bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Opioid Prescribing Guidelines on Postoperative Opioid Prescriptions Following Elective Spine Surgery: Results From an Institutional Quality Improvement Initiative
Authors: Krauss William E , Habermann Elizabeth B , Goyal Anshit , Ubl Daniel S , Alvi Mohammed Ali , Whipple Daniel C , Glasgow Amy E , Gazelka Halena M , Bydon Mohamad 
Published: May 2021

Abstract

BACKGROUND
With a dramatic rise in prescription opioid use, it is imperative to review postsurgical prescribing patterns given their contributions to the opioid epidemic.

OBJECTIVE
To evaluate the impact of departmental postoperative prescribing guidelines on opioid prescriptions following elective spine surgery.

METHODS
Patients undergoing elective cervical or lumbar spine surgery between 2017 and 2018 were identified. Procedure-specific opioid prescribing guidelines to limit postoperative prescribing following neurosurgical procedures were developed in 2017 and implemented in January 2018. Preguideline data were available from July to December 2017, and postguideline data from July to December 2018. Discharge prescriptions in morphine milliequivalents (MMEs), the proportion of patients (i) discharged with an opioid prescription, (ii) needing refills within 30 d, (iii) with guideline compliant prescriptions were compared in the 2 groups. Multivariable (MV) analyses were performed to assess the impact of guideline implementation on refill prescriptions within 30 d.

RESULTS
A total of 1193 patients were identified (cervical: 308; lumbar: 885) with 569 (47.7%) patients from the preguideline period. Following guideline implementation, fewer patients were discharged with a postoperative opioid prescription (92.5% vs 81.7%, P < .001) and median postoperative opioid prescription decreased significantly (300 MMEs vs 225 MMEs, P < .001). The 30-d refill prescription rate was not significantly different between preguideline and postguideline cohorts (pre: 24.4% vs post: 20.2%, P = .079). MV analyses did not demonstrate any impact of guideline implementation on need for 30-d refill prescriptions for both cervical (odds ratio [OR] = 0.68, confidence interval [CI] = 0.37-1.26, P = .22) and lumbar cohorts (OR = 0.95, CI = 0.66-1.36, P = .78).

CONCLUSION
Provider-aimed interventions such as implementation of procedure-specific prescribing guidelines can significantly reduce postoperative opioid prescriptions following spine surgery without increasing the need for refill prescriptions for pain control.
HIV Treatment Outcomes in Rural Georgia Using Telemedicine
Authors: Lawal Folake J , Omotayo Moshood O , Lee Tae Jin , Srinivasa Rao Arni S R , Vazquez Jose A 
Published: May 2021

Abstract

Background
The increasing shortage of specialized health care services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared with traditional (face-to-face [F2F]) care in rural populations. The objective of this study was to compare the effectiveness of HIV care delivered through TM with the F2F model.

Methods
We conducted a retrospective chart review of a subset of patients with HIV who attended a TM clinic in Dublin, Georgia, and an F2F clinic in Augusta, Georgia, between May 2017 and April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV viral load (VL) and CD4 count gain were compared using t test and Mann-Whitney U statistics.

Results
Three hundred eighty-five patients were included in the analyses (F2F = 200; TM = 185). The mean CD4 in the TM group was higher (643.9 cells/mm3) than that of the F2F group (596.3 cells/mm3; P &lt; .001). There was no statistically significant difference in VL reduction, control, or mean VL (F2F = 416.8 cp/mL; TM = 713.4 cp/mL; P = .30). Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54; TM = 14/31), with a mean change of 3.34 × 104 and –1 to 0.24 × 104, respectively (P = 1.00).

Conclusions
TM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited health care access in the rural United States. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted.
Inoculation now or later? Lower efficacy and vaccine passport concerns
Authors: Brazal Agnes M 
Published: May 2021

Abstract
This correspondence explores other reasons for vaccine hesitancy especially among the educated sector, as expressed in the decision to delay inoculation because of the lower efficacy of currently available vaccines and/or the lack of access to European Medicines Agency-approved jabs that are required for an European Union vaccine passport. The challenge to promote the common good is posed not only to individuals, but also to governments and international agencies.
Development and Clinical Uses of a Mobile Application for Smart Wound Nursing Management
Authors: Zhang Qijian , Huang Weihong , Dai Weiwei , Tian Hanzhang , Tang Qiongfang , Wang Shihui 
Published: May 2021

ABSTRACT

OBJECTIVE
Establishing a smart platform for wound nursing management is imperative to accelerating the development of this specialty. A mobile application (app) was created based on the clinical needs of wound care to improve working efficiency and wound management, as well as enable information sharing and categorical retrieval of patient records.

METHODS
Supported by the National Mobile Laboratory of China, the authors’ wound care center collaborated with information technology engineers and user interface designers to establish a multidisciplinary team of experts in wound nursing information management and develop a digital app. Electronic tablets were chosen as a convenient clinical method to collect complete information in a standardized format. In the app, case records are synchronously cataloged for rapid retrieval. The app was designed such that practicing nurses could quickly learn how to use the various functions of the app. Through constant iterative optimization, the relevant functional modules have been further improved.

RESULTS AND CONCLUSIONS
After a 1-year clinical trial, app functions have stabilized, fulfilling the expectations of technicians and boosting the operating efficiency of clinical practices. In comparison with traditional methods, the app allows for easy access to patient information; rapidly reviewed, synchronous cataloguing; and convenient retrieval. Further exploration is warranted.
Twenty years of clinical trials in axial spondyloarthritis: what can we learn for the future?
Authors: Sieper Joachim , Poddubnyy Denis 
Published: May 2021

Purpose of review
We have now about 20 years of experience with the treatment of axial spondyloarthritis with biologics, which raises the question what we can learn from past experience, and which open questions should be addressed in future investigations.

Recent findings
Many studies have shown that axSpA patients – both patients in their nonradiological and radiological stage – respond similarly well to biologic treatment and these patients should be seen as having the same disease at different stages. AxSpA respond best to TNF-blocker – and probably also to other biologics – if the disease duration is short and if objective parameters of inflammation, such as C-reactive protein or MRI are positive. Primary aim of treatment is to reach and maintain clinical remission. Once remission is achieved, it can be maintained by continuing treatment, and in a proportion of yet not well defined patients the drug dose can be reduced without inducing a flare. The recent demonstration of a good efficacy, in addition to TNF blockers, also of IL-17 inhibitors and JAK-inhibitors in axSpA patients raises the question how to select the best patients for the best treatment. Radiographic progression can best be stopped by effectively suppressing inflammation, whether different drugs have here a different effect has still to be defined. More sensitive measurements of radiographic progression are urgently needed.

Summary
Reaching and maintaining clinical remission and preventing structural bony damage is the primary treatment target in patients with axSpA. How to reach this aim best has to be further explored in the future.
The use of artificial intelligence for the diagnosis of bladder cancer: a review and perspectives
Authors: Chan Erica On-Ting , Pradere Benjamin , Teoh Jeremy Yuen-Chun 
Published: May 2021

Purpose of review
White light cystoscopy is the current standard for primary diagnosis and surveillance of bladder cancer. However, cancer changes can be subtle and may be easily missed. With the advancement of deep learning (DL), image recognition by artificial intelligence (AI) proves a high accuracy for image-based diagnosis. AI can be a solution to enhance bladder cancer diagnosis on cystoscopy.

Recent findings
An algorithm that classifies cystoscopic images into normal and tumour images is essential for AI cystoscopy. To develop this AI-based system requires a training dataset, an appropriate type of DL algorithm for the learning process and a specific outcome classification. A large data volume with minimal class imbalance, data accuracy and representativeness are pre-requisite for a good dataset. Algorithms developed during the past two years to detect bladder tumour achieved high performance with a pooled sensitivity of 89.7% and specificity of 96.1%. The area under the curve ranged from 0.960 to 0.980, and the accuracy ranged from 85.6 to 96.9%. There were also favourable results in the various attempts to enhance detection of flat lesions or carcinoma-in-situ.

Summary
AI cystoscopy is a possible solution in clinical practice to enhance bladder cancer diagnosis, improve tumour clearance during transurethral resection of bladder tumour and detect recurrent tumours upon surveillance.
Do government expenditure reduce income inequality: evidence from developing and developed countries
Authors: Sidek Noor Zahirah Mohd 
Published: May 2021

Purpose
This paper aims to re-examine the impact of government expenditure on income inequality. Existing studies provide mixed results on whether government expenditure reduces or increases income inequality. In this paper, government expenditure is viewed as a tool for redistribution, hence, its impact on inequality is examined.

Design/methodology/approach
A sample of 122 countries with 91 and 31 countries categorized as developing and developed countries is used. The dynamic panel threshold regression is used to examine the impact of government expenditure on income inequality and to estimate the turning point of the negative or positive effects.

Findings
The major findings suggest that, in general, government expenditure does reduce income inequality. Results from developed countries support the inversed U-shaped Kuznet curve where higher government expenditure initially led to more inequality but would eventually bring about a positive effect after a certain threshold level. For developing countries, education and development expenditure were the driving forces towards lower income inequality.

Practical implications
Several policy implications can be derived from this paper. First, government expenditure is a useful tool to alleviate the problem of income inequality. More integration with the global economy via trading activities is also an important channel to help reduce income inequality. Finally, better institutional quality provides an effective ecosystem in promoting better redistribution of income via government expenditure.

Originality/value
This paper presents a maiden attempt to estimate a threshold value or when government expenditure starts to reduce or increase income inequality. The sample is segregated into developed and developing countries to further control the effect of government size and the level of development of a country.
Knowledge management in local governments in developing countries: a systematic literature review
Authors: Ndiege Joshua Rumo Arongo , Backhouse Judy 
Published: May 2021

Purpose
The purpose of this study is to examine the state of research into knowledge management within local government in developing countries, to identify themes that have been studied and to identify important gaps in the literature that can inform a research agenda going forward.

Design/methodology/approach
A structured literature review method was used in this study. The authors reviewed academic literature published between 2009 and 2019. A total of 15 articles were identified and reviewed.

Findings
The findings reveal that, few authors have contributed to knowledge management within local government in developing countries and there is little international collaboration between authors. The authors found limited methodological and theoretical diversity and rigor in the reviewed work. The review identified themes that have been researched but evidenced a lack of guidelines and frameworks developed to promote knowledge management initiatives within local governments in developing countries. Overall, it was evident that this area was still little explored. As a result, there are many possibilities for future research.

Originality/value
This study provides a comprehensive systematic literature review of papers published on knowledge management in local governments in developing countries, identifying themes that have been studied and gaps for further research.
An alternative approach to measuring the welfare implications of input subsidies: Evidence from Malawi
Authors: Gemessa Sinafikeh Asrat 
Published: May 2021

AbstractMost studies that have evaluated the welfare impacts of agricultural input subsidy programmes (ISPs) in developing countries have focused on measuring their effects on various outcomes of interest such as agricultural productivity. I estimate the consumer surplus accrued by direct and indirect beneficiaries of ISPs in Malawi. Malawi's Farm Input Subsidy Programme (FISP), introduced in 2005, is the largest such scheme in sub‐Saharan Africa. I find that the programme provides low direct benefits compared to the public costs of the programme. At the national level, the benefit‐cost ratio (BCR) is up to 0.37 for FISP households with no option to resell the fertiliser accessed through the programme. When reselling of the fertiliser is allowed for, the BCR increases to 0.64 including spillover benefits to direct non‐beneficiaries of FISP. I also found 60% of all fertiliser vouchers and benefits accrued to farm households with above the median wealth level. Many farmers demand 25 kg of fertiliser or less at the subsidised price. Thus, when resource poor direct beneficiaries have the option to buy 25 kg bags of fertiliser in addition to the 50 kg bags currently being offered under FISP, their benefits increase by about 53% compared to the status quo. Overall, my results suggest that a more flexible redemption of the fertiliser vouchers as well as complementary investments such as improved access to credit could increase the programme's contribution to farmers’ welfare.
Quantifying variations in browsing pressure caused by feral deer for a range of threatened ecological communities and plant growth forms
Authors: Burns Heather , Gibbons Philip , Claridge Andrew 
Published: May 2021

AbstractGlobally, high‐density populations of feral deer have been associated with a range of negative ecological consequences. Within Australia, limited quantitative research has assessed the impacts of deer, particularly in threatened ecological communities (TECs). Our study aimed to quantify the impact of feral deer on the herbivory of a range of woody plant species, non‐woody growth forms and TECs; and assess whether feral deer increase herbivory in TECs above background rates caused by native herbivores. We surveyed 356 transects across 89 sites representing eight TECs and collected herbivory data for woody and non‐woody plants. At each site, we recorded the presence or absence of deer sign and abundance of macropod pellets to account for variations in herbivory between groups of sympatric species. Generalised linear mixed models were developed to predict: (i) proportion of individual plants browsed (or grazed); and (ii) average browsing (or grazing) intensity for woody plant species and non‐woody plants. Controlling for macropod abundance, we found the average grazing intensity and proportion of non‐woody plants grazed was higher when deer were present compared to absent. Specifically, grazing pressure on rushes, cycads, sedges and grasses was significantly higher where deer were present. In contrast, we did not observe a significant impact of deer on woody plant species. The presence of deer resulted in higher grazing intensity in coastal saltmarsh, freshwater wetland, littoral rainforest and bangalay sand forest TECs. Although the deer population across our study region generally appears to be at low density compared to neighbouring regions, their presence is resulting in grazing pressure above that caused by native herbivores for a range of non‐woody plants. Our results contribute to a growing body of research about the ecological impacts of feral deer in Australia and can be used as a baseline for ongoing regional monitoring of deer impacts in TECs.
Efficacy and safety of the Clearum dialyzer
Authors: Maduell Francisco , Broseta José Jesús , Rodríguez‐Espinosa Diana , Hermida‐Lama Evelyn , Cuadrado‐Payán Elena , Rodas Lida María , Gómez Miquel , Arias‐Guillén Marta , Fontseré Néstor , Vera Manel , Rico Nayra 
Published: May 2021

AbstractThe Clearum dialyzer, built by Medtronic, became commercially available in several European countries in 2020, but there are still no reports of in vivo data. The aim of this study was to evaluate the efficacy and risk of hypoalbuminemia of this dialyzer compared with previously evaluated hemodialysis (HD), expanded hemodialysis (HDx), and postdilution hemodiafiltration (HDF) treatments. A prospective study was carried out in 15 patients. Each patient underwent seven dialysis sessions: FX80 Cordiax in HD, Clearum HS17 in HD, Phylther 17‐SD in HDx, Theranova 400 in HDx, Phylther 17‐G in postdilution HDF, Clearum HS17 in postdilution HDF, and FX80 Cordiax in postdilution HDF. The reduction ratios of urea, creatinine, ß2‐microglobulin, myoglobin, prolactin, α1‐microglobulin, α1‐acid glycoprotein, and albumin were compared intraindividually. Dialysate albumin loss was also measured. Comparison of dialysis techniques revealed no differences between small molecules, but HDx and HDF were significantly higher than HD with medium and large molecular weights. The Clearum dialyzer in HDF obtained similar results to FX80 Cordiax in HDF, was slightly superior to Phylther 17‐G in HDF, and was statistically superior to both dialyzers in HDx. Albumin losses with the Clearum dialyzer were among the lowest, both in HD and HDF treatments. The highest global removal score (GRS) values were obtained with the helixone and Clearum dialyzers in HDF, with similar results both in HD and HDF. In addition, the GRS values with HDx treatments were statistically significantly higher than those with HD. The new Clearum dialyzer has excellent behavior and tolerance in HD and HDF. Its adequate permeability has been proven with its maximal performance in HDF, which could represent an upgrade versus its predecessor polyphenylene dialyzers.
Non-organ-specific autoimmunity in adult 47,XXY Klinefelter patients and higher-grade X-chromosome aneuploidies
Authors: Panimolle Francesca , Tiberti Claudio , Spaziani Matteo , Riitano Gloria , Lucania Giuseppe , Anzuini Antonella , Lenzi Andrea , Gianfrilli Daniele , Sorice Maurizio , Radicioni Antonio F 
Published: May 2021

Abstract
Current literature regarding systemic autoimmune diseases in X-chromosome aneuploidies is scarce and limited to case reports. Our aim was to evaluate the frequency of anti-nuclear (ANAs), extractable nuclear (ENA), anti-double-stranded DNA (dsDNAs), anti-smooth muscle (ASMAs) and anti-mitochondrial (AMAs) antibodies in a large cohort of adults with Klinefelter's syndrome (KS, 47,XXY) and rare higher-grade sex chromosome aneuploidies (HGAs) for the first time. Sera from 138 X-chromosome aneuploid patients [124 adult patients with 47,XXY KS and 14 patients with HGA (six children, eight adults)] and 50 age-matched 46,XY controls were recruited from the Sapienza University of Rome (2007–17) and tested for ANAs, ENAs, anti-dsDNAs, ASMAs and AMAs. Non-organ-specific immunoreactivity was found to be significantly higher in patients with 47,XXY KS (14%) than in the controls (2%, p = 0.002). Among all the antibodies investigated, only ANAs were observed significantly more frequently in patients with 47,XXY KS (12.1%) than in the controls (2%, p = 0.004). No anti-dsDNA immunoreactivity was found. Stratifying by testosterone replacement therapy (TRT), non-organ-specific autoantibody frequencies were higher in TRT-naive (p = 0.01) and TRT-treated groups than in controls. No patients with HGA were found positive for the various autoantibodies. Non-organ-specific autoantibodies were significantly present in 47,XXY adult patients. Conversely, HGAs did not appear to be target of non-organ-specific immunoreactivity, suggesting that KS and HGAs should be considered as two distinct conditions. The classification and diagnosis of systemic autoimmune diseases is frequently difficult. To support a correct clinical evaluation of KS disease and to prevent eventual secondary irreversible immune-mediated damages, we highlight the importance of screening for non-organ-specific autoimmunity in Klinefelter's syndrome.
Clinical and histopathological evaluation of cutaneous angiofibromas
Authors: Nasimi Maryam , Kamyab Kambiz , Moradi Arezou , Dasdar Shayan , Kianfar Nika 
Published: May 2021

AbstractBackgroundAngiofibromas are common benign skin lesions that are diagnosed clinically and histopathologically. Fibrous papule (FP) is one of the clinical types of angiofibromas located primarily on the nose.MethodsThe cases with the confirmed diagnosis of angiofibroma were enrolled. Demographic features of the patients and clinical characteristics of the lesions were extracted. Moreover, histopathological features of the available slides were microscopically reviewed.ResultsFrom 83 cases of cutaneous angiofibromas, 57 (69%) had lesions consistent with FP. The mean age at diagnosis was 37.7 ± 16.3 years and the most common site of involvement was the nose (53% of cases). Regarding the histopathological evaluation of 71 slides, most cases represented vascular changes (97%) and dermal fibroplasia (87%). Melanin incontinence (41%), acanthosis (31%), and lichenoid features (25%) were other common histopathological findings. Moreover, a sparse inflammatory cell infiltrate was present in 68% of cases. The most prevalent inflammatory cells were lymphocytes (61%) and histiocytes (34%).ConclusionThis study presented the histopathological findings of a series of cutaneous angiofibromas. Dermatopathologists should be aware of these features, especially those that are less common, to better diagnose and differentiate them from malignant neoplasms.