bluuebunny/crossref_metadata_2025_split huggingface dataset:
P04 Biologics combined with conventional systemic agents for the treatment of children with severe psoriasis: practice survey among French and Italian paediatric dermatologists
Authors: Mahé Emmanuel , di Lernia Vito 
Published: August 2023

Abstract
Combined therapies involve the use of multiple drugs to increase efficacy and reduce the toxicity of individual treatments. We performed a survey carried out among French and Italian paediatric dermatologists (SFPD, GrPso, SIDerP) to better understand the reasons for using or avoiding these combinations. The survey was completed by 61 paediatric dermatologists (France, 57.4%; Italy, 42.6%; hospital practice, 98.4%; members of societies of paediatric societies and/or psoriasis working groups, 73.8%). Thirty-nine (63.9%) had previously used or planned to use the combined therapies, most commonly TNF-α inhibitors with acitretin or methotrexate. The most common reasons for dermatologists not using combined therapies were a lack of information about the safety (27.3%) or effectiveness (22.7%) of the combinations and the absence of recommendations on how to use combined therapies (22.7%). The main reason for using these treatments was to improve the outcome of biologic therapies in cases of partial efficacy or loss of efficacy. The most frequent clinical situations in which the dermatologists indicated that they combined therapies were to control a loss of efficacy (82.1%) and to treat psoriasis flare-ups (51.3%). Combined therapies have been used by the majority of paediatric dermatologists in the treatment of childhood psoriasis. Absence of information about these combined therapies, and no guidelines about their use are major limits for their use. However, these combined therapies should be considered for the treatment of children with severe psoriasis, psoriatic arthritis and recalcitrant disease. Their use needs to be clarified in future management guidelines.
P14 Blueberry muffin syndrome secondary to acute myeloid leukaemia: a learning point
Authors: Melchionda Veronica , Kreuser-Genis Inge , McPherson Tess 
Published: August 2023

Abstract
A baby was initially referred at 6 weeks developing multiple erythematous, bruise-like and light-brown subdermal lumps over the head, face, arms, legs and buttocks. She had been born following breech presentation by elective C-section, which had been complicated by trauma and blood loss. No other clinical concerns were raised at this time. Nonaccidental injury was considered; however, subcutaneous fat necrosis of the newborn was the diagnosis made by paediatric team following slightly raised calcium and suggestive ultrasounds features. Newer lesions continued to arise in the same areas over 6 weeks, now with difficulty in feeding and irritability. One small cervical lymph node could be palpated. This was atypical for subcutaneous fat necrosis of the newborn and an urgent dermatological option was sought. On review, the lesions were clinically in keeping with an infiltrative process (blueberry muffin syndrome) and an urgent skin biopsy, blood film and TORCH screen were requested. A 4-mm punch biopsy confirmed leukaemia cutis with evidence of myeloid differentiation. MLL (KMT2A) rearrangement was detected, which was also subsequently found on a bone marrow sample. A peripheral blood film identified a population for NG2-positive myeloid blasts (6%), raising the possibility of infant acute myeloid leukaemia (AML). A TORCH screen did not highlight any congenital infections. The baby was promptly commenced on chemotherapy for AML. This case highlights how presentation can be atypical, the importance of reviewing possible diagnoses and considering an early biopsy to enable prompt treatment if required.
Construction and testing of a risk prediction classifier for cardia carcinoma
Authors: Liu Zhiqiang , Xia Ganshu , Liang Xiaolong , Li Shoumiao , Gong Yanxin , Li Baozhong , Deng Jingyu 
Published: August 2023

Abstract

Objectives
This research aimed to construct a prediction model for stages II and III cardia carcinoma (CC), and provide an effective preoperative evaluation tool for clinicians.

Methods
CC mRNA expression matrix was obtained from Gene Expression Omnibus and The Cancer Genome Atlas databases. Non-negative matrix factorization was used to cluster data to obtain subgroup information, and weighted gene co-expression network analysis was used to uncover key modules linked to different subgroups. Gene-set enrichment analysis analyzed biological pathways of different subgroups. The related pathways of multiple modules were scrutinized with Kyoto Encyclopedia of Genes and Genomes. Key modules were manually annotated to screen CC-related genes. Subsequently, quantitative real-time polymerase chain reaction assessed CC-related gene expression in fresh tissues and paraffin samples, and Pearson correlation analysis was performed. A classification model was constructed and the predictive ability was evaluated by the receiver operating characteristic curve.

Results
CC patients had four subgroups that were associated with brown, turquoise, red, and black modules, respectively. The CC-related modules were mainly associated with abnormal cell metabolism and inflammatory immune pathways. Then, 76 CC-elated genes were identified. Pearson correlation analysis presented that THBS4, COL14A1, DPYSL3, FGF7, and SVIL levels were relatively stable in fresh and paraffin tissues. The area under the curve of 5-gene combined prediction for staging was 0.8571, indicating good prediction ability.

Conclusions
The staging classifier for CC based on THBS4, COL14A1, DPYSL3, FGF7, and SVIL has a good predictive effect, which may provide effective guidance for whether CC patients need emergency surgery.
The association between patients’ frailty status, multimorbidity, and demographic characteristics and changes in primary care for chronic conditions during the COVID-19 pandemic: a pre-post study
Authors: Fikree Shireen , Hafid Shuaib , Lawson Jennifer , Agarwal Gina , Griffith Lauren E , Jaakkimainen Liisa , Mangin Dee , Howard Michelle 
Published: August 2023

Abstract

Background
The purpose of this study was to assess the impact of SARS-COV-2 (Severe acute respiratory syndrome coronavirus 2) pandemic on primary care management (frequency of monitoring activities, regular prescriptions, and test results) of older adults with common chronic conditions (diabetes, hypertension, and chronic kidney disease) and to examine whether any changes were associated with age, sex, neighbourhood income, multimorbidity, and frailty.

Methods
A research database from a sub-set of McMaster University Sentinel and Information Collaboration family practices was used to identify patients ≥65 years of age with a frailty assessment and 1 or more of the conditions. Patient demographics, chronic conditions, and chronic disease management information were retrieved. Changes from 14 months pre to 14 months since the pandemic were described and associations between patient characteristics and changes in monitoring, prescriptions, and test results were analysed using regression models.

Results
The mean age of the 658 patients was 75 years. While the frequency of monitoring activities and prescriptions related to chronic conditions decreased overall, there were no clear trends across sub-groups of age, sex, frailty level, neighbourhood income, or number of conditions. The mean values of disease monitoring parameters (e.g. blood pressure) did not considerably change. The only significant regression model demonstrated that when controlling for all other variables, patients with 2 chronic conditions and those with 4 or more conditions were twice as likely to have reduced numbers of eGFR (Estimated glomerular filtration rate) measures compared to those with only 1 condition ﻿﻿((OR (odds ratio) = 2.40, 95% CI [1.19, 4.87]); (OR = 2.19, 95% CI [1.12, 4.25]), respectively).

Conclusion
In the first 14 months of the pandemic, the frequency of common elements of chronic condition care did not notably change overall or among higher-risk patients.
Integrating STEADI for Falls Prevention in Outpatient Rehabilitation Clinics: An Outcomes Evaluation Using the RE-AIM Framework
Authors: Vincenzo Jennifer L , Caulley Jamie , Scott Aaron J , Wilson Brian S , Wingood Mariana , Curran Geoffrey M 
Published: August 2023

Abstract

Background and Objectives
The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to describe the implementation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Initiative (2018–2021) for screening and assessing all older adults ≥65 years for falls risk across 34 outpatient rehabilitation clinics within a large health system.

Research Design and Methods
We described the Implementation process and strategies. Using Electronic Health Records (EHRs), we identified Reach, Adoption, and Maintenance of screenings and physical assessments to identify fall risk among older adults.

Results
STEADI Implementation strategies included health system mandates, EHR revisions, email instructions, educational sessions and resources, clinical leads and champions, and chart audits. Reach: 76.4% (50,023) had a completed screening, and 44.1% screened at risk for falls. Adoption: Clinic-level adoption varied, with most performing screenings. Profession-level adoption was highest for physical therapists (PTs; 94.2% initiated, 80.6% completed) and lowest for speech-language pathologists (SLPs; 79.8% initiated, 55.9% completed). Reach and Adoption of functional outcomes measures (FOM): PTs completed an FOM on 59.5% of at-risk patients, occupational therapists on 11.6%, and SLPs on 7.9%. Maintenance: All measures declined 1%–10% annually between 2018 and 2021.

Discussion and Implications
STEADI screening and FOMs were implemented systemwide in 34 outpatient rehabilitation clinics, reaching over 50,000 older adults. Screening adoption rates varied by clinic. PTs had the highest adoption rate. All adoption rates declined over time. Future research should consider an implementation science approach with input from key partners before implementation to identify barriers and develop strategies to support STEADI in outpatient rehabilitation.
Two Paths: Why States Join or Avoid China’s Belt and Road Initiative
Authors: Atkins Eleanor , Fravel M Taylor , Wang Raymond , Ackert Nick , Huang Sihao 
Published: August 2023

Abstract
Although China’s motives for developing the Belt and Road Initiative (BRI) have been well studied, scholars have yet to comprehensively examine why states seek to join the initiative. We fill this gap by examining how and why states join the BRI. Countries join by signing a Memorandum of Understanding (MOU) with China on cooperation under the BRI framework. These MOUs create few or no obligations for the states who sign them but increase the possibility of reaping future economic benefits. Thus, we argue that most states should join the BRI unless they view the costs of participation as higher. We hypothesize, and find support for, the argument that democracies are less likely to join because they view participating in a Chinese-led initiative as more costly than non-democracies. Our statistical analysis using a new dataset of BRI participants and paired case studies provides quantitative and qualitative support for this argument.
Patterns of GP and nurse independent prescriber prescriptions for antibiotics dispensed in the community in England: a retrospective analysis
Authors: Courtenay Molly , Gillespie David , Lim Rosemary 
Published: August 2023

Abstract

Background
Physician–nurse task shifting, a process of delegation whereby tasks are moved to other specialized healthcare workers, is used in primary care in many countries to improve access, efficiency and quality of care. One such task is the prescription of medicines.

Objectives
To identify nurse independent prescriber (NIP) and GP numbers in England, the proportions and types of NIP and GP antibiotic prescriptions dispensed in the community, and the impact of COVID-19 on the volume, rate and types of antibiotic prescriptions dispensed.

Methods
Descriptive population-based retrospective cohort study using routinely collected data on prescriptions for antibiotics dispensed in the community in England between January 2014 and October 2021.

Results
Between 2014 and 2021, numbers (headcount) of NIPs whose prescriptions were dispensed in the community rose by 146% to 34 997. GP numbers (headcount) rose by 10% to 44 681. Of the 25.373 million antibiotic prescriptions dispensed between 2014 and 2021, NIPs were responsible for 8.6%. The rate of dispensed antibiotic prescriptions per prescriber per calendar year decreased (by 50% for NIPs and by 21% for GPs) between 2014 and 2020. This decreasing trend continued following the onset of the COVID-19 pandemic across both groups. Narrow-spectrum antibiotics (penicillins, macrolides, tetracyclines) were the most frequently dispensed across both NIPs and GPs.

Conclusions
NIPs are an increasing contributory influence on total antibiotic prescribing and should be included in antimicrobial stewardship efforts. Interventions for this group need to be tailored to the population and context in which they work.
Standardized amino acid digestibility and protein quality in extruded canine diets containing hydrolyzed protein using a precision-fed rooster assay
Authors: Hsu Clare , Utterback Pamela L , Parsons Carl M , Marx Fabio , Guldenpfennig Ryan , de Godoy Maria R C 
Published: August 2023

Abstract
Protein hydrolysate has become a choice of alternative protein source in canine diets as it showed greater digestibility, lower allergenic responses, and various functional properties when compared with intact proteins. The objective of the study was to determine the effect of hydrolyzed protein inclusion on amino acid digestibility and protein quality in extruded canine diets when compared with a traditional protein source for adult dogs. Five treatment diets were formulated to have similar compositions except for the main protein source. The control diet was formulated with chicken meal (CM) as the primary protein source. Test hydrolyzed proteins, chicken liver and heart hydrolysate (CLH) and chicken hydrolysate (CH) were used to partially or completely substitute CM. The diets were: CONd: CM (30%) diet; 5%CLHd: 5% CLH with 25% CM diet; CLHd: CLH (30%) diet; 5%CHd: 5% CH with 25% CM diet; CHd: CH (30%) diet. A precision-fed rooster assay was used to determine standardized amino acid digestibility for the ingredients and diets. In addition, Digestible Indispensable Amino Acid Score (DIAAS)-like values were calculated for the protein ingredients. All protein ingredients had higher than 80% of digestibility for all indispensable amino acids with no difference among sources (P &gt; 0.05). From the DIAAS-like values referencing AAFCO nutrient profile for adult dogs, CLH and CH did not have any limiting amino acid; on the other hand, CM has a lower DIAAS-like value (93.3%) than CLH and CH (P &lt; 0.05) with tryptophan being the first-limiting amino acid. The DIAAS-like values were often lower when the amino acid combinations methionine + cysteine and phenylalanine + tyrosine were included in the calculation. When referencing NRC recommended allowances and minimal requirements, methionine was the first-limiting amino acid for all protein sources. Amino acid digestibility was mostly above 80% and comparable among the treatment diets. Regarding the digestible indispensable amino acid concentrations in the diets, all of them met the AAFCO nutrient profile for adult dogs at maintenance. In conclusion, both protein hydrolysates were highly digestible, high-quality protein sources, and a full substitution from CM to protein hydrolysate could result in greater protein quality, according to the DIAAS-like values of the ingredients, when compared with CM in extruded canine diets.
Who is a Human Rights Defender? An Appraisal of Labour Practices in the Human Rights Economy
Authors: Georgi F Richard 
Published: August 2023

Abstract
The last decades have witnessed a conceptual opening of human rights practices, hitherto prerogative of a chosen few legal experts, towards a multiplicity of subjectivities. This afforded human rights scholarship to address subaltern histories and reckon with past exclusions. Conversely, critical deconstruction and empirical diversification have aggravated the seemingly basic, yet thorny quest for defining human rights activism and identifying human rights defenders. This not only poses a challenge to research but, foremost, opens human rights concepts to abuse and undermines protection regimes. In this contribution to the Journal of Human Rights Practice’s Anniversary Issue, I trace the definition dilemma as it emerges from emancipatory developments in human rights practice scholarship. I am not pretending to solve this dilemma; rather, I offer ‘metaphorical dislocations’ changing the terms of discussion to elicit new avenues of thought. Taking common allusions to the economy of human rights as my point of departure, I pursue Marx’s critique of political economy as a metaphor to describe human rights activism as a labour practice that a) produces discursive value qua rendering violence legible and b) transforms activist cultures socio-politically. Hence, I encounter the subjectivity of human rights defenders in the tensions between the co-dependent dimensions of practice and its political representation. The aspiration of this think piece is to emphasize the importance of co-constructing common foundations in the research on human rights activism, and to provoke responses leading us out of the all-too-well known trenches of debate.
Exploratory analysis of the spatial distribution of adult glioma age-adjusted county incidence rates, Nebraska Medicine, 2009–2019
Authors: Ratnapradipa Kendra L , Yellala Amulya , Shonka Nicole 
Published: August 2023

Abstract

Background
Central nervous system (CNS) cancers including gliomas have low incidence but high mortality. The age-adjusted incidence rate for CNS cancers is higher in Nebraska than nationally. This exploratory study was motivated by glioma patient inquiries about possible clustering of cases within the state to see if more in-depth investigation was warranted.

Methods
Using electronic health records from Nebraska Medicine, we identified Nebraska adult (age ≥19) glioma patients diagnosed between January 1, 2009 and November 1, 2019. Patient residential addresses were geocoded, mapped, and combined with annual US Census data to compute age-adjusted incidence rates (AAIR) at the county level. Counties with fewer than five cases were excluded to protect patient identity. ArcGIS software was used for geocoding and mapping.

Results
Of the 285 cases included in the analysis, 53.2% were geocoded with exact match and the remainder were processed manually. Cases occurred in 47 of the 93 counties. After data suppression, 11 counties (228 cases) visually clustered in eastern and central Nebraska with AAIR ranging from 0.85 to 5.66 per 100 000.

Conclusions
Many counties in the state were excluded from analysis of this rare cancer due to the small number of cases leading to unstable rates and the need to suppress data to protect patient privacy. However, this preliminary study suggests that glioma incidence is highest in central and eastern Nebraska. Next steps include analysis of state cancer registry data to ensure more complete case ascertainment.
Weighing the Odds: Novel β-Lactam/β-Lactamase Inhibitor Use in Hospital-Acquired and Ventilator-Associated Pseudomonas aeruginosa Pneumonia for Patients Who Are Morbidly Obese
Authors: Kunz Coyne Ashlan J , Orzol Carolina , Veve Michael P , Rybak Michael J 
Published: August 2023

Abstract

Background
Pseudomonas aeruginosa is a leading cause of hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP). Novel β-lactam/β-lactamase inhibitor (BL/BLI) combinations are often used for these infections; however, limited data exist to guide the dosing of BL/BLI in patients who are morbidly obese. Thus, we sought to evaluate the clinical and safety endpoints of patients who are morbidly obese (body mass index ≥35 kg/m2) and non–morbidly obese (&lt;35 kg/m2) and receiving BL/BLI for P aeruginosa HABP/VABP.

Methods
This retrospective study was based on a cohort of patients hospitalized at 2 urban academic medical centers in Detroit, Michigan, from August 2014 through February 2021 with P aeruginosa HABP/VABP who were receiving BL/BLI (ceftazidime/avibactam, ceftolozane/tazobactam, or meropenem/vaborbactam) for ≥72 continuous hours. The primary endpoint was presumed treatment failure, defined as the presence of all-cause in-hospital mortality or the continuation of infectious symptoms. Analyses were adjusted for possible confounding with inverse probability of treatment weighting. Multivariable regression was used to identify predictors of treatment failure.

Results
In total, 285 patients with HABP (61.4%) and/or VABP (56.1%) were enrolled (morbidly obese, n = 95; non–morbidly obese, n = 190). The median Acute Physiology and Chronic Health Evaluation II score was 23 (IQR, 13–26), and 60% of patients were admitted to the intensive care unit at index culture collection. Patients who were morbidly obese demonstrated significantly greater odds of presumed treatment failure vs those who were non–morbidly obese (58.9% vs 37.9%, respectively; adjusted odds ratio, 1.675 [95% CI, 1.465–1.979]). In multivariable analysis, morbid obesity (1.06; 95% CI, 1.02–1.79), prolonged time to BL/BLI initiation (1.47; 95% CI, 1.28–2.66), renal dose–adjusted BL/BLI in the first 48 hours of therapy (1.12; 95% CI, 1.09–1.75), and continuous renal replacement therapy during BL/BLI therapy (1.35; 95% CI, 1.06–1.68) were independently associated with increased odds of presumed treatment failure.

Conclusions
Among hospitalized patients receiving BL/BLI for P aeruginosa HABP/VABP, those who were morbidly obese had significantly greater odds of presumed treatment failure when compared with those who were non–morbidly obese.
Breast myiasis in an elderly male patient: a case report
Authors: Sierra Natalia , Toro Ana C , Valencia Manuela , Prada Ángela M , Varela Gabriel J , Herazo Fernando A 
Published: August 2023

Abstract
Fly larvae cause myiasis. The most common of these are Cordylobia anthropophaga and Dermatobia hominis. Clinically, myiasis manifests as an erythematous papule that may become ulcerated and form furuncular lesions. In patients who have been in endemic areas, these larvae are to be suspected. Below, we present a 75-year-old male with a clinical picture of a palpable mass in the areola associated with the outflow of serohematic fluid through a central orifice. A breast intraductal lesion was suspected, so a breast ultrasound and biopsy were performed, which showed a structure compatible with myiasis. The diagnostic challenge was the high number of different diagnoses and the little knowledge of health professionals about tropical diseases.
Colonoscopy for foreign body retrieval in ileocecal valve: a rare case report
Authors: Doya Leen J , Mohammad Mohammad F , Mohammad Aria , Ibrahim Ali 
Published: August 2023

Abstract
Foreign body (FB) ingestion is a common emergency among the pediatric population. They usually pass spontaneously through the gastrointestinal (GI) tract. In rare cases, it may cause complications because of the impaction. That depends on the type of an FB, its location, the patient’s age and the duration of impaction. Colonoscopy as management of FB ingestion in the ileocecal valve (IC) is rare in the medical literature review. Herein, we reported a case of an FB (thin needle-shaped FB 4 cm long) in the IC that was removed from the IC by colonoscopy. Although colonoscopic retrieval of impacted foreign bodies at the GI tract in children has been rarely reported in the literature review, it may be helpful in young children to avoid invasive surgical treatment.