bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of a Europe‐wide Survey on Paediatric Nutrition Training
Authors: Broekaert Ilse J. , Jahnel Joerg , Moes Nicolette , van der Doef Hubert , Hojsak Iva , Tzivinikos Christos 
Published: February 2020

ABSTRACTCommissioned by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), we investigated how European physicians training in these fields are educated in nutrition. A survey on time spent in nutrition training, composition of multidisciplinary nutrition teams, and topics covered during training enrolled 50 participants. A median of 20% of training time was spent on nutrition training during fellowship. Fourteen (28%) had regular nutrition teaching. Thirty‐four (68%) were part of a multidisciplinary nutrition team. Twelve (24%) used the ESPGHAN syllabus. Most frequent topics during nutrition training were diagnosis/investigation of failure to thrive, indications/contraindications for enteral feeds, and benefits/risks of enteral/parenteral nutrition. Twenty‐seven (54%) had taken a formal nutrition course. Nutrition training in Europe varies and the ESPGHAN training syllabus is not yet implemented Europe‐wide. ESPGHAN nutrition summer schools, and Web‐based learning may provide appropriate training. We suggest that all patients necessitating nutritional care be treated by multidisciplinary nutrition teams.
Microbiologically Documented Bloodstream Infection in Children With Malignancies: A Single-center Experience
Authors: Tang Yue-Jia , Su Ying , Cao Qing , Gao Yi-Jin 
Published: February 2020

Background:
Bloodstream infection (BSI) remains a considerable cause of morbidity and mortality for cancer patients. With a better understanding of it, better methods can be used. The primary objective of this study was to describe the characteristics of BSIs in our institution, and the second was to determine the possible risk factors associated with them.

Materials and Methods:
Data of cancer patients from 2009 to 2015 at our institution were included. Medical information and blood cultures were analyzed to determine the BSI rate. The χ2 and Fisher exact tests were used for categorical data and to determine risk factors associated with BSIs and pathogens.

Results:
A total of 565 (8.6%) events were diagnosed with BSIs. Although Gram-negative bacteria (52.6%) were the most commonly isolated pathogens, Gram-positive microorganisms (45.0%) were also prevalent. Oral and gastrointestinal organisms were common. Pathogens were more likely to be identified in patients with central venous catheters and in patients with prolonged neutropenia (P<0.05).

Conclusions:
This study provides updated epidemiology in BSIs and helps with the prevention and management of suspected BSIs in vulnerable patients. Better anti-infection therapy could be provided to these patients based on the isolated pathogens.
Childhood Extracorporeal Membrane Oxygenation Survivors: Parents Highlight Need for Structured Follow-Up and Support After Hospital Discharge
Authors: Wray Jo , Kakat Suzan , Brown Katherine , O’Callaghan Maura , Thiruchelvam Timothy , Hoskote Aparna 
Published: February 2020

Objectives:
To examine parental experiences of childhood extracorporeal membrane oxygenation survivors to understand: 1) the problems children faced and 2) the support received following hospital discharge.

Design:
Single-center descriptive study.

Setting:
Nationally commissioned center for neonatal and pediatric extracorporeal membrane oxygenation.

Patients:
All traceable survivors less than 18 years old who received extracorporeal membrane oxygenation from January 1998 to April 2013.

Intervention:
Anonymized postal questionnaire completed by parents of extracorporeal membrane oxygenation survivors.

Measurements and Main Results:
Parent-reported developmental problems, follow-up, and the degree of satisfaction with any follow-up experience. Parents of 89 of 366 extracorporeal membrane oxygenation survivors (24%) responded. Sixty-six (74%) reported having developmental concerns about their child, including speech and language (n = 32; 36%), concentration (n = 28; 31%), movement/physical difficulties (n = 26; 29%), and educational difficulties (n = 22; 25%); 46 (52%) indicated that their child had difficulties across multiple domains. Twenty-one (34%) of those with one or more reported developmental concerns were not receiving any follow-up. However, 57 (64%) attended our 1-year follow-up extracorporeal membrane oxygenation clinic and 54 of 57 (95%) found it very useful. Three themes related to perceived need were identified from parents’ free-text comments: the need for an expert point of contact and follow-up at the extracorporeal membrane oxygenation center; more information on extracorporeal membrane oxygenation and any long-term effects; and more support from, and easier access to, community specialist services.

Conclusions:
A proportion of children who have undergone extracorporeal membrane oxygenation treatment have needs that are not being met, with variable access to service provision. Structured follow-up after discharge would enable early identification of developmental concerns, permit early referral or intervention, and provide support to families. Education and sharing of information about extracorporeal membrane oxygenation with general practitioners/family physicians, community professionals, and schools are essential.
Outcomes of Children Who Present to the Emergency Department After Hematopoietic Cell Transplantation
Authors: Bergmann Kelly R. , Orchard Paul J. , Roback Mark G. , Gaillard Philippe , Furnival Ronald A. 
Published: February 2020

Objectives
Our primary objective was to describe emergency department (ED) presentation, treatment, and outcomes for children after hematopoietic cell transplantation (HCT). Our secondary objective was to identify factors associated with serious infection in this population.

Methods
This is a retrospective review of HCT patients who presented to our university children's hospital ED from January 1, 2011, to June 30, 2013. Emergency department presentation, treatment, and outcomes were described. Descriptive statistics were used to compare children with definite serious infection with those without serious infection. Multiple binary logistic regression was performed for risk factors associated with definite serious infection.

Results
Fifty-four HCT patients (132 encounters) presented to our ED. Most were transplanted for a malignant (46%) or metabolic (36%) diagnosis and were recipients of bone marrow (51%) or umbilical cord blood (45%). Fever was the most common complaint (25%). Emergency department laboratory (64%) or imaging (58%) studies were frequently obtained. Admission was common (n = 70/132, 53%), with 79% (n = 55) of admissions to intensive care or bone marrow transplant units. Thirty-five encounters had definite serious infection, 5 had probable serious infection, and 92 had no serious infection. Fever (P < 0.001) and high-risk white blood cell (WBC) count of less than 5 or greater than 15 k/μL (P < 0.001) were associated with definite serious infection. Fever (odds ratio = 8.84, 95% confidence interval = 2.92–26.73) and high-risk WBC (odds ratio = 6.67, 95% confidence interval = 2.24–19.89) remained significantly associated with definite serious infection in our regression model.

Conclusions
Children presenting to the ED after HCT require extensive support and resources, with more than half requiring admission. Fever and high-risk WBC are associated with serious infection.
Physicians' Approach to Anaphylaxis in Childhood
Authors: Tuncel Tuba , Sancaklı Ozlem , Bag Ozlem , Cetin Hafize Selma , Özdoğru Emine Ece 
Published: February 2020

Objectives
Anaphylaxis is a life-threatening, severe, generalized, or systemic hypersensitivity reaction. The incidence of anaphylaxis is increasing especially in pediatric age. Our aim in this study was to investigate the knowledge and attitudes of the physicians on the diagnosis and treatment of anaphylaxis.

Methods
A questionnaire form consisting of a total of 18 questions was prepared. Six questions concerned demographic data; 7 questions inquired about physician's knowledge level about treatment of anaphylaxis. In the last part, 5 different case scenarios were given, and their diagnoses and treatments were asked.

Results
A total of 120 physicians participated in the study. Of the participants, 66.7% were residents. The rate of correct answer about dose of epinephrine was 57.5%. The rates of making correct diagnoses in anaphylaxis case scenarios 1, 2, and 3 were 60%, 73.3%, and 91.7%, respectively, whereas epinephrine administration rates were 54%, 67.5%, and 92.5%, respectively. When the answers of all these questions given by the residents and specialists and among physicians who updated and did not update were compared, there were no statistically significant differences except epinephrine administration rate and its route (P < 0.05).

Conclusions
The results of the current study suggest that physicians' knowledge levels were inadequate in making the diagnosis of anaphylaxis, and physicians use epinephrine in conditions without hypotension or an undefined possible/known allergen contact. Information about epinephrine administration was partially correct. It is currently considered to be the simplest measure to have a written anaphylaxis action plan including diagnostic criteria for anaphylaxis.
Racial Disparities in Anal Cancer Screening Among Men Living With HIV: Findings From a Clinical Cohort Study
Authors: Gillis Jennifer L. , Grennan Troy , Grewal Ramandip , Ogilvie Gina , Gaspar Mark , Grace Daniel , Lofters Aisha , Raboud Janet M. , Saarela Olli , Rosenes Ron , Salit Irving E. , Burchell Ann N. ,   the OHTN Cohort Study Team
Published: February 2020

Background:
Our objective was to quantify the extent of anal cancer screening among men receiving HIV specialty care in Ontario, Canada, and evaluate factors associated with screening.

Setting:
Cross-sectional questionnaire within a multisite clinical HIV cohort.

Methods:
A questionnaire assessing knowledge and experience with human papillomavirus–associated diseases and their prevention was administered in 2016–2017 to 1677 men in the Ontario HIV Treatment Network Cohort Study. We used logistic regression to identify factors associated with having discussed screening with a health care provider and self-reported receipt of screening [digital anal rectal examinations (DARE); anal cytology or anoscopy]. Results reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results:
Forty percent of men reported ever having had anal cytology/anoscopy, and 70% had ever had DARE. After accounting for differences in age, sexual orientation, years since HIV diagnosis, previous diagnosis with AIDS, knowing someone with human papillomavirus–associated cancer, comfort discussing anal health, education, and income, the proportion screened differed by self-identified race. Compared with white men, Asian men were less likely to have discussed screening with a health care provider (aOR = 0.48; 95% CI: 0.29 to 0.80) or to have been screened by DARE (aOR = 0.27; 95% CI: 0.17 to 0.44) or anal cytology/anoscopy (aOR = 0.51; 95% CI: 0.31 to 0.83), and African, Caribbean, or black men (aOR = 0.47; 95% CI: 0.31 to 0.70) were less likely to have had DARE. Results were consistent when restricting the analyses to gay, bisexual, and other men who have sex with men.

Conclusion:
Our findings highlight the potential for disparities in anal cancer screening that need to be considered when developing guidelines and screening programs to reduce the burden of anal cancer among men living with HIV and ensure health equity.
Creating Options for Difficult-to-match Kidney Transplant Candidates
Authors: de Klerk Marry , Kal-van Gestel Judith A. , van de Wetering Jacqueline , Kho Marcia L. , Middel-de Sterke Sandra , Betjes Michiel G.H. , Zuidema Willij C. , Roelen Dave , Glorie Kristiaan , Roodnat Joke I. 
Published: February 2020

Background.
Most transplantation centers recognize a small patient population that unsuccessfully participates in all available, both living and deceased donor, transplantation programs for many years: the difficult-to-match patients. This population consists of highly immunized and/or ABO blood group O or B patients.

Methods.
To improve their chances, Computerized Integration of Alternative Transplantation programs (CIAT) were developed to integrate kidney paired donation, altruistic/unspecified donation, and ABO and HLA desensitization. To compare CIAT with reality, a simulation was performed, including all patients, donors, and pairs who participated in our programs in 2015–2016. Criteria for inclusion as difficult-to-match, selected-highly immunized (sHI) patient were as follows: virtual panel reactive antibody >85% and participating for 2 years in Eurotransplant Acceptable Mismatch program. sHI patients were given priority, and ABO blood group incompatible (ABOi) and/or HLA incompatible (HLAi) matching with donor-specific antigen–mean fluorescence intensity (MFI) <8000 were allowed. For long-waiting blood group O or B patients, ABOi matches were allowed.

Results.
In reality, 90 alternative program transplantations were carried out: 73 compatible, 16 ABOi, and 1 both ABOi and HLAi combination. Simulation with CIAT resulted in 95 hypothetical transplantations: 83 compatible (including 1 sHI) and 5 ABOi combinations. Eight sHI patients were matched: 1 compatible, 6 HLAi with donor-specific antigen-MFI <8000 (1 also ABOi), and 1 ABOi match. Six/eight combinations for sHI patients were complement-dependent cytotoxicity cross-match negative.

Conclusions.
CIAT led to 8 times more matches for difficult-to-match sHI patients. This offers them better chances because of a more favorable MFI profile against the new donor. Besides, more ABO compatible matches were found for ABOi couples, while total number of transplantations was not hampered. Prioritizing difficult-to-match patients improves their chances without affecting the chances of regular patients.
Olanzapine-Associated Pisa Syndrome in an Autistic Adolescent
Authors: Guler Hasan Ali , Turkoglu Serhat , Cetin Fatih Hilmi , Ucar Halit Necmi , Erdogan Yakup 
Published: February 2020

Objectives
The objective of this study is to report a case of Pisa syndrome due to olanzapine use in an autistic adolescent.

Methods
The patient was a 12-year-old adolescent girl who was taking olanzapine for autism-related behavioral problems. Abnormal posture and balance problems appeared in the third month of olanzapine treatment. The patient was diagnosed as having Pisa syndrome after clinical evaluation. Biperiden was started on the patient whose complaints continued despite olanzapine treatment was stopped. Patient's complaints regressed with biperiden treatment.

Results
According to our knowledge, there is no an autistic adolescent case of Pisa syndrome previously reported in the literature. Further studies are needed to clarify the etiology and treatment of Pisa syndrome.

Conclusions
In patients with balance problems and abnormal posture as a result of olanzapine use, the clinician should keep in mind Pisa syndrome.
Stocktaking the environmental coverage of a continental ecosystem observation network
Authors: Guerin Greg R. , Williams Kristen J. , Sparrow Ben , Lowe Andrew J. 
Published: February 2020

AbstractField-based sampling of terrestrial habitats at continental scales is required to build ecosystem observation networks. However, a key challenge for detecting change in ecosystem composition, structure and function is to obtain a representative sample of habitats. Representative sampling contributes to ecological validity when analysing large spatial surveys, but field resources are limited and representativeness may differ markedly from purely practical sampling strategies to statistically rigorous ones. Here, we report a post hoc assessment of the coverage of environmental gradients as a surrogate for ecological coverage by a continental-scale survey of the Australian Terrestrial Ecosystem Research Network (TERN). TERN’s surveillance program maintains a network of ecosystem observation plots that were init ially established in the rangelands through a stratification method (clustering of bioregions by environment) and Ausplots methodology. Subsequent site selection comprised gap filling combined with opportunistic sampling. Firstly, we confirmed that environmental coverage has been a good surrogate for ecological coverage. The cumulative sampling of environments and plant species composition over time were strongly correlated (based on mean multivariate dispersion; r = 0.93). We then compared the environmental sampling of Ausplots to 100,000 background points and a set of retrospective (virtual) sampling schemes: systematic grid, simple random, stratified random, and generalised random-tessellation stratified (GRTS). Differences were assessed according to sampling densities along environmental gradients, and multivariate dispersion (environmental space represented via multi-dimensional scaling). Ausplots outperformed systematic grid, simple random and GRTS in coverage of environmental space (Tukey HSD of mean dispersion, p < .001). GRTS site selection obtained similar coverage to Ausplots when employing the same bioregional stratification. Stratification by climatic zones generated the highest environmental coverage (p < .001), but the resulting sampling densities over-represented mesic coastal habitats. The Ausplots stratification by bioregions implemented under practical constraints represented complex environments well compared to statistically oriented or spatially even samples. However, potential statistical inference and power also depend on spatial and temporal replication, unbiased site selection, and accurate field measurements relative to the magnitude of change. A key conclusion is that environmental, rather than spatial, stratification is required to maximise ecological coverage across continental ecosystem observation networks.
Prognostic significance ofSOCS1andSOCS3tumor suppressors in hepatocellular carcinoma and its correlation to key oncogenic signaling pathways
Authors: Khan Md Gulam Musawwir , Ghosh Amit , Varia Bhavesh , Santharam Madanraj Appiya , Ihsan Awais Ullah , Ramanathan Sheela , Ilangumaran Subburaj 
Published: February 2020

AbstractSuppressor of cytokine signaling (SOCS) proteins SOCS1 and SOCS3 are considered tumor suppressors in liver hepatocellular carcinoma (LIHC). To gain insight into the underlying molecular mechanisms, the expression ofSOCS1/ SOCS3was evaluated in The Cancer Genome Atlas LIHC dataset along with key oncogenic signaling pathway genes.SOCS1expression was not significantly reduced in HCC yet higher expression predicted favorable prognosis, whereasSOCS3lacked predictive potential despite lower expression. Only a small proportion of the cell cycle, receptor tyrosine kinase, growth factor and RAS-RAF-MEK-MAPK signaling genes negatively correlated withSOCS1orSOCS3, of which even fewer showed elevated expression in HCC and predicted survival. However, many PI3K-AKT-MTOR pathway genes showed mutual exclusivity withSOCS1/SOCS3and displayed independent predictive ability. Among genes that negatively correlated withSOCS1/SOCS3, CDK2, MLST8, AURKA, MAP3K4andRPTORshowed corresponding modulations in the livers of mice lackingSocs1orSocs3during liver regeneration and in experimental HCC, and in Hepa1-6 murine HCC cells overexpressing SOCS1/SOCS3. However, Cox proportional hazards model identifiedCXCL8, DAB2andPIK3R1as highly predictive in combination withSOCS1orSOCS3. These data suggest that developing prognostic biomarkers and precision treatment strategies based onSOCS1/SOCS3expression need careful testing in different patient cohorts.
Estimating indirect parental genetic effects on offspring phenotypes using virtual parental genotypes derived from sibling and half sibling pairs
Authors: Hwang Liang-Dar , Tubbs Justin D , Luong Justin , Lundberg Mischa , Moen Gunn-Helen , Sham Pak C , Cuellar-Partida Gabriel , Evans David M 
Published: February 2020

AbstractIndirect parental genetic effects may be defined as the influence of parental genotypes on offspring phenotypes over and above that which results from the transmission of genes from parents to children. However, given the relative paucity of large-scale family-based cohorts around the world, it is difficult to demonstrate parental genetic effects on human traits, particularly at individual loci. In this manuscript, we illustrate how parental genetic effects on offspring phenotypes, including late onset diseases, can be estimated at individual loci in principle using large-scale genome-wide association study (GWAS) data, even in the absence of parental genotypes. Our strategy involves creating “virtual” mothers and fathers by estimating the genotypic dosages of parental genotypes using physically genotyped data from relative pairs. We then utilize the expected dosages of the parents, and the actual genotypes of the offspring relative pairs, to perform conditional genetic association analyses to obtain asymptotically unbiased estimates of maternal, paternal and offspring genetic effects. We develop a freely available web application that quantifies the power of our approach using closed form asymptotic solutions. We implement our methods in a user-friendly software packageIMPISH(IMputingParental genotypesInSiblings andHalf-Siblings) which allows users to quickly and efficiently impute parental genotypes across the genome in large genome-wide datasets, and then use these estimated dosages in downstream linear mixed model association analyses. We conclude that imputing parental genotypes from relative pairs may provide a useful adjunct to existing large-scale genetic studies of parents and their offspring.
A statistical modelling reveals bi-directional chromatin scanning by RAG in the human TCR-α locus
Authors: O’Connor Ciarán , McNamara Deirdre , Nakagome Shigeki 
Published: February 2020

AbstractRearrangements of germline variable (V), diversity (D), and joining (J) coding gene segments generate a diverse T cell receptor (TCR) repertoire. Two different molecular mechanisms govern a stochastic nature of gene choices by the recombination activating gene (RAG) protein complex. One is diffusion access in which a chromatin loop containing a coding gene bounces back and forth until the loop encounters a distant gene. The other is a linear chromatin scan, which extrudes chromatin loops to assemble a gene pair in a distance-dependent manner. However, the extent to which those two mechanisms underlie V(D)J recombination in human TCRs still remains unclear. Applying statistical modelling to TCR sequence data, we infer the stochastic process of gene choices during this recombination. The inferred usage of V and J gene segments vary from gene to gene. This pattern of gene usage is consistent across individuals, suggesting a fundamental bias in the gene choice. Our modelling shows the dependency of VJ pairing on their linear distance in the TCR-α locus; proximal-proximal and distal-distal VJ pairs are more preferred than proximal-distal or distal-proximal gene pairs. These results support bi-directional RAG scanning into proximal and distal sides of the TCR-α V gene locus.