bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spatiotemporal Clustering and Analysis of Road Accident Hotspots by Exploiting GIS Technology and Kernel Density Estimation
Authors: Kazmi Syed Saqib Ali , Ahmed Mehreen , Mumtaz Rafia , Anwar Zahid 
Published: January 2020

Abstract
Traffic accidents are a common problem in any transportation network. Road traffic accidents are predicted to be the seventh leading cause of deaths by the year 2030. Recently research in the integration of geographical information systems (GIS) for analyzing accidents, road design and safety management has increased considerably. The perpetual use of GIS tools, lead this study to propose the identification of accident hotspots by exploiting GIS technology coupled with kernel density estimation (KDE). This paper proposes the use of KDE technique and GIS technology to automatically identify the accident hotspots using UK as the study area. Analysis shows that most of the accidents occur when there is a 30 mph speed limit, a weekend, in the evening time, during the months of October and November, on the single carriageway, where there is ‘T’ or staggered junction and on ‘A’ road class. Moreover, this study also proposed techniques to classify the accident severity that is classified as either fatal, serious or slight. The driver behavior and environmental features achieved an accuracy up to 85% on the severity classification with Bagging technique. Further, the shortcomings, limitations and recommendations for future work are also identified.
Prevalence, distribution, and age at clinical detection of missing permanent incisors
Authors: Beltrami Fara , Antonarakis Gregory S , Kiliaridis Stavros 
Published: January 2020

Summary

Objectives
To determine the prevalence and distribution of clinically missing permanent incisors, and the age at which they are detected, in school-aged children.

Methods
A total of 2573 children aged 4–13 underwent oral health screening on at least one occasion between 2001 and 2017. In order to define a threshold age, after which permanent incisor agenesis could be suspected clinically with reasonable certainty, children who had been seen for at least three consecutive years, with any clinically missing permanent incisor were selected (n = 19). The maximum age of detection among these children was chosen as the threshold age. Based on this, a total of 766 children at or above the threshold age were screened for a cross-sectional epidemiological survey. Chi-squared tests were used to compare the prevalence of clinically missing permanent incisors among boys and girls, comparing unilateral versus bilateral, and right- versus left-sided missing teeth.

Results
Roughly 2% of the sample presented with at least one clinically missing maxillary lateral incisor. This was bilateral in half of cases. Clinically missing mandibular incisors were found in 0.5% of children. Finally, the threshold age for clinical suspicion of maxillary lateral incisor agenesis was set at 11.5 years. Agenesis was confirmed in all of the children attending a follow-up radiographic visit.

Conclusions
Approximately 1 in 50 children present with a clinically missing maxillary lateral incisor. The age at suspicion of maxillary lateral incisor agenesis can sometimes be several years after its expected eruption, perhaps due to significant variation in eruption times.
Providers’ perceptions of disrespect and abuse during childbirth: a mixed-methods study in Kenya
Authors: Afulani Patience A , Kelly Ann Marie , Buback Laura , Asunka Joseph , Kirumbi Leah , Lyndon Audrey 
Published: January 2020

AbstractDisrespect and abuse during childbirth are violations of women’s human rights and an indicator of poor-quality care. Disrespect and abuse during childbirth are widespread, yet data on providers’ perspectives on the topic are limited. We examined providers’ perspectives on the frequency and drivers of disrespect and abuse during facility-based childbirth in a rural county in Kenya. We used data from a mixed-methods study in a rural county in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical) in 2016. Providers were asked structured questions on disrespect and abuse, followed by open-ended questions on why certain behaviours were exhibited (or not). Most providers reported that women were often treated with dignity and respect. However, 53% of providers reported ever observing other providers verbally abuse women and 45% reported doing so themselves. Observation of physical abuse was reported by 37% of providers while 35% reported doing so themselves. Drivers of disrespect and abuse included perceptions of women being difficult, stress and burnout, facility culture and lack of accountability, poor facility infrastructure and lack of medicines and supplies, and provider attitudes. Provider bias, training and women’s empowerment influenced how different women were treated. We conclude that disrespect and abuse are driven by difficult situations in a health system coupled with a facilitating sociocultural environment. Providers resorted to disrespect and abuse as a means of gaining compliance when they were stressed and feeling helpless. Interventions to address disrespect and abuse need to tackle the multiplicity of contributing factors. These should include empowering providers to deal with difficult situations, develop positive coping mechanisms for stress and address their biases. We also need to change the culture in facilities and strengthen the health systems to address the system-level stressors.
Does improving appropriate use of malaria medicines change population beliefs in testing and treatment? Evidence from a randomized controlled trial
Authors: Maffioli Elisa M , Mohanan Manoj , Saran Indrani , O’Meara Wendy Prudhomme 
Published: January 2020

Abstract
A major puzzle in malaria treatment remains the dual problem of underuse and overuse of malaria medications, which deplete scarce public resources used for subsidies and lead to drug resistance. One explanation is that health behaviour, especially in the context of incomplete information, could be driven by beliefs, pivotal to the success of health interventions. The objective of this study is to investigate how population beliefs change in response to an experimental intervention which was shown to improve access to rapid diagnostic testing (RDT) through community health workers (CHWs) and to increase appropriate use of anti-malaria medications. By collecting data on individuals’ beliefs on malaria testing and treatment 12 and 18 months after the experimental intervention started, we find that the intervention increases the belief that a negative test result is correct, and the belief that the first-line anti-malaria drugs (artemisinin-based combination therapies or ACTs) are effective. Using mediation analysis, we also explore some possible mechanisms through which the changes happen. We find that the experience and knowledge about RDT and experience with CHWs explain 62.4% of the relationship between the intervention and the belief that a negative test result is correct. Similarly, the targeted use of ACTs and taking the correct dose—in addition to experience with RDT—explain 96.8% of the relationship between the intervention and the belief that the ACT taken is effective. As beliefs are important determinants of economic behaviour and might guide individuals’ future decisions, understanding how they change after a health intervention has important implications for long-term changes in population behaviour.
P062 A SYSTEMATIC REVIEW ON POWER ESTIMATION TO SUPPORT SAMPLE SIZE CALCULATION FOR RANDOMISED TRIALS IN INFLAMMATORY BOWEL DISEASE
Authors: Lakunina Svetlana , Iheozor-Ejiofor Zipporah , Gordon Morris , Akintelure Daniel , Sinopoulou Vassiliki 
Published: January 2020

Abstract
Inflammatory bowel disease is a collection of disorders of the gastrointestinal tract, characterised by relapsing and remitting inflammation. Studies have reported several pharmacological or non-pharmacological interventions being effective in the management of the disease. Sample size estimation with power calculation is necessary for a trial to detect the effect of an intervention. This project critically evaluates the sample size estimation and power calculation reported by randomised controlled studies of inflammatory bowel disease management to effectively conclude appropriateness of the studies results.
We conducted a literature search in the Cochrane database to identify systematic literature reviews. Their reference lists were screened, and studies were selected if they met the inclusion criteria. The data was extracted based on power calculation parameters and outcomes, results were analysed and summarised in percentages, means and graphs.
We screened almost all trials about the management of inflammatory bowel disease published in the past 25 years. 232 studies were analysed, of which 167 reported power calculation. Less than half (48%) of these studies achieved their target sample size, needed for them to accurately conclude that the interventions were effective. Moreover, the average minimal difference those studies were aimed to detect was 30%, which could be not enough to prove the effect of an intervention.
To conclude inaccurate power calculations and failure to achieve the target sample sizes can lead to errors in the results on how effective an intervention is in the management of inflammatory bowel disease.
P055 MARKOV CHAIN ECONOMIC IMPACT MODEL FOR ANTI-TNF NON-RESPONSE STRATIFICATION OF PATIENTS WITH MODERATE TO SEVERE ULCERATIVE COLITIS
Authors: Jeter Anna , Sanchez Helia , Withers Johanna , Akmaev Viatcheslav , Chaihorsky Lena , Saleh Alif 
Published: January 2020

Abstract

Objective
The annual cost of ulcerative colitis (UC) in the US is estimated to be as high as $14.9 billion, of which therapeutics account for up to 45%. The mean annual drug cost per patient with moderate to severe UC is $28,586. However, only 49% of patients achieve endoscopic healing on their first anti-tumor necrosis factor (anti-TNF) therapy and up to half of UC patients on biologics discontinue therapy within 12 months of initiation which leads to high rates of hospitalization and surgery. We performed a health care payer budget impact analysis to assess the influence of a precision medicine RNA-based classifier (PrismUC) that predicts, at baseline, anti-TNF non-response in patients with moderate to severe UC.

Methods
We developed a 12-month budget impact model for a 1-million-member health plan by analyzing peer-reviewed literature of treatment patterns in commercial and Medicare populations moderate to severe UC patients. Inputs included drug and medical costs, UC prevalence, biologic assignment patterns, therapy response rates, therapy persistence, therapy cycling, endoscopic healing rates, and risk of surgery. Drug and medical costs were obtained from published literature. A Markov model was created to estimate indirect effects of treatment efficacy, timing and cost of disease progression in subjects identified as anti-TNF non-responders (patients who fail to achieve endoscopic healing). Non-responders were assigned either to an alternative first-line therapy (vedolizumab) or to the standard of care (SOC) as determined by clinician judgments and payer formularies. The SOC included cycling patients through various biologics such as anti-TNF, vedolizumab, tofacitinib and ustekinumab. The cost of SOC was compared that of implementing a classifier to stratify patients by primary non-response to anti-TNF. Final cost savings included the cost of drugs, hospitalizations, and surgeries.

Results
Introducing a classifier that identifies anti-TNF non-responder UC patients to a 1-million-member health plan resulted in annual cost savings ranging from $6.8 to $9.6 million total (Table 1) within a 12-month period with and $9.0 to $12.7 thousand per patient (Table 2), depending on classifier performance metrics.

Conclusion
The PrismUC precision medicine classifier test that identifies non-responders to anti-TNF therapy will provide significant economic savings to payers by decreasing expenditures on unnecessary drugs and shortening times to endoscopic healing. These savings provide an economic incentive for payers to proactively engage with diagnostics manufacturers and encourage development of such tools to improve care management. A subsequent classifier that predicts response to therapies with alternative mechanisms of action is in development and expected to yield even higher cost savings.
P110 ASSOCIATION OF FECAL CALPROTECTIN WITH ENDOSCOPIC AND HISTOLOGY ACTIVITY IN PEDIATRIC INFLAMMATORY BOWEL DISEASE PATIENTS
Authors: Crawford Erin , Gestrich Catherine , Malay Sindhoosha , Sferra Thomas , Saab Shahrazad , Moses Jonathan 
Published: January 2020

Abstract

Background
Inflammatory bowel disease (IBD) treatment strategies have evolved to target mucosal healing, which has been shown to be associated with clinical remission and reduced complications. Fecal calprotectin (FC) is a non-invasive marker of intestinal inflammation, and has been shown to correlate with disease activity in IBD patients, though values which correlate with mucosal healing vary across studies. We aim to examine the association of quantitative FC levels with endoscopic and histologic severity, and compare FC in IBD patients with endoscopic remission with a control population.

Methods
We conducted a retrospective chart review of patients who had a FC completed between 30 and 1 days before colonoscopy at UH Rainbow Babies and Children’s Hospital between 2014 and 2018. IBD patients had disease severity endoscopically graded using the SES-CD or Mayo UC score, and had disease severity histologically graded using the Geboes method. Severity was classed as no disease, mild, moderate or severe. FC values of IBD patients with mucosal healing and the control population (those without gastrointestinal pathology or diagnosis on evaluation) were compared.

Results
331 cases were included in the study; 107 IBD cases and 224 controls. 63 patients (19%) had a diagnosis of Crohn’s disease (CD) and 44 patients (13%) had ulcerative colitis (UC). When assessing endoscopic scoring of IBD patients, the median FC was lowest in those with no disease (181 ug/g), followed by those with mild and moderate disease (499, 599 ug/g) and highest in those with severe disease (921 ug/g). There was significance comparing no disease to moderate and severe disease (p=0.019, 0.003), and between mild and severe disease (p=0.012). When assessing histology, the median FC was lowest in IBD patients with no disease (328 ug/g), followed by those with mild and moderate disease (399 ug/g, 674 ug/g) and highest in those with severe disease (895 ug/g). There was significance comparing no disease to moderate and severe disease (p=0.021, 0.018). In CD patients, there was significance in FC between no disease and moderate and severe disease (p=0.047, 0.0047) on endoscopic scoring. In UC patients, there was significance in FC between no disease and moderate disease (p=0.023) for histologic scoring. When comparing FC of endoscopically normal patients, the control group had a significantly lower median FC than the IBD population with endoscopic remission (43 ug/g vs 181 ug/g, p=0.018).

Conclusion
FC showed association with disease severity on gross endoscopy and histology and significance between severities in our IBD cohort. Additionally, normal cut-off values of FC may depend on the presence or absence of underlying disease. While larger studies are needed, this noninvasive test may help mitigate frequency of invasive procedures.
P111 CORRELATION OF FECAL CALPROTECTIN AND MUCOSAL BIOPSY IN IDENTIFYING SUBCLINICAL INFLAMMATION IN ULCERATIVE COLITIS PATIENTS: A PRELIMINARY STUDY
Authors: Hashim Mahmoud , Perry Courtney , Schaberg Kurt , Elkheshen Ahmed , Hussein Mohamed , Barrett Terrence 
Published: January 2020

Abstract

Background
For years, the gold standard for Ulcerative Colitis (UC) remission was mucosal appearance during endoscopy. However, recent literature suggests histological or “deep” remission is important for preventing flares and maintaining clinical remission. There are now validated histological scoring systems to identify subclinical inflammation, the simplest being the Nancy Histology Index (NHI). Colonoscopy with histological evaluation is the gold standard for UC monitoring, but frequent endoscopy is not always possible. Literature reporting the utility of fecal calprotectin (FC) in detecting subclinical inflammation is limited. We seek to evaluate the correlation of FC and C-reactive protein (CRP) with NHI scores to better assess their role in detecting subclinical UC.

Methods
We retrospectively evaluated clinical data and pathology slides of 69 UC patients that were collected over 6-months period at university of Kentucky. Pathology slides were scored according to NHI by a trained researcher and verified by an IBD pathologist. Presence of acute activity was defined as NHI&gt;2. Mayo endoscopic scores (MES) were based on endoscopic reports from one expert endoscopist. Endoscopic remission was defined as MES &lt;2. FC and CRP were recorded if collected within a month of endoscopy. FC was defined as elevated (≥120 mcg/g) or borderline (50.1–120 mcg/g). Elevated CRP was defined as (&gt; 0.9 mg/dl).

Results
33 of the 69 (47.8%) patients analyzed were in endoscopic remission. 17 of those 33 (51.5%) patients in endoscopic remission had acute histological activity (NHI &gt;2). 7 (21.2%) patients with acute histological activity completed FC testing. Of the 7 who submitted FC, 4 were elevated, and 1 was borderline. 15 of the 17 NHI positive patients submitted CRP, 4 (26%) were elevated. Finally, among the 17 patients with NHI &gt;2, four patients flared within a year (Table 1). In these 4 flared patients, FC was abnormal in 3 patients. CRP was negative in these three patients. One patient did not complete a FC or CRP. Conversely, of the 16 patients with quiescent UC and NHI &lt;2 only 1 patient flared within a year. FC and CRP were not completed at the time of endoscopy.

Conclusion
We successfully identified an important subset of UC patients in clinical and endoscopic remission with active histological activity. Most patients in this subset had elevated fecal calprotectin levels. This suggests fecal calprotectin can be used for disease monitoring to proactively identify subclinical activity before disease flare. Our findings suggest that biopsies should be performed in all UC patients even in the absence of endoscopic abnormality, and fecal calprotectin should be ordered at regular intervals to pre-emptively detect and prevent UC flares.
P113 EVALUATION OF THE EFFICACY OF TOFACITINIB IN PATIENTS WITH ULCERATIVE COLITIS UTILIZING THE MODIFIED MAYO SCORE: DATA FROM THE OCTAVE PROGRAM
Authors: Sandborn William , Sands Bruce , Steinwurz Flavio , Vermeire Séverine , Guo Xiang , Maller Eric , Modesto Irene , Su Chinyu , Wang Wenjin , Woodworth Deborah , Panes Julian 
Published: January 2020

Abstract

Introduction
Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis (UC). Safety and efficacy of tofacitinib were evaluated in 2 Phase 3 induction studies (OCTAVE Induction 1 & 2, NCT01465763 & NCT01458951), a 52-week (wk), Phase 3 maintenance study (OCTAVE Sustain, NCT01458574),1 and an ongoing open-label, long-term extension study (NCT01470612).2 In these trials, endpoint definitions were based on the conventional Mayo score comprising 4 subscores (stool frequency, rectal bleeding, endoscopic findings, Physician Global Assessment [PGA]). The FDA recommend the use of a modified Mayo (mMayo) score in which the PGA subscore is omitted (a subjective measure, and a recognized Mayo score limitation) as an endpoint measure for UC clinical trials.3 In this post hoc analysis, we assessed the efficacy of tofacitinib using endpoint definitions based on mMayo score.

Methods
In OCTAVE Induction 1 & 2, patients received placebo or tofacitinib 10 mg twice daily (BID) for 8 wks; clinical responders were re-randomized into OCTAVE Sustain for 52 wks and received placebo, tofacitinib 5 or 10 mg BID. Trial endpoints included remission, symptomatic remission, and clinical remission (Table), assessed at Wk 8 in OCTAVE Induction 1 & 2 and Wk 52 in OCTAVE Sustain. Treatment effects (ie difference from placebo) using mMayo and Mayo scores were evaluated and compared.

Results
In OCTAVE Induction 1 & 2, numerically more patients achieved remission using the mMayo score (7.7% placebo; 24.8% tofacitinib 10 mg BID) compared with the Mayo score (6.0% placebo; 17.6% tofacitinib 10 mg BID), with a greater difference from placebo with mMayo scores (Table). Likewise, the proportion of patients achieving clinical remission was numerically greater with mMayo scores (7.7% placebo; 25.0% tofacitinib 10 mg BID) compared with Mayo scores (6.0% placebo; 17.7% tofacitinib 10 mg BID), whereas the same proportion of patients achieved symptomatic remission with both scores. The same trends were noted in OCTAVE Sustain, with numerically more patients in placebo and tofacitinib groups achieving remission and clinical remission using mMayo scores compared with Mayo scores (Table), and symptomatic remission achieved by the same proportion of patients with both scores.

Conclusion
In this post hoc analysis, a statistically significant effect of tofacitinib treatment vs placebo was demonstrated across endpoints based on the mMayo score, agreeing with previously reported data based on the Mayo score.1 Treatment effect sizes for endpoints based on the mMayo score without PGA were the same or numerically greater than corresponding endpoints based on the Mayo score.

References
P109 PASSIVE ECCRINE SWEAT SENSING FOR DUPLEX TEMPORAL DETECTION OF CYTOKINES
Authors: Jagannath Badrinath , Muthukumar Sriram , Prasad Shalini 
Published: January 2020

Abstract

Introduction
Sweat based wearable sensors have shown a lot of promise in the recent years due to the ability of tracking the biomarkers in real-time. Among the various biomarkers present in sweat, cytokine concentrations have been shown in comparable range to the blood cytokines. Detection of sweat cytokines can help in monitoring of inflammation in real-time. In this work, we demonstrate a duplex cytokine sweat based sensor for real-time monitoring. The developed sensor can detect interleukin-6 (IL-6) and interleukin-10 (IL-10) in real-time that can aid in prognosis or recovery of inflammation.

Materials and Methods
The sweat based sensor was developed with semiconducting electrode on porous polymeric substrate on a porous polymer substrate. Affinity capture probes were immobilized on the sensor surface via a thiol-cross linking chemistry. ATR-IR was used to validate immobilization of the capture probes. Electrochemical impedance measurements technique was used to detect the interaction between the specific antibody and target analyte. The impedance response based on the binding interaction was used to quantify the sensor metrics.

Results
In this work, a sweat sensor platform for the duplex detection of IL-6 and IL-10 has been demonstrated. The conjugation of the antibodies to the sensor surface was confirmed using ATR-IR spectroscopy. Impedance response was used to characterize the sensor performance metrics. Calibration dose response curve was developed with decreasing impedance response for increasing concentrations of target analyte. A limit of detection of 2 pg/mL was obtained with a dynamic range from 2 pg/mL- 200 pg/mL for IL-6. IL-10 demonstrated a limit of detection of 1.5pg/mL with a dynamic range from 1.5- 150pg/mL. The developed sensor demonstrated minimal or no cross-reactivity to non-specific molecules.

Conclusion
A novel sweat-based biosensor for duplex detection of cytokine markers has been demonstrated. The developed biosensor can detect pro and anti-inflammatory cytokines that can aid in the prognosis or recovery of inflammation.