bluuebunny/crossref_metadata_2025_split huggingface dataset:
ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of Cushing's syndrome
Authors: Newell-Price John , Nieman Lynnette K , Reincke Martin , Tabarin Antoine 
Published: April 2020

AbstractClinical evaluation should guide those needing immediate investigation. Strict adherence to COVID-19 protection measures is necessary. Alternative ways of consultations (telephone, video) should be used. Early discussion with regional/national experts about investigation and management of potential and existing patients is strongly encouraged. Patients with moderate or severe clinical features need urgent investigation and management. Patients with active Cushing's syndrome, especially when severe, are immunocompromised and vigorous adherence to the principles of social isolation is recommended. In patients with mild features or in whom a diagnosis is less likely, clinical re-evaluation should be repeated at 3 and 6 months or deferred until the prevalence of SARS-CoV-2 has significantly decreased; however, those individuals should be encouraged to maintain social distancing. Diagnostic pathways may need to be very different from usual recommendations in order to reduce possible exposure to SARS-CoV-2. When extensive differential diagnostic testing and/or surgery is not feasible, it should be deferred and medical treatment should be initiated. Transsphenoidal pituitary surgery should be delayed during high SARS-CoV-2 viral prevalence. Medical management rather than surgery will be the used for most patients, since the short- to mid-term prognosis depends in most cases on hypercortisolism rather than its cause; it should be initiated promptly to minimize the risk of infection in these immunosuppressed patients. The risk/benefit ratio of these recommendations will need re-evaluation every 2–3 months from April 2020 in each country (and possibly local areas) and will depend on the local health care structure and phase of pandemic.
Racial and Ethnic Differences in Emergency Department Pain Management of Children With Fractures
Authors: Goyal Monika K. , Johnson Tiffani J. , Chamberlain James M. , Cook Lawrence , Webb Michael , Drendel Amy L. , Alessandrini Evaline , Bajaj Lalit , Lorch Scott , Grundmeier Robert W. , Alpern Elizabeth R. ,   PEDIATRIC EMERGENCY CARE APPLIED RESEARCH NETWORK (PECARN)
Published: April 2020

OBJECTIVES:To test the hypotheses that minority children with long-bone fractures are less likely to (1) receive analgesics, (2) receive opioid analgesics, and (3) achieve pain reduction.METHODS:We performed a 3-year retrospective cross-sectional study of children &lt;18 years old with long-bone fractures using the Pediatric Emergency Care Applied Research Network Registry (7 emergency departments). We performed bivariable and multivariable logistic regression to measure the association between patient race and ethnicity and (1) any analgesic, (2) opioid analgesic, (3) ≥2-point pain score reduction, and (4) optimal pain reduction (ie, to mild or no pain).RESULTS:In 21 069 visits with moderate-to-severe pain, 86.1% received an analgesic and 45.4% received opioids. Of 8533 patients with reassessment of pain, 89.2% experienced ≥2-point reduction in pain score and 62.2% experienced optimal pain reduction. In multivariable analyses, minority children, compared with non-Hispanic (NH) white children, were more likely to receive any analgesics (NH African American: adjusted odds ratio [aOR] 1.72 [95% confidence interval 1.51–1.95]; Hispanic: 1.32 [1.16–1.51]) and achieve ≥2-point reduction in pain (NH African American: 1.42 [1.14–1.76]; Hispanic: 1.38 [1.04–1.83]) but were less likely to receive opioids (NH African American: aOR 0.86 [0.77–0.95]; Hispanic: aOR 0.86 [0.76–0.96]) or achieve optimal pain reduction (NH African American: aOR 0.78 [0.67–0.90]; Hispanic: aOR 0.80 [0.67–0.95]).CONCLUSIONS:There are differences in process and outcome measures by race and ethnicity in the emergency department management of pain among children with long-bone fractures. Although minority children are more likely to receive analgesics and achieve ≥2-point reduction in pain, they are less likely to receive opioids and achieve optimal pain reduction.
Determinación del módulo de elasticidad de dos concretos autocompactantes de alta resistencia (70 MPa)
Authors: Murillo Chacón Minor Eduardo , Ramírez Castro Manfred 
Published: April 2020

El módulo de elasticidad es una propiedad de gran importancia en el cálculo estructural, que permite entender la relación que existe entre el esfuerzo y la deformación del material evaluado, de tal manera que, una correcta predicción del módulo de elasticidad del concreto permite al Ingeniero Estructural diseñar elementos o estructuras que desempeñen el propósito para el cual fueron concebidas.
Esta investigación permitió determinar una ecuación para calcular el módulo de elasticidad de dos mezclas de concreto autocompactante (SCC por sus siglas en inglés) con resistencia nominal de 70 MPa a la edad de veintiocho días, siendo la única variable el tipo de cemento hidráulico: cemento modificado con caliza de alta resistencia inicial y cemento modificado con puzolana. Para el concreto en estado fresco se analizó comparativamente la temperatura (ASTM C1064), peso unitario (ASTM C138), contenido de aire (ASTM C231) y flujo sin restricción (ASTM C1611). Para el concreto endurecido se estudió su afectación en la resistencia a la compresión (ASTM C39), módulo de elasticidad, relación de Poisson y módulo de cortante (ASTM C469).
Determinación de propiedades últimas a tracción en geomallas según normativa ASTM
Authors: Campos Zeledón Jordan Josué 
Published: April 2020

Recientemente se implementó en el Laboratorio Nacional de Materiales y Modelos Estructurales de la Universidad de Costa Rica (LANAMME UCR) el método de ensayo ASTM D6637 de la Asociación Americana de Ensayos de Materiales (ASTM por sus siglas en inglés).
En la etapa de verificación de la correcta implementación del método de ensayo, se trabajó con 2 tipos de geomallas utilizadas como refuerzo a nivel nacional; que fueron ensayadas para determinar sus propiedades mecánicas a la tracción (resistencia última y deformación última). Una vez obtenidas dichas características, se procedió a compararlas con los datos reportados en sus fichas técnicas. En dicha etapa se encontraron incongruencias entre los datos hallados a nivel de laboratorio y los reportados por el fabricante; lo cual dio indicios de posibles sobrevaloraciones en los datos reportados por los fabricantes y comercializadores de geomallas.
También se encontraron pruebas de reportes de datos en valores distintos a la especificación MARV, la cual es la que adopta ASTM en el tema de control de calidad.
Este documento se desprende medularmente del trabajo final de graduación: “Implementación de los métodos de ensayo para la determinación de las propiedades a tracción en geomallas y geotextiles según las normas ASTM D6637 y ASTM D4595” (ver referencia bibliográfica 6).
EMERGENCIA, GESTIÓN, VULNERABILIDAD Y RESPUESTAS FRENTE AL IMPACTO DE LA PANDEMIA COVID-19 EN EL PERÚ
Authors: Llerena Renato , Sánchez Narvaez Cesar 
Published: April 2020

La emergencia generada por la pandemia del COVID-19, evidencia las deficiencias en la gestión de los servicios de salud pública, la necesidad de su articulación desde el Ministerio de Salud con los diferentes organismos que componen los servicios sanitarios en el Perú, la articulación de la Investigación y desarrollo de tecnologías, nuestra legislación laboral y el sector productivo del país y su precariedad; el cuestionamiento a la gestión de las autoridades regionales sobre su labor frente a la emergencia, la visibilidad de los trabajos esenciales y su importancia imprescindible en la cadena de sostén en la crisis, el desarrollo de alternativas de vigilancia, solidaridad y de cuestionamientos a todo el sistema, han levantado voces en varios sectores sobre la necesidad de un cambio social, político, económico, cultural y organizacional, ¿cómo tendrán lugar la etapa de reestructuración de la “normalidad”?, durante los siguientes meses la discusión sobre las decisiones que se vayan tomando configurarán quizás un nuevo enfoque sobre lo que debemos y podemos cambiar, en el presente análisis abordaremos algunos de los problemas en el desarrollo de las acciones frente a la emergencia y el impacto en algunos grupos sociales.
Sözcük Türlerinin Öğretiminde Beyin Temelli Öğrenmeye Yönelik Uygulamaların Kalıcı Öğrenme Üzerine Etkisi
Authors: Eyüp Bircan , Kırbaşoğlu Kılıç Latife 
Published: April 2020

Bu
çalışmanın amacı, sözcük türlerinin öğretiminde beyin temelli öğrenmeye dayalı
uygulamaların öğrencilerin öğrendiklerinin kalıcı olmasında etkili olup
olmadığını incelemektir. Çalışmada ön test son test kontrol gruplu araştırma
deseni kullanılmıştır. Çalışma grubunu Trabzon il merkezinde bulunan Millî
Eğitim Bakanlığına bağlı Mehmet Akif Ersoy Ortaokulunun 6. sınıflarında öğrenim
gören 66 öğrenci oluşturmaktadır. Yansız örneklem atama
yöntemiyle gruplardan biri deney (34), biri kontrol (32) grubu olarak atanmıştır.
Deney grubunda sözcük türleri beyin temelli öğrenme uygulamalarına yönelik
işlenirken, kontrol grubunda geleneksel yöntemle işlenmiştir. Uygulamalar sekiz
hafta sürmüştür. Araştırmada veri toplama aracı olarak ‘Kişisel Bilgi Formu’
(KBF) ve ‘Sözcük Türleri Başarı Testi’ (STBT)
kullanılmıştır. KBF uygulamaların başında öğrencilere ait demografik
bilgileri belirlemek amacıyla kullanılmıştır. STBT uygulamanın başında, sonunda
ve öğrencilerin öğrendiklerinin ne kadar kalıcı olup olmadığını belirlemek
amacıyla uygulama bittikten dört ay sonra tekrar uygulanmıştır. Verilerin
analizinde betimsel istatistiksel yöntemler, karışık ölçümler için ANOVA ve tek
faktörlü ANOVA teknikleri kullanılmıştır. Araştırmanın sonucunda beyin temelli
öğrenmeye dayalı uygulamaların yapıldığı deney grubu öğrencileri lehine anlamlı
bir fark bulunmuştur. Ancak grupların kendi içerisinde son test ve kalıcılık
testi puanlarına bakıldığında kontrol grubunda unutma oranının deney grubuna
oranla daha az olduğu görülmüştür.
Minimal residual disease in plasma cell (multiple) myeloma: flow cytometric approaches
Authors: Grivtsova L. Yu. , Lunin V. V. , Semenova A. A. , Larionova V. B. , Tumyan G. S. 
Published: April 2020

The minimum residual disease (MRD) for hematopoietic and lymphoid systems tumors is an important component of patient examination during therapy. The MRD detection is performed to evaluate the effect of therapy and risk stratification during chemotherapy (acute leukemia) or at the end of it (peripheral B-cell lymphomas). The main laboratory methods for MRD assessing are molecular (polymerase chain reaction) and immunological (multi-parameter flow cytometry (FC)) methods. Immunological evaluation of MRD is the standard of clinical protocols for the treatment of childhood acute lymphoblastic leukemia during induction therapy. In the case of acute leukemia in adults, MRD assessment is usually performed at the end of the consolidation course. Clinically significant and practically standardized is the immunological assessment of MRD in B-cell chronic lymphocytic leukemia.In multiple myeloma (in World Health Organization (2016) classification – plasma cell myeloma (PCM)), work is also underway to standardize protocols and unify approaches to MRD detection. With the introduction of new drugs and treatment regimens, as well as transplantation clinical outcome of patients significantly improved and MRD value is considered as a prognostic factor. To date, the use of the MRD value as a biomarker of treatment response in PCM has been approved by the US Food and Drug Administration.With the accumulation of our knowledge regarding the MRD and to establish the clinical significance of the FC in PCM, International Multiple Myeloma Study Group (IMWG) in 2011 was added the following definition to the traditional criteria of PCM complete remission: “Immunophenotypic complete remission” – the immunophenotypically absence of aberrant clonal plasma cells in the bone marrow when analyzing at least 1 million myelocaryocytes using a multiparameter FC (4 or more parameters).This article discusses the evolution of immunological approaches using a multi-parameter FC to detect MRD in patients with PCM in accordance with various existing protocols, features of the preanalytical stage and general rules for FC detection of MRD in PCM.
Evaluation of the possibilities of shear wave elastography for differentiation of lymphomatous and reactive changes of superficial lymph nodes
Authors: Kovaleva E. V. , Danzanova T. Yu. , Sinyukova G. T. , Gudilina E. A. , Lepedatu P. I. , Allahverdieva G. F. , Zeynalova P. A. , Larionova V. B. , Semenova A. A. 
Published: April 2020

Objective: to evaluate the possibilities of ultrasound elastography for differentiation of reactive and lymphomatous superficial lymph nodes (LN).Materials and methods. The prospective study included 138 patients with enlarged superficial LN. Based on a previous histological examination, patients were divided into two groups: 1st group (n = 108) – patients with non-Hodgkin’s lymphomas and Hodgkin’s lymphoma; 2nd (n = 30) – patients with reactive (inflammatory) changes in superficial LN. All patients underwent ultrasound elastography of the enlarged LN using ARFI technology.Results. According to the results of ultrasound elastography, the average, minimum, and maximum shear wave velocities for enlarged LN in lymphoma (1st group) were 2.616 ± 0.684; 1.980 ± 0.557 and 3.351 ± 0.987 m / s, respectively; for LN with reactive changes (2nd group) – 1.704 ± 0.223; 1.414 ± 0.209 and 2.027 ± 0.261 m / s, respectively. Thus, the average, minimum, and maximum values of shear wave velocities significantly different between the groups (p ˂0.001). The cut off values of the average shear wave velocity in the differential diagnosis of lymphoma and hyperplasia are determined at the level of 2.05 m / s, with a sensitivity of 88.5 %, specificity of 100 %, and AUC of 0.942 (p ˂0.001).Conclusion. Ultrasound elastography demonstrated statistically significant differences in shear wave velocity in the enlarged superficial LN in lymphoma and in inflammatory processes that can be used as a preliminary non-invasive differential diagnosis of enlarged superficial LN in these conditions.
Severe acute malnutrition and its associated factors among under-five children in two districts of Nepal
Authors: Ghimire Umesh , Aryal Binod Kumar , Gupta Ankush Kumar , Sapkota Suman Sapkota 
Published: April 2020

Abstract
Background: Despite consistent efforts to enhance nutritional child nutrition, poor nutritional status of children continues to be a major public health problem in Nepal. This study identified the predictors of severe acute malnutrition (SAM) among children aged 6-59 months in the two districts of Nepal. Methods: We used data from a cross-sectional study conducted among mothers of 6 to 59 months children admitted to the Outpatient Therapeutic Centres (OTCs). The nutritional status of 398 children was assessed using mid-upper arm circumference (MUAC) measurement. To evaluate associated factors with SAM, adjusted odds ratio was computed using multivariate logistic regression and p-value <0.05 was considered as statistically significant. Results: Among 398 children, 5.8 percent were found to be severely malnourished including under-two years and female children. Family size (five or more members) (Adjusted Odds Ratio [AOR]: 3.96; 95% Confidence Interval [CI]: 1.23 - 12.71) was positively associated with SAM. Children from severely food insecure households (AOR: 4.04; 95% CI: 1.88-10.53) were four times more likely to be severely malnourished. Younger age-group (AOR: 12.10; 95% CI: 2.06 - 71.09) children (0 - 12 vs. 24 - 59 months) were significantly associated with childhood undernutrition. Conclusions: The findings of this study indicated that household size, household food access, and child’s age were the major predictors of severe acute malnutrition. Hence, nutrition health programs should be targeted to improve the nutritional status of children by ensuring household food access by focusing poor families engaging them in kitchen gardening to promote nutritious diet to the children.
Prevalence and associated factors of visual impairment among adults at Debre Berhan Town, North Shewa, Ethiopia.
Authors: Assefa Natnael Lakachew , Admas Addisu , Adimasu Nebiyat 
Published: April 2020

Abstract
Background: Visual impairment refers to presenting distance visual acuity worse than 6/18 in the worst eye. It remains a global challenge that greatly affects the mobility, social participation and the quality of life of the people. This study was aimed to determine the prevalence and associated factors of visual impairment among adults aged 18 years. Methods: A community-based cross-sectional study was conducted at Debre Berhan town. Systematic random sampling method was employed to select the study participants from adult’s aged ≥ 18 years. Data were collected by interview with a pre-tested semi structured questionnaire. Both anterior and posterior segment ocular examinations were done by Optometrists and Ophthalmologist. After all ocular examinations adult’s aged ≥ 18 years with presenting Visual acuity of < 6/18 in the worst eye were considered as visually impaired. Multivariate logistic regression was used to identify the determinant factors and p value less than 0.05 was considered as statistically significant. Results: A total of 416 participants were enrolled in the study with a 98.6% response rate. The prevalence of visual impairment among adults aged 18 years was 16.8% (95% CI: 13.5%-20.2%). Aged > 64 years (AOR=12.18, 95%CI: 4.47-33.20), illiterates AOR=3.02, 95% CI: 1.36-6.72), previous eye trauma (AOR=4.44, 95% CI: 1.64-12.04), family size > 5 (AOR: 4.44, 95% CI: 1.43-13.75) and family history of eye problem (AOR=7.02, 95% CI: 1.95-25.22) had statistically significant association with visual impairment.Conclusions: Prevalence of visual impairment among adults was found to be a significant public health problem. Older age, illiterates, previous eye trauma, large family size and family history eye problem were positively associated with visual impairment.
The distribution of refraction by age and gender in a non-myopic Chinese children population aged 6-12 years
Authors: Zhang Xiyan , Zhou Yonglin , Yang Jie , Wang Yan , Yang Wenyi , Gao Liuwei , Xiang Yao , Zhang Fengyun 
Published: April 2020

Abstract
Background: This study aimed to explore the distribution of spherical equivalent (SE) and its association with age, BMI, sex in a non-myopic Chinese children population aged 6 to 12 years. Alarming threshold values were proposed to predict the future onset of myopia, and relationship between alert values and myopia related factors was explored.Methods: Demographic information was gathered from an ophthalmic examination taken by a total of 6362 students. SE value was obtained by the application of autorefractors. Some of the parents filled in a questionnaire of factors related to myopia among children.Results: Among 6362 students, 3900 (61.3%) were non-myopic. The prevalence of myopia is 38.0% for boys and 39.5% for girls. The average SE values were 0.50±0.70 D for boys and 0.60±0.80 D for girls. The mean SE values decreased with age, and the value of height and BMI took on a stable trend. Alarming threshold values for myopia were set as follows: for children aged 6 years, 0.40-0.60 D for boys and 0.80-1.00 D for girls; for children aged 7 years, 0.40-0.60 D for boys and 0.30-0.50 D for girls; for children aged 8 years, 0.20-0.40 D for boys and 0.30-0.50D for girls; for children aged 9 years, 0.20-0.40 D for boys and 0.30-0.40D for girls; for children aged 10 years, 0.10-0.30 D for boys and 0.30D for girls; for children aged 11 years, 0.10-0.30 D for boys and -0.30-0.30 D for girls; for children aged 12, -0.10-0.10 D for boys and -0.30-0.10 D for girls. Paternal myopia (OR: 1.22, 95%CI: 1.01-1.48), near work on weekends (OR: 2.56, 95%CI: 1.17-5.61), and outdoor activities (OR: 0.68, 95%CI: 0.54-0.86) had an impact on non-myopic students with myopic alarming threshold.Conclusion: This study described a distribution of refraction for non-myopic students in Jiangsu Province, China. A series of alert values were proposed to provide early warning reference for Chinese children aged 6 to 12 years. Paternal myopia, near work, and outdoor activities had an impact on non-myopic students with myopic alert threshold, and sensitive continuous data concerning risk factors mentioned above should be explored to be used as an early alert value in the future.
Early discontinuation of empirical antibiotic treatment in neutropenic patients with acute myeloid leukaemia and high-risk myelodysplastic syndrome
Authors: Niessen Floor Annabel , Mourik Maaike S. M. van , Bruns Anke H. W. , Raijmakers Reinier A. P. , de Groot Mark C.H. , Bruggen Tjomme van der 
Published: April 2020

Abstract
Introduction: Current guidelines advocate empirical antibiotic treatment (EAT) in haematological patients with febrile neutropenia. However, the optimal duration of EAT is unknown. In 2011, we have introduced a protocol, promoting discontinuation of carbapenems as EAT after three days in most patients and discouraging the standard use of vancomycin. This study assesses the effect of introducing this protocol on carbapenem and vancomycin use in high-risk haematological patients and its safety. Methods: A retrospective before-after study was performed comparing a cohort from 2007 to 2011 (period I, before restrictive EAT use) with a cohort from 2011-2014 (period II, restrictive EAT use). Neutropenic episodes related to chemotherapy or stem cell transplantation (SCT) in patients with acute myeloid leukaemia (AML) or high-risk myelodysplastic syndrome (MDS) were analysed. The primary outcome was the use of carbapenems and vancomycin as EAT during neutropenia, expressed as days of therapy (DOT)/100 neutropenic days and analysed with interrupted time series (ITS). Also the use of other antibiotics was analysed. Safety measurements included 30-day mortality, ICU admittance within 30 days after start of EAT and positive blood cultures with carbapenem-susceptible microorganisms. Results : 362 neutropenic episodes with a median duration of 18 days were analysed, involving 201 patients. ITS analysis showed decreased carbapenem use with a step change of -16.1 DOT/100 neutropenic days (95% CI -26.77 to -1.39) and an overall reduction of 21.6% (8.7 DOT/100 neutropenic days). Vancomycin use decreased with a step change of -13.7 DOT/100 neutropenic days (95% CI -23.75 to -3.0) and an overall reduction of 54.7% (14.6 DOT/100 neutropenic days). The use of all antibiotics combined decreased from 155.6 to 138 DOT/100 neutropenic days, a reduction of 11.3%. No deaths directly related to early discontinuation of EAT were identified, also no notable difference in ICU-admission (9/116 in period I, 9/152 in period II) and positive blood cultures (4/116 in period I, 2/152 in period II) was detected. Conclusion : The introduction of a protocol promoting restrictive use of EAT resulted in reduction of carbapenem and vancomycin use and appears to be safe in AML or high-risk MDS patients with febrile neutropenia during chemotherapy or SCT.