bluuebunny/crossref_metadata_2025 huggingface dataset:
Contamination Measurements from Simultaneous Activated Potassium Bromide Radiological Dispersal Devices with a Collimated Vehicular Sensor
Authors: Simerl Nathanael , Beavers Jace , Milburn Jacob , Dodson Miranda , Strahler Ryan , Kroeger Richard , Ulloa-Garcia Ivan , Moosman Bryan , Sin Terence , Kagan Jeffrey , Nelson Kyle , Paradis Nathan , Bahadori Amir Alexander , McNeil Walter
Published: February 2021

Surface contamination was quantified over a distributed source of activated potassium bromide from three detonations of Radiological Dispersal Devices (RDDs) at the Idaho National Laboratory Radiological Response Training Range, with a maximum sampled area of 19,900 m2, to provide a baseline comparison with other rapid, remote mapping methods. Measurements were obtained with a cerium bromide sensor collimated to a field of view of 3.14 m2, using lead shielding, and towed behind a ground vehicle. Sensor response correction factors for activated potassium bromide were calculated through simulation with SWORD to obtain activity per meter-squared. Continuous maps were produced by interpolating coverage from lawnmower raster scans. Radiological data was overlaid with aerial imagery from an automated unmanned aerial vehicle flight to provide contextual geological information relative to contamination levels. The contamination distribution measurements will be compared to unmanned aerial vehicle methods in future work.
Simulations and Experimental Verifications of an Algorithm for Radiation Source Mapping and Navigational Path Generation
Authors: Chung Long Kiu , Kent Andrew J. E. , Cooney Margaret A. , Noey Jordan D. , Liebler Kyle J. , Kearfott Kimberlee J.
Published: February 2021

Accurate and efficient mapping and localization of both ionizing and non-ionizing radiation sources are important across many different fields. As such, a versatile mapping and navigational path generation algorithm, which can be applied to any point source measurements that follow an inverse-square characteristic, was developed using non-linear least squares methods. Forty thousand simulations were performed on the algorithm, which located sources successfully in a 10 m × 10 m × 10 m three-dimensional space with a success rate of over 80% across different noise functions, given a proportional constant of 10 to 1,000. The algorithm was also verified experimentally with small-scale radioactive decontamination of a 70 cm × 70 cm surface and localization of a lost Wi-Fi router in a 70 m × 70 m open field. One hundred twenty-one measurements were taken from each experiment, which were then fed into the algorithm for navigation. For the radioactive 137Cs source, the estimated locations were within 7 cm × 7 cm of the answer in 79.3% of the scenarios, while the Wi-Fi router was located to within 7 m × 7 m in 57.9% of the tests. In general, the method requires much less information and data than a geographically comprehensive survey and thus shows a lot of potential for practical applications, such as lost source retrieval with unmanned aerial vehicles, small-scale decontamination, mapping undocumented Wi-Fi routers or radio towers, and radiation simulation with radio signals. Different failure modes, desirable features, and potential improvements were also identified but remain as future work.
Radon Kinetics in a Basement Space Measured with Different Devices
Authors: Chung Long Kiu , Piersma Nathan P. , Kearfott Kimberlee J.
Published: February 2021

Although indoor monitoring of radon and benchmarking of radon measurement devices remain important research topics, few intercomparisons of active radon measurement devices have been performed under realistic conditions, let alone dynamic ones enabling comparison of their transient behavior. Five different radon monitors were therefore placed in a poorly ventilated basement space under three different conditions: 24 h under a steady, elevated radon level, 24 h with fans turned on to produce a radon washout transient, and 9 d with fans turned off for a radon buildup transient. Resulting radon concentrations varied between ~200 and ~2,000 Bq m−3. Accuracy of the devices were evaluated using root-mean-square error, and ventilation data were fit to first order linear compartmental models. To more accurately model behaviors such as cyclic diurnal variations, the source term corresponding to entry of radon from soil into the basement was considered to be non-constant, as it is likely to vary drastically with both the indoor-outdoor pressure differential and soil concentration variations. The improved radon washout model fit very well with the measurements. Despite a wide variety in list prices, all devices performed similarly during transients and at different radon concentrations.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY ASSESSMENT OF THE DIABETIC MACULA
Authors: Borrelli Enrico , Sacconi Riccardo , Parravano Mariacristina , Costanzo Eliana , Querques Lea , Battista Marco , Grosso Domenico , Giorno Paola , Bandello Francesco , Querques Giuseppe
Published: February 2021

Purpose:

To assess the impact of histogram adjustments and binarization thresholding selection on quantitative measurements of diabetic macular ischemia using optical coherence tomography angiography (OCTA).

Methods:

Patients with diabetic retinopathy (DR) who had swept-source OCTA imaging obtained were enrolled. An additional group of 15 healthy control subjects was included for comparison. Previously used brightness/contrast changes and binarization thresholds were applied to original OCTA images to obtain and compare different binarized images. Qualitative and quantitative comparisons were performed.

Results:

Thirty patients with DR (30 eyes) were included in the analysis. Fifteen eyes displayed the presence of diabetic macular edema. Qualitative grading revealed that binarized images obtained using a global threshold had better quality compared with local or multistep thresholds. The “median” filter was most frequently graded as the histogram adjustment resulting in binarized images with best quality. In the quantitative analysis, local thresholds tended to generate higher values of measured metrics. Differences in OCTA metrics between global and local thresholds were associated with presence of diabetic macular edema and signal strength index value. In the comparison between healthy and DR eyes, differences in OCTA metrics were significantly affected by binarization threshold selection.

Conclusion:

Quantitative OCTA parameters may be significantly influenced by strategies to quantify macular perfusion. Image quality and presence of macular edema can significantly impact OCTA-derived quantitative vascular measurements and differences between global and local binarization thresholds. These findings highlight the importance of consistent strategies to reliably generate quantitative OCTA metrics in patients with DR.
Engagement of TLR and Dectin-1/Syk Signaling Is Required for Activation of Notch Targets in Dendritic Cells
Authors: Zhao Yuna , Ju Chanyang , Au Karmen , Zhu Jimmy , Zhao Baohong , Shang Yingli , Hu Xiaoyu
Published: February 2021

Pattern-recognition receptors, such as toll-like receptors (TLRs), detect a wide range of microbial products and initiate innate immune responses leading to the production of inflammatory mediators. In addition, TLR signaling also activates expression of Notch target genes that play crucial roles in suppression of TLR-triggered inflammatory responses. However, whether TLR signaling pathways engaged by other classes of pattern-recognition receptors induce expression of Notch target genes remains unclear. Here we demonstrate that zymosan, a stimulus for TLR2 and dectin-1, strongly induces expression of multiple Notch target genes in both human and murine dendritic cells. Mechanistically, induction of Notch targets by zymosan is both TLR2- and Syk-dependent through activation of mitogen-activated protein kinases and the transcription factor c-Fos. Hence, our data reveals a novel mechanism that efficient induction of Notch target genes requires engagement of TLR and dectin-1/Syk signaling pathways.
Purifying air over the operating field with a new mobile laminar airflow device to reduce the possibility of airborne contamination
Authors: Osher Robert H. , Figueiredo Gabriel B. , Schneider Julia G. , Kratholm Jens
Published: February 2021

Purpose:

To investigate the effectiveness of a mobile laminar airflow (LAF) device designed to reduce both airborne particles and lint fibers within the sterile field during cataract surgery.

Setting:

Cincinnati Eye Institute, Cincinnati, Ohio.

Design:

Prospective case series.

Methods:

The number of airborne particles sized 0.5 μm, 1.0 μm, and 1.5 μm were measured at different locations and times during 116 routine phacoemulsification procedures with and without the use of a mobile LAF device. In a companion study, the presence of lint fibers in 99 eyes undergoing cataract surgery with a mobile LAF device was compared with 50 eyes in the control group. Lint fibers were differentiated as either falling onto the ocular surface or being carried into the sterile field by an instrument.

Results:

A statistically significant reduction (P < .0005) occurred in all 3 particle sizes measurements when the LAF device was used: 79.0% (93.6 ± 16.1 vs 445.3 ± 30.9), 81.7% (11.30 ± 1.98 vs 61.85 ± 5.34), and 90.8% (0.241 ± 0.056 vs 2.624 ± 0.362) in the 0.5 μm, 1.0 μm and 5.0 μm particles, respectively. Lint fibers were identified in 18% (9/50) of eyes in the control group and 16.16% (16/99) of eyes in the LAF group. Although the number of lint fibers carried into the sterile field was similar in each group, the incidence of lint fibers falling onto the sterile field was reduced from 6% (3/50) to 0% (0/99) when the LAF was used (P = .014).

Conclusions:

The mobile LAF device was highly effective in reducing the number of particulate matter and lint fibers within the sterile surgical field when used during cataract surgery.
In anticipation of pain: expectancy modulates corticospinal excitability, autonomic response, and pain perception
Authors: Barnes Kirsten , McNair Nicolas A. , Harris Justin A. , Sharpe Louise , Colagiuri Ben
Published: February 2021

Pain is a ubiquitous experience encompassing perceptual, autonomic, and motor responses. Expectancy is known to amplify the perceived and autonomic components of pain, but its effects on motor responses are poorly understood. Understanding expectancy modulation of corticospinal excitability has important implications regarding deployment of adaptive and maladaptive protective behaviours in anticipation of pain. We developed a protocol to compare corticospinal excitability to expected high pain, expected low pain, and critically low pain when high pain was expected. Expecting high pain suppressed corticospinal excitability and heightened perceptual and autonomic responses to the low-pain stimulus, as with increased noxious stimulation (ie, expected high pain). Multilevel modelling revealed that perceived pain mediated the effect of both noxious stimulation and this expectancy-modulated pain on autonomic responses, but corticospinal excitability did not. These results demonstrate that merely expecting pain influenced all pain components. Findings shed new light on the aetiology of expectancy-modulated pain, whereby expecting pain mobilises the motor system to protect the body from harm by a protective withdrawal reflex, associated with reduced corticospinal excitability, and activates similar processes as increased nociceptive stimulation. This has significant practical implications for the treatment of pain, particularly in scenarios where avoidance of pain-related movement contributes to its maintenance.
Baseline resting-state functional connectivity determines subsequent pain ratings to a tonic ecologically valid experimental model of orofacial pain
Authors: Ayoub Lizbeth J. , McAndrews Mary Pat , Barnett Alexander J. , Jeremy Ho Ka Chun , Cioffi Iacopo , Moayedi Massieh
Published: February 2021

Pain is a subjective experience with significant individual differences. Laboratory studies investigating pain thresholds and experimental acute pain have identified structural and functional neural correlates. However, these types of pain stimuli have limited ecological validity to real-life pain experiences. Here, we use an orthodontic procedure—the insertion of an elastomeric separator between teeth—which typically induces mild to moderate pain that peaks within 2 days and lasts several days. We aimed to determine whether the baseline structure and resting-state functional connectivity of key regions along the trigeminal nociceptive and pain modulatory pathways correlate with subsequent peak pain ratings. Twenty-six healthy individuals underwent structural and resting-state functional MRI scanning before the placement of a separator between the first molar and second premolar, which was kept in place for 5 days. Participants recorded pain ratings 3 times daily on a 100-mm visual analogue scale. Peak pain was not significantly correlated with diffusion metrics of the trigeminal nerve or gray matter volume of any brain region. Peak pain did, however, positively correlate with baseline resting-state functional connectivity between the thalamus contralateral to the separator and bilateral insula, and negatively correlated with connectivity between the periaqueductal gray (PAG) and core nodes of the default mode network (medial prefrontal and posterior cingulate cortices). The ascending (thalamic) nociceptive and the descending (PAG) pain modulatory pathways at baseline each explained unique variation in peak pain intensity ratings. In sum, preinterventional functional neural architecture of both systems determined the individual pain experience to a subsequent ecologically valid pain stimulus.
Mrgprd Cre lineage neurons mediate optogenetic allodynia through an emergent polysynaptic circuit
Authors: Warwick Charles , Cassidy Colleen , Hachisuka Junichi , Wright Margaret C. , Baumbauer Kyle M. , Adelman Peter C. , Lee Kuan H. , Smith Kelly M. , Sheahan Tayler D. , Ross Sarah E. , Koerber H. Richard
Published: February 2021

Most cutaneous C fibers, including both peptidergic and nonpeptidergic subtypes, are presumed to be nociceptors and respond to noxious input in a graded manner. However, mechanically sensitive, nonpeptidergic C fibers also respond to mechanical input in the innocuous range, so the degree to which they contribute to nociception remains unclear. To address this gap, we investigated the function of nonpeptidergic afferents using the Mrgprd

Cre
allele. In real-time place aversion studies, we found that low-frequency optogenetic activation of Mrgrpd

Cre
lineage neurons was not aversive in naive mice but became aversive after spared nerve injury (SNI). To address the underlying mechanisms of this allodynia, we recorded responses from lamina I spinoparabrachial (SPB) neurons using the semi-intact ex vivo preparation. After SNI, innocuous brushing of the skin gave rise to abnormal activity in lamina I SPB neurons, consisting of an increase in the proportion of recorded neurons that responded with excitatory postsynaptic potentials or action potentials. This increase was likely due, at least in part, to an increase in the proportion of lamina I SPB neurons that received input on optogenetic activation of Mrgprd

Cre
lineage neurons. Intriguingly, in SPB neurons, there was a significant increase in the excitatory postsynaptic current latency from Mrgprd

Cre
lineage input after SNI, consistent with the possibility that the greater activation post-SNI could be due to the recruitment of a new polysynaptic circuit. Together, our findings suggest that Mrgprd

Cre
lineage neurons can provide mechanical input to the dorsal horn that is nonnoxious before injury but becomes noxious afterwards because of the engagement of a previously silent polysynaptic circuit in the dorsal horn.
Greater Compliance With Early Sepsis Management is Associated With Safer Care and Shorter Hospital Stay
Authors: Rodriguez-Homs Larissa G. , Masoud Sabran J. , Mosca Matthew J. , Jawitz Oliver K. , O'Brien Cara , Mosca Paul J.
Published: February 2021

This retrospective, cross-sectional study of U.S. hospitals in Medicare's Inpatient Quality Reporting Program aimed to determine whether variation in Sepsis/Septic Shock (Bundle SEP-1) compliance is linked to hospital size and measures of safety and operational efficiency. Two thousand six hundred and fifty-three acute care hospitals in Medicare's Hospital Compare online database were included in the study. Relationships between SEP-1 bundle compliance, hospital size, and indices of operational excellence (including Patient Safety Index [PSI-90], average length of stay [ALOS] and readmission rate) were analyzed. SEP-1 compliance score was inversely associated with staffed bed number (r = −.14, p < .001), PSI-90 (r = −.01, p < .001), and ALOS (r = −.13, p < .001) in a multivariate analysis. Hospitals in the lowest versus highest quartile by bed number had SEP-1 compliance score of 49.8 ± 20.2% versus 46.9 ± 16.8%, p < .001. Hospitals in the lowest versus highest quartile for SEP-1 score had an ALOS of 5.0 ± 1.2 days versus 4.7 ± 1.1 days and PSI-90 rate of 1.03 ± 0.22 versus 0.98 ± 0.16, p < .001 for both. Although this does not establish a causal relationship, it supports the hypothesis that the ability of hospitals to successfully implement SEP-1 is associated with superior performance in key measures of operational excellence.
Grappling With Professionalism: A Developmental Approach to a Dynamic Concept
Authors: Nesbit Kathryn C. , Fitzsimmons Amber
Published: February 2021

Introduction.

Professionalism is difficult to define, explicitly teach, and assess. The purpose of this study was to examine the data gathered from professionalism rubrics from one cohort of students over 3 years and to identify the implications of these findings for our program.

Review of Literature.

Studies in the current literature situate professionalism in the context of the interplay between actors, systems, and environments. Professionalism is recognized not only as a characteristic of the individual but of social interactions with material systems and communities of practice.

Subjects.

A convenience sample of one cohort of students enrolled in a Doctor of Physical Therapy graduate program (n = 49) participated in this 3-year study.

Methods.

This was a retrospective, cross-sectional study. Quantitative results were analyzed using percentiles, mean values, median values and Cohen's Kappa. Qualitative results were analyzed using a general inductive approach.

Results.

Students in year 1 lacked professionalism in the area of preparedness, students in year 2 lacked professionalism in the area of stress management, and students in year 3 lacked professionalism in the area of social responsibility.

Discussion and Conclusion.

The study findings illustrate how a social–material teaching and learning tool can inform curricular design, program supports, and assessment processes. By viewing professionalism as a developmental, dynamic concept influenced by contextual factors, physical therapy education programs can better assess and support student success.
Job Satisfaction and Retention Among Physical Therapist Education Program Directors
Authors: Bowens Andrea N. , Ford Deana J. , Boggs Olivia M.
Published: February 2021

Introduction.

The attrition of leaders in physical therapist (PT) education programs has been linked to job stress and satisfaction. Specifically, Program Director (PD) attrition has been associated with multiple extrinsic factors, such as perceived support, internal conflict, workload, and burnout. Institution type has also been linked to job satisfaction. However, there is limited evidence directly assessing PD job satisfaction and the impact of institutional characteristics on levels of satisfaction. Thus, we sought to determine the degree to which current PT PDs experience job satisfaction, what institution-related factors impact satisfaction, and the position PDs foresee themselves having in 3 years.

Methods.

All current PD at accredited PT education programs were invited to participate in the survey, of which 88 responded. Data were collected using an electronic survey composed of the Job Satisfaction Scale (JSS), demographics, and a question on PD intended job status in 3 years. Statistical analyses of the respondents looked for associations between Carnegie classification, institution type, and anticipated position with the 9 facets of the JSS.

Results.

Program directors were satisfied with their current roles, and most respondents intended to stay at their current institution, either in the same or different role. Program director working at public institutions felt less appreciation and reward from their institution. Respondents working at public and Research/Doctoral universities were less satisfied with the organizational communication, whereas respondents from Master's colleges and universities were more likely to not like their supervisors and less satisfied with their coworkers.

Discussion and Conclusion.

These findings call attention to the impact that institution-related factors can have on aspects of PD job satisfaction. Results can be used inform strategies to improve educational leaders' work–life satisfaction and increase PD retention and underscore the importance of current and future leaders considering individual fit for the institution.
Comparison of Sample Adequacy and Diagnostic Yield of the 21-G and 25-G EBUS TBNA Needles
Authors: Sood Rahul , Alape Daniel , Thakkar Dhaval , Shadchehr Sara , Acash Ghazwan , Tronic Bruce J. , Lamb Carla R.
Published: February 2021

Background:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) of mediastinal lymphadenopathy has been shown to be equivalent and possibly even superior to mediastinoscopy. Since the original dedicated 22-G aspiration needle, 21-G, 25-G, and recently 19-G needles have been introduced. Smaller needles may be more flexible and adept at accessing more difficult nodes, and may have less blood contamination compared with larger needles.

Patients and Methods:

This is a prospective observational study of 50 consecutive patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration with a 21-G needle and a 25-G needle for a total of 100 biopsies. The study slides were examined by a dedicated lung cytopathologist, who was blinded to the needle size used for each slide. Demographic data, and lymph node size were recorded. Comparisons between the 2 needles with regards to sample adequacy and diagnostic yield was performed using the McNemar test for dichotomous variables and marginal homogeneity test for nondichotomous variables since samples were related.

Results:

The majority of lymph nodes (96%) were at least >1 cm. Adequate specimens were obtained in 78% of cases with the 21-G needle and 86% of cases with 25-G needle (P-value=0.424). The overall diagnostic yield was 74% and 80% with the 21-G needle and 25-G needle, respectively (P-value=0.607).

Conclusion:

Our study demonstrates that the there is no difference in terms of specimen adequacy and diagnostic yield when the 25-G needle is compared with the 21-G needle.
Near-Histologic Resolution Images of Cervical Dysplasia Obtained With Gabor Domain Optical Coherence Microscopy
Authors: Paczos Tamera , Bonham Adrienne , Canavesi Cristina , Rolland Jannick P. , O'Connell Rachel
Published: February 2021

Objective

Histopathology is the criterion standard for evaluating cervical squamous intraepithelial neoplasia (dysplasia). In this pilot feasibility study, we examined whether a novel 3-dimensional imaging device using Gabor-domain optical coherence microscopy (GDOCM) could distinguish features of cervical dysplasia comparable with histopathology.

Methods

A prospective observational pilot study enrolled a small sample of women undergoing loop electrosurgical excision procedure for cervical squamous intraepithelial neoplasia. Fresh ex vivo specimens were imaged with the GDOCM device. Digital images were reviewed by a pathologist who was blinded to the histopathology results. Histopathologic features were then compared with the digital observations.

Results

Standard histologic features of cervical squamous epithelium and of squamous intraepithelial neoplasia could be observed in GDOCM images. Cervical epithelium, stroma, basement membrane, and squamous papilla could all be identified. Human papillomavirus effects, such as vacuolization and cellular density, were also observed.

Conclusions

A GDOCM imaging system has the potential to obtain histologic resolution images of the cervix in the evaluation of squamous intraepithelial neoplasia. This pilot study allowed for optimizing the imaging system and paved the way for a future diagnostic accuracy study. The development of this technology could streamline the evaluation of patients at risk for cervical neoplasia.
Female Genital Tract Melanoma: 10 Years of Experience at a Single Tertiary Center
Authors: Lewin Jonathan , Egbe Azelle , Ellery Peter , Wilkinson Nafisa , MacDonald Nicola , Kotsopoulos Ioannis C. , Olaitan Adeola
Published: February 2021

Objective

Malignant melanoma of the female genital tract is a rare disease with poor prognosis, with controversies remaining in its staging and management. In this study, we investigate clinical, pathological, and outcome data for patients referred to a tertiary cancer center with female genital tract melanoma over a decade.

Methods

Patients were retrospectively identified using a search of pathology reports to identify all cases of female genital tract melanoma from 2007 to 2019. Electronic patient records were used to record clinical information. Histopathology specimens were reviewed by a gynecological and dermatological pathology specialist.

Results

We identified 30 cases of genital tract melanoma, of which 19 were vulvar, 10 were vaginal, and 1 cervical. Overall survival at 1, 3, and 5 years was found to be 80%, 60%, and 57%. Patients who died were not significantly older at presentation than patients who survived (62 y vs 69 y, p = .215). No association was found between mortality and microscopic ulceration, lymphovascular invasion, pigmentation, resection margins, or radical versus local surgery.

Nonvulvar lesions were significantly associated with mortality compared with vulvar lesions (p = .0018), despite similar age and Breslow thickness. Five patients were diagnosed at in situ stage, all of these were vulvar. Even after excluding these melanomas in situ, nonvulvar melanomas still had a significantly worse mortality rate (p = .048). A higher proportion of nonvulvar lesions than vulvar lesions displayed loss of pigmentation (p = .026).

Conclusions

Nonvulvar genital tract melanomas carry a significantly worse prognosis. Survival was not related to resection margins, supporting the use of more conservative surgical margins.
The Viability and Growth of HaCaT Cells After Exposure to Bioactive Glass S53P4-Containing Cell Culture Media
Authors: Sarin Jussi , Vuorenmaa Minna , Vallittu Pekka K. , Grénman Reidar , Boström Pia , Riihilä Pilvi , Nissinen Liisa , Kähäri Veli-Matti , Pulkkinen Jaakko
Published: February 2021

Hypothesis:

Bioactive glass (BG) S53P4 reduces the viability of epidermal keratinocyte-derived immortalized cell line, HaCaT in sufficient concentrations in vitro.

Background:

Although used in mastoid obliteration surgery, there is no data available on whether BG S53P4 granules have an inhibitory or excitatory effect on keratinocytes, found in normal skin and ear cholesteatoma in vivo.

Methods:

HaCaT cell cultures were incubated with a direct BG S53P4 granule contact. Microscopic evaluation of the cultures was performed and interleukin-6 (IL-6) and -8 (IL-8) concentrations were measured from the medium samples. In addition, BG granules were incubated in two cell culture media for 6 days and the pure media were used in confluent HaCaT cultures preceding cell viability assay. Finally, a scratch assay test was performed to reveal the possible BG effect on HaCaT cultures.

Results:

Eight to ten cell thick layers of dead HaCaT cells were noticed after a 2-day BG granule contact. With a BG concentration of 2.5%, IL-6 and IL-8 concentrations were smaller compared with the control group without BG after 2 days’ incubation. Overall, HaCaT cell viability decreased when BG was incubated in keratinocyte growth medium, but did not change in Dulbecco's modified Eagle's medium. In a scratch assay test, cell regrowth in the scratch area was notable in cultures without BG.

Conclusions:

BG S53P4 seems to have an inhibitory effect on HaCaT cell growth. Although further studies are needed, this observation seems advantageous for cholesteatoma treatment.
HVAD Usage and Outcomes in the Current Pediatric Ventricular Assist Device Field: An Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Analysis
Authors: Auerbach Scott R. , Simpson Kathleen E.
Published: February 2021

Advanced Cardiac Therapies Improving Outcomes Network (ACTION) is the first pediatric ventricular assist device (VAD) quality improvement network (46 centers). We aimed to describe outcomes with the HeartWare HVAD from ACTION centers. Patients with an HVAD implant in the ACTION registry (April 2018–April 2020) were analyzed. Baseline characteristics, adverse events, and survival were described. There were 50 patients implanted with a HVAD during the study period [36 cardiomyopathy, 8 congenital heart disease (CHD), and 6 other] and 21 (42%) had a prior sternotomy. Median age (range) was 12.9 years (3.4–19.1), body surface area was 1.3 m2 (0.56–2.62), and weight was 41.8 kg (12.8–135.3). Most were INTERMACS profile 2 (n = 26, 52%). Mechanical ventilation and ECMO were used pre-HVAD in 13 (26%) and 6 (12%), respectively. Median time on VAD was 71 (5–602) days. Survival was 96% at 1 year; 3 deaths were recorded, all of whom had CHD (p = 0.001). Neither ECMO nor mechanical ventilation were associated with death (p > 0.29). Most frequent AEs were bleeding (n = 7, 14%) and infection (n = 7, 14%). Stroke was rare (n = 2, 4%). ACTION Network HVAD outcomes were excellent, with 96% survival at 1 year and only 4% occurrence of stroke. Major bleeding and infection were the most common adverse events.
Patient-Reported Issues Following Left Ventricular Assist Device Implantation Hospitalization
Authors: Casida Jesus M. , Pavol MaryKay , Craddock Heidi , Schroeder Sarah E. , Cagliostro Barbara , Budhathoki Chakra
Published: February 2021

The purpose of this study was to explore the information reported by patients via a smartphone application (VAD Care App) used for left ventricular assist device (LVAD) self-care monitoring and reporting post hospital discharge. Specific aims were to examine the type and frequency of issues reported by patients through the app during months 1, 3, and 6 postdischarge. An exploratory-descriptive research design was used with 17 patients (12 males and 5 females) with durable LVADs, mean age of 48.6 ± 16 years. Data generated by the patients’ daily smartphone app usage more than 6 months were extracted from the server. Data were coded and clustered according to issues reported by patients via the app and analyzed with descriptive statistics. Three clusters of issues were found: physiologic, behavioral (self-care), and signs and symptoms. LVAD flows and pulsatility indices, hypertension, driveline care, and heart failure symptoms were worse at month 1, and then appeared to improve at months 3–6. However, abnormal levels of the international normalization ratio were common at all assessment points. Further research is needed to understand the mechanism of the reported issues on treatment outcomes, then develop and test interventions to inform evidence-based practice and clinical guidelines for smartphone apps used in LVAD self-care monitoring.
Drugs in Focus: Proton Pump Inhibitors
Authors: Orel Rok , Benninga Marc A. , Broekaert Ilse J. , Gottrand Frederic , Papadopoulou Alexandra , Ribes-Koninckx Carmen , Thomson Mike , Wilschanski Michael , Thapar Nikhil
Published: February 2021

Proton pump inhibitors (PPIs) are amongst the most commonly prescribed drugs in infants and children with the last decades witnessing a dramatic rise in their utilization. Although PPIs are clearly effective when used appropriately and have been regarded as safe drugs, there is growing evidence regarding their potential adverse effects. Although, largely based on adult data it is clear that many of these are also relevant to pediatrics. PPI use potentially affects gastrointestinal microbiota composition and function, decreases defence against pathogens resulting in increased risk for infections, interferes with absorption of minerals and vitamins leading to specific deficiencies and increased risk for bone fractures as well as interferes with protein digestion resulting in increased risk of sensitization to allergens and development of allergic diseases and eosinophilic esophagitis. An association with gastric, liver and pancreatic cancer has also been inferred from adult data but is tenuous and causation is not proven. Overall, evidence for these adverse events is patchy and not always compelling. Overall, the use of PPIs, for selected indications with a good evidence base, has significant potential benefit but carries more caution in infants and children. Pediatricians should be aware of the concerns regarding the potential adverse events associated with their use.
The Influence of Multiple Chronic Conditions on Symptom Clusters in People With Solid Tumor Cancers
Authors: Saeidzadeh Seyedehtanaz , Perkhounkova Yelena , Gilbertson-White Stephanie , Cherwin Catherine H.
Published: February 2021

Background

People with cancer who also have multiple chronic conditions (MCCs) experience co-occurring symptoms known as symptom clusters.

Objective

To describe MCC and symptom clusters in people with cancer and to evaluate the relationships between MCCs and symptom severity, symptom interference with daily life, and quality of life (QoL).

Methods

Weekly over a 3-week chemotherapy cycle, 182 adults with solid tumor cancer receiving chemotherapy completed measures of symptom severity, symptom interference with daily life, and QoL. Medical records reviewed to count number of MCCs in addition to cancer. Exploratory factor analysis was performed to identify symptom clusters. The relationships between the number of MCCs and the outcomes (symptom severity and symptom interference with daily life and QoL) at each time point were examined using the χ
2 test. Longitudinal changes in outcomes were examined graphically.

Results

The number of MCCs ranged from 0 to 9, but most participants (62.1%) had 2 or fewer MCCs. Obesity was the most prevalent chronic condition. Four symptom clusters were identified: nutrition, neurocognitive, abdominal discomfort, and respiratory clusters. At each time point, no significant differences were found for MCCs and any outcome. However, symptom severity in all the symptom clusters, symptom interference with daily life, and QoL demonstrated a worsening in the week following chemotherapy.

Conclusion

A majority of our sample had 2 or fewer MCCs, and MCCs did contribute to patient outcomes. Rather, timing of chemotherapy cycle had the greatest influence of patient outcomes.

Implications for Practice

Additional support on day 7 of chemotherapy treatment is needed for people with MCCs.
Existential Distress in Cancer Patients
Authors: Chen Weiling , Chen Ying , Xiao Huimin
Published: February 2021

Background

Existential distress is a widely used concept used in describing cancer patients. However, this concept is vague and has failed to achieve a consensus. The lack of a recognized conceptual framework could hinder future research on existential distress.

Objective

The aim of this study was to clarify and analyze the concept of existential distress in cancer patients.

Methods

The Walker and Avant concept analysis approach was applied.

Results

For cancer patients, the concept of existential distress included 5 core attributes: (a) lack of meaning; (b) loss of autonomy; (c) loss of dignity; (d) hopelessness; and (e) death anxiety. Existential distress is a key factor causing poor quality of life, a poor emotional state, demoralization, and even suicide. It is often underpinned by uncontrolled physical pain, serious psychological morbidity, and a perceived sense of being a burden on others.

Conclusion

The concept analysis provides a theoretical framework for healthcare providers to better understand existential distress in cancer patients, to improve patient well-being.

Implications for Practice

On the basis of the antecedents of this concept, cancer patients experiencing uncontrolled physical pain, severe psychological morbidity, and a perceived sense of being a burden on others are at a high risk of existential distress. These factors should be eliminated in a timely manner to prevent cancer patients from being caught in a state of existential distress. The 5 defining attributes and empirical referents of this concept could be used to develop tools to screen for existential distress in cancer patients and distinguish it from similar concepts.
Sexually Transmitted Infection Testing and Prevalence Before and After Preexposure Prophylaxis Initiation Among Men Aged ≥18 Years in US Private Settings
Authors: Tao Guoyu , Pearson William S. , Sullivan Jane M. , Henk Henry J. , Gift Thomas L.
Published: February 2021

Background

The Centers for Disease Control and Prevention recommends initial and follow-up sexually transmitted infection (STI) and HIV testing when taking HIV preexposure prophylaxis (PrEP). We assessed frequencies of STIs and HIV testing and rates of STIs before and after PrEP initiation among men aged ≥18 years.

Methods

We used the OptumLabs database for this cohort study. We measured STI/HIV testing rates and prevalence in 2 time intervals: (1) within 90 days before and on the date of PrEP initiation and (2) within 45 days of the 180th day after the date of PrEP initiation.

Results

Of 4210 men who initiated PrEP in 2016 to 2017 and continuously used PrEP for ≥180 days, 45.7%, 45.7%, and 56.0% were tested for chlamydia, gonorrhea, and HIV, respectively, at the second time interval. These percentages were significantly lower than those at the first time interval (58.3%, 57.9%, and 73.5%, respectively; P < 0.01). Chlamydia and gonorrhea prevalence rates at the second time interval were 6.5% and 6.2%, respectively, versus 5.0% and 4.7%, respectively, at the first time interval. Most gonorrhea or chlamydia infections at the second time intervals seem to be new infections new infections.

Conclusions

Sexually transmitted infection/HIV testing for PrEP users in the real-world private settings is much lower than in clinical trials. High STI prevalence before and after PrEP initiation in this study suggests that patients taking PrEP have an increased risk of acquiring STI. Interventions to improve provider adherence for PrEP users are urgently needed.
The Estimated Impact of Implementing a Funding Allocation Formula on the Number of Gonorrhea Cases in the United States, 2014 to 2018
Authors: Aslam Maria Vyshnya , Chesson Harrell
Published: February 2021

Background

The Centers for Disease Control and Prevention (CDC) allocates funds annually to state and local programs in the United States to monitor and prevent sexually transmitted diseases (STDs). In 2014, a funding formula was implemented to allocate prevention funds to jurisdictions according to their STD burden and population size. We estimated the effect of implementing the funding formula in terms of gonorrhea cases averted from 2014 to 2018, a period during which inflation-adjusted CDC STD prevention funding declined.

Methods

Our model assumed that STD prevention funds have a measurable effect on subsequent reported gonorrhea case rates, and the magnitude of this effect was as estimated in an empirical analysis of decades of state-level gonorrhea rates. In applying this equation-based model, we assumed all factors affecting jurisdictions' gonorrhea rates were constant over time except for their STD prevention funding allocations. We used data on CDC STD prevention funding allocated to each jurisdiction over time. We estimated gonorrhea rates under the “funding formula” scenario compared with a hypothetical “status quo” funding scenario, which reflected traditional methods to allocate prevention funds.

Results

In the model, gonorrhea cases increased from 2014 to 2018 by approximately 6% because of a decline in prevention funding, regardless of how funds were allocated. However, the estimated increase in gonorrhea cases was 5222 (range, 1181–9195) cases less in the funding formula scenario than in the status quo scenario.

Conclusions

By shifting resources toward jurisdictions with greater disease burden, the funding formula averted a substantial number of gonorrhea cases at no additional cost.
mTOR Pathway Activation Assessed by Immunohistochemistry in Cervical Biopsies of HPV-associated Endocervical Adenocarcinomas (HPVA): Correlation With Silva Invasion Patterns
Authors: Segura Sheila , Stolnicu Simona , Boros Monica , Park Kay , Ramirez Pedro , Salvo Gloria , Frosina Denise , Jungbluth Achim , Soslow Robert A.
Published: February 2021

The Silva pattern of invasion, recently introduced to stratify patients at risk for lymph node metastases in human papillomavirus-associated endocervical adenocarcinomas (HPVAs), can only be assessed in cone and loop electrosurgical excision procedure excisions with negative margins or in a hysterectomy specimen. Previous studies found associations between destructive stromal invasion patterns (Silva patterns B and C) and mutations in genes involved in the MEK/PI3K pathways that activate the mammalian target of rapamycin (mTOR) pathway. The primary aim of this study was to use cervical biopsies to determine whether markers of mTOR pathway activation associate with aggressive invasion patterns in matched excision specimens. The status of the markers in small biopsy specimens should allow us to predict the final and biologically relevant pattern of invasion in a resection specimen. Being able to predict the final pattern of invasion is important, since prediction as Silva A, for example, might encourage conservative clinical management. If the pattern in the resection specimen is B with lymphovascular invasion or C, further surgery can be performed 34 HPVA biopsies were evaluated for expression of pS6, pERK, and HIF1α. Immunohistochemical stains were scored semiquantitatively, ranging from 0 to 4+ with scores 2 to 4+ considered positive, and Silva pattern was determined in follow-up excisional specimens. Silva patterns recognized in excisional specimens were distributed as follows: pattern A (n=8), pattern B (n=4), and pattern C (n=22). Statistically significant associations were found comparing pS6 and pERK immunohistochemistry with Silva pattern (P=0.034 and 0.05, respectively). Of the 3 markers tested, pERK was the most powerful for distinguishing between pattern A and patterns B and C (P=0.026; odds ratio: 6.75, 95% confidence interval: 1.111-41.001). Although the negative predictive values were disappointing, the positive predictive values were encouraging: 90% for pERK, 88% for pS6 and 100% for HIF1α. mTOR pathway activation assessed by immunohistochemistry in cervical biopsies of HPVA correlate with Silva invasion patterns.
Epidemiology of Critical Interventions in Children With Traumatic Intracranial Hemorrhage
Authors: Chaudhari Pradip P. , Pineda Jose , Bachur Richard G. , Khemani Robinder G.
Published: February 2021

Objective

To estimate rates of critical medical and neurosurgical interventions and resource utilization for children with traumatic intracranial hemorrhage (ICH).

Methods

This was a retrospective study of children younger than 18 years hospitalized in 1 of 35 hospitals in the Pediatric Health Information System from 2009 to 2019 for ICH. We defined critical intervention as a critical medical (hyperosmotic agents and intubation) or neurosurgical intervention. We determined rates of critical interventions, intensive care unit (ICU) admission, and repeat neuroimaging. We used hierarchical logistic regression to identify high-level factors associated with undergoing critical interventions, controlling for hospital-level effects.

Results

There were 12,714 children with ICH included in the study. Median (interquartile range) age was 4.3 (0.7–11.0) years. Twelve percent (n = 1470) of children underwent a critical clinical intervention. Critical medical interventions occurred in 10% (n = 1219), and neurosurgical interventions occurred in 3% (n = 419). Intensive care unit admission occurred in 44% (n = 5565), whereas repeat neuroimaging occurred in 40% (n = 5072). Among ICU patients, 79% (n = 4366) did not undergo a critical intervention. Of the 11,244 children with no critical interventions, 39% (n = 4366) underwent ICU admission, and 37% (n = 4099) repeat neuroimaging. After controlling for hospital, children with isolated subdural (P = 0.013) and isolated subarachnoid (P < 0.001) hemorrhage were less likely to receive critical interventions.

Conclusions

Critical medical interventions occurred in 10% of children with ICH, and neurosurgical interventions occurred in 3%. Intensive care unit admission and repeat neuroimaging are common, even among those who did not undergo critical interventions. Selective utilization of ICU admission and repeat neuroimaging in children who are at low risk of requiring critical interventions could improve overall quality of care and decrease unnecessary resource utilization.
Pediatric Myopericarditis Presenting to the Emergency Department as Chest Pain
Authors: Babbitt Christopher J. , Babbitt Michael J. , Byrne Francesca , Morphew Tricia
Published: February 2021

Objectives

Myopericarditis is a newly described entity that is primarily a pericardial syndrome with elevated cardiac enzymes that has been seen with increasing frequency in our pediatric intensive care unit. For this reason, we performed a retrospective cohort analysis with a goal of establishing differences between myopericarditis and myocarditis that could lead to proper diagnosis on emergency department presentation.

Methods

A database query was performed and identified patients over a 9-year period, and clinical data, laboratory data, and cardiac studies were extracted and analyzed from the electronic health record.

Results

A total of 36 patients were identified with the discharge diagnosis of myopericarditis and 22 with myocarditis. The median age for myopericarditis patients was 16.2 years, and 97% were male. The median initial troponin was 7.1 ng/mL, the peak was at 16.6 ng/mL, and 58% had ST changes on electrocardiogram. The median length of stay for myopericarditis patients was 1.7 days, and 50% were discharged home on nonsteroidal anti-inflammatory medication. Compared with myocarditis, myopericarditis patients were older, had a higher incidence of chest pain, and were less likely to have fever, vomiting, abdominal pain, upper respiratory infection symptoms, chest radiograph abnormalities, or T-wave inversion (P < 0.05). Myopericarditis patients also had lower Pediatric Risk of Mortality version 3 scores, B-type natriuretic peptide levels, and higher left ventricular ejection fractions on admission (67% vs 41%; P < 0.05). A classification model incorporating initial left ventricular ejection fraction, B-type natriuretic peptide, electrocardiogram, and chest radiograph findings distinguished myopericarditis from myocarditis with correct classification in 95% of patients.

Conclusions

Myopericarditis is a relatively common cause of chest pain for patients admitted to the pediatric intensive care unit, presents differently than true myocarditis, and carries a good prognosis.