bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment Tool by UNICEF and LATCH Scoring System for Identification of Inadequacy of Breastfeeding in Early Neonatal Period: An Observational Cross-sectional Comparative Study
Authors: Jain Juhi , Hemrajani Satyen K. , Sharma Shyam Sundar , Gurjar Varun , Banveer Parul 
Published: May 2024

Background Breast milk is the most ideal nourishment for a neonate with a high level of bio-efficacy. Learning the right breastfeeding technique is a challenging job, especially for new and young mothers; hence, there is a need for a valid and reliable measuring tool to determine the adequacy of breastfeeding. Objective To check the adequacy of breastfeeding in mother–neonate dyads using breastfeeding assessment tools by comparing UNICEF and LATCH scoring systems and to test the reliability of the tools through test–retest reliability. Design An observational cross-sectional comparative study. Setting Department of Neonatology, Fortis Escorts Hospital, Jaipur, Rajasthan, India. Methods All stable neonates of ≥34 weeks gestational age born at the private tertiary care hospital were included in the study. Dyads in which breastfeeding was initiated within 6 hours of life were assessed using both LATCH and UNICEF tools on days 1 and 2 of life in the case of normal vaginal delivery and on days 1, 2 and 3 in caesarean deliveries, and were further followed up on days 5 and 7. Results The median LATCH score and UNICEF score for breastfeeding showed an increase throughout the assessment period. A moderately positive correlation (Spearman’s rho = 0.732) was noticed between the two scores on day 1 of the assessment. On day 2 (Spearman’s rho = 0.81) and day 3 (Spearman’s rho = 0.735), a high positive correlation between the two tools was observed. However, day 4 revealed a low positive correlation (Spearman’s rho = 0.456). Meanwhile, the follow-up scores of both tools showed a high positive correlation (Spearman’s rho = 0.713). Conclusion The study evidenced a positive correlation between the LATCH and UNICEF scores; both scoring systems displayed a good percent agreement on all the five assessment days. The test–retest reliability was high between the tools on days 1 and 2.
San Raymundo: Focus Group About Comadronas’ Response to Obstetrical Emergencies in Urban Guatemala
Authors: Garcia Kimberly 
Published: May 2024

Introduction: Comadronas attend most births in rural and urban Guatemala where the maternal mortality rate (MMR) is highest in Latin America. Information has been published regarding rural comadronas’ response to obstetrical emergencies. Understanding urban comadronas’ response to obstetrical emergencies is essential to addressing Guatemala’s MMR. Methods: A total of 17 urban comadronas participated in one, 34-min focus group to share their knowledge, practices, and attitudes regarding obstetrical emergencies. We used the long table to analyze the content to develop a matrix of themes. Results: Five themes emerged. Urban comadronas receive consistent training, have hospital transportation, and feel confident in their knowledge, but they lack equipment and feel hospital providers disrespect them. Still, the joy of attending births outweighs the challenges they face. Discussion: Urban comadronas described a different experience of responding to obstetrical emergencies than rural comadronas. Distinct approaches are needed to provide culturally congruent support for urban and rural comadronas when responding to obstetrical emergencies.
Low-Dose Valganciclovir Prophylaxis Against Cytomegalovirus in Intermediate-Risk Liver and Dual-Abdominal Transplant Recipients
Authors: Li Yihan , Pluckrose Dawn M. , Patolia Roshani , Arnouk Serena , Dubrovskaya Yanina , Papadopoulos John , Jonchhe Srijana 
Published: May 2024

Background: Low-dose valganciclovir (VGC) for cytomegalovirus (CMV) prophylaxis post-transplant has been employed due to cost and safety. The incidence of CMV disease in CMV intermediate-risk liver recipients at 1-year after standard-dose prophylaxis is approximately 5%. However, there are limited data on outcomes after using a “true” low-dose VGC prophylaxis regimen in liver and dual-abdominal transplant recipients as VGC was not dose-adjusted in all patients with impaired renal function in prior studies. Objective: The objective was to assess the incidence of CMV associated with low-dose VGC prophylaxis in CMV intermediate-risk liver, simultaneous pancreas-kidney (SPK), and simultaneous liver-kidney (SLK) recipients with creatinine clearance (CrCl) >60 mL/min. Methods: This was a retrospective review of CMV intermediate-risk liver, SPK, and SLK recipients with CrCl >60 mL/min transplanted January 2018 to June 2022 who received VGC 450 mg daily for prophylaxis. The primary outcome was incidence of CMV infection 6-months post-transplant. Results: Ninety-nine transplant recipients were included (79 liver, 11 SPK, 9 SLK). The primary outcome occurred in 13% of patients (liver 10%, SPK 36%, SLK 10%), including 1 case of CMV disease and 3 breakthrough infections. In addition, 6 patients experienced CMV infection between 6-months and 1-year. Recurrence occurred in 3 patients. There was no evidence of CMV resistance. Thirty patients experienced neutropenia within 1-year, 32 were prescribed granulocyte-colony stimulating factors, and 5 experienced thrombocytopenia. Two patients died due to graft-vs-host disease. Conclusion and Relevance: Low-dose VGC prophylaxis led to comparable CMV infection rates at 6-months in CMV intermediate-risk liver and SLK recipients. However, as SPK recipients displayed higher rates of CMV infection, low-dose VGC should be avoided in this population.
The Influence of Patient Characteristics and Social Determinants of Health on Postoperative Complications Following Achilles Tendon Rupture
Authors: Hendriks Joris R. H. , Baker Riley J. , de Groot Tom M. , Lans Amanda , Waryasz Gregory R. , Kerkhoffs Gino M. M. J. , Ashkani-Esfahani Soheil , DiGiovanni Christopher W. , Guss Daniel 
Published: May 2024

Background: The influence of social determinants of health (SDH) on postoperative complications has been investigated in several studies, although correlation with Achilles tendon rupture (ATR) repair remains uninvestigated. SDH encompasses several factors, including insurance status and area-based measurements, including the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), which ranks neighborhoods by social disadvantage. This study investigated the correlation between patient demographics, SDH, and complications following ATR repair. Methods: A retrospective cohort study was conducted on 521 patients who presented with acute ATR and met the inclusion criteria, including age ≥18 years, a minimum of 30-day follow-up, and repair within 28 days of rupture. We reviewed patient demographics, time to surgery (TTS), and postoperative complications, including venous thromboembolism (VTE), rerupture, surgical site infection (SSI), wound dehiscence, and sural nerve injury. SDH variables included race, smoking status, insurance status, level of education, ADI, and SVI. Univariate regression tested the correlation between complications and SDH indicators. Significant variables ( P < .05) were included in a multivariate regression. Results: Sixty-eight complications occurred in 59 patients (11.3%). Multivariate regression showed that a higher ADI, that is, socially deprived individuals, was associated with lower rates of VTE (OR = 0.41, P = .04). Higher body mass index (BMI) was associated with rerupture (OR = 8.73, P < .01). Male patients had lower rates of wound dehiscence (OR = 0.31, P = .03) and VTE (OR = 0.32, P = .02) compared with women. Longer TTS correlated with sural nerve injuries (OR = 2.23, P < .01) and shorter TTS with reruptures (OR = 0.02, P  = .02). Conclusion: Some measures of SDH were associated with postoperative complications. Gender also may have an effect, with male sex associated with lower rates of wound dehiscence and VTE. BMI was associated with higher rates of reruptures and overall general complications.
A Network Approach to Understanding the Role of Executive Functioning and Alpha Oscillations in Inattention and Hyperactivity-Impulsivity Symptoms of ADHD
Authors: Vera Juan Diego , Freichel René , Michelini Giorgia , Loo Sandra K. , Lenartowicz Agatha 
Published: May 2024

Objective: ADHD is a prevalent neurodevelopmental disorder characterized by symptoms of inattention and hyperactivity-impulsivity. Impairments in executive functioning (EF) are central to models of ADHD, while alpha-band spectral power event-related decreases (ERD) have emerged as a putative electroencephalography (EEG) biomarker of EF in ADHD. Little is known about the roles of EF and alpha ERD and their interactions with symptoms of ADHD. Method: We estimated network models of ADHD symptoms and integrated alpha ERD measures into the symptom network. Results: EF emerges as a bridge network node connecting alpha ERD and the hyperactivity/impulsivity and inattention symptoms. We found that EF most closely relates to a subset of symptoms, namely the motoric symptoms, “seat” (difficulty staying seated), and “runs” (running or climbing excessively). Conclusions: EF functions as a bridge node connecting alpha ERD and the ADHD symptom network. Motoric-type symptoms and EF deficits may constitute important nodes in the interplay between behavior/symptoms, cognition, and neurophysiological markers of ADHD.
Supersonic jet noise mitigation by angled tab perforation
Authors: Khandai Suresh C , Bogadi Surendra , Manikanta TVS 
Published: May 2024

Supersonic jet noise, a significant concern in military and civilian aerospace due to its impact on aircraft operability, environmental compliance, and community noise standards, drives the need for studies on jet mixing to optimize processes and reduce noise emissions effectively. This study presents the design and development of a Mach 1.6 nozzle, designed to evaluate the jet decay, directional spread and noise attenuation character. Incorporated at the nozzle exit are two rectangular tabs, with perforation angles of zero and 30 degrees. These tabs, with a blockage ratio of 0.09, are strategically positioned to modify the exhaust flow pattern. Experimental analyses, inclusive of jet decay and acoustic assessments, were conducted at a nozzle pressure ratio of 4.25, corresponding to optimal expansion conditions. Observations were made on the centerline pressure decay along the jet axis and the lateral jet spreading for baseline and controlled jets. Utilizing the Schlieren optical method, the shockwave structures were visualized to understand the flow physics. The results indicated a substantial reduction in the length of the potential core, amounting to 65.13% and 80.76% for zero- and thirty-degrees perforation angles, respectively, compared to an unmodified baseline jet. Moreover, as compared to the baseline jet the 30 degrees perforation configuration demonstrated a significant 9 dB reduction in jet noise.
Developing preceptorship programmes by exploring the needs of newly qualified sonographers through the lens of experienced ultrasound preceptors
Authors: Phillips Rita , Alsop Siobhan 
Published: May 2024

Introduction: This study aimed to explore the needs of newly qualified sonographers with respect to the requirements of preceptorship. This paper describes the first stage of research, with data obtained from a cohort of experienced preceptors. A second stage of research with data from newly qualified sonographers is pending synthesis with this work. The aim is to produce an evidenced-based tool to support departments in developing and implementing effective and robust preceptorship. Methods: Twelve experienced participants from eight trusts, with a range of clinical backgrounds and experience were recruited. Two focus groups were held with questions structured around known themes highlighted in current evidence regarding newly qualified sonographers. The interviews were recorded and transcribed, and the qualitative data were analysed using thematic analysis. Results: Four main themes with subthemes emerged. These were: (1) the gaps between qualification and proficiency, (2) the need for managerial investment and formalisation, (3) the preceptor and (4) tools to support the transition and prevent burnout. Frequency data and quotes are given as exemplars. Conclusion: Participants report that newly qualified sonographers require support in report writing, clinical reasoning and confidence, and this should be addressed within preceptorship while acknowledging individual needs. Managerial investment is essential in ensuring adequate support and protected time is available for important preceptorship activities, such as meeting for feedback and feedforward with opportunity to clearly document progression. Inadequate support may be damaging for the wellbeing of preceptor and preceptee and ultimately impact the standard of our ultrasound services and patient care.
Unmet needs in treatment of symptomatic uncomplicated diverticular disease and prevention of recurrent acute diverticulitis: a scoping review
Authors: Carabotti Marilia , Cuomo Rosario , Marasco Giovanni , Barbara Giovanni , Radaelli Franco , Annibale Bruno 
Published: May 2024

Background: Diverticular disease (DD) represents a common gastrointestinal condition that poses a heavy burden on healthcare systems worldwide. A high degree of uncertainty surrounds the therapeutic approaches for the control of symptoms in patients with symptomatic uncomplicated diverticular disease (SUDD) and primary and secondary prevention of diverticulitis and its consequences. Objectives: To review the current knowledge and discuss the unmet needs regarding the management of SUDD and the prevention of acute diverticulitis. Eligibility criteria: Randomized trials, observational studies, and systematic reviews on lifestyle/dietary interventions and medical treatment (rifaximin, mesalazine, and probiotics) of SUDD or prevention of acute diverticulitis. Sources of evidence: The literature search was performed from inception to April 2023, without language restriction, following the modified Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) reporting guidelines. References of the papers selected were checked to identify additional papers of potential interest. The final list of references was evaluated by a panel of experts, who were asked to check for any lack of relevant studies. Charting methods: Information on patient population, study design, intervention, control group, duration of the observation, and outcomes assessed was collected by two authors independently. Results: The review shows a high degree of uncertainty about therapeutic interventions, both dietary/lifestyle and pharmacological, in patients with SUDD, because of the scarcity and weakness of existing evidence. Available studies are generally of low quality, heterogeneous, and outdated, precluding the possibility to draw robust conclusions. Similarly, acute diverticulitis prevention has been seldom investigated, and there is a substantial lack of evidence supporting the role of dietary/lifestyle or pharmacological approaches to reduce the risk of diverticulitis. Conclusion: The lack of robust evidence regarding therapeutic options for gastrointestinal symptoms in SUDD patients and for primary and secondary prevention of acute diverticulitis remains an important unmet need in the management of DD.
TAURUS-MS II: real-world use of teriflunomide in Germany and changes in treatment patterns over time
Authors: Kallmann Boris-Alexander , zu Eulenburg Georg , Kullmann Jennifer S. , Mäurer Mathias 
Published: May 2024

Background: Teriflunomide is a once-daily oral disease-modifying therapy (DMT) for the treatment of relapsing-remitting multiple sclerosis (RRMS). Only limited information is available about its real-world use and changes over time. Objectives: To collect real-world data on teriflunomide use in clinical routine (and comparison to the previously conducted study TAURUS-MS). Design: National, open, non-interventional, prospective, multicenter study. Methods: TAURUS-MS II was conducted at 220 German sites between July 2017 and March 2022, including RRMS patients treated with teriflunomide. Data on patient demographics, MS history, previous treatment, therapy satisfaction, and safety were collected. Results: In total, 752 patients were included (65% female) with a mean age (±standard deviation) of 43 ± 11 years. Sixty-six percent had DMT before, and 46% had discontinued their last pretreatment ≤6 months prior to study entry. Among the latter, previous DMTs were interferon (21%), glatiramer acetate (11%), and dimethyl fumarate (9%), and reasons for discontinuation were adverse events (AEs; 55%) and insufficient efficacy (16%). Over 24 months, the mean treatment Satisfaction Questionnaire for Medication scores improved by 6 ± 29 points on effectiveness, 8 ± 20 on convenience, and 12 ± 25 on global satisfaction. The mean number of MS relapses decreased from 0.81 ± 0.81 in the 24 months prior to 0.27 ± 0.57 within 24 months after study entry. Non-serious AEs occurred in 423 patients (56%) and serious AEs in 49 patients (7%). Most reported AEs were alanine aminotransferase increase (11%), hypertension (8%), and alopecia (7%). Compared to TAURUS-MS, patients in TAURUS-MS II were younger, had a higher employment rate, and a higher share of treatment-naïve patients. Conclusion: Mean number of relapses was significantly reduced. Patient satisfaction was significantly improved compared to previous DMT. Tolerability was comparable to previous trials. Trial registration: Bundesinstitut für Arzneimittel und Medizinprodukte public database for non-interventional studies, number 7138.
Therapeutic drug monitoring guidelines in oncology: what do we know and how to move forward? Insights from a systematic review
Authors: Li Xinya , Song Zaiwei , Yi Zhanmiao , Qin Jiguang , Jiang Dan , Wang Zhitong , Li Huibo , Zhao Rongsheng 
Published: May 2024

Background: Compared with anti-infective drugs, immunosuppressants and other fields, the application of therapeutic drug monitoring (TDM) in oncology is somewhat limited. Objective: We aimed to provide a comprehensive understanding of TDM guidelines for antineoplastic drugs and to promote the development of individualized drug therapy in oncology. Design: This study type is a systematic review. Data sources and methods: This study was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Databases including PubMed, Embase, the official websites of TDM-related associations and Chinese databases were comprehensively searched up to March 2023. Two investigators independently screened the literature and extracted data. The methodological and reporting quality was evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) and the Reporting Items for Practice Guidelines in Healthcare (RIGHT), respectively. Recommendations and quality evaluation results were presented by visual plots. This study was registered in PROSPERO (No. CRD42022325661). Results: A total of eight studies were included, with publication years ranging from 2014 to 2022. From the perspective of guideline development, two guidelines were developed using evidence-based methods. Among the included guidelines, four guidelines were for cytotoxic antineoplastic drugs, three for small molecule kinase inhibitors, and one for antineoplastic biosimilars. Currently available guidelines and clinical practice provided recommendations of individualized medication in oncology based on TDM, as well as influencing factors. With regard to methodological quality based on AGREE II, the average overall quality score was 55.21%. As for the reporting quality by RIGHT evaluation, the average reporting rate was 53.57%. Conclusion: From the perspective of current guidelines, TDM in oncology is now being expanded from cytotoxic antineoplastic drugs to newer targeted treatments. Whereas, the types of antineoplastic drugs involved are still small, and there is still room for quality improvement. Furthermore, the reflected gaps warrant future studies into the exposure–response relationships and population pharmacokinetics models.
Does Managing Patients With Chronic Rhinosinusitis Improve Their Depression Score? Prospective Study
Authors: Almofada Hesham Saleh , Almutairi Nasser , Aldakhil Haifa , Alokby Ghassan 
Published: May 2024

Background To assess the risk of depression in patients with chronic rhinosinusitis (CRS) in a tertiary care center and the effect of treatment on depression scores. Methods This prospective cohort study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between November 2021 and June 2022 and included adult patients (≥14 years) with CRS. The validated Arabic or English Sinonasal Outcome Test (SNOT-22) and Patient Health Questionnaire-9 (PHQ-9) were used before treatment and 3 to 6 months after surgery and maximal medical treatment. PHQ-9 scores were compared at baseline and follow-up visits. The relationship between changes in SNOT-22 and PHQ-9 scores were assessed using Spearman’s correlation and simple linear regression. Results Overall, 38 participants with a mean ± SD age of 32.7 ± 12 years were enrolled. CRS with nasal polyps (55.26%) was the most frequently seen condition, followed by allergic fungal CRS (31.58%) and CRS without nasal polyps (13.16%). Six patients (15.7%) had PHQ-9 scores ≥10, indicating they had major depressive disorder. PHQ-9 and SNOT-22 scores improved significantly after treatment (3.7 ± 5.8 vs 6.5 ± 6.9 pretreatment, P = .001; 20.7 ± 20.5 vs 45.6 ± 28.9 pretreatment, P < .0001, respectively). Mean ± SD change in PHQ-9 and SNOT-22 scores was −2.7 ± 7 and −24.9 ± 29.8, respectively. SNOT-22 and PHQ-9 scores were positively correlated ( r = .522, P < .001). PHQ-9 score change was significantly associated with SNOT-22 score change (β = .178, 95% confidence interval 0.12-0.23, P < .0001). Conclusion CRS affects the quality of life and psychological well-being of patients. Patient-centered care with maximal medical and surgical treatment help overcome its deleterious consequences.
A comparative study of fatigue and processing speed in patients with multiple sclerosis treated with natalizumab or rituximab
Authors: Hellgren Johan , Strandberg Maria Compagno , Källén Kristina , Svenningsson Anders 
Published: May 2024

Background Fatigue is the most debilitating symptom in patients with multiple sclerosis (MS). Natalizumab and rituximab are the most used MS disease modifying therapies in Sweden, but comparative data on the effect on fatigue is sparse. Objective Primary objective was to compare fatigue levels between patients on natalizumab and rituximab. As secondary objective, we assessed processing speed, an attention domain quality, between treatment groups. Method In this Swedish multicentre cross-sectional study, patients with relapsing-remitting MS and >24 months treatment duration were identified in the Swedish MS-registry. Fatigue was assessed using the Fatigue Scale for Motor and Cognitive functions (FSMC) and processing speed using Symbol Digit Modalities Test (SDMT). Results 128 patients were enrolled (natalizumab: 56, rituximab: 72). No significant differences in FSMC were found when adjusting for potential confounders (p = 0.936), with age having the biggest impact, correlating with increased fatigue. Individuals on natalizumab performed significantly better on SDMT at cross-section (natalizumab 64.7, rituximab 56.2; p = 0.003), with an improvement from treatment initiation, compared to rituximab (change: natalizumab 8.9, rituximab −1.0; p = 0.002). Conclusion We found no difference in fatigue levels between natalizumab and rituximab cohorts. Patients treated with natalizumab showed significantly better results on SDMT than patients on rituximab.