bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetes insipidus secondary to nivolumab-induced neurohypophysitis and pituitary metastasis
Authors: Fosci Michele , Pigliaru Francesca , Salcuni Antonio Stefano , Ghiani Massimo , Cherchi Maria Valeria , Calia Maria Antonietta , Loviselli Andrea , Velluzzi Fernanda
Published: February 2021

A 62-year-old patient with metastatic hypopharyngeal carcinoma underwent treatment with nivolumab, following which he developed symptoms suggestive of diabetes insipidus. Nivolumab was stopped and therapy with methylprednisolone was started. During corticosteroid therapy, the patient presented himself in poor health condition with fungal infection and glycemic decompensation. Methylprednisolone dose was tapered off, leading to the resolution of mycosis and the restoration of glycemic compensation, nevertheless polyuria and polydipsia persisted. Increase in urine osmolarity after desmopressin administration was made diagnosing central diabetes insipidus as a possibility. The neuroradiological data by pituitary MRI scan with gadolinium was compatible with coexistence of metastatic localization and infundibulo-neurohypophysitis secondary to therapy with nivolumab. To define the exact etiology of the pituitary pathology, histological confirmation would have been necessary; however, unfortunately, it was not possible. In the absence of histological confirmation, we believe it is likely that both pathologies coexisted.

Learning points:

A remarkable risk of endocrine immune-related adverse events (irAEs) during therapy with checkpoint inhibitors exsists.

In order to ensure maximum efficiency in the recognition and treatment of endocrine iRAes related to immune checkpoint inhibitors, multidisciplinary management of oncological patients is critical.

The pituitary syndrome in oncological patients who underwent immunotherapy represents a challenge in the differential diagnosis between pituitary metastasis and drug-induced hypophysitis.

This is the first case, described in the literature of diabetes insipidus in a patient suffering from nivolumab-induced infundibulo-neurohypophysitis and anterohypophyseal metastasis.
ENDOCRINOLOGY IN PREGNANCY: Metabolic impact of bile acids in gestation
Authors: Fan Hei Man , Mitchell Alice L , Williamson Catherine
Published: February 2021

Bile acids are lipid-solubilising molecules that also regulate metabolic processes. Farnesoid X receptor (FXR) and Takeda G-protein coupled receptor 5 (TGR5) are two bile acid receptors with key metabolic roles. FXR regulates bile acid synthesis in the liver and influences bile acid uptake in the intestine. TGR5 is mainly involved in regulation of signalling pathways in response to bile acid uptake in the gut and therefore prandial response. Both FXR and TGR5 have potential as therapeutic targets for disorders of glucose and/or lipid homeostasis. Gestation is also known to cause small increases in bile acid concentrations, but physiological hypercholanaemia of pregnancy is usually not sufficient to cause any clinically relevant effects. This review focuses on how gestation alters bile acid homeostasis, which can become pathological if the elevation of maternal serum bile acids is more marked than physiological hypercholanaemia, and on the influence of FXR and TGR5 function in pregnancy on glucose and lipid metabolism. This will be discussed with reference to two gestational disorders: intrahepatic cholestasis of pregnancy (ICP), a disease where bile acids are pathologically elevated, and gestational diabetes mellitus (GDM), characterised by hyperglycaemia during pregnancy.
White adipose tissue-infiltrated CD11b+ myeloid cells are a source of S100A4, a new potential marker of hepatic damage
Authors: Reyes Marjorie , González Lorena , Ibeas Kevin , Cereijo Rubén , Taxerås Siri D , Pellitero Silvia , Martínez Eva , Tarascó Jordi , Moreno Pau , Malagón Paloma , Higueras Carmen , Soria Andrea , Puig-Domingo Manel , Villarroya Francesc , Serra Dolors , Herrero Laura , Sánchez-Infantes David
Published: February 2021

Context

The endocrine and immunological properties of subcutaneous vs visceral adipose tissue (sWAT and vWAT, respectively) have turned a milestone in the study of metabolic diseases. The cytokine S100A4 is increased in obesity and has a role in adipose tissue dysfunction. However, the cellular source and its potential role in hepatic damage in obesity has not been elucidated.

Objective

We aim to study the regulation of S100A4 in immune cells present in sWAT and vWAT, as well as its potential role as a circulating marker of hepatic inflammation and steatosis.

Design

A cohort of 60 patients with obesity and distinct metabolic status was analyzed. CD11b+ myeloid cells and T cells were isolated from sWAT and vWAT by magnetic-activating cell sorting, and RNA was obtained. S100A4 gene expression was measured, and correlation analysis with clinical data was performed. Liver biopsies were obtained from 20 patients, and S100A4 circulating levels were measured to check the link with hepatic inflammation and steatosis.

Results

S100A4 gene expression was strongly upregulated in sWAT- vs vWAT-infiltrated CD11b+ cells, but this modulation was not observed in T cells. S100A4 mRNA levels from sWAT (and not from vWAT) CD11b+ cells positively correlated with glycemia, triglycerides, TNF-α gene expression and proliferation markers. Finally, circulating S100A4 directly correlated with liver steatosis and hepatic inflammatory markers.

Conclusion

Our data suggest that sWAT-infiltrated CD11b+ cells could be a major source of S100A4 in obesity. Moreover, our correlations identify circulating S100A4 as a potential novel biomarker of hepatic damage and steatosis.
Semen quality and testicular adrenal rest tumour development in 46,XY congenital adrenal hyperplasia: the importance of optimal hormonal replacement
Authors: Rohayem Julia , Bäumer Lena Maria , Zitzmann Michael , Fricke-Otto Susanne , Mohnike Klaus , Gohlke Bettina , Reschke Felix , Jourdan Claus , Müller Herman L , Dunstheimer Désirée , Weigel Johannes , Jorch Norbert , Müller-Rossberg Elke , Lankes Erwin , Gätjen Imke , Richter-Unruh Annette , Hauffa Berthold P , Kliesch Sabine , Krumbholz Aniko , Brämswig Jürgen
Published: February 2021

Objective

To study the impact of the quality of therapeutic control on fertility and on the prevalence of testicular adrenal rest tumours (TART) in young males with congenital adrenal hyperplasia (CAH).

Design

Combined cross-sectional and retrospective clinical study.

Methods

Twenty-nine patients and age-matched controls underwent clinical investigation, including semen analysis, testicular and adrenal ultrasound imaging, and serum and hair steroid analysis. The quality of therapeutic control was categorized as ‘poor’, ‘moderate’ or ‘medium’. Evaluation of current control was based on concentrations of 17-hydroxy-progesterone and androstenedione in serum and 3 cm hair; previous control was categorized based on serum 17-hydroxy-progesterone concentrations during childhood and puberty, anthropometric and puberty data, bone age data and adrenal sizes.

Results

Semen quality was similar in males with CAH and controls (P  = 0.066), however patients with ‘poor’ past control and large TART, or with ‘poor’ current CAH control had low sperm counts. Follicle-stimulating hormone was decreased, if current CAH control was ‘poor’ (1.8 ± 0.9 U/L; ‘good’: 3.9 ± 2.2 U/L); P  = 0.015); luteinizing hormone was decreased if it was ‘poor’ (1.8 ± 0.9 U/L; P  = 0.041) or ‘moderate’ (1.9 ± 0.6 U/L; ‘good’: 3.0 ± 1.3 U/L; P  = 0.025). None of the males with ‘good’ past CAH control, 50% of those with ‘moderate’ past control and 80% with ‘poor past control had bilateral TART. The prevalence of TART in males with severe (class null or A) CYP21A2 mutations was 53% and 25% and 0% in those with milder class B and C mutations, respectively.

Conclusions

TART development is favoured by inadequate long-term hormonal control in CAH. Reduced semen quality may be associated with large TART. Gonadotropin suppression by adrenal androgen excess during the latest spermatogenic cycle may contribute to impairment of spermatogenesis.
Recovery of hypothalamus–pituitary–gonadal dysfunction after the treatment of suprasellar germ cell tumors
Authors: Zhang Kun , Wang Linjie , Duan Lian , Yang Hongbo , Pan Hui , Lian Xin , Yao Yong , Zhu Huijuan
Published: February 2021

Objective

To investigate the incidence of hypothalamus–pituitary–gonadal (HPG) axis initiation/recovery after treatment and to identify predictive risk factors for noninitiation/recovery.

Methods

A total of 127 consecutive suprasellar germ cell tumor (GCT) patients managed at Peking Union Medical College Hospital (2006–2019) were retrospectively analyzed. Prepubertal patients (followed up until 13 years of age for girls and 14 years of age for boys) and patients with HPG dysfunction (followed up for 2 years) were divided into the initiation/recovery and noninitiation/recovery groups.

Results

Of the 127 suprasellar GCT patients, 75 met the follow-up criteria, 28 (37.3%) of whom experienced HPG axis initiation/recovery. Compared to the noninitiation/recovery group, the initiation/recovery group included more males and had shorter delayed diagnosis times, smaller tumor sizes, lower panhypopituitarism rates, thinner pituitary stalk widths, lower visual deficit rates, and higher serum testosterone and estradiol levels. The cutoff values of pituitary stalk width, tumor size, and delayed diagnosis time used to predict noninitiation/recovery were 6.9 mm, 6.9 mm and 1.7 years, respectively. Tumor size ≥6.9 mm (odds ratio (OR) = 7.5, 95% CI: 2.2–25.8, P = 0.001), panhypopituitarism (OR = 5.0, 95% CI: 1.4–17.6, P = 0.013), and delayed diagnosis time ≥1.7 years (OR = 5.7, 95% CI: 1.5–20.7, P = 0.009) were risk factors for noninitiation/recovery.

Conclusions

Among suprasellar GCT patients, nearly one-third of prepubertal patients and patients with HPG dysfunction experience HPG axis initiation/recovery after treatment. Tumor size ≥6.9 mm, panhypopituitarism, and delayed diagnosis time ≥1.7 years were identified as predictive risk factors for noninitiation/recovery.
Adult growth hormone deficiency guidelines: more difficult than it seems to incorporate into clinical practice universally
Authors: Yuen Kevin C J
Published: February 2021

Adult growth hormone deficiency (GHD) is a syndrome characterized by adverse phenotypic, metabolic, and quality-of-life features. Over the past 2 decades, there is accumulating evidence demonstrating improvement of most of these parameters when GH is optimally replaced. Appropriate selection of patients at risk of GHD is crucial when considering and performing testing to establish the diagnosis. While generally safe, GH replacement requires careful dose initiation and monitoring to assure effectiveness and tolerance in treated patients. Several consensus clinical practice guidelines recommend evaluation of adults presenting with hypothalamic-pituitary disorders for GHD. However, the clinical practice of managing such patients varies among countries largely due to lack of recognition of the condition, lack of GH availability, and lack of reimbursement of the drug, as demonstrated from a large online survey prepared by the European Society of Endocrinology involving 2148 patients from Europe and Australia. These data reinforce the notion of the large variability of disease recognition, clinical practice and education of adult GHD amongst healthcare professionals, and the lack of availability and reimbursement of the drug contributing to the under-utilization of GH replacement therapy in several countries. This commentary article highlights the fact that despite the publication of several guideline recommendations and positive long-term safety and efficacy data of GH replacement, there is still a need for increased education to enhance the awareness in the general population and improve the knowledge of healthcare professionals and administrators of adult GHD as a disease state to allow for early identification and treatment optimization.
COVID-19 and male reproductive function: a prospective, longitudinal cohort study
Authors: Hajizadeh Maleki Behzad , Tartibian Bakhtyar
Published: February 2021

The existing evidence suggests that the human reproductive system may be potentially vulnerable to COVID-19 infection. However, little is known about the virus–host interaction of COVID-19 in sperm cells. We are the first to address the connection between changes in multiple seminal biomarkers and reproductive function in male patients recovering from COVID-19. In a prospective longitudinal cohort study, seminal ACE2 activity, markers of inflammation and oxidative stress, apoptotic variables, and semen quality parameters were evaluated at 10-day intervals for a maximum follow-up time of 60 days among male patients with laboratory-confirmed COVID-19 (n = 84) and healthy controls (CON; n = 105). At the baseline and the subsequent follow-ups, the COVID-19 group revealed significantly higher levels of seminal plasma ACE2 enzymatic activity, IL-1β, IL-6, IL-8, IL-10, TGF-β, TNF-α, IFN-α, IFN-γ, ROS, caspase-8, caspase-9, and caspase-3 activity as well as lower levels of SOD activity than those in the CON group (P  < 0.05). These perturbations tended to persist over time and were correlated with significant impairments in semen volume, progressive motility, sperm morphology, sperm concentration, and the number of spermatozoa. We provide the direct experimental evidence that the male reproductive system could be targeted and damaged by the COVID-19 infection. These findings go beyond our current understanding of the disease, suggesting that the reproductive function of the patients recovering from the disease should be precisely followed and evaluated to detect and avoid more serious reproductive problems in the future, as they may develop a transient state of male subfertility like those with oligoasthenoteratozoospermia.
Computational simulations reveal the binding dynamics between human ACE2 and the receptor binding domain of SARS‐CoV‐2 spike protein
Authors: Lupala Cecylia S. , Li Xuanxuan , Lei Jian , Chen Hong , Qi Jianxun , Liu Haiguang , Su Xiao‐Dong
Published: February 2021

Background

A novel coronavirus (the SARS‐CoV‐2) has been identified in January 2020 as the causal pathogen for COVID‐19, a pandemic started near the end of 2019. The Angiotensin converting enzyme 2 protein (ACE2) utilized by the SARS‐CoV as a receptor was found to facilitate the infection of SARS‐CoV‐2, initiated by the binding of the spike protein to human ACE2.

Methods

Using homology modeling and molecular dynamics (MD) simulation methods, we report here the detailed structure and dynamics of the ACE2 in complex with the receptor binding domain (RBD) of the SARS‐CoV‐2 spike protein.

Results

The predicted model is highly consistent with the experimentally determined structures, validating the homology modeling results. Besides the binding interface reported in the crystal structures, novel binding poses are revealed from all‐atom MD simulations. The simulation data are used to identify critical residues at the complex interface and provide more details about the interactions between the SARS‐CoV‐2 RBD and human ACE2.

Conclusion

Simulations reveal that RBD binds to both open and closed state of ACE2. Two human ACE2 mutants and rat ACE2 are modeled to study the mutation effects on RBD binding to ACE2. The simulations show that the N‐terminal helix and the K353 are very important for the tight binding of the complex, the mutants are found to alter the binding modes of the CoV2‐RBD to ACE2.
Forecasting the development of the COVID‐19 epidemic by nowcasting: when did things start to get better?
Authors: Zhang Yuehui , Chen Lin , Shi Qili , Luo Zhongguang , Shen Libing
Published: February 2021

Background

Now the coronavirus disease 2019 (COVID‐19) epidemic becomes a global phenomenon and its development concerns billions of peoples’ lives. The development of the COVID‐19 epidemic in China could be used as a reference for the other countries’ control strategy.

Methods

We used a classical susceptible‐infected‐recovered (SIR) model to forecast the development of the COVID‐19 epidemic in China by nowcasting. The linear regression analyses were employed to predict the COVID‐19 epidemic’s inflexion point. Finally, we used a susceptible‐exposed‐infected‐recovered (SEIR) model to simulate the development of the COVID‐19 epidemic in China throughout 2020.

Results

Our nowcasts show that the COVID‐19 transmission rate started to slow down on January 30. The linear regression analyses further show that the inflexion point of this epidemic would arrive between February 17 and 18. The final SEIR model simulation forecasted that the COVID‐19 epidemic would probably infect about 82,000 people and last throughout 2020 in China. We also applied our method to USA’s and global COVID‐19 data and the nowcasts show that the development of COVID‐19 pandemic is not optimistic in the rest of 2020.

Conclusion

The COVID‐19 epidemic’s scale in China is much smaller than the previous estimations. After implemented strict control and prevention measures, such as city lockdown, it took a week to slow down the COVID‐19 transmission and about four weeks to really mitigate the COVID‐19 prevalence in China.
Métricas de autor Alexander Sellamén-Garzón
Authors: Camilo Alejandro Corchuelo Rodriguez , Cristian Alexander Vega Mosquera , Luz Marina Paez
Published: February 2021

Informe de las métricas de autor del Dr. Alexander Sellamén-Garzón de las publicaciones indexadas en Google Académico cuyo objetivo es entregar un insumo para el fortalecimiento de las capacidades y potencialidades de los autores de la Universidad Santo Tomás en el posicionamiento y visibilidad de sus publicaciones
Video Testimonios Proyecto de Aula- Facultad Diseño gráfico USTA
Authors: Paula Camila Amador Cardona , Sandra María Ramírez Botero
Published: February 2021

Este proyecto tiene como propósito fundamentar una apuesta didáctica a partir de las teorías que nacen de la neuro-educación, donde se plantea las emociones como elemento fundamental del proceso de enseñanza – aprendizaje, en tanto permanente y continuo, siendo este complemento psicosocial que además contribuye al desarrollo de un profesional integro. Para esto se realiza un análisis a las didácticas de los espacios académicos Teoría de la Comunicación y Comunicación Visual del pregrado en Diseño Gráfico de la Universidad Santo Tomás con el fin de desarrollar estrategias didácticas basadas en neuro-educación y aprendizaje significativo con enfoque emocional para fomentar competencias comunicativas del diseño gráfico desde la identidad personal y social, núcleos problémicos transversales a las asignaturas. Para este fin se plantea una investigación analítica – descriptiva y propositiva, con un enfoque etnográfico pedagógico que, desde un enfoque hermenéutico-analógico, logre generar comparaciones entre pasado, presente y futuro, entendiendo la representación simbólica que el estudiante realiza de si mismo y de su contexto, para construir sociedad y en específico identidad desde el diseño gráfico.
El auto conocimiento como estrategia didáctica en el aprendizaje de competencias conceptuales de comunicación social -Sistematización de experiencias
Authors: Fanny Stella Duque Gómez
Published: February 2021

Cuando se habla de la enseñanza de teorías o de fundamentación en los diferentes campos de las ciencias, el imaginario que se tiene de manera intuitiva es una enseñanza de tipo magistral, donde el docente posee el conocimiento y los estudiantes son meros recipientes de autores, teorías, enfoques, conceptos, fechas. Para los estudiantes lo teórico es aburrido, pesado, difícil. Cabe decir que, la misma caracterización de los jóvenes que se presenta hoy; hace necesario que los procesos de enseñanza-aprendizaje en este tipo de espacios académicos cambien para que el estudiante no solo comprenda el fundamento teórico del campo, sino que a la vez se vuelva significativo el aprendizaje tanto para el docente como para el estudiante, es decir que lo teórico ocupe el espacio que debe tener como orientador en la comprensión del mundo desde cada uno de los campos del conocimiento. Por tanto, todo lo anterior, obliga a que la practica didáctica propicie espacios de reconocimiento y de participación de ambos actores y que sea en el escenario áulico donde la tensión de enseñar comunicación y comunicar para enseñar adquiera un nuevo sentido. Hacer cambios en las didácticas para enseñar el componente de fundamentación ha desafiado de manera permanente mi ejercicio de 30 años como docente. Las evoluciones, de las tecnológicas y generacionales de los jóvenes que nos acompañan en la clase hacen pensar y repensar esas estrategia y didácticas. Pero, definitivamente la pedagogía problémica y el aprendizaje basado en problemas ha hecho modificar las prácticas pedagógicas y didácticas de mis procesos de enseñanza – aprendizaje, esto fue hacia el 2012 en que reviso mi manera de pedagogía orientada a los aprendizajes basados en problemas allí en un contexto de enseñanza de fundamentación en primer semestre. Comprender desde un análisis cualitativo los resultados de los aprendizajes con estas actividades didácticas permite hallar nuevas rutas para la enseñanza de la comunicación desde una mirada contextualizada y ubicada en los entornos de los estudiantes. La sistematización de experiencias como metodología de análisis hace mucho más valioso el proceso de enseñanza aprendizaje en tanto que destaca los procesos de los estudiantes y acerca lo esperado y lo aprendido a la posibilidad de mejorar para continuar.
Ponencia - Julio Cesar Rueda Cantor - la Plata, Argentina - 2015
Authors: Julio Cesar Rueda Cantor
Published: February 2021

Informe de movilidad académica.
Associations among Toddlers’ and Preschoolers’ Sleep Problems, Emotional Reactivity, Sleep Regime and Parental Applied Rules for Screen-Based Media Use
Authors: Baukienė Edita , Jusienė Roma
Published: February 2021

Background. Children’s sleep problems are associated with temperament. One of the dimensions of temperament – higher emotional reactivity – is defined as a risk factor for children’s emotional, behavioral, and sleep problems. Screen-based media use is a very common phenomenon among children that relates to sleep problems. Still there is a gap of research explaining the interactions between children’s sleep problems, temperament, and parental discipline (sleep regime and rules for screen-based media use). The aim of this study is to evaluate the relations between preschool children’s sleep problems and parents’ discipline (sleep regime and rules for screen-based media use), and the role of children’s emotional reactivity. Methods. This research is a part of the longitudinal study “Electronic Media Use and Young Children’s Health” conducted in the year 2017–2018 and funded by the Research Council of Lithuanian (agreement no. GER-006/2017). Participants are 876 children aged 2 to 5 years old and their parents. Children’s sleep problems and emotional reactivity were assessed using the Child Behavior Checklist (CBCL/1½-5). Information about rules for screen-based media use and sleep regime was obtained using the parent-report questionnaire. Results. Sleep problems are related to emotional reactivity, sleep regime, and rules for screen media use. Children without regular sleep regime and without constant rules for screen-based media use have higher sleep problems and emotional reactivity. The results of the regression analysis show that emotional reactivity, together with sleep regime and rules for screen-based media use, significantly explain one-fifth to one-third of children’s sleep problems at different ages of the preschool period. However, the prognostic value of emotional reactivity and parental discipline varies according to a child’s age, as they are significant predictors of sleep problems among two, three and four-year-olds, but no longer explain sleep problems of five-year-olds. The path analysis confirmed that emotional reactivity, directly and through mediating variables, e.g., parental reported child’s sleep regime and rules for screen-based media use, is significantly associated with children’s sleep problems. Conclusions. Emotional reactivity should be considered as a significant risk factor in the relation between children’s sleep problems, sleep regime and parental applied rules for screen-based media use. These results are important while identifying children at higher risk for sleep problems. The results also support that parental discipline, such as sleep regime and rules for screen-based media use, are significant for preventing sleep problems in children with higher emotional reactivity.
Weld metal irradiation embrittlement analysis in the range of over-design neutron fluences
Authors:   Institute for Nuclear Research, National Academy of Sciences of Ukraine, Kyiv, Ukraine, Chyrko L.I. , Revka V.M. , Chaikovskyi Yu.V. , Goliak M.G. , Trygubenko O.V. , Shkapyak O.V.
Published: February 2021

The comparison of experimental values of the critical brittle temperature ΔTF and reference temperature ΔT0 of VVER-1000 reactor vessel weld metal with an elevated content of manganese and nickel is performed. ΔTF and ΔT0 values are defined proceeding from the standard impact bend Charpy and Charpy cracked fracture toughness specimen tests, respectively. Specimens were irradiated in industrial reactors in the frame of surveillance specimen program up to the fast (E ≥ 0.5 MeV) neutron fluences corresponding to the NPP long term operation period. The research results showed the shifts ΔTF and ΔT0 to agree with each other. Besides, it was discovered that in the range of over-design fluences the design embrittlement model has a tendency to underestimate the critical brittle temperature shift.
Enteral Nutrition Improves Vital Signs in Children With Bronchiolitis on Noninvasive Ventilation
Authors: Sochet Anthony A. , Nunez Miranda , Wilsey Michael J. , Morrison John M. , Bessone Stacey K. , Nakagawa Thomas A.
Published: February 2021

OBJECTIVES:

In children hospitalized for bronchiolitis, enteral nutrition (EN) practices during noninvasive ventilation (NIV) vary widely. We sought to assess the potential impact of EN by observing changes in physiometric indices (heart rate [HR] and respiratory rate [RR]) before and after EN initiation.

METHODS:

We performed a retrospective cohort study in children <2 years of age hospitalized for bronchiolitis receiving NIV from 2017 to 2019 in a quaternary ICU. The primary outcome was patient HR and RR before and after EN initiation. Descriptive data included demographics, anthropometrics, comorbidities, NIV parameters, EN characteristics, and general hospital outcomes. Analyses included paired comparative and descriptive statistics.

RESULTS:

Of the 124 children studied, 85 (69%) were permitted EN at a median of 12 (interquartile range [IQR]: 7 to 29) hours. The route was oral (76.5%), nasogastric (15.3%), or postpyloric (8.2%) and was predominantly started during high-flow nasal cannula (71%) at flow rates of 1 (IQR: 0.7 to 1.4) L/kg per minute. After EN initiation, reductions in the median RR (percentage change: −11 [IQR: −23 to 3]; P < .01) and HR (percentage change: −5 [IQR: −12 to 1]; P < .01) were noted. Those permitted EN were younger (5 [IQR: 2 to 11] vs 11 [IQR: 3 to 17] months; P < .01) and more likely to have bronchopulmonary dysplasia (19% vs 5%; P = .04). Malnutrition rates, comorbidities, admission timing, flow rates, length of stay, and NIV duration did not differ for those provided or not provided EN. No aspiration events were observed.

CONCLUSIONS:

Reductions between pre- and postprandial RR after EN initiation among children hospitalized for bronchiolitis on NIV were observed without clinically significant aspiration. These findings support existing data that suggest that EN is safe during NIV and may lessen distress in some patients.
Validation of Administrative Codes for Palliative Care Consultation Among Critically Ill Children
Authors: O’Keefe Siobhán , Czaja Angela S.
Published: February 2021

OBJECTIVES:

To determine the validity of palliative care (PC) administrative codes (V66.7 and Z51.5) among critically ill pediatric patients.

METHODS:

In this single-center retrospective cohort study, we included all hospitalizations with a PICU admission between March 2016 and March 2018. Sensitivity, specificity, and positive and negative predictive values of the relevant codes were estimated by using a gold standard of a local PC registry.

RESULTS:

During the study period, 4670 hospitalizations were included. The median admission age was 5 years (interquartile range 1.5–12.9) with 55% having at least 1 complex chronic condition. The median length of PICU stay was 1.8 days (interquartile range 1–3.4) and mortality was low (1.3%). A total 182 (3.9%) hospitalizations had evidence of a PC consultation. Administrative codes for PC had a sensitivity of 11% (95% confidence interval [CI] 6.8%–16.5%) and a specificity of 99.8% (95% CI 99.6%–99.9%). The positive and negative predictive values were 66.7% (95% CI 47.2%–82.7%) and 96.5% (95% CI 95.9%–97.0%), respectively.

CONCLUSIONS:

Among critically ill children, PC administrative codes had high specificity but poor sensitivity. The potential for underascertainment of this resource should be considered in future research using administrative data.
Risk Factors for Adverse Events in Children Receiving Outpatient Parenteral Antibiotic Therapy
Authors: Townsley Elizabeth , Gillon Jessica , Jimenez-Truque Natalia , Katz Sophie , Garguilo Kathryn , Banerjee Ritu
Published: February 2021

BACKGROUND:

Outpatient parenteral antibiotic therapy (OPAT) can decrease length of hospital stay but is associated with adverse events (AEs). The purpose of this study was to quantify and identify risk factors for OPAT-associated AEs in children.

METHODS:

Retrospective single-center study of children ≤21 years old discharged on OPAT from January 2016 to April 2019 with infectious diseases follow-up. Demographic and clinical factors and medication and central venous catheter (CVC)–associated AEs were assessed through chart review. Univariable and multivariable analyses were performed.

RESULTS:

Among 181 OPAT courses, an AE occurred in 70 (39%). Medication AEs occurred in 30 of 181 courses (16.6%). Children residing in an urban area had a 4.5 times higher risk of having a medication-related AE compared with those in a rural area (odds ratio: 4.51; 95% confidence interval: 1.60–12.77; P = .005). CVC AEs occurred in 47 of 181 courses (26%). Every additional day of OPAT increased the odds of having a CVC-related AE by 4% (odds ratio: 1.04; 95% confidence interval: 1.01–1.07; P = .003). Twenty (11.1%) courses resulted in readmission to the hospital because of an AE.

CONCLUSIONS:

In this cohort, 39% of children experienced an OPAT-associated AE, and CVC AEs were more common than medication AEs. Longer duration of intravenous therapy and urban residence were independently associated with OPAT-associated AEs, highlighting the importance of converting to oral antibiotic therapy as soon as feasible to reduce OPAT-associated AEs.
Pediatric Faculty and Trainee Attitudes Toward the COVID-19 Pandemic
Authors: Kazmerski Traci M. , Friehling Erika , Sharp Eleanor A. , Muzumdar Ishan , Corbera-Hincapie Montserrat , Dewar Stephanie , Nowalk Andrew , Srinath Arvind , Muzumdar Hiren
Published: February 2021

OBJECTIVES:

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented event in modern medicine. In this study, we evaluate pediatric faculty and trainee attitudes and perspectives related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their roles in the COVID-19 pandemic.

METHODS:

We surveyed a pediatric hospital’s faculty and trainees (n = 701) in April 2020 about their concerns related to SARS-CoV-2, trust in current recommendations, and attitudes toward trainee roles. We used descriptive statistics to analyze results and compared across sex and roles using logistic regression.

RESULTS:

Among 320 respondents (46% response rate), 73% were concerned with personal risk of SARS-CoV-2 infection and 88% were concerned with loved ones’ risk. Twenty-four percent were concerned because of personal risk factors. Nearly half expressed concerns as their family’s major provider and about salary changes (48% and 46%). Seventy-nine percent were concerned about lack of personal protective equipment and 43% about redeployment. Respondents endorsed varying levels of trust in recommendations related to COVID-19. Nearly three-fourths (72%) felt trainees are essential personnel. The majority were receptive to returning to usual patient care and training as the pandemic progresses. Significant differences exist across sex and roles related to levels of concern, trust, and trainee roles.

CONCLUSIONS:

In this study, we assess the concerns and perspectives of pediatric faculty and trainees related to the COVID-19 pandemic. Most view trainees as essential personnel and recognize the importance of direct patient care in their training. These results can be used to inform policy changes and trainee roles as the COVID-19 pandemic progresses.
Quantifying Electronic Health Record Data: A Potential Risk for Cognitive Overload
Authors: Gal Dana B. , Han Brian , Longhurst Chistopher , Scheinker David , Shin Andrew Y.
Published: February 2021

OBJECTIVES:

To quantify and describe patient-generated health data.

METHODS:

This is a retrospective, single-center study of patients hospitalized in the pediatric cardiovascular ICU between February 1, 2020, and February 15, 2020. The number of data points generated over a 24-hour period per patient was collected from the electronic health record. Data were analyzed by type, and frontline provider exposure to data was extrapolated on the basis of patient-to-provider ratios.

RESULTS:

Thirty patients were eligible for inclusion. Nineteen were hospitalized after cardiac surgery, whereas 11 were medical patients. Patients generated an average of 1460 (SD 509) new data points daily, resulting in frontline providers being presented with an average of 4380 data points during a day shift (7:00 am to 7:00 pm). Overnight, because of a higher patient-to-provider ratio, frontline providers were exposed to an average of 16 060 data points. There was no difference in data generation between medical and surgical patients. Structured data accounted for >80% of the new data generated.

CONCLUSIONS:

Health care providers face significant generation of new data daily through the contemporary electronic health record, likely contributing to cognitive burden and putting them at risk for cognitive overload. This study represents the first attempt to quantify this volume in the pediatric setting. Most data generated are structured and amenable to data-optimization systems to mitigate the potential for cognitive overload and its deleterious effects on patient safety and health care provider well-being.
Obesity and Pregnancy
Authors: Paredes Carmen , Hsu Richard C. , Tong Anna , Johnson Jeffery R.
Published: February 2021

The worldwide rates of obesity have increased significantly in recent decades. In the United States, more than 50% of pregnant women are overweight or obese. Obese gravid women are more prone to adverse pregnancy outcomes, including gestational diabetes, hypertensive disorders, and cardiovascular diseases. The adverse outcomes extend beyond the pregnant obese woman; offspring of obese women are themselves at increased risk of prematurity, fetal death, injury during birth, and transient respiratory problems and metabolic effects (ie, neonatal hypoglycemia). Furthermore, maternal obesity can predispose their offspring to long-term health problems, potentially generating an intergenerational cycle of obesity and insulin resistance.
Fetal Heart Rate Tracing Category II: A Broad Category in Need of Stratification
Authors: G. Shilkrut Alexander , C. Hsu Richard , M. Fuks Aleksandr
Published: February 2021

Fetal heart rate (FHR) tracings are classified into 3 categories per the National Institute of Child Health and Human Development guidelines. There exists broad consensus on the recognition and management of categories I and III. However, a category II FHR tracing is considered “indeterminate” and cannot be classified as either reassuring or non-reassuring. Absence of variability and high frequency and increased depth of decelerations are the key determining factors that make a category II tracing non-reassuring and are associated with fetal metabolic acidosis. Periodic category II tracing is present in the majority of normal laboring patients. In the setting of a category II tracing, an initial attempt should be made for in utero resuscitation of the fetus. If the tracing fails to improve over a period of 1 to 2 hours, or the fetal tracing gradually deteriorates, a decision should be made for operative vaginal or cesarean delivery. Category II tracing management algorithms can aid in decision-making in this uncertain clinical scenario. Team training and simulation may improve team performance and have a positive impact on neonatal outcomes.
Maternal Hematologic Conditions and Fetal/Neonatal Outcomes of Pregnancy
Authors: Murakhovskaya Irina , Demasio Kafui A.
Published: February 2021

Hematologic conditions in reproductive-age women can complicate pregnancy and the neonatal period. Affected pregnancies have a higher risk of severe morbidity and mortality. Coagulation factor changes that occur in the normal state of pregnancy can delay detection and recognition of a bleeding disorder in cases without an apparent bleeding history, thus hindering the appropriate management during gestation and the neonatal period. In addition, unique maternal immunologic changes occur during pregnancy, which are meant to protect the fetus who shares paternal antigens. Rarely, derangement of the maternal immune system may result in alloimmunization against fetal platelet antigens, leading to the development of fetal and/or neonatal thrombocytopenia. Bleeding and platelet disorders pose significant risk of intracranial hemorrhage for the fetus and newborn that is associated with significant morbidity and mortality. We discuss contemporary diagnosis and management of rare bleeding and platelet disorders in pregnancy and their effect on the neonatal period.
Encephalitis in Previously Healthy Children
Authors: Fraley Claire E. , Pettersson David R. , Nolt Dawn
Published: February 2021

Encephalitis is defined as altered mental status for more than 24 hours accompanied by 2 or more findings concerning for inflammation of the brain parenchyma: fever, seizures or other focal neurologic disorders, cerebrospinal fluid pleocytosis, and abnormal neuroimaging and electroencephalographic findings. Herpes simplex virus causes the most severe form of virus-induced encephalitis; the early administration of acyclovir can improve the prognosis of this disease. The rising interest in autoimmune causes of encephalitis, most notably anti–N-methyl-d-aspartate receptor, should prompt the clinician to consider immunomodulatory treatments, which may improve outcomes. A broad testing panel may be necessary to detect the etiologic agent; a few published pediatric cases suggest that infectious and autoimmune causes may occur concurrently in the same patient with encephalitis. More than 40% of children diagnosed as having encephalitis will not return to their previous level of neurologic function after resolution of their disease, although outcomes are highly variable depending on the etiologic agent.
Case presentation from a family physician from the frontline in the pandemic
Authors: Yeğin Feyza
Published: February 2021

The World Health Organization China National Office have announced pneumonia cases of unknown etiology from Hubei district of China for the first time on 31st of December 2019. On 7th of January 2020 the etiologic agent has been accepted as a new coronavirus (Covid19) that is not formerly detected in human. World Health Organization classified Covid19 epidemic as “international public health emergency” on the 30th of January, and as a global pandemic on the 11th of March, since Covid19 cases have been detected in 113 countries other than China, where the epidemic has first begun, and because of the expansion of the virus and its severity. Covid19 related studies have been started in our country on the 10th of January 2020 and the first meeting of the T.R. Ministry of Health Scientific Advisory Committee has been realized on 22 January, and due to the preventive measures, the first Covid19 case is seen on 11 March after Europe and Iran, the countries in our neighborhoods. With the case presentations in this article we tried to present a section from the field.
An improved meshless method for finite deformation problem in compressible hyperelastic media
Authors: Nguyen Nha Thanh , Nguyen Minh Ngoc , Truong Thien Tich , Bui Tinh Quoc
Published: February 2021

Hyperelastic materials are considered as special category of elastic solid materials because of their nonlinear complicated constitutive laws. Due to large strain state, the behaviour of such materials is often considered in finite deformation analysis. The nonlinear large deformation behavior of such materials is important. In this study, a novel meshless radial point interpolation method (RPIM) enhanced by Cartesian transformation method (CTM), an effective numerical integration, is presented for nonlinear behavior of hyperelastic media under finite deformation state with total Lagrange formulation. Unlike the mesh-based approaches, the meshless methods have shown their advantages in analysis of large deformation problems. The developed CTM-based RPIM is thus free from the need for background cells, which are often used for numerical integration in many conventional meshfree approaches. The developed meshfree method owns some desirable features of an effective technique in solving large deformation, which will be illustrated through the numerical experiments in which our computed results are validated against reference solutions derived from other approaches.
Undrained bearing capacity of the cutting face for an open caisson
Authors: Royston Ronan , Sheil Brian B. , Byrne Byron W.
Published: February 2021

Large-diameter open caissons are an increasingly common means of constructing underground storage and attenuation tanks, as well as launch and reception shafts for tunnel-boring machines. A ‘cutting face’ at the base of the caisson wall, resembling an inclined ring footing, is typically used to aid the sinking phase. This paper describes a suite of over 15 000 finite-element limit analyses exploring the bearing capacity of a caisson cutting face, partially or wholly embedded in undrained soil. The primary aim of the study is to assess the influence of the cutting face inclination angle on the vertical bearing capacity. The effects of cutting face roughness, internal overburden and surcharge, and caisson radius are also investigated. In particular, the results indicate that a steepening of the inclination angle may not always reduce the bearing capacity, if the cutting face is rough. The numerical output informs the development of a closed-form approach for application in routine design. The new design method is shown to provide an excellent representation of the numerical output.
Unilateral herpes keratiti olan hastaların bilateral oküler yüzey ve gözyaşı osmolaritesinin değerlendirilmesi
Authors: BAYHAN Hasan , ASLAN Seray , KÜÇÜK Bekir
Published: February 2021

Amaç: Bu çalışmada tek taraflı herpetik keratit tanısı ile takip edilen hastaların kuru göz bulgularını ve gözyaşı osmolaritelerini değerlendirmek ve bu bulguların hastalık olmayan diğer gözde var olup olmadığını incelemek amaçlanmıştır.

Gereç ve Yöntemler: Bu prospektif çalışmada kliniğimiz kornea biriminde tek taraflı herpetik keratit tanısı ile takip edilen 40 hastanın keratit olan gözü (Grup 1) ve keratit olmayan diğer gözü (Grup 2) ile 40 kontrol olgusunun bir gözü (Grup 3) değerlendirildi. Olguların detaylı göz muayeneleri ve gözyaşı kırılma zamanı (GYKZ), Schirmer testleri ve osmolarite cihazı ile ölçülen gözyaşı osmolariteleri kaydedildi. Tüm bireylerin alt ve üst kapak meibografi çekimleri yapıldı ve meibomian bez kayıp oranları manuel olarak ölçüldü.

Bulgular: Çalışma grubundaki hastaların (22 erkek, 18 kadın) ortalama yaşı 53,5 ± 9,6 yıl iken, kontrol grubunun (21 erkek, 19 kadın) ortalama yaşı 52,4 ± 9,2 yıl idi (p>0,05). Osmolarite skoru Grup 1 ve 2’de sırasıyla 307,5±6,9 ve 303,4±7,8 mOsm/L iken Grup 3’te 295,5±6,3 mOsm/L olarak bulundu (p
FORMAÇÃO DOCENTE COMO PRESSUPOSTO DA INVESTIGAÇÃO ACADÊMICA NA ÁREA DE TI
Authors:   CENTRO UNIVERSITÁRIO INTERNACIONAL UNINTER, CASTRO FRANCIELI , GAIO ORIANA ,   CENTRO UNIVERSITÁRIO INTERNACIONAL UNINTER, KOWALSKI ALCIMAR ,   FAEL
Published: February 2021

PRETENDE-SE NESTE ARTIGO ABORDAR A VISÃO DO PAPEL DO PROFESSOR FORMADO NO SÉCULO XX, NA CONDIÇÃO DE FORMADOR NO SÉCULO XIX, PERANTE AS SUAS CRENÇAS, PERSPECTIVAS E MÉTODOS NA ÁREA DE TECNOLOGIA DA INFORMAÇÃO. PARA ISTO, OPTAMOS POR UM ESTUDO QUALITATIVO, DE NATUREZA EXPLORATÓRIA, UTILIZANDO COMO TÉCNICA DE COLETA DE DADOS A ENTREVISTA, REALIZADA COM UMA COORDENADORA E DUAS PROFESSORAS DO CURSO DE TECNOLOGIA DA INFORMAÇÃO DE UMA FACULDADE PARTICULAR SITUADA EM CURITIBA E A PARTIR DOS DADOS COLETADOS, OPTAMOS EM CONCENTRAR NOSSA INVESTIGAÇÃO NA ANÁLISE DE CONTEÚDO. LOGO, OBTIVEMOS TRÊS CATEGORIAS PRINCIPAIS QUE FORAM TRATADAS NO REFERENCIAL DESTE TRABALHO: “PAPEL DO PROFESSOR”, “METODOLOGIAS (MÉTODOS)” E “APRENDIZAGEM (CONHECIMENTO)”. SOBRE O CENÁRIO PESQUISADO, NOTAMOS A PREOCUPAÇÃO DOS ENTREVISTADOS COM A FORMAÇÃO DOS ALUNOS COMO FUNDAMENTAL, PORÉM NÃO IDENTIFICAMOS DURANTE AS RESPOSTAS A IDEIA DE PROFESSOR COMO FORMADOR DE PROFESSORES, OU SEJA, ELES NÃO EVIDENCIAM O PAPEL DE FORMADOR DOCENTE COMO ATIVIDADE INERENTE À FUNÇÃO EXERCIDA.
Invoking learner voice and developing leadership: what matters to learners?
Authors: Grant Callie
Published: February 2021

Educational leadership and management (ELM) research overly focuses on adult leadership development at the expense of leadership of learners. Framed by the concept of learner voice, this article focuses on learner leadership and argues that learners should be treated as people whose ideas matter. It draws on a Bachelor of Education Honours (ELM) elective which required students (practicing teachers) to establish school leadership clubs and involve learners in a reform initiative in pursuit of leadership development. The longitudinal study which informed this article was designed as a multi-case study to explore learner voice and the development of leadership across 44 leadership clubs drawing on three data sources. The study found that while the phenomenon of learner leadership was not common across schools, leadership clubs offered a space for the development of learner voice. Learner voice was generated in relation to the school physical environment, English proficiency amongst learners, improved learner conduct, developments pertaining to the extra-mural curriculum, and leadership training initiatives. In addition, the clubs afforded learners the opportunity to initiate and lead a change project in their schools. However, the take-up of learner leadership as a whole school initiative was problematic in the majority of schools. The article concludes with some suggestions for a future research agenda emerging out of the first phase of the project.