bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of a multifaceted intervention to improve emergency department care of low back pain: a stepped-wedge, cluster-randomised trial
Authors: Coombs Danielle M , Machado Gustavo C , Richards Bethan , Needs Chris , Buchbinder Rachelle , Harris Ian A , Howard Kirsten , McCaffery Kirsten , Billot Laurent , Edwards James , Rogan Eileen , Facer Rochelle , Li Qiang , Maher Christopher G 
Published: March 2021

BackgroundOveruse of lumbar imaging is common in the emergency department (ED). Few trials have examined interventions to address this. We evaluated the effectiveness of a multifaceted intervention to implement guideline recommendations for low back pain in the emergency department.MethodsWe conducted a stepped-wedge, cluster-randomised trial in four EDs in New South Wales, Australia. After a 13-month control phase of usual care, the EDs received a multifaceted intervention to support guideline-endorsed care in a random order, based on a computer-generated random sequence, every 4 weeks over a 4-month period. All sites were followed up for at least 3 months. The primary outcome was the proportion of low back pain presentations receiving lumbar imaging. Secondary healthcare utilisation outcomes included prescriptions of opioid and non-opioid pain medicines, inpatient admissions, length of ED stay, specialist referrals and re-presentations. Clinician beliefs and knowledge about low back pain care were measured before and after the intervention. Patient-reported pain, disability, quality of life and satisfaction were measured at 1, 2 and 4 weeks post ED presentation.ResultsA total of 269 ED clinicians and 4625 episodes of care for low back pain (4491 patients) were included. The data did not provide clear evidence that the intervention reduced lumbar imaging (OR 0.77; 95% CI 0.47 to 1.26; p=0.29). It did reduce opioid use (OR 0.57; 95% CI 0.38 to 0.85; p=0.006) and improved clinicians’ beliefs (mean difference (MD), 2.85; 95% CI 1.85 to 3.85; p<0.001; on a scale from 9 to 45) and knowledge about low back pain care (MD, 0.48; 95% CI 0.13 to 0.83; p<0.01; on a scale from 0 to 11). There was no difference in pain scores at 1-week follow-up (MD, 0.04; 95% CI −1.00 to 1.08; p=0.94; on a scale from 0 to 10). A similar trend was observed for all other patient-reported outcomes and time points. This study found no effect on the other secondary healthcare utilisation outcomes.ConclusionIt is uncertain if a multifaceted intervention to implement guideline recommendations for low back pain care decreased lumbar imaging in the ED; however, it did reduce opioid prescriptions without adversely affecting patient outcomes.Trial registration numberACTRN12617001160325.
Naltrexone for cholestatic itch: a systematic review
Authors: Murray-Brown Fay Louise 
Published: March 2021

BackgroundCholestatic itch is caused by intrahepatic liver diseases, such as primary biliary cirrhosis and extrahepatic obstruction of the biliary tree, often caused by tumours. The pathophysiology of cholestatic itch is complex and no single treatment has proved definitive. Naltrexone is an opioid receptor antagonist, which reduces central opioidergic tone, believed to be raised in patients with cholestatic pruritus.AimTo review and assess the efficacy of oral naltrexone for the treatment of cholestatic itch.MethodsSearch of electronic databases, grey literature, clinical trials registries and handsearching for studies including naltrexone for cholestatic itch. Full papers were obtained if relevant and studies graded.ResultsThirteen papers were included in the analysis, including three randomised controlled trials, one controlled clinical trial, one open-label pilot study, seven case reports and one retrospective notes review. All studies found naltrexone to be effective in relieving pruritus. In all five studies performing statistical analysis, naltrexone significantly reduced pruritus compared with baseline. 37% of patients reported side effects, notably opioid withdrawal-type reactions and recurrence of previous pain, from all pathologies.ConclusionsOral naltrexone therapy helps relieve cholestatic itch and although it should be used with caution in patients using exogenous opioids for analgesia, it should be considered when treating refractory pruritus in patients with end-stage liver disease.
‘Who is going to put their life on the line for a dollar? That’s crazy’: community perspectives of financial compensation in clinical research
Authors: Devlin Amie , Brownstein Kirsten , Goodwin Jennifer , Gibeau Emily , Pardes Mariana , Grunwald Heidi , Fisher Susan 
Published: March 2021

BackgroundFinancial compensation of research participants has been standard practice for centuries, however, there is an ongoing debate among researchers and ethicists regarding the ethical nature of this practice. While these debates develop ethical arguments and theories, they fail to incorporate input from those most affected by financial compensation: potential research participants.MethodsTo identify attitudes surrounding clinical research, participants of a long-standing cohort completed a one-time interview. Open-ended questions stimulated a participant-driven discussion surrounding medical research. Following a grounded theory methodology, 58 semistructured interview transcripts were coded, focusing on attitudes surrounding financial compensation of research participants.ResultsOf the interviews coded, the majority of participants identified as Black/African American (n=44) and were women (n=40). Five major themes emerged. In support of financial compensation, participants felt that study participants should be compensated for time, effort and risk. However, participants were concerned that compensation may differentially impact low-income populations and entice them to hide potentially harmful side effects. Participants also mentioned that financial compensation may invalidate study results if participants knowingly provide false information to subvert inclusion/exclusion criteria.ConclusionThe emergence of both positive and negative themes reiterates the complicated issue of providing financial compensation for study participation. While compensation as a motivator for research participation raises ethical concerns, participants discussed weighing the benefits with the risks in order to make an informed decision. To avoid paternalistic behaviours, research staff must allow potential research participants to review the available information and make the decision that best reflects their wishes.
Reviewing the use and quality of machine learning in developing clinical prediction models for cardiovascular disease
Authors: Allan Simon , Olaiya Raphael , Burhan Rasan 
Published: March 2021

AbstractCardiovascular disease (CVD) is one of the leading causes of death across the world. CVD can lead to angina, heart attacks, heart failure, strokes, and eventually, death; among many other serious conditions. The early intervention with those at a higher risk of developing CVD, typically with statin treatment, leads to better health outcomes. For this reason, clinical prediction models (CPMs) have been developed to identify those at a high risk of developing CVD so that treatment can begin at an earlier stage. Currently, CPMs are built around statistical analysis of factors linked to developing CVD, such as body mass index and family history. The emerging field of machine learning (ML) in healthcare, using computer algorithms that learn from a dataset without explicit programming, has the potential to outperform the CPMs available today. ML has already shown exciting progress in the detection of skin malignancies, bone fractures and many other medical conditions. In this review, we will analyse and explain the CPMs currently in use with comparisons to their developing ML counterparts. We have found that although the newest non-ML CPMs are effective, ML-based approaches consistently outperform them. However, improvements to the literature need to be made before ML should be implemented over current CPMs.
Anchorage capacity of headed bars in steel fiber reinforced concrete
Authors: Sachdeva Payal , Roy A.B.D. , Kwatra Naveen 
Published: March 2021

Headed bars (HB) with different head shapes (Square, Circular, and Rectangular) and bar diameters (db: 16, 20, and 25 mm) embedded in steel fiber reinforced concrete have been subjected to pull-out test. The influence of head shapes, concrete compressive strength (M20 and M40), db, and steel fibers (0, 0.5, 1, and 1.5%) on the anchorage capacity of HB have been evaluated. Numerical model for improving the anchorage capacity of HB has also been proposed. Results have revealed that the anchorage capacity of HB increases with the increase in concrete compressive strength, db, and steel fibers, which have been validated by nonlinear regression analysis using dummy variables. Two failure modes namely, steel and concrete-blowout have been observed and the prevailing mode of failure is steel failure. Based on load–deflection curves and derived descriptive equations, it is observed that the circular HB has displayed the highest peak load.
Study of $$qqq{\bar{q}}Q$$ pentaquark system in the chiral quark model
Authors: Zhang Qi , Hu Xiao-Huang , He Bing-Ran , Ping Jia-Lun 
Published: March 2021

AbstractWith the discovery of some hidden-charm pentaquark resonances by the LHCb Collaboration, investigations of pentaquark states containing heavy quarks have aroused the interest of theorists. We study herein $$qqq{\bar{q}}Q$$

q
q
q

q

¯

Q

($$q = u$$

q
=
u

or d, $$Q=c$$

Q
=
c

or b) pentaquark system, in the framework of the chiral quark model. In consequence, some charmed and bottomed pentaquarks are considered to exist by five-body dynamical calculations. In the charm sector, $$\Sigma _c\pi (IJ^P=0\frac{1}{2}^-)$$

Σ
c

π

(
I

J
P

=
0

1
2

-

)

and $$\Sigma _c^*\pi (IJ^P=0\frac{3}{2}^-)$$

Σ
c
∗

π

(
I

J
P

=
0

3
2

-

)

are possible candidates of $$\Lambda _c(2595)$$

Λ
c

(
2595
)

and $$\Lambda _c(2625)$$

Λ
c

(
2625
)

, respectively. Besides, two high-spin states, $$\Sigma _c^*\rho (IJ^P=0\frac{5}{2}^-)$$

Σ
c
∗

ρ

(
I

J
P

=
0

5
2

-

)

and $$\Delta D^*(IJ^P=1\frac{5}{2}^-)$$

Δ

D
∗

(
I

J
P

=
1

5
2

-

)

, are also found in the energy region of $$3.2 \sim 3.3$$

3.2
∼
3.3

GeV. In the bottom sector, $$\Sigma _b\pi (IJ^P=0\frac{1}{2}^-)$$

Σ
b

π

(
I

J
P

=
0

1
2

-

)

, $$\Sigma _b^*\pi (IJ^P=0\frac{3}{2}^-)$$

Σ
b
∗

π

(
I

J
P

=
0

3
2

-

)

could be candidates of $$\Lambda _b(5912)$$

Λ
b

(
5912
)

and $$\Lambda _b(5920)$$

Λ
b

(
5920
)

, respectively. And $$\Sigma _b^*\rho (IJ^P=0\frac{5}{2}^-)$$

Σ
b
∗

ρ

(
I

J
P

=
0

5
2

-

)

and $$\Delta B^*(IJ^P=1\frac{5}{2}^-)$$

Δ

B
∗

(
I

J
P

=
1

5
2

-

)

are found in the energy region of $$6.5 \sim 6.6$$

6.5
∼
6.6

GeV. $$\Sigma _c^{(*)}\pi $$

Σ
c

(

∗
)

π

and $$\Sigma _b^{(*)}\pi $$

Σ
b

(

∗
)

π

are expected as compact states, while $$\Sigma _c^*\rho $$

Σ
c
∗

ρ

, $$\Sigma _b^*\rho $$

Σ
b
∗

ρ

, $$\Delta D^*$$

Δ

D
∗

and $$\Delta B^*$$

Δ

B
∗

are expected as molecular states.
Mackenzie–Peel Platform and Ellesmerian Foreland Composite Tectono-Sedimentary Element, northwestern Canada
Authors: Fallas Karen M. , MacNaughton Robert B. , Hannigan Peter K. , MacLean Bernard C. 
Published: March 2021

Abstract
The Mackenzie–Peel Platform Tectono-Sedimentary Element (TSE), and the overlying Ellesmerian Foreland TSE, consist of Cambrian–Early Carboniferous shelf and slope sedimentary deposits in Canada's northern Interior Plains. In this chapter, these elements are combined into the Mackenzie–Ellesmerian Composite TSE. The history of the area includes early extensional faulting and subsidence in the Mackenzie Trough, passive-margin deposition across the Mackenzie–Peel Platform, local uplift and erosion along the Keele Arch, subsidence and deposition in the Ellesmerian Foreland, possible minor folding during the Ellesmerian Orogeny, and folding and faulting in Cretaceous–Eocene time associated with the development of the Canadian Cordillera. Recorded petroleum discoveries are within Cambrian sandstone (Mount Clark Formation), Devonian carbonate strata (Ramparts and Fort Norman formations) and Devonian shale (Canol Formation). Additional oil and gas shows are documented from Cambrian–Silurian carbonate units (Franklin Mountain and Mount Kindle formations), Devonian carbonate units (Arnica, Landry and Bear Rock formations) and Late Devonian–Early Carboniferous siliciclastic units (Imperial and Tuttle formations). Petroleum exploration activity within the area has occurred in several phases since 1920, most of it associated with the one producing oilfield at Norman Wells.
Type I IFN Activating Type I Dendritic Cells for Antitumor Immunity
Authors: Liang Yong , Hannan Raquibul , Fu Yang-Xin 
Published: March 2021

Abstract
Immune checkpoint inhibitors are successful immunotherapy modalities that enhance CD8+ T-cell responses. Although T cells are initially primed in draining lymph nodes, the mechanisms that underlie their reactivation inside the tumor microenvironment are less clear. Recent studies have found that not only is the cross-priming of conventional type 1 dendritic cells (cDC1) required to initiate CD8+ T-cell responses during tumor progression, but it also plays a central role in immunotherapy-mediated reactivation of tumor-specific CD8+ T cells for tumor regression. Moreover, many cancer treatment modalities trigger type I IFN responses, which play critical roles in boosting cDC1 cross-priming and CD8+ T-cell reactivation. Inducing type I IFNs within tumors can overcome innate immune resistance and activate antitumor adaptive immunity. Here, we review recent studies on how type I IFN-cDC1 cross-priming reactivates CD8+ T cells and contributes to tumor control by cancer immunotherapy.
Avadomide Induces Degradation of ZMYM2 Fusion Oncoproteins in Hematologic Malignancies
Authors: Renneville Aline , Gasser Jessica A. , Grinshpun Daniel E. , Jean Beltran Pierre M. , Udeshi Namrata D. , Matyskiela Mary E. , Clayton Thomas , McConkey Marie , Viswanathan Kaushik , Tepper Alexander , Guirguis Andrew A. , Sellar Rob S. , Cotteret Sophie , Marzac Christophe , Saada Véronique , De Botton Stéphane , Kiladjian Jean-Jacques , Cayuela Jean-Michel , Rolfe Mark , Chamberlain Philip P. , Carr Steven A. , Ebert Benjamin L. 
Published: March 2021

Abstract

Thalidomide analogues exert their therapeutic effects by binding to the CRL4CRBN E3 ubiquitin ligase, promoting ubiquitination and subsequent proteasomal degradation of specific protein substrates. Drug-induced degradation of IKZF1 and IKZF3 in B-cell malignancies demonstrates the clinical utility of targeting disease-relevant transcription factors for degradation. Here, we found that avadomide (CC-122) induces CRBN-dependent ubiquitination and proteasomal degradation of ZMYM2 (ZNF198), a transcription factor involved in balanced chromosomal rearrangements with FGFR1 and FLT3 in aggressive forms of hematologic malignancies. The minimal drug-responsive element of ZMYM2 is a zinc-chelating MYM domain and is contained in the N-terminal portion of ZMYM2 that is universally included in the derived fusion proteins. We demonstrate that avadomide has the ability to induce proteasomal degradation of ZMYM2–FGFR1 and ZMYM2–FLT3 chimeric oncoproteins, both in vitro and in vivo. Our findings suggest that patients with hematologic malignancies harboring these ZMYM2 fusion proteins may benefit from avadomide treatment.

Significance:
We extend the potential clinical scope of thalidomide analogues by the identification of a novel avadomide-dependent CRL4CRBN substrate, ZMYM2. Avadomide induces ubiquitination and degradation of ZMYM2–FGFR1 and ZMYM2–FLT3, two chimeric oncoproteins involved in hematologic malignancies, providing a proof of concept for drug-induced degradation of transcription factor fusion proteins by thalidomide analogues.
ДОСВІД ВЕДЕННЯ ПОСТЕМБОЛІЗАЦІЙНОГО СИНДРОМУ У ПАЦІЄНТОК ІЗ МІОМОЮ МАТКИ
Authors: Plaksiieva K. D. 
Published: March 2021

Мета дослідження – оптимізувати ведення післяопераційного періоду у пацієнток із міомою матки після емболізації маткових артерій (ЕМА).
Матеріали та методи. Проаналізовано клінічну документацію 32 пацієнток із міомою матки, які зазнали ЕМА в одній із приватних клінік Києва та перебували під нашим спостереженням у післяопераційному періоді. Середній вік пацієнток склав (39,75±2,19) року. Знеболювання відбувалось за вибором пацієнтки: 28,125 % (n=9) пацієнток обрали епідуральну анестезію (ЕДА), 21,875 % (n=7) – внутрішньовенну седацію та у 50 % (n=16) ЕМА виконували під внутрішньовенним наркозом зі спонтанним диханням. Усі пацієнтки у стаціонарі в післяопераційному періоді з метою знеболювання отримували тримеперидин, парацетамол, декскетопрофен, для антибактеріальної терапії призначали метронідазол та цефуроксим. Для амбулаторного лікування усім пацієнткам призначали таблетовані метронідазол та цефуроксим, тривалість приймання складала 10 днів. Із метою знеболювання пацієнткам пропонували ректальні супозиторії з диклофенаком або таблетований лорноксикам чи ібупрофен, залежно від проявів больового синдрому. Для профілактики висхідної інфекції пацієнтки отримували вагінальні супозиторії з Lactobacillus acidophilus 2 рази на тиждень протягом 1 місяця.
Результати дослідження та їх обговорення. Після ЕМА середній показник болю за числовою рейтинговою шкалою болю (від 1 до 10) на 2-гу добу після ЕМА склав (4,06±0,59) бала. Середня тривалість госпіталізації після ЕМА склала (2,5±0,25) дня, а 28,12 % (n=9) пацієнток вимушені були провести вдома до 3 додаткових днів з метою реабілітації.
Висновки. ЕМА має гарні показники переносимості та короткі терміни реабілітації. Тривалість госпіталізації та реабілітації після ЕМА співмірна з такою при лапароскопічній операції. Задовільний рівень больового синдрому досягається проведенням ЕМА під загальним внутрішньовенним наркозом або епідуральною анестезією, а амбулаторна антибіотикотерапія (до 10 днів), протизапальна терапія з використанням вагінальних та пероральних пробіотичних препаратів забезпечують профілактику септичних ускладнень після ЕМА та адекватне знеболювання.
ОСОБЛИВОСТІ КЛІНІЧНОГО ПЕРЕБІГУ ПЕРЕДРАКУ І РАКУ ВУЛЬВИ У ЖІНОК ПРЕ- І ПОСТМЕНОПАУЗАЛЬНОГО ВІКУ
Authors: Tatarchuk T. F. , Dunaievska V. V. , Zakharenko N. F. 
Published: March 2021

Мета дослідження – вивчити особливості клінічного перебігу передраку і раку вульви у жінок пре- і постменопаузального віку.
Матеріали та методи. Із 2017 до 2020 рр. у поліклінічному відділенні Національного інституту раку обстежено 160 хворих із дистрофічними захворюваннями, передраком і початковим раком вульви. Аналіз амбулаторних карт та історій хвороб усіх жінок дозволив нам додатково вивчити особливості клінічного перебігу патологічних процесів зовнішніх статевих органів залежно від віку. Вік хворих у дослідженні коливався від 49 до 70 років, у середньому (59,6±3,5) року. Менструальна функція була не змінена у 40 (25 %) зі 160 жінок. Вік менархе варіював від 11 до 18 років (середній вік – (14,5±0,3) року). Середня тривалість менструального циклу склала (30±0,4) дня. Більшість пацієнток неодноразово зверталася до гінекологів і дерматологів із приводу свербежу та дискомфорту в ділянці зовнішніх статевих органів. Лікар проводив консервативне лікування «лейкоплакії і краурозу» впродовж багатьох місяців, а іноді й років, без гістологічного уточнення діагнозу.
Результати дослідження та їх обговорення. При дослідженні біоптатів вульви переважали хворі із діагнозом раку вульви I А стадії (34 %) порівняно з VIN (інтраепітеліальною неоплазією вульви) (12 %). При цьому VIN і початковий рак вульви були асоційовані з вірусом папіломи людини лише в 37,5 % випадків.
Висновок. Однією з особливостей клінічного перебігу неоплазій вульви у жінок пре- і постменопаузального віку є те, що злоякісний процес частіше виявляється на стадії монофокальної інвазивної пухлини.
ANTERIOR PLACENTA POSITION AS A CAUSING FACTOR OF PRE-ECLAMPSIA
Authors: Berlinska L. I. , Marichereda V. G. , Pavlovska O. M. , Petrovskiy Y. Y. 
Published: March 2021

The aim of the study – to determine the frequency of preeclampsia in pregnant females with anterior location of the placenta and to determine the prognostic significance when combined with a marker of acute renal damage – cystatin C level.
Materials and Methods. In 2018–2020, a prospective cohort study that enrolled 91 pregnant women at their second trimester of gestation was conducted at Maternity Clinic and Obstetric Hospital of Maternity Hospital No. 2, Odesa. The group with the anterior location of the placenta consisted of 47 (51.65 %) pregnant women and 44 (48.35 %) had the posterior location of the placenta. Assessment of serum cystatin C was performed in women without clinical manifestations of PE at the second or third trimester of gestation (18–36 weeks), the average term was (32.22±0.41) weeks of pregnancy (p=0.011).
Results and Discussion. 28.57 % of pregnant women were subsequently diagnosed with preeclampsia (PE), of whom 19 (20.88 %) had anterior and 7 (7.69 %) posterior placenta location. Body mass index (BMI) before pregnancy, age, and height: no statistically significant difference observed between groups (p> 0.05). Analysis of maternal factors of PE in relation to the anterior location of the placenta: odds ratio (OR) higher than 1.0 was noted for combination with obesity (OR 2.38 (95 % CI 0.75–7.53)), the age over 35 years (OR 1.01 (95 % CI 0.41–2.49)) and history of PE during previous pregnancy (OR 1.38 (95 % CI 0.21–9.01)), but no statistical significance was observed (р˃0.05). When analyzing cystatin C values over 1.0 mmol/l relative to the anterior location of the placenta, the OR was 3.92 (95 % CI 1.45–10.57), sensitivity 84.09 %, specificity 42.55 %, accuracy 62.64 % were reported, p=0.011. When analyzing the frequency of preeclampsia in the anterior location of the placenta, the OR was 3.59 (95 % CI 1.32 - 9.71), sensitivity 84.09 %, specificity 40.43 %, accuracy 61.54 % were reported with statistical significance p=0.019.
Conclusions. The risk of preeclampsia in patients with the anterior location of the placenta increases by 3.59 times with a prognostic accuracy of 61.54 %. To increase the prognostic significance for the detection of preeclampsia in women with anterior location of the placenta, it is recommended to assess the serum level of cystatin C.