bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nonclinical Factors in Autism Diagnosis: Results From a National Health Care Provider Survey
Authors: Azim Aniqa , Rdesinski Rebecca E. , Phelps Randall , Zuckerman Katharine E. 
Published: April 2020

ABSTRACT:

Objective:
The prevalence of autism spectrum disorder (ASD) has increased 10-fold in the past 40 years, and disparities have been noted by race/ethnicity and socioeconomic status, prompting concern about diagnostic accuracy. Provider perceptions of ASD diagnostic accuracy are not known. We conducted a survey of providers who diagnose ASD assessing how nonclinical factors might affect ASD diagnostic rates.

Methods:
The mixed-mode survey was sent to the members of the Society of Developmental and Behavioral Pediatrics with clinical interest in ASD (n = 400). Respondents used a Likert-type scale to address how often they and their colleagues overdiagnosed or underdiagnosed ASD. They were also asked how families grouped by race/ethnicity, education, socioeconomic status, and urbanicity perceived an ASD diagnosis.

Results:
Sixty-three percent of providers completed the survey. Eight point seven percent of providers self-reported that they overdiagnose ASD at least sometimes. However, 58% of providers reported that local colleagues overdiagnose ASD at least sometimes. Seven point eight percent of providers self-reported underdiagnosing ASD at least sometimes and cited parents not wanting a diagnosis as one of the most common reasons they may underdiagnose. Providers reported that non-white and rural families were more likely to think that ASD diagnosis was “a bad thing” than “a good thing” than white and urban and suburban families, respectively.

Conclusion:
Providers report moderate rates of ASD misdiagnosis and perceive differences in diagnostic preferences according to family characteristics. The study results may help explain the trends and disparities in ASD diagnosis.
Maternal Thyroid Disorders and Risk of Autism Spectrum Disorder in Progeny
Authors: Rotem Ran S. , Chodick Gabriel , Shalev Varda , Davidovitch Michael , Koren Gideon , Hauser Russ , Coull Brent A. , Seely Ellen W. , Nguyen Vy T. , Weisskopf Marc G. 
Published: April 2020

Background:
Maternal thyroid dysfunction is suspected of causing adverse neurodevelopmental effects, but current evidence is inconclusive. Epidemiologic investigations generally suggest an association between maternal thyroid dysfunction and neurodevelopment impairments in progeny, but clinical trials of thyroid treatment during pregnancy reported null effects. To better understand these discrepant findings, we evaluated the association between maternal thyroid conditions and autism spectrum disorder (ASD), including examining the role of gestational thyroid-related hormone concentrations and thyroid medications use.

Methods:
Analyses considered 437,222 singleton live births occurring in a large Israeli health fund in 1999–2013, followed through 2016. Thyroid conditions and ASD cases were identified through International Classification of Diseases-9 codes with subsequent validation through review of medical records. Laboratory gestational thyroid hormone measurements were also considered.

Results:
Children of mothers who ever experienced hypothyroidism had a higher risk of ASD compared with children of mothers without hypothyroidism (adjusted odds ratio [aOR] = 1.26, 95% confidence interval [CI] = 1.12, 1.42). The association with hyperthyroidism was less consistent, but elevated in main analyses (aOR = 1.42, 95% CI = 1.04, 1.94). These associations were not explained by maternal gestational thyroid hormones levels nor mitigated by gestational use of thyroid medications.

Conclusions:
Results indicate that maternal thyroid conditions are associated with increased ASD risk in progeny, but suggestively not due to direct effects of thyroid hormones. Instead, factors that influence maternal thyroid function could have etiologic roles in ASD through pathways independent of maternal gestational thyroid hormones and thus be unaffected by medication treatment. Factors known to disrupt thyroid function should be examined for possible involvement in ASD etiology.
Apparent treatment-resistant hypertension: characteristics and prevalence in a real-world environment of an integrated health system
Authors: An Jaejin , Sim John J. , Calhoun David A. , Liu Ran , Wei Rong , Zhou Hui , Luong Tiffany , Reynolds Kristi 
Published: April 2020

Objectives:
We compared the prevalence of apparent treatment-resistant hypertension (aTRH) according to the seventh report of the Joint National Committee (JNC 7) and the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline in an integrated healthcare delivery system.

Methods:
We identified individuals aged at least 18 years with hypertension from Kaiser Permanente Southern California between 1 July 2014 and 30 June 2015. aTRH was defined as either blood pressure (BP) above goal (≥140/90 mmHg per JNC7, and ≥130/80 mmHg per 2017 ACC/AHA for most adults with hypertension) while taking at least 3 classes of antihypertensive medication or taking at least four classes regardless of BP level. A secondary analysis was conducted requiring use of a diuretic for the definition of aTRH. Patient clinical characteristics and antihypertensive medication use were described using electronic health records.

Results:
We included 469 509 patients with treated hypertension [mean (SD) age 65 years (12), 46% white, 26% Hispanic, 13% black, and 12% Asian]. The prevalence of aTRH was 16.9 and 21.8% according to the JNC 7 and the 2017 ACC/AHA guidelines, respectively [Δ = 4.9% (95% CI: 4.7--5.1%)]. By requiring a diuretic to be considered as aTRH, the prevalence of aTRH decreased to 13.4 and 17.2% according to the JNC 7 and the 2017 ACC/AHA guidelines, respectively. Among patients with aTRH, 1.9% received a long-acting thiazide-like diuretic, and 5.6% received a mineralocorticoid receptor blocker.

Conclusion:
The prevalence of aTRH increased using the more stringent BP goals of the 2017 ACC/AHA guideline. The use of recommended therapy for aTRH was suboptimal suggesting a potential area for improvement.
Analysis of Graft Failure After Primary Penetrating Keratoplasty in Children With Peters Anomaly
Authors: Sun Yajie , Lin Qi , Miao Sen , Wang Wenying , Pan Zhiqiang 
Published: April 2020

Purpose:
To investigate the causes of graft failure and risk factors associated with total graft opacity after primary penetrating keratoplasty (PK) in children with Peters anomaly (PA).

Methods:
In this retrospective study, patients with PA (younger than 5 years) who received primary PK in Beijing Tongren Hospital were reviewed. The follow-up period was a minimum of 6 months. A modified PA classification system was used, and all failed grafts were categorized into partial and total opacity groups. Patient demographics, PA classification, operation details, degree of graft opacity, and causes of graft failure were recorded.

Results:
Of the 165 eyes, 54 eyes (32.7%) demonstrated graft failure along with various degrees of graft opacity. Approximately half of the grafts applied failed within 6 months postoperatively. The partial and total opacity groups did not demonstrate any significant differences regarding diagnosis distribution. Irreversible immune rejection accounted for 61.1% of all graft failures; furthermore, it had a significantly higher proportion in the partial opacity group than in the total opacity group (71.0% and 47.8%, respectively; P = 0.058). The degree of graft opacity was significantly associated with patient age at surgery (P = 0.002), preoperative corneal vascularization (P = 0.009), and iris defects (P = 0.001). However, administration of intensive topical corticosteroids could reduce the risk of total opacity in the rejected grafts.

Conclusions:
Irreversible immune rejection is the most common cause of graft failure after primary PK in pediatric patients with PA. The degree of graft opacity is closely related to patient age at surgery, preoperative corneal vascularization, and iris defects.
The Relationship Between Intraocular Pressure and Rates of Central Versus Peripheral Visual Field Progression
Authors: Shukla Aakriti G. , De Moraes C. Gustavo , Cioffi George A. , Girkin Christopher A. , Weinreb Robert N. , Zangwill Linda M. , Liebmann Jeffrey M. 
Published: April 2020

Precis:
In this longitudinal prospective cohort study of open-angle glaucoma patients, intraocular pressure (IOP) parameters (mean, fluctuation, and maximum) had a similar effect on glaucomatous progression in the central and peripheral visual field (VF) regions.

Purpose:
To study the effects of IOP on rates of glaucomatous central versus peripheral VF progression.

Methods:
The African Descent and Glaucoma Evaluation Study (ADAGES) is a longitudinal prospective cohort study that recruited patients from 3 centers. A sample of those with established glaucoma were included in this study. The mean peripheral sensitivity (MPS) and the mean central sensitivity (MCS) were defined based upon the average total deviation of the peripheral and central (10 degrees) points of the 24-2 VF, respectively. Progression was based upon central and peripheral change from linear mixed-effects models. The relationships between VF progression and IOP mean, maximum, and fluctuation as continuous variables were also investigated. Main outcome measures were MPS and MCS progression rates.

Results:
A total of 452 eyes of 344 patients were studied. The mean number of VFs (SD) for each eye was 13.3 (6.4) over 9.1 (3.7) years. The mean baseline MD was −5.1 (3.9) dB and the mean rate of MD change was −0.26 dB/y [95% confidence interval (CI): −0.33 to −0.20, P<0.001]. Mean rates of MPS (−0.27 dB/y, 95% CI: −0.33 to −0.22, P<0.001) and MCS change (−0.26 dB/y, 95% CI: −0.31 to −0.21, P<0.001) were similar (P=0.351). Mean, fluctuation, and maximum IOP were significantly associated with MPS and MCS (all P<0.025).

Conclusions:
The effect of IOP parameters on VF progression was statistically similar between central and peripheral VF regions.
Early Bacterial Infections After Pediatric Liver Transplantation in the Era of Multidrug-resistant Bacteria
Authors: Béranger Agathe , Capito Carmen , Lacaille Florence , Ferroni Agnès , Bouazza Naïm , Girard Muriel , Oualha Mehdi , Renolleau Sylvain , Debray Dominique , Chardot Christophe , Frange Pierre , Moulin Florence 
Published: April 2020

Background:
Early bacterial infection is a major and severe complication after liver transplantation (LT). The rise of antimicrobial resistance, especially extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), is a growing concern for these patients. This study aimed to assess the epidemiology of early bacterial infections in a pediatric population, including those caused by multidrug-resistant (MDR) pathogens, and to identify risk factors for infection.

Methods:
We conducted a monocentric retrospective study including 142 consecutive LTs performed in 137 children between 2009 and 2017.

Results:
Ninety-three bacterial infections occurred after 67 (47%) LTs. Among the 82 isolated pathogens, the most common was Klebsiella pneumoniae (n = 19, 23%). Independent risk factors for early bacterial infection were low weight [odds ratio (OR) = 0.96; 95% confidence interval (CI): 0.9–0.99; P = 0.03] and the presence of a prosthetic mesh (OR = 2.4; 95% CI: 1.1–5.4; P = 0.046). Sixty-one children (45%) carried MDR bacteria and 16 infections were caused by MDR pathogens, especially ESBL-producing K. pneumoniae (n = 12). ESBL-PE stool carriage was associated with ESBL-PE infection (OR = 4.5; 95% CI: 1.4–17.4; P = 0.02). Four children died from an infection, three due to ESBL-producing K. pneumoniae.

Conclusions:
This study confirmed a shift toward a predominance of Gram-negative early bacterial infections after pediatric LT. The risk factors for infection were low weight and the presence of a prosthetic mesh. ESBL-PE stool carriage was associated with ESBL-PE infection. Adapted antimicrobial prophylaxis and personalized antibiotherapy are mandatory to reduce infection prevalence and mortality.
Isavuconazole As Successful Salvage Therapy for Mucormycosis in Pediatric Patients
Authors: Ashkenazi-Hoffnung Liat , Bilavsky Efraim , Levy Itzhak , Grisaru Galia , Sadot Efraim , Ben-Ami Ronen , Novikov Anna , Fischer Salvador , Nahum Elhanan , Scheuerman Oded 
Published: April 2020

Background:
Mucormycosis is a rare but emerging life-threatening fungal disease with limited treatment options. Isavuconazole is a new triazole that has shown efficacy in adults for primary and salvage treatment of mucormycosis. However, data in children are scarce.

Methods:
The demographic and clinical data of pediatric patients with proven mucormycosis who were treated with isavuconazole in 2015 to 2019 at 2 centers were collected.

Results:
Four children of median age 10.5 years (range 7–14) met the study criteria. Three had underlying hematologic malignancies, and 1 had sustained major trauma. Isavuconazole was used as salvage therapy in all: in 3 patients for refractory disease, and in 1 after intolerance to another antifungal drug. Isavuconazole was administered alone or combined with other antifungal agents. Following treatment and surgical intervention, complete clinical, radiologic and mycologic responses were documented in all patients. A literature review identified 8 children with mucormycosis who were successfully treated with isavuconazole, as salvage therapy in the majority.

Conclusion:
Our limited experience supports the use of isavuconazole as salvage therapy in pediatric mucormycosis.
Anatomical and Histological Study of the Conjoint Fascial Sheath of the Levator and Superior Rectus for Ptosis Surgery
Authors: Li Bei , Yang Jianwei , Wu Wencan , Chai Chang , Gu Zhuo , He Zaiqing , Tan Zhiwei , Cheng Shuanghua , Lu Ping , Zeng Liuzhi 
Published: April 2020

Purpose:
An anatomical and histological study of the conjoint fascial sheath of the levator and superior rectus (CFS) was carried out by using the cadavers for teaching.

Methods:
Three adult Asian cadaver heads fixed in formalin were used. The CFS was exposed by the same surgeon in each case. Then the CFS was observed and measured in vivo and ex vivo. And the CFS, the levator and the frontal muscle were removed from the same eye for histological study.

Results:
The CFS was located 2.1 ± 0.4 mm posterior to the fornix. A special muscle sheath of the levator was observed. The special muscle sheath and the tendon of the superior rectus were fused to the CFS through loose connective tissue. Hematoxylin-Eosin (HE) staining showed a large amount of connective tissue on examination of the CFS by microscopy. Double staining with Victoria-blue and Masson trichrome staining confirmed elastic fibers and collagen fibers in the CFS tissues.

Conclusions:
If ptosis correction surgery is performed by looking for the CFS from the upper edge of the conjunctiva, in fact, only a special part of the muscle sheath of the levator in the CFS, but not the integral CFS, is used in the surgery. The histological results confirm that the CFS is a fibrous tissue membrane with both elasticity and toughness. Perhaps the best choice is to recombine the special muscle sheath of the levator in the CFS with the levator muscle tissue during ptosis correction surgery to suspend the eyelids.
A Prediction Model of Rehabilitation Motivation in Middle-Aged Survivors of Stroke in Rehabilitation Facilities in Korea
Authors: Oh Soo Yong , Hwang Seon Young , Chung Misook L. , Lennie Terry A. 
Published: April 2020

Background
To improve the health outcomes of survivors of stroke, it is critical that they are highly motivated to engage in rehabilitation activities. Despite the increasing prevalence of strokes among middle-aged adults, there is limited knowledge regarding factors that may affect survivors' motivation to engage in rehabilitation.

Objective
The aim of this study was to examine the relationship among factors that predict the rehabilitation motivation of middle-aged survivors after a stroke through structural equation modeling.

Methods
A total of 200 middle-aged (40–64 years) survivors of stroke from 9 rehabilitation hospitals in Korea completed questionnaires on depressive symptoms, self-efficacy, social support, and rehabilitation motivation. Information on clinical characteristics, including physical function (activities performed during daily life), was collected through the review of medical records. Structural equation modeling was used to construct a prediction model of rehabilitation motivation.

Results
The average subject's age was 56.2 ± 6.6 years, and the mean time since the event of their stroke was 15.02 ± 8.95 months. Subjects' self-efficacy (being able to live everyday life) after their stroke (β = .500, P < .001) and the social support provided by family and medical personnel (β = .284, P < .010) directly affected their rehabilitation motivation. The bootstrapping method showed that depressive symptoms indirectly affected rehabilitation motivation through self-efficacy, as did physical function.

Conclusions
In middle-aged survivors of stroke, self-efficacy and social support play a critical role in maintaining intrinsic motivation to engage in rehabilitation activities. Self-efficacy should be evaluated periodically and improved by encouraging individuals to achieve goals, emphasizing their self-regulation, especially among those who reported depressive symptoms and low physical function.
Help or hindrance: Exploring nurse practitioners' perceptions of transition to practice legislation
Authors: Speight Chandra , Scott Elaine S. 
Published: April 2020

ABSTRACT

Background:
Fourteen states have adopted transition to practice (TP) legislation, which requires newly certified nurse practitioners (NPs) to practice under a senior clinician. States have adopted such legislation despite vast evidence indicating NPs provide safe care.

Purpose:
The purpose of this study is to explore NPs' perceptions of the effects of this legislation and to describe communication between NPs and senior clinicians working in TP states.

Methods:
Using a cross-sectional, descriptive design, we surveyed a convenience sample of NPs working in TP states. Descriptive statistical analysis and qualitative content analysis were conducted.

Results:
Most respondents believed TP legislation posed unnecessary regulatory barriers but also believed it promoted professional development. No statistically significant relationships between professional characteristics, regulatory variations, and these perceptions were identified.

Implications for practice:
Given the increasing number of states considering TP legislation, and the vast variability in TP models, additional research into the effects of this regulation is needed.
High-specific-activity iodine 131 metaiodobenzylguanidine for the treatment of metastatic pheochromocytoma or paraganglioma: a novel therapy for an orphan disease
Authors: Jimenez Camilo , Núñez Rodolfo , Wendt Richard 
Published: April 2020

Purpose of review
Pheochromocytomas and paragangliomas represent less than 1% of all endocrine tumors. Approximately 15–20% of these tumors are malignant. The definition of malignancy relies on the presence of metastasis. Metastatic pheochromocytomas and paragangliomas are usually advanced, incurable tumors with limited therapeutic options. About 50–60% of these tumors express the noradrenaline transporter in their cell membranes. Recently, the United States Food and Drug Administration approved high-specific-activity iodine 131 metaiodobenzylguanidine (HSA-I-131-MIBG) for the treatment of metastatic pheochromocytomas and paragangliomas that express the noradrenaline transporter. This review reports the benefits and toxicity of HSA-I-131-MIBG, its physical and dosimetric aspects, and radiation safety precautions, as well as its potential therapeutic value for other malignancies (neuroblastoma, gastroenteropancreatic neuroendocrine tumors, and medullary thyroid carcinoma).

Recent findings
A phase 2 clinical trial with HSA-I-131-MIBG reported an impressive clinical benefit rate, acceptable toxicity and long-term benefits.

Summary
HSA-I-131-MIBG is an effective medication for metastatic pheochromocytomas and paragangliomas that express the noradrenaline transporter.
Length of Clinical Shift on Quality of Care, Learning Outcomes, and Satisfaction in Prelicensure Nursing Programs
Authors: Hamilton Diane J. , Benson Julie A. , Callahan Rebecca 
Published: April 2020

Background
Some schools and nursing care organizations have implemented 12-hour shifts for students' clinical experiences.

Purpose
The aim of this review was to identify how student 12-hour shifts compared to shifts of less than 12 hours influence patient safety, care quality, learning outcomes, and student, faculty, and staff satisfaction.

Methods
Searches for academic literature using electronic databases resulted in 13 primary research articles covering the period between 1982 and 2018.

Results
During longer clinical shifts, no change in patient safety events occurred. Students and clinical staff perceived care quality was maintained or influenced positively. Faculty were undecided or minimally did not believe care quality improved. While students perceived meeting learning outcomes, faculty perceptions were divided. Students were satisfied with longer shifts; however, the satisfaction of faculty and clinical staff was mixed.

Conclusions
Within realms of patient safety, care quality, learning outcomes, and student, faculty, and clinical staff satisfaction, research has been insufficient and inconclusive regarding 12-hour student shifts.
Transforming the Experience of Mirror Viewing for Individuals Faced With Disfiguring Injuries
Authors: Thayer Virginia (Becky) , Freysteinson Wyona , Thomas Lisa W. 
Published: April 2020

Purpose/Aims
This study explored the feasibility of educating nurses on an emotionally sensitive topic using video. The aim was to educate nurses on how to assist individuals who have had an amputation of a limb in viewing themselves in the mirror.

Design
One-group repeated-measures design with 2 time points (pretest and posttest at 1 month).

Methods
Nurses viewed a video in which 8 amputee actors described how and why nurses should support individuals' viewing of self in the mirror following amputation.

Results
This video-based education was feasible, and recommendations were made for future research. Participants were engaged and shared insight into how this knowledge would change their nursing practice.

Conclusions
A larger educational research study to test the effect of this education on improving nursing confidence and offering the mirror is recommended.