bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimating the costs and benefits of stroke rehabilitation in South Africa
Authors: Louw Quinette , Twizeyemariya Asterie , Grimmer Karen , Leibbrandt Dominique 
Published: September 2019

AbstractObjectiveThis paper explores the economic value of rehabilitation to South Africa, using a costed example of cerebrovascular accident (CVA) (stroke) rehabilitation.DesignWe report an economic modelling approach using a worked cost‐effectiveness to validate the argument for the cost‐saving benefits of stroke rehabilitation.SettingSouth African health care, employing analysis of available secondary data from South African research and government reports.ParticipantsIn line with international trends in stroke epidemiology, we focused on people who were employed prior to having their stroke, with return‐to‐work as the desired rehabilitation outcome.InterventionsNot applicable.Main outcome measure(s)We used information on stroke rehabilitation and secondary data derived from grey and published literature, to determine if early stroke rehabilitation represents value for money from the government perspective. For our worked example, we used return‐to‐work rates, intervention costs, and the cost of rehabilitation services to estimate cost‐savings as a result of an individualized workplace intervention.ResultsThe cost of delivering the individualized intervention was estimated at R5633/patient. Combining survivor rates, return‐to‐work rate, and costs of the programme, a work intervention programme could result in a net saving of R133.1 million over 5 years (or about R26.6 per year (discount 3%).ConclusionThe value of rehabilitation should not be considered in terms of cost‐effectiveness alone, but also as an investment for the country. A staged, prioritized approach should be considered in future South African national health budget.
Scale‐up of extraction processes: Dimensionless modeling and virtualization via lattice Boltzmann method
Authors: Rabi José A. , de Lima Caneppele Fernando , Ribeiro Rogers , Dacanal Gustavo C. 
Published: September 2019

AbstractWhile modeling and virtualization pose challenges and opportunities to food engineering, lattice Boltzmann method (LBM) is a recent computational technique. By relying on existing dynamic one‐dimensional models, in‐house LBM simulators have been developed toward extraction processes in agitated‐batch or continuous‐flow equipment. In view of supporting process scale‐up, this work aimed at casting the aforesaid extraction models (and related LBM simulators) in dimensionless form. Together with available experimental data for validation, pectin extraction from fruit peels in agitated reactor and essential oil extraction from gorse in fixed bed were taken as case studies. Primitive influencing parameters (e.g., intraparticle diffusivity, solid–fluid partition coefficient, fluid‐phase diffusivity, bed length, and interstitial fluid velocity) were fruitfully lumped into fewer dimensionless parameters (e.g., mass‐transfer Biot, Péclet and Damköhler numbers). In‐house LBM simulators remained operational in their dimensionless versions, with a reduced amount of dimensionless numbers indeed grouping the influence of different process parameters, which may help future sensitivity analyses and scale‐up procedures.Practical ApplicationsInitially used for academic purposes, computational modeling has experienced notable evolution and has become strategic to research, development, and innovation (RD&I) in food processing. Computational modeling can support novel food processes as different parameters and scenarios can be quickly simulated toward scale‐up and cost‐effectiveness. Accordingly, computational modeling may save valuable material, energy, water, and human resources in RD&I activities at industrial scale. The present work casts in‐house computer codes to numerically simulate extraction processes in either agitated‐batch or continuous‐flow equipment into dimensionless form. Related process parameters in primitive form were fruitfully lumped into fewer dimensionless numbers, which may ease scale‐up as well as sensitivity analysis.
Low‐Interventional Approaches to Intrapartum Care: Hospital Variation in Practice and Associated Factors
Authors: Lundsberg Lisbet S. , Main Elliott K. , Lee Henry C. , Lin Haiqun , Illuzzi Jessica L. , Xu Xiao 
Published: September 2019

IntroductionDespite evidence supporting the safety of low‐interventional approaches to intrapartum care, defined by the American College of Obstetricians and Gynecologists as “practices that facilitate a physiologic labor process and minimize intervention,” little is known about how frequently such practices are utilized. We examined hospital use of low‐interventional practices, as well as variation in utilization across hospitals.MethodsData came from 185 California hospitals completing a survey of intrapartum care, including 9 questions indicating use of low‐ versus high‐interventional practices (eg, use of intermittent auscultation, nonpharmacologic pain relief, and admission of women in latent labor). We performed a group‐based latent class analysis to identify distinct groups of hospitals exhibiting different levels of utilization on these 9 measures. Multivariable logistic regression identified institutional characteristics associated with a hospital's likelihood of using low‐interventional practices. Procedure rates and patient outcomes were compared between the hospital groups using bivariate analysis.ResultsWe identified 2 distinct groups of hospitals that tended to use low‐interventional (n = 44, 23.8%) and high‐interventional (n = 141, 76.2%) practices, respectively. Hospitals more likely to use low‐interventional practices included those with midwife‐led or physician‐midwife collaborative labor management (adjusted odds ratio [aOR], 7.52; 95% CI, 2.53‐22.37; P < .001) and those in rural locations (aOR, 3.73; 95% CI, 1.03‐13.60; P = .04). Hospitals with a higher proportion of women covered by Medicaid or other safety‐net programs were less likely to use low‐interventional practices (aOR, 0.96; 95% CI, 0.93‐0.99; P = .004), as were hospitals in counties with higher medical liability insurance premiums (aOR, 0.53; 95% CI, 0.33‐0.85; P = .008). Hospitals in the low‐intervention group had comparable rates of severe maternal and newborn morbidities but lower rates of cesarean birth and episiotomy compared with hospitals in the high‐intervention group.DiscussionOnly one‐quarter of hospitals used low‐interventional practices. Attention to hospital culture of care, incorporating the midwifery model of care, and addressing medical‐legal concerns may help promote utilization of low‐interventional intrapartum practices.
Topical metformin in the treatment of melasma: A preliminary clinical trial
Authors: Banavase Channakeshavaiah Ravikumar , Andanooru Chandrappa Naveen Kumar 
Published: September 2019

AbstractBackgroundMelasma is a common acquired pigmentary disorder characterized by symmetric hyperpigmented macules on the face. Triple combination cream (TCC) remains the gold standard treatment but its prolonged use often causes adverse effects. Recently, studies have shown that topical metformin has melanopenic action.AimsTo evaluate the safety and efficacy of topical metformin in the treatment of melasma and to compare its efficacy with TCC (hydroquinone 2% + tretinoin 0.025% + fluocinolone acetonide 0.01%).MethodsThis was a randomized controlled study conducted on 40 patients with melasma aged more than 18 years. Patients in group 1 (n = 20) were treated with 30% metformin lotion, whereas group 2 patients (n = 20) were treated with TCC for 8 weeks. Pigmentation was assessed using Melasma Area and Severity Index (MASI) at baseline and after 8 weeks. Outcome measures included global improvement scale (grades 1‐4) and patient satisfaction. Safety was assessed according to adverse events and patch testing.ResultsAll 40 patients completed the study. Out of 20 patients in group 1, 11 showed grade 1 improvement (1% to <25%) and grade 2 (25%‐50%) and grade 3 (>50%‐75%) improvements were seen in one patient each. In group 2, grades 1, 2, 3, and 4 improvements were seen in 14, 2, 1, and 1 patients, respectively. However, the difference was not statistically significant. Adverse events were noted in three patients in group 2 and none in group 1.ConclusionTopical metformin is a novel, safe, and almost as effective modality as TCC to treat melasma.
Decreased cytokeratin 7 expression correlates with the progression of cervical squamous cell carcinoma and poor patient outcomes
Authors: Hashiguchi Mariko , Masuda Masanori , Kai Keita , Nakao Yoshifumi , Kawaguchi Atsushi , Yokoyama Masatoshi , Aishima Shinichi 
Published: September 2019

AbstractAimTo identify potential biomarkers for tumor progression and patient outcomes in cervical squamous cell carcinoma.MethodsWe examined the expressions of CK7 and CK17 as potential markers of the squamo‐columnar junction, and podoplanin as a basal cell marker using surgical and biopsy samples of patients in grade 3 cervical intraepithelial neoplasia (n = 30), operable invasive carcinoma (OP group, n = 53) and inoperable invasive carcinoma before radiotherapy and/or chemotherapy (RC group, n = 76).ResultsThe positive rates of CK7 and podoplanin in invasive carcinoma were significantly lower than those in grade 3 cervical intraepithelial neoplasia (P = 0.001, P < 0.0001). The positive rates of CK7 and podoplanin in the RC group were significantly lower than those in the OP group (P < 0.0001, P = 0.04), while CK17 expression showed significantly higher positivity in the RC group than in the OP group (P < 0.0001). Negative CK7 expression showed a potential impact on overall survival in early‐stage patients. In the RC group, the prevalence of cases with post‐therapeutic residual carcinoma cells was higher in the CK7‐negative group than in the positive group (P = 0.003). We found that decreased expression of CK7 could be a prognostic factor in early‐stage cervical cancer patients.ConclusionThis result may provide strategies and suggestions for new treatment options and follow‐up practices in managing patients with cervical cancer.
Preferred way of delivery of the impacted fetal head in cesarean sections during second stage of labor
Authors: Gil Moran , Chill Henry H. , Kogan Liron , Porat Shay , Levitt Lorinne , Eliasi Elior , Dior Uri 
Published: September 2019

AbstractAimTo compare maternal and neonatal outcomes between the ‘head first’ and ‘legs first’ delivery methods during a second stage cesarean section.MethodsWe conducted a retrospective study between January 2009 and May 2015 at a large public university tertiary referral center. Included were all women who underwent cesarean delivery with a fully dilated cervix and a fetal head at the level of the ischial spines or below. The study population was divided into two groups according to way of fetal delivery: The ‘legs first’ (reverse breech) method and the ‘head first’ method. Demographics and maternal and fetal outcomes were retrieved for both groups.ResultsDuring the study period 447 women underwent a cesarean section while their cervix was fully dilated. Of them, 321 met the inclusion criteria: One hundred and twenty‐one (38%) were delivered using the ‘legs first’ method and 200 (62%) were delivered using the ‘head first’ method. Indication for surgery and fetal head station was similar for both groups. While no difference in overall intraoperative uterine incision extension rate was observed, a higher rate of uterine incision extension was demonstrated in the ‘head first’ group in cases in which the second stage was longer than 180 min (33 vs 8 cases, P = 0.02). No differences in maternal postoperative complication rates and neonatal outcomes were observed.ConclusionFetal extraction via the ‘legs first’ method during prolonged second stage of labor may lower maternal morbidity. Method of delivery does not seem to have an effect on neonatal outcomes.
Prenatally diagnosed congenital hemangioma with elevated middle cerebral artery peak systolic velocity mimicking the Kasabach‐Merritt phenomenon: A case report
Authors: Someya Masayuki , Sasahara Jun , Yamamoto Satoshi , Sawada Akihisa , Nishikawa Masanori , Ishii Keisuke 
Published: September 2019

AbstractCongenital hemangioma is a rare vascular tumor that develops prenatally, and a large congenital hemangioma may be accompanied by the Kasabach‐Merritt phenomenon. We present a case of prenatally diagnosed fetal congenital hemangioma through ultrasound and maternal anti‐Jr(a) antibody alloimmunization with elevated middle cerebral artery peak systolic velocity. To investigate fetal anemia and hemostatic condition, we performed percutaneous umbilical blood sampling, which revealed no symptom of either Kasabach‐Merritt phenomenon or sensitization to anti‐Jr(a) antibody. Consequently, pregnancy could be continued without further intervention. After birth, congenital hemangioma was found on the infant's left thigh, and Kasabach‐Merritt phenomenon was not shown. Percutaneous umbilical blood sampling could provide precise information prenatally in case of congenital hemangioma with maternal alloimmunization.
Biofilm production by pathogens associated with canine otitis externa, and the antibiofilm activity of ionophores and antimicrobial adjuvants
Authors: Chan Wei Yee , Hickey Elizabeth E. , Page Stephen W. , Trott Darren J. , Hill Peter B. 
Published: September 2019

AbstractOtitis externa (OE) is a frequently reported disorder in dogs associated with secondary infections by Staphylococcus, Pseudomonas and yeast pathogens. The presence of biofilms may play an important role in the resistance of otic pathogens to antimicrobial agents. Biofilm production of twenty Staphylococcus pseudintermedius and twenty Pseudomonas aeruginosa canine otic isolates was determined quantitatively using a microtiter plate assay, and each isolate was classified as a strong, moderate, weak or nonbiofilm producer. Minimum biofilm eradication concentration (MBEC) of two ionophores (narasin and monensin) and three adjuvants (N‐acetylcysteine (NAC), Tris‐EDTA and disodium EDTA) were investigated spectrophotometrically (OD570nm) and quantitatively (CFU/ml) against selected Staphylococcus and Pseudomonas biofilm cultures. Concurrently, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of planktonic cultures were assessed. 16/20 of the S. pseudintermedius clinical isolates were weak biofilm producers. 19/20 P. aeruginosa clinical isolates produced biofilms and were distributed almost equally as weak, moderate and strong biofilm producers. While significant antibiofilm activity was observed, no MBEC was achieved with narasin or monensin. The MBEC for NAC ranged from 5,000–10,000 µg/ml and from 20,000–80,000 µg/ml against S. pseudintermedius and P. aeruginosa, respectively. Tris‐EDTA eradicated P. aeruginosa biofilms at concentrations ranging from 6,000/1,900 to 12,000/3,800 µg/ml. The MBEC was up to 16‐fold and eightfold higher than the MIC/MBC of NAC and Tris‐EDTA, respectively. Disodium EDTA reduced biofilm growth of both strains at concentrations of 470 µg/ml and higher. It can be concluded that biofilm production is common in pathogens associated with canine OE. NAC and Tris‐EDTA are effective antibiofilm agents in vitro that could be considered for the treatment of biofilm‐associated OE in dogs.
Drivers of the growth–survival trade‐off in a tropical forest
Authors: Meira‐Neto João Augusto Alves , Nunes Cândido Hélder Marcos , Miazaki Ângela , Pontara Vanessa , Bueno Marcelo Leandro , Solar Ricardo , Gastauer Markus 
Published: September 2019

AbstractQuestionsThe growth–survival trade‐off is a central concept for the conflicting strategies of acquisitive species that grow quicker and conservative species that grow slower. Understanding which, and how, cross‐species functional traits contribute to the growth–survival trade‐off is a key topic for understanding the functioning of tropical forests. The present study aimed to: (a) determine if leaf traits, wood density and fruit size influence the growth–survival trade‐off at the community level; and (b) test the hypothesis that averaged leaf traits, averaged wood density and averaged fruit size among all trees of subplots explain tree height in a 50‐ha plot of secondary Atlantic Forest in Brazil.MethodsAll trees with DBH > 3 cm had their heights estimated and were taxonomically identified. The functional traits used were leaf length (LL), leaf width (LW), petiole length (PL), petiole width (PW), leaf width/petiole width (LW/PW), leaf length × leaf width (LL*LW), wood density (WD), fruit length (FL) and fruit width (FW).ResultsA total of 74,335 trees of 178 species were recorded in 5,076 subplots of 100 m2. Associations between functional traits and mean height (Hmean) and height mode (Hmode) were congruent with expected trends of LW, LL, LW/PW, WD and FW with the top‐ranked global model explaining most of the found variance suggesting that Hmean and Hmode are the best averaged response variables. The growth response represented by Hmean and Hmode had the most distinctive, congruent and consistent association with LW/PW, WD and FW.ConclusionsHigher LW and higher LW/PW indicated higher dependence of leaf blade on local microclimatic conditions, and lower dependence on petiole support for plant growth, which is beneficial for the acquisitive strategy. Smaller fruits and higher WD were also associated with the acquisitive strategy. Therefore, LW, LW/PW, WD and FW influenced the growth–survival trade‐off at the community level and explained tree height variation in the studied tropical forest.
The medical impact of hepatitis D virus infection in Uzbekistan
Authors: Khodjaeva Malika , Ibadullaeva Nargiz , Khikmatullaeva Aziza , Joldasova Elizaveta , Ismoilov Umed , Colombo Massimo , Caviglia Gian Paolo , Rizzetto Mario , Musabaev Erkin 
Published: September 2019

AbstractBackground & AimsThe hepatitis B virus (HBV) is endemic in Uzbekistan but the medical impact of infection with the HBV‐dependent hepatitis D virus (HDV) is unknown in the Country. An Hepatology Center was recently established at the Institute of Virology in Tashkent, which has set up a database enlisting patients with chronic viral liver disorders from all over Uzbekistan; it provides an observatory on the current scenario of viral hepatitis in the Country.MethodsThe prevalence of HBV monoinfection, hepatitis C virus (HCV) infection and HDV superinfection on hepatitis B surface antigen (HBsAg)‐positive cirrhosis was determined in 6589 patients with viral cirrhosis collected in the last 3 years.ResultsOf 1089, 1150 and 1455 carriers of the HBsAg with cirrhosis recruited in 2016, 2017 and 2018, 834 (76.5%), 926 (80.5%) and 1224 (84%) respectively, had antibody to the HDV. In 2016, 2017 and 2018, the prevalence of HDV infection has been 41%, 45% and 49.1% respectively, largely exceeding the prevalence of HBV monoinfection (12.5%, 11% and 9.3% respectively) and surpassing the prevalence of HCV in 2017 and 2018 (44% and 41.5% respectively). The median age of the patients with HDV cirrhosis was 39 years, distinctly lower than that of HBV and HCV patients (46 and 55).ConclusionsSuperinfection with the HDV is present in over 80% of the HBsAg‐positive cirrhosis in Uzbekistan. The HDV appears to be the major cause of advanced viral liver disease and of juvenile cirrhosis in the Country.
Management of portal hypertension and ascites in polycystic liver disease
Authors: Bernts Lucas H. P. , Drenth Joost P. H. , Tjwa Eric T. T. L. 
Published: September 2019

AbstractPatients suffering from polycystic liver disease may develop Hepatic Venous Outflow Obstruction, Portal Vein Obstruction and/or Inferior Caval Vein Syndrome because of cystic mass effect. This can cause portal hypertension, leading to ascites, variceal haemorrhage or splenomegaly. For this review, we evaluate the evidence to provide clinical guidance for physicians faced with this complication. Diagnosis is made with imaging such as ultrasound, computed tomography or magnetic resonance imaging. Therapy includes conventional therapy with diuretics and paracentesis, and medical therapy using somatostatin analogues. Based on disease phenotype various (non‐)surgical liver‐volume reducing therapies, hepatic or portal venous stenting, transjugular intrahepatic portosystemic shunts and liver transplantation may be considered. Because of complicated anatomy, use of high‐risk interventions and lack of empirical evidence, patients should be treated in expert centres.
Long‐term outcomes after liver transplantation in the Hispanic population
Authors: Ochoa‐Allemant Pedro , Ezaz Ghideon , Trivedi Hirsh D. , Sanchez‐Fernandez Lady , Bonder Alan 
Published: September 2019

AbstractBackground & AimsRacial/ethnic disparities in liver transplantation (LT) are well‐recognized. Although Hispanics represent the largest and youngest minority group in the United States, limited data exist on long‐term outcomes. We aimed to investigate long‐term post‐liver transplant outcomes in Hispanic patients and identify potential disparities compared to a baseline demographic of non‐Hispanic white patients.MethodsWe performed a retrospective cohort study of first‐time liver transplant recipients using the United Network for Organ Sharing database from 2002 to 2013, with follow‐up through 2018. The primary outcomes of interest were overall patient and graft survival after LT.Results45 767 patients underwent LT (85.0% non‐Hispanic white, 15.0% Hispanic). Hispanics had lower socioeconomic status, higher prevalence of pretransplant comorbidities and more severe liver disease compared to non‐Hispanic whites. Hispanics had similar patient (76.6% vs 75.6%;P = .12) and graft (71.7% vs 70.8%;P = .28) survival at 5 years and significantly better patient (62.9% vs 59.7%;P < .001) and graft (58.6% vs 55.6%;P = .002) survival at 10 years. In multivariable analysis, Hispanics had lower associated all‐cause mortality (HR 0.86, 95% CI, 0.82‐0.91;P < .001) and graft failure (HR 0.89, 95% CI, 0.85‐0.93;P < .001) compared to non‐Hispanic whites. In etiology‐specific subanalysis, Hispanics transplanted for ALD, NASH and HCV had lower all‐cause mortality compared to non‐Hispanic whites.ConclusionsHispanics have similar or better long‐term post‐LT outcomes compared to non‐Hispanic whites despite a worse pretransplant risk factor profile. Further research is needed to clarify if this survival advantage reflects uncaptured protective factors or more stringent transplant selection in the Hispanic population.
PAOLO MANTEGAZZA'S VISION: The Science of Man behind the World's First Museum of Anthropology (Florence, Italy, 1869)
Authors: Taylor Paul Michael , Marino Cesare 
Published: September 2019

AbstractThis article examines some significant yet little‐known early anthropological achievements in Italy. These include the world's first museum of anthropology, founded in 1869 by Paolo Mantegazza (1831–1910) at Florence (Firenze), Italy, where that same year he also established Italy's (and the world's) first cattedra (university professorship) of anthropology. Mantegazza sought to develop a unified “science of man,” with a broad definition of the new discipline that brought together human physiological, ethnographic, and “comparative psychology” collections within his new anthropology museum, later complemented by a companion “psychological” museum. Even though Mantegazza's Florentine school of anthropology ended under Fascism, today the surviving Museum of Anthropology in Florence is still the repository of important ethnographic collections from early Italian traveler‐explorers and other contributors. Their study was an important component of Mantegazza's science, which is receiving new attention by modern Italian anthropologists.