bluuebunny/crossref_metadata_2025_split huggingface dataset:
Active Transcutaneous Bone Conduction Implant: Middle Fossa Placement Technique in Children With Bilateral Microtia and External Auditory Canal Atresia
Authors: Der Carolina , Bravo-Torres Sofía , Pons Nicolás 
Published: April 2018

Aim:
The aim of this study is to present the middle fossa technique (MFT) as an alternative for patients who cannot undergo traditional surgery for active transcutaneous bone conduction implants (ATBCI) due to their altered anatomy or desire for future aesthetic reconstruction.

Design:
A case series descriptive study was designed. The MFT was developed. Preoperative and postoperative information from 24 patients with external auditory canal atresia (EACA) and implanted with ATBCI was reviewed.

Results:
A total of 24 children with bilateral EACA received implants in the middle cranial fossa. Their average age was 12. Of these patients, eight had an associated congenital disorder: Goldenhar Syndrome, Treacher Collins Syndrome or the Pierre Robin Sequence. The average follow-up was at 17 months (ranging from between 2– and 36 mo) and there were no major complications. Four patients showed skin erythema at the processor site after turn on, which was solved by lowering the magnet strength. One patient had a scalp hematoma that required puncture drainage. The hearing thresholds went down on average from 66.5 to 25.2 dB 1 month after turn on. Speech recognition improved respectively from 29.4% without and 78.9% with a bone conduction hearing aid to 96.4%.

Conclusion:
MFT placement of the ATBCI was proven to be safe and effective and a viable option for treating pediatric patients with EACA who cannot receive implants at the sinodural angle or in the retrosigmoidal position because of their altered anatomy and/or desire for future aesthetic reconstruction.
A Randomized Controlled Trial Comparing Nitazoxanide Plus Lactulose With Lactulose Alone in Treatment of Overt Hepatic Encephalopathy
Authors: Abd-Elsalam Sherief , El-Kalla Ferial , Elwan Nadia , Badawi Rehab , Hawash Nehad , Soliman Shaimaa , Soliman Samah , Elkhalawany Walaa , ElSawaf Mennat-Allah , Elfert Asem 
Published: April 2018

Background and Aims:
Hepatic encephalopathy (HE) is a reversible spectrum of neuropsychiatric abnormalities associated with liver dysfunction. Lactulose is a nonabsorbable disaccharide presently used to treat HE. Nitazoxanide (NTZ) has a broad-spectrum activity against urease-producing bacteria, so it decreases ammonia production and is therefore expected to reverse the symptoms of HE. A previous pilot study on HE patients given NTZ and lactulose had encouraging results with regard to amelioration of the clinical picture. Patients showed improvement in mental status and the drug was well-tolerated. Results such as these are encouraging larger studies. The aim of this study was to compare the safety and adequacy of NTZ plus lactulose versus lactulose and placebo in management of overt HE.

Methods:
In total, 120 cirrhotic patients suffering from overt HE were randomly designated to take either NTZ plus lactulose (n=60) or lactulose and placebo (n=60). The Clinical Hepatic Encephalopathy Staging Scale (CHESS) score was assessed for all patients on inclusion to the study and 1 week from the start of treatment.

Results:
Both groups evinced an improvement in CHESS score at 1 week, yet the improvement was significantly better in the NTZ group as the score decreased from 4.15±2.09 to 0.00±0.00 compared with 4.96±2.29 to 1.28±0.91 in patients receiving lactulose and placebo (P-value <0.001).

Conclusions:
NTZ significantly decreases the CHESS score and improves mental status in the form of patient alertness, orientation, response to stimulation, and ability to talk. NTZ is safe and well-tolerated apart from infrequent epigastric pain.
Choice Defines QALYs
Authors: Craig Benjamin M. , Rand Kim 
Published: April 2018

Background:
The 5-level version of the EQ-5D (EQ-5D-5L) was introduced as an improvement on the original 3-level version (EQ-5D-3L). To date, 6 country-specific value sets have been published for EQ-5D-5L and 9 US value sets have been published for other instruments. Our aims were to (1) produce EQ-5D-5L values on a quality-adjusted life year (QALY) scale from the perspective of US adults and (2) compare them with US EQ-5D-3L values and the other country-specific EQ-5D-5L values.

Methods:
In 2016, 8222 US respondents from all 50 states and Washington, DC completed an online survey including a discrete choice experiment with 20 paired comparisons. Each comparison asked respondents, “Which do you prefer?” regarding a pair of alternatives described using EQ-5D-5L and lifespan attributes. On the basis of more than 50 choices on each of the 3160 pairs, we estimated EQ-5D-5L values on a QALY scale and compared them with the US EQ-5D-3L values and the other country-specific EQ-5D-5L values.

Results:
Ranging from −0.287 (55555) to 0.992 (11121) on a QALY scale, the estimated EQ-5D-5L values were similar to the US EQ-5D-3L values. Compared with the US EQ-5D-3L values, the values exhibited greater sensitivity and specificity and higher correlation with the EQ-5D-5L values of other countries, particularly England.

Conclusions:
Like previous US valuation studies, this study produced nationally representative EQ-5D-5L values on a QALY scale. The results further demonstrate the advantages of the EQ-5D-5L over its 3-level predecessor as a preference-based summary measure of health-related quality of life from the perspective of US adults.
Coverage of Medications That Treat Opioid Use Disorder and Opioids for Pain Management in Marketplace Plans, 2017
Authors: Huskamp Haiden A. , Riedel Lauren E. , Barry Colleen L. , Busch Alisa B. 
Published: April 2018

Background:
Efficacious medications to treat opioid use disorders (OUDs) have been slow to diffuse into practice, and insurance coverage limits may be one important barrier.

Objectives:
To compare coverage for medications used to treat OUDs and opioids commonly prescribed for pain management in plans offered on the 2017 Health Insurance Marketplace exchanges.

Research Design:
We identified a sample of 100 plans offered in urban and in rural counties on the 2017 Marketplaces, weighting by population. We accessed publicly available plan coverage information on healthcare.gov for states with a federally facilitated exchange, the state exchange website for state-based exchanges, and insurer websites.

Results:
About 14% of plans do not cover any formulations of buprenorphine/naloxone. Plans were more likely to require prior authorization for any of the covered office-based buprenorphine or naltrexone formulations preferred for maintenance OUD treatment (ie, buprenorphine/naloxone, buprenorphine implants, injectable long-acting naltrexone) than of short-acting opioid pain medications (63.6% vs. 19.4%; P<0.0001). Only 10.6% of plans cover implantable buprenorphine, 26.1% cover injectable naltrexone, and 73.4% cover at least 1 abuse-deterrent opioid pain medication.

Conclusions:
Many Marketplace plans either do not cover or require prior authorization for coverage of OUD medications, and these restrictions are often more common for OUD medications than for short-acting opioid pain medications. Regulators tasked with enforcement of the Mental Health Parity and Addiction Equity Act, which requires that standards for formulary design for mental health and substance use disorder drugs be comparable to those for other medications, should focus attention on formulary coverage of OUD medications.
Examining Trends in Obstetric Quality Measures for Monitoring Health Care Disparities
Authors: Janevic Teresa , Egorova Natalia N. , Zeitlin Jennifer , Balbierz Amy , Hebert Paul L. , Howell Elizabeth A. 
Published: April 2018

Background:
Elective delivery (ED) before 39 weeks, low-risk cesarean delivery, and episiotomy are routinely reported obstetric quality measures and have been the focus of quality improvement initiatives over the past decade.

Objective:
To estimate trends and differences in obstetric quality measures by race/ethnicity.

Research Design:
We used 2008–2014 linked birth certificate–hospital discharge data from New York City to measure ED before 39 gestational weeks (ED <39), low-risk cesarean, and episiotomy by race/ethnicity. Measures were following the Joint Commission and National Quality Forum specifications. Average annual percent change (AAPC) was estimated using Poisson regression for each measure by race/ethnicity. Risk differences (RD) for non-Hispanic black women, Hispanic women, and Asian women compared with non-Hispanic white women were calculated.

Results:
ED<39 decreased among whites [AAPC=−2.7; 95% confidence interval (CI), −3.7 to −1.7), while it increased among blacks (AAPC=1.3; 95% CI, 0.1–2.6) and Hispanics (AAPC=2.4; 95% CI, 1.4–3.4). Low-risk cesarean decreased among whites (AAPC=−2.8; 95% CI, −4.6 to −1.0), and episiotomy decreased among all groups. In 2008, white women had higher risk of most measures, but by 2014 incidence of ED<39 was increased among Hispanics (RD=2/100 deliveries; 95% CI, 2–4) and low-risk cesarean was increased among blacks (RD=3/100; 95% CI, 0.5–6), compared with whites. Incidence of episiotomy was lower among blacks and Hispanics than whites, and higher among Asian women throughout the study period.

Conclusions:
Existing measures do not adequately assess health care disparities due to modest risk differences; nonetheless, continued monitoring of trends is warranted to detect possible emergent disparities.
Osteopontin Levels in Human Milk Vary Across Countries and Within Lactation Period
Authors: Bruun Signe , Jacobsen Lotte Neergaard , Ze Xiaolei , Husby Steffen , Ueno Hiroshi M. , Nojiri Keisuke , Kobayashi Shunjiro , Kwon Jungil , Liu Xihong , Yan Shuyuan , Yang Jiyeon , Zachariassen Gitte , Chen Liang , Zhou Wei , Christensen Brian , Sørensen Esben S. 
Published: April 2018

ABSTRACTObjectives:Osteopontin (OPN) is a multifunctional protein expressed in many cell types, tissues and body fluids with the highest concentrations found in milk; significantly higher in human than in bovine milk. Intervention studies have indicated beneficial effects of supplementing infant formula with bovine OPN. In this multicenter study, we determined the OPN content in human milk samples from 629 Chinese, Danish, Japanese and Korean mothers.Methods:At each study site, milk samples were collected and analyzed for OPN and protein concentration using ELISA and infrared spectroscopy, respectively.Results:A total of 829 milk samples from 629 women were included. When delivering the first sample, mean maternal age was 31.4 years (SD 4.0), and median infant age was 13.4 weeks (interquartile range 4.6–17.9). The median OPN concentration varied across sites; from 99.7 mg/L in Danish, 185.0 mg/L in Japanese, 216.2 mg/L in Korean to 266.2 mg/L in Chinese mothers (P < 0.001), corresponding to 1.3%, 2.4%, 1.8% and 2.7% of the total protein content (OPN/protein%) (P < 0.05), respectively. Based on 75 Chinese and 33 Japanese mothers delivering more than 1 sample, multilevel (mixed model) linear regression analysis showed a decrease in OPN concentration with infant age (β = (−11.3), 95% confidence interval (CI) = (−13.9) to (−8.8) and β = (−2.1), 95% CI = (−3.2) to (−0.9), respectively).Conclusions:In this large multicenter study, we observed statistically significant differences in the OPN concentration and the OPN/protein% in human milk samples between countries. Based on mothers delivering more than 1 sample, a significant decrease within the lactation period was observed.
Epstein-Barr Virus, High-Risk Human Papillomavirus and Abnormal Cervical Cytology in a Prospective Cohort of African Female Sex Workers
Authors: Cameron Jennifer E. , Rositch Anne F. , Vielot Nadja A. , Mugo Nelly R. , Kwatampora Jessie K.L. , Waweru Wairimu , Gilliland Aubrey E. , Hagensee Michael E. , Smith Jennifer S. 
Published: April 2018

Background
High-oncogenic-risk human papillomavirus (hrHPV) is necessary, although insufficient, to promote cervical cancer. Like HPV, Epstein-Barr virus (EBV) is a common pathogen with the capacity to promote epithelial neoplasms. We examined the association between cervical EBV, hrHPV, and cytology in female sex workers in Nairobi, Kenya.

Methods
Women (n = 332) with known cervical cytology and hrHPV mRNA results were evaluated for cervical EBV DNA by conventional polymerase chain reaction. Prevalence ratios (PRs) were calculated to assess the relationships between EBV, hrHPV, and cervical cytology. Prospective analyses used risk ratios and time-to-event analyses to determine the association of EBV with hrHPV clearance and with abnormal cytology outcomes.

Results
Baseline prevalence of hrHPV and EBV was 29% and 19%, respectively. Higher EBV prevalence was found among women with older age, HIV, hrHPV, abnormal cytology, Mycoplasma genitalium infection, smoking habits, younger age at sexual debut, and less frequent condom use. At baseline, women with EBV had a higher prevalence of hrHPV infection than did EBV-negative women (52% vs. 24%; HIV-adjusted PR [95% confidence interval], 1.8 [1.3–2.6]). Epstein-Barr virus–positive women had a higher prevalence than did EBV-negative women of high-grade precancer (15% vs. 2%) and abnormal cytology (37% vs. 15%), although HIV- and hrHPV-adjusted associations were not significant (high-grade precancer: PR, 2.0 [0.7–5.9]; abnormal cytology: PR, 1.4 [0.9–2.2]). In prospective analyses, a marginal association was observed between baseline EBV detection and delayed hrHPV clearance.

Conclusions
Our data support a possible role for EBV as a high-risk marker or cofactor for HPV-mediated cervical cancer development.
The Proportion of Young Women Tested for Chlamydia Who Had Urogenital Symptoms in Physician Offices
Authors: Patel Chirag G. , Trivedi Shivika , Tao Guoyu 
Published: April 2018

Abstract
Using National Ambulatory Medical Care Survey data from 2006 to 2015, we estimated the proportions of young women tested for chlamydia who were symptomatic (urogenital symptoms) or asymptomatic in physician offices. Among women tested for chlamydia, the proportions of women with and without urogenital symptoms were 31.6% and 59.2%, respectively.
Traumatic Brain Injury and Infectious Encephalopathy in Children From Four Resource-Limited Settings in Africa*
Authors: Fink Ericka L. , von Saint Andre-von Arnim Amelie , Kumar Rashmi , Wilson Patrick T. , Bacha Tigist , Aklilu Abenezer Tirsit , Teklemariam Tsegazeab Laeke , Hooli Shubhada , Tuyisenge Lisine , Otupiri Easmon , Fabio Anthony , Gianakas John , Kochanek Patrick M. , Angus Derek C. , Tasker Robert C. 
Published: April 2018

Objectives:
To assess the frequency, interventions, and outcomes of children presenting with traumatic brain injury or infectious encephalopathy in low-resource settings.

Design:
Prospective study.

Setting:
Four hospitals in Sub-Saharan Africa.

Patients:
Children age 1 day to 17 years old evaluated at the hospital with traumatic brain injury or infectious encephalopathy.

Interventions:
None.

Measurements and Main Results:
We evaluated the frequency and outcomes of children presenting consecutively over 4 weeks to any hospital department with traumatic brain injury or infectious encephalopathy. Pediatric Cerebral Performance Category score was assessed pre morbidity and at hospital discharge. Overall, 130 children were studied (58 [45%] had traumatic brain injury) from hospitals in Ethiopia (n = 51), Kenya (n = 50), Rwanda (n = 20), and Ghana (n = 7). Forty-six percent had no prehospital care, and 64% required interhospital transport over 18 km (1–521 km). On comparing traumatic brain injury with infectious encephalopathy, there was no difference in presentation with altered mental state (80% vs 82%), but a greater proportion of traumatic brain injury cases had loss of consciousness (80% vs 53%; p = 0.004). Traumatic brain injury patients were older (median [range], 120 mo [6–204 mo] vs 13 mo [0.3–204 mo]), p value of less than 0.001, and more likely male (73% vs 51%), p value of less than 0.01. In 78% of infectious encephalopathy cases, cause was unknown. More infectious encephalopathy cases had a seizure (69% vs 12%; p < 0.001). In regard to outcome, infectious encephalopathy versus traumatic brain injury: hospital lengths of stay were longer for infectious encephalopathy (8 d [2–30 d] vs 4 d [1–36 d]; p = 0.003), discharge rate to home, or for inpatient rehabilitation, or death differed between infectious encephalopathy (85%, 1%, and 13%) and traumatic brain injury (79%, 12%, and 1%), respectively, p value equals to 0.044. There was no difference in the proportion of children surviving with normal or mild disability (73% traumatic brain injury vs 79% infectious encephalopathy; p = 0.526).

Conclusions:
The epidemiology and outcomes of pediatric traumatic brain injury and infectious encephalopathy varied by center and disease. To improve outcomes of these conditions in low-resource setting, focus should be on neurocritical care protocols for pre-hospital, hospital, and rehabilitative care.
A Comparison of Robotic Versus Open Thyroidectomy for Papillary Thyroid Cancer
Authors: Paek Se Hyun , Kang Kyung Ho , Park Sung Jun 
Published: April 2018

Objectives:
This study investigated the potential advantages of robotic thyroidectomy and determined whether it is safe and complete compared with conventional open surgery in patients with papillary thyroid cancer.

Materials and Methods:
A total 376 consecutive patients who underwent total thyroidectomy and central neck dissection for papillary thyroid cancer from February 2013 to July 2014 were retrospectively reviewed. Postoperative complication rates and surgical completeness were compared between the robotic and open groups.

Results:
Transient hypoparathyroidism was higher in the open group (10.5%) compared with the robotic group (2.8%; P=0.042). There were no differences in mean number of retrieved or metastatic lymph nodes. The mean values of stimulated thyroglobulin level were acceptably low in both groups. There was no difference in the proportion of patients with stimulated thyroglobulin levels <1 ng/mL.

Conclusion:
Our study results show that outcomes of robotic thyroidectomy may be similar to that of conventional thyroidectomy, with possible better preservation of the parathyroid blood supply.
Reinventing the wheel: Impact of prolonged antibiotic exposure on multidrug-resistant ventilator-associated pneumonia in trauma patients
Authors: Lewis Richard H. , Sharpe John P. , Swanson Joseph M. , Fabian Timothy C. , Croce Martin A. , Magnotti Louis J. 
Published: April 2018

BACKGROUND
Multidrug-resistant (MDR) strains of both Acinetobacter baumannii (AB) and Pseudomonas aeruginosa (PA) as causative ventilator-associated pneumonia (VAP) pathogens are becoming increasingly common. Still, the risk factors associated with this increased resistance have yet to be elucidated. The purpose of this study was to examine the changing sensitivity patterns of these pathogens over time and determine which risk factors predict MDR in trauma patients with VAP.

METHODS
Patients with either AB or PA VAP over 10 years were stratified by pathogen sensitivity (sensitive [SEN] and MDR), age, severity of shock, and injury severity. Prophylactic and empiric antibiotic days, risk factors for severe VAP, and mortality were compared. Multivariable logistic regression was performed to determine which risk factors were independent predictors of MDR.

RESULTS
Three hundred ninety-seven patients were identified with AB or PA VAP. There were 173 episodes of AB (91 SEN and 82 MDR) and 224 episodes of PA (170 SEN and 54 MDR). The incidence of MDR VAP did not change over the study (p = 0.633). Groups were clinically similar with the exception of 24-hour transfusions (14 vs. 19 units, p = 0.009) and extremity Abbreviated Injury Scale (AIS) score (1 vs. 3, p < 0.001), both significantly increased in the MDR group. Antibiotic exposure as well as multiple episodes of inadequate empiric antibiotic therapy (mIEAT) (63% vs. 81%, p < 0.001) were significantly increased in the MDR group. Multivariable logistic regression identified prophylactic antibiotic days (odds ratio, 23.1; 95% confidence interval, 16.7–28, p < 0.001) and mIEAT (odds ratio, 18.1; 95% confidence interval, 12.2–26.1, p = 0.001) as independent predictors of MDR after adjusting for severity of shock, injury severity, severity of VAP, and antibiotic exposure.

CONCLUSION
Prolonged exposure to unnecessary antibiotics remains one of the strongest predictors for the development of antibiotic resistance. Multivariable logistic regression identified prophylactic antibiotic days and mIEAT an independent risk factors for MDR VAP. Thus, limiting prophylactic antibiotic days is the only potentially modifiable risk factor for the development of MDR VAP in trauma patients.

LEVEL OF EVIDENCE
Level IV Therapeutic; level III Prognostic.
Beyond Core Object Recognition: Recurrent processes account for object recognition under occlusion
Authors: Rajaei Karim , Mohsenzadeh Yalda , Ebrahimpour Reza , Khaligh-Razavi Seyed-Mahdi 
Published: April 2018

AbstractCore object recognition, the ability to rapidly recognize objects despite variations in their appearance, is largely solved through the feedforward processing of visual information. Deep neural networks are shown to achieve human-level performance in these tasks, and explain the primate brain representation. On the other hand, object recognition under more challenging conditions (i.e. beyond the core recognition problem) is less characterized. One such example is object recognition under occlusion. It is unclear to what extent feedforward and recurrent processes contribute in object recognition under occlusion. Furthermore, we do not know whether the conventional deep neural networks, such as AlexNet, which were shown to be successful in solving core object recognition, can perform similarly well in problems that go beyond the core recognition. Here, we characterize neural dynamics of object recognition under occlusion, using magnetoencephalography (MEG), while participants were presented with images of objects with various levels of occlusion. We provide evidence from multivariate analysis of MEG data, behavioral data, and computational modelling, demonstrating an essential role for recurrent processes in object recognition under occlusion. Furthermore, the computational model with local recurrent connections, used here, suggests a mechanistic explanation of how the human brain might be solving this problem.Author SummaryIn recent years, deep-learning-based computer vision algorithms have been able to achieve human-level performance in several object recognition tasks. This has also contributed in our understanding of how our brain may be solving these recognition tasks. However, object recognition under more challenging conditions, such as occlusion, is less characterized. Temporal dynamics of object recognition under occlusion is largely unknown in the human brain. Furthermore, we do not know if the previously successful deep-learning algorithms can similarly achieve human-level performance in these more challenging object recognition tasks. By linking brain data with behavior, and computational modeling, we characterized temporal dynamics of object recognition under occlusion, and proposed a computational mechanism that explains both behavioral and the neural data in humans. This provides a plausible mechanistic explanation for how our brain might be solving object recognition under more challenging conditions.