room, and the burn unit. Desflurane was the anesthetic agent more frequently above the upper limit of threshold value. To complement environmental surveillance, it is essential to establish a health surveillance system for professionals exposed to anesthetic agents.
Effectiveness and safety of Guilu Erxian Glue (a traditional Chinese medicinal product) for the treatment of postmenopausal osteoporosis
Authors: Si Yuhao , Yao Yao , Ma Yong , Guo Yang , Yin Heng 
Published: July 2020

Abstract

Background:
The prevalence of postmenopausal osteoporosis is rapidly rising, with a high proportion of patients who are vulnerable to fractures and other chronic symptoms. The commonly applied Western medicine lacks cost-efficiency and tends to have various potential side effects. Guilu Erxian Glue (GEG), an orally taken traditional Chinese medicinal product, has been advocated to manage osteoporosis for a long period. However, the evidence of the efficacy of GEG on osteoporosis seems to be less convincing and conclusive. Therefore, the purpose of this study is to assess the effectiveness and safety of GEG on postmenopausal osteoporosis.

Methods:
We will implement a systematic review and meta-analysis following the requests of the preferred reporting items for systematic reviews and meta-analyses protocols (PRISMA-P). The PubMed database, Scopus, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, VIP database, Sinomed, and grey literature sources will be retrieved for eligible studies. Randomized controlled trials investigating GEG in women with postmenopausal osteoporosis employing osteoporosis-associated outcomes measures will be eligible for inclusion. Two reviewers will independently complete the study selection procedure, data extraction, and risk of bias assessment. A third reviewer will mediate when irreconcilable discrepancies occur. Should sufficient clinical homogeneity exist, a meta-analysis will be conducted. Additionally, we will utilize the Grading of Recommendations Assessment, Development and Evaluation to assess the strength of quantitative outcomes.

Results:
The current systematic review and meta-analysis will provide the effectiveness and safety of GEG on postmenopausal osteoporosis.

Conclusion:
The study will offer high-quality and explicit evidence for applying GEG on the treatment of postmenopausal osteoporosis.

OSF Registration:
DOI 10.17605/OSF.IO/JCVBH.
Efficacy of integrative Traditional Chinese and Western medicine for the treatment of patients infected with 2019 novel coronavirus (COVID-19)
Authors: Liu Dan , You Yanyan , Chen Yunhui , Tang Songqi 
Published: July 2020

Abstract

Background:
No specific anti-virus drugs or vaccines have been available for the treatment of COVID-19. Integrative traditional Chinese and western medicine has been proposed as a therapeutic option with substantial applications in China. This protocol is proposed for a systematic review and meta-analysis that aims to evaluate the efficacy of integrative traditional Chinese and western medicine treatment on patients with COVID-19.

Methods:
Ten databases including PubMed, EMBASE, Cochrane Library, CIHAHL, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wanfang database, China Biomedical Literature Database (CBM) and Chinese Biomedical Literature Service System (SinoMed) will be searched. All published randomized controlled trials, clinical controlled trials, case-control, and case series that meet the pre-specified eligibility criteria will be included. Primary outcome measures include mortality, clinical recovery rate, duration of fever, progression rate from mild or moderate to severe, improvement of symptoms, biomarkers of laboratory examination and changes in computed tomography. Secondary outcomes include dosage of hormonotherapy, incidence and severity of adverse events and quality of life. Study selection, data extraction and assessment of bias risk will be conducted by 2 reviewers independently. RevMan software (V.5.3.5) will be used to perform data synthesis. Subgroup and sensitivity analysis will be performed when necessary. The strength of evidence will be assessed by the GRADE system.

Results:
This study will provide a well-reported and high-quality synthesis on the efficacy of integrative traditional Chinese and western medicine treatment on patients with COVID-19.

Conclusion:
This systematic review protocol will be helpful for providing evidence of whether integrative traditional Chinese and western medicine treatment is an effective therapeutic approach for patients with COVID-19.

Ethics and dissemination:
Ethical approval is unnecessary as no individual patient or privacy data is collected. The results of this study will be disseminated in a peer-reviewed scientific journal and/or conference presentation.

Systematic review registration:
PROSPERO CRD42020167205.
Fetal aneuploidy screening by non-invasive prenatal testing of maternal plasma DNA sequencing with “false negative” result due to confined placental mosaicism
Authors: Li Xiaozhou , Ju Duan , Shi Yunfang , Li Yan , Dong Haiwei , Huang Jianhua , Zhang Ying 
Published: July 2020

Abstract

Rationale:
Non-invasive prenatal testing (NIPT) is an accurate screening method with high specificity and sensitivity and a low false-positive rate of trisomy 21, 18, and 13. However, false-negative NIPT results could also limit the clinical application of NIPT.

Patient concerns:
A 34-year-old primigravida woman who underwent NIPT at 16 + 3 weeks’ gestation was identified as being at high risk for fetal trisomy X (47, XXX). Fetal cardiac defect and hand posture were observed during prenatal ultrasound examination at the 23rd week of gestation.

Diagnoses:
Amniocentesis conducted at the 24th week of gestation. Fetal karyotyping and FISH identified karyotype 48, XXX, + 18, which indicated that the NIPT failed to detect trisomy 18 in this case.

Interventions:
The couple decided to terminate pregnancy at the 26th week of gestation and was willing to undergo further examinations.

Outcomes:
Discordant results between fetus with trisomy 18 and placenta with mosaic T18 were further identified with massive parallel sequencing, which might be due to that the fetal cell-free DNA in maternal plasma for NIPT that was assessed principally originated from the trophoblast cells.

Lessons:
The presence of trisomy 18 mosaicism in the placenta might be the reason for the false-negative NIPT result in this case of double aneuploidy with 48, XXX, + 18, karyotype. Although the NIPT is a valuable screening method that has evident advantages in prenatal aneuploidy screening for certain chromosomal abnormalities compared to other methods, it is not a “diagnostic test” yet.
Renal denervation as a synergistic tool for the treatment of polymorphic ventricular ectopic beats
Authors: Kiuchi Márcio Galindo , Chen Shaojie , Villacorta Humberto , Carnagarin Revathy , Nolde Janis M. , Matthews Vance B. , Schlaich Markus P. 
Published: July 2020

Abstract

Introduction:
Ventricular ectopic beats (VEBs) are very common and often occur in hypertensive or obese individuals, as well as in patients presenting with either sleep apnea or structural cardiac disease. Sympathetic overactivity plays a crucial role in the development, continuation, and exacerbation of ventricular arrhythmias. Recent studies have reported the relevance of sympathetic activation in patients with ventricular arrhythmias and suggested a potential role for catheter-based renal denervation (RDN) in reducing the arrhythmic burden.

Patient concerns:
We describe a 38-year-old female symptomatic patient that at the time of presentation was complaining of fatigue in response to minor and medium efforts and not tolerating any physical activity, and episodes of tachycardia associated with dyspnoea, pre-syncope, and syncope.

Diagnosis:
She had a high incidence of polymorphic VEBs on 24-hour-Holter monitoring who also presented with left ventricular (LV) hypertrophy for which she was treated with bisoprolol 10 mg/d. The 24-hour-Holter on bisoprolol at baseline showed sinus rhythm with an average heart rate of 92 bpm. There were 44,743 isolated VEBs. A total of 2538 nonsustained ventricular tachycardia events were registered. Her cardiac magnetic resonance imaging showed an increase in LV diastolic diameter and impairment of the right ventricle.

Interventions:
The patient underwent endocardial ablation of the right ventricular outflow tract and the LV free lateral wall, and concomitantly underwent bilateral RDN.

Outcomes:
Three months post-procedure, her 24-hour-Holter off medication demonstrated an average heart rate 72 bpm and a substantially reduced number of 2823 isolated monomorphic VEBs. Thus far, 18-months follow-up, she has been asymptomatic and doing physical exercises.

Conclusion:
In our current patient, we used RDN as a synergistic method to attenuate the sympathetic overactivity, which is narrowly linked to VEBs appearance. Our case report highlighted that RDN may become a potential adjuvant treatment for VEBs in the future.
Cytoreductive surgery for advanced stage ovarian cancer in the second trimester of pregnancy—a case report and literature review
Authors: Bacalbaşa Nicolae , Bălescu Irina , Vîlcu Mihaela , Dima Simona , Iliescu Laura , Brezean Iulian 
Published: July 2020

Abstract

Rationale:
Advanced stage ovarian cancer is rarely encountered in pregnant women, due to the high number of ultrasound imagistic studies performed during this period. The clinical course of patients diagnosed with advanced stage ovarian cancer is similar in pregnant and nonpregnant women.

Patient concerns:
We present the case of a 27-year-old woman initially submitted to emergency surgery for ovarian cyst torsion in the ninth week of gestation, at that moment ovarian cystectomy being performed.

Diagnoses:
The histopathological studies demonstrated the presence of a moderately differentiated epithelial ovarian cancer.

Interventions:
Although the interdisciplinary team decided for staging surgery followed by platinum-based chemotherapy beginning from the second trimester of pregnancy, both the patient and her family refused this strategy and opined for total hysterectomy en bloc with bilateral adnexectomy. Surprisingly, intraoperatively both ovaries had a tumoral aspect, whereas peritoneal carcinomatosis nodules were found in the Douglas pouch. Therefore, the neoplastic process was staged as a IIIC epithelial ovarian cancer, a total hysterectomy with bilateral adnexectomy, Douglas pouch peritonectomy, omentectomy, pelvic and para-aortic lymph node dissection being performed.

Outcomes:
The patient was discharged in the sixth postoperative day and was confined to the oncology service in order to be submitted to the standard taxanes and platinum based chemotherapy.

Lessons:
Although ovarian cancer has been rarely reported during pregnancy, this diagnostic should be taken in consideration whenever persistent adnexal masses are encountered.