bluuebunny/crossref_metadata_2025_split huggingface dataset:
No significant long-term complications from inadvertent exposure to gonadotropin-releasing hormone agonist during early pregnancy in mothers and offspring: a retrospective analysis
Authors: Wu Huan , Xu Xiaoyan , Ma Cong , Zhou Yiran , Pei Shanai , Geng Hao , He Ye , Xu Qianhua , Xu Yuping , He Xiaojin , Zhou Ping , Wei Zhaolian , Xu Xiaofeng , Cao Yunxia 
Published: March 2021

Abstract
Background
Administration of gonadotropin-releasing hormone agonist (GnRH-a) in the luteal phase is commonly used for pituitary suppression during in vitro fertilisation (IVF). There is an ineluctable risk of inadvertent exposure of spontaneous pregnancy to GnRH-a. However, little is known about the pregnancy complications and repregnancy outcomes of the affected women and the neurodevelopmental outcomes of the GnRH-a-exposed children.

Methods
Retrospective analysis was used to determine obstetric and repregnancy outcomes after natural conception in 114 women who naturally conceived while receiving GnRH-a during their early pregnancy over the past 17 years. The GnRH-a-exposed children were evaluated to determine their neonatal characteristics and long-term neurodevelopmental outcomes. The outcomes were compared to those of relevant age-matched control groups.

Results
Sixty-five women had 66 live births. The neonatal health outcomes and the incidence of maternal complications were similar in the GnRH-a-exposed and control groups. Thirty-one GnRH-a-exposed children, aged 2–8 years, were available for investigation of neurodevelopment. Except for one case of autism spectrum disorder, the full-scale intelligence quotient score was within the normal range and similar to that of the control group. Most mothers with successful pregnancies and about one-third of the women who had spontaneous abortions were subsequently able to conceive naturally again. IVF is recommended for repregnancy in women who have experienced ectopic pregnancies.

Conclusions
Accidental exposure to GnRH-a in early pregnancy might be safe. Reproductive treatment suggestions for repregnancy should be made with consideration of the outcomes of the previously GnRH-a-exposed spontaneous pregnancy.
Size, composition and distribution of health workforce in India: why, and where to invest?
Authors: Karan Anup , Negandhi Himanshu , Hussain Suhaib , Zapata Tomas , Mairembam Dilip , De Graeve Hilde , Buchan James , Zodpey Sanjay 
Published: March 2021

Abstract
Background
Investment in human resources for health not only strengthens the health system, but also generates employment and contributes to economic growth. India can gain from enhanced investment in health workforce in multiple ways. This study in addition to presenting updated estimates on size and composition of health workforce, identifies areas of investment in health workforce in India.

Methods
We analyzed two sources of data: (i) National Health Workforce Account (NHWA) 2018 and (ii) Periodic Labour Force Survey 2017–2018 of the National Sample Survey Office (NSSO). Using the two sources, we collated comparable estimates of different categories of health workers in India, density of health workforce and skill-mix at the all India and state levels.

Results
The study estimated (from NHWA 2018) a total stock of 5.76 million health workers which included allopathic doctors (1.16 million), nurses/midwives (2.34 million), pharmacist (1.20 million), dentists (0.27 million), and traditional medical practitioner (AYUSH 0.79 million). However, the active health workforce size estimated (NSSO 2017–2018) is much lower (3.12 million) with allopathic doctors and nurses/midwives estimated as 0.80 million and 1.40 million, respectively. Stock density of doctor and nurses/midwives are 8.8 and 17.7, respectively, per 10,000 persons as per NHWA. However, active health workers’ density (estimated from NSSO) of doctor and nurses/midwives are estimated to be 6.1 and 10.6, respectively. The numbers further drop to 5.0 and 6.0, respectively, after accounting for the adequate qualifications. All these estimates are well below the WHO threshold of 44.5 doctor, nurses and midwives per 10,000 population. The results reflected highly skewed distribution of health workforce across states, rural–urban and public–private sectors. A substantial proportion of active health worker were found not adequately qualified on the one hand and on the other more than 20% of qualified health professionals are not active in labor markets.

Conclusion
India needs to invest in HRH for increasing the number of active health workers and also improve the skill-mix which requires investment in professional colleges and technical education. India also needs encouraging qualified health professionals to join the labor markets and additional trainings and skill building for already working but inadequately qualified health workers.
Should policy makers trust composite indices? A commentary on the pitfalls of inappropriate indices for policy formation
Authors: Kaiser Matthias , Chen Andrew Tzer-Yeu , Gluckman Peter 
Published: March 2021

AbstractBackgroundThis paper critically discusses the use and merits of global indices, in particular, the Global Health Security Index (GHSI; Cameron et al.https://www.ghsindex.org/#l-section--map) in times of an imminent crisis, such as the current pandemic. This index ranked 195 countries according to their expected preparedness in the case of a pandemic or other biological threat. The coronavirus disease 2019 (Covid-19) pandemic provides the background to compare each country's predicted performance from the GHSI with the actual performance. In general, there is an inverted relation between predicted versus actual performance, i.e. the predicted top performers are among those that are the worst hit. Obviously, this reflects poorly on the potential policy uses of this index in imminent crisis management.MethodsThe paper analyses the GHSI and identifies why it may have struggled to predict actual pandemic preparedness as evidenced by the Covid-19 pandemic. The paper also uses two different data sets, one from the Worldmeter on the spread of the Covid-19 pandemics, and the other from the International Network for Government Science Advice (INGSA) Evidence-to-Policy Tracker, to draw comparisons between the actual introduction of pandemic response policies and the corresponding death rate in 29 selected countries.ResultsThis paper analyses the reasons for the poor match between prediction and reality in the index, and mentions six general observations applying to global indices in this respect. These observations are based on methodological and conceptual analyses. The level of abstraction in these global indices builds uncertainties upon uncertainties and hides implicit value assumptions, which potentially removes them from the policy needs on the ground.ConclusionsFrom the analysis, the question is raised if the policy community might have better tools for decision-making in a pandemic. On the basis of data from the INGSA Evidence-to-Policy Tracker, and with backing in studies from social psychology and philosophy of science, some simple heuristics are suggested, which may be more useful than a global index.
Generation and validation of a formula to calculate hemoglobin loss on a cohort of healthy adults subjected to controlled blood loss
Authors: Hahn-Klimroth Max , Loick Philipp , Kim-Wanner Soo-Zin , Seifried Erhard , Bonig Halvard 
Published: March 2021

Abstract
Background
The ability to approximate intra-operative hemoglobin loss with reasonable precision and linearity is prerequisite for determination of a relevant surgical outcome parameter: This information enables comparison of surgical procedures between different techniques, surgeons or hospitals, and supports anticipation of transfusion needs. Different formulas have been proposed, but none of them were validated for accuracy, precision and linearity against a cohort with precisely measured hemoglobin loss and, possibly for that reason, neither has established itself as gold standard. We sought to identify the minimal dataset needed to generate reasonably precise and accurate hemoglobin loss prediction tools and to derive and validate an estimation formula.

Methods
Routinely available clinical and laboratory data from a cohort of 401 healthy individuals with controlled hemoglobin loss between 29 and 233 g were extracted from medical charts. Supervised learning algorithms were applied to identify a minimal data set and to generate and validate a formula for calculation of hemoglobin loss.

Results
Of the classical supervised learning algorithms applied, the linear and Ridge regression models performed at least as well as the more complex models. Most straightforward to analyze and check for robustness, we proceeded with linear regression. Weight, height, sex and hemoglobin concentration before and on the morning after the intervention were sufficient to generate a formula for estimation of hemoglobin loss. The resulting model yields an outstanding R2 of 53.2% with similar precision throughout the entire range of volumes or donor sizes, thereby meaningfully outperforming previously proposed medical models.

Conclusions
The resulting formula will allow objective benchmarking of surgical blood loss, enabling informed decision making as to the need for pre-operative type-and-cross only vs. reservation of packed red cell units, depending on a patient’s anemia tolerance, and thus contributing to resource management.
Response to treatment with intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligo articular juvenile idiopathic arthritis
Authors: Harhay Rana , Jeelani Wajiha , Agbor Barbine Tchamba Agbor , Hennon Teresa , Wrotniak Brian H. , Abdul-Aziz Rabheh 
Published: March 2021

Abstract
Background
Oligo-articular juvenile idiopathic arthritis (Oligo JIA) is the most common subtype of juvenile idiopathic arthritis. Intra-articular corticosteroid (IAC) injection is a mainstay treatment of oligo JIA providing pain relief, improving mobility and preventing further joint destruction in the majority of patients. In 2015, production of triamcinolone hexacetonide (TH) an intra-articular corticosteroid was discontinued in the United States leading to use of triamcinolone acetonide (TA) as an alternative. In this study, we compared response to treatment in children with oligo JIA who underwent therapy with intra-articular TA and TH injection.

Methods
Our study is a retrospective chart review of children with oligo JIA who were treated with IAC injections with TH between January 2012 and June 2015 and TA between J uly 2015 and December 2018. The two groups were followed at John R. Oishei Children’s Hospital of Buffalo and were evaluated for response to treatment, side effects and predictors of response including duration of disease before treatment, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP). Response to treatment was defined as at least 6 months follow up without evidence of active arthritis in injected joints. Patients were considered to be non-responders if they continued to show active arthritis during their first follow up after joint injection. The primary objective was to evaluate whether there was a significant difference in rate of response between TH and TA.

Results
Forty-nine patients, 38 female and 11 male with oligo JIA were included in the study. The average age was 6.7 years. A total of 111 joints were injected includin g 78 knees, 13 ankles, 9 wrists, 4 hips, 4 elbows, 2 TMJ and one subtalar joint. In the TA group, 49% (29/59) did not show response to injection compared to 27% (14/52) in the TH group. After 6 months, response rates were better for individuals injected with TH compared to TA (73% vs. 51%). In general, response to intra-articular TH was superior to TA with P = .016 using chi-square test of independence. This difference in outcome was not influenced by other variables such as duration of illness before treatment (P value 0.784) or elevated ESR and CRP. No difference in side effects between the two groups were noted.

Conclusion
Our results in conjunction with prior published data suggests that TH intra-articular joint injection in oligo JIA is superior to TA, although future controlled trials are necessary for confirmation. An effective, long lasting treatment can have a great impact on the outcome of these children.
Extrinsic stressors modulate resource evaluations: insights from territoriality under artificial noise
Authors: Kareklas Kyriacos , Kunc Hansjoerg P. , Arnott Gareth 
Published: March 2021

AbstractBackgroundCompetition is considered to rely on the value attributed to resources by animals, but the influence of extrinsic stressors on this value remains unexplored. Although natural or anthropogenic environmental stress often drives decreased competition, assumptions that this relies on resource devaluation are without formal evidence. According to theory, physiological or perceptual effects may influence contest behaviour directly, but motivational changes due to resource value are expected to manifest as behavioural adjustments only in interaction with attainment costs and resource benefits. Thus, we hypothesise that stressor-induced resource devaluations will impose greater effects when attainment costs are high, but not when resource benefits are higher. Noise may elicit such effects because it impacts the acoustic environment and imposes physiological and behavioural costs to animals. Therefore, we manipulated the acoustic environment using playbacks of artificial noise to test our hypotheses in the territorial male Siamese fighting fish,Betta splendens.ResultsCompared to a no-playback control, noise reduced defense motivation only when territory owners faced comparatively bigger opponents that impose greater injury costs, but not when territories also contained bubble nests that offer reproductive benefits. In turn, nest-size decreases were noted only after contests under noise treatment, but temporal nest-size changes relied on cross-contest variation in noise and comparative opponent size. Thus, the combined effects of noise are conditional on added attainment costs and offset by exceeding resource benefits.ConclusionOur findings provide support for the hypothesised modulation of resource value under extrinsic stress and suggest implications for competition under increasing anthropogenic activity.
Capgras delusion in postpartum psychosis: a case report
Authors: Joshi Sulochana , Thapa Mankaji , Manandhar Anusha , Shakya Rabi 
Published: March 2021

Abstract
Background
Capgras delusion is one of the delusional misidentification syndromes characterized by the belief by the patient that the close person is replaced by an imposter who looks physically the same. It rarely occurs in Postpartum Psychosis. An intriguing phenomenon with ongoing debates, particularly about its feature and prevalence, its course, occurrence, and phenomenon in the postpartum period are poorly understood.

Case presentation
A 26-year-old Nepalese woman presented to the emergency for abnormal behavior on her 9th postpartum day. Capgras delusion was observed for 2 days during her hospital stay. Other psychotic symptoms appeared progressively and were treated as a case of Postpartum Psychosis.

Conclusion
This case describes the temporal sequence of various psychopathologies during Postpartum Psychosis including Capgras delusion. We attempt to explain the occurrence of Capgras delusion in Postpartum Psychosis.
Entomotherapy: a study of medicinal insects of seven ethnic groups in Nagaland, North-East India
Authors: Mozhui Lobeno , Kakati L. N. , Meyer-Rochow Victor Benno 
Published: March 2021

Abstract
Background
The ethnic communities in Nagaland have kept a close relationship with nature since time immemorial and have traditionally used different kinds of insects and their products as folk medicine to treat a variety of human ills and diseases. The present study was conducted to record the entomotherapeutic practices of seven different ethnic groups of Nagaland.

Method
Documentation is based on semi-structured questionnaires and group discussions with a total of 370 informants. The data collected were analysed using fidelity level (FL) and informant consensus factor (ICF).

Results
Fifty species of medicinal insects belonging to 28 families and 11 orders were identified in connection with treatments of at least 50 human ailments, of which the most frequently cited were coughs, gastritis, rheumatoid arthritis, stomach ache and wound healing. Mylabris sp. showed the highest fidelity level (FL) of 100% for its therapeutic property as a dermatologic agent, while the informant consensus factor (ICF) ranged from 0.66 to 1.00. The use of medicinal insects varies amongst the seven ethnic groups, suggesting that differences in cultures and geographic location can lead to the selection of specific insect species for specific medicinal purposes. The largest number of insect species appear to be used for treating gastrointestinal, dermatological and respiratory diseases.

Conclusion
The list of medicinal insect species, many of which are reported for the first time in the present study, suggests the presence of a considerable diversity of therapeutically important insect species in the region and elaborate folk medicinal knowledge of the local ethnic groups. This knowledge of insects not just as a food, but also as therapy is passed down verbally from generation to generation, but is in danger of being lost if not documented in a systematic way. Having stood the test of time, traditional folk medicinal knowledge and its contribution through entomotherapy should not be regarded as useless as it has the potential to lead to the development of novel drugs and treatment methods.
Prevalence and correlates of non-daily and daily cannabis use among persons 15 years and older in South Africa: results of a national survey in 2017
Authors: Ramlagan Shandir , Peltzer Karl , Pengpid Supa 
Published: March 2021

Abstract
Background
The study aimed to assess the prevalence and correlates of non-daily and daily cannabis use among persons 15 years and older in South Africa.

Method
In a national cross-sectional 2017 survey, 39,207 persons 15 years and older (Median = 34 years) responded to a questionnaire on cannabis use and health variables. Multinominal logistic regression was used to assess the determinants of nondaily and daily cannabis use among the general population and logistic regression for the determinants of daily cannabis use among active cannabis users.

Results
Results indicate that 5.0% of the participants engaged in non-daily and 2.8% in daily cannabis use in the past 3 months. In adjusted multinomial logistic regression analysis, male sex, Grade 8–11 education, Coloureds, alcohol use disorder, never married, and other drug use were positively associated with daily cannabis use while not in not labour force was negatively associated with daily cannabis use. Moreover, male sex, never married, alcohol use disorder, and other drug use were positively, while physical multimorbidity was negatively associated with nondaily cannabis use. In adjusted logistic regression, compared to nondaily cannabis users, daily cannabis users were more likely male and were less likely not in the labour force and were less likely using other drugs.

Conclusion
About one in ten participants had used cannabis in the past 3 months in South Africa. Several sociodemographic and health indicators were identified that were associated with non-daily and/or daily cannabis use.
Topographic distribution of lymph node metastasis in patients with stage IB1 cervical cancer: an analysis of 8314 lymph nodes
Authors: Cai Jing , He Xiaoqi , Wang Hongbo , Dong Weihong , Zhang Yuan , Zhao Jing , Willborn Kay C. , Huang Bangxing , Wang Zehua , Jiang Ping 
Published: March 2021

Abstract
Background
Systematic pelvic lymphadenectomy or whole pelvic irradiation is recommended for the patients with stage IB1 cervical cancer. However, the precise pattern of lymphatic tumor spread in cervical cancer is unknown. In the present study we evaluated the distribution of nodal metastases in stage IB1 cervical cancer to explore the possibilities for tailoring cancer treatment.

Methods
A total of 289 patients with cervical cancer of stage IB1, according to FIGO 2009, were retrospectively analyzed. All patients underwent laparoscopic radical hysterectomy (Querleu and Morrow type C2) and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy (level 2 or level 3 according to Querleu and Morrow) from October 2014 to December 2017. Lymph nodes removed from 7 well-defined anatomical locations as well as other tissues were examined histopathologically, and typed, graded, and staged according to the WHO/IARC classification.

Results
Totally 8314 lymph nodes were analyzed with the average number of 31.88 ± 10.34 (Mean ± SD) lymph nodes per patient. Nodal metastases were present in 44 patients (15.22%). The incidence of lymphatic spread to different anatomic sites ranged from 0% (presacral) to 30.92% (obturator nodes). Tumor size above 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion were shown to be significantly correlated with the higher risk of lymphatic metastasis, while obesity (BMI ≥ 25) was independently negatively associated with lymphatic metastases.

Conclusions
The incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. Individual treatment could be considered for the selected low-risk patients who have smaller tumors and obesity and lack of the parametrial invasion or LVSI.
Percutaneous transluminal stenting for superior vena cava syndrome caused by malignant tumors: a single-center retrospective study
Authors: Liu Haitao , Li Yahua , Wang Yang , Yan Lei , Zhou Pengli , Han Xinwei 
Published: March 2021

Abstract
Objectives
To evaluate the efficacy of percutaneous stent placement in the treatment of superior vena cava syndrome caused by malignant tumors.

Methods
We retrospectively analyzed the clinical data of 32 patients with superior vena cava syndrome who underwent percutaneous endovascular stent treatment in our department from 2015 to 2019 due to malignant tumors and summarized the patient’s sex, age, tumor type, endovascular treatment plan, complications and postoperative follow-up.

Results
All patients successfully underwent percutaneous intraluminal stent placement with digital subtraction angiography (DSA). Thirty-seven endovascular stents were implanted in 32 patients, including 21 Eluminexx stents, 12 Wallstent stents and 4 covered stents. The technical success rate was 100%, and there were no serious surgery-related complications. The remission rate of clinical symptoms was 53.1% (17/32) at 24 h and 84.4% (27/32) at 48 h. After 48 h, the symptoms of the remaining patients were slowly relieved, and the symptom relief rate was 100% at 7 days. The follow-up period was 1.5–24 months, with an average follow-up period of 6.5 months. During the follow-up, 3 patients had restenosis and 1 patient had secondary thrombosis in the stent. Their symptoms were relieved after the second treatment.

Conclusion
For superior vena cava syndrome caused by malignant tumors, percutaneous endoluminal stent therapy can quickly and effectively relieve the clinical symptoms of patients, and the incidence of complications is low.