bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anatomical and Functional Consequences of Microneedle Perforation of Round Window Membrane
Authors: Yu Michelle , Arteaga Daniel N. , Aksit Aykut , Chiang Harry , Olson Elizabeth S. , Kysar Jeffrey W. , Lalwani Anil K. 
Published: November 2019

Hypothesis:
Microneedles can create microperforations in the round window membrane (RWM) without causing anatomic or physiologic damage.

Background:
Reliable delivery of agents into the inner ear for therapeutic and diagnostic purposes remains a challenge. Our novel approach employs microneedles to facilitate intracochlear access via the RWM. This study investigates the anatomical and functional consequences of microneedle perforations in guinea pig RWMs in vivo.

Methods:
Single three-dimensional-printed, 100 μm diameter microneedles were used to perforate the guinea pig RWM via the postauricular sulcus. Hearing was assessed both before and after microneedle perforation using compound action potential and distortion product otoacoustic emissions. Confocal microscopy was used ex vivo to examine harvested RWMs, measuring the size, shape, and location of perforations and documenting healing at 0 hours (n = 7), 24 hours (n = 6), 48 hours (n = 6), and 1 week (n = 6).

Results:
Microneedles create precise and accurate perforations measuring 93.1 ± 29.0 μm by 34.5 ± 16.8 μm and produce a high-frequency threshold shift that disappears after 24 hours. Examination of perforations over time demonstrates healing progression over 24 to 48 hours and complete perforation closure by 1 week.

Conclusion:
Microneedles can create a temporary microperforation in the RWM without causing significant anatomic or physiologic dysfunction. Microneedles have the potential to mediate safe and effective intracochlear access for diagnosis and treatment of inner ear disease.
Adrenoleukodystrophy in the era of newborn screening
Authors: Eng Liane , Regelmann Molly O. 
Published: November 2019

Purpose of review
Adrenoleukodystrophy (ALD) is a peroxisomal disorder with varying clinical presentations, including adrenal insufficiency, neurologic disease, and testicular dysfunction. The present review is intended to describe the current knowledge of the pathophysiology of ALD and provide an update regarding newborn screening, diagnosis, monitoring, and treatment.

Recent findings
New York State initiated newborn screening for ALD on December 30, 2013. Successful ALD newborn screening has led to its addition on other state newborn screens and recommendations for universal screening. Initial incidence reports, based on newborn screening, suggest ALD may be more common than previously described. The Pediatric Endocrine Society has published guidance for monitoring newborn males with ALD and case reports suggest biochemical adrenal insufficiency can be present during early infancy. Allogeneic hematopoietic stem cell transplant and gene therapy have been effective at halting the progression of cerebral ALD.

Summary
Early diagnosis and monitoring for progression of ALD can prevent adrenal crisis and treat the cerebral form of the disease. Initial guidelines for surveillance are likely to evolve as newborn screening not only aids in early detection and therapeutic interventions for ALD, but also expands our knowledge of the natural history of ALD.
Update on pediatric hyperthyroidism
Authors: Kaplowitz Paul B. , Vaidyanathan Priya 
Published: November 2019

Purpose of review
This review is intended to highlight recent studies which provide new data on the epidemiology and management of children with hyperthyroidism, including neonates.

Recent findings
A French study demonstrates differences in age-related trends in incidence of hyperthyroidism in males versus females and suggests the overall incidence may be increasing. New studies confirm the effectiveness and safety of long-term medical therapy (up to 10 years), including from the first randomized trial of short-term versus long-term therapy. Radioiodine ablation (RAI) is the main alternative therapy, though surgery may have some advantages if done in a high-volume center; using higher weight-based doses of I-131 (250 μCI/g thyroid tissue) could increase proportion of patients achieving hypothyroidism and decrease repeat ablations. Maternal or neonatal thyroid-stimulating hormone (TSH) receptor antibodies in children of mothers with Graves’ disease, and TSH at 3–7 days of age are good predictors of which neonates will have problems.

Summary
More research is needed on the epidemiology of Graves’ disease. Long-term medical therapy well past two years should be considered an option in compliant patients to decrease the number who need definitive therapy. For those receiving RAI, a dose of about 250 μCI/g thyroid tissue should result in fewer cases of persistent hyperthyroidism than lower doses.
Resurgence of measles in the United States: how did we get here?
Authors: Feemster Kristen A. , Szipszky Claire 
Published: November 2019

Purpose of review
In September 2019, the United States was at risk of losing measles elimination status due to several large-scale outbreaks resulting in more than 1200 confirmed cases across 31 states. This resurgence caps approximately 10 years of increasing incidence, marked by a highly publicized outbreak in 2015 associated with Disneyland when an infected traveler from the Philippines unknowingly spread the virus to susceptible park visitors and the recently ended large outbreak in undervaccinated Orthodox Jewish communities in New York City and Rockland counties. This review highlights current literature elucidating factors associated with current trends in measles epidemiology in the United States, the public health implications of current measles outbreaks and a path forward for addressing challenges contributing to the resurgence of measles in the United States and globally.

Recent findings and summary
As the most highly transmissible vaccine preventable disease, measles is especially sensitive to changes in herd immunity, the impact of vaccine refusal and globalization. Results highlight the confluence of these factors in current outbreaks, provide tools to predict outbreak risk, demonstrate the growing impact of misinformation and evaluate the impact of policy approaches for outbreak control and prevention.
Follicular T-cell regulation of alloantibody formation
Authors: Mohammed Mostafa T. , Sage Peter T. 
Published: November 2019

Purpose of review
To summarize recent studies elucidating the roles of follicular T cells in controlling allospecific antibody responses and antibody-mediated rejection (AbMR).

Recent findings
The field of antibody regulation has provided an in depth identification of the T-cell subsets involved in regulation of antibody responses. In addition, tools have been developed to study these cells during disease. Over the past few years, these strategies have been implemented in the field of transplantation to study the roles of T cells in mediating pathogenic antibody responses.

Summary
AbMR is largely responsible for long-term graft failure after solid organ transplantation and is induced by allospecific antibodies. In vaccination and infection, antiboody responses are controlled by humoral immunoregulation in which T follicular helper (Tfh) cells promote, and T follicular regulatory (Tfr) cells inhibit, antibody responses. Recent studies have suggested multifaceted roles for follicular T-cell subsets in regulating allospecific antibody responses and AbMR during organ transplantation. In addition, we discuss research priorities for the field to help elucidate mechanisms used by these cells so that new targeted therapeutics can be developed to prevent AbMR in human organ transplantation.
Teenagers Who Coexist With Cancer
Authors: Yang Hui-Chuan , Mu Pei-Fan , Chang Te-Kau , Curia Marianne 
Published: November 2019

Background
The experiences of teenagers with cancer are related to falling ill, receiving treatment, and the way they exist in the world. The understanding of the meaning of teenagers coexisting with cancer must be placed in the social context with the teenagers at the core.

Objective
By using an interpretive ethnographic research method, this study applied the body perception view of Merleau-Ponty to how teenagers with cancer understand self through the body in a social and cultural context.

Methods
Participant observation and individual semistructured interviews of 18 teenagers diagnosed with cancer were conducted over a 20-month period.

Results
The illness experience of teenagers undergoing chemotherapy was described as self-integration. Five themes emerged: boundary ambiguity of body, medical equipment as part of the body, confined body space, from self-dissociation toward self-integration, and healing power formed by self and others.

Conclusion
In the face of the adjustments of body disorder, the teenagers with cancer initiated motility of the body, self-displacement, and integration in order to regain control of the body.

Implications for Practice
The provision of correct disease knowledge to strengthen teenagers’ understanding and their sense of mastery of their bodies throughout the participation in their cancer treatment is essential. Discussions on making decisions, self-management, and social identification are related to the relationship between body and self as well as between healthcare and otherness. Providing culture and social sensitivity support systems and resources to teenagers and families can strengthen them to face the disease and promote positive healing.
Predictors of Disagreement Between Diagnoses From Consult Requesters and Consultation-Liaison Psychiatry
Authors: Otani Victor , Otani Thaís , Freirias Andrea , Calfat Elie , Aoki Patricia , Cross Sean , Sumskis Susan , Kanaan Richard , Cordeiro Quirino , Uchida Ricardo 
Published: November 2019

Abstract
We evaluated disagreement between reported symptoms and a final diagnosis of depression, anxiety, withdrawal, psychosis, or delirium through regression models assessing individual and combined diagnoses. Highest disagreement rates were reported for services classified as others (88.2%), general surgery (78.5%), and bone marrow transplant (77.7%). Disagreement rates varied widely across different diagnoses, with anxiety having the highest disagreement rate (63.3%), whereas psychosis had the lowest disagreement rate (10.6%). When evaluating kappa coefficients, the highest agreement occurred with diagnoses of withdrawal and psychosis (0.66% and 0.51%, respectively), whereas anxiety and depression presented the lowest values (0.31% and 0.11%, respectively). The best-performing predictive model for most outcomes was random forest, with the most important predictors being specialties other than the ones focused on single systems, older age, lack of social support, and the requester being a resident. Monitoring disagreement rates and their predictors provides information that could lead to quality improvement and safety programs.
Avoiding Misdiagnosis When Auditory Verbal Hallucinations Are Present in Borderline Personality Disorder
Authors: Beatson Josephine A. , Broadbear Jillian H. , Duncan Charlotte , Bourton David , Rao Sathya 
Published: November 2019

Abstract
Misdiagnosis is common for patients with a primary diagnosis of borderline personality disorder (BPD) who experience auditory verbal hallucinations (AVHs). AVHs in BPD are associated with severe BPD and high levels of suicidality. Wrongly treating these patients as though they are suffering from schizophrenia or other primary psychotic disorder and not treating BPD can cause significant iatrogenic damage. We outline a specific pattern of symptoms and phenomenology that will assist diagnostic accuracy in these cases. A focused review identified the following characteristic pattern: AVHs in BPD cannot be distinguished phenomenologically from AVH in schizophrenia, often meet the criteria for First-Rank Symptoms (FRSs), are highly stress related, and are strongly associated with dissociative experiences and childhood trauma. Formal thought disorder is uncommon, negative symptoms are usually absent, bizarre delusions are absent, affect remains reactive, and sociability is usually retained. Diagnostic accuracy can be improved by examining the overall clinical presentation and is essential to improving the prognosis for these patients.
Faculty and Student Perspectives of a Graduate Online Delivery Model Supported by On-Campus Immersion
Authors: Hardin-Pierce Melanie , Hampton Debra , Melander Sheila , Wheeler Kathy , Scott Leslie , Inman Dianna , Parrish Evelyn , Mudd-Martin Gia 
Published: November 2019

Purpose
The purpose of this article is to describe an immersion model implemented in a doctor of nursing practice program with the goal of engaging students and optimizing learning.

Description of the Project
The immersion model was designed to support learners in an online doctor of nursing practice program to promote self-direction and active involvement in diagnosing, planning, implementing, and evaluating their own learning. The Community of Inquiry framework, based on learning and teaching theory, was used in developing this immersion model.

Outcome
Students expressed positive opinions about immersion. Students valued simulation and skills practice, peer interaction, engagement with faculty, and the leadership colloquium. Faculty reported value in having group advising meetings and in collaborating across specialty tracks for skills laboratory experiences.

Conclusion
The immersion model has enhanced student engagement and helped optimize learning outcomes. Students and faculty found the use of the immersion model to be beneficial for practicing skills, use of simulated learning experiences, and student advising.
Breathing Easier: Decreasing Tracheal Intubation-associated Adverse Events in the Pediatric ED and Urgent Care
Authors: Neubrand Tara L. , Alletag Michelle , Woods Jason , Mendenhall Marcela , Leonard Jan , Schmidt Sarah K. 
Published: November 2019

Introduction:
Tracheal intubation is a high-risk procedure in the pediatric emergency department (PED) and pediatric urgent care (PUC) settings. We aimed to develop an airway safety intervention to decrease severe tracheal intubation-associated adverse events (TIAEs) by decreasing process variation.

Methods:
After gathering baseline data on TIAE, an interdisciplinary team underwent a mini-Delphi process to identify key drivers for decreasing severe TIAE rates. We launched a 4-part airway safety bundle that included: (1) color-coded weight-based equipment chart, (2) visual schematic of airway equipment, (3) recommended medication dosing, and (4) safety checklist across a single, tertiary PED and 5 satellite community PUCs/PEDs. Multiple plan–do–study–act cycles were undertaken, and results were monitored using statistical process control charts. Charts were restaged when special cause variation was achieved. This study aimed to decrease the severe TIAE rate from a baseline of 23% in the tertiary site and 25% in the community sites to <15% within 12 months and to sustain these outcomes for 6 months.

Results:
During the study period, we noted decreased rates of severe TIAE in both the PED and PUC setting during the intervention period, and we have sustained this improvement for more than 6 months in all sites with no associated change in balancing measures.

Conclusions:
Implementation of an airway safety bundle over a wide geographic area and among personnel with variable levels of training is possible and has the potential to decrease severe TIAE across multiple clinical settings.
Preschool Vision Screening Collaborative: Successful Uptake of Guidelines in Primary Care
Authors: Anzeljc Samantha , Ziemnik Lisa , Koscher Stephanie , Klein Wendy , Bridge Christine , Van Horn Allyson 
Published: November 2019

Introduction:
Preschool vision screening rates in primary care are suboptimal and poorly standardized. The purpose of this project was to evaluate pediatric primary care adherence to and improvement in preschool vision screening guidelines through a learning collaborative environment.

Methods:
Thirty-nine Ohio primary care providers interested in preschool vision screening self-selected to participate in an Institute for Healthcare Improvement Breakthrough Series learning collaborative that spanned 18 months. Charts of patients attending 3-, 4-, and 5-year well-child visits were randomly selected and reviewed for documentation of vision screening attempts, referrals, and need for rescreening.

Results:
Practitioners improved evidenced-based screening attempts for distance visual acuity and stereopsis of 3–5-year-old patients from 18% at baseline to 87% (P < 0.001) at 6 months; improved screening rates were sustained through completion of the collaborative. Baseline referral rates (26%) of abnormal vision screens improved by 59% (P < 0.001) during the first 6 months and were maintained through month 18. Rates for children with incomplete screens that were scheduled for a repeated screening increased during the first 6 months. However, changes in this metric did not reach statistical significance (P = 0.265), nor did it change during the remainder of the collaborative.

Conclusions:
Rapid integration and maintenance of preschool vision screening guidelines are feasible across primary care settings utilizing a structured learning collaborative. Challenges with the rescreening processes for children with incomplete vision screens remain, with the 3-year age group having the greatest room for improvement.
Microneedling of Scars: A Large Prospective Study with Long-Term Follow-Up
Authors: Alster Tina S. , Li Monica Ka Yi 
Published: November 2019

Background:
In recent years, microneedling has been increasingly used to treat a number of dermatologic conditions, including scars. Although initial studies demonstrated improvement of (mostly) atrophic scars with microneedling, the number of patients evaluated was relatively small, and the devices and treatment protocols used and posttreatment follow-up varied widely. Through this prospective observational study, the results of microneedling on 20 patients with a variety of scars are described.

Methods:
One hundred twenty consecutive patients (skin phototypes I through VI) with facial and nonfacial scars from a variety of etiologic sources (acne, trauma, surgery) were treated using a mechanical microneedling device. No additional treatments (topical or intralesional) were applied. Two assessors blinded to treatment protocol rated clinical improvement of scars 1, 3, 6, and 12 months after treatment on a five-point scale. Side effects were monitored and tabulated.

Results:
Patients received one to six consecutive monthly microneedling treatments. All scars improved at least 50 percent after an average of 2.5 treatments. Over 80 percent of patients had 50 to 75 percent improvement, and 65 percent of patients demonstrated over 75 percent improvement. No significant clinical differences were observed in treatment responses of facial scars versus nonfacial scars nor between responses of atrophic acne scars and traumatic or surgical scars.

Conclusions:
This study supports the use of microneedling for various facial and nonfacial scars across a broad range of skin phototypes with minimal risk of adverse effects. Further studies will help to establish standardized protocols to optimize treatment outcomes for different scar types.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Impact of a Nurse-Driven Diabetic Ketoacidosis Insulin Infusion Calculator on the Rate of Hypoglycemia
Authors: Lee Cynthia , Szwak Jennifer Austin , Bastow Samantha , McCarthy Sarah 
Published: November 2019

Objective
The aim of the study was to evaluate the impact of an insulin infusion calculator incorporated into electronic health record system in reducing the rate of hypoglycemia in diabetic ketoacidosis (DKA) management.

Methods
Retrospective chart review of patients with primary admission diagnosis of DKA was conducted in a university-affiliated academic medical center. End points including the rate of hypoglycemia, time to DKA resolution, rate of hypokalemia, time on insulin drip, and length of stay were measure before and after implementation of DKA calculator.

Results
Of 181 adult patients admitted for primary diagnosis of DKA, 103 were managed using the calculator. After implementation of the calculator, incidence of hypoglycemia and severe hypoglycemia were significantly reduced by 70% and 87%, respectively (P < 0.01). No difference was observed for time to DKA resolution, time on insulin drip, and length of stay.

Conclusions
Implementation of DKA insulin infusion calculator significantly reduced the rate of hypoglycemia. Future improvements should focus on reducing time to DKA resolution and length of stay.
Digital health for sexually transmitted infection and HIV services: a global scoping review
Authors: Cao Bolin , Bao Huanyu , Oppong Emmanuela , Feng Siyang , Smith Kumi M. , Tucker Joseph D. , Tang Weiming 
Published: November 2019

Purpose of review
The current study aimed to review how digital health has been used for sexually transmitted infection (STI)/HIV prevention, testing, and treatment.

Recent findings
A scoping review was conducted by searching five databases for peer-reviewed literature published between March 2018 to August 2019. 23 out of 258 studies met the inclusion criteria and were assessed. Six studies used digital platform to enhance STI/HIV prevention messaging; four studies found that digital health can provide vivid promotional information and has been instrumental in increasing the accessibility and acceptability of STI/HIV testing; three studies reported digital health provides a channel to understand and interpret the discourses on preexposure prophylaxis (PrEP) and increase PrEP uptake; three studies focused on refining big data algorithms for surveillance; four studies reported on how digital interventions could be used to optimize clinical interventions; and four studies found digital interventions can be used to assist mental health services.

Summary
Digital health is a powerful and versatile tool that can be utilized in the production of high-quality, innovative strategies on STIs and HIV services. Future studies should consider focusing on strategies and implementations that leverage digital platforms for network-based interventions, in addition to recognizing the norms of individual digital intervention platforms.
Host–vaginal microbiota interactions in the pathogenesis of bacterial vaginosis
Authors: Muzny Christina A. , Łaniewski Paweł , Schwebke Jane R. , Herbst-Kralovetz Melissa M. 
Published: November 2019

Purpose of review
The cause of bacterial vaginosis, the most common cause of vaginal discharge in women, remains controversial. We recently published an updated conceptual model on bacterial vaginosis pathogenesis, focusing on the roles of Gardnerella vaginalis and Prevotella bivia as early colonizers and Atopobium vaginae and other bacterial vaginosis-associated bacteria (BVAB) as secondary colonizers in this infection. In this article, we extend the description of our model to include a discussion on the role of host–vaginal microbiota interactions in bacterial vaginosis pathogenesis.

Recent findings
Although G. vaginalis and P. bivia are highly abundant in women with bacterial vaginosis, neither induce a robust inflammatory response from vaginal epithelial cells. These early colonizers may be evading the immune system while establishing the bacterial vaginosis biofilm. Secondary colonizers, including A. vaginae, Sneathia spp., and potentially other BVAB are more potent stimulators of the host–immune response to bacterial vaginosis and likely contribute to its signs and symptoms as well as its adverse outcomes.

Summary
Elucidating the cause of bacterial vaginosis has important implications for diagnosis and treatment. Our current bacterial vaginosis pathogenesis model provides a framework for key elements that should be considered when designing and testing novel bacterial vaginosis diagnostics and therapeutics.