bluuebunny/crossref_metadata_2025_split huggingface dataset:
Point-of-Care Lung Ultrasound Pattern in Healthy Parturients: Prevalence of Pulmonary Interstitial Syndrome Following Vaginal Delivery, Elective and Unplanned Intrapartum Cesarean Delivery
Authors: Macias Paul , Wilson Jennifer G. , Austin Naola S. , Guo Nan , Carvalho Brendan , Ortner Clemens M. 
Published: March 2021

BACKGROUND:
Pregnancy-related cardiovascular physiologic changes increase the likelihood of pulmonary edema, with the risk of fluid extravasating into the pulmonary interstitium being potentially at a maximum during the early postpartum period. Data on the impact of labor and peripartum hemodynamic strain on lung ultrasound (LUS) are limited, and the prevalence of subclinical pulmonary interstitial syndrome in peripartum women is poorly described. The primary aim of this exploratory study was to estimate the prevalence of pulmonary interstitial syndrome in healthy term parturients undergoing vaginal (VD), elective (eCD), and unplanned intrapartum cesarean deliveries (uCD). Secondary aims were to estimate the prevalence of positive lung regions (≥3 B-lines on LUS per region) and to assess the associations between positive lung regions and possible contributing factors.

METHODS:
In this prospective observational cohort study, healthy women at term undergoing VD, eCD, or uCD were enrolled. Following international consensus recommendations, a LUS examination was performed within 4 hours after delivery applying an 8-region technique. Pulmonary interstitial syndrome was defined by the presence of 2 or more positive lung regions per hemithorax. Ultrasound studies were reviewed by 2 blinded reviewers and assessed for interobserver reliability.

RESULTS:
Seventy-five women were assessed (n = 25 per group). No pulmonary interstitial syndrome was found in the VD and eCD groups (each 0 of 25; 0%, 95% confidence interval [CI], 0-13.7). Pulmonary interstitial syndrome was found in 2 of 25 (8%, 95% CI, 1-26) women undergoing an uCD (P = .490 for VD versus uCD and P = .490 for eCD versus uCD). In 1 woman, this correlated clinically with the development of pulmonary edema. One or more positive lung regions were present in 5 of 25 (20%), 6 of 25 (24%), and 11 of 25 (44%) parturients following VD, eCD, and uCD, respectively (P = .136). Positive lung regions were predominantly found in lateral lung regions. The number of positive lung regions showed a weak correlation with patient age (r = 0.25, 95% CI, 0.05-0.47; P = .033). No significant association was found between LUS pattern and parity, duration of labor, labor augmentation, labor induction, estimated total intravenous fluid intake, or net intravenous fluid intake.

CONCLUSIONS:
Although many focal areas of increased extravascular lung water (20%–44% prevalence) can be identified on LUS, the overall prevalence of pulmonary interstitial syndrome was 2.7% (2 of 75; 95% CI, 0.3-9.3) among healthy term parturients soon after delivery. Focal areas of positive lung water regions were weakly correlated with maternal age.
Midazolam Premedication Immediately Before Surgery Is Not Associated With Early Postoperative Delirium
Authors: Wang Man-Ling , Min Jie , Sands Laura P. , Leung Jacqueline M. ,   the Perioperative Medicine Research Group
Published: March 2021

BACKGROUND:
Postoperative delirium is common among older surgical patients and may be associated with anesthetic management during the perioperative period. The aim of this study is to assess whether intravenous midazolam, a short-acting benzodiazepine used frequently as premedication, increased the incidence of postoperative delirium.

METHODS:
Analyses of existing data were conducted using a database created from 3 prospective studies in patients aged 65 years or older who underwent elective major noncardiac surgery. Postoperative delirium occurring on the first postoperative day was measured using the confusion assessment method. We assessed the association between the use or nonuse of premedication with midazolam and postoperative delirium using a χ2 test, using propensity scores to match up with 3 midazolam patients for each control patient who did not receive midazolam.

RESULTS:
A total of 1266 patients were included in this study. Intravenous midazolam was administered as premedication in 909 patients (72%), and 357 patients did not receive midazolam. Those who did and did not receive midazolam significantly differed in age, Charlson comorbidity scores, preoperative cognitive status, preoperative use of benzodiazepines, type of surgery, and year of surgery. Propensity score matching for these variables and American Society of Anesthesiology physical status scores resulted in propensity score–matched samples with 1–3 patients who used midazolam (N = 749) for each patient who did not receive midazolam (N = 357). After propensity score matching, all standardized differences in preoperative patient characteristics ranged from –0.07 to 0.06, indicating good balance on baseline variables between the 2 exposure groups. No association was found between premedication with midazolam and incident delirium on the morning of the first postoperative day in the matched dataset, with odds ratio (95% confidence interval) of 0.91 (0.65-1.29), P = .67.

CONCLUSIONS:
Premedication using midazolam was not associated with higher incidence of delirium on the first postoperative day in older patients undergoing major noncardiac surgery.
Association Between Cerebral Desaturation and Postoperative Delirium in Thoracotomy With One-Lung Ventilation: A Prospective Cohort Study
Authors: Cui Fan , Zhao Wei , Mu Dong-Liang , Zhao Xu , Li Xue-Ying , Wang Dong-Xin , Jia Hui-Qun , Dai Feng , Meng Lingzhong 
Published: March 2021

BACKGROUND:
The association between cerebral desaturation and postoperative delirium in thoracotomy with one-lung ventilation (OLV) has not been specifically studied.

METHODS:
A prospective observational study performed in thoracic surgical patients. Cerebral tissue oxygen saturation (Scto
2) was monitored on the left and right foreheads using a near-infrared spectroscopy oximeter. Baseline Scto
2 was measured with patients awake and breathing room air. The minimum Scto
2 was the lowest measurement at any time during surgery. Cerebral desaturation and hypersaturation were an episode of Scto
2 below and above a given threshold for ≥15 seconds during surgery, respectively. The thresholds based on relative changes by referring to the baseline measurement were <80%, <85%, <90%, <95%, and <100% baseline for desaturation and >105%, >110%, >115%, and >120% baseline for hypersaturation. The thresholds based on absolute values were <50%, <55%, <60%, <65%, and <70% for desaturation and >75%, >80%, >85%, and >90% for hypersaturation. The given area under the threshold (AUT)/area above the threshold (AAT) was analyzed. Delirium was assessed until postoperative day 5. The primary analysis was the association between the minimum Scto
2 and delirium using multivariable logistic regression controlled for confounders (age, OLV time, use of midazolam, occurrence of hypotension, and severity of pain). The secondary analysis was the association between cerebral desaturation/hypersaturation and delirium, and between the AUT/AAT and delirium using multivariable logistic regression controlled for the same confounders. Multiple testing was corrected using the Holm-Bonferroni method. We additionally monitored somatic tissue oxygen saturation on the forearm and upper thigh.

RESULTS:
Delirium occurred in 35 (20%) of 175 patients (65 ± 6 years old). The minimum left or right Scto
2 was not associated with delirium. Cerebral desaturation defined by <90% baseline for left Scto
2 (odds ratio [OR], 5.82; 95% confidence interval [CI], 2.12-19.2; corrected P =.008) and <85% baseline for right Scto
2 (OR, 4.27; 95% CI, 1.77-11.0; corrected P =.01) was associated with an increased risk of delirium. Cerebral desaturation defined by other thresholds, cerebral hypersaturation, the AUT/AAT, and somatic desaturation and hypersaturation were all not associated with delirium.

CONCLUSIONS:
Cerebral desaturation defined by <90% baseline for left Scto
2 and <85% baseline for right Scto
2, but not the minimum Scto
2, may be associated with an increased risk of postthoracotomy delirium. The validity of these thresholds needs to be tested by randomized controlled trials.
Role of Pelvic Lymph Node Resection in Vulvar Squamous Cell Cancer: A Subset Analysis of the AGO-CaRE-1 Study
Authors: Woelber Linn , Bommert Mareike , Harter Philipp , Prieske Katharina , zu Eulenburg Christine , Jueckstock Julia , Hilpert Felix , de Gregorio Nikolaus , Iborra Severine , Sehouli Jalid , Ignatov Atanas , Hillemanns Peter , Fuerst Sophie , Strauss Hans-Georg , Baumann Klaus , Beckmann Matthias , Mustea Alexander , Meier Werner , Mahner Sven , Jaeger Anna 
Published: March 2021

Abstract
Background
As the population at risk for pelvic nodal involvement remains poorly described, the role of pelvic lymphadenectomy (LAE) in vulvar squamous cell cancer (VSCC) has been a matter of discussion for decades.

Methods
In the AGO-CaRE-1 study, 1618 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB or higher primary VSCC treated at 29 centers in Germany between 1998 and 2008 were documented. In this analysis, only patients with pelvic LAE (n = 70) were analyzed with regard to prognosis and correlation between inguinal and pelvic lymph node involvement.

Results
The majority of patients had T1b/T2 tumors (n = 47; 67.1%), with a median diameter of 40 mm (2–240 mm); 54/70 patients (77.1%) who received pelvic LAE had positive groin nodes. For 42 of these 54 patients, the number of affected groin nodes had been documented as a median of 3; 14/42 (33.3%) of these patients had histologically confirmed pelvic nodal metastases (median number of affected pelvic nodes 3 [1–12]). In these 14 patients, the median number of affected groin nodes was 7 (1–30), with a groin metastases median maximum diameter of 42.5 mm (12–50). Receiver operating characteristic analysis showed an area under the curve of 0.85, with 83.3% sensitivity and 92.6% specificity for the prediction of pelvic involvement in cases of six or more positive groin nodes. No cases of pelvic nodal involvement without groin metastases were observed. Prognosis in cases of pelvic metastasis was poor, with a median progression-free survival of only 12.5 months.

Conclusion
For the majority of node-positive patients with VSCC, pelvic nodal staging appears unnecessary since a relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease.
Impact of 1.5 oC and 2 oC global warming scenarios on malaria transmission in East Africa
Authors: Ogega Obed Matundura , Alobo Moses 
Published: March 2021

Background: Malaria remains a global challenge with approximately 228 million cases and 405,000 malaria-related deaths reported in 2018 alone; 93% of which were in sub-Saharan Africa. Aware of the critical role than environmental factors play in malaria transmission, this study aimed at assessing the relationship between precipitation, temperature, and clinical malaria cases in East Africa and how the relationship may change under 1.5 oC and 2.0 oC global warming levels (hereinafter GWL1.5 and GWL2.0, respectively). Methods: A correlation analysis was done to establish the current relationship between annual precipitation, mean temperature, and clinical malaria cases. Differences between annual precipitation and mean temperature value projections for periods 2008-2037 and 2023-2052 (corresponding to GWL1.5 and GWL2.0, respectively), relative to the control period (1977-2005), were computed to determine how malaria transmission may change under the two global warming scenarios. Results: A predominantly positive/negative correlation between clinical malaria cases and temperature/precipitation was observed. Relative to the control period, no major significant changes in precipitation were shown in both warming scenarios. However, an increase in temperature of between 0.5 oC and 1.5 oC and 1.0 oC to 2.0 oC under GWL1.5 and GWL2.0, respectively, was recorded. Hence, more areas in East Africa are likely to be exposed to temperature thresholds favourable for increased malaria vector abundance and, hence, potentially intensify malaria transmission in the region. Conclusions: GWL1.5 and GWL2.0 scenarios are likely to intensify malaria transmission in East Africa. Ongoing interventions should, therefore, be intensified to sustain the gains made towards malaria elimination in East Africa in a warming climate.
Grandchild’s IQ is associated with grandparental environments prior to the birth of the parents
Authors: Golding Jean , van den Berg Gerard , Northstone Kate , Suderman Matthew , Ellis Genette , Iles-Caven Yasmin , Gregory Steve , Pembrey Marcus 
Published: March 2021

Background. Despite convincing animal experiments demonstrating the potential for environmental exposures in one generation to have demonstrable effects generations later, there have been few relevant human studies. Those that have been undertaken have demonstrated associations, for example, between exposures such as nutrition and cigarette smoking in the grandparental generation and outcomes in grandchildren. We hypothesised that such transgenerational associations might be associated with the IQ of the grandchild, and that it would be likely that there would be differences in results between the sexes of the grandparents, parents, and children.Method.We used three-generational data from the Avon Longitudinal Study of Parents and Children (ALSPAC). We incorporated environmental factors concerning grandparents (F0) and focussed on three exposures that we hypothesised may have independent transgenerational associations with the IQ of the grandchildren (F2): (i) UK Gross Domestic Product (GDP) at grandparental birth year; (ii) whether grandfather smoked; and (iii) whether the grandmother smoked in the relevant pregnancy. Potential confounders were ages of grandparents when the relevant parent was born, ethnic background, education level and social class of each grandparent.Results. After adjustment, all three target exposures had specific associations with measures of IQ in the grandchild. Paternal grandfather smoking was associated with reduced total IQ at 15 years; maternal grandfather smoking with reduced performance IQ at 8 years and reduced total IQ at 15. Paternal grandmother smoking in pregnancy was associated with reduced performance IQ at 8, especially in grandsons. GDP at grandparents’ birth produced independent associations of reduced IQ with higher GDP; this was particularly true of paternal grandmothers.Conclusions.These results are complex and need to be tested in other datasets. They highlight the need to consider possible transgenerational associations in studying developmental variation in populations.
Skull base reconstruction: A question of flow? A critical analysis of 521 endoscopic endonasal surgeries
Authors: Di Perna Giuseppe , Penner Federica , Cofano Fabio , De Marco Raffaele , Baldassarre Bianca Maria , Portonero Irene , Garbossa Diego , Ceroni Luca , Pecorari Giancarlo , Zenga Francesco 
Published: March 2021

Introduction
Post-operative CSF leak still represents the main drawback of Endoscopic Endonasal Approach (EEA), and different reconstructive strategies have been proposed in order to decrease its rate.

Objective
To critically analyze the effectiveness of different adopted reconstruction strategies in patients that underwent EEA.

Materials and methods
Adult patients with skull base tumor surgically treated with EEA were retrospectively analyzed. Data recorded for each case concerned patient demographics, type of surgical approach, histotype, anatomical site of surgical approach, intra-operative CSF leak grade (no leak (INL), low flow (ILFL), high flow (IHFL)), reconstructive adopted strategy, Lumbar Drain positioning, post-operative CSF leak rate and intra/post-operative complications.

Results
A total number of 521 patients (January 2012-December 2019) was included. Intra-operative CSF leak grade showed to be associated with post-operative CSF leak rate. In particular, the risk to observe a post-operative CSF leak was higher when IHFL was encountered (25,5%; Exp(B) 16.25). In particular, vascularized multilayered reconstruction and fat use showed to be effective in lowering post-operative CSF leaks in IHFL (p 0.02). No differences were found considering INL and ILFL groups. Yearly post-operative CSF leak rate analysis showed a significative decreasing trend.

Conclusion
Intra-operative CSF leak grade strongly affected post-operative CSF leak rate. Multilayer reconstruction with fat and naso-septal flap could reduce the rate of CSF leak in high risk patients. Reconstructive strategies should be tailored according also to the type and the anatomical site of the approach.
Laboratory biomarkers of COVID-19 disease severity and outcome: Findings from a developing country
Authors: Leulseged Tigist W. , Hassen Ishmael S. , Ayele Birhanu T. , Tsegay Yakob G. , Abebe Daniel S. , Edo Mesay G. , Maru Endalkachew H. , Zewde Wuletaw C. , Naylor Lydia K. , Semane Dejene F. , Dresse Menayit T. , Tezera Bereket B. 
Published: March 2021

Aim
To identify laboratory biomarkers that predict disease severity and outcome among COVID-19 patients admitted to the Millennium COVID-19 Care Center in Ethiopia.

Methods
A retrospective cohort study was conducted among 429 COVID-19 patients who were on follow up from July to October 2020. Data was described using frequency tables. Robust Poisson regression model was used to identify predictors of COVID-19 severity where adjusted relative risk (ARR), P-value and 95 CI for ARR were used to test significance. Binary Logistic regression model was used to assess the presence of statistically significant association between the explanatory variables and COVID-19 outcome where adjusted odds ratio (AOR), P-value and 95%CI for AOR were used for testing significance.

Results
Among the 429 patients studied, 182 (42.4%) had Severe disease at admission and the rest 247 (57.6%) had Non-severe disease. Regarding disease outcome, 45 (10.5%) died and 384 (89.5%) were discharged alive. Age group (ARR = 1.779, 95%CI = 1.405–2.252, p-value <0.0001), Neutrophil to Lymphocyte ratio (NLR) (ARR = 4.769, 95%CI = 2.419–9.402 p-value <0.0001), Serum glutamic oxaloacetic transaminase (SGOT) (ARR = 1.358, 95%CI = 1.109–1.662 p-value = 0.003), Sodium (ARR = 1.321, 95%CI = 1.091–1.600 p-value = 0.004) and Potassium (ARR = 1.269, 95%CI = 1.059–1.521 p-value = 0.010) were found to be significant predictors of COVID-19 severity.
The following factors were significantly associated with COVID-19 outcome; age group (AOR = 2.767, 95%CI = 1.099–6.067, p-value = 0.031), white blood cell count (WBC) (AOR = 4.253, 95%CI = 1.918–9.429, p-value = 0.0001) and sodium level (AOR = 3.435, 95%CI = 1.439–8.198, p-value = 0.005).

Conclusions
Assessing and monitoring the laboratory markers of WBC, NLR, SGOT, sodium and potassium levels at the earliest stage of the disease could have a considerable role in halting disease progression and death.
Social heterogeneity and the COVID-19 lockdown in a multi-group SEIR model
Authors: Dolbeault Jean , Turinici Gabriel 
Published: March 2021

Abstract
The goal of the lockdown is to mitigate and if possible prevent the spread of an epidemic. It consists in reducing social interactions. This is taken into account by the introduction of a factor of reduction of social interactions q, and by decreasing the transmission coefficient of the disease accordingly. Evaluating q is a difficult question and one can ask if it makes sense to compute an average coefficient q for a given population, in order to make predictions on the basic reproduction rate ℛ0, the dynamics of the epidemic or the fraction of the population that will have been infected by the end of the epidemic. On a very simple example, we show that the computation of ℛ0 in a heterogeneous population is not reduced to the computation of an average q but rather to the direct computation of an average coefficient ℛ0. Even more interesting is the fact that, in a range of data compatible with the Covid-19 outbreak, the size of the epidemic is deeply modified by social heterogeneity, as is the height of the epidemic peak, while the date at which it is reached mainly depends on the average ℛ0 coefficient. This paper illustrates more technical results that can be found in [4], with new numerical computations. It is intended to draw the attention on the role of heterogeneities in a population in a very simple case, which might be difficult to apprehend in more realistic but also more complex models.
Spectral Theory For Strongly Continuous Cosine
Authors: Boua Hamid 
Published: March 2021

Abstract
Let (C(t))
t∈ℝ be a strongly continuous cosine family and A be its infinitesimal generator. In this work, we prove that, if C(t) – cosh λt is semi-Fredholm (resp. semi-Browder, Drazin inversible, left essentially Drazin and right essentially Drazin invertible) operator and λt ∉ iπℤ, then A – λ
2 is also. We show by counterexample that the converse is false in general.
Dissipativity analysis of delayed stochastic generalized neural networks with Markovian jump parameters
Authors: Rajchakit Grienggrai , Sriraman Ramalingam , Samidurai Rajendran 
Published: March 2021

Abstract
This article discusses the dissipativity analysis of stochastic generalized neural network (NN) models with Markovian jump parameters and time-varying delays. In practical applications, most of the systems are subject to stochastic perturbations. As such, this study takes a class of stochastic NN models into account. To undertake this problem, we first construct an appropriate Lyapunov–Krasovskii functional with more system information. Then, by employing effective integral inequalities, we derive several dissipativity and stability criteria in the form of linear matrix inequalities that can be checked by the MATLAB LMI toolbox. Finally, we also present numerical examples to validate the usefulness of the results.
Exploring the role of City Networks in supporting urban resilience to COVID-19 in conflict-affected settings
Authors: Meagher Kristen , Achi Nassim El , Bowsher Gemma , Ekzayez Abdulkarim , Patel Preeti 
Published: March 2021

Abstract
Background: It is estimated that by 2050, almost 70 percent of the global population will be residing in urban areas. In recent years, cities have become central in tackling key urban challenges and have demonstrated greater flexibility in policymaking and innovation than national governments. Cities are currently more inclined to learn from each other via networks, partnerships, and pairings to develop solutions to many global challenges including pandemics such as COVID-19.
Aim: To explore the role cities and city networks present in supporting urban resilience to pandemics focusing on conflict-affected settings.
Methods: A desk-based literature review of academic and grey sources was conducted followed by thematic analysis.
Results: Although most COVID-19 response plans have been developed and implemented by governments, the pandemic has revealed the significant potential for city networks in providing platforms for knowledge sharing and coordination of mitigation plans to address pandemic-specific interventions. We found that in conflict settings, city networks continue to play only a minor role, if any, compared to humanitarian and informal actors.
Conclusion: City networks have the potential to contribute to strengthening global collaborative approaches to pandemic responses, but this has not been given sufficient investment and even less so in conflict-affected settings. It is essential for these networks to be integrated within a wider multidisciplinary and multisectoral platform that includes academics, humanitarian and informal actors.