bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of Vestibular Schwannoma Growth
Authors: Sethi Mantegh , Borsetto Daniele , Bance Manohar , Cho Yeajoon , Gair Juliette , Gamazo Nicola , Joannides Alexis , Jefferies Sarah , Mannion Richard , Macfarlane Robert , Donnelly Neil , Tysome James R. , Axon Patrick 
Published: December 2020

Objective:
Management of vestibular schwannomas (VS) involves surgery, radiotherapy, or surveillance, based on patient and tumor factors. We recently described conditional probability as a more accurate method for stratifying VS growth risk. Building on this, we now describe determinants of VS growth, allowing clinicians to move toward a more personalized approach to growth-risk profiling.

Methods:
Retrospective analysis of a prospectively collected database in a tertiary referral skull base unit between 2005 and 2014. Inclusion of patients with unilateral VS managed on surveillance protocol for a minimum of 5 years. Analysis of patient age, sex, tumor location, tumor size, and symptomology using conditional probability.

Results:
A total of 340 patients met inclusion criteria. The conditional probability of growth of extracanalicular VS was significantly higher versus intracanalicular (IC) VS (30% versus 13%, p < 0.001) as was small-sized VS versus IC VS (28 versus 13%, p = 0.002), but only in the first year after diagnosis. Sex, age, and presenting symptoms did not significantly affect VS growth.

Conclusion:
In our series, extracanalicular VS were more likely to grow than IC VS and small-sized VS more likely to grow than IC VS, but only in the first year after diagnosis. Conversely, sex, age, and presenting symptoms did not affect the conditional probability of VS growth.
Overlapping Symptoms of Gastroesophageal Reflux and Aspiration Highlight the Limitations of Validated Questionnaires
Authors: Duncan Daniel R. , DiFilippo Courtney , Kane Madeline , Lurie Margot , McSweeney Maireade E. , Rosen Rachel L. 
Published: December 2020

ABSTRACTObjectives:Infants frequently present with feeding difficulties and respiratory symptoms, which are often attributed to gastroesophageal reflux but may be because of oropharyngeal dysphagia with aspiration. The Infant Gastroesophageal Reflux Questionnaire Revised (I‐GERQ‐R) is a clinical measure of gastroesophageal reflux disease but now there is greater understanding of dysphagia as a reflux mimic. We aimed to determine the degree of overlap between I‐GERQ‐R and evidence of dysphagia, measured by Pediatric Eating Assessment Tool‐10 (Pedi‐EAT‐10) and videofluoroscopic swallow study (VFSS).Methods:We performed a prospective study of subjects <18 months old with feeding difficulties. All parents completed Pedi‐EAT‐10 and I‐GERQ‐R as a quality initiative to address parental feeding concerns. I‐GERQ‐R results were compared with Pedi‐EAT‐10 and, whenever available, results of prior VFSS. Pearson correlation coefficients were calculated to determine the relationship between scores. Groups were compared with 1‐way ANOVA and Fisher exact test. ROC analysis was completed to compare scores with VFSS results.Results:One hundred eight subjects with mean age 7.1 ± 0.5 months were included. Pedi‐EAT‐10 and I‐GERQ‐R were correlated (r = 0.218, P = 0.023) in all subjects and highly correlated in the 77 subjects who had prior VFSS (r = 0.369, P = 0.001). The blue spell questions on I‐GERQ‐R had relative risk 1.148 (95% confidence interval [CI] 1.043–1.264, P = 0.142) for predicting aspiration/penetration on VFSS, with 100% specificity. Scores on the question regarding crying during/after feedings were also higher in subjects with abnormal VFSS (1.1 ± 0.15 vs 0.53 ± 0.22, P = 0.04).Conclusions:I‐GERQ‐R and the Pedi‐EAT‐10 are highly correlated. I‐GERQ‐R results may actually reflect oropharyngeal dysphagia and not just gastroesophageal reflux disease in infants.
One‐year Experience With Composite Intravenous Lipid Emulsion in Children on Home Parenteral Nutrition
Authors: Raphael Bram P. , Mitchell Paul D. , Carey Alexandra , Gura Kathleen M. , Puder Mark 
Published: December 2020

ABSTRACTBackground:Composite lipid emulsion (CLE) composed of soybean oil, medium‐chain triglycerides, olive oil, and fish oil is approved in the US for parenterally fed adults. For stable children discharged on home parenteral nutrition (HPN) without cholestasis (direct bilirubin > 2.0 mg/dL), CLE has theoretical benefits over soybean‐based intravenous lipid emulsion due to reduced phytosterol exposure with higher calorie support to permit reduced glucose infusion rates (GIRs), omega‐3 supplementation, and supplemental α‐tocopherol.Methods:In this prospective, single‐center open‐label research study, safety and efficacy outcomes were evaluated in patients on HPN younger than 18 years treated with CLE at 1 to 3 g · kg−1 · day−1 over 12 months. The primary outcome was change in anthropometrics and GIRs compared with baseline. Secondary outcomes were changes in fatty acid profiles and liver function and enzyme tests compared with baseline.Results:Fifty‐seven subjects were treated with a median age of 7 years. The diagnosis was short bowel syndrome in 72%. Change in practice was associated with a decrease in mean GIRs from 17 to 14 mg · kg−1 · h−1 at 4 to 6 months postbaseline and beyond with a coincidental decline in mean arachidonic acid and stable growth parameters. No significant adverse events were noted.Conclusions:CLE was safe and well‐tolerated in stable children on HPN at 1 year, but further studies are needed in this population to appreciate long‐term outcomes.
High genetic diversity among diarrheagenic Escherichia coli isolates from patients with acute diarrhea in Khuzestan province, Southwestern Iran
Authors: Owlia Parviz , Bouzari Saeid , Saderi Horieh , Ghanavati Roya , Darbandi Atieh 
Published: December 2020

Background:
Diarrheagenic Escherichia coli (DEC) is an enteric pathogen that causes a wide variety of gastrointestinal diseases in developing countries. In our previous study, the prevalence of DEC pathotypes from acute diarrhea patients in Khuzestan province was determined. In this study, we investigated the antimicrobial resistance profile and molecular genetic characteristics of this isolate.

Methods:
Antibiotic susceptibility testing of bacterial isolates was determined by disc diffusion technique on Muller Hinton agar. The production of extended-spectrum beta-lactamases (ESBLs) was confirmed by the Double Disc Synergy Test (DDST). The genetic diversity of isolates was determinate by pulsed-field gel electrophoresis (PFGE).

Results:
Among all DEC strains, 100% were resistant to at least one commonly prescribed antibiotic. Strains were resistant to first-line antibiotics, such as tetracycline, ampicillin, and sulfamethoxazole-trimethoprim. Furthermore, 72% of DEC isolates were multidrug-resistant and aEPEC and STEC were the categories with a major proportion of this feature. ESBL-producing strains were observed in 38% of all DEC isolates. PFGE analysis showed 19 unique pulsotypes of 22 studied DEC pathotypes. However, a few isolates were found to be clonal (clusters A, B, and C).

Conclusion:
The current study provides novel information about the presence of DEC isolates particularly with the rate of high antibiotic resistance among acute diarrheal samples in Khuzestan, Iran. Our data revealed that there was almost high heterogeneity among isolated DEC pathotypes. Proper infection control policies are needed to be implemented in order for the infections to be effectively controlled.
Nurse Sensemaking for Responding to Patient and Family Safety Concerns
Authors: Groves Patricia S. , Bunch Jacinda L. , Cannava Kaitlin E. , Sabadosa Kathryn A. , Williams Janet K. 
Published: December 2020

Background
Hospitals need to prevent, respond to, and learn from safety risks and events perceived by patients and families, who in turn rely on nurses to respond to and report their safety concerns.

Objectives
The aim of the study was to describe the process by which bedside nurses evaluate and determine the appropriate response to safety concerns expressed by patients or their families.

Methods
A qualitative design was employed. We recruited inpatient bedside nurses in an 811-bed Midwest academic medical center. Nurses provided demographic information and participated in semistructured interviews designed to elicit narratives related to evaluation and response to patient- or family-expressed safety concerns. Data analysis and interpretation were guided by grounded theory.

Results
We enrolled 25 nurses representing 22 units. Based on these nurses’ experiences, we developed a grounded theory explaining how nurses evaluate a patient or family safety concern. Nurses make sense of the patient’s or family’s safety concern in order to take action. Achieving this goal requires evaluation of the meaningfulness and reasonableness of the concern, as well as the potential effect of the concern on the patient. Based on this nursing evaluation, nurses respond in ways designed to (a) manage emotions, (b) immediately resolve concerns, (c) involve other team members, and (d) address fear or uncertain grounding in reality. Nurses reported routinely handling safety concerns at the bedside without use of incident reporting.

Discussion
Safety requires an interpersonal and evaluative nursing process with actions responsive to patient and family concerns. Safety interventions designed to be used by nurses should be developed with the dynamic, cognitive, sensemaking nature of nurses’ routine safety work in mind. Being sensitive to the vulnerability of patients, respecting patient and family input, and understanding the consequences of dismissing patient and family safety concerns are critical to making sense of the situation and taking appropriate action to maintain safety. Measuring patient safety or planning improvement based on patient or family expression of safety concerns would be a difficult undertaking using only standard approaches. A more complex approach incorporating direct patient engagement in data collection is necessary to gain a complete safety picture.
Integrated Review of Psychosocial and Behavioral Health Assessments and Interventions in Pulmonary Hypertension
Authors: Von Visger Tania T. , Lee Diana , Lyons Amy , Chang Yu-Ping 
Published: December 2020

Abstract

Background
The medical management of patients with pulmonary hypertension (PH) has advanced, with few evidence-based recommendations about psychosocial and behavioral health interventions. There is also a lack of comprehensive understanding of PH psychosocial and behavioral health needs. Some psychosocial and behavioral health interventions have been tested; however, there is a gap in the systematic evaluation of nonpharmacological complementary approaches to augment PH management when addressing psychosocial and behavioral health needs.

Objectives
The objectives are to explore psychosocial and behavioral health needs and describe psychosocial and behavioral health interventions for patients with PH.

Methods
We conducted an integrative systematic review of publications between January 1, 2010, and January 31, 2020, obtained from electronic databases: EMBASE, PubMed, Cumulative Index of Nursing and Allied Health Literature, Cochrane, PsycINFO, and Web of Science. The literature searches focused on empirical literature reporting psychosocial needs and psychosocial and behavioral health interventions for adult PH patients. We included peer-reviewed studies published in English. Search terms used in the study were: “hypertension,” “pulmonary hypertension,” “psychosocial,” “depression,” “anxiety,” “quality of life,” “behavioral health,” “self-management,” “psychosocial intervention,” and “psychological distress.” Excluded were opinion and discussion publications, reviews, non-PH populations, and pediatric articles. We used the constant comparison method to guide the synthesis of reports applying the Joanna Briggs quality assessment guidelines.

Results
A total of 44 articles meeting the criteria were included for final consideration. We conducted an integrative systematic review of 27 quantitative studies, narrative synthesis of 10 qualitative studies, and 7 psychosocial and behavioral health intervention studies. PH patients reported psychosocial needs, such as financial, social connections, sexual health, and palliative care needs, as well as levels of psychological distress symptoms. The results from both quantitative and qualitative studies revealed similar overarching psychosocial and behavioral health conceptual categories. Patients described their ongoing needs in PH management by relying on their psychosocial and behavioral health capabilities to adjust to changes at each stage of disease progression. Patients had high levels of psychosocial and behavioral health needs requiring interventions beyond medical treatment.

Discussion
Pilot studies testing psychosocial and behavioral health interventions reported improvement in levels of anxiety and depression and health-related quality of life. Larger scale studies are needed to advance this knowledge. Psychosocial and behavioral health interventions with cognitive-guided foci have the potential of meeting these unmet needs.
Effects of Mindfulness-Based Stress Reduction on Experimental Pain Sensitivity and Cortisol Responses in Women With Early Life Abuse: A Randomized Controlled Trial
Authors: Andersen Elizabeth , Geiger Paul , Schiller Crystal , Bluth Karen , Watkins Lana , Zhang Ying , Xia Kai , Tauseef Hafsah , Leserman Jane , Girdler Susan , Gaylord Susan 
Published: December 2020

ABSTRACT

Objective
Early life abuse (ELAb) initiates pathophysiological cascades resulting in long-term maladaptive stress responsivity, hyperalgesia, and an increased risk of psychopathology. Mindfulness-based stress reduction (MBSR) is effective in modifying psychological and somatic symptoms; thus, we predicted that MBSR would be particularly efficacious for women with ELAb.

Method
Medically healthy women (mean age = 31 years) with or without a history of early (≤13 years) physical or sexual abuse provided self-report measures and were tested in the laboratory before and after randomization to standard MBSR (n = 52) or social support (SSG) (n = 60) for 8 weeks. The laboratory procedure involved pain testing using the cold pressor and temporal summation of heat pain (indexing central sensitization) procedures, and exposure to the Trier Social Stress Test. Plasma cortisol in response to the experimental protocol was assessed as area under the curve (AUC).

Results
The interventions differentially impacted pain sensitivity and cortisol AUC for women with ELAb, as MBSR increased the temporal summation of heat pain intensity ratings (p = .024) and reduced cortisol AUC (p = .004). For women without ELAb, MBSR decreased cold pressor tolerance (p = .045) and decreased the temporal summation of heat pain intensity ratings relative to SSG (p = .024). Both MBSR and SSG improved depression symptoms and emotion regulation abilities (p values < .001); however, MBSR was associated with greater benefits in describing emotions (p = .008) and impulse control (p = .017) for women with ELAb.

Conclusions
Women with ELAb benefited from MBSR-specific improvements in central sensitization, mindfulness skills, and emotion regulation abilities. This is the first study to examine the efficacy of MBSR in modifying affective and somatic symptoms based on ELAb status and provides evidence for considering ELAb in tailoring treatment approaches.

Trial Registration: ClinicalTrials.gov Identifier: NCT01995916; https://clinicaltrials.gov/ct2/show/NCT01995916.
Efficacy and Safety of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide as Maintenance Treatment in HIV/HBV-Coinfected Patients
Authors: Huang Yu-Shan , Cheng Chien-Yu , Liou Bo-Huang , Lu Po-Liang , Cheng Shu-Hsing , Lee Yuan-Ti , Liu Chun-Eng , Sun Hsin-Yun , Yang Chia-Jui , Tang Hung-Jen , Lin Shih-Ping , Ho Mao-Wang , Huang Sung-Hsi , Tsai Hung-Chin , Lee Chen-Hsiang , Hung Chien-Ching ,   on behalf of the Taiwan HIV Study Group
Published: December 2020

Background:
The efficacy and safety of switching from tenofovir disoproxil fumarate-based antiretroviral therapy to coformulated elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (E/C/F/TAF) has not been widely investigated in HIV/hepatitis B virus (HBV)-coinfected Asian population.

Methods:
Between February and October 2018, HIV/HBV-coinfected patients who had achieved HIV viral suppression with tenofovir disoproxil fumarate-containing regimens were switched to E/C/F/TAF. Assessments of plasma HBV and HIV viral load, HBV serology, renal function, lipid profiles, and bone mineral density (BMD) were performed at weeks 24 and 48 after switch.

Results:
A total of 274 HIV/HBV-coinfected participants were enrolled, with 12.8% testing HBeAg-positive and 94.2% having plasma HBV DNA <20 IU/mL at baseline. At weeks 24 and 48, 92.7% and 89.8% achieved plasma HBV DNA <20 IU/mL; 4.7% and 5.1% had HBV DNA ≥20 IU/mL; and 2.6% and 5.1% had no data, respectively. At weeks 24 and 48, 95.6% and 94.2% of participants maintained HIV RNA <50 copies/mL, respectively. Compared with baseline, the median urine β2-microglobulin-to-creatinine ratio at week 48 decreased significantly from 165 to 90 μg/g (P < 0.001). The mean BMD of the spine and hip improved at week 48 (+1.77% and +1.33%, respectively). Significantly higher lipid profiles were observed after switch to E/C/F/TAF. Thirteen (4.7%) patients withdrew from the study before week 48, with 7 (2.6%) patients because of adverse effects.

Conclusions:
Switch to E/C/F/TAF maintained HBV and HIV viral suppression and resulted in the improvement of proteinuria and BMD of the spine and hip but increased lipid levels in HIV/HBV-coinfected patients at week 48.
Impact of Systemic Lupus Erythematosus on Pregnancy
Authors: Miranda-Hernández Dafhne , Sánchez Antonio , Sánchez-Briones Reyna E. , Rivas-Ruiz Rodolfo , Cruz-Reynoso Leonardo , Cruz-Domínguez Pilar , Jara Luis Javier , Saavedra Miguel Ángel 
Published: December 2020

Background
Pregnancy in patients with systemic lupus erythematosus is considered a high risk one since it is associated with a higher rate of maternal-fetal complications compared with the pregnancies in healthy women.

Objectives
The aim of this study was to describe the maternal-fetal outcomes in a cohort of Mexican patients with systemic lupus erythematosus and to identify risk factors associated with adverse maternal and fetal outcomes.

Patients and Methods
A cohort of pregnant lupus patients was analyzed. Maternal-fetal complications were described, and clinical, biochemical, and immunological variables associated with obstetric adverse outcomes were studied. Descriptive statistics, comparison of variables using appropriate tests, and finally logistic regression analysis were performed to identify potential risk factors for adverse maternal and fetal outcomes.

Results
A total of 351 pregnancies were included in a 10-year period. The most frequently observed maternal adverse outcomes were lupus flare (35%) and preeclampsia (14.5%). Active lupus before pregnancy (hazards ratio [HR], 3.7; 95% confidence interval [CI], 1.1–12.5; p = 0.003) was a predictor for these complications, whereas the use of antimalarial drugs (HR, 0.4; 95% CI, 0.2–0.7; p = 0.007) was a protective factor. The most frequent fetal adverse outcomes were preterm birth (38.1%), miscarriages (10%), and low birth weight babies (28%), and very low birth weight newborns (11%). Proteinuria in early pregnancy (HR, 7.1; 95% CI, 1.01–50.3; p = 0.04) and preeclampsia (HR, 9.3; 95% CI, 1.7–49.7; p = 0.009) were risk factors associated with these complications.

Conclusions
Variables related to systemic lupus erythematosus activity predict an adverse maternal outcome, whereas proteinuria in early pregnancy and preeclampsia are associated with an adverse fetal outcome.
Systemic Sclerosis Is Associated With Increased Inpatient Mortality in Patients Admitted for Acute Coronary Syndrome
Authors: Edigin Ehizogie , Ojemolon Pius Ehiremen , Eseaton Precious Obehi , Jamal Shakeel , Shaka Hafeez , Akuna Emmanuel , Asemota Iriagbonse Rotimi , Manadan Augustine 
Published: December 2020

Objective
This study aims to compare the outcomes of patients primarily admitted for acute coronary syndrome (ACS) with and without systemic sclerosis (SSc). The primary outcome was odds of inpatient mortality. Hospital length of stay, total hospital charges, rates of cardiovascular procedures, and treatments were secondary outcomes of interest.

Methods
Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for hospitalizations for adult patients with ACS (ST-segment elevation myocardial infarction [STEMI], non–ST-segment elevation myocardial infarction [NSTEMI], and unstable angina) as principal diagnosis with and without SSc as secondary diagnosis using International Classification of Diseases, Tenth Revision codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders.

Results
There were more than 71 million discharges included in the combined 2016 and 2017 NIS database. There were 1,319,464 hospitalizations for adult patients with a principal International Classification of Diseases, Tenth Revision code for ACS. There were 1155 (0.09%) of these hospitalizations that had SSc. The adjusted odds ratios for inpatient mortality for ACS, STEMI, and NSTEMI hospitalizations with coexisting SSc compared with those without SSc were 2.02 (95% confidence interval [CI], 1.19–3.43; p = 0.009), 2.47 (95% CI, 1.05–5.79; p = 0.038), and 2.19 (95% CI, 1.14–4.23; p = 0.019), respectively.

Conclusions
Acute coronary syndrome hospitalizations with SSc have increased inpatient mortality compared with those without SSc. ST-segment elevation myocardial infarction and NSTEMI hospitalizations with SSc have increased inpatient mortality compared with STEMI and NSTEMI hospitalizations without SSc, respectively. Acute coronary syndrome hospitalizations with SSc have similar hospital length of stay, total hospital charges, rates of revascularization strategies (percutaneous coronary intervention, coronary artery bypass surgery, and thrombolytics), and other interventions (such as percutaneous external assist device and intra-aortic balloon pump) compared with those without SSc.