bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Drivers of Greenhouse Gas Emissions Intensity Improvements in Major Economies: Analysis of Trends 1995–2009
Authors: Ghosh Madanmohan , Luo Deming , Siddiqui Muhammad Shahid , Rutherford Thomas , Zhu Yunfa 
Published: May 2020

This article analyses the trends in greenhouse gas (GHG) emissions intensity over the period 1995–2009 in a mix of developing and developed economies that account for almost two-thirds of global emissions. From the accounting point of view, it distinguishes between the production-based emissions (PBEs) and consumption or demand-based emissions (DBEs). Several studies find that while PBEs in many developed economies during the last decades have stabilised, the DBEs are on the rise. Understanding the relative influence of various factors that have shaped the different patterns of emissions growth can provide us with important policy insights for controlling GHG emissions. The article undertakes a decomposition exercise to understand the variations/fluctuations in both PBEs and DBEs intensities due to changes in technology and changes in economic structure (i.e., composition of aggregate production and final consumption). The main findings of this article are that, over the period 1995–2009, technological change has been the key driver of emissions intensity improvements in both PBEs and DBEs. Emissions intensity improvements in consumption activities have been slower than production, particularly in EU 27. Structural changes or changes in the composition of aggregate production and demand have relatively smaller contribution in overall intensity improvement. Structural shifts in the economy have somewhat negatively contributed to emissions intensity improvements in Canada and China. In India, structural shifts in both production and consumption activities have contributed significantly to emissions intensity improvements. When taking account of trade, changes in the sources of imports have worked against overall emissions intensity improvements, particularly in the developed economies of Canada, European Union (EU 27) and USA, where imports from relatively emissions intensive sources have increased during the period. JEL: D58, Q56, O13
The Recent Coronavirus (COVID-19) Pandemic: A Review of Issues for Indian Pharmaceutical Exports
Authors: Ahmed Aaheli , Chakraborty Debashis , Bhattacharyya Ranajoy 
Published: May 2020

The world today is facing a major challenge in adjusting to the adverse effects of the Coronavirus (COVID-19) spread. Meeting the demand for several key drugs and preventive medical supplies has emerged as major concern in many countries. India has over the years consolidated its position as a major producer and exporter of not only bulk drugs and formulations but also other medical provisions and equipment. The present commentary makes an attempt to understand the possible trade opportunities for India’s pharmaceutical sector in light of the recent export policy interventions. An analysis of the recent export policy adjustments reflects the evolving attitude of the country towards domestic risk perception and commitment to support other countries. The trade opportunities for India are analysed next with the help of select trade indices, and it appears that there is significant scope for enhancing India’s global competitiveness in several product groups. The evolving trends have then been judged by exploring their plausible implications from a theoretical standpoint. It has been concluded that in order to meet the growing world demands for these products, India needs to enhance productivity of the upstream segments through a rigorous policy framework. JEL: F10, F13, I18
Psychophysical Olfactory Tests and Detection of COVID-19 in Patients With Sudden Onset Olfactory Dysfunction: A Prospective Study
Authors: Lechien Jerome R. , Cabaraux Pierre , Chiesa-Estomba Carlos M. , Khalife Mohamad , Plzak Jan , Hans Stéphane , Martiny Delphine , Calvo-Henriquez Christian , Barillari Maria R. , Hopkins Claire , Saussez Sven 
Published: May 2020

Objective: To investigate the coronavirus disease 2019 (COVID-19) status of patients with initial sudden olfactory anosmia (ISOA) through nasopharyngeal swabs for reverse transcription–polymerase chain reaction (RT-PCR) analysis and to explore their olfactory dysfunctions with psychophysical olfactory evaluation. Methods: A total of 78 ISOA patients were recruited from April 6, 2020, to April 10, 2020, through a public call of University of Mons (Mons, Belgium). Patients benefited from nasopharyngeal swabs and fulfilled the patient-reported outcome questionnaire. Among them, 46 patients performed psychophysical olfactory evaluation using olfactory identification testing. Based on the duration of the ISOA, 2 groups of patients were compared: patients with olfactory dysfunction duration ≤12 days (group 1) and those with duration >12 days (group 2). Results: In group 1, 42 patients (87.5%) had a positive viral load determined by RT-PCR and 6 patients (12.5%) were negative. In group 2, 7 patients (23%) had a positive viral load and 23 patients (77%) were negative. The psychophysical olfactory evaluation reported that anosmia and hyposmia occurred in 24 (52%) and 11 (24%) patients, respectively. Eleven patients were normosmic. The viral load was significantly higher in patients of group 1 compared with those of group 2. Conclusions: Coronavirus disease 2019 was detected in a high proportion of ISOA patients, especially over the first 12 days of olfactory dysfunction. Anosmia is an important symptom to consider in the detection of COVID-19 infection.
Validation of the modified NUTRIC score on critically ill Jordanian patients: A retrospective study
Authors: Alramly Manal K , Abdalrahim Maysoon S , Khalil Amani 
Published: May 2020

Background: Nutritional status has been proven to be associated with poor outcomes in mechanically ventilated patients in intensive care units (ICU). Nutritional assessment has been assessed using different tools. Few data are available on the validity of the modified Nutrition Risk Assessment Tool for Critically Ill (mNUTRIC) score in ICU patients receiving mechanical ventilation (MV). Aim: This study aimed to assess prognostic performance of the mNUTRIC score for discriminative abilities for 30-day mortality and prolonged MV. Methods: This was a multi-centre retrospective study that included 737 mechanically ventilated patients using secondary data analysis. Data were collected on variables required to calculate mNUTRIC score. Patients with a mNUTRIC score ≥5 were considered at nutritional risk. Predictive performance of the mNUTRIC was assessed for discriminative abilities for Acute Physiology and Chronic Health Evaluation II at baseline, mortality in 42 days of follow-up and outcomes related to MV. Results: A total of 737 patients on MV met the inclusion criteria. The majority (57.1%) of patients were male. The mean age of the participants was 62.1±18 years. Of all patients, 482 (58%) were at high nutritional risk (mNUTRIC score ≥5). Median ventilator days were 3 (±7.2) days and 72 (±174) hours. The overall mortality rate was 78.8% ( n=652), and weaning failure was 79.8% ( n=660). Conclusions: This study showed new evidence on the validity of the mNUTRIC as a tool for assessing nutritional risk in an ICU population in Jordan. The mNUTRIC score obtained from the current retrospective data suggests that the use of the tool can truly identify and diagnose critically ill patients with malnutrition.
Dexmedetomidine as an adjuvant for single spinal anesthesia in patients undergoing cesarean section: a system review and meta-analysis
Authors: Shen Qi-hong , Li Hui-fang , Zhou Xu-yan , Yuan Xiao-zong , Lu Ya-ping 
Published: May 2020

Objective Previous studies reported the effect of dexmedetomidine on intrathecal anesthesia. In this review, we explored the impact of dexmedetomidine as an adjunct for lumbar anesthesia in patients undergoing cesarean section. Methods Two authors searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, the Chinese BioMedical database, Chinese Scientific Journal Database, and the Wanfang database. Results Ten trials comprising 970 patients were included in this review. Intrathecal dexmedetomidine significantly reduced the onset time of sensory block (standardized mean difference (SMD), −1.50, 95% confidence interval (CI) −2.15, −0.85, I2 = 92%) and motor block (SMD −0.77, 95% CI −1.50, −0.49, I2 = 60%) and prolonged the block duration time (sensory block: SMD 2.02, 95% CI 1.29, 2.74, I2 = 93%; motor block: SMD 1.90, 95% CI 1.07, 2.74, I2 = 94%). Patients who received dexmedetomidine showed a lower incidence of shivering. No significant difference was reported for the neonatal Apgar score and other complications. Conclusion The use of intrathecal dexmedetomidine during cesarean section can shorten the onset time of spinal anesthesia and enhance the effect of local anesthetic. It has no significant impact on neonates and there were no other adverse events.
A systematic review of ethical and legal issues in elder care
Authors: Podgorica Nertila , Flatscher-Thöni Magdalena , Deufert Daniela , Siebert Uwe , Ganner Michael 
Published: May 2020

Background: Ethical and legal issues are increasingly being reported by health caregivers; however, little is known about the nature of these issues in geriatric care. These issues can improve work and care conditions in healthcare, and consequently, the health and welfare of older people. Aim: This literature review aims to identify research focusing on ethical and legal issues in geriatric care, in order to give nurses and other health care workers an overview of existing grievances and possible solutions to take care of old patients in a both ethical and legally correct way. Methods: Using a systematic approach based on Aveyard, a search of the PubMed, CINAHL, and Ethicshare databases was conducted to find out the articles published on ethical and legal issues in geriatric care. Ethical considerations: The approval for the study was obtained from UMIT-The Health and Life Sciences University, Austria. Results: Only 50 articles were included for systematic analysis reporting ethical and legal issues in the geriatric care. The results presented in this article showed that the main ethical issues were related to the older people’s autonomy, respect for their needs, wishes and values, and respect for their decision-making. The main legal issues were related to patients’ rights, advance directives, elderly rights, treatment nutrition dilemma, and autonomy. Conclusion: Further education for professional caregivers, elderly people, and their families is needed on following topics: care planning, directive and living wills, and caregiver-family member relationships to guide and support the elderly people within their decision-making processes and during the end-of-life care.
Medium-term outcome and classification of traumatic anterior hip dislocations
Authors: Yaari Lee S , Kadar Assaf , Shemesh Shai , Haviv Barak , Leslie Michael P 
Published: May 2020

Introduction: Traumatic anterior hip dislocations are subdivided to obturator (inferior) and pubic (superior) dislocations by Epstein’s descriptive classification. This rare injury is thought to have favourable clinical outcomes. The incidence of associated femoral head and acetabular injuries has been low in past case series. We sought to revisit this injury and classification in the era of advanced imaging and contemporary surgical techniques. Materials and methods: A retrospective study of 15 patients treated for anterior hip dislocation was performed. Medical records were reviewed for demographic and surgical data. Imaging studies were revisited to determine direction of dislocation and associated fractures. Patients were assessed for pain, hip function using the modified Harris Hip Score (mHHS), hip range of motion and radiographic changes. Mean follow-up time was 3 years. Results: Anterior dislocation occurred in an obturator (inferior), pubic (superior) or central direction. 9 patients had concomitant femoral head impaction and 7 patients suffered from acetabular fractures. 8 patients with an anterior hip dislocation underwent surgical treatment. This therapy, along with early range of motion and weight bearing, produced favourable clinical outcomes with 9 patients reporting no pain and an average mHHS of 83.8. 6 patients had heterotopic ossification at latest follow-up. Conclusions: Traumatic anterior hip dislocation is commonly associated with femoral head impaction and acetabular injuries which should be addressed operatively when appropriate to produce favourable results. In this paper, we propose a revision to the commonly used descriptive classification system.
Validation of the Three-Item Skindex-Mini Among Hidradenitis Suppurativa Patients With Diverse Racial Backgrounds
Authors: Orenstein Lauren A.V. , Amah Adaugo , Shaw Fiona M. , Zhang Chao , Swerlick Robert A. , Chen Suephy C. 
Published: May 2020

Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that severely impairs patients’ quality of life (QoL). Instruments such as the 10-item Dermatology Life Quality Index and 16-item Skindex-16 have been used to assess QoL in HS; however, it is unknown whether the shorter 3-item Skindex-mini can also provide an accurate assessment of skin-related QoL in patients with HS. Objectives The aim was to assess how well the Skindex-16 correlates with its shorter adaptation, the Skindex-mini, in capturing QoL among patients with HS. Methods This retrospective cross-sectional study included all HS patients seen in the HS Clinic at The Emory Clinic between January 1, 2019, and August 16, 2019. We compared the correlation between the symptom, emotion, and function domains of the Skindex-16 and Skindex-mini using Pearson correlation coefficients (CC). Secondary outcome measures included individual survey item analysis, ItchyQuant scores, and numeric rating scale of pain. Results We identified 108 encounters among 75 unique hidradenitis suppurativa patients (43 black/African American, 18 white, 5 Asian/Pacific Islander, 3 Latino, 4 Other, 2 unknown). Pearson CC between the Skindex-16 and Skindex-mini domain scores for all encounters were 0.770 ( P < .001), 0.787 ( P < .001), and 0.801 ( P < .001) for the symptom, emotion, and function domains, respectively. The mean pain and ItchyQuant scores were 4.14 (SD 3.31) and 3.55 (SD 3.34), respectively. Conclusions The Skindex-mini correlated highly with the Skindex-16 in a racially diverse group of patients with HS. The Skindex-mini is a streamlined QoL instrument that could be practically implemented into routine clinical care among diverse patients presenting to dermatology.
Risk of malignancies in patients with spondyloarthritis treated with biologics compared with those treated with non-biologics: a systematic review and meta-analysis
Authors: Kwan Yu Heng , Lim Ka Keat , Fong Warren , Goh Hendra , Ng Linkai , Haaland Benjamin , Phang Jie Kie , Low Lian Leng , Yeo Joo Guan , Huang Feng , Leung Ying Ying , Thumboo Julian , Østbye Truls 
Published: May 2020

Background: The aim of our study was to synthesize evidence on the occurrence of malignancy in spondyloarthritis (SpA), from randomized controlled trials (RCTs) comparing biologics with non-biologics and biologics to each other. Methods: We systematically searched Medline, Cochrane Library, EMBASE, Scopus and ClinicalTrials.gov from inception until 31 October 2018. RCTs with ⩾24-week follow-up were included. We extracted data using standardized forms and assessed the risk of bias using the Cochrane Risk of Bias Tool. We performed pair-wise meta-analyses and network meta-analyses to compare the risk of malignancy for each biologics class and SpA type. We reported the Peto odds ratio (OR) of any malignancy along with 95% confidence intervals (95% CI). Bayesian posterior probabilities comparing risk of malignancy of each biologic class with non-biologics were computed as supplementary measures. Results: Fifty-four trials were included; most (44/54) had follow-up <1 year. Among 14,245 patients, 63 developed a malignancy. While most Peto ORs were >1, they had wide 95% CI and p >0.05. The overall Peto OR comparing biologics with non-biologics was 1.42 (95% CI 0.80–2.53). Only interleukin-17 inhibitors in peripheral SpA had p <0.05 (Peto OR 2.77, 95% CI 1.07–7.13); the posterior probability that the risk was higher than non-biologics was 98%. Stratified analyses revealed no consistent trend by prior exposure to biologics, duration of follow-up, study quality, study-arm crossover, analytical approaches and type of malignancy. Conclusions: Our findings indicate no overall elevated risk of malignancy with biologics in SpA. As our meta-analyses are unable to conclude on the long-term risk, long-term pharmacovigilance of biologics in SpA may still be warranted.
Cystodistension injuries and long-term bladder functional outcomes: A unique case series from medical malpractice
Authors: Goldsmith Louise , Eyre David , Reynard John 
Published: May 2020

Objectives: Bladder overdistension injuries are rare, but they can have devastating effects on the individual and lead to litigation. We aimed to (a) test the hypothesis that larger distension volumes and longer distension times are more likely to generate acontractile bladders, (b) determine prognostic information and (c) guide management protocols aimed at preventing cystodistension injuries. Patients and methods: We report 18 cases of cystodistension injury following acute urinary retention. One author provided expert medical opinion in these cases, where redress was sought in the UK courts through medical malpractice claims. Data were collected retrospectively. Results: The cohort comprised 17 females and 1 male. The mean age was 31 years (range 17–69 years). Precipitating events included six surgical procedures, 11 vaginal deliveries and one episode of back pain. The median retention volume was 1450 mL (range 1000–3800 mL), and the median duration of retention was 1200 minutes (range 470–10,365 minutes). Fourteen patients performed intermittent self-catheterisation (ISC), six requiring this temporarily. No statistically significant association was demonstrated between retention characteristics and long-term functional outcomes of the bladder. Conclusions: This case series demonstrates cystodistension injuries to be unpredictable in their long-term impact. No association between volume and duration of retention and long-term bladder function was found. In the long term, 50% void spontaneously, 33% void spontaneously but require ISC to effect complete bladder emptying and 17% remain catheter dependent. Level of evidence: Level 4
Evaluating how much dutasteride actually reduces serum dihydrotestosterone level: A Reconsideration based on unexpected results from a study of treatment of benign prostatic hyperplasia with dutasteride
Authors: Nukui Masanori 
Published: May 2020

Objective: This study aimed to evaluate the effect of dutasteride treatment of benign prostatic hyperplasia on serum steroidal sex hormones and prostate volume (PV). Methods: Thirty patients with benign prostate hyperplasia treated with dutasteride for one year were assessed for changes in PV and serum sex hormones (testosterone (T), dihydotestosterone (DHT), estradiol (E2) and dehydroepiandrosterone sulphate (DHEAS)). PV was measured by ultrasonography. A paired or unpaired t-test and Pearson’s correlation coefficient test were used for statistical analysis. Results: DHT and DHEAS decreased by 38.5% and 20.3%, respectively. On the contrary, T and E2 increased by 34.3% and 9.4%, respectively. PV and prostate-specific antigen decreased by 17.7% and 63.4%, respectively. The rate of decrease of DHT had a negative correlation with PV, and the rate of decrease of DHEAS had positive correlation with PV. Conclusion: DHT did not decrease as expected (previous studies showed a decrease of approximately 90%). However, DHEAS decreased more than a natural decrease. It is possible that the conversion from DHEAS to DHT, via the conversion to T, in the prostate was accelerated by the decrease of DHT, especially in larger prostates. However, this discrepancy cannot be full explained by the conversion from DHEAS to DHT, as mentioned above. Level of evidence: Level 2c
Coagulopathy-related soft tissue hematoma: a comparison between computed tomography findings and clinical severity
Authors: Nakayama Manabu , Kato Kenichi , Yoshioka Kunihiro , Sato Hirotaka 
Published: May 2020

Background Despite increases in the incidence of coagulopathy-related soft-tissue hematoma (CRSH), the relationship between computed tomography (CT) features and clinical severity remains unclear. Purpose To retrospectively evaluate the correlation between CT findings and clinical outcomes in CRSH. Material and Methods We retrospectively reviewed data of patients diagnosed with CRSH between March 2011 and March 2018. CRSH was morphologically classified according to the presence or absence of the fluid level pattern and was also divided into groups with or without extravasation as per CT findings. These CT findings were compared with the patients’ vital signs and laboratory investigation results. Results A total of 47 patients with CRSH were examined. Fluid level and non-fluid level patterns were observed in 28 (60%) and 19 (40%) patients, respectively. Anticoagulant therapy and extravasation were significantly correlated with the fluid level pattern. However, other clinicolaboratory outcomes, including shock index, hemoglobin, hematocrit, platelet count, and coagulation factors, showed no significant difference between the two patterns. In the comparison of hematomas with and without extravasation, none of the clinicolaboratory outcomes except for anticoagulant therapy showed significant differences. Conclusion CRSH with a fluid level pattern is significantly associated with extravasation. However, extravasation, which is generally suggestive of active bleeding, does not seem to be related to clinical severity in CRSH.
A sagittal reference line using the preoperative radiograph in total knee arthroplasty
Authors: Kim Hee-June , Kim Jeong-Woo , Shin Ji-Yeon , Kim Junekyu , Lee Hyun-Joo , Park Kyeong-Hyeon , Kyung Hee-Soo 
Published: May 2020

Background: We evaluated the accuracy of a sagittal alignment of tibial component in total knee arthroplasty (TKA) with the sagittal reference line using the preoperative radiograph. Methods: We evaluated 151 patients who underwent primary TKA with posterior cruciate substituting type implant. For 75 patients, the sagittal reference line using preoperative radiograph (group A) was used, while for 76 patients the sagittal reference using intraoperative fibular shaft line (group B) was used. The parallel line (line S) to the anatomical axis of the tibia in the lateral plain radiograph was used as the sagittal reference. The distance from line S to proximal tibia cutting area and to skin surface 20 cm distal to the cutting area was measured in preoperative radiographs. Next, the distance to the extramedullary guide rod was applied intraoperatively, reflecting the results. The intraoperative fibular shaft line was determined using the connecting line between the tip of fibular head and the lateral malleolus. The postoperative tibial component slope angle and the difference to the target slope angle were compared. Results: The difference to the target angle was 1.8 ± 1.3° in group A, whereas the difference was 2.5 ± 1.4° in group B ( p = 0.04). The patients with difference within 3° to the target angle were 78.7% in group A and 61.8% in group B ( p = 0.024). Conclusion: The sagittal reference line using the preoperative lateral radiograph was helpful as a reference guide for the tibial slope in TKA.