bluuebunny/crossref_metadata_2025_split huggingface dataset:
A defense of conscientious objection: Why health is integral to the permissibility of medical refusals
Authors: Kulesa Ryan 
Published: October 2021

AbstractSchuklenk, Smalling, and Savulescu put forth four conditions that delineate when conscientious objection is impermissible. Roughly, they argue for the following claim: if some practice is legal, standard, expected of a profession, and in the patient's interest, then medical professionals cannot refuse to perform the practice. In this essay, I argue that these conditions are not jointly sufficient to deny medical professionals the ability to refuse to perform procedures that detract from a patient's health. They are insufficient to bar medical refusals to perform certain practices because, even when these conditions are met, non‐health conducive practices would not be open to refusal by the physician. I provide an example of a non‐health conducive practice female genital mutilation, which meets all of the proposed conditions but, intuitively, should be open to medical refusals. As a result, I conclude that the proposed conditions are insufficient to determine when conscientious objection is impermissible. I then offer an amendment to their position by suggesting that a practice, in addition to the other four conditions, must also be health conducive in order to remove the medical professional's ability to refuse to perform the practice.
The clinical landscape of chronic graft‐versus‐host disease management in 2021
Authors: Holtzman Noa G. , Pavletic Steven Z. 
Published: October 2021

SummaryChronic graft‐versus‐host disease (cGVHD) is an important systemic complication of allogeneic haematopoietic stem cell transplantation with heterogeneous, multi‐organ involvement that can lead to increased morbidity and mortality. Despite significant advances in understanding the complex pathophysiology driving the disease, curative treatment options remain suboptimal. The past decade, however, has seen much growth in collaborative research efforts and standardization of criteria for clinical trials that have led to discovery of several new second‐line therapies in cGVHD. The key to successful cGVHD control and management includes a comprehensive and sustained multidisciplinary effort with emphasis on ancillary and supportive care for these patients. The focus of this review is to summarize the new developments in systemic, organ‐specific, and topical treatments in the management of cGVHD that emerged since the 2014 NIH consensus conference.
Extraction, chemical modification, and antioxidant activities of Daucus carota polysaccharide
Authors: Qi Kang , Xia Guangda , Huang Gangliang , Huang Hualiang 
Published: October 2021

AbstractThe Daucus carota polysaccharides were extracted by hot water extraction and alcohol precipitation, and the phosphorylated and carboxymethylated derivatives were prepared. Their structures were characterized by FT‐IR, NMR, and SEM. The antioxidant activities of Daucus carota polysaccharide were enhanced by phosphorylation. However, carboxymethylated Daucus carota polysaccharide was not as good as unmodified one.
Transrectal natural orifice specimen extraction in left hemicolectomy for tumours around the splenic flexure: Old wine in new bottles
Authors: Jong Bor‐Kang , Cheng Ching‐Chung , Hsu Yu‐Jen , Chern Yih‐Jong , Tsai Wen‐Sy , Hung Hsin‐Yuan , Liao Chun‐Kai , Yeh Chien‐Yu , Hsieh Pao‐Shiu , You Jeng‐Fu 
Published: October 2021

AbstractAimLaparoscopic anterior resection with natural orifice specimen extraction (NOSE) has favourable short‐term outcomes. However, NOSE is rarely adopted for left hemicolectomy procedures. This study aimed to review the feasibility, safety and short‐term outcomes of transrectal NOSE in patients undergoing laparoscopic left hemicolectomy.MethodAll consecutive patients who underwent laparoscopic left hemicolectomy surgery with transrectal NOSE in a single institution between January 2018 and December 2020 were reviewed. Transrectal NOSE was performed with an enterotomy at the upper rectum. The specimen was brought out via a transanal endoscopic microsurgery scope inserted through the anus. A supplementary video demonstrates this technique. Surgical outcomes, including complications, postoperative short‐term recovery and the level of pain intensity, are presented.ResultsTwenty patients were reviewed. There were no immediate postoperative complications and no wound infections in these patients. The average time to tolerate a soft diet was 3.6 days, and the average postoperative hospital stay was 4.5 days. The average score on the numerical rating scale of postoperative pain was 3.0 on postoperative day 1. The median follow‐up time was 23.5 months.ConclusionLaparoscopic left hemicolectomy with transrectal NOSE is a safe and feasible procedure that leads to early postoperative recovery and a short hospital stay.
Prenatal care: Mechanisms and impacts on infant health and health care utilization
Authors: Bersak Tim , Sonchak‐Ardan Lyudmyla 
Published: October 2021

AbstractWe estimate that prenatal care has positive impacts on health measured at birth, shifts the distribution of future health care utilization away from inpatient care, and find that some of these impacts likely come from an informational mechanism. We also find well child visits are used in a complementary fashion with emergency department care in the production of infant health, suggesting that factors beyond barriers to access may drive the demand for emergency care. Finally, we find differential impacts of prenatal care across racial groups with evidence that the information mechanism may be particularly important for black mothers.
Aptamer‐conjugated mesoporous polydopamine for docetaxel targeted delivery and synergistic photothermal therapy of prostate cancer
Authors: Dai Liang , Wei Dapeng , Zhang Jidong , Shen Tianyu , Zhao Yuming , Liang Junqiang , Ma Wangteng , Zhang Limin , Liu Qingli , Zheng Yue 
Published: October 2021

AbstractObjectivesIt is imperative to develop efficient strategies on the treatment of prostate cancer. Here, we constructed multifunctional nanoparticles, namely AS1411@MPDA‐DTX (AMD) for targeted and synergistic chemotherapy/photothermal therapy of prostate cancer.Materials and MethodsMesoporous polydopamine (MPDA) nanoparticles were prepared by a one‐pot synthesis method, DTX was loaded through incubation, and AS1411 aptamer was modified onto MPDA by the covalent reaction. The prepared nanoparticles were characterized by ultra‐micro spectrophotometer, Fourier transform infrared spectra, transmission electron microscope, and so on. The targeting ability was detected by selective uptake and cell killing. The mechanism of AMD‐mediated synergistic therapy was detected by Western blot and immunofluorescence.ResultsThe prepared nanoparticles can be easily synthesized and possessed excellent water solubility, stability, and controlled drug release ability, preferentially in acidic context. Based on in vitro and in vivo results, the nanoparticles can efficiently target prostate cancer cells, promote DTX internalization, and enhance the antitumor effects of chemo‐photothermal therapy strategies under the NIR laser irradiation.ConclusionsAs a multifunctional nanoplatform, AS1411@MPDA‐DTX could efficiently target prostate cancer cells, promote DTX internalization, and synergistically enhance the antiprostate cancer efficiency by combining with NIR irradiation.
Understanding landowner decisions regarding access to private land for conservation research
Authors: O'Brien Rebecca S. M. , Dayer Ashley A. , Hopkins William A. 
Published: October 2021

AbstractPrivate land comprises over half the land mass of the United States—dominating certain ecosystems and hosting large numbers of threatened and endangered species. Understanding privately owned properties is thus critically important to conservation, yet these lands remain understudied by conservation biologists. A key factor in this lack of research is the difficulty of gaining permission to access private lands. However, there has been almost no empirical work to offer guidance for natural scientists on this issue. Using a combination of mail surveys and interviews, we undertook one of the first empirical studies of landowner decisions regarding access to their private property for research, and we identified the primary drivers and deterrents. We found that natural scientists may have more success gaining access if the landowners are interested in learning about the research taking place, if they have previously allowed research on their property, if they have positive attitudes toward conservation, and if they have larger properties. We also found that many landowners allowed research out of a desire to be helpful. Conversely, landowners are less likely to allow research if they are concerned that doing so will restrict free use of their property. Landowner age, education, trust in science, and attitude toward the subject of study were not significant predictors of landowner decisions. By considering our findings when requesting access to properties and engaging with landowners during research, scientists can improve their chances of accessing properties, enhance landowner satisfaction with the experience, and increase the likelihood that landowners will be amenable to future requests to conduct research on their land.
Evolution of electroencephalogram in infants with tuberous sclerosis complex and neurodevelopmental outcome: a prospective cohort study
Authors: De Ridder Jessie , Kotulska Katarzyna , Curatolo Paolo , Jansen Anna C , Aronica Eleonora , Kwiatkowski David J , Jansen Floor E , Jóźwiak Sergiusz , Lagae Lieven ,   the Epistop Consortium
Published: October 2021

AimTo describe the evolution of electroencephalogram (EEG) characteristics in infants with tuberous sclerosis complex (TSC) and the relationship with neurodevelopmental outcome at 24 months.MethodEighty‐three infants were enrolled in the EPISTOP trial and underwent serial EEG follow‐up until the age of 24 months (males n=45, females n=37, median age at enrolment 28d, interquartile range 14–54d). Maturation of the EEG background and epileptiform discharges were compared between the TSC1 and TSC2 variants and between preventive and conventional groups respectively.ResultsChildren with TSC2 more frequently had a slower posterior dominant rhythm (PDR) at 24 months (51% vs 11%, p=0.002), a higher number of epileptiform foci (median=8 vs 4, p=0.003), and a lower fraction of EEGs without epileptiform discharges (18% vs 61%, p=0.001) at follow‐up. A slower PDR at 24 months was significantly associated with lower cognitive (median=70 vs 80, p=0.028) and motor developmental quotients (median=70 vs 79, p=0.008). A higher fraction of EEGs without epileptiform discharges was associated with a lower probability of autism spectrum disorder symptoms (odds ratio=0.092, 95% confidence interval=0.009–0.912, p=0.042) and higher cognitive (p=0.004), language (p=0.002), and motor (p=0.001) developmental quotients at 24 months.InterpretationTSC2 is associated with more abnormal EEG characteristics compared to TSC1, which are predictive for neurodevelopmental outcome.
Isolated bulbar palsy and dysphagia in children with respiratory symptoms
Authors: Zimmels Stacey , Balfour‐Lynn Ian M , Christodoulou Loucas , Pantazi Mantha , Pavlidou Efterpi , Pitt Matthew , Kinali Maria , Ismayilova Naila 
Published: October 2021

AbstractOropharyngeal dysphagia can cause chronic aspiration leading to significant respiratory symptoms. When dysphagia is diagnosed, an underlying cause is sought. We present a case series of 15 children diagnosed aged 6 months to 5 years (mean 2y 5mo; 11 males, four females) over a 6‐year period, who were found to have an isolated bulbar palsy on genioglossus electromyography, with no accompanying neurological or neurodevelopmental disorder. Eight children had dysphagia but a normal EMG. In those with isolated bulbar palsy, management included thickened fluids (n=13), cooled boiled water (n=1), and nasogastric tube feeding (n=1). Follow‐up over 1 to 8 years (mean 5y) showed complete resolution in six children, improvement in four children, and no improvement in five children (including two requiring fluids via a gastrostomy). Eight children no longer had any respiratory symptoms. Isolated bulbar palsy is under‐recognized and has not been reported previously as a cause of significant dysphagia in children.
Protective effect of SARS‐CoV‐2 preventive measures against ESKAPE and Escherichia coli infections
Authors: Gaspari Rita , Spinazzola Giorgia , Teofili Luciana , Avolio Alfonso W. , Fiori Barbara , Maresca Gian M , Spanu Teresa , Nicolotti Nicola , De Pascale Gennaro , Antonelli Massimo 
Published: October 2021

AbstractBackground/ObjectivesWe investigated whether behavioral precautions adopted during Coronavirus disease (COVID‐19) pandemic also influenced the spreading and multidrug resistance (MDR) of ESKAPEEc (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii [AB], Pseudomonas aeruginosa, Enterobacter spp and Escherichia Coli, [EC]) among Intensive Care Unit (ICU) patients.Subjects/MethodsWe performed a single‐center retrospective study in adult patients admitted to our COVID‐19‐free surgical ICU. Only patients staying in ICU for more than 48 hours were included. The ESKAPEEc infections recorded during the COVID‐19 period (June 1, 2020 ‐ February 28, 2021) and in the corresponding pre‐pandemic period (June 1, 2019 ‐ February 28, 2020) were compared. An interrupted time series analysis was performed to rule out possible confounders.ResultsOverall, 173 patients in the COVID‐19 period and 132 in the pre‐COVID‐19 period were investigated. The ESKAPEEc infections were documented in 23 (13.3%) and 35 (26.5%) patients in the pandemic and the pre‐pandemic periods, respectively (p = 0.005). Demographics, diagnosis, comorbidities, type of surgery, Simplified Acute Physiology Score II, length of mechanical ventilation, hospital and ICU length of stay, ICU death rate, and 28‐day hospital mortality were similar in the two groups. In comparison with the pre‐pandemic period, no AB was recorded during COVID‐19 period, (p = 0.017), while extended‐spectrum beta‐lactamase‐producing EC infections significantly decreased (p = 0.017). Overall, the ESKAPEEc isolates during pandemic less frequently exhibited multidrug‐resistant (p = 0.014).ConclusionsThese findings suggest that a robust adherence to hygiene measures together with human contact restrictions in a COVID‐19 free ICU might also restrain the transmission of ESKAPEEc pathogens.
End of treatment FDG‐PET in primary mediastinal B‐cell lymphoma treated with R‐chemotherapy: Prognostic indicator and implications for consolidation radiotherapy
Authors: Freitas Ana Carolina , Carvalho Inês Patrocínio , Esteves Susana , Salgado Lucília , Gomes da Silva Maria 
Published: October 2021

AbstractThe ideal therapeutic regimen in primary mediastinal B‐cell lymphoma (PMBCL) is controversial and may include consolidation radiotherapy (RT). An adequate strategy is essential in a population where long‐term effects of RT are significant. We evaluated the prognostic value of end‐of‐treatment (EOT) FDG‐PET in 50 patients receiving rituximab and anthracycline‐containing chemotherapy and its implications for consolidative RT. Thirty patients (60%) obtained complete metabolic response (CMR), five received consolidation RT. The remaining patients had partial response (14) and progression (6). Of these, 12 received mediastinal RT, six salvage chemotherapy, and two no further treatment. Five‐year progression free survival was 100% and 48% (95% CI 30%‐77%) in patients with negative and positive EOT FDG‐PET, respectively (P < .001). Five‐year overall survival for negative and positive EOT FDG‐PET was 100% and 67% (95% CI 48%‐93%) respectively (P = .001). Within positive EOT FDG‐PET cases, an association was found between Deauville score and survival. The negative predictive value (NPV) of EOT FDG‐PET for disease relapse/progression was 100% (95% CI 0.88‐1.00); the positive predictive value was 47% (95% CI 0.24‐0.71). This study demonstrates the importance of metabolic assessment in PMBCL and is relevant for its high NPV. Our data favor the use of EOT FDG‐PET for decisions concerning RT.
Intravenous ibuprofen for acute treatment of migraine: A double‐blind, randomized, placebo‐controlled pilot study
Authors: Yuan Hsiangkuo , Curran John G. , Keith Scott W. , Hopkins Mary M. , Silberstein Stephen D. 
Published: October 2021

AbstractObjectiveTo evaluate the efficacy and safety of intravenous (IV) Ibuprofen for acute treatment of migraine.BackgroundIV nonsteroidal anti‐inflammatory drugs (NSAIDs) are an alternative to oral NSAIDs, especially in patients with severe migraine who have emesis or gastroparesis. To date, only three IV NSAIDs (ketorolac, ibuprofen, and meloxicam) are available in the United States for use in moderate and severe pain, but no placebo‐controlled trial is available for migraine. We performed a single‐center, double‐blind, randomized, placebo‐controlled pilot study to evaluate the efficacy and safety of IV ibuprofen as an acute treatment of migraine (NCT01230411).MethodsIndividuals with episodic migraine were screened at the Jefferson Headache Center. Qualified subjects were treated for migraine attacks within 2–72 h following the headache onset with either 800 mg of IV ibuprofen or placebo in 250 ml saline bolus. Migraine pain intensity (4‐point Likert scale) and associated symptoms were assessed at predetermined time points (0.25, 0.5, 1, 1.5, 2, 4, 8, 24 h). The primary endpoint was pain relief at 2 h after infusion. Important secondary endpoints included pain freedom at 2 h, sustained relief over 24 h, use of rescue therapy, and absence of associated symptoms. Adverse events (AEs) were also collected.ResultsSeventy‐four participants were enrolled between 2011 and 2017. Forty‐four subjects (female 33/44; 75.0%) with mean (SD) age 41.0 (11.2) 11.2 years came for the treatment. All treated subjects (n = 44) were included in the analysis. Among them, 23 were randomized to receive IV ibuprofen. Both groups were demographically similar except for longer migraine duration (i.e., years lived with disease) in the active treatment than in the placebo group. At 2 h posttreatment, pain relief was found in 74% (17/23) and 48% (10/21) after IV ibuprofen and placebo, respectively (odds ratio [OR] 3.12, 95% CI: 0.88–11.0;p = 0.078). Other secondary endpoints at 2 and 24 h were not significant. The longitudinal repeated‐measures analysis within 2 h on ibuprofen treatment showed significant pain relief (OR 2.47, 95% CI 1.08–5.7;p = 0.033) and absence of associated symptoms: photophobia (OR 4.0, 95% CI 1.57–10.3;p = 0.004), phonophobia (OR 3.12, 95% CI 1.16–8.4;p = 0.025), and osmophobia (OR 3.45, 95% CI 1.01–11.8;p = 0.048). AEs were observed in seven subjects in both groups, with arm pain being the most common. No serious AE was reported.ConclusionThis study did not meet the primary endpoint but showed pain relief and elimination of several associated symptoms within 2 h on repeated‐measures analysis. Although limited by small sample size and high placebo response, our results indicate that IV ibuprofen may be a safe and effective option for acute treatment of migraine, but more extensive studies are necessary.
Interobserver agreement in the diagnosis of anal dysplasia: comparison between gastrointestinal and gynaecological pathologists and utility of consensus conferences
Authors: Abu‐Farsakh Sohaib , Drage Michael G , Huber Aaron R , Turner Bradley M , Varghese Sharlin , Wang Xi , Whitney‐Miller Christa L , Gonzalez Raul S 
Published: October 2021

AimsManagement of anal dysplasia relies upon the accurate diagnosis of anal biopsy specimens. As institutions move towards subspecialty signout (SSSO), decisions must be made regarding whether to assign anal biopsies to the gastrointestinal (GI) or gynaecological (GYN) pathology service.Materials and resultsWe identified 200 archival tissue biopsies of anal mucosa and circulated them among three GI pathologists and three GYN pathologists. Each pathologist separately scored each biopsy as normal, atypical, low‐grade squamous intra‐epithelial lesion (LSIL) or high‐grade squamous intra‐epithelial lesion (HSIL). Every case that was called HSIL by at least one pathologist was stained with p16 immunostain and a ‘gold standard’ interpretation of whether or not a case represented HSIL was made. The GI pathologists agreed on 97 (49%) cases prior to consensus; the GYN pathologists agreed on 33 (17%). The sensitivities of the three GI pathologists in detecting HSIL against the ‘gold standard’ were 47, 100 and 21% and for the GYN pathologists the sensitivities were 74, 89 and 84%; the sensitivities of the GI and GYN consensus diagnoses were 74% each. The specificities of the three GI pathologists in detecting HSIL were 99, 90 and 100% and for the GYN pathologists the specificities were 99, 92 and 91%; the specificities of both the GI and GYN consensus diagnoses were 100%.ConclusionsA mild to moderate degree of interobserver variability exists in the diagnosis of anal dysplasia among pathologists. Our study indicates the utility of some form of consensus conference, as overall agreement among GI pathologists and among GYN pathologists improved following in‐person consensus.
Impact of network topology on the thermal and mechanical properties of lithium germanate glasses
Authors: Sørensen Søren S. , To Theany , Christensen Johan F. S. , Johra Hicham , Smedskjaer Morten M. 
Published: October 2021

AbstractIn this work, we study the structure–topology–property relations of a series of melt‐quenched lithium germanate glasses. These glasses exhibit the so‐called germanate anomaly, that is, the germanium atoms feature a distribution of four‐coordinated and higher coordinated germanium species, manifesting itself as anomalies in several material properties. Here, we couple variations in the number of atomic bond constraints with measured variations in thermal and mechanical properties, including thermal conductivity, Vickers hardness, and fracture toughness. For thermal conductivity, a strong correlation is found with sound velocity as well as with the volumetric constraint density. For hardness, a good correlation with volumetric constraint density is found, whereas, for fracture toughness, variations in network topology alone are insufficient to explain the composition–property relation. To account for this, we apply a recent model which incorporates knowledge of local structure, mechanical properties, and fracture patterns to predict the fracture toughness, showing a good qualitative agreement with the experimental data.
Mixed‐signal stock splits
Authors: Elnahas Ahmed M. , Jain Pankaj K. , McInish Thomas H. 
Published: October 2021

AbstractWe investigate CEOs who combine insider selling with stock splits, which is suspicious, because dumping stocks is inconsistent with the positive stock‐split signal. Our empirical results indicate that, compared with other splits, these mixed‐signal splits perform poorly and are followed by much lower buy‐and‐hold abnormal returns and much higher likelihoods of announcing an earnings restatement and CEO turnover in the post‐split period. Our results are robust to entropy balancing and controlling for CEO characteristics, incentives, and corporate governance and highlight previously ignored agency issues around stock splits. Attention to insider trades is essential to properly interpret a stock‐split signal.