bluuebunny/crossref_metadata_2025 huggingface dataset:
Vitamin D is associated with the hypertriglyceridemic waist phenotype in Brazilian children
Authors: Milagres Luana Cupertino , Filgueiras Mariana De Santis , Rocha Naruna Pereira , Juvanhol Leidjaira Lopes , Franceschini Sylvia do Carmo Castro , Farias de Novaes Juliana
Published: March 2020

Background

Prevalence of cardiometabolic risk factors is increasing and vitamin D insufficiency/deficiency has become a worldwide public health problem, even in tropical countries. Therefore, we identified the prevalence of hypertriglyceridemic waist phenotype (HWP) and evaluate its relationship with vitamin D insufficiency/deficiency.

Methods

A cross-sectional study with 378 children aged 8 and 9 enrolled in all urban schools in the city of Viçosa, MG, Brazil. Anthropometric measurements, body composition (dual energy X-ray absorptiometry), biochemical tests and clinical evaluation were performed. Poisson regression was used to analyze the association between vitamin D and HWP.

Results

Prevalence of HWP was 16.4%. This prevalence was higher among children with vitamin D insufficiency and deficiency and in those with a greater number of other cardiometabolic risk factors. Multiple regression analysis showed that children with vitamin D insufficiency and deficiency had, respectively, prevalence 85% (95% CI: 1.03–3.30) and 121% (95% CI: 1.11–4.45) higher of HWP than the vitamin D sufficiency group.

Conclusion

Vitamin D insuffiency and deficiency were associated with a higher prevalence of HWP among children, regardless of the presence of other cardiometabolic risk factors, indicating an additional risk of inadequate vitamin D status to cardiometabolic health in childhood.
Financialization, wealth and the changing political aftermaths of banking crises
Authors: Chwieroth Jeffrey M , Walter Andrew
Published: March 2020

Households face two politically salient risks associated with financial instability. The first risk, which has existed for perhaps centuries, is associated with the indirect effect of systemic banking crises on employment and income flows. The second risk arises from the direct effects of crises on asset prices and thus household wealth stocks. Historically, the second risk mainly affected only a narrow wealthy elite. We argue that the rapid expansion and financialization of middle-class wealth since the mid-20th century mean that many voters now have ‘great expectations’ regarding government responsibility to protect their wealth. The political risks of financial instability for incumbent governments have thus increased sharply, especially when institutional constraints hamper their ability to respond to voters’ new expectations. We show that the probability of incumbent governments facing significant institutional constraints retaining office after systemic banking crises has indeed fallen sharply in recent decades compared to the pre-1945 period.
Sleep disorders in essential tremor: systematic review and meta-analysis
Authors: Jiménez-Jiménez Félix Javier , Alonso-Navarro Hortensia , García-Martín Elena , Agúndez José A G
Published: March 2020

Sleep disorders are frequent in patients diagnosed with essential tremor (ET). The present review focuses on sleep disorders and the results of polysomnographic studies performed in patients with ET. For this purpose we performed a systematic review crossing the search term “essential tremor” with “sleep,” “sleep disorders,” “sleep disturbances” and “polysomnography,” and with specific sleep disorders, according to the International Classification of the Sleep Disorders—Third Edition, using the PubMed, EMBASE, MEDLINE, and Web of Science Databases. The most frequent sleep problems reported by patients with ET were the bad quality of sleep and excessive daytime somnolence (the latter could be related to drugs commonly used for the treatment of ET). Probable rapid eye movement sleep behavior disorder, coexistent restless legs syndrome, insomnia, and nocturia were not infrequent complaints, while the presence of other sleep disorders in patients with ET was restricted to anecdotal reports or not described. Meta-analyses of previous reports showed that patients with ET (according to the PRISMA and MOOSE guidelines) showed higher scores in the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale than controls and lower scores than those of patients diagnosed with Parkinson’s disease. Studies using polysomnography in patients with ET are scarce and do not permit to establish valid conclusions regarding polysomnographic features in this disorder.
Serological evidence of Mayaro virus infection in blood donors from São Carlos, São Paulo, Brazil
Authors: Romeiro Marilia Farignoli , Fumagalli Marcílio Jorge , dos Anjos Ana Beatriz , Figueiredo Luiz Tadeu Moraes
Published: March 2020

Background

Human infections by Mayaro virus (MAYV) occur by insect bites upon exposure to rural or sylvatic areas. Information regarding MAYV transmission is limited due to a lack of commercial diagnostic assays and diagnostic confusion on account of similarities of clinical signs with other co-circulating arboviral diseases.

Methods

A serological survey of MAYV and Chikunguya virus (CHIKV) antibodies was performed by ELISA. Between 2017 and 2018, 5608 blood donor samples were tested.

Results

Specific IgM and IgG antibodies to MAYV were detected respectively in 36 and 11 samples, indicating a total seroprevalence of approximately 0.83%. Neutralization activity was observed in two IgG positive sera. Additionally, eight distinct samples had IgM antibodies to CHIKV alone.

Conclusions

Our data suggest previously unreported circulation of MAYV in São Carlos city, from southeastern Brazil.
Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States
Authors: Kudchadkar Sapna R. , Nelliot Archana , Awojoodu Ronke , Vaidya Dhananjay , Traube Chani , Walker Tracie , Needham Dale M. ,   for the Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: March 2020

Objectives:

With decreasing mortality in PICUs, a growing number of survivors experience long-lasting physical impairments. Early physical rehabilitation and mobilization during critical illness are safe and feasible, but little is known about the prevalence in PICUs. We aimed to evaluate the prevalence of rehabilitation for critically ill children and associated barriers.

Design:

National 2-day point prevalence study.

Setting:

Eighty-two PICUs in 65 hospitals across the United States.

Patients:

All patients admitted to a participating PICU for greater than or equal to 72 hours on each point prevalence day.

Interventions:

None.

Measurements and Main Results:

The primary outcome was prevalence of physical therapy– or occupational therapy–provided mobility on the study days. PICUs also prospectively collected timing of initial rehabilitation team consultation, clinical and patient mobility data, potential mobility–associated safety events, and barriers to mobility. The point prevalence of physical therapy– or occupational therapy–provided mobility during 1,769 patient-days was 35% and associated with older age (adjusted odds ratio for 13–17 vs < 3 yr, 2.1; 95% CI, 1.5–3.1) and male gender (adjusted odds ratio for females, 0.76; 95% CI, 0.61–0.95). Patients with higher baseline function (Pediatric Cerebral Performance Category, ≤ 2 vs > 2) less often had rehabilitation consultation within the first 72 hours (27% vs 38%; p < 0.001). Patients were completely immobile on 19% of patient-days. A potential safety event occurred in only 4% of 4,700 mobility sessions, most commonly a transient change in vital signs. Out-of-bed mobility was negatively associated with the presence of an endotracheal tube (adjusted odds ratio, 0.13; 95% CI, 0.1–0.2) and urinary catheter (adjusted odds ratio, 0.28; 95% CI, 0.1–0.6). Positive associations included family presence in children less than 3 years old (adjusted odds ratio, 4.55; 95% CI, 3.1–6.6).

Conclusions:

Younger children, females, and patients with higher baseline function less commonly receive rehabilitation in U.S. PICUs, and early rehabilitation consultation is infrequent. These findings highlight the need for systematic design of rehabilitation interventions for all critically ill children at risk of functional impairments.
Attention to breath sensations does not engage endogenous opioids to reduce pain
Authors: Wells Rebecca E. , Collier Jason , Posey Grace , Morgan Afrayem , Auman Timothy , Strittmatter Brian , Magalhaes Rossana , Adler-Neal Adrienne , McHaffie John G. , Zeidan Fadel
Published: March 2020

The endogenous opioidergic system is critically involved in the cognitive modulation of pain. Slow-breathing-based techniques are widely used nonpharmacological approaches to reduce pain. Yet, the active mechanisms of actions supporting these practices are poorly characterized. Growing evidence suggest that mindfulness-meditation, a slow-breathing technique practiced by nonreactively attending to breathing sensations, engages multiple unique neural mechanisms that bypass opioidergically mediated descending pathways to reduce pain. However, it is unknown whether endogenous opioids contribute to pain reductions produced by slow breathing. The present double-blind, placebo-controlled crossover study examined behavioral pain responses during mindfulness-meditation (n = 19), sham-mindfulness meditation (n = 20), and slow-paced breathing (n = 20) in response to noxious heat (49°C) and intravenous administration (0.15 mg/kg bolus + 0.1 mg/kg/hour maintenance infusion) of the opioid antagonist, naloxone, and placebo saline. Mindfulness significantly reduced pain unpleasantness ratings across both infusion sessions when compared to rest, but not pain intensity. Slow-paced breathing significantly reduced pain intensity and unpleasantness ratings during naloxone but not saline infusion. Pain reductions produced by mindfulness-meditation and slow-paced breathing were insensitive to naloxone when compared to saline administration. By contrast, sham-mindfulness meditation produced pain unpleasantness reductions during saline infusion but this effect was reversed by opioidergic antagonism. Sham-mindfulness did not lower pain intensity ratings. Self-reported “focusing on the breath” was identified as the operational feature particularly unique to the mindfulness-meditation and slow paced-breathing, but not sham-mindfulness meditation. Across all individuals, attending to the breath was associated with naloxone insensitive pain-relief. These findings provide evidence that slow breathing combined with attention to breath reduces pain independent of endogenous opioids.
Initiating palliative care consultation for acute critically ill patients in the emergency department intensive care unit
Authors: Yang Che , Yang Tsu-Te , Tsou Yu-Ju , Lin Ming-Hui , Fan Ju-Sing , Huang Hsien-Hao , Tsai Ming-Che , Yen David Hung-Tsang
Published: March 2020

Background:

Little is known about the characteristics of patients needing palliative care consultation in the emergency department (ED). This study aimed to investigate the impacts of initiating screening in acute critically ill patients needing palliative care on mortality, health care resources, and end-of-life (EOL) care in the intensive care unit in ED (EICU).

Methods:

We conducted an analysis study in Taipei Veterans General Hospital. From February 1 to July 31, 2018, acute critically ill patients in EICU were recruited. The primary outcomes were inhospital mortality and EOL care. The secondary outcomes included clinical characteristics and health care utilization.

Results:

A total of 796 patients were screened, with 396 eligible and 400 noneligible patients needing palliative care consultations. The mean age was 74.8 ± 17.1 years, and 62.6% of the patients were male. According to logistic regression analysis, clinical predictors, including age (adjusted odds ratio [AOR], 1.028; 95% CI, 1.015-1.042), respiratory distress and/or respiratory failure (AOR, 2.670; 95% CI, 1.829-3.897), the Acute Physiology and Chronic Health Evaluation II score (AOR, 1.036; 95% CI, 1.009-1.064), Charlson Comorbidity Index score (AOR, 1.212; 95% CI, 1.125-1.306), and Glasgow Coma Scale (AOR, 0.843; 95% CI, 0.802-0.885), were statistically more significant in eligible patients than in noneligible patients. The inhospital mortality rate was significantly higher in eligible patients than that in noneligible patients (40.7% vs 11.5%, p < 0.01). Eligible patients have a higher ratio in both vasopressor and narcotic use and withdrawal of endotracheal tube than noneligible patients (p < 0.05).

Conclusion:

Our study results demonstrated that initiating palliative consultation for acute critically ill patients in ED had an impact on the utilization of health care resources and quality of EOL care. Further assessments of the viewpoints of ED patients and their family on palliative care consultations and hospice care are required.
Hematologic adverse drug reactions leading to hospitalization among cancer patients: A retrospective case-control study
Authors: Chiou Be-Ling , Ho Chin-Chin , Yang Chen-Chang
Published: March 2020

Background:

Cancer is one of the leading causes of death worldwide. Despite the rapid evolution of cancer treatment, chemotherapy remains the mainstay in the management of cancer. Chemotherapy can result in various adverse drug reactions (ADRs), which may lead to hospitalization and even life-threatening side-effects. Hematologic ADRs are among the most severe forms of ADR following chemotherapy, as they generally lead to hospitalization. It is important to realize the predictors and outcome of hematologic ADRs in cancer patients.

Methods:

We conducted a hospital-based case-control study to include all the cancer patients who were hospitalized to receive chemotherapy in Taipei Veterans General Hospital during 2013. Among them the patients rehospitalized after chemotherapy due to neutropenia, leucopenia, or pancytopenia were identified as the study group. Control subjects consisted of hospitalized cancer patients who did not display the aforementioned ADRs. The study and control groups were numbered in the ratio of 1:4 and were age- and gender-matched. Their demographic and clinical characteristics were collected through chart review. Determinants of hematologic ADRs were then analyzed.

Results:

During the study period, we collected a total of 64 patients into the study group and 256 as control subjects. The mean length of hospitalization was 11 days in the study group of patients, which was 5 days longer than that in the control group (p < 0.001). Predictors of hematologic ADR-related hospitalization included history of hematologic ADRs, hypertension, cisplatin treatment, and a Charlson comorbidity score of 2 to 3.

Conclusion:

Severe outcomes of hematologic ADRs may increase healthcare costs and decrease patient productivity. Therefore, the determinants of ADR-related hospitalization identified in this study may help improve the quality of healthcare for cancer patients.
A comparison of thyroid blockade strategies in paediatric 123I-meta-iodobenzylguanidine scanning: a dual centre study
Authors: Thurlow Ben , Morris Elizabeth , Price Leanne , Melhuish Timothy , Michopoulou Sofia , King Simon , Easty Marina , Biassoni Lorenzo
Published: March 2020

Objective

The aim of this study was to evaluate three thyroid blockade regimes to determine which protocol provides the optimal level of thyroidal protection for paediatric 123-I-meta-iodobenzylguanidine (mIBG) imaging and estimate the relative radiation dose inferred from unbound radioiodine.

Methods

A total of 231 patients were retrospectively evaluated for thyroid uptake and categorised into five subgroups depending upon the protocol of thyroid blockade received. Efficacy of thyroid blockade was established by visual scoring and image quantitation with comparison against a control group.

Results

Visual Likert scale responses were subjected to the Mann–Whitney U and Kruskal–Wallis tests, respectively. Statistical significance was reached for observed thyroid uptake in potassium perchlorate recipients (U = 1107, P = 0.001). No statistically significant difference was observed in thyroid uptake for iohexol blockade (U = 176, P = 0.71) or potassium iodate blockade despite variations in iodate dosage and duration (χ
2(2) = 0.203, P = 0.93). The analyses were repeated for the image quantitation data. A statistically significantly higher absorbed thyroid dose was observed using potassium perchlorate blockade compared with the control group (U = 719, P = 0.001). The Mann–Whitney U did not reach statistical significance in absorbed thyroid dose for iohexol blockade (U = 126, P = 0.209, r = −0.13). The Kruskal–Wallis test, conducted across the potassium iodate groups, did not reach statistical significance (χ
2(2) = 0.513, P = 0.774). The median absorbed thyroid dose across the iodate groups ranged from 3.58 to 3.91 mGy indicating comparable blockade effectiveness for single-dose potassium iodate.

Conclusion

Potassium iodate blockade is more efficacious compared with potassium perchlorate within the cohort observed. Both visual and quantitative data indicate that potassium iodate given at 30–60 min before 123I-mIBG injection provides comparable blockade effectiveness to lengthier administrations, suggesting that a single dose is well tolerated and practical.
Application of 18F-fluorodeoxyglucose positron emission tomography/computerized tomography in mantle cell lymphoma
Authors: Yang Shaoxi , Fu Lilan , AbuduRxiti Meilinur , Wu Jianhua , Wang Qiaoyu , Qin Yongde , Zou Xiaoguang , Li Hongsheng
Published: March 2020

Objective

The study is to investigate the application of 18F-fluorodeoxyglucose (18F-FDG) PET/computerized tomography (CT) for the evaluation of mantle cell lymphoma (MCL).

Methods

We retrospectively analyzed 39 patients who were pathologically diagnosed with MCL and underwent 18F-FDG PET/CT before treatment between August 2007 and August 2018. We compared the clinical information and PET/CT imaging characteristics in different groups based on bone marrow invasion, spleen invasion or International Prognostic Index (IPI) score. We also assessed the efficacy of PET/CT evaluation basing on the follow-up PET CT findings of 21 MCL patients and their biopsies.

Results

Thirty-five patients were stage IV according to the Revised Ann Arbor Staging System. Lymph node involvement was observed in all 39 cases. The maximum diameter of the affected lymph nodes (4.33 ± 3.09 cm) and maximum standardized uptake value (SUVmax) (8.38 ± 4.99) was positively correlated (r = 0.486, P = 0.002). Extranodal invasion was identified in 38 patients with MCL, and the SUVmax of extranodal invasion was 7.34 ± 3.31. Extranodal invasion was most common in the spleen (25/38) and bone marrow (18/38). The group with bone marrow invasion was more prone to nasopharyngeal, lung and renal invasions (all P < 0.05). The groups with bone marrow invasion or spleen invasion were more likely to have decreased hemoglobin (Hgb) and platelets (all P < 0.01). The IPI high-risk group was more prone to lung involvement, elevated LDH and CRP, and decreased Hgb (all P < 0.05). Among the follow-up of 30 MCL patients, the 2-year progression-free survival and overall survival rates were 73.33 and 87.50%, respectively. PET/CT reexaminations of 21 MCL patients after treatment showed that the sensitivity, specificity, negative predictive value, positive predictive value and accuracy of the efficacy evaluation were 80, 90.91, 88.89, 83.33 and 85.71%, respectively.

Conclusion

18F-FDG PET/CT imaging has important application value in the diagnosis, staging, treatment efficacy assessment and prognosis monitoring of MCL, especially in the systemic assessment of advanced MCL.
Potential use of radiolabelled neurotensin in PET imaging and therapy of patients with pancreatic cancer
Authors: Hodolic Marina , Ambrosini Valentina , Fanti Stefano
Published: March 2020

Pancreatic cancer is the fourth leading cause of cancer-related death in both men and women. Neurotensin receptors are overexpressed in different malignancies, above all pancreatic cancer. On the other hand, neurotensin receptor expression in inflammation is quite low. This fact can probably solve the most important problem of 18F-FDG PET imaging – distinguishing malignant and inflammatory processes. The first therapeutic injection of radiolabelled neurotensin in human with pancreatic cancer has been successfully performed. Animal experiments are also very close to the first in human injection of radiolabelled neurotensin for diagnostic purposes. The purpose of this article is to provide an overview of radiolabelled neurotensin analogues that can be used in imaging and therapy in patients with pancreatic ductal adenocarcinoma.
Platelet Inhibition With IV Glycoprotein IIb/IIIa Inhibitor to Prevent Thrombosis in Pediatric Patients Undergoing Aortopulmonary Shunting*
Authors: Emani Sirisha , Pereira Luis M. , Piekarski Breanna L. , Diallo Fatoumata , Chu Esther , Wesley Mark C. , Thiagarajan Ravi , Emani Sitaram M.
Published: March 2020

Objectives:

Shunt thrombosis, a potential complication of aortopulmonary shunting, is associated with high mortality. Commonly used oral antiplatelet drugs such as aspirin demonstrate variable absorption and inconsistent antiplatelet effect in critically ill patients early after surgery. IV glycoprotein IIb/IIIa inhibitors are antiplatelet agents with rapid and reproducible effect that may be beneficial as a bridge to oral therapy.

Design:

Retrospective review of pediatric patients undergoing treatment with IV tirofiban. Discarded blood samples were used to determine pharmacokinetic parameters.

Setting:

Pediatric cardiac ICU at a single institution.

Patients:

Fifty-two pediatric patients (< 18 yr) undergoing surgical aortopulmonary shunt procedure who received tirofiban infusion as a bridge to oral aspirin.

Interventions:

None.

Measurements and Main Results:

Primary outcome measures were shunt thrombosis and bleeding events, whereas secondary outcomes included measurement of platelet inhibition by thromboelastography with platelet mapping and pharmacokinetic analysis (performed in a subset of 15 patients). Shunt thrombosis occurred in two of 52 patients (3.9%) after prophylaxis treatment with tirofiban; both thrombosis events occurred after discontinuation of the drug. One patient (1.9%) experienced bleeding complication during the infusion. A tirofiban bolus of 10 µg/kg and infusion of 0.15 µg/kg/min resulted in significantly increased platelet inhibition via adenosine diphosphate pathway (median 66% [43–96] pre-tirofiban compared with 97% [92–99%] at 2 hr; p < 0.05). Half-life of tirofiban in plasma was 142 ± 1.5 minutes, and the average steady-state concentration was 112 ± 62 ng/mL. Age and serum creatinine were significant covariates associated with systemic clearance. Dosing simulations were generated based upon one compartment model.

Conclusions:

IV glycoprotein IIb/IIIa inhibitor as a bridge to oral antiplatelet therapy is safe in pediatric patients after aortopulmonary shunting. Dosing considerations should include both age and renal function. Randomized trials are warranted to establish efficacy compared with current anticoagulation practices.
Outcomes of Pediatric Patients Treated With Extracorporeal Membrane Oxygenation for Intractable Supraventricular Arrhythmias
Authors: Ghaleb Stephanie , Thiagarajan Ravi R. , Cooper David S. , Czosek Richard J.
Published: March 2020

Objectives:

Extracorporeal membrane oxygenation is used to support refractory cardiorespiratory failure. Outcomes and complications when extracorporeal membrane oxygenation is used to support cardiorespiratory failure secondary to arrhythmia in pediatric patients remain poorly defined. Our purpose is to describe pediatric patients requiring extracorporeal membrane oxygenation support for supraventricular arrhythmias in the context of normal cardiac anatomy and congenital heart disease and identify patient/peri-extracorporeal membrane oxygenation variables associated with extracorporeal membrane oxygenation–related complications and survival.

Design:

Retrospective multicenter review from 1993 to 2016.

Setting:

Extracorporeal Life Support Organization registry.

Subjects:

Patients younger than 21 years old requiring extracorporeal membrane oxygenation support for supraventricular arrhythmias.

Interventions:

None.

Measurements and Main Results:

A total of 342 patients were identified (weight, 3.8 kg [3.2–7.5 kg]; age at extracorporeal membrane oxygenation initiation, 24 d [6–222]; 61% male). Sixty-five percentage survived to hospital discharge. Complications were frequent (85%) and most commonly cardiac related (31%). In multivariable modeling, mortality was associated with congenital heart disease, time from intubation to extracorporeal membrane oxygenation initiation, use of bicarbonate prior to extracorporeal membrane oxygenation, extracorporeal membrane oxygenation duration, and the presence of a complication. The presence of any complication was associated with a three-fold increase in the odds of death. In subgroup analysis of isolated supraventricular arrhythmias patients, similar patient and extracorporeal membrane oxygenation characteristics were associated with outcome. A lower pre-extracorporeal membrane oxygenation pH and Pco
2 and site of venous cannulation were associated with complications (p < 0.02).

Conclusions:

Extracorporeal membrane oxygenation use for medically refractory supraventricular arrhythmias was associated with a 65% survival to hospital discharge. However, there was a high rate of complications, the presence of which was associated with decreased survival. Complications appeared to be related to pre-extracorporeal membrane oxygenation clinical status and whether earlier extracorporeal membrane oxygenation cannulation prior to patient deterioration would improve outcomes needs additional evaluation.
A Respiratory Therapist-Driven Pathway Improves Timeliness of Extubation Readiness Assessment in a Single PICU
Authors: Loberger Jeremy M. , Jones Ryan M. , Prabhakaran Priya
Published: March 2020

Objectives:

Our smart aim was to decrease the time between when a mechanically ventilated patient was eligible for and when they underwent their first extubation readiness test (delta time) by 50% within 3 months through the development and implementation of a respiratory therapist-driven extubation readiness test pathway.

Design:

Quality improvement project.

Setting:

Single, tertiary care, 24-bed, academic PICU.

Patients:

Pediatric patients admitted to the PICU and requiring mechanical ventilation for a primary pulmonary process.

Interventions:

We developed an extubation readiness test pathway that consisted of an eligibility screen and a standard testing process. Patients were screened every 3 hours. Upon passing the screen and being cleared by a prescriber, a test was initiated. No clinical management was dictated to prescribers.

Measurements and Main Results:

The preintervention and intervention cohorts included 109 and 43 mechanical ventilation courses, respectively. The mean delta time decreased from 33.77 hours to 2.92 hours after pathway implementation (p = 0.000). The medical length of stay decreased from 196.6 to 177.2 hours (p = 0.05). There were no statistically significant changes in duration of mechanical ventilation until first extubation (112.9 vs 122.3 hr; p = 0.651) and 48-hour extubation failure rate (16.5% vs 4.8%; p = 0.056). The sensitivity and positive predictive value for the extubation readiness test were 89.5% and 94.4%, respectively. The mean for all process compliance measures was 91.5%.

Conclusions:

A respiratory therapist-driven extubation readiness test pathway can be safely implemented in a large, academic PICU. The pathway resulted in earlier extubation readiness testing without increasing key balancing measures—the duration of mechanical ventilation, PICU length of stay, or the extubation failure rate.
Closing the Gap: Optimizing Performance to Reduce Interruptions in Cardiopulmonary Resuscitation*
Authors: Jones Sara I. , Jeffers Justin M. , Perretta Julie , Stella Andrew , Sorcher Jill L. , Hunt Elizabeth A. , Duval-Arnould Jordan M.
Published: March 2020

Objectives:

The American Heart Association recommends minimizing pauses of chest compressions and defines high performance resuscitation as achieving a chest compression fraction greater than 80%. We hypothesize that interruption times are excessively long, leading to an unnecessarily large impact on chest compression fraction.

Design:

A retrospective study using video review of a convenience sample of clinically realistic in situ simulated pulseless electrical activity cardiopulmonary arrests.

Setting:

Johns Hopkins Children’s Center; September 2013 to June 2017.

Patients:

Twenty-two simulated patients.

Interventions:

A framework was developed to characterize interruptions. Two new metrics were defined as follows: interruption time excess (the difference between actual and guideline-indicated allowable duration of interruption from compressions), and chest compression fraction potential (chest compression fraction with all interruption time excess excluded).

Measurements and Main Results:

Descriptive statistics were generated for interruption-level and event-level variables. Differences between median chest compression fraction and chest compression fraction potential were assessed using Wilcoxon rank-sum test. Comparisons of interruption proportion before and after the first 5 minutes were assessed using the X
2 test statistic. Seven-hundred sixty-six interruptions occurred over 22 events. Median event duration was 463.0 seconds (interquartile range, 397.5–557.8 s), with a mean 34.8 interruptions per event. Auscultation and intubation had the longest median interruption time excess of 13.0 and 7.5 seconds, respectively. Median chest compression fraction was 76.0% (interquartile range, 67.7–80.7 s), and median chest compression fraction potential was 83.4% (interquartile range, 80.4–87.4%). Comparing median chest compression fraction to median chest compression fraction potential found an absolute percent difference of 7.6% (chest compression fraction: 76.0% vs chest compression fraction potential: 83.4%; p < 0.001).

Conclusions:

This lays the groundwork for studying inefficiency during cardiopulmonary resuscitation associated with chest compression interruptions. The framework we created allows for the determination of significant avoidable interruption time. By further elucidating the nature of interruptions, we can design and implement targeted interventions to improve patient outcomes.
Hypothermia Plus Melatonin in Asphyctic Newborns: A Randomized-Controlled Pilot Study
Authors: Jerez-Calero Antonio , Salvatierra-Cuenca Maria Teresa , Benitez-Feliponi Ángela , Fernández-Marín Carmen Elisabeth , Narbona-López Eduardo , Uberos-Fernández José , Muñoz-Hoyos Antonio
Published: March 2020

Objectives:

To investigate the effect of adding melatonin to hypothermia treatment on neurodevelopmental outcomes in asphyctic newborns.

Design:

Pilot multicenter, randomized, controlled, double-blind clinical trial. Statistical comparison of results obtained in two intervention arms: hypothermia plus placebo and hypothermia plus melatonin.

Setting:

Level 3 neonatal ICU.

Patients:

Twenty-five newborns were recruited.

Interventions:

The hypothermia plus melatonin patients received a daily dose of IV melatonin, 5 mg per kg body weight, for 3 days. General laboratory variables were measured both at neonatal ICU admission and after intervention. All infants were studied with amplitude-integrated electroencephalography and brain MRI within the first week of life. The neurodevelopmental Bayley III test, the Gross Motor Function Classification System, and the Tardieu scale were applied at the ages of 6 and 18 months.

Measurements and Main Results:

Clinical characteristics, laboratory evaluations, MRI findings, and amplitude-integrated electroencephalography background did not differ between the treatment groups. The newborns in the hypothermia plus melatonin group achieved a significantly higher composite score for the cognitive section of the Bayley III test at 18 months old, with respect to the hypothermia plus placebo group (p= 0.05). There were no differences between the groups according to the Gross Motor Function Classification System and Tardieu motor assessment scales.

Conclusions:

The early addition of IV melatonin to asphyctic neonates is feasible and may improve long-term neurodevelopment. To our knowledge, this is the first clinical trial to analyze the administration of IV melatonin as an adjuvant therapy to therapeutic hypothermia.
Nondaily Use of HIV Preexposure Prophylaxis in a Large Online Survey of Primarily Men Who Have Sex With Men in the United States
Authors: Sewell Whitney C. , Powell Victoria E. , Mayer Kenneth H. , Ochoa Aileen , Krakower Douglas S. , Marcus Julia L.
Published: March 2020

Background:

Event-driven dosing of HIV preexposure prophylaxis (PrEP) using a 2-1-1 regimen is efficacious for men who have sex with men (MSM). However, data are limited on the prevalence, correlates, and patterns of nondaily PrEP use in the United States.

Setting:

Nationwide online survey.

Methods:

We distributed a survey to assess experiences with PrEP, including nondaily use, in May 2019 on geosocial networking sites commonly used by MSM.

Results:

Among 9697 respondents, the mean age was 43 years, 67% were non-Hispanic white, and 90% were MSM. Nearly all (91.0%) had heard of PrEP, 40.1% ever used PrEP, and 33.3% used PrEP in the past 6 months. Most (60.6%) were interested in nondaily PrEP. Those without health insurance and those with higher incomes were more likely to be interested in nondaily PrEP. Of the 3232 who used PrEP in the past 6 months, 176 (5.4%) reported nondaily use. Fewer sexual partners, frequent sex planning, and substance use were associated with nondaily use. Common reasons for nondaily use were inconsistent sexual activity (59%) and cost (49%). The most prevalent regimen was event driven (48.3%); of those, 64.7% used 2-1-1. Of nondaily users, 24.0% used PrEP on a regular schedule but not every day, including only on weekends or days starting with T or S.

Conclusions:

Given substantial interest in nondaily PrEP, and use of nondaily strategies that have not been evaluated in clinical studies, there is a need for US public health authorities to provide guidance on safe and effective nondaily dosing for MSM.
HIV Oral Self-Testing for Male Partners of Women Attending Antenatal Care in Central Uganda: Uptake of Testing and Linkage to Care in a Randomized Trial
Authors: Korte Jeffrey E. , Kisa Rose , Vrana-Diaz Caroline J. , Malek Angela M. , Buregyeya Esther , Matovu Joseph K.B. , Kagaayi Joseph , Musoke William , Chemusto Harriet , Mukama Semei C. , Ndyanabo Anthony , Mugerwa Shaban , Wanyenze Rhoda K.
Published: March 2020

Background:

In Uganda, HIV testing rates are approximately 90% among women in antenatal care, with male rates much lower. The World Health Organization has recommended HIV self-testing (HIVST), and one promising model is for women in antenatal care to deliver HIVST kits to their male partners. We investigated the impact of this model on male partner testing rates.

Setting:

Three high-volume antenatal clinics in central Uganda.

Methods:

We implemented a cluster-randomized controlled trial comparing standard of care to intervention, with the primary outcome of self-reported male partner HIV testing. Women and male partners were followed at 1 and 3 months. We used unadjusted analyses and log-linear models with an intent-to-treat approach accounting for clustering.

Results:

Study coordinators randomized 1514 women (777 intervention and 737 control). Baseline characteristics were balanced across arms with mean age (SD) of 25.2 (5.5) years and >44% with secondary education or higher. More male partners tested for HIV in intervention [576/746 (77.2%)] versus control [264/709 (37.2%)], P < 0.01. We identified 34 HIV-positive men in intervention versus 10 in control, with 6/26 (23%) and 4/6 (67%), respectively, reporting linking to care.

Conclusions:

Our results demonstrate an enormous increase in self-reported partner HIV testing when HIVST is available at home. However, men testing positive through HIVST appeared less likely to link to care than men testing positive at a clinic. These results highlight the potential of HIVST in increasing HIV testing rates, while underscoring the importance of developing effective approaches to maximizing linkage to care among those testing positive through HIVST.
Haemophilus seminalis sp. nov., isolated from human semen
Authors: Zheng Min-ling , Li Liang-hui , Liu Bin , Lin Yu-bo , Zhang Xiao-tuan , Chen Cha , Qu Ping-Hua , Zeng Jian
Published: March 2020

TwoHaemophilus-like isolates with similar biochemical characteristics, designated strains SZY H1Tand SZY H2, were isolated from human semen specimens. Cells were Gram-negative, non-motile, non-acid-fast, pleomorphic rods or coccobacilli. The major fatty acids (>10 %) were C16 : 0, C14 : 0, iso-C16 : 0and/or C14 : 03-OH and C16 : 1ω6cand/or C16 : 1ω7c. The polar lipids were determined to be phosphatidylethanolamine, phosphatidylglycerol, an unidentified phospholipid, an unidentified aminophospholipid, two unidentified polar lipids and four unidentified aminolipids. The major polyamine was found to be cadaverine. The near-full-length (1462 nt) 16S rRNA gene sequences analysis showed the two isolates were nearly identical (>99.8 %), and closely matchedHaemophilus haemolyticusATCC 33390Twith 98.9–99.1 % sequence similarities. Phylogenetic analysis based on 16S rRNA gene sequences and concatenation of 30 protein markers also revealed that the isolates clustered together withH. haemolyticusATCC 33390T, and formed a distinct lineage well separated from the other members of the genusHaemophilus. Further, the average nucleotide identity values between the two isolates and their related species were below the established cut-off values for species delineation (95 %). Based on these findings, the two isolates are considered to represent a new species of the genusHaemophilus, for which nameHaemophilus seminalissp. nov. is proposed. The type strain is SZY H1T(=NBRC 113782T=CGMCC 1.17137T).
Early, low-dose and short-term application of corticosteroid treatment in patients with severe COVID-19 pneumonia: single-center experience from Wuhan, China
Authors: Wang Yin , Jiang Weiwei , He Qi , Wang Cheng , Liu Baoju , Zhou Pan , Dong Nianguo , Tong Qiaoxia
Published: March 2020

Background

Severe patients with 2019 novel coronavirus (2019-nCoV) pneumonia progressed rapidly to acute respiratory failure. We aimed to evaluate the definite efficacy and safety of corticosteroid in the treatment of severe COVID-19 pneumonia.

Methods

Forty-six hospitalized patients with severe COVID-19 pneumonia hospitalized at Wuhan Union Hospital from January 20 to February 25, 2020, were retrospectively reviewed. The patients were divided into two groups based on whether they received corticosteroid treatment. The clinical symptoms and chest computed tomography(CT) results were compared.

Results

A total of 26 patients received intravenous administration of methylprednisolone with a dosage of 1-2mg/kg/d for 5-7 days, while the remaining patients not. There was no significant difference in age, sex, comorbidities, clinical or laboratory parameters between the two groups on admission. The average number of days for body temperature back to the normal range was significantly shorter in patients with administration of methylprednisolone when compared to those without administration of methylprednisolone (2.06±0.28 vs. 5.29±0.70, P=0.010). The patients with administration of methylprednisolone had a faster improvement of SpO2, while patients without administration of methylprednisolone had a significantly longer interval of using supplemental oxygen therapy (8.2days[IQR 7.0-10.3] vs. 13.5days(IQR 10.3-16); P<0.001). In terms of chest CT, the absorption degree of the focus was significantly better in patients with administration of methylprednisolone.

Conclusion

Our data indicate that in patients with severe COVID-19 pneumonia, early, low-dose and short-term application of corticosteroid was associated with a faster improvement of clinical symptoms and absorption of lung focus.
Forensic genomics of a novel Klebsiella quasipneumoniae type from an NICU in China reveals patterns of genetic diversity, evolution and epidemiology
Authors: Perlaza-Jiménez Laura , Wu Qing , Torres Von Vergel L. , Zhang Xiaoxiao , Li Jiahui , Rocker Andrea , Lithgow Trevor , Zhou Tieli , Vijaykrishna Dhanasekaran
Published: March 2020

During March of 2017 a neonate patient suffered severe diarrhea and subsequently developed septicemia and died, with Klebsiella isolated as the causative microorganism. Coincident illness of an attending staff member and three other neonates with Klebsiella triggered a response, leading to a detailed microbiological and genomics investigation of isolates collected from the staff member and all 21 co-housed neonates. Multilocus sequence typing and genomic sequencing identified that the Klebsiella from all 21 neonates was a new MLST ST2727, and belonged to a less frequently detected subspecies K. quasipneumoniae subsp. similipneumoniae (KpIIB). Genomic characterization showed that the isolated ST2727 strains had diverged from other KpIIB strains at least >90 years ago, whereas the neonate samples were highly similar with a genomic divergence of 3.6 months and not related to the staff member, indicating that transmission did not occur from staff to patient or between patient to patient, but were acquired from a common hospital source. The genomes revealed that the isolates contained the ubiquitous ampH gene responsible for resistance to penicillin G, cefoxitin and cephalosporin C, and all Kp-IIB strains were competent for host cell adhesion. Our results highlight the clinical significance and genomic properties of relatively mild, but persistent MLST types such as ST2727, and urges for genomic surveillance and eradication within hospital environments.

Data summary

Genome sequences generated in this study are available in NCBI under BioProject ID PRJNA610124. All bioinformatic protocols used to process the genomic data are available at https://github.com/vjlab/KpIIB_ST2727.
Characterization of disease course and remission in early seropositive rheumatoid arthritis: Results from the TACERA longitudinal cohort study
Authors:   RA-MAP Consortium, Tom Brian
Published: March 2020

Background

To characterize disease course and remission in a longitudinal observational study of newly diagnosed, initially treatment naïve patients with seropositive rheumatoid arthritis (RA).

Methods

Patients with early untreated seropositive RA were recruited from 28 UK centres. Multiple clinical and laboratory measures were collected every 3 months for up to 18 months. Disease activity was measured using DAS28-CRP and SDAI. Logistic regression models examined clinical predictors of 6-month remission and latent class mixed models characterized disease course.

Results

We enrolled 275 patients of whom 267 met full eligibility and provided baseline data. According to SDAI definition, 24.3% attained 6-month remission. Lower baseline HAQ and SDAI predicted 6-month remission (p=0.002 and 0.021). Alcohol intake and baseline prescribing of methotrexate with a second DMARD (versus monotherapy without glucocorticoids) were also predictive. Three distinct SDAI trajectory subpopulations emerged; corresponding to an Inadequate Responder group (6.5%), and Higher and Lower Baseline Activity Responder groups (22.4% and 71.1%). Baseline HAQ and SF-36 MCS only distinguished these groups. Additionally a number of baseline clinical predictors correlated with disease activity severity within subpopulations. Beneficial effects of alcohol intake were found across subpopulations.

Conclusions

Three distinct disease trajectory subpopulations were identified. Differential effects of functional and mental well-being, alcohol consumption and baseline RA medication prescribing on disease activity severity were found across subpopulations. Heterogeneity across trajectories cannot be fully explained by baseline clinical predictors. Biological markers collected early in disease course (within 6 months) may help patient management and to better target existing and novel therapies.
Integrating epidemiological and genetic data with different sampling intensities into a dynamic model of respiratory syncytial virus transmission
Authors: Kombe Ivy K. , Agoti Charles N. , Munywoki Patrick K. , Nokes D. James , Medley Graham F.
Published: March 2020

Background

Respiratory syncytial virus (RSV) is responsible for a significant burden of acute respiratory illness in children under 5 years old. Prior to rolling out any vaccination program, identification of the source of infant infections could further guide vaccination strategies.

Methods

We extended a dynamic model calibrated at the individual host level initially fit to social-temporal data on shedding patterns to include whole genome sequencing data available at a lower sampling intensity.

Results

In this study population of 493 individuals with 55 infants under the age of 1 year distributed across 47 households, we found that 52% of RSV-B and 60% of RSV-A cases arose from infection within the household. Forty-five percent of infant infections appeared to occur in the household, of which 68% were a result of transmission from a child aged between 2 and 13 years living in the same household as the infant.

Conclusion

These results further highlight the importance of pre-school and school-aged children in RSV transmission, particularly the role they play in directly infecting the household infant. These age groups are a potential RSV vaccination target group.
Predicting cohort-specific cervical cancer incidence from population-based HPV prevalence surveys: a worldwide study
Authors: Schulte-Frohlinde Rosa , Georges Damien , Clifford Gary M. , Baussano Iacopo
Published: March 2020

Background

Predictions of cervical cancer burden and impact of control measures are often modelled from HPV prevalence. However, predictions could be improved by data on time between prevalent HPV detection and cervical cancer occurrence.

Methods

Based upon high-risk (HR) HPV prevalence and cervical cancer incidence in the same birth cohorts from 17 worldwide locations, and informed by individual-level data on age at HR HPV detection and on sexual debut, we built a mixed model to predict cervical cancer incidence up to 14 years following prevalent HR HPV detection.

Findings

Cervical cancer incidence increased significantly during the 14 years following HR HPV detection in women <35 years, e.g. from 0·02 (95% CI 0·003–0·06) per 1000 within 1 year to 2·8 (1·2–6·5) at 14 years for unscreened women, but remained relatively constant following prevalent HR HPV detection above 35 years, e.g. from 5·4 (2·5–11) per 1000 within 1 year to 6·4 (2·4–17·1) at 14 years for unscreened HR HPV positive women aged 45–54 years. Age at sexual debut was a significant modifier of cervical cancer incidence in HR HPV positive women aged <25, but less so at older ages, whereas screening was a modifier in women ≥35 years. Lastly, we predicted annual number and incidence of cervical cancer in ten additional IARC HPV prevalence survey locations without representative cancer incidence data.

Interpretation

These findings can inform cervical cancer control programmes, particularly in settings without cancer registries, as they allow prediction of future cervical cancer burden from population-based surveys of HPV prevalence.

Funding

Bill & Melinda Gates Foundation; Canadian Institutes of Health Research.