bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic importance of mean platelet volume, platelet distribution width and platelet large cell ratio as screening tool in immune thrombocytopenia
Authors: Khan Muhammad Ihtesham , Ullah Ihsan 
Published: November 2020

Abstract

Objective:
To determine diagnostic importance of mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (PLCR) in diagnosing cases of immune thrombocytopenia.

Methodology:
The study was done in Khyber Teaching hospital from January 2017 to May 2018. Cases with low platelet count of all the ages and both the genders were included in the study by non probability purposive sampling technique and were subjected to bone marrow aspiration to rule out other causes of thrombocytopenia and thus confirm the diagnosis of immune thrombocytopenia. The platelet indices were noted and their sensitivity, specificity and accuracy were determined for immune thrombocytopenia. Mean and standard deviation were used for quantitative data. Percentage and frequency were used to measure qualitative data. Data was analysed by SPSS.

Results:
84 cases with thrombocytopenia of mean age 23.4 ± 12.1 years (range 7–81 years) were included in the study. There were 38 (45.2%) males and 46 (54.8%) females. There were 40 cases of immune thrombocytopenia. The sensitivity and specificity for PDW (59.1% and 43.1%, respectively), MPV (59.1% and 52.9%, respectively), and PLCR (50% and 52.9%, respectively) were found low to be used as screening tool for immune thrombocytopenia.

Conclusion:
The MPV, PDW and PLCR has low sensitivity and specificity and therefore should not be used as reliable screening tool in giving preliminary diagnosis of the immune thrombocytopenia.
Identification of afzelin potential targets in inhibiting triple-negative breast cancer cell migration using reverse docking
Authors: Rachmi Eva , Purnomo Basuki Bambang , Endharti Agustina Tri , Fitri Loeki Enggar 
Published: November 2020

Abstract

Background:
Triple-negative breast cancer (TNBC) tends to be aggressive and metastatic, characteristics attributable to its cellular migration capabilities. Afzelin is a chemical compound with anti-metastatic potentials. This study aimed to predict proteins involved in TNBC cell migration which could be inhibited by afzelin.

Methods:
The protein database was constructed from the Kyoto Encyclopedia of Genes and Genomes pathways collection which related to cell motility, then screened for druggability using SuperTarget and Therapeutic Target Database. The involvement of druggable proteins in the TNBC metastasis process was investigated through existing publications in The National Center for Biotechnology Information PubMed database. Inhibitory potential of afzelin toward target proteins was compared to the proteins’ known-inhibitor, using the reverse docking method.

Results:
Ten proteins identified as potential targets of afzelin, with the top 3 being ERK2, KRas, and FAK, respectively. Afzelin's 3-O-rhamnoside group played a dominant role in forming hydrogen bonds with the target proteins. Further analysis with STRING suggested that afzelin might be able to inhibit chemotaxis and haptotaxis of TNBC cells.

Conclusions:
Afzelin was predicted to inhibit TNBC cell motility, by targeting ERK2, KRas, and FAK activation.
Is Celiac Disease Testing Necessary in Functional Abdominal Disorders? A Study in Predominantly Latino Children
Authors: Falcon Ana C. , Fifi Amanda C. , Valdes Lilibet Fernandez , Jaquez Jessica , Mariaud Carolina , Saps Miguel 
Published: November 2020

ABSTRACTBackground: :Functional abdominal pain disorders (FAPDs) are among the most common causes of consultation in general pediatrics and pediatric gastroenterology. The Rome IV criteria recommend testing for celiac disease (CD) in children with irritable bowel syndrome‐diarrhea (IBS‐D) and leaves testing in cases of other FAPDs to the practitioner's discretion. These recommendations were based on a single study that showed a 4‐fold increase of CD among patients with IBS in Italy. It is unclear if these findings can be extrapolated to other populations. Understanding whether those results are reproducible in areas with different racial/ethnic backgrounds can optimize patient care.Aim:The aim of the study was to assess the prevalence of CD in a sample of children consulting for FAPDs to a tertiary care center in Miami.Methods:The charts of all pediatric patients consulting for FAPDs from January 2016 to November 2019 at the University of Miami were reviewed. Demographics, diagnosis, and CD testing for each child were analyzed.Results:One hundred eighty‐one children with FAPDs and celiac testing were seen. Mean age of 12.89 years, girls 61.34%. 84 (46.40%) had a diagnosis of IBS and 97 (53.59%) had a diagnosis of other FAPD. One of 181 children with FAPDs (0/84 with IBS and 1/97 with other FAPDs) had positive CD serological testing and EGD confirmation.Conclusions:Our study suggests that the prevalence of CD among children with FAPDs is similar to the community prevalence. This data questions the benefit of testing all children FAPDS (including IBS) for CD. Studies with larger sample size and various racial/ethnic makeup should be done to confirm our findings.
Pediatric Patient and Parent Perceptions of Fecal Microbiota Transplantation for the Treatment of Ulcerative Colitis
Authors: Popov Jelena , Hartung Emily , Hill Lee , Chauhan Usha , Pai Nikhil 
Published: November 2020

ABSTRACTBackground:Fecal microbiota transplantation (FMT) has gained attention for its role in the treatment of ulcerative colitis (UC). Acceptance of this treatment, particularly among children and their parents, is an important aspect of assessing its feasibility for pediatric inflammatory bowel disease care. To date, no studies have assessed FMT acceptance among pediatric patients who underwent FMT treatment. Here, we explored the perceptions and experiences of FMT in a population of pediatric UC patients who participated in a recent FMT pilot randomized controlled trial.Methods:Children who received bi‐weekly FMT treatments for 6 weeks through a clinical trial (NCT02606032) and their parents participated in face‐to‐face, semi‐structured interviews led by study investigators. Interviews were audiotaped, transcribed, and analyzed using validated qualitative research methods.Results:Eight patients and eight parents were interviewed, with qualitative data summarized across four themes and 11 subthemes. The majority of participants perceived FMT as a “natural treatment” and cited lack of response to conventional medications and fear of medication side‐effects as motivators for pursuing FMT. Pre‐treatment, patients and parents expressed concerns regarding physical discomfort with FMT administration; post‐treatment, most patients reported feeling “completely normal.” Both patients and parents uniformly expressed interest in pursuing FMT again in the future if available. Convenience of medication therapies, and perceived naturality and efficacy of FMT were all endorsed.Conclusions:This is the first study to describe pediatric and parent experiences receiving FMT. This information is valuable to develop and encourage future FMT trials involving children. Pre‐treatment, concerns about FMT were common. Post‐treatment, patients reported tolerance to FMT and a desire to continue receiving this therapy if available. Further trials of FMT in UC are needed. Investigators should include pediatric patients without concern of acceptance.
Medical Management of Chronic Pancreatitis in Children
Authors: Freeman A. Jay , Maqbool Asim , Bellin Melena D. , Goldschneider Kenneth R. , Grover Amit S. , Hartzell Cheryl , Piester Travis L. , Szabo Flora , Kiernan Bridget Dowd , Khalaf Racha , Kumar Rakesh , Rios Mirta , Husain Sohail Z. , Morinville Veronique D. , Abu‐El‐Haija Maisam 
Published: November 2020

ABSTRACTThis position paper summarizes the current understanding of the medical management of chronic pancreatitis (CP) in children in light of the existing medical literature, incorporating recent advances in understanding of nutrition, pain, lifestyle considerations, and sequelae of CP. This article complements and is intended to integrate with parallel position papers on endoscopic and surgical aspects of CP in children. Concepts and controversies related to pancreatic enzyme replacement therapy (PERT), the use of antioxidants and other CP medical therapies are also reviewed. Highlights include inclusion of tools for medical decision‐making for PERT, CP‐related diabetes, and multimodal pain management (including an analgesia ladder). Gaps in our understanding of CP in children and avenues for further investigations are also reviewed.
Comorbid Diagnosis of Eosinophilic Esophagitis and Inflammatory Bowel Disease in the Pediatric Population
Authors: Moore Hillary , Wechsler Joshua , Frost Carrie , Whiteside Elizabeth , Baldassano Robert , Markowitz Jonathan , Muir Amanda B. 
Published: November 2020

ABSTRACTBackground and Aims:The incidence and prevalence of eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are rising with similar patterns. Co‐occurrence of both diseases in the same patient has been increasingly reported. We sought to examine the pediatric population with both EoE and IBD to better understand the epidemiology and clinical implications of this overlap.Methods:We conducted a retrospective case‐control study at 2 tertiary care children's hospitals. Subjects with both EoE and IBD were identified and compared with randomly selected controls with EoE and IBD alone in terms of: demographics, atopic conditions, IBD classification, location and phenotype of Crohn disease (CD), IBD medications, endoscopic findings, and histopathology. Descriptive statistics summarized the data.Results:Sixty‐seven subjects with dual‐diagnosis were identified across both institutions. The prevalence of IBD in the EoE population was 2.2% and EoE in IBD was 1.5%. Subjects with both diseases were more likely to have IgE‐mediated food allergy compared with IBD alone (36% vs 7%, P < 0.001). Subjects with CD‐EoE were less likely to have perianal disease than CD alone (2% vs 20%, P = 0.004). There was no difference in fibrostenotic EoE between the dual‐diagnosis group and EoE alone. Treatment with a TNF‐alpha inhibitor (anti‐TNF) for management of preexisting IBD was protective against development of EoE with a relative risk of 0.314 [95% confidence interval [CI] 0.159‐0.619].Conclusions:This is a unique population in whom the underlying pathway leading to dual‐diagnosis is unclear. Concomitant atopic conditions, especially IgE‐mediated food allergy, and medication exposures, particularly anti‐TNFs, may help predict likelihood of developing dual‐diagnosis.
Metronomic Maintenance With Weekly Vinblastine After Induction With Bevacizumab-Irinotecan in Children With Low-grade Glioma Prevents Early Relapse
Authors: Roux Clémence , Revon-Rivière Gabriel , Gentet Jean Claude , Verschuur Arnauld , Scavarda Didier , Saultier Paul , Appay Romain , Padovani Laetitia , André Nicolas 
Published: November 2020

Background:
Pediatric low-grade glioma (pLGG) represents the most common brain tumor in childhood. Previous studies have reported that a therapeutic strategy on the basis of the association of bevacizumab alone (B) or in combination with irinotecan (BI) could produce rapid tumor response and clinical improvement in children with pLGG. Nevertheless, a majority of patients relapses shortly (median, 5 mo) after stopping B or BI treatment. We proposed metronomic maintenance with weekly vinblastine added after a 6 months induction of B/BI to prevent early relapse.

Patients and Methods:
Monocentric retrospective analysis of a patient with pLGG treated with B or BI for 6 months followed by a 12-month maintenance with weekly vinblastine (6 mg/m²) from October 2012 to September 2019 in a single institution.

Results:
In total, 18 patients (7 males and 11 females) were identified. Because of progression during the B or BI induction 2/18 children were excluded. In total, 16 patients were analyzed with a median age of 10 years (range, 4 to 16 y). A total of 13 patients received BI and 3 patients received B alone. The mean duration of induction was 6.2 months (range, 2 to 12 mo). After induction 5/16 patients had a partial radiologic response, 11/16 patients had stable disease. All patients started maintenance (median duration, 12 mo; range, 3 to 12 mo). With a median follow-up of 3.9 years after the end of B or BI (range, 11 mo to 7.2 y), 15/16 patients were alive and 9/16 patients were progression-free. Seven of 16 children progressed with a median time to progression of 23 months (ranges, 5 to 39 mo). Three of 16 (18%) children progressed during vinblastine maintenance and 4/16 (25%) patients after the end of maintenance. After the total duration of treatment, clinical improvement was noted in 4 patients, 9 patients had stable symptoms, and only 3 patients progressed. One and 2-year event-free survival were, respectively, 81.2% and 56.2%. Two-year overall survival was 93.7%.

Conclusions:
We report here, the potential benefit and the improvement of progression-free survival by adding metronomic maintenance with weekly vinblastine after initial induction with B or BI in children with low-grade glioma.
Changes in Care Delivery for Children With Sickle Cell Anemia During the COVID-19 Pandemic
Authors: Noisette M. Laurence , Phillips Shannon , Schlenz Alyssa M. , Mueller Martina , Kanter Julie 
Published: November 2020

Background:
Specialty care for children with sickle cell disease (SCD) may be disrupted during the coronavirus (COVID-19) pandemic. Our DISPLACE consortium includes 28 pediatric SCD centers.

Methods:
In May 2020, we surveyed the consortium on the impact of COVID-19 on their practice focusing on transcranial Doppler ultrasound, chronic red cell transfusions, telehealth, and COVID-19 testing.

Observation:
Twenty-four DISPLACE providers completed the survey. Transcranial Doppler ultrasound screening decreased to 67% but chronic red cell transfusions remained at 96%. Most investigators (92%) used telehealth and 40% of providers had patients test positive for COVID-19.

Conclusion:
The COVID-19 pandemic has affected routine care and necessitated changes in practice in SCD.
The Auto-eFACE: Machine Learning–Enhanced Program Yields Automated Facial Palsy Assessment Tool
Authors: Miller Matthew Q. , Hadlock Tessa A. , Fortier Emily , Guarin Diego L. 
Published: November 2020

Background:
Facial palsy assessment is nonstandardized. Clinician-graded scales are limited by subjectivity and observer bias. Computer-aided grading would be desirable to achieve conformity in facial palsy assessment and to compare the effectiveness of treatments. This research compares the clinician-graded eFACE scale to machine learning–derived automated assessments (auto-eFACE).

Methods:
The Massachusetts Eye and Ear Infirmary Standard Facial Palsy Dataset was employed. Clinician-graded eFACE assessment was performed on 160 photographs. A Python script was used to automatically generate auto-eFACE scores on the same photographs. eFACE and auto-eFACE scores were compared for normal, flaccidly paralyzed, and synkinetic faces.

Results:
Auto-eFACE and eFACE scores differentiated normal faces from those with facial palsy. Auto-eFACE produced significantly lower scores than eFACE for normal faces (93.83 ± 4.37 versus 100.00 ± 1.58; p = 0.01). Review of photographs revealed minor facial asymmetries in normal faces that clinicians tend to disregard. Auto-eFACE reported better facial symmetry in patients with flaccid paralysis (59.96 ± 5.80) and severe synkinesis (62.35 ± 9.35) than clinician-graded eFACE (52.20 ± 3.39 and 54.22 ± 5.35, respectively; p = 0.080 and p = 0.080, respectively); this result trended toward significance.

Conclusions:
Auto-eFACE scores can be obtained automatically using a freely available machine learning–based computer software. Automated scores predicted more asymmetry in normal patients, and less asymmetry in patients with flaccid palsy and synkinesis, compared to clinician grading. Auto-eFACE is a quick and easy-to-use assessment tool that holds promise for standardization of facial palsy outcome measures and may eliminate observer bias seen in clinician-graded scales.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, III.
Organizational Health Literacy: Opportunities for Patient-Centered Care in the Wake of COVID-19
Authors: Sentell Tetine , Foss-Durant Anne , Patil Uday , Taira Deborah , Paasche-Orlow Michael K. , Trinacty Connie Mah 
Published: November 2020

Background and Objectives:
The coronavirus disease-2019 (COVID-19) pandemic is transforming the health care sector. As health care organizations move from crisis mobilization to a new landscape of health and social needs, organizational health literacy offers practical building blocks to provide high-quality, efficient, and meaningful care to patients and their families. Organizational health literacy is defined by the Institute of Medicine as “the degree to which an organization implements policies, practices, and systems that make it easier for people to navigate, understand, and use information and services to take care of their health.”

Methods:
This article synthesizes insights from organizational health literacy in the context of current major health care challenges and toward the goal of innovation in patient-centered care. We first provide a brief overview of the origins and outlines of organizational health literacy research and practice. Second, using an established patient-centered innovation framework, we show how the existing work on organizational health literacy can offer a menu of effective, patient-centered innovative options for care delivery systems to improve systems and outcomes. Finally, we consider the high value of management focusing on organizational health literacy efforts, specifically for patients in health care transitions and in the rapid transformation of care into myriad distance modalities.

Results:
This article provides practical guidance for systems and informs decisions around resource allocation and organizational priorities to best meet the needs of patient populations even in the face of financial and workforce disruption.

Conclusions:
Organizational health literacy principles and guidelines provide a road map for promoting patient-centered care even in this time of crisis, change, and transformation. Health system leaders seeking innovative approaches can have access to well-established tool kits, guiding models, and materials toward many organizational health literacy goals across treatment, diagnosis, prevention, education, research, and outreach.
Personality Traits in the International Classification of Diseases 11th Revision (ICD-11)
Authors: Oltmanns Joshua R. 
Published: November 2020

Purpose of review
The International Classification of Diseases 11th Revision (ICD-11) officially adopted a dimensional system of personality disorder that was a paradigm shift for the classification of personality disorders. The purpose of this article is to review the growing amount of research on one component of that system – the personality trait domain model. Importantly, several self-report measures have been developed to measure the ICD-11 domains and have been subjected to initial validation through examination of their factor structure, multimethod use, convergent and discriminant validity with other prominent dimensional personality models (such as the Five-Factor Model), and criterion validity for important life outcomes.

Recent findings
Studies indicate the ICD-11 domains align with the Five-Factor Model and prior influential models of dimensional personality traits, as expected, and thus rest on an impressive body of empirical research. They also capture large amounts of variance included in the ICD-10/Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Section II personality disorders.

Summary
Together these findings support the construct validity of the ICD-11 trait domains. However, continued validation research is necessary, as well as research on how to implement these domains into clinical practice, and research on the more specific facet-level of the trait domains – although the ICD-11 model is only officially at the domain-level.
Mixed-precision iterative refinement using tensor cores on GPUs to accelerate solution of linear systems
Authors: Haidar Azzam , Bayraktar Harun , Tomov Stanimire , Dongarra Jack , Higham Nicholas J. 
Published: November 2020

Double-precision floating-point arithmetic (FP64) has been the de facto standard for engineering and scientific simulations for several decades. Problem complexity and the sheer volume of data coming from various instruments and sensors motivate researchers to mix and match various approaches to optimize compute resources, including different levels of floating-point precision. In recent years, machine learning has motivated hardware support for half-precision floating-point arithmetic. A primary challenge in high-performance computing is to leverage reduced-precision and mixed-precision hardware. We show how the FP16/FP32 Tensor Cores on NVIDIA GPUs can be exploited to accelerate the solution of linear systems of equations
Ax
=
b
without sacrificing numerical stability. The techniques we employ include multiprecision LU factorization, the preconditioned generalized minimal residual algorithm (GMRES), and scaling and auto-adaptive rounding to avoid overflow. We also show how to efficiently handle systems with multiple right-hand sides. On the NVIDIA Quadro GV100 (Volta) GPU, we achieve a

4
×
−
5
×

performance increase and 5× better energy efficiency versus the standard FP64 implementation while maintaining an FP64 level of numerical stability.
On the accuracy and applicability of a new implicit Taylor method and the high-order spectral method on steady nonlinear waves
Authors: Klahn Mathias , Madsen Per A. , Fuhrman David R. 
Published: November 2020

This paper presents an investigation and discussion of the accuracy and applicability of an implicit Taylor (IT) method versus the classical higher-order spectral (HOS) method when used to simulate two-dimensional regular waves. This comparison is relevant, because the HOS method is in fact an explicit perturbation solution of the IT formulation. First, we consider the Dirichlet–Neumann problem of determining the vertical velocity at the free surface given the surface elevation and the surface potential. For this problem, we conclude that the IT method is significantly more accurate than the HOS method when using the same truncation order,
M
, and spatial resolution,
N
, and is capable of dealing with steeper waves than the HOS method. Second, we focus on the problem of integrating the two methods in time. In this connection, it turns out that the IT method is less robust than the HOS method for similar truncation orders. We conclude that the IT method should be restricted to
M
= 4, while the HOS method can be used with
M
≤ 8. We systematically compare these two options and finally establish the best achievable accuracy of the two methods as a function of the wave steepness and the water depth.