bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional inequalities: causes and cures
Authors: Cörvers Frank , Mayhew Ken 
Published: December 2020

Abstract
Significant regional inequalities of income and wealth exist in every Western European country and in North America, but their extent varies from country to country. In both Europe and the US, it is generally thought that they tended to narrow from the early 1900s until about 1980, since when they have widened. This widening has become associated with the rise of populism, while the Covid-19 crisis has thrown regional disadvantage into sharp relief. This article discusses measurement issues, traces developments over time, and explores the social and economic consequences of regional disparities. It describes the evolution of regional policy, and in particular the move to more localized approaches in Europe, analysing their strengths and weaknesses.
Designing trials of Universal Basic Income for health impact: identifying interdisciplinary questions to address
Authors: Johnson Matthew Thomas , Johnson Elliott Aidan , Nettle Daniel , Pickett Kate E 
Published: December 2020

Abstract

Background
A large body of evidence indicates the importance of upstream determinants to health. Universal Basic Income (UBI) has been suggested as an upstream intervention capable of promoting health by affecting material, biopsychosocial and behavioural determinants. Calls are emerging across the political spectrum to introduce an emergency UBI to address socioeconomic insecurity. However, although existing studies indicate effects on health through cash transfers, UBI schemes have not previously been designed specifically to promote health.

Methods
In this article, we scope the existing literature to set out a set of interdisciplinary research challenges to address in designing a trial of the effectiveness of UBI as a population health measure.

Results
We present a theoretical model of impact that identifies three pathways to health impact, before identifying open questions related to regularity, size of payment, needs-based supplements, personality and behaviour, conditionality and duration.

Conclusions
These results set, for the first time, a set of research activities required in order to maximize health impact in UBI programmes.
Dissecting the clinical heterogeneity of adult-onset Still’s disease: results from a multi-dimensional characterization and stratification
Authors: Berardicurti Onorina , Conforti Alessandro , Iacono Daniela , Pantano Ilenia , Caso Francesco , Emmi Giacomo , Grembiale Rosa Daniela , Cantatore Francesco Paolo , Atzeni Fabiola , Perosa Federico , Scarpa Raffaele , Guggino Giuliana , Ciccia Francesco , Giacomelli Roberto , Cipriani Paola , Ruscitti Piero 
Published: December 2020

Abstract

Objectives
To stratify adult-onset Still’s disease (AOSD) patients in distinct clinical subsets to be differently managed, by using a multi-dimensional characterization.

Methods
AOSD patients were evaluated by using a hierarchical unsupervised cluster analysis comprising age, laboratory markers systemic score and outcomes. The squared Euclidean distances between each pair of patients were calculated and put into a distance matrix, which served as the input clustering algorithm. Derived clusters were descriptively analysed for any possible difference.

Results
Four AOSD patients clusters were identified. Disease onset in cluster 1 was characterized by fever (100%), skin rash (92%) and arthritis (83%), with the highest ferritin levels [mean (S.D.) 14 724  (6837) ng/ml]. In cluster 2, the onset was characterized by fever (100%), arthritis (100%) and liver involvement (90%), together with the highest CRP levels [288.10  (46.01) mg/l]. The patients in cluster 3 presented with fever (100%), myalgia (96%) and sore throat (92%). The highest systemic score values [8.88  (1.70)] and the highest mortality rate (54.2%) defined cluster 3. Fever (100%) and arthritis (90%) were the symptoms at the onset in cluster 4, which was characterized by the lowest ferritin and CRP levels [1457  (1298) ng/ml and 54.98  (48.67) mg/l, respectively].

Conclusion
Four distinct phenotypic subgroups in AOSD could be suggested, possibly associated with different genetic background and pathogenic mechanisms. Our results could provide the basis for a precision medicine approach in AOSD in an attempt to find a clinical and laboratory multidimensional stratification and characterization, which would drive a tailored therapeutic approach in these patients.
About the model law for the CIS member states “On fiduciary management of property and trust”
Authors: Rudokvas Anton 
Published: December 2020

Abstract
On 22 November 2019, the Interparliamentary Assembly of the Commonwealth of Independent States adopted a model law for the CIS member states “On fiduciary management of property and trusts”. Its section on fiduciary management of property was inspired in a very high degree by innovative ideas of Professor M. Lupoi on such a functional surrogate device of “trusts” as the construction of “affidamento fiduciario”, already absorbed in the legislation of the Republic of San Marino and implemented in practice in Italy due to the principle of the freedom of contract. The section on trusts contains also some borrowings from foreign experience.
Clinical and Economic Impact of Wound Care Using a Polyurethane Foam Multilayer Dressing
Authors: Tiscar-González Verónica , Menor-Rodríguez Maria José , Rabadán-Sainz Carlos , Fraile-Bravo Mercedes ,   The Life Group, Styche Tim , Valenzuela-Ocaña Francisco José , Muñoz-García Leticia 
Published: December 2020

ABSTRACT

OBJECTIVE
To study the impact of a newly introduced dressing on efficiency and quality of care in routine clinical practice in a Spanish community setting.

DESIGN AND SETTING
An ambispective multicenter observational study was conducted in 24 primary care centers and 6 nursing homes in 4 different Spanish regions. The study was carried out between November 2017 and March 2019.

PATIENTS AND INTERVENTION
A total of 128 wounds in 94 patients (primary care, n = 79; nursing home, n = 15) were analyzed before and 4 weeks after switching to the study dressing.

OUTCOME MEASURES
Frequency of dressing changes; secondary outcomes were change in the mean wound area and weekly cost and patient and provider satisfaction.

MAIN RESULTS
The mean number of dressing changes was significantly reduced with the study dressing from 3.14 ± 1.77 changes per week to 1.66 ± 0.87 (P < .001), a 47.1% reduction in frequency. Wound area significantly reduced from 9.90 ± 19.62 cm2 to 7.10 ± 24.33 cm2. In addition, a 58.7% reduction in weekly costs was achieved with the intervention. Patients and providers agreed that their satisfaction with wound care improved.

CONCLUSIONS
The use of the study dressing in routine clinical practice could lead to a major improvement in both efficiency and quality of wound care. Its use could reduce wound care-related costs through improvements in healing and a reduced frequency of dressing changes. It also enhanced the wound care experience from the perspective of both patients and providers.
Postoperative delirium – treatment and prevention
Authors: Duning Thomas , Ilting-Reuke Katharina , Beckhuis Mara , Oswald Daniel 
Published: December 2020

Purpose of review
Postoperative delirium (POD) is one of the most severe complications after surgery.
The consequences are dramatic: longer hospitalization, a doubling of mortality and almost all cases develop permanent, yet subtle, cognitive deficits specific to everyday life. Actually, no global guideline with standardized concepts of management exists. Advances in prevention, diagnosis and treatment can improve recognition and risk stratification of delirium and its consequences.

Recent findings
Management of POD is a multiprofessional approach and consists of different parts: First, the detection of high-risk patients with a validated tool, preventive nonpharmacological concepts and an intraoperative anesthetic management plan that is individualized to the older patient (e.g. avoiding large swings in blood pressure, vigilance in maintaining normothermia, ensuring adequate analgesia and monitoring of anesthetic depth). In addition to preventive standards, treatment and diagnostic concepts must also be available, both pharmaceutical and nonpharmacological.

Summary
Not every POD can be prevented. It is important to detect patients with high risk for POD and have standardized concepts of management. The most important predisposing risk factors are a higher age, preexisting cognitive deficits, multimorbidity and an associated prodelirious polypharmacy. In view of demographic change, the implementation of multidisciplinary approaches to pharmacological and nonpharmacological POD management is highly recommended.
Prevent deterioration and long-term ventilation: intensive care following thoracic surgery
Authors: Kalbhenn Johannes 
Published: December 2020

Purpose of review
Patients with indication for lung surgery besides the pulmonary pathology often suffer from independent comorbidities affecting several other organ systems. Preventing patients from harmful complications due to decompensation of underlying organ insufficiencies perioperatively is pivotal. This review draws attention to the peri- and postoperative responsibility of the anaesthetist and intensivist to prevent patients undergoing lung surgery deterioration.

Recent findings
During the last decades we had to accept that ‘traditional’ intensive care medicine implying deep sedation, controlled ventilation, liberal fluid therapy, and broad-spectrum antimicrobial therapy because of several side-effects resulted in prolongation of hospital length of stay and a decline in quality of life. Modern therapy therefore should focus on the convalescence of the patient and earliest possible reintegration in the ‘life-before.’ Avoidance of sedative and anticholinergic drugs, early extubation, prophylactic noninvasive ventilation and high-flow nasal oxygen therapy, early mobilization, well-adjusted fluid balance and reasonable use of antibiotics are the keystones of success.

Summary
A perioperative interprofessional approach and a change in paradigms are the prerequisites to improve outcome and provide treatment for elder and comorbid patients with an indication for thoracic surgery.
Immunopathogenesis of skin injury in systemic lupus erythematosus
Authors: Hile Grace A. , Kahlenberg J. Michelle 
Published: December 2020

Purpose of review
Skin injury is the most common clinical manifestation of SLE and is disfiguring, difficult to treat, and incompletely understood. We provide an overview of recently published articles covering the immunopathogenesis of skin injury in SLE

Recent findings
Skin of SLE has an inherent susceptibility to apoptosis, the cause of which may be multifactorial. Chronic IFN overexpression leads to barrier disruption, infiltration of inflammatory cells, cytokine production, and release of autoantigens and autoantibody production that result in skin injury. Ultraviolet light is the most important CLE trigger and amplifies this process leading to skin inflammation and potentially systemic disease flares.

Summary
The pathogenesis of skin injury in CLE is complex but recent studies highlight the importance of mechanisms driving dysregulated epidermal cell death likely influenced by genetic risk factors, environmental triggers (UV light), and cytotoxic cells and cellular signaling.
Translation, Cross-cultural Adaptation and Psychometric Evaluation of the Hausa Roland-Morris Disability Questionnaire in Mixed Rural and Urban Nigerian Populations with Low Back Pain
Authors: Raheem Sarafadeen , Ibrahim Aminu A. , Ganiyu Sokunbi O. , Faruk Abdulmanaf U. , Akindele Mukadas O. 
Published: December 2020

Study Design.
Cross-cultural adaptation and cross-sectional study.

Objective.
The aim of this study was to translate and cross-culturally adapt the Roland-Morris Disability Questionnaire (RMDQ) into Hausa language, and evaluate its psychometric properties in mixed rural and urban populations with low back pain (LBP).

Summary of Background Data.
The RMDQ is one of the most commonly used and recommended condition-specific measures of disability related to LBP. However, no formal adapted and validated Hausa version exists at the time our study was initiated.

Methods.
The Hausa version of the RMDQ (Hausa-RMDQ) was developed according to established guidelines. Psychometric properties were evaluated in 125 patients with LBP recruited from rural and urban Nigerian clinics. Internal consistency (Cronbach's α), test–retest reliability using Intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and limits of agreement using Bland-Altman plots were calculated to evaluate reliability. Using Spearman's correlation for a priori hypotheses, the Hausa-RMDQ was correlated with Oswestry Disability Index (ODI) to evaluate concurrent validity, Numerical Pain Rating Scale (NPRS) to evaluate convergent validity, and age, educational level, and occupational status to evaluate divergent validity. Reliability and validity analyses were also conducted separately for rural and urban subgroups.

Results.
The Hausa-RMDQ had no major translation problems. The questionnaire had adequate internal consistency (α = 0.70), test–retest reliability (ICC = 0.79), minimal SEM (1.30) and MDC (3.60), and good agreement between test–retest values. The Hausa-RMDQ had a strong correlation with ODI (rho = 0.59), a moderate correlation with NPRS (rho = 0.46), and a null correlation with age, educational level, and occupational status (P > 0.05), thus confirming all the (5:5) a priori hypotheses constructed. These reliability and validity results were also replicated in the rural and urban subgroups.

Conclusion.
The Hausa-RMDQ was successfully developed and proved to be a reliable and valid measure of functional disability in Hausa culture. This questionnaire is recommended for future clinical and scientific research purposes.

Level of Evidence: 3
Design and Implementation of an Enhanced Recovery After Surgery Protocol in Elective Lumbar Spine Fusion by Posterior Approach
Authors: Garg Bhavuk , Mehta Nishank , Bansal Tungish , Shekhar Shubhankar , Khanna Puneet , Baidya Dalim Kumar 
Published: December 2020

Study Design.
Retrospective, comparative.

Objective.
The aim of this study was to design an enhanced recovery after surgery (ERAS) protocol for elective lumbar spine fusion by posterior approach, and to compare the results after ERAS implementation in patients undergoing elective lumbar spine fusion with conventional perioperative care.

Summary of Background Data.
Despite wide adoption in other surgical disciplines, ERAS has only been recently implemented in spine surgery. The integrated multidisciplinary approach of ERAS aims to reduce surgical stress to achieve better outcomes.

Methods.
Hospital records of adult patients who underwent one- to three-level elective lumbar spine fusion by posterior approach at a single center were retrospectively studied. An ERAS protocol was designed based on the prevalent hospital practices, local resources and supportive evidence from literature. The ERAS protocol was implemented at our institute in December 2016—dividing patients into pre-ERAS and post-ERAS groups. The outcome measures for comparison were: length of hospital stay (LOS), postoperative complications, 60-day readmission rate, 60-day reoperation rate, and patient-reported outcome measures (visual analogue scale [VAS] and Oswestry Disability Index [ODI] score) at stipulated time intervals.

Results.
A total of 812 patients were included – 496 in the pre-ERAS group and 316 in the post-ERAS group. There was no significant difference between the two groups in baseline demographic, clinical, and surgery-related variables. Patients in the post-ERAS group had a significantly shorter LOS (2.94 vs. 3.68 days). The rate of postoperative complications (13.5% vs. 11.7%), 60-day readmission (1.8% vs. 2.2%), and 60-day reoperation (1.2% vs. 1.3%) did not differ significantly between the pre-ERAS and post-ERAS groups. The VAS and ODI scores, similar at baseline, were significantly lower in the post-ERAS group (VAS: 49.8 ± 12.0 vs. 44 ± 10.8, ODI: 31.6 ± 14.2 vs. 28 ± 12.8) at 4 weeks after surgery. This difference however was not significant at intermediate-term follow-up (6 months and 12 months).

Conclusion.
Implementation of an ERAS protocol is feasible for elective lumbar spine fusion, and leads to shorter LOS and improved early pain and functional outcome scores.

Level of Evidence: 3
Mitogen-activating protein kinase pathway alterations in Langerhans cell histiocytosis
Authors: Jouenne Fanélie , Benattia Amira , Tazi Abdellatif 
Published: December 2020

Purpose of review
Langerhans cell histiocytosis (LCH) is a rare disorder characterized by the infiltration of involved tissues by specialized dendritic cells. The demonstration of the constant activation of the mitogen-activated protein kinase (MAPK) pathway in LCH lesions has been a breakthrough in the understanding of the pathogenesis of this rare disease. We will summarize the current knowledge on MAPK alterations in LCH and the new therapeutic options indicated by these findings.

Recent findings
Since the description of the B-Raf proto-oncogene, serine/threonine kinase (BRAF)
V600E mutation in LCH lesions, several other molecular alterations affecting the MAPK pathway have been identified in most cases. Based on these driver alterations, LCH cells were shown to be derived from hematopoietic precursors, which yielded the current concept of LCH as a myeloid inflammatory neoplasia. MAPK pathway inhibitors have emerged as an innovative therapy in severe forms of LCH, resulting in virtually no acquired resistance. However, although they are highly effective, their effect is only temporary, as the disease relapses upon discontinuation of the treatment.

Summary
LCH is an inflammatory myeloid neoplastic disorder, driven by mutations activating the MAPK pathway. MAPK-targeted treatments represent an important stepforward in the management of patients with severe progressive LCH.
IPAA in Known Preoperative Crohn’s Disease: A Systematic Review
Authors: Lightner Amy L. , Jia Xue , Zaghiyan Karen , Fleshner Phillip R. 
Published: December 2020

BACKGROUND:
Crohn’s disease is a relative contraindication to IPAA due to perceived increased rates of pouch failure.

OBJECTIVE:
This study aimed to determine pouch functional outcomes and failure rates in patients with a known preoperative diagnosis of Crohn’s disease.

DATA SOURCES:
A database search was performed in Ovid Medline In-Process & Other NonIndexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, and Ovid Cochrane Database of Systematic Reviews.

STUDY SELECTION:
The published human studies that reported short-term postoperative outcomes and/or long-term outcomes following IPAA in adult (≥18 years of age) Crohn’s disease populations were selected.

INTERVENTION:
Ileal pouch anal anastomoses were constructed in patients who had Crohn’s disease diagnosed preoperatively or through proctocolectomy pathology.

MAIN OUTCOMES MEASURES:
The primary outcomes measured were long-term functional outcomes (to maximal date of follow-up) and the pouch failure rate.

RESULTS:
Of 7019 records reviewed, 6 full articles were included in the analysis. Rates of pelvic sepsis, small-bowel obstruction, pouchitis, anal stricture, and chronic sinus tract were 13%, 3%, 31%, 18%, and 28%. Rates of incontinence, urgency, pad usage in the day, pad usage at night, and need for antidiarrheals were 24%, 21%, 19%, 20%, and 28%, and mean 24-hour stool frequency was 6.3 bowel movements at a mean 69 months of follow-up. The overall pouch failure rate was 15%; no risk factors for pouch failure were identified.

LIMITATIONS:
This investigation was limited by the small number of studies with significant study heterogeneity.

CONCLUSION:
In patients with known preoperative Crohn’s disease, IPAA construction is feasible with functional outcomes equivalent to patients with ulcerative colitis, but, even in highly selected patients with Crohn’s disease, pouch failure rates remain higher than in patients with ulcerative colitis.
Optimization of Aztreonam in Combination With Ceftazidime/Avibactam in a Cystic Fibrosis Patient With Chronic Stenotrophomonas maltophilia Pneumonia Using Therapeutic Drug Monitoring: A Case Study
Authors: Cowart Mallory C. , Ferguson Chelsea L. 
Published: December 2020

Abstract:
In this clinician-therapeutic drug monitoring (TDM) consultant interaction, the authors describe the use of TDM in an 11-year-old female patient with cystic fibrosis receiving ceftazidime/avibactam and aztreonam for the treatment of persistent pulmonary exacerbations caused by Stenotrophomonas pneumonia. Serum drug concentrations at a steady state confirmed inadequate antimicrobial exposure, and continuous infusions of both ceftazidime/avibactam and aztreonam were required to optimize the percentage of time when free drug remained above the minimum inhibitory concentration (MIC), known as fT > MIC. After dose adjustment, this continuous infusion strategy resulted in 100% target attainment for fT > MIC. This case illustrates the importance of TDM, and the logistical issues encountered with the use of alternative dosing strategies in pediatric patients with CF.
SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN SMALL CHOROIDAL MELANOMAS AND CHOROIDAL NEVI
Authors: Greig Eugenia Custo , Laver Nora V. , Mendonca Luisa S.M. , Levine Emily S. , Baumal Caroline R. , Waheed Nadia K. , Duker Jay S. 
Published: December 2020

Purpose:
To evaluate the use of swept-source optical coherence tomography angiography to detect distinct vascular features in small choroidal melanomas and choroidal nevi.

Methods:
Patients with a choroidal nevus or a treatment-naïve choroidal melanoma were imaged with color fundus photography, ultrasound, and swept-source optical coherence tomography angiography (12 × 12 mm). High-risk features including overlying fluid, orange pigment, shaggy photoreceptors, acoustic hollowness, depth >2 mm, and basal diameter >5 mm were assessed. Optical coherence tomography angiography vascular markers included: choroidal vessel visualization, choroidal vessel depth, and choriocapillaris flow signal, assessed qualitatively by comparison with surrounding, unaffected choriocapillaris.

Results:
Twenty-nine lesions were included in this study, seven flat choroidal nevi, 17 elevated choroidal nevi, and 5 choroidal melanomas. Distinct vascular patterns were noted between flat nevi, elevated nevi, and small choroidal melanomas. Choroidal melanomas displayed two types of vasculature: “nevus-like” vasculature with straight parallel vessels and complex vasculature with vascular loops and crosslinking. Visualized choroidal vessels were significantly deeper in melanomas (110 µm) than elevated (84 µm) or flat nevi (70 µm). In a size-matched subanalysis of 5 elevated choroidal nevi and 5 choroidal melanomas, choroidal melanomas had increased mean choroidal vessel depth (P = 0.015), deepest choroidal vessel visualized (P = 0.034), and presence of a deep choroidal vessel >155 µm (P = 0.048).

Conclusion:
Swept-source optical coherence tomography angiography may detect distinct vascular features in choroidal nevi and small choroidal melanomas.