bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dramatic Reduction in Opioid Prescribing for Common Outpatient Orthopaedic Lower Extremity Surgical Procedures at a Louisiana University-Based Safety-Net Hospital After Enactment of Opioid-Limiting State Legislation
Authors: Bronstone Amy B. , Leonardi Claudia , Kubilay Tara , Plessl Daniel S. , Morreale Peter J. , Tortorich Gregory M. , Krause Peter C. 
Published: December 2021

Introduction:
The opioid epidemic in the United States has been fueled by overprescribing opioids, which is particularly apparent in orthopaedics. Stakeholders, including state legislatures, have attempted to curb opioid overprescribing to reduce related abuse/dependence, overdose deaths, and diversion.

Objective:
To examine trends in opioid prescribing for common outpatient lower extremity orthopaedic surgeries in a population vulnerable to prolonged opioid use before and after the enactment of a 2017 Louisiana state law limiting opioid prescribing for acute pain.

Methods:
Eligible patients were adults who underwent one of the five most common outpatient lower extremity orthopaedic surgeries done during 2013 to 2018 at an urban tertiary care academic medical center. Excluded were prisoners and patients who required inpatient hospitalization, had no documented discharge opioid prescription, or filled an opioid prescription unrelated to their orthopaedic procedure within 30 days before surgery.

Results:
During 2013 to 2018, 655 surgical procedures were done in 655 eligible patients, of whom 49% were Black and 54% were insured by Medicaid. The mean morphine milligram equivalent per discharge prescription decreased by almost 70% from 2014 to 2018. A statistically significant decrease in the mean morphine milligram equivalent per discharge prescription was observed in 2018 versus all previous years (P < 0.0001 for all) and in 2017 versus all previous years (P < 0.0001 for all). Patients receiving at least one new opioid prescription after their discharge prescription declined over time from a high of 50% in 2013 to a low of 19.3% in 2018 with a statistically significant effect over time (P < 0.0001).

Discussion:
Opioid prescribing for patients undergoing common outpatient lower extremity orthopaedic surgeries who were at high risk for prolonged opioid use markedly declined after the enactment of a state law limiting first-time opioid prescriptions to 7 days, requiring physicians to check the state's Prescription Monitoring Program database and mandating continuing education for opioid prescribers.
Depression and Functional Mobility Decline in Long Term Care Home Residents with Dementia: a Prospective Cohort Study
Authors: Chu Charlene H. , Quan Amanda My Linh , McGilton Katherine S. 
Published: December 2021

Objective
Assess the association between depression among new long-term care residents (<3 months stay) with dementia and functional mobility decline.
Methods
A multi-site prospective cohort study was carried out among 26 participants diagnosed with dementia. Functional mobility was measured by Timed-Up-and-Go (TUG) and 2-Minute walk test (2MWT) at baseline, and 60-day post-baseline while participants received usual care. Linear mixed models were applied to examine the association between depression and functional mobility decline.
Results
Residents experienced a statistically significant decline in functional mobility in as soon as 60 days. Each additional year of age was associated with a 2% increase in TUG. The interaction between depression and time spent in LTC was statistically significant. Age and time living in LTC were significantly associated with functional mobility decline in new residents with dementia.
Discussion
Further work determining why residents with dementia experience decline in functional mobility at an accelerated rate is needed.
Effect of Memantine on Prolonging Safe Driving in Early AD: a Pilot Study
Authors: Holland Peter J. , Tappen Ruth M. , Newman David O. , Freeman-Costin Katherine C. , Fisher Lori  J. 
Published: December 2021

Background
To determine the feasibility of conducting an RCT on the potential effectiveness of memantine hydrochloride in prolonging safe driving in mild AD.
Methods
A placebo-controlled, double blind randomized trial was conducted. Forty-three individuals ≥60 with mild AD met screening criteria and were randomized. Driving ability was measured by a standardized on-road driving test. Outcomes were driving capacity at 6 and 12 months and completion of the 12-month intervention.
Results
Of 43 participants randomized, 59% of the memantine group and 52% of the placebo group completed the on-road test at 12 months (p = .66). All 13 memantine group participants maintained their driving status at 12 months, whereas only 8 of the 11 placebo group participants did (p = .040, OR = 4.45).
Conclusions
Results provide the framework for designing a rigorous multisite clinical trial of memantine effect on maintaining driving capacity in mild AD.
Consensus Statement Regarding the Application of Biogen to Health Canada for Approval of Aducanumab
Authors: Chertkow Howard , Rockwood Kenneth , Hogan David B. , Phillips Natalie , Montero-Odasso Manuel , Amanullah Shabbir , Black Sandra , Bocti Christian , Borrie Michael , Feldman Howard , Freedman Morris , Hsiung Robin , Kirk Andrew , Masellis Mario , Nygaard Haakon , Rajji Tarek , Verret Louis 
Published: December 2021

Alzheimer’s disease is a major cause of morbidity and mortality. Currently, there are no disease-modifying pharmacotherapies for this condition. Aducanumab, an amyloid beta-directed monoclonal antibody that targets aggregated forms of amyloid-beta in the brains of people with Alzheimer’s disease, has raised hopes that such a therapy has been discovered, but its approval by the US Food and Drug Administration has engendered a good deal of controversy. A similar application for approval has been submitted to Health Canada. In response to this, a group of Canadian clinical dementia experts representing a number of organizations, including the Canadian Geriatrics Society, was convened by the Canadian Consortium on Neurodegeneration in Aging (CCNA) to discuss the evidence currently available on this agent and seek consensus on what advice they would offer Health Canada on the application. There was wide-spread agreement that it would be premature for aducanumab to receive approval for the treatment of Alzheimer’s disease. It was also noted that the Canadian health-care system is poorly prepared at this time to deal with a disease-modifying therapeutic with targeting, administration, and monitoring characteristics like aducanumab. In this paper, the consensus reached is presented along with its underlying rationale.
Product property of global $P$-extremal functions
Authors: Dieu Nguyen Quang , Long Tang Van 
Published: December 2021

In this note, we establish a product property for $P$-extremal functions in the same spirit as the original product formula due to J. Siciak in Ann. Polon. Math., 39 (1981), 175–211. As a consequence, we obtain convexity for the sublevel sets of such extremal functions. Moreover, we also generalize the product property of $P$-extremal functions established by L. Bos and N. Levenberg in Comput. Methods Funct. Theory 18 (2018), 361–388, and later by N. Levenberg and M. Perera, in Contemporary Mathematics 743 (2020), 11–19, in which no restriction on $P$ is needed.
Haçlı Devletleri Döneminde Kadın Algısı, Siyasi Evlilikler ve Devlet Yönetiminde Kadınların Rolü
Authors: Altınay Ramazan , Dağdeviren Habibe Ceren 
Published: December 2021

Bu araştırmada Haçlı Seferleri dönemindeki kadın algısı, siyasi evlilikler ve devlet yönetiminde kadınların rolünün ne olduğu incelenmektedir. Orta Çağların en büyük askerî harekâtlarından biri olan Haçlı Seferleri, Batılı Hıristiyanlar ile Doğulu Müslümanları karşı karşıya getiren ve 1096 yılında başlayıp 1291 yılında Latin Hıristiyanların Doğu'da Akka’dan çıkartılmalarına kadar süren ve sekiz büyük askeri seferi kapsayan yaklaşık iki yüz yıllık bir dönemi kapsamaktadır. Araştırmanın giriş bölümünde Haçlı Seferlerinin tarihsel süreci incelendikten sonra seferlerin yapıldığı dönemdeki kadın algısı ve kadınların seferlere karşı yaklaşımı incelenmeye çalışılmıştır. Daha sonra Haçlı devletlerinde (Urfa Haçlı Kontluğu (1098-1144), Antakya Prinkepsliği (1098-1268), Kudüs Krallığı (1099-1291) ve Trablus Kontluğu (1109-1289) soylu kadınlarla yapılan evliliklerin siyaset üzerindeki etkisi tartışılmıştır. Araştırmanın bu bölümünde soylu kadınlarla yapılan evliliklerin siyaset üzerindeki etkisi ile ilgili çok sayıda örneğe yer verilmiştir. Verilen örnekler ışığında, Haçlı devletlerinin yöneticilerinin, oluşturdukları siyasi organizasyonu devam ettirebilmek, güçlendirmek ve hâkimiyet alanlarını genişletebilmek için çıkarlar doğrultusunda anlaşmalar yapmak ya da savaşmak gibi faktörlerin yanı sıra evlilik yoluyla kurulan ilişkilere de önem verdikleri sonucuna varılmıştır. Soylu kadınlar ya da yerel yöneticilerin kızları ile yapılan evlilikler yolu ile kurulan akrabalık ilişkilerinin bazen hâkimiyet alanlarını genişletmek ve hatta tehdit oluşturan güçlere karşı ittifak sağladıkları gibi, bazen devletlerin devamının bu evlilikler sayesinde gerçekleştiği tespiti yapılmıştır. Böylece Haçlı Seferleri esnasında, Orta Çağlar’ın olumsuz kadın algısına rağmen, soylu kadınların siyasi ilişkilerde devleti yönetecek konuma kadar yükselerek siyasette etkin bir rol üstlendikleri sonucuna ulaşılmıştır. Çalışma bu yönüyle Haçlı devletleri dönemindeki kadın rollerini inceleyerek kadınların tarih boyunca üstlendikleri rollerin anlaşılması noktasında genel bir bakış açısı sunmaktadır.
To Assess the Effectiveness of Video-assisted Teaching on Knowledge Regarding Male Breast Cancer among Adult Males
Authors: Gadhave Shalaka , Gahane Vaishali , Gajbhiye Poonam , Gandhare Harsha , Pohekar Savita 
Published: December 2021

Introduction: As the healthcare programs focus on the relatively higher incidence, women have a fair level of awareness of breast cancer. Breast of male hence ignored in the community. Studies from India have shown that medical care is often taken in an advanced stage because of lack of awareness, and the aggressive nature of breast cancer in Indian men and seen at quite an early age. Video-assisted knowledge teachings about awareness of male breast cancer among adult males would improve their understanding and exploration of the perceptions and opinions of Indian male cancers.
Aim: To determine the effectiveness of video-assisted education on male breast cancer knowledge among adult males in the city of Wardha.
Methods and Materials: One group pretest and posttest design with a quantitative research approach has been used in this interventional study design. This study has been carried out in community set up. Sample size was100. Validated Pretested predesigned structured questionnaires were used. In Microsoft excel sheet, data collected was entered. SPSS-software was used to perform the statistical analysis. Frequencies and percentages for categorical variables have been presented.
Results: The pre-test findings show that 15(15%) of the adult males had a poor level of knowledge score, 50(50%) had average knowledge and 31(31%) of them had good knowledge and 4(4%) of them had found a very good level of knowledge. After video-assisted teaching in the post-test 3(3%) had a good knowledge score and 97(97%) had very good knowledge, thus it shows that after the post-test the knowledge score was increased. The Mean value of the pre-test is 9.32 and the post-test is 23.14 (p-value is 0.001), the calculated t-value is 35.47. Hence it indicates that Teaching aided with video was effective. The post-test score was significantly associated with population variables such as occupation and bad habits. The post-testing knowledge score with demographic variables such as age, religion, family type, education, marital status, dietary pattern, and area of residence was not significantly linked.
Conclusion: The study shows that the expected teaching on male breast cancer has helped adult males to gain a better understanding of the nature of the disease and to take measures to prevent male breast cancer.
A 2 Years Girls with Nephroblastoma: A Case Report
Authors: Mendhe Deeplata , Jiwane Achal , Sharma Ranjana , Wanjari Mayur 
Published: December 2021

Introduction: Wilm's tumor, also known as nephroblastoma, is a common complication in children with renal cancer. It was responsible for 6% of all malignancies. It almost always affects children under the age of five. 90% of cases are diagnosed before the age of three, with the peak incidence occurring between the ages of two and five years. The case of a 2-year-old girl with Wilm's tumor is shown below. The majority of cases are unilateral, but 5% to 10% of the time both kidneys are affected.
Case Presentation: A 2-year-old girl was taken to the hospital with a chief complaint of a lump in the abdomen, fever, vomiting and fatigue, nausea, swelling, pain in the abdomen, weakness. On physical examination the patient has experienced in weakness the upper and lower limb, pain experiencing in the abdomen and presenting lumps in the abdomen S1 and S2 are heard in the cardiological system, and air entry is bilaterally equal in the respiratory system. Pupils are reflected light, tone, and a palpable smooth abdominal mass is frequently discovered by chance. The infant was never admitted to a neonatal intensive care unit (NICU). There had been no previous evidence of neonatal sepsis or jaundice. For a year, the girl was breastfed. The right side of the abdomen was where the first symptoms appeared. Small at first, but quickly grew larger and more asymmetrical.
A Study Protocol on the Effectiveness of Post Mastectomy Exercises in Breast Cancer Patients on Reduction of Lymphedema and Improving Range of Motion among Patients Undergone Mastectomy
Authors: Kothe Amruta , Ankar Ruchira 
Published: December 2021

Background: Breast cancer is the most commonly diagnosed type of cancer in the world and it is a major stressor in women's lives. Breast cancer cases are increasing in both rural and urban settings. Mastectomy is a procedure that removes the breast to prevent cancer cells from returning. Many complications can develop after a mastectomy but lymphedema and limited range of motion are the most prevalent. The present study aimed to assess the effectiveness of post mastectomy exercises in breast cancer patients on reduction of lymphedema and improving range of motion among patients undergone mastectomy.
Objectives:

To assess pre interventional level of lymphedema among patients undergone mastectomy.
To assess pre interventional range of motion among patients undergone mastectomy.
To evaluate the effectiveness of post mastectomy exercises in reducing lymphedema among patients undergone mastectomy
To evaluate the effectiveness of post mastectomy exercises in improving range of motion among patients undergone mastectomy.
To associate demographic variable with post mastectomy exercises.
To associate correlation of post mastectomy exercise with lymphedema and range of motion.

Methodology: A pre interventional one group pretest posttest design would be adopted to assess the effectiveness of post mastectomy exercises in breast cancer patients on reduction of lymphedema and improving range of motion among patients undergone mastectomy. In this study interventional analytical study will be used. Purposive sampling technique will be used to collect the data. The study will include 30 patients undergone mastectomy will be assessed by using American lymphology lymphedema scale and Elvaru STJ (Subtalar joint) range of motion and range of motion reliability tool with the help of inch tape and goniometer and then post mastectomy exercises will be teach by researcher as intervention.
Expected Results: The goal of this study is to see how effective post-mastectomy exercises are at reducing lymphedema and improving range of motion in breast cancer patients who had undergone mastectomy. Teaching post-mastectomy exercises can help the respondents reduce lymphedema and improve their range of motion.
A Case of Mucinous Cystadenoma Carcinoma
Authors: G. Hatwar Vaibhav , Sharma Ranjana , Wanjari Mayur , Wankhede Pratibha , Alwadkar Sagar , Rodge Hina 
Published: December 2021

Introduction: Mucinous Cystadenoma carcinoma is a type of tumor in the cyst adenocarcinoma grouping it can occur in the breast as well as the ovary. Tumors are normally multiocular with various smooth thin-walled cysts. Within the cyst is found an emergence or cellular debris.
Patient History: The female patient 63-year-old who was admitted to AVBRH on the date 21/05/2021 in the obstetric and gynae ward with a chief complaint of generalized weakness, loss of appetite, fever for 2 days 7 days ago, 2-3 fever spikes and burning micturition. All over investigation observed like blood and urine investigation, CT scan of the abdomen, histopathology then the final diagnosis is confirmed as mucinous Cystadenoma carcinoma.
Pharmacology: The patient was treated with antibacterial medicine, antibiotics, and diabetics, thyroxin stimulating drugs, etc. Management: Inj. Ceftriaxone 1gm 12 hourly, Inj.-piptaz 4.45 gm, 8 hourly, tab. Gimipride 0.5 mg with tab. Metformin 500 mg 12 hourly, tab. Thyrox 62.5 mcg, tab telmisartan 40 mg with tab. Chlorthalidone 12.512.5 mg 12 hourly, Inj.-pan 40 mg, 12 hourly, Inj.- Neomol 100 ml, and Tablet- nitrofurantoin 6 hourly.
Nursing Management: Monitor the vital sign, monitor nutritional status and monitor random blood sugar. Maintained bed rest of patient, managed the pain level of the patient. The patient was assessed for risk of bleeding.
Conclusion: The patient was admitted to the hospital with the chief complaint of generalized weakness, loss of appetite, fever for 2 days 7 days ago, 2-3 fever spikes and burning micturition. and the patient was admitted to AVBR Hospital in the obstetric and gynae ward, immediate treatment was started by a health team member and all possible treatments were given and now the patient's condition is satisfactory.
Validation of Monte Carlo dose calculation algorithm for CyberKnife multileaf collimator
Authors: Gondré Maude , Marsolat Fanny , Bourhis Jean , Bochud François , Moeckli Raphaël 
Published: December 2021

AbstractPurposeTo commission and evaluate the Monte Carlo (MC) dose calculation algorithm for the CyberKnife equipped with a multileaf collimator (MLC).MethodsWe created a MC model for the MLC using an integrated module of the CyberKnife treatment planning software (TPS). Two parameters could be optimized: the maximum energy and the source full width at half‐maximum (FWHM). The optimization was performed by minimizing the differences between the measured and the MC calculated tissue phantom ratios and profiles. MLC plans were calculated in the TPS with the MC algorithm and irradiated on different phantoms. The dose was measured using an A1SL ionization chamber and EBT3 Gafchromic films, and then compared to the TPS dose to obtain dose differences (ΔD). Finally, patient‐specific quality assurances (QA) were performed with global gamma index criteria of 3%/1 mm.ResultsThe maximum energy and source FWHM showing the best agreement with measurements were 6.4 MeV and 1.8 mm. The output factors calculated with these parameters gave an agreement within ±1% with measurements. The ΔD showed that MC model systematically underestimated the dose with an average of −1.5% over all configurations tested. For depths deeper than 12 cm, the ΔD increased, up to −3.0% (maximum at 15.5 cm depth).ConclusionsThe MC model for MLC of CyberKnife is clinically acceptable but underestimates the delivered dose by an average of −1.5%. Therefore, we recommend using the MC algorithm with the MLC only in heterogeneous regions and for shallow‐seated tumors.
Long‐term follow‐up in a cohort of children with isolated corpus callosum agenesis at fetal MRI
Authors: Romaniello Romina , Arrigoni Filippo , De Salvo Patrizia , Bonaglia Maria Clara , Panzeri Elena , Bassi Maria Teresa , Parazzini Cecilia , Righini Andrea , Borgatti Renato 
Published: December 2021

AbstractObjectiveThis long‐term retrospective follow‐up study aimed to address the knowledge gap between prenatal diagnosis of complete isolated Agenesis of Corpus Callosum (cACC) at fetal MRI and postnatal neurodevelopmental outcome to improve prenatal counseling for parents.MethodsData on fetuses with isolated cACC from a single‐center MRI database built up in two decades were considered. Detailed postnatal clinical, neuropsychological evaluations were performed and descriptions of available neuroradiological and genetic data were provided.ResultsFollowing a detailed neuropsychological evaluation and a long‐term follow‐up, the subsequent results emerged: 38 school‐aged children (older than 6 years) of 50 (aged 2.5‐15 years) showed normal intellectual functions (50%), intellectual disability (21%), and borderline intelligence quotient (29%). Deficits in motor functions (58%), executive functions (37%), language (61%), memory abilities (58%), and academic performances (53%) were found. Twenty‐one percent of participants showed behavioral difficulties. Almost half of the participants underwent rehabilitation. Additional findings (21%) were detected at postnatal brain MRI, and a significant association between additional findings at postnatal imaging and abnormal neurodevelopmental outcome was observed.InterpretationsThis study supports the view that children with prenatal diagnosis of isolated cACC may present with several degrees of neurologic and neuropsychological impairment which become more evident only in their second decade of life. Postnatal MRI and detailed genetic analysis may add crucial information to prenatal data and substantially influence final judgment on the outcome and orient clinical management and counseling.
Journal Club Review of "What Is the Persistence to Methotrexate in Rheumatoid Arthritis, and Does Machine Learning Outperform Hypothesis‐Based Approaches to Its Prediction?"
Authors: Park Elizabeth 
Published: December 2021

ObjectiveThe objectives of this study were to assess the 1‐year persistence to methotrexate (MTX) initiated as the first ever conventional synthetic disease‐modifying antirheumatic drug in new‐onset rheumatoid arthritis (RA) and to investigate the marginal gains and robustness of the results by increasing the number and nature of covariates and by using data‐driven, instead of hypothesis‐based, methods to predict this persistence.MethodsThrough the Swedish Rheumatology Quality Register, linked to other data sources, we identified a cohort of 5475 patients with new‐onset RA in 2006‐2016 who were starting MTX monotherapy as their first disease‐modifying antirheumatic drug. Data on phenotype at diagnosis and demographics were combined with increasingly detailed data on medical disease history and medication use in four increasingly complex data sets (48‐4162 covariates). We performed manual model building using logistic regression. We also performed five different machine learning (ML) methods and combined the ML results into an ensemble model. We calculated the area under the receiver operating characteristic curve (AUROC) and made calibration plots. We trained on 90% of the data, and tested the models on a holdout data set.ResultsOf the 5475 patients, 3834 (70%) remained on MTX monotherapy 1 year after treatment start. Clinical RA disease activity and baseline characteristics were most strongly associated with the outcome. The best manual model had an AUROC of 0.66 (95% confidence interval [CI] 0.60‐0.71). For the ML methods, Lasso regression performed best (AUROC = 0.67; 95% CI 0.62‐0.71).ConclusionApproximately two thirds of patients with early RA who start MTX remain on this therapy 1 year later. Predicting this persistence remains a challenge, whether using hypothesis‐based or ML models, and may yet require additional types of data.
https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/acr2.11266
Westerlind H, Maciejewski M, Frisell T, Jelinsky SA, Ziemek D, Askling J. What is the persistence to methotrexate in rheumatoid arthritis, and does machine learning outperform hypothesis‐based approaches to its prediction? ACR Open Rheumatol 2021;3:457‐463.