bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Clinical Outcome in AChR-Positive Generalized Myasthenia Gravis: A Retrospective Observational Study
Authors: Ojha Pawan T. , Gaikwad Abhijeet M. , Singh Rakesh , Jagiasi Kamlesh , Nagendra Shashank 
Published: August 2023

Abstract

Background:
Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction, and in over 80% of cases, antibodies are identified against the nicotinic type of acetylcholine receptor (AChR) on the muscle endplate. Despite the availability of various treatment options, patients with MG experience relapses and remission during the course of the disease. Aims and Objective: To understand the clinical profile, predictors of outcomes in acetyl choline receptor (AChR) antibody positive generalized MG.

Methods:
This is a retrospective, single-centre, observational study of 108 patients with AChR positive generalized MG. We collected data on clinical and demographical profiles, treatments received, and treatment responses from those who fulfilled inclusion criteria over a mean follow up period of 33.75 ±7.30 months. Clinical outcomes were studied in terms of the type of remission and crisis or disease exacerbations patients had, considering different variables and treatment received.

Results:
We found the commonest initial symptoms were ocular or oculo-bulbar, which progressed to generalized MG in the first year of disease onset. 36 (33.3%) patients experienced a crisis requiring mechanical ventilation within a mean period of 9.4 ±4.77 months from the disease onset. Multivariate regression analysis showed late-onset MG (age of onset between 50-70 years) and treatment with rituximab were better correlated with remission, (odd ratio of 4.7; 95 % CI ,1.12 -12.6; P value < 0.05 and odd ratio of 4.56; 95 % CI ,1.2 -10.04; P value < 0.05) respectively. While treatment with Mycofenolate Mofetile (MMF) was associated with a higher number of relapses (odd ratio of 1.8; 95 % CI ,0.08 -0.96; P value < 0.05). Treatment with Rituximab showed a higher rate of remission as compared to treatment refractory (TR) on conventional immunosuppressant therapy (IST). Out of 35(32 %) thymoma patients, 21 patients underwent thymectomy and these patients showed significantly greater rate of remission as compared both thymoma patients who denied thymectomy as a treatment option (N = 10 ;55.60 % vs N = 4; 23.50%).

Conclusion:
In this study of AChR antibody positive generalized MG patients, we found that nearly one-third of them experienced myasthenic crisis despite receiving the best medical care. Rituximab appeared to be effective in the treatment of refractory MG and those who failed thymectomy. Thymectomy was associated with better outcomes in patients, both with or without a thymoma.
Knowledge of Rabies Prophylaxis among Junior Doctors in a Tertiary Hospital in Manipur – A Cross-sectional Study
Authors: Singh Kh Sonarjit , Elangbam Vijaya , Singh Toijam Gambhir 
Published: August 2023

Context:
Rabies, a zoonotic disease caused by Lyssavirus genus rabies virus, is 100% fatal yet preventable. Appropriate and timely management of rabies cases will help in reducing and preventing mortality. Health-care personnel, especially the junior doctors who are at the threshold of their public health service, need to be equipped with adequate knowledge to be able to provide effective care.

Aims:
The aims of the study are to assess the knowledge about rabies and to assess the association between knowledge with sociodemographic characteristics among the junior doctors of a tertiary care hospital, Imphal.

Settings and Design:
A cross-sectional study was conducted among 520 junior doctors of a tertiary care hospital including interns, house officers, and postgraduate trainees from June 2018 to July 2019.

Subjects and Methods:
Data collection was done by questionnaire method.

Statistical Analysis Used:
The data were analyzed using IBM SPSS for Windows, Version 21.0. Armonk, NY, USA.

Results:
Only 17.5% of the junior doctors had adequate knowledge about rabies. Those who had come across and those who had treated rabies were 35.4% and 23.7%, respectively. Only around half of the respondents knew the management of the WHO Category I and III animal bite exposure.

Conclusions:
In the present study, it was seen that the overall knowledge of the junior doctors was poor. Only 2 out of 10 of the participants had adequate knowledge of rabies. One-fourth of the participants had treated rabies in their clinical practice and those who had treated rabies had better knowledge compared to those respondents who had never treated.
COVID-19 Positivity in the COVID Suspect and Green Zones of a Large Emergency Department during the First Wave of the Pandemic in South India
Authors: Selvan Saravanan , Krishnaraj Vivek Raja , Mathiyalagan Ponnivalavan , Nesamani Hepzibah , Kumar Paul Vinod W. , Paul Anna , Gunasekaran Karthik , Abhilash Kundavaram Paul Prabhakar 
Published: August 2023

Background:
During the COVID-19 pandemic, there was a necessary division of the emergency department (ED) into the COVID suspect zone and a green zone based on a modified “The” Christian Medical college (CMCTS). Triaging was initially done based on the epidemiological criteria and evolved into symptom-based assessment when community transmission began.

Methodology:
This retrospective study included all patients who were triaged in the ED from April 2020 to December 2020. Data were collected from the ED triage software and were analyzed to determine the performance of the modified triage criteria in admitting patients to the ED.

Results:
Forty-three thousand patients were triaged during the study. Of which 35.9% (n = 15429) were sent to the COVID suspect zone and 64.1% (n = 27571) to the green zone. Of the 8490 (55%) nasopharyngeal swab reverse transcription polymerase chain reaction (RT-PCR) tests done in the COVID suspect zone, 61.4% were positive for COVID-19 while only 9.2% (n = 274) of 2866 tested in the green zone were positive. COVID-19 positivity was the highest in the mid-pandemic months of July, August, and September 2020. In the COVID suspect zone, factors for predicting a negative RT-PCR result were priority 1 presentation and early and late pandemic presentations. The positive predictive value of our modified triage criteria during the pandemic was 85% with a higher accuracy during the peak of the first wave (July–September 2020).

Conclusion:
The modified CMCTS successfully segregated COVID-19-positive patients from the COVID-19 negative patients during the first wave of the COVID-19 in 2020. The CMCTS criteria can be easily adopted or adapted in other hospitals in India in case of future waves of COVID-19.
Healthcare-Seeking Behavior and Awareness Regarding Snakebites and its First-Aid Management among Tribal Women in Rural Maharashtra
Authors: Shah Anuradha Kunal , Sapkal Ashwini Baburao , Deshpande Swati 
Published: August 2023

Background:
In rural India, snake bite is a major health problem with high morbidity and mortality. Women have poor knowledge regarding snakebite and first aid measures and often resort to home remedies or visit traditional healers. This study was taken up to assess the healthcare-seeking behavior and awareness regarding snakebites and first-aid management among tribal women.

Materials and Methods:
This cross-sectional study was conducted from February to July 2019 in a tribal village, Palghar, Maharashtra. The sample size was 278. Women above the age of 18 years were selected by simple random sampling. A prevalidated semi-structured questionnaire was used for data collection which was done through door-to-door visit.

Results:
The mean age of the women was 36.59 years. Around 55.4% of women had good knowledge regarding snakebite and 39.9% of women had good knowledge of first aid in the event of Snakebite. Awareness regarding signs and symptoms in event of snakebite was good. The majority of the women preferred government medical facilities (71.58%) for the treatment of snakebite followed by traditional healers (20.14%). The main reasons for visiting traditional healers were transport difficulties, easy accessibility, and traditional beliefs and rituals. The most common form of first aid that was provided to the victims was tying of tight cloth/wire (72.86%), herbal medicines (30.85%), and use of “mantras” (8.17%).

Conclusion:
There is good knowledge regarding snakebites among tribal women, however, knowledge about appropriate first aid seems to be lacking. They are aware of the signs and symptoms and know how to prevent them however, preventive action is lacking. A targeted health education program focusing on these issues is the need of the hour.
Diabetic Foot Care: Knowledge and Practice – A Cross-sectional Study from a Tertiary Care Hospital in Southern India
Authors: Mandal Amit , Thomas Nihal , Zachariah Anand , Mathuram Alice Joan 
Published: August 2023

Background:
Diabetes mellitus is one of the major problems in health systems and a global public health threat and diabetic foot ulcers and lower extremity amputations are common, complex, costly, and disabling complications of diabetes. Poor foot care knowledge and practices are important risk factors for foot-related problems among diabetic people.

Aims:
The aim of the study is to assess the knowledge about foot care, foot care practices, the prevalence and risk factors of diabetic foot and foot-related complications in adult diabetic patients.

Settings and Design:
The cross-sectional study was conducted in 204 consecutive diabetic patients attending the outpatient department of a tertiary care hospital.

Methods:
A questionnaire including demographic details, knowledge questionnaire, attitude, and awareness for foot problems based on the Nottingham Assessment of Functional Foot Care Revised 2015 questionnaire was administered. This was followed by a foot examination for various aspects related to foot care and risk stratification.

Statistical Analysis Used:
Descriptive analysis with frequency distribution for knowledge and practice scores, univariate analysis, and multiple logistic regressions to find significant variables associated with good foot care knowledge and practice scores.

Results:
About 30.39% had good knowledge score. Rural background (adjusted odds ratio [OR]: 1.98, 95% confidence interval [CI]: 1.08–3.65), poor education status (adjusted OR: 4.63, 95% CI: 1.04–20.54), poor glycemic control (adjusted OR: 1.46, 95% CI: 0.83–2.58), and previous history of foot ulcer (adjusted OR: 3.05, 95% CI: 1.42–6.65) were significantly associated with poor knowledge on foot care.

Conclusion:
Our study shows that knowledge and practice of foot care of diabetic patients are still substandard. Poor communication between patients and nurses/physicians, rural background, poor education, and poor glycemic control were significant barriers of foot care. Policymakers should initiate foot care education programs throughout the regional state for increasing awareness about proper foot care practice in diabetic patients to reduce the incidence of complications.
Correlation between physician- and patient-directed disease assessments in ulcerative colitis patients from Saudi Arabia and Kuwait: Data from ICONIC
Authors: Harbi Othman Al , Owayed Salem , Qari Yousif , Mosli Mahmoud , Anwar Ali , Masri Alaa , Gouda Mohamed , Alfadhli Ahmed 
Published: August 2023

Abstract

Background:
The aim of the observational, prospective study was to validate a novel, nonverbal assessment tool for perceived disease burden—Pictorial Representation of Illness and Self-Measure (PRISM)—in ulcerative colitis (UC) against established patient health questionnaires. The cumulative burden of patients recently diagnosed (<3 years) with UC was also evaluated.

Methods:
“ICONIC” - Understanding the impact of ulcerative colitis and its associated disease burden on patients - was a noninterventional, multicountry, multicenter study performed in a 2-year follow-up format in adult patients with recently diagnosed UC in 33 countries, regardless of disease severity or treatment. Data collection consisted of five visits, scheduled at approximately 6-month intervals. For the current analysis, patient data from Saudi Arabia and Kuwait were evaluated. The collected data comprised demographics, disease-related data, UC treatment, and healthcare resources, as well as physician- and patient-assessed quality-of-life and disease burden questionnaires. Correlations between selected questionnaire scores were performed using Spearman’s rho.

Results:
Disease severity at baseline and throughout the study was slightly less favorable in this country analysis compared with the global study cohort. Disease burden was assessed by PRISM and improved within 24 months.

Conclusions:
The detected moderate correlation between PRISM and other assessment methods supports the validity of PRISM. Differences in perceptions of UC-related burden between physician and patient may reflect to some degree insufficient patient–physician communication.
Model for distributing the daily demand into a train schedule
Authors: Aurignac Albert , Benattar Maryvonne 
Published: August 2023

Adjusting supply to demand is a constant issue for public carriers, especially at seasonal changes in timetables and when studying proposed futures services for the medium or long terms. In this article can be found a method of analysis dealing with the interaction between supply and demand in rail passengers services on medium and long distances for standard days only (off-peak days).The proposed model is based on the assumption, that for a given type of route with a specific distance, there exists an hourly distribution for the daily passenger demand and that the user's decision process for selecting a train on departure can be described in terms of probability, provided the various train characteristics of a daily timetable were introduced.From observations on the actual loading factor of trains for a lar¬ge number of routes, hourly distributions of passenger demand were calibrated together with relevant parameters in the selection between several trains. Finally, the model was validated after evidence, that it reproduced fairly accurately the loading factor of trains running on routes with rather different timetables.
L'adaptation de l'offre à la demande est un problème permanent pour les transporteurs publics, qui se pose en particulier à l'occasion des changements de service et pour l'étude des projets de desserte à moyen ou long terme. Cet article présente une méthode d'analyse de l'interaction entre l'offre et la demande ferroviaire en transport de voyageurs à moyenne et longue distance, limitée aux jours ordinaires (hors jours de pointe).Le modèle présenté suppose que, pour un type de relation donné caractérisé notamment par la distance, il existe une distribution horaire de la demande journalière et que le mécanisme de choix du train de départ par l'usager peut être décrit en termes de probabilité, en faisant intervenir les caractéristiques des différents trains de la grille journalière.Au moyen d'observations sur l'occupation réelle des trains portant sur un grand nombre de relations, ont été calibrées les distributions horaires de la demande ainsi que les paramètres caractéristiques du choix entre plusieurs trains. Enfin, le modèle a été validé en montrant qu'il reproduit assez correctement l'occupation des trains sur des relations présentant des grilles horaires assez différentes.
L’évaluation sans jugement. Analyse des pratiques a posteriori des politiques de transports urbains en France
Authors: Offner Jean-Marc 
Published: August 2023

The a posteriori evaluation of public policies, having an increasing interest in France, is made in France since the seventies, following actions of development of public transport. Corresponding originally to a demand of Government, the « follow-up» of great projects has been used progressively by local responsable people for managing the success of their investments. On the contrary, the works of critical evaluation - questioning by « why » rather than by « how » - has not been able to impose itself, taking into account the constitutional and intellectual context privileging a priori evaluation. Hence the synthetical statement of an «evaluation without judgment».
L'évaluation a posteriori des politiques publiques, qui connaît un intérêt croissant en France, est pratiquée dans ce pays depuis les années soixante-dix, suite aux actions de développement des transports collectifs. Répondant originellement à une démarche de l'Etat, les «suivis» des grands projets ont été progressivement utilisés par les responsables locaux pour gérer le succès de leurs investissements. En revanche, les travaux d'évaluation critique - s'interrogeant sur le «pourquoi» plus que sur le «comment» - n'ont pas su ou pu s'imposer, compte tenu d'un contexte institutionnel et intellectuel privilégiant l'évaluation a priori. D'où le constat synthétique d'une «évaluation sans jugement».
Quels acteurs pour quelles stratégies logistiques de distribution physique
Authors: Colin Jacques 
Published: August 2023

This article after defining the part and the field of physical distribution, analyses the strategy that manufacturers, distributors and transporters try to built around this step. The strategy described here is shown as being able to upset in the area of the transportation of goods.
Cet article, après avoir défini le rôle et le champ de la distribution physique, analyse les stratégies que les industriels, les distributeurs et les transporteurs tentent de bâtir autour de cette démarche. Les stratégies décrites se révèlent alors capables de bouleverser les équilibres actuels du secteur des transports de marchandises.
Economies of scale in urban bus transportation in developing countries
Authors: Prud'Homme Rémy , Hyu Hwang Sang 
Published: August 2023

This paper tries to find out wether there are economies of scale in urban bus transportation in developing countries or, to put it otherwise, wether unit costs in large bus companies are lower than unit costs in small companies. The paper discusses methodological choices that have to be made for such a study, it examines previous work done on this issue, and proposes a model. This model is derived from a production functions rather than form a cost function. It is then applied to the cases of Seoul, Pusan and Shanghai. The results of the calculations made suggest a negative answer to the initial question.
Cet article cherche à savoir si la production de transports urbains dans les pays en développement est sujette ou non à économie d'échelles, c'est-à-dire si les très grosses compagnies d'autobus sont susceptibles de fonctionner à un coût unitaire plus faible que les petites. Après avoir analysé les choix méthodologiques à faire pour répondre à cette question, examiné les études antérieures comparables, l'article propose un modèle d'analyse. Ce modèle est dérivé d'une fonction de production plus que d'une fonction de coût. Il est ensuite testé sur les cas des villes de Séoul, Pusan et Shanghai. Les résultats des calculs effectués suggèrent une réponse négative à la question posée.
New Tools for Urban Transportation Planning and Analysis with a Totally Disaggregate Approach
Authors: Chapleau Robert 
Published: August 2023

Urban transportation planning and analysis is undertaken with a new approach integrating an informational perspective to traditional synthetic modeling. A totally disaggregate and multi-dimensional (territory, network, travel demand) approach is imbedded into the MADITUC (Model for the Disaggregate Analysis of Urban Transit Trips) system, contributing to a wider spectrum of urban travel analyses and issues, such as : network resources' estimation, transit trip assignation, modal shift modeling, fare integration and service coordination, market analysis, socio-demographic trends.
Selon un contexte méthodologique essentiellement informationnel, où la problématique des transports urbains est analysée sous les perspectives de territorialité, réseautique et demande désagrégée, les principales fonctions du logiciel MADITUC (Modèle d'analyse désagrégée des Itinéraires de Transport Urbain Collectif) sont décrites à partir de différents contextes d'application : évaluation des ressources, simulation des trafics, changement modal, financement, analyse de marchés, tendances socio-démographiques.
Tarified underground and urban trip structure
Authors: Gannon Frédéric 
Published: August 2023

Whatever their main objective may be - to improve the accessibility to the city centre or to case the go-through automobile traffic-urban - transportation planners can choose, among possible technical tools, to develop underground road network, in the most central zones of the town. This policy, which tends to generalize in France, may represent a trustable (valuable) way to regulate urban transportation. This paper shows that, from the point of view of the road user, a trade-off between the two modes (underground and surface road networks), set on the comparison of generalized costs can lead, in a simplified analytical framework, to an income-based segregation of urban households. The "twinning" of transportation offer, by the mean of a complementarily between a tarified underground road network and a free surface network, much like the Pigou-Knight scheme, allows new perspectives in the efficient ruling of the urban land, in limited disposition by definition.
Que leur objectif consiste en l'amélioration de l'accessibilité au centre-ville ou en une facilitation du trafic automobile de transit, les responsables du transport urbain peuvent envisager parmi l'ensemble des moyens techniques dont ils disposent la mise en souterrain partielle de la voirie, dans les zones les plus centrales de l'agglomération. Cette politique, dont la mise en application commence à se généraliser en France, peut constituer l'un des volets crédibles (ou efficace) d'une régulation des déplacements urbains. Cet article montre, sous l'angle de l'usager, qu'un arbitrage modal (entre voirie souterraine et voirie de surface) établi sur la seule comparaison des coûts généralisés, peut mener, dans un cadre analytique simplifié, à une partition des ménages selon leur niveau de revenu. La « dualisation » de l'offre de transport sous la forme d'une complémentarité entre voirie souterraine payante et voirie de surface gratuite, selon le schéma de Pigou-Knight, permet d'ouvrir des perspectives à court et moyen ternie sur la gestion efficace d'une ressource foncière urbaine, par définition limitée.