bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of biologic disease-modifying anti-rheumatic drugs targeting remission in axial spondyloarthritis: systematic review and meta-analysis
Authors: Cruz-Machado Ana Rita , Rodrigues-Manica Santiago , Silva Joana Leite , Alho Irina , Coelho Constança , Duarte Joana , Florêncio Cláudia , Pimentel-Santos Fernando M , Tavares-Costa José , Vieira-Sousa Elsa 
Published: April 2020

Abstract

Objectives
To assess the efficacy of biologic DMARDs (bDMARDs) in achieving Assessment of Spondyloarthritis International Society partial remission (ASAS-PR) and/or Ankylosing Spondylitis Disease Activity Score inactive disease (ASDAS-ID), as remission-like surrogates, in axial SpA (axSpA).

Methods
Data from randomized controlled trials (RCTs), including long-term extensions, were included. A systematic literature review was performed using the MEDLINE database (first search May 2018, updated February 2020) and PICO criteria according to Patients—adults with radiographic or non-radiographic axSpA; Intervention—any bDMARD; Comparator—placebo and/or any different drug; Outcomes—ASAS-PR and/or ASDAS-ID as primary or secondary endpoints. Meta-analysis was performed after assessment of the homogeneity of study designs, populations and outcomes.

Results
After screening 155 references, a total of 22 RCTs and 28 long-term extensions were retrieved. ASAS-PR was the dominant remission-like definition used. Concerning TNF inhibitors, 14/17 RCTs provided evidence of efficacy in reaching remission at different time points: 12, 16, 24 and 28 weeks (ASAS-PR in 16–62% of patients and ASDAS-ID in 24–40% of patients). With a limited number of studies available, IL-17A inhibitors exhibited remission rates of 15–21% for ASAS-PR and 11–16% for ASDAS-ID at week 16. A meta-analysis regarding ASAS-PR was performed considering RCTs with a similar duration (12, 16 or 24 weeks). The relative risk for achieving remission was 3.864 (95% CI 2.937, 5.085).

Conclusion
bDMARDs have a clear impact in axSpA remission evaluated by ASAS-PR. Nevertheless, these data show an unmet need for improved reporting of remission-like outcomes.
ASSESSMENT OF ADULT DIAGNOSTIC REFERENCE LEVELS IN INTRAORAL RADIOGRAPHY IN TAMIL NADU REGION, INDIA
Authors: Jose Amal , Saravana Kumar A , Govindarajan K N , Manimaran P 
Published: April 2020

Abstract
In the present study, incident air kerma has been measured, for six intraoral examinations, for establishing regional adult diagnostic reference levels (DRLs), in intraoral radiography, in Tamil Nadu, India. A total of 131 units, both digital (semiconductor-based) and analog (film-based) radiography systems, were selected for the study. The third quartile values, for the six intraoral examinations selected for the present study, ranged from 1.2 to 2.0 mGy, for the adult settings. The results showed a wide range of patient doses existing across the clinics or hospitals studied. This is the primary study for the establishment of adult intraoral DRL, in Tamil Nadu, one of the major states of the country. Similar studies will be undertaken in other major states across the country to establish national DRLs in intraoral radiography in the country.
Mapping the probability of detecting Burkholderia pseudomallei in rural rice paddy soil based on indicator kriging and spatial soil factor analysis
Authors: Saengnill Wacharapong , Charoenjit Kitsanai , Hrimpeng Karnjana , Jittimanee Jutharat 
Published: April 2020

Abstract

Background
Melioidosis is an infectious disease commonly found in Thailand. This infectious disease is caused by Burkholderia pseudomallei in soil. This study aims to analyze the association between spatial soil factors and B. pseudomallei detection, as well as to map the probability of B. pseudomallei contamination based on indicator kriging in paddy soil.

Methods
Seventy-eight soil samples were collected randomly on 22 April 2018 in various paddy fields. Oxidase, Gram staining and monoclonal antibody-based latex agglutination assays were performed to confirm the presence of B. pseudomallei in soil samples. The association between B. pseudomallei detection and spatial soil factors including soil temperature, soil pH, soil texture and soil drainage were analyzed by the Mann–Whitney U test and χ2 test. Subsequently, a semivariogram model and indicator kriging were used to map the probability of B. pseudomallei contamination.

Results
Of the 78 samples, B. pseudomallei was detected in 32 (41.03%). The presence or absence of B. pseudomallei was not significantly associated with spatial soil factors. The semivariogram model showed that the lag distance between positive B. pseudomallei samples was 90.51 m.

Conclusion
The empirical semivariogram and indicator kriging are an alternative option for predicting the spatial distribution of B. pseudomallei in soil.
Sexually dimorphic characters and shared aposematic patterns mislead the morphology-based classification of the Lycini (Coleoptera: Lycidae)
Authors: Kusy Dominik , Motyka Michal , Fusek Lukas , Li Yun , Bocek Matej , Bilkova Renata , Ruskova Michaela , Bocak Ladislav 
Published: April 2020

AbstractThe Lycini (Elateroidea: Lycidae) contains &gt; 400 species placed in four typologically based genera and numerous subgenera. We assembled a mito-ribosomal dataset representing ~100 species from the whole range and recovered a phylogeny rejecting Lycus and Lycostomus as polyphyletic assemblages. The male-specific wide elytra and elytral thorns are identified in unrelated Neolycus and Lycus. The morphological similarity based on sexual dimorphism and aposematic patterns defined terminal clades and misled the genus-rank classification. We delimit Neolycus, Rhyncheros reinst. name (= Thoracocalon syn. nov. = Lyconotus syn. nov.), LipernesLycostomus, Haplolycus and Lycus. Demosis and six subgenera of Lycus are synonymized with Lycus. Celiasis Laporte, 1840 is kept in the classification as a nomen dubium until any specimen is available. The deep lineages are known from the Americas and Asia. Africa was colonized by Lycus and Haplolycus. Each specific aposematic pattern occurs in a limited range, and the similar body shape and coloration evolved in unrelated sympatrically occurring lineages. High intraspecific polymorphism is putatively a result of the adaptation of various populations to local mimetic assemblages. Therefore, the delimitation of many phenotypically diverse species should be investigated.
The Duke Hotspotting Initiative: Providing Meaningful Clinical Experiences and Improving Clinical Readiness for First-Year Medical Students
Authors: Bunning Thomas , Goodwin Matthew , Barney Emily , Thakkar Aarti , Clay Alison S. 
Published: April 2020

Problem
Many medical schools now incorporate meaningful clinical experiences for first-year medical students (MS1s). However, these clinical placements often fail to teach components of the physician experience, including health care logistics, cost-conscious care, longitudinal patient care, and interaction with an interprofessional team. The Duke Hotspotting Initiative (DHSI) is a student-led elective longitudinal experience for MS1s to serve as a patient’s health care liaison to encourage proactive health management and efficient use of resources.

Approach
DHSI is a combined didactic-clinical experience at Duke University School of Medicine. Students complete a didactic curriculum to develop relevant skills and maintain weekly contact with a patient in Durham, North Carolina, for the duration of the academic year. In their meetings with patients, students help them set and monitor health goals, identify and address barriers to health resources, and efficiently access primary care. Across 2 academic years (2017–2018 and 2018–2019), 54 MS1s were surveyed electronically before and after their participation in DHSI. They were asked about their comfort navigating various patient management scenarios, using communication tools, and assuming clinical responsibilities.

Outcomes
DHSI offers MS1s a unique immersive opportunity to gain experience applying the clinical skills they will need in their future careers. Based on comparisons of responses from the 48 students (89%) who completed the pre-DHSI survey and 40 students (74%) who completed the post-DHSI survey, there was a significant increase in comfort with communication and patient advising, managing common chronic diseases, using interview skills, and assuming clinical responsibilities.

Next Steps
DHSI continues to expand in both size and scope, with the goal of incorporating team members from other health professions training programs at multiple institutions. Future analysis will investigate the longer-term impact of the program on students’ professional development, objective changes in clinical skills, and outcomes for patients involved with DHSI.
Augmented intelligence in pediatric anesthesia and pediatric critical care
Authors: Görges Matthias , Ansermino J. Mark 
Published: April 2020

Purpose of review
Acute care technologies, including novel monitoring devices, big data, increased computing capabilities, machine-learning algorithms and automation, are converging. This enables the application of augmented intelligence for improved outcome predictions, clinical decision-making, and offers unprecedented opportunities to improve patient outcomes, reduce costs, and improve clinician workflow. This article briefly explores recent work in the areas of automation, artificial intelligence and outcome prediction models in pediatric anesthesia and pediatric critical care.

Recent findings
Recent years have yielded little published research into pediatric physiological closed loop control (a type of automation) beyond studies focused on glycemic control for type 1 diabetes. However, there has been a greater range of research in augmented decision-making, leveraging artificial intelligence and machine-learning techniques, in particular, for pediatric ICU outcome prediction.

Summary
Most studies focusing on artificial intelligence demonstrate good performance on prediction or classification, whether they use traditional statistical tools or novel machine-learning approaches. Yet the challenges of implementation, user acceptance, ethics and regulation cannot be underestimated. Areas in which there is easy access to routinely labeled data and robust outcomes, such as those collected through national networks and quality improvement programs, are likely to be at the forefront of the adoption of these advances.
Sugammadex and neuromuscular reversal: special focus on neonatal and infant populations
Authors: Grigg Eliot 
Published: April 2020

Purpose of review
Sugammadex is a novel selective muscle relaxant binding agent capable of reversing deep neuromuscular blockade from rocuronium or vecuronium. It has not been approved for use in children by the US FDA because of lack of literature regarding pediatric patients.

Recent findings
A series of new studies has reported sugammadex administration to increasingly younger patients ranging in the newborn period. Although the literature in pediatrics is improving, most of the available studies in pediatrics are underpowered, retrospective, and measure too many different variables to draw reliable, collective conclusions.

Summary
All available evidence suggests that sugammadex is likely well tolerated and effective and can be dosed similarly to adults in patients 2 years’ old and greater. Sugammadex should be used with caution in patients less than 2 years old.
State of the art in clinical decision support applications in pediatric perioperative medicine
Authors: Wang Ellen , Brenn B. Randall , Matava Clyde T. 
Published: April 2020

Purpose of review
The goal of this review is to describe the recent improvements in clinical decision tools applied to the increasingly large and complex datasets in the pediatric ambulatory and inpatient setting.

Recent findings
Clinical decision support has evolved beyond simple static alerts to complex dynamic alerts for: diagnosis, medical decision-making, monitoring of physiological, laboratory, and pharmacologic inputs, and adherence to institutional and national guidelines for both the patient and the healthcare team. Artificial intelligence and machine learning have enabled advances in predicting outcomes, such as sepsis and early deterioration, and assisting in procedural technique.

Summary
With more than a decade of electronic medical data generation, clinical decision support tools have begun to evolve into more sophisticated and complex algorithms capable of transforming large datasets into succinct, timely, and pertinent summaries for treatment and management of pediatric patients. Future developments will need to leverage patient-generated health data, integrated device data, and provider-entered data to complete the continuum of patient care and will likely demonstrate improvements in patient outcomes.
Anesthetic considerations for repeat cesarean section
Authors: Ioscovich Alexander , Gozal Yaacov , Shatalin Daniel 
Published: April 2020

Purpose of review
The prevalence of cesarean delivery is increasing worldwide despite the advance of Trial of Labor After Cesarean section. In many countries, a history of previous cesarean section is an almost absolute indication for a repeat cesarean section. The purpose of this review was to examine if the perioperative anesthetic management of patients with repeat cesarean section is different from the anesthetic management of patients with primary cesarean section.

Recent findings
This review discusses important topics, such as early diagnosis of cases with a potentially high risk for complications; the need for assessment of patients diagnosed with abnormal placentation; the importance of a multidisciplinary approach that includes interaction of the anesthesiologist, gynaecologist, and invasive radiologist; emphasizing the need for reinforcement of new methods of invasive procedures; management of massive bleeding, use of new technologies, and development of an institutional protocol for management of patients with abnormal placentation.

Summary
According to this review, we show that the management of patients with repeat cesarean section without abnormal placentation is almost the same as the management of patients for primary cesarean section. Timely diagnosis of patient with abnormal placentation and multidisciplinary approach is crucial for prevention of morbidity or even mortality.
Fetal anesthesia: intrauterine therapies and immediate postnatal anesthesia for noncardiac surgical interventions
Authors: Nelson Olivia , Simpao Allan F. , Tran Kha M. , Lin Elaina E. 
Published: April 2020

Purpose of review
This review describes maternal and fetal anesthetic management for noncardiac fetal surgical procedures, including the management of lower urinary tract obstruction, congenital diaphragmatic hernia (CDH), myelomeningocele, sacrococcygeal teratoma, prenatally anticipated difficult airway and congenital lung lesions.

Recent findings
Fetal interventions range from minimally invasive fetoscopic procedures to mid-gestation open surgery, to ex-utero intrapartum treatment procedure. Anesthetic management depends on the fetal intervention and patient characteristics. Anesthesia for most minimally invasive procedures can consist of intravenous sedation and local anesthetic infiltration in clinically appropriate maternal patients. Open fetal and ex-utero intrapartum treatment procedures require maternal general anesthesia with volatile anesthetic and other medications to maintain uterine relaxation. Tracheal balloons are a promising therapy for CDH and can be inserted via minimally invasive techniques. Management of the prenatally anticipated difficult airway during delivery and removal of tracheal balloons from patients with CDH during delivery can be clinically dynamic and require flexibility, seamless communication and a high-functioning, multidisciplinary care team.

Summary
Maternal and fetal anesthetic management is tailored to the fetal intervention and the underlying health of the fetus and mother.
Unilateral Laminectomy by Endoscopy in Central Lumbar Canal Spinal Stenosis
Authors: Sun Fenglong , Liang Qingchen , Yan Ming , Wang Hongqing , Liu Zuyao , Li Fu , Dong Jie , Liu Tiejun 
Published: April 2020

Study Design.
Retrospective study.

Objective.
To evaluate the outcomes and safety of endoscopic laminectomy for central lumbar canal spinal stenosis.

Summary of Background Data..
Spinal endoscopy is mostly used in the treatment of lumbar disc herniation, while endoscopic laminectomy for lumbar spinal stenosis is rarely reported.

Methods.
From January 2016 to June 2017, 38 patients with central lumbar canal spinal stenosis were treated with endoscopic laminectomy. Clinical symptoms were evaluated at 1, 3, 6, and 12 months and the last follow-up after surgery. Functional outcomes were assessed by using the Japanese Orthopedic Association Scores (JOA) and Oswestry Disability Index (ODI). The decompression effect was assessed by using the dural sac cross-sectional area (DSCA). Lumbar stability was evaluated using lumbar range of motion (ROM), ventral intervertebral space height (VH), and dorsal intervertebral space height (DH).

Results.
The mean age of the cases was 60.8 years, the mean operation time was 66.3 minutes, the blood loss was 38.8 mL, and the length of incision was 19.6 mm. The mean time in bed was 22.3 hours, and the mean hospital stay was 8.8 days. JOA scores were improved from 10.9 to 24.1 (P < 0.05), ODI scores were improved from 79.0 to 27.9 (P < 0.05), DSCA was improved from 55.7 to 109.5 mm2 (P < 0.05), ROM scores were improved from 5.6° to 5.7° (P < 0.05), and DH scores were reduced from 6.6 to 6.5 mm (P < 0.05). There was no significant difference in VH before and after operation (P > 0.05). There were no serious complications during the follow-ups.

Conclusion.
Endoscopic laminectomy had the advantage of a wider view, which was effective, safe, and less invasive for lumbar spinal stenosis.

Level of Evidence: 5
Timing of Onset, Burden, and Postdischarge Mortality of Persistent Critical Illness in Scotland, 2005–2014: A Retrospective, Population-Based, Observational Study
Authors: Shaw Martin , Viglianti Elizabeth M. , McPeake Joanne , Bagshaw Sean M. , Pilcher David , Bellomo Rinaldo , Iwashyna Theodore J. , Quasim Tara 
Published: April 2020

Objectives:
We aimed to understand the prevalence, timing of onset, resource use, and long-term outcomes of patients who developed persistent critical illness in a national dataset.

Design:
Retrospective cohort. Using a physiologic risk adjustment model from ICU admission, we examined the relative ability of acute (related to reason for ICU presentation) and antecedent (demographics, comorbidities) characteristics to discriminate hospital mortality models. Persistent critical illness was defined as the point during an ICU stay when, at the population-level, patients’ acute diagnoses and physiologic disturbance are no longer more accurate at discriminating who survives than are baseline demographics and comorbidity. We examined the change across ICU stay in the relative discrimination of those characteristics, and short-term (in-hospital and 30 d after admission) and medium-term (90 d after admission) survival. Finally, we analyzed the changes in the population definition of persistent critical illness over time.

Setting:
Patients admitted as level 3 to Scottish ICUs between 2005 and 2014.

Patients:
Seventy-two–thousand two-hundred fifty-three adult level 3 ICU admissions in 23 ICUs across Scotland.

Interventions:
None.

Measurements and Main Results:
The onset of persistent critical illness, occurs at an average of 5.0 days (95% CI, 3.9–6.4 d) across this dataset. The crossing point increased across the decade, by an average of 0.36 days (95% CI, 0.22–0.50 d) per year. In this dataset, 24,425 (33.8%) remained in the ICU long enough to meet this greater than 5-day definition of persistent critical illness. The care of such patients involved 72.3% ICU days used by any level 3 patient; 46.5% of all Scottish ICU bed-days were after day 5. Although rates of 30 days after admission survival rose dramatically during the decade under study, these rates were similar for those with shorter or longer ICU stays, as were the rates of 90-day survival among those who survived at least 30 days.

Conclusions:
Persistent critical illness occurred in one in three ICU patients in Scotland. These minority of patients accounted for disproportionate hospital resources but did not have worse 30- or 90-day postadmission survival.
The Relative Economy and Drug Overdose Deaths
Authors: Rudolph Kara E. , Kinnard Elizabeth N. , Aguirre Ariadne Rivera , Goin Dana E. , Feelemyer Jonathan , Fink David , Cerda Magdalena 
Published: April 2020

Background:
Overdose deaths increased exponentially in the United States to be the leading cause of adult injury deaths, and declining economic opportunity may contribute. To our knowledge, there has been no quantitative research into the impact of relative economic measures on overdose risk. Prior longitudinal studies on impact of socioeconomic conditions used fixed effects approaches that can result in biased estimates in the presence of time-varying confounders.

Methods:
We estimated county-level longitudinal associations between drug overdose deaths and unemployment and labor-force nonparticipation rates by gender and racial/ethnic subgroup using longitudinal g-computation and the clustered bootstrap.

Results:
We find evidence for associations between both overall and relative aspects of unemployment and labor-force nonparticipation and drug overdose mortality; patterns of associations differed, sometime qualitatively, across subgroups. For males across racial-ethnic groups, greater overall and relative unemployment rates were generally associated with greater overdose mortality in both the short and long terms [e.g., for white males, increasing the overall percentage of unemployed adults by 5% points in 2000, 2009, and 2015 is associated with an increase of 3.2 overdose deaths (95% confidence interval [CI] = −2.8, 14) in 2015, and increasing the ratio by 0.5 in 2000, 2009, and 2015 is associated with an increase of 9.1 overdose deaths (95% CI = 1.6, 24)].

Conclusions:
These findings point to important complexity in how the economic and contextual landscape differentially shapes overdose risks, underscoring a need for increased understanding of the mechanisms operating for women and minority groups.
Frozen embryo transfer and preeclampsia: where is the link?
Authors: Dall’Agnol Henrique , García Velasco Juan A. 
Published: April 2020

Purpose of review
Preeclampsia is the leading cause of maternal death and has a higher incidence in patients undergoing assisted reproduction treatments. New studies about the mechanisms by which it is more frequent in this population have emerged. The purpose of this review is to gather current information about the available results on this correlation and its possible physiopathology.

Recent findings
Recent publications on the physiopathology of preeclampsia indicate that the corpus luteum is the main source of hormonal production until placental formation and that apart from the secretion of estrogen and progesterone, corpus luteum also produces important substances involved in maternal circulatory adaptation, such as relaxin.
With the recent increasing number of frozen embryos transfer in natural cycles or under hormonal replacement, this adaptive circulatory process may be unbalanced and predispose this population to preeclampsia.

Summary
This article provides a review of frozen embryo transfer and available protocols, the highest incidence of gestational hypertensive disorders presented by the infertile population and an overview of the possible impact of the absence of corpus luteum on the genesis of this disease.