bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enteropathogens and Rotavirus Vaccine Immunogenicity in a Cluster Randomized Trial of Improved Water, Sanitation and Hygiene in Rural Zimbabwe
Authors: Church James A. , Rogawski McQuade Elizabeth T. , Mutasa Kuda , Taniuchi Mami , Rukobo Sandra , Govha Margaret , Lee Benjamin , Carmolli Marya P. , Chasekwa Bernard , Ntozini Robert , McNeal Monica M. , Moulton Lawrence H. , Kirkpatrick Beth D. , Liu Jie , Houpt Eric R. , Humphrey Jean H. , Platts-Mills James A. , Prendergast Andrew J. 
Published: November 2019

Background:
Oral rotavirus vaccines (RVVs) are less efficacious in low-income versus high-income settings, plausibly due to more enteropathogen exposure through poor water, sanitation and hygiene (WASH). We explored associations between enteropathogens and RVV immunogenicity and evaluated the effect of improved WASH on enteropathogen carriage.

Methods:
We detected stool enteropathogens using quantitative molecular methods and measured anti–rotavirus immunoglobulin A by enzyme-linked immunosorbent assay in infants enrolled to a cluster randomized 2 × 2 factorial trial of improved WASH and improved infant feeding in Zimbabwe (NCT01824940). We used multivariable regression to explore associations between enteropathogens and RVV seroconversion, seropositivity and geometric mean titer. We evaluated effects of improved WASH on enteropathogen prevalence using linear and binomial regression models with generalized estimating equations.

Results:
Among 224 infants with enteropathogen and immunogenicity data, 107 (47.8%) had ≥1 pathogen and 39 (17.4%) had ≥2 pathogens detected at median age 41 days (interquartile range: 35–54). RVV seroconversion was low (23.7%). After adjusting for Sabin-poliovirus quantity, pan-enterovirus quantity was positively associated with RVV seroconversion (relative risk 1.61 per 10-fold increase in pan-enterovirus; 95% confidence interval: 1.35–1.91); in the same model, Sabin quantity was negatively associated with RVV seroconversion (relative risk: 0.76; 95% confidence interval: 0.60–0.96). There were otherwise no meaningful associations between individual or total pathogens (bacteria, viruses, parasites or all pathogens) and any measure of RVV immunogenicity. Enteropathogen detection did not differ between randomized WASH and non-WASH groups.

Conclusions:
Enteropathogen infections were common around the time of rotavirus vaccination in rural Zimbabwean infants but did not explain poor RVV immunogenicity and were not reduced by a package of household-level WASH interventions.
Comprehensive Detection of Respiratory Bacterial and Viral Pathogens in the Middle Ear Fluid and Nasopharynx of Pediatric Patients With Acute Otitis Media
Authors: Sawada Shoichi , Okutani Fumino , Kobayashi Taisuke 
Published: November 2019

Background:
Acute otitis media (AOM) is a common ear infection caused by respiratory viruses and bacteria of the nasopharynx. The present study aimed to detect various respiratory viruses and bacteria in middle ear fluid (MEF) and nasopharyngeal aspirates (NPA) using polymerase chain reaction (PCR).

Methods:
We collected MEF and NPA samples from 122 pediatric patients with AOM. Real-time PCR detected 11 types of respiratory viruses (respiratory syncytial virus A/B, parainfluenza virus 1/2/3, human metapneumovirus, influenza virus A/B, adenovirus, human bocavirus and rhino virus) and 7 types of bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Streptococcus pyogenes, Legionella pneumophila and Moraxella catarrhalis). MEF specimens were also examined using bacterial culture.

Results:
At least 1 respiratory viral or bacterial pathogen was detected in MEF of 120 cases (98%) by viral and bacterial PCR and of 93 cases (76%) by viral PCR and bacterial culture. Respiratory viruses were detected in NPA of 84 cases (69%) and MEF of 67 cases (55%). The most common virus detected in MEF was respiratory syncytial virus (21%), followed by parainfluenza virus (15%). All the viruses present in MEF were also detected in NPA specimens. Bacteria were detected by PCR in MEF of 109 cases (89%); H. influenzae was the most frequently detected (65%).

Conclusions:
In many cases, pediatric AOM was found to constitute a respiratory polymicrobial infection. Multiplex PCR was useful to detect multiple respiratory viruses and bacteria in AOM. To understand intractable AOM, further studies regarding the clinical features of each viral and bacterial coinfection are required.
Early-onset Sepsis Among Preterm Neonates in China, 2015 to 2018
Authors: Jiang Siyuan , Hong Luyang , Gai Jianfang , Shi Jingyun , Yang Yi , Lee Shoo K. , Cao Yun 
Published: November 2019

Background:
The epidemiology of early-onset sepsis (EOS) in China is poorly understood because of the paucity of high-quality data. We aimed to examine the epidemiology, pathogen distribution and neonatal outcomes of EOS among a large cohort of preterm infants in China.

Methods:
All infants born at <34 weeks of gestation and admitted to 25 tertiary neonatal intensive care units in China from April 2015 to May 2018 were enrolled. EOS was defined as a culture-confirmed infection that occurred within 72 hours after birth.

Results:
Among 27,532 enrolled infants, 321 (11.7 cases per 1000 admissions) infants developed EOS, and 61 (19.0%) infants died within seven days after EOS onset. The incidence of EOS among inborn infants in 18 perinatal centers was 9.7 cases per 1000 live births <34 weeks’ gestation (186/19,084). The case fatality rate was 22.6% (42/186). Gram-negative bacteria were responsible for 61.7% of EOS and 82.0% of EOS-related deaths. Escherichia coli (20.3%) was the leading pathogen, followed by Coagulase-negative staphylococcus (16.5%), Achromobacter xylosoxidans (9.0%) and Klebsiella pneumoniae (8.1%). Group B streptococci infections were relatively rare (2.5%). EOS was an independent risk factor for all-cause mortality and retinopathy of prematurity.

Conclusions:
There is a high burden of EOS among preterm infants in China with a distinctive pathogen distribution. Longitudinal epidemiologic monitoring, further investigation of causative pathogens and development of targeted strategies for prevention and treatment of EOS are needed.
Characteristics of Delphi Processes in Orthotics and Prosthetics Research
Authors: Falbo Kierra Jean , Brinkmann John 
Published: November 2019

ABSTRACTIntroductionThe implementations of a structured consensus process can facilitate agreement among experts on varied and inconsistent clinical and educational practices. Recommendations exist for use of the Delphi consensus process in health care research. Most Delphi studies in orthotics and prosthetics research occurred after these recommendations were published, and it is unclear how closely these recommendations have been followed when applying this method. The aim of this review is to summarize the characteristics of Delphi processes in orthotics and prosthetics in order to guide future research.Materials and MethodsA review was undertaken of published reports of Delphi processes used to research some aspect of the orthotics and prosthetics profession. Research methods were evaluated to identify and characterize features of the application of the Delphi process. These features were compared with the recommendations for Delphi processes in health care research.ResultsThe application of the Delphi method in the 19 reviewed studies varied significantly in regards to topic, qualifications and number of experts, survey item creation, number of rounds, consensus requirements, outcomes, inclusion of a final conference, dropout rate, and final output. Although some studies closely followed the recommendations for the use of the Delphi method in health care, others deviated greatly.ConclusionsAlthough the Delphi method is a common consensus process used in orthotics and prosthetics research, study methods vary and do not always follow recommended guidelines. Guidelines for future Delphi processes in orthotics and prosthetics research can be developed based on the data collected in this review. It is likely that there will be an increase in the number of Delphi studies conducted in this field in the future. Understanding the way this method has been implemented in previous studies can inform the design of future studies and may result in a more consistent application of this valuable research method.
Exploring substance use and mental health for minority transgender youth: Implications for advanced practice nurses
Authors: Raynor Phyllis A. , Nation Austin , Outlaw Freida 
Published: November 2019

ABSTRACT

Background:
Transgender youth, particularly if they are transgender female and of a minority racial or ethnic group (i.e., minority transgender youth [MTY]), are known to have higher incidence of new HIV infections, substance abuse, and suicidality when compared with cisgender youth. Mental health disparities and substance use among MTY, between the ages of 13–24 years, have been underexplored in the United States, although they have serious public health concerns contributing to morbidity and mortality.

Objectives:
To examine the US literature to discover what is known about the intersection of substance use, mental health disorders, and associated health risks for MTY.

Data sources:
An integrative review exploring experimental and nonexperimental research was conducted from 2010 to 2018 using Cumulative Index for Nursing and Allied Health (CINAHL), PsycINFO, and PubMed. Articles were selected if the research identified MTY, mental health and/or substance use risks, data-driven outcomes, or considerations that could potentially influence MTY outcomes. Ten articles were included in the final selection.

Conclusions:
All studies addressed mental health, substance use, and/or health risks, although many of the articles explored all transgender youth outcomes without a particular focus on MTY. Identified factors linked to poor health outcomes included socioeconomic vulnerability, substance use, mood disorders, self-harm, and risky sexual behaviors.

Implications for practice:
The authors have provided recommendations regarding culturally appropriate, compassionate, evidence-informed practices for engaging MTY and their families to promote greater well-being for all youth, regardless of gender identity.
“Now that you've got that coverage”: Promoting use of a regular source of primary care among homeless persons
Authors: Dickins Kirsten , Buchholz Susan W. , Ingram Diana , Hamilton Rebekah J. , Braun Lynne T. , Karnik Niranjan S. , Earle Melinda 
Published: November 2019

ABSTRACT

Background:
The growing number of homeless persons in the United States demonstrates greater morbidity and mortality than the population as a whole. Homeless persons are often without a regular source of primary care. Homeless persons use emergency departments and are hospitalized at higher rates than nonhomeless persons. In 2010, the enactment of the Affordable Care Act expanded access to primary care services. Nurse practitioners were at the forefront of its subsequent implementation.

Purpose:
The purpose of this qualitative study was to explore the factors that influence establishing and maintaining a regular source of primary care among homeless persons.

Methodological orientation:
In 2017, semistructured interviews were conducted in a federally qualified health center that serves predominately homeless persons.

Sample:
A purposive convenience sample included adult health center users (N = 20). The majority of participants were insured (90%), African American (70%), and male (65%).

Conclusions:
Thematic analysis revealed five facilitators: sense of community, mutual patient–provider respect, financial assurance, integrated health services, and patient care teams. To establish and maintain use of a regular primary care source, homeless persons desire to experience a sense of community, feel respected by their provider/staff, and have certainty that costs will not exceed their capacity to pay. Integrated care models that leverage a multidisciplinary team approach support the use of a regular primary care source.

Implications for practice:
Actualizing achievable strategies that promote the consistent use of a regular primary care source can reduce use of avoidable emergency and hospital-based services, thereby improving health outcomes among homeless persons.
Central Catheter‐related Bloodstream Infection Rates in Children on Home Parenteral Nutrition
Authors: Trivić Ivana , Mišak Zrinjka , Kerman Višnjica , Prlić Hrvoje , Kolaček Sanja , Hojsak Iva 
Published: November 2019

ABSTRACTReliable venous access is prerequisite for patients receiving long‐term parenteral nutrition (PN). Central venous catheters are, however, an important risk factor for the development of potentially lethal complications, including catheter‐related bloodstream infection (CRBSI). We have retrospectively assessed the incidence of CRBSIs in children on long‐term PN who were treated at the Children's Hospital Zagreb from January 2011 until January 2019 and the cost effectiveness of the use of taurolidine line locks in children at home PN (HPN). During this period 48 children received long‐term PN and 24 children were discharged to HPN. The rate of CRBSI 1.15/1000 catheter days in total; 2.35/1000 days in the hospital; and 0.48/1000 days at home. If taurolidine line lock was used every day of PN for children on HPN total costs would exceed existing CRBSI treatment costs >5 times.
Normal Gamma Glutamyl Transferase Levels at Presentation Predict Poor Outcome in Biliary Atresia
Authors: Shankar Sahana , Bolia Rishi , Foo Hee Wei , D'Arcy Colleen E , Hardikar Natasha , Wensing Martin , Hardikar Winita 
Published: November 2019

ABSTRACTObjectives:Gamma‐glutamyl transferase levels (GGT) are typically elevated in biliary atresia (BA), but normal GGT levels have been observed. This cohort of “normal GGT” BA has neither been described nor has the prognostic value of GGT level on outcomes in BA. We aimed to describe outcomes of a single‐centre Australian cohort of infants with BA and assess the impact of GGT level at presentation on outcomes in BA.Methods:Infants diagnosed with BA between 1991 and 2017 were retrospectively analysed. Outcomes were defined as survival with native liver, liver transplantation (LT), and death. Patients were categorized into normal (<200I U/L) or high GGT groups based on a mean of 3 consecutive GGT values done before Kasai portoenterostomy (KPE). Baseline parameters, age at surgery, clearance of jaundice (COJ), and outcomes were compared between the 2 groups.Results:One hundred thirteen infants underwent KPE at median 61 (30–149) days. At a median follow‐up of 14.2 (0.9–26.3) years, 35% (39/113) patients were surviving with native liver, 55% (62/113) underwent LT and 11% (12/113) died pretransplant. 12.3% (14/113) patients had normal GGT. Age at KPE and time to COJ were similar between normal and high GGT groups. Normal GGT group had shorter time from KPE to LT (11 vs 18 months, P = 0.02), underwent LT at a younger age (14 vs 20 months, P = 0.04), and had poorer transplant‐free survival (P = 0.04) than high GGT group.Conclusions:12.3% of infants with BA had normal GGT levels at diagnosis. Low GGT levels at presentation in BA was associated with a poorer outcome.
Calling Out MS Fatigue: Feasibility and Preliminary Effects of a Pilot Randomized Telephone-Delivered Exercise Intervention for Multiple Sclerosis Fatigue
Authors: Kratz Anna L. , Atalla Mareena , Whibley Daniel , Myles Abigail , Thurston Taylor , Fritz Nora E. 
Published: November 2019

Background and Purpose:
Fatigue is a common and debilitating symptom of multiple sclerosis (MS). Exercise therapy is effective in reducing MS-related fatigue; however, its feasibility, acceptability, and effectiveness when delivered over the telephone remain unknown. This randomized study aimed to determine the feasibility and acceptability of a telephone-delivered exercise intervention for MS-related fatigue. In addition, pre-/postchange in fatigue and secondary outcomes were compared with an otherwise identical in-person delivered exercise intervention.

Methods:
Twenty participants with MS and clinically significant fatigue were randomized to 8 sessions of either telephone (n = 10) or in-person (n = 10) delivered exercise therapy. Primary outcome measures concerned feasibility (number of sessions attended), acceptability (Client Satisfaction Questionnaire), and fatigue (Fatigue Severity Scale and two 11-point numeric rating scales: fatigue intensity and interference). Data on a range of secondary outcome measures were also collected.

Results:
There was no difference in average session attendance by group (telephone group: 7.6 ± 1.3 sessions; in-person 7.8 ± 0.42). Acceptability and reductions in fatigue were observed regardless of group, and improvements in a range of secondary outcomes were comparable.

Discussion and Conclusions:
A telephone-delivered exercise intervention that targets MS-related fatigue is both feasible and acceptable. Primary and secondary outcome measures signaled that telephone-delivered exercise may be an effective mode of delivery that overcomes barriers to care in persons with MS and warrants testing in larger efficacy trials.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A293).
Screening for Trisomies by cfDNA Testing of Maternal Blood in Twin Pregnancy: Update of the Fetal Medicine Foundation Results and Meta-analysis
Authors: Gil M. M. , Galeva S. , Jani J. , Konstantinidou L. , Akolekar R. , Plana M. N. , Nicolaides K. H. 
Published: November 2019

(Abstracted from Ultrasound Obstet Gynecol 2019;53:734–742)
Cell-free DNA (cfDNA) analysis of maternal blood is useful and effective when screening for trisomies 21, 18, and 13 in singleton pregnancies. However, in twin pregnancies, data on cfDNA tests are much more limited: in a previous literature review and meta-analysis, there were only 5 prospective studies.
Factors Associated With Human Immunodeficiency Virus Infections Linked in Genetic Clusters But Disconnected in Partner Tracing
Authors: Pasquale Dana K. , Doherty Irene A. , Miller William C. , Leone Peter A. , Sampson Lynne A. , Ledford Sue Lynn , Sebastian Joseph , Dennis Ann M. 
Published: November 2019

Background
Successful partner notification can improve community-level outcomes by increasing the proportion of persons living with human immunodeficiency virus (HIV) who are linked to HIV care and virally suppressed, but it is resource intensive. Understanding where HIV transmission pathways may be undetected by routine partner notification may help improve case finding strategies.

Methods
We combined partner notification interview and HIV sequence data for persons diagnosed with HIV in Wake County, NC in 2012 to 2013 to evaluate partner contact networks among persons with HIV pol gene sequences 2% or less pairwise genetic distance. We applied a set of multivariable generalized estimating equations to identify correlates of disparate membership in genetic versus partner contact networks.

Results
In the multivariable model, being in a male-male pair (adjusted odds ratio [AOR], 16.7; P = 0.01), chronic HIV infection status (AOR, 4.5; P < 0.01), and increasing percent genetic distance between each dyad member's HIV pol gene sequence (AOR, 8.3 per each 1% increase, P < 0.01) were all associated with persons with HIV clustering but not being identified in the partner notification network component. Having anonymous partners or other factors typically associated with risk behavior were not associated.

Conclusions
Based on genetic networks, partnerships which may be stigmatized, may have occurred farther back in time or may have an intervening partner were more likely to be unobserved in the partner contact network. The HIV genetic cluster information contributes to public health understanding of HIV transmission networks in these settings where partner identifying information is not available.
Point-of-Care Ultrasound to Assess Gastric Content
Authors: Moake Matthew M. , Jackson Benjamin F. , Presley Bradley C. 
Published: November 2019

Abstract
Gastric ultrasound (US) is a growing modality within the point-of-care ultrasound (POCUS) field. It provides the ability to directly measure an individual patient's gastric content and has potential use as both a clinical and a research tool. Here, we review the historical development of current gastric US models and their clinical application within the field of general anesthesia, describe the US findings and technique for using POCUS to assess gastric content, and discuss the current and potential applications of gastric POCUS within the emergency department.
An Intervention to Increase Knowledge and Utilization of the Low Risk Ankle Rule Among Pediatric Emergency Department Providers
Authors: Loftus Kirsten V. , Gittelman Michael A. , FitzGerald Michael , Pomerantz Wendy J. 
Published: November 2019

Objectives
The Low Risk Ankle Rule (LRAR) can assist pediatric emergency department providers in reducing radiographs without missing significant fractures. Most providers are unaware of this tool. This study sought to educate providers about the LRAR then determine their self-reported use immediately and 2 months after education.

Methods
A web-based survey was e-mailed to providers at one large pediatric emergency department. The survey assessed knowledge and use of the rule. Clinical scenarios, in which radiographs were not indicated, helped determine radiograph ordering practices. After a brief LRAR tutorial, respondents were requeried about radiograph ordering practices along with likelihood of future LRAR use. At 2 months, radiograph ordering was again assessed using the same scenarios; interim LRAR use was also determined.

Results
Response rates on the initial and follow-up surveys were 61.4% and 96.2%, respectively. A minority (20%) had heard of the LRAR. Providers initially reported ordering radiographs on 84% of ankle injuries and 82.5% ordered radiographs in the scenario. Immediately after education, only 32% ordered a radiograph in the scenario; 85% reported that they would use the tool consistently. At 2 months, there was no significant change in radiograph ordering practices (79.5% vs 84%). In the interim, 30% reported using the rule at least once.

Conclusions
Most pediatric emergency department providers were unfamiliar with the LRAR. After a brief tutorial, most providers reported that planning to use the tool and self-reported radiograph ordering was significantly reduced; however, at 2 months, clinical practice was unaffected. Further work to implement the tool into practice is necessary.