bluuebunny/crossref_metadata_2025 huggingface dataset:
Competing Models
Authors: Montiel Olea José Luis , Ortoleva Pietro , Pai Mallesh M , Prat Andrea
Published: March 2022

Different agents need to make a prediction. They observe identical data, but have different models: they predict using different explanatory variables. We study which agent believes they have the best predictive ability—as measured by the smallest subjective posterior mean squared prediction error—and show how it depends on the sample size. With small samples, we present results suggesting it is an agent using a low-dimensional model. With large samples, it is generally an agent with a high-dimensional model, possibly including irrelevant variables, but never excluding relevant ones. We apply our results to characterize the winning model in an auction of productive assets, to argue that entrepreneurs and investors with simple models will be overrepresented in new sectors, and to understand the proliferation of “factors” that explain the cross-sectional variation of expected stock returns in the asset-pricing literature.
Dual-energy CT assessment of rapid monosodium urate depletion and bone erosion remodelling during pegloticase plus methotrexate co-therapy
Authors: Dalbeth Nicola , Becce Fabio , Botson John K , Zhao Lin , Kumar Ada
Published: March 2022

Objectives

Pegloticase rapidly lowers serum urate in uncontrolled/refractory gout patients, with ≥1 tophus resolution in 70% of pegloticase responders and 28% of non-responders. Dual-energy computed tomography (DECT) non-invasively detects MSU deposition, including subclinical deposition, quantifies MSU volumes and depicts bone erosions. This report presents DECT findings in MIRROR open-label trial participants receiving pegloticase+MTX co-therapy.

Methods

Serial DECT scans were obtained during pegloticase (8 mg biweekly infusions)+oral MTX (15 mg/week) co-therapy. Bilateral hand/wrist, elbow, foot/ankle and knee images were analysed with default post-processing settings. MSU volumes were quantified and bone erosions were identified and evaluated for remodelling (decreased size, sclerosis, new bone formation). DECT and physical examination findings were compared.

Results

2 patients underwent serial DECT. Patient 1 (44-year-old male) completed 52 weeks of pegloticase+MTX co-therapy (26 infusions). Baseline examination detected 4 tophus-affected joints while DECT identified 73 MSU-affected joints (total MSU volume: 128.76 cm3). At end-of-treatment, there were no clinically-affected joints and 4 joints with DECT-detected MSU deposition. MSU volume decreased by 99% and bone erosion remodelling was evident. Patient 2 (51-year-old male) had 10 weeks of therapy (5 infusions), discontinuing because of urate-lowering response loss. Baseline examination detected 7 tophus-affected joints while DECT identified 55 MSU-affected joints (total MSU volume: 59.20 cm3). At end-of-treatment, there were 5 clinically affected joints and 42 joints with DECT-detected MSU deposition. MSU volume decreased by 58% and bone erosion remodelling was evident.

Conclusion

DECT detected subclinical MSU deposition and quantified changes over time. Rapid tophus resolution and bone erosion remodelling occurred during pegloticase+MTX co-therapy.

Trial registration

ClinicalTrials.gov, https://clinicaltrials.gov, NCT03635957.
THE IMPACT OF VENTILATION RATE ON RADON CONCENTRATION INSIDE HIGH-RISE APARTMENT BUILDINGS
Authors: Cucu Marina , Dupleac Daniel
Published: March 2022

Radon is the main pollutant of indoor air, being considered a primary cause of lung cancer, especially in non-smokers. In 2013, European legislation required the standardization of regulations on radon exposure in member states using EC Directive 59/2013 EURATOM. The directive establishes basic safety rules for protection against the dangers represented by the exposure to ionizing radiation. Directive 59/2013 mandates each European country to establish a national action plan to reduce the risks of lung cancer attributed to radon in the general population and exposed workers. Romania is a European country with almost 20 million citizens, with over half of population living in urban locations. Most urban buildings in Romania are high-rise structures (4–10 floors), having many residential units. In this paper, we present results of season-dependent measurements of radon concentration and ventilation rates in high-rise apartment buildings and show the influence of ventilation on indoor radon levels. Indoor radon concentrations varied between 70 and 168 Bq m−3 in winter and 17–30 Bq m−3 in summer, being higher than the respective outdoor concentrations by 2–5 times in winter and 1–4 times in summer. Ventilation rates varied with season and were influenced by meteorological conditions at the time of measurements. Findings indicate that levels of indoor radon concentration depend on ventilation rates of the unit, but also on building materials, wind speed around building, time of day (higher around noon) and season of the year (higher in the cold season when ventilation rate is lower).
Status hierarchies and norm diffusion: the increase of top incomes in high finance
Authors: Ajdacic Lena
Published: March 2022

In this article, I argue that small, but lucrative high-status subgroups lead to an upward ratcheting of compensation levels through the diffusion of norms. Combining relational theories of inequalities and theories of social norms I show how subfield status hierarchies play out at the firm level. I examine the impact of excess compensation in alternative finance (private equity, hedge and venture funds) on traditional finance. Based on multilevel regression on 2159 US and UK executives and longitudinal analyses on 261 firms from 2010 to 2017, I find first, that managers with an alternative finance background receive a pay premium in traditional finance (19.7%). Secondly, within the UK, compensation levels in organizations that witnessed the arrival of sectoral migrants rise above the expected increase. The findings suggest that understanding income dynamics requires detailed scrutiny of high-status subgroups, especially if activities are structured as opaque and lightly regulated organizational forms.
Ideology, Legitimation and Collective Action: Evidence from Chile on the Mechanism of Ideological Inversion
Authors: Puga Ismael , Moya Cristóbal
Published: March 2022

We present evidence on a social mechanism of legitimation—ideological inversion—proposing that a fantasy consensus deters collective actions oriented toward social change, even in contexts were individuals support transformations. This fantasy consensus emerges as individuals infer the order’s validity mainly from the practices of others, which are largely constrained by social structures. Relying on a factorial survey experiment conducted in Chile, our results support the two main hypotheses from ideological inversion: people systematically overestimate the support for the status quo, and this overestimation has a deterrent effect on collective actions oriented toward social change. We argue that ideological inversion helps explain how legitimation crises often remain hidden, and therefore how political crisis often emerge abruptly. For instance, before the revolt of 2019 Chile was perceived as an example of social stability within Latin America, yet after an ordinary subway fare hike the country erupted in an unrelenting and massive wave of protests. Our findings suggest that the social support for the status quo previously perceived in Chile was a fantasy consensus enforced by constrained practices, and that this fantasy was very effective until recently in deterring social change. Ideological inversion thus provides a mechanism that contributes to explain the stability of social structures and inequalities regardless of individual dispositions or shared norms.
Investigation of toxicity effect of TiCN coated on 304 SS and 410 SS substrates in rat fibroblasts and B-lymphocytes
Authors: Naserzadeh Parvaneh , Razmi Abbas , Yesildal Ruhi , Ashtari Behnaz
Published: March 2022

In the present study, TiCN thin films were coated on AISI 304 and AISI 410 stainless steel (SS) substrates by Cathodic Arc Physical Vapor Deposition method. TiCN-coated substrates were confirmed by the XRD analysis results. Dense morphology and fine-grained surface of TiCN film were established by SEM images. Cellular toxicity of the coated 304 SS and 410 SS substrates was investigated in the fibroblasts and B-lymphocyte. In respect to that, we have shown coated substrates cytotoxicity, oxidative stress as well as cell viability, reactive oxygen species (ROS), lipid peroxidation (MDA), protein carbonyl, glutathione oxidase (GSSG), and glutathione reductase (GSH) assessment, releasing cytochrome c (Cytc), lysosomal membrane destabilization (AO) may lead to cell death signaling. Our results showed that the coated 304 SS and 410 SS substrates induced cells dysfunction via a significant increase in ROS production, MDA (P < 0.01 and P < 0.001), protein carbonyl (P < 0.05), and GSSG (P < 0.05 and P < 0.01) that correlated to cytochrome c release (P < 0.01). In addition, increased disturbance in oxidative phosphorylation was also shown by the decrease in cell viability (P < 0.001) and GSH (P < 0.01 and P < 0.001) in the coated 304 SS and 410 SS substrates-treated fibroblast and B-lymphocytes. The coated 304 SS and 410 SS substrates contacted cells and trafficked to the lysosomes and this is followed by lysosomal damage, leading to apoptosis/Necrosis. Our results indicated that these materials cause cellular dysfunction and subsequent oxidative stress leading to cognitive impairment in the rat fibroblasts and B-lymphocytes cells.
Onset of Pyoderma Gangrenosum in Patients on Biologic Therapies: A Systematic Review
Authors: Lytvyn Yuliya , Mufti Asfandyar , Maliyar Khalad , Sachdeva Muskaan , Yeung Jensen
Published: March 2022

OBJECTIVE

To summarize clinical outcomes of paradoxical pyoderma gangrenosum (PG) onset in patients on biologic therapy.

METHODS

The authors conducted MEDLINE and EMBASE searches using PRISMA guidelines to include 57 patients (23 reports).

RESULTS

Of the included patients, 71.9% (n = 41/57) noted PG onset after initiating rituximab, 21.1% (n = 12/57) noted tumor necrosis factor α (TNF-α) inhibitors, 5.3% (n = 3/57) reported interleukin 17A inhibitors, and 1.8% (n = 1/57) reported cytotoxic T-lymphocyte-associated protein 4 antibodies. The majority of patients (94.3%) discontinued biologic use. The most common medications used to resolve rituximab-associated PG were intravenous immunoglobulins, oral corticosteroids, and antibiotics, with an average resolution time of 3.3 months. Complete resolution of PG in TNF-α-associated cases occurred within an average of 2.2 months after switching to another TNF-α inhibitor (n = 1), an interleukin 12/23 inhibitor (n = 2), or treatment with systemic corticosteroids and cyclosporine (n = 3), systemic corticosteroids alone (n = 1), or cyclosporine alone (n = 1).

CONCLUSIONS

Further investigations are warranted to determine whether PG onset is associated with underlying comorbidities, the use of biologic agents, or a synergistic effect. Nevertheless, PG may develop in patients on rituximab or TNF-α inhibitors, suggesting the need to monitor and treat such adverse effects.
Promoting Female Leadership in Academic Surgery: Disrupting Systemic Gender Bias
Authors: Welten Vanessa M. , Dabekaussen Kirsten F.A.A. , Davids Jennifer S. , Melnitchouk Nelya
Published: March 2022

Gender bias is a pervasive issue in academic surgery and is characterized by familiar patterns previously described in the business world. In this article, the authors illuminate gender bias patterns in academic surgery identified in prior in-depth interviews with female surgical department chairs across the United States.

The 4 main gender bias patterns drawn from the business world and illuminated with data from the interviews are (1) prove-it-again, (2) tightrope or double-blind dilemma, (3) maternity wall or benevolent bias, and (4) tug-of-war. The authors propose steps to disrupt systemic gender bias issues recognized in the academic surgery community. The proposed steps are informed by guidance from surgical diversity task forces, by existing literature, and by the authors’ own experiences in the field. The steps are divided into 3 main categories: education, structured mentorship, and transparency. The proposed changes include improving training and recognition of unconscious bias, establishing level-appropriate and deliberate mentorship across all stages of training and practice, standardizing promotional requirements, and eliminating outdated standards that contribute to the gender pay gap.

Although this article addresses gender bias in academic surgery, the proposed steps toward change can promote equity across the surgical community as a whole and extend to other underrepresented groups in the field.
Accelerated Critical Therapy Now in the Emergency Department Using an Early Intervention Team: The Impact of Early Critical Care Consultation for ICU Boarders
Authors: Jayaprakash Namita , Pflaum-Carlson Jacqueline , Gardner-Gray Jayna , Hurst Gina , Kinni Harish , Tang Amy , Coba Victor , Rivers Emanuel P.
Published: March 2022

OBJECTIVES:

Evaluate the impact of an emergency department (ED)–based critical care consultation service, hypothesizing early consultation results in shorter hospital length of stay (LOS).

DESIGN:

Retrospective observational study from February 2018 to 2020.

SETTING:

An urban academic quaternary referral center.

PATIENTS:

Adult patients greater than or equal to 18 years admitted to the ICU from the ED. Exclusion criteria included age less than 18 years, do not resuscitate/do not intubate documented prior to arrival, advanced directives outlining limitations of care, and inability to calculate baseline modified Sequential Organ Failure Assessment (mSOFA) score.

INTERVENTIONS:

ED-based critical care consultation by an early intervention team (EIT) initiated by the primary emergency medicine physician compared with usual practice.

MEASUREMENTS:

The primary outcome was hospital LOS, and secondary outcomes were hospital mortality, ICU LOS, ventilator-free days, and change in the mSOFA.

MAIN RESULTS:

A total 1,764 patients met inclusion criteria, of which 492 (27.9%) were evaluated by EIT. Final analysis, excluding those without baseline mSOFA score, limited to 1,699 patients, 476 in EIT consultation group, and 1,223 in usual care group. Baseline mSOFA scores (±sd) were higher in the EIT consultation group at 3.6 (±2.4) versus 2.6 (±2.0) in the usual care group. After propensity score matching, there was no difference in the primary outcome: EIT consultation group had a median (interquartile range [IQR]) LOS of 7.0 days (4.0–13.0 d) compared with the usual care group median (IQR) LOS of 7.0 days (4.0–13.0 d), p = 0.64. The median (IQR) boarding time was twice as long subjects in the EIT consultation group at 8.0 (5.0–15.0) compared with 4.0 (3.0–7.0) usual care, p < 0.001.

CONCLUSIONS:

An ED-based critical care consultation model did not impact hospital LOS. This model was used in the ED and the EIT cared for critically ill patients with higher severity of illness and longer ED boarding times.
Exploring the Knowledge Structure of Patient Safety in Nursing Using a Keyword Network Analysis
Authors: Kim Eun Jung , Seomun GyeongAe
Published: March 2022

Patient safety is a critical and long-standing issue in nursing research. The purposes of this study were to explore the knowledge structure of patient safety and to provide a direction for future research by offering new perspectives and a theoretical clarification of patient safety in nursing.

Keyword network analysis was performed by extracting keywords from abstracts of 6072 published articles. To reflect nursing perspectives, focus group interviews were conducted and Kim's typology consisting of four domains was used as the framework of analysis. Visualized knowledge structure showed avoiding medication error and preventing pressure ulcers or falls remain important topics within this research field. The distribution of core keywords as per four domains was in the following order: practice, client, environment, and client-nurse domain. Within the client domain, patients' harm-related core keywords were limited to physical harm. The detailed knowledge structure consisted of five themes: patient, preventable patient harm, practice, error, and environment. It comprised risk assessment for patients' characteristics and environmental elements surrounding patient and nursing practice, and risk management using information as knowledge-based nursing practice. Regarding further research, we suggest a multidimensional approach to patient harm, and the utilization of the client-nurse relationship and information systems as strategies for patient safety.
Research Types and New Trends on the Omaha System Published From 2012 to 2019
Authors: Tomotaki Ai , Iwamoto Taiki , Yokota Shinichiroh
Published: March 2022

The Omaha System is a popular and standard term used in community health. This scoping review aimed to update the research types and identify new usage trends for the Omaha System through articles published between 2012 and 2019. The bibliography databases PubMed, CINAHL, Scopus, PsycInfo, Ovid, and ICHUSHI and the Omaha System's Web site were used to search for publications. Research articles published between 2012 and 2019 that included “Omaha System” in the title or abstract and were written in English or Japanese were included in this review. After excluding duplicate articles, 305 articles were screened and 82 were included in our analysis. There was a median of 10.3 articles per year. The percentages for each type of use of the Omaha System to “analyze client problem,” “analyze clinical process,” “analyze client outcomes,” and “advanced classification research” were 18.3%, 12.2%, 23.2%, and 4.9%, respectively. The reclassification of the type “others” (41.5%) included “use the Omaha System data for assessment for other than clients,” “use the Omaha System data as structured data,” “encode by the Omaha System code,” “adopt the OS framework,” “clinical information system,” and “literature review.” This newly reclassified category will help capture future research trends using the Omaha System.
Feasibility and Pilot Testing of Mobile Health Apps to Supplement 2 Healthy Lifestyle Interventions in Chronic Traumatic Brain Injury
Authors: Juengst Shannon B. , McShan Evan , Conley Michael , Luu Ivan , Driver Simon
Published: March 2022

Objectives:

To determine the feasibility of mobile health (mHealth) apps for enhancing participation of people with chronic traumatic brain injury (TBI) in the Group Lifestyle Balance (GLB-TBI) weight loss intervention and Brain Health Group (BHG-TBI) active control intervention.

Setting:

Community.

Participants:

n = 56 overweight/obese adults with moderate-severe TBI.

Design:

The GLB-TBI is a 12-month group- and community-based program to promote healthy eating and physical activity. The BHG-TBI is a 12-month group- and community-based program to promote general brain health, designed as an active control condition matched on time, structure, and perceived benefit to the GLB-TBI. In a randomized controlled trial testing the efficacy of the GLB-TBI for weight loss, participants used a group-specific mHealth app providing daily tips customized according to their intervention allocation.

Main Measures:

Compliance (percentage of daily prompts read and completed) and participant-reported satisfaction and usability.

Results:

In conjunction with relevant stakeholders, we developed the content and structure of the GLB-TBI and BHG-TBI apps based on core curriculum components. We incorporated cognitive strategies (app notifications) to address potential cognitive impairment common after TBI. Both apps delivered brief daily educational and motivational “tips” derived directly from their respective curricula. Daily use of the apps varied greatly across participants, with most participants who used the apps completing 10% to 50% of daily content. Participants found the apps to be easy to use, but only some found them helpful. App use was substantially different for those who participated in the intervention during (2020) versus before (2019) the COVID-19 pandemic.

Conclusions:

Although enhancing an intensive lifestyle intervention with mHealth technology may be helpful, further refinement is needed to optimize the frequency and delivery methods of mHealth content. Although one might expect remote app use to have been higher during the pandemic, we observed the opposite, potentially due to less hands-on training and ongoing support to use the app and/or general technology fatigue with social distancing.
Headache Diary Mobile Application for Monitoring and Characterizing Posttraumatic Headaches
Authors: Liu Kevin , Madrigal Esmeralda , Chung Joyce S. , Broffman Joelle I. , Bennett Naomi , Tsai Andrea , Adamson Maheen M. , Harris Odette A. , Timmerman Molly
Published: March 2022

Objective:

This study analyzed the data collected using a headache diary mobile application to characterize posttraumatic headaches (PTHs) in a sample of US veterans. Specifically, we measured patient engagement with the mobile application and compared our findings with previous literature regarding PTHs.

Setting:

A Headache Center of Excellence (HCoE) in a Veterans Health Administration facility.

Participants:

Forty-nine veterans currently being treated for ongoing PTH-related complaints with English fluency, reliable access to the internet, and a mobile phone.

Design:

Observational study of PTH characteristics using the mobile application over the course of 1 year.

Measures:

Main outcome measures were collected via a headache diary mobile application developed for patients to track headache-associated symptoms, headache location, triggers, type, intensity, and duration. Patients also completed a baseline Headache Impact Test (HIT-6) survey.

Results:

In total, 1569 entries were completed during the first year of application deployment. On average, patients completed 2.5 entries per week and used the application for 70 days. They frequently reported associated PTH symptoms of photophobia (56.7%) and headaches triggered by emotional stress (35.1%). Network analyses revealed patterns of co-occurrence in triggers of headache pain, associated symptoms, and headache pain location. Headache pain severity and impact ratings from the headache diary demonstrated convergent validity with the established HIT-6 measure.

Conclusions:

Headache diary mobile applications are a promising tool for monitoring and characterizing PTHs in veterans. Present results mirror past studies of PTH characteristics. Mobile application headache diaries may be used in both clinical and research settings to monitor headache symptoms and communicate the functional impact of headaches in real time.
Predictive Utility of the Imminent Risk Rating Scale: Evidence From a Clinical Pilot Study
Authors: Winters Georgia M. , Chou Cordelia , Grydehøj Rasmus F. , Tully Emily
Published: March 2022

In an effort to prevent inpatient violence on forensic psychiatric units, it is necessary to have a feasible and effective measure for nursing to screen for risk of short-term verbal and physical aggression. The Imminent Risk Rating Scale (IRRS; Starzomski & Wilson, 2015) showed promise in an initial validation study. This study aimed to further examine the predictive validity of the IRRS by utilizing clinical pilot data collected from a forensic inpatient unit. Nursing staff scored the IRRS for adults who were hospitalized for at least 1 week (n = 109), as well as outcomes related to verbal and physical aggression as measured by the Modified Overt Aggression Scale. The results from the clinical pilot data provided additional support for the potential use of the IRRS for predicting physical and verbal aggression in a forensic inpatient setting, although further rigorous empirical research is needed. The findings are important for nursing staff in the prediction and prevention of inpatient violence.
Development and Implementation of a Coordinated Community Response to Address Elder Abuse and Neglect
Authors: Pickering Carolyn E. Z. , Maxwell Christopher D. , Tatro Ron , Fales Karla , Hogoboom Bonnie
Published: March 2022

Background

Elder abuse, neglect, and financial exploitation impacts over five million community-dwelling older adults in the United States. Although services are available to help these victims, they are often fragmented within communities with service providers having limited means to provide preventative services. The coordinated community response (CCR) is a type of coalition intended to overcome siloed services through a single-point-of-entry system and more team-based approaches to prevention. This article describes the development, implementation, and evaluation of the interagency functioning of a local CCR.

Methods

The main goal of the CCR has been to better serve victims of elder abuse, neglect, and financial exploitation. However, through the coalition's evolution, the mission of how to do this shifted from a victim service model to a prevention approach. Unique features of this CCR include a uniform consent form to allow sharing of protected client data among all service providers and a technology-supported infrastructure for service record documentation and referrals.

Evaluation

Using available data from administrative records, the number of unique interagency referrals for services to older adults at risk increased 450% from 2016 to 2018. The strength and type of connections between agencies changed over time. Among all eligible clients offered services, most (77%) agreed to provide uniform consent to allow data sharing among other local partner agencies.

Discussion

The evaluation showed that the coalition met most of its planned measurable outputs in the original logic model guiding the CCR programmatic development. The evaluation findings and lessons learned inform updated guidelines for self-assessment of CCRs.
Confusing Terms
Authors: Fraley Hannah E. , Subedi Gayatri
Published: March 2022

Human trafficking is a growing population health problem. More than half of all persons experiencing trafficking are youth, with many in the United States unrecognized despite experiencing exploitation. Available peer-reviewed articles report a myriad of descriptions of trafficking, yet the concept and operational definition of youth trafficking, specifically, is lacking and unclear. Youth trafficking is described differently across multidisciplinary researchers and clinicians working with trafficked youth. Furthermore, labor trafficking of youth is largely excluded from the conversation surrounding trafficking. This article presents a concept analysis of naming trafficking of persons under the age of 18 years to clarify the concept specific to youth experiencing all forms of trafficking and approaches professionals can take with this specific subpopulation of trafficked persons and survivors.
Association of Physical Therapy Treatment Frequency in the Acute Care Hospital With Improving Functional Status and Discharging Home
Authors: Johnson Joshua K. , Rothberg Michael B. , Adams Kellie , Lapin Brittany , Keeney Tamra , Stilphen Mary , Bethoux Francois , Freburger Janet K.
Published: March 2022

Background:

Physical therapists (PTs) are consulted to address functional deficits during hospitalization, but the effect of PT visit frequency on patients’ outcomes is not clear.

Objective:

The objective of this study was to examine whether PT visit frequency is independently associated with functional improvement, discharge home, and both outcomes combined.

Research Design:

This was a retrospective cohort study.

Subjects:

Patients discharged from hospitals in 1 health system between 2017 and 2020, stratified by diagnostic subgroup: cardiothoracic and vascular, general medical/surgical, neurological, oncology, and orthopedic.

Measures:

PT visit frequency was categorized as ≤2, >2–4, >4–7, >7 visits/week. Functional improvement was defined as ≥5-point improvement in Activity Measure for Post-Acute Care mobility score. Other outcomes were discharge home and both outcomes combined.

Results:

There were 243,779 patients included. Proportions within frequency categories ranged from 11.0% (>7 visits/wk) to 40.5% (≤2 visits/wk) and varied by subgroup. In the full sample, 36% of patients improved function, 64% were discharged home, and 27% achieved both outcomes. In adjusted analyses, relative to ≤2 visits/week, the adjusted relative risk (aRR) for functional improvement increased incrementally with higher frequency (aRR=1.20, 95% confidence interval: 1.14–1.26 for >2–4 visits to aRR=1.78, 95% confidence interval: 1.55–2.03 for >7 visits). For all patients and within subgroups, the higher frequency was also associated with a greater likelihood of discharging home and achieving both outcomes.

Conclusions:

More frequent PT visits during hospitalization may facilitate functional improvement and discharge home. Most patients, however, receive infrequent visits. Further research is needed to determine the optimal delivery of PT services to meet individual patient needs.
Hodgkin Lymphoma in Children Under 5 Years: Do They Behave Differently?
Authors: Mahajan Amita , Bakhshi Sameer , Seth Rachna , Verma Nishant , Mandal Piali , Singh Manisha , Jain Sandeep , Radhakrishnan Venkatraman , Kanvinde Shailesh , Arora Raman S. , Dinand Veronique , Kalra Manas , Taluja Ankit , Mallick Soumyaranjan , Kumar Rakesh , Chandra Jagdish
Published: March 2022

The median age of presentation for Hodgkin lymphoma (HL) is lower in developing countries with a higher proportion under 5 years of age possibly attributable to the high prevalence of Epstein-Barr virus-driven disease. It is unclear whether the clinical presentation and outcomes of this cohort are different with concern regarding late effects being most pronounced in this age group. We report the outcome of children under 5 years of age enrolled in the InPOG-HL-15-01, the first multicentric collaborative study for newly diagnosed children and adolescents with HL from India. Thirty-five (9%) of the study population was younger than 5 years with a striking male preponderance of 34:1. They were less likely to have bulky disease, mediastinal or splenic involvement. The outcomes appear to be at least as favorable as in the older patient group. Efforts need to be made to evolve treatment strategies that spare this very young cohort from potential late effects.
Sedation Practices for Lumbar Punctures in Patients With Acute Lymphoblastic Leukemia: A Multicenter Retrospective Study Using Pediatric Health Information Systems
Authors: Wright Mariah L. , O’Brien Sarah H. , Schloss Brian , Stanek Joseph R. , Reed Suzanne
Published: March 2022

Background:

Sedation is often used to reduce pain and anxiety in pediatric patients with acute lymphoblastic leukemia (ALL) undergoing lumbar punctures (LPs). There is a potential for long-term effects on neurocognition with repeat sedative exposures in young children. The purpose of this study is to determine the practice habits regarding sedation for LPs in pediatric patients with ALL among multiple institutions.

Methods:

This is a retrospective study of 48 hospitals in the Pediatric Health Information Systems (PHIS) between October 2015 and December 2019. Children 1 to 18 years old with ALL who received intrathecal chemotherapy in an outpatient setting were included. We analyzed the prevalence of anesthesia usage and the types of anesthetics used.

Results:

Of the 16,785 encounters with documented use of anesthetic medications, intravenous and inhaled anesthetics were used in 16,486 (98.2%) and local anesthetics alone in 299 (1.8%). The most commonly used medications used for sedation were propofol (n=13,279; 79.1%), midazolam (n=4228; 25.2%), inhaled fluranes (n=3169; 18.9%), and ketamine (n=2100; 12.5%).

Conclusion:

The majority of children’s hospitals in the United States use intravenous and inhaled anesthetics for routine therapeutic LPs in pediatric patients with ALL. Propofol is one of the most common medications used for sedation.
The Effect of Lens Design on Corneal Power Distribution in Orthokeratology
Authors: Zhang Zhe , Chen Zhi , Zhou Jiaqi , Pauné Jaume , Xue Feng , Zeng Li , Qu Xiaomei , Zhou Xingtao
Published: March 2022

SIGNIFICANCE

This study will enhance our understanding of the effects of orthokeratology lens design on corneal profile, the results of which may be useful in developing future orthokeratology lens designs.

PURPOSE

This study aimed to evaluate the effect of lens design on corneal power distribution after orthokeratology using mathematical methods.

METHODS

Sixty-five subjects were enrolled in this prospective study and assigned to four groups: Euclid with 6.2-mm back optic zone diameter (aged <14 years), Euclid with 6.2-mm back optic zone diameter (aged ≥14 years), double tear reservoir lens with 5.0-mm back optic zone diameter, and double tear reservoir lens with 6.0-mm back optic zone diameter. Manifest refraction and corneal topography were checked at baseline and 1 day, 1 week, 2 weeks, and 1 month after lens wear. Relative corneal refractive power change was calculated by a polynomial function and a monomial function. The maximum relative corneal refractive power change (Y
max) and the corresponding distance from the corneal center (X
max) were analyzed. Relative corneal refractive power change over time and between groups was compared using repeated-measures analysis of variance.

RESULTS

Refractive reduction and central corneal flattening were seen at all follow-up visits after orthokeratology lens wear, being fastest in the 5.0-mm back optic zone diameter group (P < .001). The cornea steepened in an aspheric way toward the midperiphery and peaked at approximately 2 to 3 mm off the apex. Overall, Y
max was not different among the four groups, but X
max was smallest in the 5.0-mm back optic zone diameter group (P < .001). At 1/2 X
max, relative corneal refractive power change of the 5.0-mm back optic zone diameter design was significantly higher than that of the other three groups (P < .001). The power exponent of the monomial of the 5.0-mm back optic zone diameter design was greater than that of the other three groups (P < .001).

CONCLUSIONS

An orthokeratology lens design with smaller back optic zone diameter might yield a faster myopic reduction and a smaller aspheric treatment zone.
Association Between Heart Rate Variability and Inflammatory Biomarkers in Critically Ill Children*
Authors: Badke Colleen M. , Carroll Michael S. , Weese-Mayer Debra E. , Sanchez-Pinto L. Nelson
Published: March 2022

OBJECTIVES:

The autonomic nervous system (ANS) can both modulate and be modulated by the inflammatory response during critical illness. We aimed to determine whether heart rate variability (HRV), a measure of ANS function, is associated with proinflammatory biomarker levels in critically ill children.

DESIGN

Two cohorts were analyzed. The first was a prospective observational cohort from August 2018 to August 2020 who had plasma proinflammatory cytokine measurements within 72 hours of admission, including tumor necrosis factor-α, interleukin (IL)-1β, IL-6, and IL-8. The second was a retrospective cohort from June 2012 to August 2020 who had at least one C-reactive protein (CRP) measurement within 72 hours of admission.

SETTING:

Forty-six-bed PICU.

PATIENTS:

Critically ill children in either cohort who had continuous heart rate data available from the bedside monitors.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Sixty-two patients were included in the prospective cohort and 599 patients in the retrospective cohort. HRV was measured using the age-adjusted integer heart rate variability (HRVi), which is the sd of the heart rate sampled every 1 second over 5 consecutive minutes. The median HRVi was measured in the 12-hour period ending 30 minutes prior to inflammatory biomarker collection. HRVi was inversely correlated with IL-6, IL-8, and CRP levels (p ≤ 0.02); correlation with IL-8 and CRP persisted after adjusting for Pediatric Risk of Mortality III and age, and median HR and age (p < 0.001).

CONCLUSIONS:

HRVi is inversely correlated with IL-6, IL-8, and CRP. Further studies are needed to validate this measure as a proxy for a proinflammatory state.
Psychiatric Emergencies in Minors
Authors: So Pety , Wierdsma André I. , Vermeiren Robert R.J.M. , Mulder Cornelis L.
Published: March 2022

Objective

Little information is available on young children (age 4–12 years) with mental health problems who are seen by the psychiatric emergency services. We therefore described this population to identify (1) variables that differentiated children from those aged 13 to 18 years who had been referred for psychiatric emergency consultation; and (2) to describe sex differences.

Method

We extracted data for a 9-year period from the records of the mobile psychiatric emergency services in 2 urban areas in the Netherlands. In this period, 79 children aged 4 to 12 years (37.2% girls) and 1695 children aged 12 to 18 years (62.2% girls) had been referred for psychiatric emergency consultation. Demographic and process factors were recorded. Clinical characteristics included diagnostic and statistical manual of mental disorders, 4th edition classifications and the Severity of Psychiatric Illness scale. Logistic regression analyses were used to examine differences between the girls and boys in the 2 age groups.

Results

Young children aged 4 to 12 years had been involved in 4.5% of all consultations of minors. In contrast with adolescents, a higher percentage of young children seen for emergency consultation were boys, and a lower percentage was admitted to a psychiatric hospital (7.7%). In boys and girls alike, a DSM classification of behavioral disorder was associated with younger age.

Conclusions

The young group of children referred for psychiatric emergency consultation comprised relatively more children with behavioral disorders. Decisions to refer them for urgent psychiatric consultation seemed to be influenced by the suspicion of psychotic symptoms or of danger to themselves or others.
Developing Sustainable Prehospital Pediatric Care in Rwanda
Authors: Rosenberg Ashley , Wojick Megan , Asay Basil , Williams Kenneth , Wolfe Luke , Baghdassarian Aline , Umuhoza Christian , Ntaganda Edmond , Kabagema Ignace , Uwitonze Jean Marie , Dushime Theophile , Jayaraman Sudha
Published: March 2022

Objective

Unintentional injury is the leading cause of death in children older than 1 year and disproportionately affects pediatric patients in low- and middle-income countries.

Improved prehospital care capacity has demonstrated the ability to improve care and save lives. Our collaboration developed and implemented a sustainable prehospital emergency pediatrics care course (EPCC) for Service d'Aide Medicale Urgente, the public emergency medical service in Rwanda.

Methods

A 1-day context-specific EPCC was developed based on international best practices and local feedback. Two cohorts were created to participate in the course. The first group, EPCC 1, was made of 22 Service d'Aide Medicale Urgente providers with preexisting knowledge on the topic who participated in the course and received training to lead future sessions. After completion of the EPCC1, this group led the second cohort, EPCC 2, which was composed of 26 healthcare providers from around Rwanda. Each group completed a 50 question assessment before and after the course.

Results

Emergency pediatrics care course 1 mean scores were 58% vs 98% (pre vs post), EPCC 2 mean scores were 49% vs 98% (pre vs post), using matched-pair analysis of 22 and 32 participants, respectively. When comparing unequal variances across the groups with a 2-tailed pairedttest, EPCC 1 and EPCC 2 had a statistically significant mean change in pretest and posttest assessment test scores of 40% compared with 46%,P< 0.0001, with 95% confidence interval. A 1-way analysis of variance mean square analysis for the change in scores showed that regardless of the baseline level of training for each participant, all trainees reached similar postassessment scores (F(1) = 1.45,P= 0.2357).

Conclusions

This study demonstrates effective implementation of a context-appropriate prehospital pediatric training program in Kigali, Rwanda. This program may be effective to support capacity development for prehospital care in Rwanda using a qualified local source of instructors.
Comparison of Computed Tomography Features of Gastric and Small Bowel Gastrointestinal Stromal Tumors With Different Risk Grades
Authors: Tang Bo , Feng Qiu-xia , Liu Xi-sheng
Published: March 2022

Objective

This study aimed to compare the computed tomography (CT) features of gastric and small bowel gastrointestinal stromal tumors (GISTs) and further identify the predictors for risk stratification of them, respectively.

Methods

According to the modified National Institutes of Health criteria, patients were classified into low-malignant potential group and high-malignant potential group. Two experienced radiologists reviewed the CT features including the difference of CT values between arterial phase and portal venous phase (PVPMAP) by consensus. The CT features of gastric and small bowel GISTs were compared, and the association of CT features with risk grades was analyzed, respectively. Determinant CT features were used to construct corresponding models.

Results

Univariate analysis showed that small bowel GISTs tended to present with irregular contour, mixed growth pattern, ill-defined margin, severe necrosis, ulceration, tumor vessels, heterogeneous enhancement, larger size, and marked enhancement compared with gastric GISTs. According to multivariate analysis, tumor size (P < 0.001; odds ratio [OR], 3.279), necrosis (P = 0.008; OR, 2.104) and PVPMAP (P = 0.045; OR, 0.958) were the independent influencing factors for risk stratification of gastric GISTs. In terms of small bowel GISTs, the independent predictors were tumor size (P < 0.001; OR, 3.797) and ulceration (P = 0.031; OR, 4.027). Receiver operating characteristic curve indicated that the CT models for risk stratification of gastric and small bowel GISTs both achieved the best predictive performance.

Conclusions

Computed tomography features of gastric and small bowel GISTs are different. Furthermore, the qualitative and quantitative CT features of GISTs may be favorable for preoperative risk stratification.
Scoliosis in Neurofibromatosis Type 1 on Whole-Body Magnetic Resonance Imaging: Frequency and Association With Intraspinal and Paraspinal Tumors
Authors: Haider Shamrez , Le Lu Q. , Cho Gina , Xi Yin , Chhabra Avneesh
Published: March 2022

Objectives

Scoliosis is a common orthopedic problem in patients with neurofibromatosis 1 (NF1). Spinal deformities are found in 77% of all NF1 cases, with no widely accepted etiology. This study aimed to evaluate the frequency and types of scoliosis in NF1 patients using whole-body magnetic resonance imaging and to assess the association of intraspinal and paraspinal tumors with the imaging findings of scoliosis.

Methods

A total of 122 NF1 patients with whole-body magnetic resonance imaging were found from the electronic medical records. Ninety-seven cases that met the inclusion criteria were identified. All patients underwent 3-T magnetic resonance imaging with automated software fusion of the 3 sets of short TI inversion recovery and 3-dimensional T1-weighted coronal images. Frequency and location of scoliosis and intraspinal and paraspinal tumors were recorded. Patients with severe dystrophic-type scoliosis were separately identified, and Cobb angles were measured for all such cases. Association analysis was performed. A P value less than 0.05 was considered statistically significant.

Results

Ninety-seven patients with NF1 were evaluated. Two had prior spinal surgery and were excluded. The final sample of 95 patients included 33 (35%) men and 62 (65%) women with a mean ± SD body mass index of 25.82 (4.96) kg/m2. Of the 95 patients, 43 (45.3%) had scoliosis, 13 of 43 (30.2%) of which were severely angled. Of the 95 patients, 25 (26.3%) had locoregional tumor presence. Intraclass correlation for Cobb angles measured 0.99 (confidence interval, 0.98–1.0). Fisher exact test determined no association between scoliosis and presence of either paraspinal or intraspinal tumors (P = 0.485). There was also no association between the tumors and severe dystrophic scoliosis (P = 1.0).

Conclusions

This study found no association between the presence of locoregional spinal tumors and scoliosis in NF1 patients. This work adds to the body of knowledge of scoliosis in NF1 patients and infers that presence of scoliosis should not mandate immediate search for locoregional spinal tumors.
Integrative Predictive Models of Computed Tomography Texture Parameters and Hematological Parameters for Lymph Node Metastasis in Lung Adenocarcinomas
Authors: Chen Wenping , Xu Mengying , Sun Yiwen , Ji Changfeng , Chen Ling , Liu Song , Zhou Kefeng , Zhou Zhengyang
Published: March 2022

Objectives

The aims of the study were to integrate characteristics of computed tomography (CT), texture, and hematological parameters and to establish predictive models for lymph node (LN) metastasis in lung adenocarcinoma.

Methods

A total of 207 lung adenocarcinoma cases with confirmed postoperative pathology and preoperative CT scans between February 2017 and April 2019 were included in this retrospective study. All patients were divided into training and 2 validation cohorts chronologically in the ratio of 3:1:1. The χ2 test or Fisher exact test were used for categorical variables. The Shapiro-Wilk test and Mann-Whitney U test were used for continuous variables. Logistic regression and machine learning algorithm models based on CT characteristics, texture, and hematological parameters were used to predict LN metastasis. The performance of the multivariate models was evaluated using a receiver operating characteristic curve; prediction performance was evaluated in the validation cohorts. Decision curve analysis confirmed its clinical utility.

Results

Logistic regression analysis demonstrated that pleural thickening (P = 0.013), percentile 25th (P = 0.033), entropy gray-level co-occurrence matrix 10 (P = 0.019), red blood cell distribution width (P = 0.012), and lymphocyte-to-monocyte ratio (P = 0.049) were independent risk factors associated with LN metastasis. The area under the curve of the predictive model established using the previously mentioned 5 independent risk factors was 0.929 in the receiver operating characteristic analysis. The highest area under the curve was obtained in the training cohort (0.777 using Naive Bayes algorithm).

Conclusions

Integrative predictive models of CT characteristics, texture, and hematological parameters could predict LN metastasis in lung adenocarcinomas. These findings may provide a reference for clinical decision making.
T2–Fluid-Attenuated Inversion Recovery Mismatch Sign in Grade II and III Gliomas: Is There a Coexisting T2–Diffusion-Weighted Imaging Mismatch?
Authors: Radović Niko , Špero Martina , Hrkać Pustahija Ana , Almahariq Fadi , Srdoč Dubravka
Published: March 2022

Objective

To determine whether the T2 fluid-attenuated inversion recovery (T2-FLAIR) mismatch sign in diffuse gliomas is associated with an equivalent pattern of disparity in signal intensities when comparing T2- and diffusion-weighted imaging (DWI).

Methods

The level of correspondence between T2-FLAIR and T2-DWI evaluations in 34 World Health Organization grade II/III gliomas and interreader agreement among 3 neuroradiologists were assessed by calculating intraclass correlation coefficient and κ statistics, respectively. Tumoral apparent diffusion coefficient values were compared using t test.

Results

There was an almost perfect correspondence between the 2 mismatch signs (intraclass correlation coefficient = 0.824 [95% confidence interval, 0.68–0.91]) that were associated with higher mean tumoral apparent diffusion coefficient (P < 0.01). Interreader agreement was substantial for T2-FLAIR (Fleiss κ = 0.724) and moderate for T2-DWI comparisons (Fleiss κ = 0.589) (P < 0.001).

Conclusions

The T2-FLAIR mismatch sign is usually reflected by a distinct microstructural pattern on DWI. The management of this tumor subtype may benefit from specifically tailored imaging assessments.