bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geometric Profiling of Corneal Limbal Dermoids for the Prediction of Surgical Outcomes
Authors: Kim Kyoung Woo , Kim Mee Kum , Khwarg Sang In , Oh Joo Youn 
Published: July 2020

Purpose:
To search for novel geometric parameters for corneal limbal dermoids that enable the prediction of clinical and surgical outcomes.

Methods:
We reviewed the medical records and anterior segment photographs of 85 eyes of 85 patients with corneal limbal dermoids that had been surgically excised. Patients were assigned to the following 4 cohorts (multiple assignments allowed): postoperative visual acuity (cohort 1, n = 65), amblyopia (cohort 2, n = 67), postoperative scar formation (cohort 3, n = 51), and preoperative spontaneous progression of dermoids (cohort 4, n = 39). For geometric profiling, 11 geometric parameters of lesions, including orientation, angular width, and 9 ratio parameters, were preoperatively defined in each patient based on the digital anterior-segment photographs. Each geometric parameter and demographic variable were analyzed for correlation with postoperative outcomes (cohorts 1–3) and preoperative spontaneous dermoid progression (cohort 4).

Results:
The mean patient age at surgery was 6.0 ± 6.3 years. Among the geometric and demographic parameters analyzed, the invaded angular axis of dermoid to corneal diameter ratio had the highest r coefficient (r = 0.728) in cohort 1 and best stratified patients in cohort 2 (cutoff > 0.48) and cohort 3 (cutoff > 0.56). No parameters were correlated with spontaneous dermoid progression in cohort 4.

Conclusions:
We devised geometric parameters to evaluate corneal limbal dermoids before surgery for the prediction of surgical outcomes. The invaded angular axis of dermoid to corneal diameter ratio value was the most significant factor associated with postoperative visual acuity, amblyopia development, and postoperative scarring.
A Patient With Bilateral Conjunctivitis Positive for SARS-CoV-2 RNA in a Conjunctival Sample
Authors: Sirakaya Ender , Sahiner Mustafa , Aslan Sirakaya Hatice 
Published: July 2020

Purpose:
To present a patient with bilateral conjunctivitis, testing positive for viral RNA of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in both nasopharyngeal and conjunctival samples.

Methods:
A 40-year-old man with bilateral acute conjunctivitis and suspicious signs of coronavirus disease 2019 (COVID-19) presented to the hospital. A detailed ophthalmic examination was performed. Samples obtained from conjunctival and nasopharyngeal swabs were tested by reverse transcription PCR (RT-PCR) for the detection of SARS-CoV-2 virus. Ocular findings and duration of the presence of viral RNA in the conjunctival specimens were evaluated at follow-up visits.

Results:
Slit-lamp biomicroscopy revealed bilateral acute follicular conjunctivitis. The RT-PCR assay demonstrated the presence of viral RNA in the nasopharyngeal and conjunctival specimens at the initial visit and at the 4-day follow-up. Conjunctivitis findings were decreased after 4 days and recovered completely without any sequelae within10 days. The PCR results of both nasopharyngeal and conjunctiva specimens were negative for the viral RNA at 10 days.

Conclusions:
Bilateral conjunctivitis is rare in patients infected with COVID-19. Although it is difficult to detect viral RNA from conjunctival swabs, conjunctival secretions may be a source of contamination, and protective measures must be taken.
Understanding the relationship between features associated with pain-related disability in people with painful temporomandibular disorder: an exploratory structural equation modeling approach
Authors: Miller Vanessa E. , Chen Ding-Geng , Barrett Deborah , Poole Charles , Golightly Yvonne M. , Sanders Anne E. , Ohrbach Richard , Greenspan Joel D. , Fillingim Roger B. , Slade Gary D. 
Published: July 2020

Abstract
Pain-related disability is a multifaceted construct that refers to the impact of pain on an individual's capacity to fulfill their self-defined and social roles. This research examined the relationship between clinical, psychological, and pain sensitivity factors and pain-related disability among adults with chronic temporomandibular disorder (TMD). We analyzed data from a cross-sectional community-based sample of 1088 men and women with chronic TMD. We first constructed and tested a measure of pain-related disability (ie, pain impact), including a variable assessing presenteeism, created measurement models of jaw limitation, psychological unease (negative affect, somatic symptoms, and catastrophizing), and experimental pain sensitivity (eg, pressure pain threshold, thermal tolerance, and mechanical pressure pain threshold). Subsequently, latent variables were combined in a structural equation model. Participants (n = 1088) were 18 to 44 years old (mean 29.2, SD ± 7.8) whose chronic TMD had persisted, on average, for 6.9 years (SD ± 6.4). A model of pain-related disability, jaw limitation, and psychological unease was created and refined with exploratory model revisions to account for correlation among variables. Estimation of the final model indicated excellent fit with the data (root-mean-square error of approximation = 0.048, root-mean-square error of approximation 90% confidence interval [CI] 0.043-0.053, comparative fit index = 0.956, standardized root-mean-square residual = 0.040). Jaw functional limitation and psychological unease was strongly related to pain-related disability. Experimental pain sensitivity was removed from our model because of weak direct effect and the burden of performing experimental pain sensitivity testing in a clinical setting. The final model explained 78% of the variance in pain-related disability.
Patient Length of Stay Under the Two-Midnight Rule: Assessing the Accuracy of Providers’ Predictions
Authors: Lindor Rachel A. , Bellolio Fernanda , Madsen Bo E. , Newman James S. , Lohse Christine M. , Jeffery Molly M. , Boon Ashton L. , Goyal Deepi G. , Sadosty Annie T. 
Published: July 2020

EXECUTIVE SUMMARY
We sought to determine emergency medicine physicians’ accuracy in designating patients’ disposition status as “inpatient” or “observation” at the time of hospital admission in the context of Medicare’s Two-Midnight rule and to identify characteristics that may improve the providers’ predictions. We conducted a 90-day observational study of emergency department (ED) admissions involving adults aged 65 years and older and assessed the accuracy of physicians’ disposition decisions. Logistic regression models were fit to explore associations and predictors of disposition. A total of 2,257 patients 65 and older were admitted through the ED. The overall error rate in physician designation of observation or inpatient was 36%. Diagnoses most strongly associated with stays lasting less than two midnights included diverticulitis, syncope, and nonspecific chest pain. Diagnoses most strongly associated with stays lasting two or more midnights included orthopedic fractures, biliary tract disease, and back pain. ED physicians inaccurately predicted patient length of stay in more than one third of all patients. Under the Two-Midnight rule, these inaccurate predictions place hospitals at risk of underpayment and patients at risk of significant financial liability. Further work is needed to increase providers’ awareness of the financial repercussions of their admission designations and to identify interventions that can improve prediction accuracy.
Using Technology to Combat Clinician Burnout
Authors: Davis Matthew J. 
Published: July 2020

EXECUTIVE SUMMARY
Physician burnout is a major problem affecting healthcare providers. It not only influences clinician mental health but also clinical outcomes, patient satisfaction, and the financial standing of a health system. A combination of web and mobile applications can be used to treat clinician burnout by effectively reducing stress, anxiety, and depression. When included in a well-structured program, these technology-based tools provide improved access to mental health treatments for clinicians, help remove the stigma of therapy, and reduce clinician burnout caused by job stressors.
Fire Service Organizational-Level Characteristics Are Associated With Adherence to Contamination Control Practices in Florida Fire Departments
Authors: Louzado-Feliciano Paola , Griffin Kevin A. , Santiago Katerina M. , Schaefer Solle Natasha , Koru-Sengul Tulay , Grant Casey , Niemczyk Neal , Lee David J. , Kobetz Erin N. , Caban-Martinez Alberto J. 
Published: July 2020

Objectives:
To characterize the types of contamination control practices followed by Florida fire departments and examine the association between fire department organizational-level characteristics and adherence to contamination control practices.

Methods:
Using a cross-sectional study design, a survey was administered to 142 Florida firefighters. Validated survey measures assessed organizational level characteristics and 32 recommended national contamination control practices.

Results:
An average of 18.9 contamination control practices (standard deviation = 5.54; min = 3; max = 30) were reported by fire departments of which, wearing personal protective equipment (PPE) according to manufacturer instructions (98.9%) and access to special machine for cleaning (91%) were most cited. Fire departments with one or more health and safety officers had significantly higher implementation of contamination control practices (P = 0.032).

Conclusion:
Health and safety officers may have a positive impact on the number of contamination control practices followed in Florida fire departments.
Vedolizumab Trough Levels in Children With Anti‐Tumor Necrosis Factor Refractory Inflammatory Bowel Disease
Authors: Aardoom Martine A. , Jongsma Maria M.E. , de Vries Annick , Wolthoorn Jasja , de Ridder Lissy , Escher Johanna C. 
Published: July 2020

ABSTRACTObjectives:Inflammatory bowel disease (IBD) can be successfully treated with vedolizumab. Studies in adult IBD patients have shown that differences in response to vedolizumab may be related to variability in vedolizumab trough levels, but in children with pediatric‐onset IBD data regarding vedolizumab trough levels are not available. Thus far, the role of trough levels in pediatric‐onset IBD treatment remains unclear. We aimed to investigate predictors of vedolizumab trough levels in pediatric‐onset IBD patients.Methods:Data from anti‐tumor necrosis factor refractory pediatric‐onset IBD patients who received vedolizumab were collected retrospectively. Vedolizumab trough levels were measured in serum samples collected before each infusion. A linear mixed model was conducted to analyze factors that influence trough levels.Results:Twenty‐six pediatric‐onset IBD patients (14 ulcerative colitis [UC]), 9 Crohn Disease [CD], 3 IBD‐unclassified [IBD‐U]) received 258 vedolizumab infusions. Mean vedolizumab trough level at week 6 was 29.9 μg/mL (SD 17.8), and 11.5 μg/mL (SD 4.9) during maintenance therapy. CD patients had significantly lower trough levels than IBD‐U patients (β 15.2; 95% confidence interval [CI] −1.1 to 29.2; P = 0.036). Higher fecal calprotectin (β −0.009; 95% CI −0.02 to −0.003; P = 0.007) and C‐reactive protein levels (β −0.4; 95% CI −0.72 to −0.04; P = 0.027) were associated with lower trough levels, whereas shortening of time between infusions led to higher trough levels (β −0.77; 95% CI −0.9 to 0.64; P < 0.001).Conclusions:In this group of pediatric‐onset IBD patients, trough levels were significantly lower in CD patients compared with UC/IBD‐U patients. Higher levels of inflammatory markers were associated with lower vedolizumab trough levels.
Intervention and Mechanisms of Alanyl‐glutamine for Inflammation, Nutrition, and Enteropathy
Authors: Moore Sean R. , Quinn Laura A. , Maier Elizabeth A. , Guedes Marjorie M. , Quetz Josiane S. , Perry Madeline , Ramprasad Chethan , Lanzarini Lopes Gabriela M.L. , Mayneris‐Perxachs Jordi , Swann Jonathan , Soares Alberto M. , Filho José Q. , Junior Francisco S. , Havt Alexandre , Lima Noelia L. , Guerrant Richard L. , Lima Aldo A.M. 
Published: July 2020

ABSTRACTObjective:Determine the minimum dosage of alanyl‐glutamine (Ala‐Gln) required to improve gut integrity and growth in children at risk of environmental enteropathy (EE).Methods:This was a double‐blinded randomized placebo‐controlled dose‐response trial. We enrolled 140 children residing in a low‐income community in Fortaleza, Brazil. Participants were 2 to 60 months old and had weight‐for‐age (WAZ), height‐for‐age (HAZ), or weight‐for‐height (WHZ) z‐scores less than −1. We randomized children to 10 days of nutritional supplementation: Ala‐Gln at 3 g/day, Ala‐Gln at 6 g/day, Ala‐Gln at 12 g/day, or an isonitrogenous dose of glycine (Gly) placebo at 12.5 g/day. Our primary outcome was urinary lactulose‐mannitol excretion testing. Secondary outcomes were anthropometry, fecal markers of inflammation, urine metabolic profiles, and malabsorption (spot fecal energy).Results:Of 140 children, 103 completed 120 days of follow‐up (24% dropout). In the group receiving the highest dose of Ala‐Gln, we detected a modest improvement in urinary lactulose excretion from 0.19% on day 1 to 0.17% on day 10 (P = 0.05). We observed significant but transient improvements in WHZ at day 10 in 2 Ala‐Gln groups, and in WHZ and WAZ in all Ala‐Gln groups at day 30. We detected no effects on fecal inflammatory markers, diarrheal morbidity, or urine metabolic profiles; but did observe modest reductions in fecal energy and fecal lactoferrin in participants receiving Ala‐Gln.Conclusions:Intermediate dose Ala‐Gln promotes short‐term improvement in gut integrity and ponderal growth in children at risk of EE. Lower doses produced improvements in ponderal growth in the absence of enhanced gut integrity.
Rapid Increase in Clearance of Phenobarbital in Neonates on Extracorporeal Membrane Oxygenation: A Pilot Retrospective Population Pharmacokinetic Analysis
Authors: Michaličková Danica , Pokorná Pavla , Tibboel Dick , Slanař Ondřej , Knibbe Catherijne A. J. , Krekels Elke H. J. 
Published: July 2020

Objectives:
This study characterizes the changes in the pharmacokinetics of phenobarbital associated with extracorporeal membrane oxygenation treatment in neonates, to illustrate our findings and provide guidance on dosing.

Design:
Retrospective pilot population pharmacokinetic analysis.

Setting:
Neonatal ICU.

Patients:
Thirteen critically ill neonates (birth body weight, 3.21 kg [2.65–3.72 kg]; postnatal age at start of treatment: 2 d [0–7 d]; gestational age: 38 wk [38–41 wk]) receiving venovenous or venoarterial extracorporeal membrane oxygenation.

Interventions:
Phenobarbital administered in a loading dose of 7.5 mg/kg (8.5–16 mg/kg) and maintenance dose of 6.9 mg/kg/d (4.5–8.5 mg/kg/d).

Measurements and Main Results:
Therapeutic drug monitoring data were available, yielding 5, 31, and 19 phenobarbital concentrations before, during, and after extracorporeal membrane oxygenation, respectively. Population pharmacokinetic analysis was performed using NONMEM 7.3.0 (ICON Development Solutions, Ellicott City, MD). Maturation functions for clearance and volume of distribution were obtained from literature. In a one-compartment model, clearance and volume of distribution for a typical neonate off extracorporeal membrane oxygenation and with a median birth body weight (3.21 kg) at median postnatal age (2 d) were 0.0096 L/hr (relative se = 11%)) and 2.72 L (16%), respectively. During extracorporeal membrane oxygenation, clearance was found to linearly increase with time. Upon decannulation, phenobarbital clearance initially decreased and subsequently increased slowly driven by maturation. Extracorporeal membrane oxygenation-related changes in volume of distribution could not be identified, possibly due to sparse data collection shortly after extracorporeal membrane oxygenation start. According to the model, target attainment is achieved in the first 12 days of extracorporeal membrane oxygenation with a regimen of a loading dose of 20 mg/kg and a maintenance dose of 4 mg/kg/d divided in two doses with an increase of 0.25 mg/kg every 12 hours during extracorporeal membrane oxygenation treatment.

Conclusions:
We found a time-dependent increase in phenobarbital clearance during the first 12 days of extracorporeal membrane oxygenation treatment in neonates, which results in continuously decreasing phenobarbital exposure and increases the risk of therapeutic failure over time. Due to high unexplained variability, frequent and repeated therapeutic drug monitoring should be considered even with the model-derived regimen.
Prediction of Acquired Morbidity Using Illness Severity Indices in Pediatric Intensive Care Patients*
Authors: Senna Stephanie , Ong Chengsi , Wong Judith Ju-Ming , Allen John Carson , Sultana Rehena , Lee Jan Hau 
Published: July 2020

Objectives:
To assess the ability of two illness severity scores, Pediatric Logistic Organ Dysfunction Score 2 and Pediatric Index of Mortality 3, in predicting PICU-acquired morbidity.

Design:
Retrospective chart review conducted from April 2015 to March 2016.

Setting:
Single-center study in a multidisciplinary PICU in a tertiary pediatric hospital in Singapore.

Patients:
The study included all index admissions of patients 0–18 years old to the PICU during the study period.

Interventions:
None.

Measurements and Main Results:
Three outcomes were assessed at hospital discharge: mortality, survival with new morbidity defined as an increase in the Functional Status Scale score of greater than or equal to 3 points from baseline, and survival without morbidity. Of 577 consecutive admissions, 95 were excluded: 82 readmissions, 10 patients greater than or equal to 18 years old, two patients with missing baseline data, and one transferred to another PICU. Of 482 patients, there were 37 hospital deaths (7.7%) and 39 (8.1%) with acquired new morbidity. Median admission Pediatric Logistic Organ Dysfunction Score 2 and Pediatric Index of Mortality 3 scores differed among the three outcome groups. In addition, differences were found in emergency admission and neurologic diagnosis rates, PICU mechanical ventilation usage rates, and PICU length of stay. The highest proportion of neurologic diagnoses was observed in the new morbidity group. The final model simultaneously predicted risks of mortality, survival with new morbidity and survival without morbidity using admission Pediatric Logistic Organ Dysfunction Score 2 score, admission type, neurologic diagnosis, and preexisting chronic disease. Pediatric Logistic Organ Dysfunction Score 2 was superior to Pediatric Index of Mortality 3 in predicting risks of mortality and new morbidity, as indicated by volume under surface values of 0.483 and 0.362, respectively.

Conclusions:
Risk of mortality, survival with new morbidity, and survival without morbidity can be predicted simultaneously using admission Pediatric Logistic Organ Dysfunction Score 2, admission type, admission diagnosis, and preexisting chronic disease. Future independent studies will be required to validate the proposed model before clinical implementation.
What is new with hand hygiene?
Authors: Stadler Rahel Noemi , Tschudin-Sutter Sarah 
Published: July 2020

Purpose of review
Healthcare-associated infections (HAIs) challenge healthcare systems worldwide. As healthcare workers’ hands are considered the main vector for transmission of pathogens, effective hand hygiene is the single most important action to prevent HAIs. We sought to highlight new developments and advances in hand hygiene.

Recent findings
Hand hygiene compliance averages at 38%. A sustained increase of compliance with a subsequent decrease of HAIs may be achieved by national, systematic and rigorous education, and auditing programs. Periodically deployed self-operating hand hygiene surveillance systems coupled with personalized reminders could facilitate such efforts. Alcohol-based hand-rub (ABHR) solutions remain the hand hygiene gold standard, but are modified in texture and composition to better meet healthcare workers’ preferences. Modifications of the hand hygiene procedure have been proposed targeting both time and technique of hand rub application. Reducing rub-time from 30 to 15 s and simplifying the technique to consist of three rather than six steps yielded encouraging results in terms of microbiological efficacy and higher compliance.

Summary
Implementation and promotion of compliance are the major concerns of today's research on hand hygiene. Developments towards better surveillance and systematic education, improved ABHR formulation and streamlining of hand hygiene actions are paving the way ahead.
Long-Term Patient-Reported Outcomes of Visual Field Defects and Compensatory Mechanisms in Patients After Cerebral Hemispherectomy
Authors: Meer Elana A. , Chen Monica F. , Jones Monika , Mathern Gary W. , Pineles Stacy L. 
Published: July 2020

Background:
In cases of intractable epilepsy resistant to drug therapy, hemispherectomy is often the only treatment option to mitigate seizures; however, the true long-term subjective visual outcomes are relatively unexplored. In this study, we sought to determine and characterize patient-reported visual function years after hemispherectomy.

Methods:
This was an observational study conducted on a large cohort of children with seizure disorder treated with cerebral hemispherectomy. An online survey was sent to parents with questions to assess subjective visual function with a variety of questions from presence of visual field defects after hemispherectomy, to improvement over time, compensatory mechanisms used, and development of strabismus.

Results:
This survey was emailed to 248 parents of previously evaluated children who agreed to be re-surveyed, 48 (20%) of which responded. The average age at hemispherectomy was approximately 5 (±4) years, and the average time after hemispherectomy was 7 (±5) years. Thirty-nine patients (81%) were seizure-free after 1 surgery and 85% (n = 41) were seizure-free after ≥1 surgeries. Thirty-four (71%) experienced a visual field defect after surgery, but 25 (52%) experienced subjective improvement over time. Thirty-eight (79%) used compensatory mechanisms, such as head tilting, with 16 (33%) patients experiencing subjective improvement over time. Twenty-seven (56%) patients experienced a decrease in visual acuity after surgery with 12 (25%) experiencing subjective improvement over time.

Conclusion:
In a large cohort examining patient-reported visual outcomes years after hemispherectomy, most patients experienced strabismus and/or visual field defects. However, more than half reported improvements and compensatory mechanisms (exotropic strabismus and ipsilateral esotropic strabismus) over time, presumably to enhance visual field function. By exploring subjective visual and cognitive function, this paper uniquely characterizes patient-reported improvements over time, and provides motivation for larger longitudinal studies using more quantitative measures of visual function and improvement after hemispherectomy.