bluuebunny/crossref_metadata_2025_split huggingface dataset:
Practice Improvement for Standardized Evaluation and Management of Acute Tracheitis in Mechanically Ventilated Children
Authors: Ormsby Jennifer , Conrad Paula , Blumenthal Jennifer , Carpenter Jane , Jones Sarah , Sandora Thomas J. , Vaughan Ana , Vincuilla Julie , McAdam Alexander J. , Fogg Louis F. , Flett Kelly , Kelly Daniel P. 
Published: December 2020

Introduction:
There is no consensus definition for ventilator-associated tracheitis and limited evidence to guide diagnosis and treatment. To improve acute tracheitis evaluation and management, this quality improvement project aimed to (1) improve the appropriateness of tracheal aspirate cultures while decreasing the number of unnecessary cultures by 20% and (2) decrease antibiotic use for acute tracheitis not consistent with local guidelines by 20% over 12 months among pediatric patients requiring mechanical ventilation.

Methods:
All patients admitted to the Medical Intensive Care Unit requiring mechanical ventilation via an artificial airway were included. Tracheal aspirate sampling criteria, technique, and minimum intervals were standardized. Primary outcome measures were the number of tracheal aspirate cultures obtained per 100 ETT/tracheostomy days and ventilator-associated antibiotic days per 100 ETT/tracheostomy days. Improvement cycles included: Implementation of tracheal aspirate sampling criteria, sampling technique standardization, limiting repeat cultures to >72-hour intervals, and standardizing empiric antibiotic therapy.

Results:
Tracheal aspirate culture rate decreased from 10.70 to 7.10 cultures per 100 ETT/tracheostomy days (P < 0.001). Cultures meeting sampling criteria increased from 28% to 80%. Ventilator-associated antibiotic use decreased from 24.88 to 7.30 ventilator-associated antibiotic days per 100 ETT/tracheostomy days. There were no associated increases in ventilator-associated events or days of mechanical ventilation.

Conclusions:
Implementation of standardized criteria for tracheal aspirate sampling, improved tracheal aspirate sampling technique, limiting repeat tracheal aspirate cultures, and utilizing standardized antibiotic treatment guidelines safely decreased resource utilization and antibiotic use among critically ill children requiring mechanical ventilation.
Quality Improvement Methodology to Optimize Safe Early Mobility in a Pediatric Intensive Care Unit
Authors: Gupta Neha , Sones Amber , Powell Maegan , Robbins Johanna , Wilson Stephanie , Hill Amy , Thomas Christy , Ledbetter Sara , Schmidtke Anne Grace , Rutledge Chrystal , Hayes Leslie 
Published: December 2020

Introduction:
Utilization of robust quality improvement methodology in conjunction with traditional interventions to enhance an Early Mobility program (EMP) in a tertiary pediatric intensive care unit (PICU).

Methods:
EMP was implemented in our PICU in May 2017. The percentage of appropriate physical and occupational therapist consults were determined. We also evaluated the activity levels received by the patient and the levels for which they qualified based on their medical condition. Failure Modes and Effects Analysis (FMEA) was performed to identify potential complications related to the mobilization of critically ill children. We created 4 simulation scenarios based on FMEA prioritized results.

Results:
After the implementation of EMP, appropriate physical and occupational therapist consults significantly increased (P < 0.0001). However, most patients still failed to receive the optimal level of activity recommended by protocol. This failure was partly due to concern for safety events during mobilization. FMEA identified vital sign changes [Risk Priority Number (RPN) 97.8], staff injury (RPN 64), and pain/anxiety (RPN 60.5) as potential safety events. We performed various in-situ simulation sessions based on these potential events. In post-simulation evaluations, 100% of participants agreed that the simulation experience would improve their performance in the actual clinical setting. Feedback from simulations led to the development of an EM patient safety checklist and clinical pathway.

Conclusions:
We describe a novel technique of using FMEA to develop scenarios that simulate potential adverse events to optimize safe EM in PICU. An EM checklist and pathway can guide in the implementation of safe EMP.
Improving Preventive Care for Children With Sickle Cell Anemia: A Quality Improvement Initiative
Authors: Cabana Michael D. , Marsh Anne , Treadwell Marsha J. , Stemmler Peggy , Rowland Michael , Bender M. A. , Bhasin Neha , Chung Jong H. , Hassell Kathryn , Abdul Rashid N. F. Nik , Wong Trisha E. , Bardach Naomi S. 
Published: December 2020

Introduction:
Sickle cell disease is a complex chronic disorder associated with increased morbidity and early mortality. The Pediatric Quality Measures Program has developed new sickle cell-specific quality measures focused on hydroxyurea (HU) counseling and annual transcranial Doppler (TCD) screening; however, these measures have not been used in a clinical setting to inform quality improvement (QI) efforts.

Methods:
From 2017 to 2018, 9 sickle cell subspecialty clinics from the Pacific Sickle Cell Regional Collaborative conducted a year-long QI collaborative focused on improving the percentage of patients with HU counseling and TCD screening based on the new quality measures. After an initial kick-off meeting, the 9 sites participated in monthly conference calls. We used run charts annotated with plan-do-study-act cycle activities to track each site’s monthly progress and the overall mean percentage for the entire collaborative.

Results:
There was an overall improvement in the aggregate HU counseling from 85% to 98% (P < 0.01). For TCD screening, referral frequency changed from 85% to 90% (P = 0.76). For both measures, the variation in frequencies decreased over the year.

Conclusion:
Over 1 year, we found that a regional QI collaborative increased HU counseling. Although referral for TCD screening increased, there was no overall change in TCD completion. Overall, this QI report’s findings can help clinicians adopt and implement these quality measures to improve outcomes in children.
Brief Report: HIV Testing, Diagnosis of HIV Infection, Linkage to Medical Care, and Interview for Partner Services Among Transgender Persons—United States, 2012–2017
Authors: Mulatu Mesfin S. , Wang Guoshen , Song Wei , Keatley JoAnne , Kudon Hui Zhang , Wan Choi , Rao Shubha 
Published: December 2020

Background:
Transgender persons are at high risk for HIV infection. Testing is a key component of the national effort to end the HIV epidemic in the United States.

Setting:
Sixty-one local and state health departments and 150 community-based organizations funded by the Centers for Disease Control and Prevention to conduct HIV testing programs.

Methods:
We analyzed HIV testing data submitted to the Centers for Disease Control and Prevention by funded health departments and community-based organizations during 2012–2017. Descriptive analysis examined patterns of HIV testing and key outcomes (diagnosis of HIV infection, linkage to HIV medical care, and interview for partner services) among transgender persons. Multivariate robust Poisson regression was used to assess associations between HIV testing outcomes and demographic characteristics, census region, and test setting.

Results:
A total of 82,818 HIV tests were provided to transgender persons. Of these, 2280 (2.8%) transgender persons were diagnosed with HIV infection; 1556 (1.9%) received a new and 724 (0.9%) a previous diagnosis with HIV infection. The highest percentage of new HIV diagnosis was found among persons tested in correctional settings (4.6%), non-Hispanic Blacks (3.5%) and transgender women (2.4%). Among newly diagnosed persons, 85.0% were linked to HIV medical care ≤90 days after diagnosis and 63.5% were interviewed for partner services.

Conclusions:
HIV positivity was high, and the delivery of partner services was low, among transgender persons. HIV testing outcomes among transgender persons varied significantly by demographic characteristics and test setting. HIV prevention programs that are responsive to the needs of transgender persons may address gender-related disparities in HIV testing outcomes.
International Delphi Expert Consensus on Safe Return to Surgical and Endoscopic Practice
Authors: Asbun Horacio J. , Abu Hilal Mohammad , Kunzler Filipe , Asbun Domenech , Bonjer Jaap , Conlon Kevin , Demartines Nicolas , Feldman Liane S. , Morales-Conde Salvador , Pietrabissa Andrea , Pryor Aurora D. , Schlachta Christopher M. , Sylla Patricia , Targarona Eduardo M. , Agra Yolanda , Besselink Marc G. , Callery Mark , Cleary Sean P. , De La Cruz Luis , Eckert Philippe , Evans Chad , Han Ho-Seong , Jones Daniel B. , Gan Tong Joo , Koch Daniel , Lillemoe Keith D. , Lomanto Davide , Marks Jeffrey , Matthews Brent , Mellinger John , Melvin William Scott , Moreno-Paquentin Eduardo , Navarrete Claudio , Pawlik Timothy M. , Pessaux Patrick , Ricciardi Walter , Schwaitzberg Steven , Shah Paresh , Szokol Joseph , Talamini Mark , Torres Ricardo , Triboldi Alessandro , Udomsawaengsup Suthep , Valsecchi Federica , Vauthey Jean-Nicolas , Wallace Michael , Wexner Steven D. , Zinner Michael , Francis Nader 
Published: December 2020

Objective:
The aim of this work is to formulate recommendations based on global expert consensus to guide the surgical community on the safe resumption of surgical and endoscopic activities.

Background:
The COVID-19 pandemic has caused marked disruptions in the delivery of surgical care worldwide. A thoughtful, structured approach to resuming surgical services is necessary as the impact of COVID-19 becomes better controlled. The Coronavirus Global Surgical Collaborative sought to formulate, through rigorous scientific methodology, consensus-based recommendations in collaboration with a multidisciplinary group of international experts and policymakers.

Methods:
Recommendations were developed following a Delphi process. Domain topics were formulated and subsequently subdivided into questions pertinent to different aspects of surgical care in the COVID-19 crisis. Forty-four experts from 15 countries across 4 continents drafted statements based on the specific questions. Anonymous Delphi voting on the statements was performed in 2 rounds, as well as in a telepresence meeting.

Results:
One hundred statements were formulated across 10 domains. The statements addressed terminology, impact on procedural services, patient/staff safety, managing a backlog of surgeries, methods to restart and sustain surgical services, education, and research. Eighty-three of the statements were approved during the first round of Delphi voting, and 11 during the second round. A final telepresence meeting and discussion yielded acceptance of 5 other statements.

Conclusions:
The Delphi process resulted in 99 recommendations. These consensus statements provide expert guidance, based on scientific methodology, for the safe resumption of surgical activities during the COVID-19 pandemic.
Intraoperative Red Blood Cell Transfusion Decision-making
Authors: Baker Laura , Park Lily , Gilbert Richard , Ahn Hilalion , Martel Andre , Lenet Tori , Davis Alexandra , McIsaac Daniel I. , Tinmouth Alan , Fergusson Dean A. , Martel Guillaume 
Published: December 2020

Objectives:
The objective of this work was to carry out a systematic review of clinical practice guidelines (CPGs) pertaining to intraoperative red blood cell (RBC) transfusions, in terms of indications, decision-making, and supporting evidence base.

Summary of Background Data:
RBC transfusions are common during surgery and there is evidence of wide variability in practice.

Methods:
Major electronic databases (MEDLINE, EMBASE, and CINAHL), guideline clearinghouses and Google Scholar were systematically searched from inception to January 2019 for CPGs pertaining to indications for intraoperative RBC transfusion. Eligible guidelines were retrieved and their quality assessed using AGREE II. Relevant recommendations were abstracted and synthesized to allow for a comparison between guidelines.

Results:
Ten guidelines published between 1992 and 2018 provided indications for intraoperative transfusions. No guideline addressed intraoperative transfusion decision-making as its primary focus. Six guidelines provided criteria for transfusion based on hemoglobin (range 6.0–10.0 g/dL) or hematocrit (<30%) triggers. In the absence of objective transfusion rules, CPGs recommended considering other parameters such as blood loss (n = 7), signs of end organ ischemia (n = 5), and hemodynamics (n = 4). Evidence supporting intraoperative recommendations was extrapolated primarily from the nonoperative setting. There was wide variability in the quality of included guidelines based on AGREE II scores.

Conclusion:
This review has identified several clinical practice guidelines providing recommendations for intraoperative transfusion. The existing guidelines were noted to be highly variable in their recommendations and to lack a sufficient evidence base from the intraoperative setting. This represents a major knowledge gap in the literature.
Racial Differences in Isolated Aortic, Concomitant Aortoiliac, and Isolated Iliac Aneurysms
Authors: de Guerre Livia E.V.M. , Rice Jayne , Cheng Jane , Li Chun , Dansey Kirsten D. , Marcaccio Christina , Wang Grace J. , Hughes Kakra , van Herwaarden Joost A. , Schermerhorn Marc L. 
Published: December 2020

Objective:
Our aim was to describe the racial and ethnic differences in presentation, baseline and operative characteristics, and outcomes after aortoiliac aneurysm repair.

Summary of Background Data:
Previous studies have demonstrated racial and ethnic differences in prevalence of abdominal aortic aneurysms and showed more complex iliac anatomy in Asian patients.

Methods:
We identified all White, Black, Asian, and Hispanic patients undergoing aortoiliac aneurysm repair in the VQI from 2003 to 2019. We compared baseline comorbidities, operative characteristics, and perioperative outcomes by race and ethnicity.

Results:
In our 60,435 patient cohort, Black patients, followed by Asian patients, were most likely to undergo repair for aortoiliac (W:23%, B:38%, A:31%, H:22%, P < 0.001) and isolated iliac aneurysms (W:1.0%, B:3.1%, A:1.5%, H:1.6%, P < 0.001), and White and Hispanic patients were most likely to undergo isolated aortic aneurysm repair (W:76%, B:59%, A:68%, H:76%, P < 0.001). Black patients were more likely to undergo symptomatic repair and underwent rupture repair at a smaller aortic diameter. The iliac aneurysm diameter was largest in Black and Asian patients. Asian patients were most likely to have aortic neck angulation above 60 degree, graft oversizing above 20%, and completion endoleaks. Also, Asian patients were more likely to have a hypogastric artery aneurysm and to undergo hypogastric coiling.

Conclusion:
Asian and Black patients were more likely to undergo repair for aortoiliac and isolated iliac aneurysms compared to White and Hispanic patients who were more likely to undergo repair for isolated aortic aneurysms. Moreover, there were significant racial differences in the demographics and anatomic characteristics that could be used to inform operative approach and device development.
Smoking and SARS-CoV-2 Impair Dendritic Cells and Regulate DC-SIGN Expression in Tissues
Authors: Cai Guoshuai , Bossé Yohan , Du Mulong , Albrecht Helmut , Qin Fei , Yu Xuanxuan , Luo Xizhi , Androulakis Michelle , Zhu Xia , Zhou Jun , Cui Xiang , Yi Changhua , Cheng Chao , Nagarkatti Mitzi , Nagarkatti Prakash , Christiani David , Whitfield Michael , Amos Christopher , Xiao Feifei 
Published: December 2020

SummaryThe current spreading novel coronavirus SARS-CoV-2 is highly infectious and pathogenic. In this study, we screened the gene expression of three SARS-CoV-2 host receptors (ACE2, DC-SIGN and L-SIGN) and DC status in bulk and single cell transcriptomic datasets of upper airway, lung or blood of smokers, non-smokers and COVID-19 patients. We found smoking increased DC-SIGN gene expression and inhibited DC maturation and its ability of T cell stimulation. In COVID-19, DC-SIGN gene expression was interestingly decreased in lung DCs but increased in blood DCs. Strikingly, DCs shifted from cDCs to pDCs in COVID-19, but the shift was trapped in an immature stage (CD22+ or ANXA1+ DC) with MHCII downregulation in severe cases. This observation indicates that DCs in severe cases stimulate innate immune responses but fail to specifically recognize SARS-CoV-2. Our study provides insights into smoking effect on COVID-19 risk and the profound modulation of DC function in severe COVID-19.Graphical AbstractHighlightsSmoking upregulates the expression of ACE2 and CD209 and inhibits DC maturation in lungs. SARS-CoV-2 modulates the DCs proportion and CD209 expression differently in lung and blood.Severe infection is characterized by DCs less capable of maturation, antigen presentation and MHCII expression.DCs shift from cDCs to pDCs with SARS-CoV-2 infection but are trapped in an immature stage in severe cases.
Plasmodium falciparum genomic surveillance reveals spatial and temporal trends, association of genetic and physical distance, and household clustering
Authors: Sy Mouhamad , Deme Awa , Warren Joshua L. , Daniels Rachel F. , Dieye Baba , Ndiaye Pape Ibrahima , Diedhiou Younous , Mbaye Amadou Moctar , Volkman Sarah K. , Hartl Daniel L. , Wirth Dyann F. , Ndiaye Daouda , Bei Amy K. 
Published: December 2020

ABSTRACTMolecular epidemiology using genomic data can help identify relationships between malaria parasite population structure, malaria transmission intensity, and ultimately help generate actionable data to assess the effectiveness of malaria control strategies. Genomic data, coupled with geographic information systems data, can further identify clusters or hotspots of malaria transmission, parasite genetic and spatial connectivity, and parasite movement by human or mosquito mobility over time and space. In this study, we performed longitudinal genomic surveillance in a cohort of 70 participants over four years from different neighborhoods and households in Thiès, Senegal—a region of exceptionally low malaria transmission (entomological inoculation rate (EIR) less than 1). Genetic identity (identity by state) was established using a 24 single nucleotide polymorphism molecular barcode and a multivariable linear regression model was used to establish genetic and spatial relationships. Our results show clustering of genetically similar parasites within households and a decline in genetic similarity of parasites with increasing distance. One household showed extremely high diversity and warrants further investigation as to the source of these diverse genetic types. This study illustrates the utility of genomic data with traditional epidemiological approaches for surveillance and detection of trends and patterns in malaria transmission not only by neighborhood but also by household. This approach can be implemented regionally and countrywide to strengthen and support malaria control and elimination efforts.
“GrimAge,” an epigenetic predictor of mortality, is accelerated in Major Depressive Disorder
Authors: Protsenko Ekaterina , Yang Ruoting , Nier Brent , Reus Victor , Hammamieh Rasha , Rampersaud Ryan , Wu Gwyneth W. Y. , Hough Christina M. , Epel Elissa , Prather Aric , Jett Marti , Gautam Aarti , Mellon Synthia H. , Wolkowitz Owen M. 
Published: December 2020

AbstractMajor Depressive Disorder (MDD) is associated with premature mortality and is an independent risk factor for a broad range of diseases, especially those associated with aging, such as cardiovascular disease, diabetes, and Alzheimer’s Disease. However, the pathophysiology underlying increased rates of somatic disease in MDD remains unknown. It has been proposed that MDD represents a state of accelerated cellular aging, and several measures of cellular aging have been developed in recent years. Among such metrics, estimators of biological age based on predictable age-related patterns of DNA methylation (DNAm), so called ‘epigenetic clocks’, have shown particular promise for their ability to capture accelerated aging in psychiatric disease. The recently developed DNAm metric known as ‘GrimAge’ is unique in that it was trained on time-to-death data and has outperformed its predecessors in predicting both morbidity and mortality. Yet, GrimAge has not been investigated in MDD. Here we measured GrimAge in 49 somatically healthy unmedicated individuals with MDD and 60 age-matched healthy controls. We found that individuals with MDD exhibited significantly greater GrimAge relative to their chronological age (‘AgeAccelGrim’) compared to healthy controls (p=0.001), with a median of two years of excess cellular aging. This difference remained significant after controlling for sex, current smoking status and body-mass index (p=0.015). These findings are consistent with prior suggestions of accelerated cellular aging in MDD, but are the first to demonstrate this with an epigenetic metric predictive of premature mortality.
Staff to staff transmission as a driver of healthcare worker infections with COVID-19
Authors: Gordon Claire L , Trubiano Jason A , Holmes Natasha E , Chua Kyra YL , Feldman Jeff , Young Greg , Sherry Norelle L , Grayson M Lindsay , Kwong Jason C 
Published: December 2020

ABSTRACTObjectivesTo investigate the COVID-19 infections among staff at our institution and determine the interventions required to prevent subsequent staff infections.DesignRetrospective cohort studyParticipants and settingStaff working at a single tertiary referral hospital who returned a positive test result for SARS-CoV-2 between 25 January 2020 and 25 November 2020.Main outcome measuresSource of COVID-19 infection.ResultsOf 45 staff who returned a positive test result for SARS-CoV-2, 19 were determined to be acquired at Austin Health. Fifteen (15/19; 79% [95% CI: 54–94%]) of these were identified through contact tracing and testing following exposures to other infected staff and were presumed to be staff-staff transmission, including 10 healthcare workers (HCWs) linked to a single ward that cared for COVID-19 patients. Investigation of the outbreak identified the staff tearoom as the likely location for transmission, with subsequent reduction in HCW infections and resolution of the outbreak following implementation of enhanced control measures in tearoom facilities. No HCW contacts (0/204; 0% [95% CI: 0–2%]) developed COVID-19 infection following exposure to unrecognised patients with COVID-19.ConclusionsUnrecognised infections among staff may be a significant driver of HCW infections in healthcare settings. Control measures should be implemented to prevent acquisition from other staff as well as patient-staff transmission.