bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing Pathology Report Quality Indicators in 2 Distinct Whipple Resection Specimen Protocols
Authors: DeCoste Ryan , McDonell Laura M. , Uzans Drea , Molinari Michele , Huang Weei-Yuarn 
Published: June 2020

Objectives
Pancreaticoduodenectomy specimens are complex, with varying gross examination techniques. In 2012, our institution began using axial sectioning. We sought to determine if this resulted in more complete pathology reporting.

Methods
Quality indicators were analyzed for pathology reports from 2 cohorts: 2001 to 2009 grossed traditionally and 2012 to 2017 using an axial technique (n = 81 and 51). Continuous and categorical data were compared using 2-tailed t test and Fisher exact test, respectively.

Results
The later cohort exhibited increased reporting of stage, lymphovascular invasion, margins/surfaces, mean number of lymph nodes, and mean number of slides (P < 0.01). No differences were seen in reporting of size, grade, or perineural invasion. In the later cohort, superior mesenteric vein/portal vein surface was positive in 17 cases (33%), showing strong correlation with superior mesenteric artery/uncinate margin involvement (13/17 cases; P = 0.0001). There was a higher rate of lymph node positivity (86% vs 65%, P < 0.01) in the later cohort.

Conclusions
There is a trend toward higher-quality pathology reports in 2012 to 2017. A possible drawback of the axial approach is increased histopathology slides. Potential additional contributors include College of American Pathologists protocols, increasing subspecialty practice, and updates to the American Joint Committee on Cancer staging criteria.
Intraoperative Ultrasound Elastography Is Useful for Determining the Pancreatic Texture and Predicting Pancreatic Fistula After Pancreaticoduodenectomy
Authors: Kawabata Yusuke , Okada Toshihiro , Iijima Hiroko , Yoshida Masahiro , Iwama Hideaki , Xu Jinyang , Hatano Etsuro , Fujimoto Jiro , Suzumura Kazuhiro 
Published: June 2020

Objectives
Pancreatic fistula (PF) is one of the most common complications after pancreaticoduodenectomy (PD). The soft pancreatic texture is known to be an important predictive factor for PF after PD. However, its evaluation is dependent on the sense of touch by the operator during operation, thus not objective. The aim of this study was to investigate the relationship between mean elasticity via intraoperative ultrasound elastography and histological pancreatic hardness, as well as predictive factor of PF after PD.

Methods
Forty-eight patients who underwent ultrasound elastography during PD and had pancreatic parenchyma histologically evaluated were included.

Results
Pancreatic fistula was noted in 20 patients. There were significant differences in the histological pancreatic fibrosis rate between soft pancreas group (8.2%) and hard pancreas group (28.4%, P < 0.05) and in the mean elasticity between soft pancreas group (1.94 m/s) and hard pancreas group (3.17 m/s, P < 0.05). The mean elasticity was significantly correlated with pancreatic fibrosis rate (P < 0.05). A multivariate analysis revealed that the mean elasticity of less than 2.2 m/s was a significant predictor of PF after PD (P = 0.003).

Conclusions
Intraoperative ultrasound elastography could predict pancreatic texture objectively. The mean elasticity of less than 2.2 m/s was a significant predictor of PF after PD.
Radiation as a Single-Modality Treatment in Localized Pancreatic Cancer
Authors: Shaib Walid L. , Zakka Katerina , Shahin Asser A. , Yared Fares , Switchenko Jeffrey M. , Wu Christina , Akce Mehmet , Alese Olatunji B. , Patel Pretesh R. , Mcdonald Mark , El-Rayes Bassel F. 
Published: June 2020

Objectives
Locally advanced pancreatic cancer (LAPC) is managed with multimodality therapy. We aim to evaluate the outcome of single-modality radiation therapy for LAPC.

Methods
Locally advanced pancreatic cancer patients were identified between 2004 and 2013 using the National Cancer Database excluding patients who received chemotherapy or surgery.

Results
A total of 6590 patients were included. The mean age was 73.5 (range, 28–90) years, 83.2% were white, and 54.4% were female. Tumors of 4 cm or greater (>T3 stage) accounted for 52.7%. The median radiation dose was 39.6 Gy. Stereotactic body radiation (SBRT) delivered to 64 patients and external-beam/intensity modulated radiotherapy in 416 patients. Radiation therapy was associated with improved overall survival (OS) compared with no treatment in univariate and multivariable analyses. The medians OS for patients who received SBRT, external-beam/intensity modulated radiotherapy, or no radiation were 8.6, 6.7, and 3.4 months, respectively (P < 0.001). There is a significant difference in 12-month OS for the SBRT cohort (31.9%; 95% confidence interval [CI], 20.9%–43.5%) compared with patients who received no radiation (15.1%; 95% CI, 14.2%–16.0%), and on multivariable analysis (hazard ratio, 0.50; 95% CI, 0.38–0.65; P < 0.001).

Conclusions
The current study suggests potential benefit for radiation therapy alone in comparison with no treatment in LAPC.
Helicobacter pylori Infection in Pediatric Patients Living in Europe
Authors: Kori Michal , Le Thi Thu Giang , Werkstetter Katharina , Sustmann Andrea , Bontems Patrick , Lopes Ana Isabel , Oleastro Monica , Iwanczak Barbara , Kalach Nicolas , Misak Zrinjka , Cabral José , Homan Matjaž , Cilleruelo Pascual Maria Luz , Pehlivanoglu Ender , Casswall Thomas , Urruzuno Pedro , Martinez Gomez Maria José , Papadopoulou Alexandra , Roma Eleftheria , Dolinsek Jernej , Rogalidou Maria , Urbonas Vaidotas , Chong Sonny , Kindermann Angelika , Miele Erasmo , Rea Francesca , Cseh Áron , Koletzko Sibylle ,   Helicobacter pylori Working Group of ESPGHAN
Published: June 2020

ABSTRACTObjectives:The aim of the study was to assess clinical presentation, endoscopic findings, antibiotic susceptibility and treatment success of Helicobacter pylori (H. pylori) infected pediatric patients.Methods:Between 2013 and 2016, 23 pediatric hospitals from 17 countries prospectively submitted data on consecutive H. pylori‐infected (culture positive) patients to the EuroPedHP‐Registry.Results:Of 1333 patients recruited (55.1% girls, median age 12.6 years), 1168 (87.6%) were therapy naïve (group A) and 165 (12.4%) had failed treatment (group B). Patients resided in North/Western (29.6%), Southern (34.1%) and Eastern Europe (23.0%), or Israel/Turkey (13.4%). Main indications for endoscopy were abdominal pain or dyspepsia (81.2%, 1078/1328). Antral nodularity was reported in 77.8% (1031/1326) of patients, gastric or duodenal ulcers and erosions in 5.1% and 12.8%, respectively. Primary resistance to clarithromycin (CLA) and metronidazole (MET) occurred in 25% and 21%, respectively, and increased after failed therapy. Bacterial strains were fully susceptible in 60.5% of group A, but in only 27.4% of group B. Primary CLA resistance was higher in Southern and Eastern Europe (adjusted odds ratio [ORadj] = 3.44, 95% confidence interval [CI] 2.22–5.32, P < 0.001 and 2.62, 95% CI: 1.63–4.22, P < 0.001, respectively) compared with Northern/Western Europe. Children born outside Europe showed higher primary MET resistance (ORadj = 3.81, 95% CI: 2.25–6.45, P < 0.001). Treatment success in group A reached only 79.8% (568/712) with 7 to 14 days triple therapy tailored to antibiotic susceptibility.Conclusions:Peptic ulcers are rare in dyspeptic H. pylori‐infected children. Primary resistance to CLA and MET is markedly dependent on geographical regions of birth and residence. The ongoing survey will show whether implementation of the updated ESPGHAN/NASPGHAN guidelines will improve the eradication success.
Predictors of Posttraumatic Stress Disorder, Anxiety, and Depression Symptoms in Survivors of Torture Living in the United States
Authors: Tran Ann , Brickman Sophie , Jordan Joshua , Samuelson Kristin W. 
Published: June 2020

Abstract
A constellation of psychosocial factors contributes to the complex trauma symptoms that survivors of torture may experience. We examined the roles of pretrauma, peritrauma, and postmigration factors as predictors of posttraumatic stress disorder, depression, and anxiety in a sample of 101 culturally heterogeneous torture survivors residing in the United States. Predictors included demographic variables (sex, education, marital status), peritrauma torture type variables generated by principal components analysis (PCA), and postmigration variables (employment status, legal immigration status, and family separation). Of the torture factors identified through PCA (torture inflicted on the self and torture inflicted on family members), torture inflicted on the self significantly predicted anxiety. Undocumented legal status and female sex were related to poorer psychological outcomes. Results highlight the importance of considering postmigration factors, specifically legal status, rather than elements of the torture experience itself, in the delivery of trauma-informed psychological interventions and policy development for survivors of torture.
Child Abuse Response Simulation for Advanced Practice Nursing Students
Authors: McClure Natasha , Nelson Brittany , Anderson Margaret , Donnell Carrie , Knox Danielle 
Published: June 2020

Purpose
The purpose of this project was for advanced practice nursing students to gain experience taking a history from a parent or caregiver and communicating the treatment plan for an infant in which child abuse is suspected.

Project
Fifty-three students participated in a 1:1 simulated encounter with a standardized patient acting as the mother of an infant with a leg injury that reportedly resulted from a fall from the couch. Students received feedback from the standardized patient via an assessment tool and debriefed with faculty immediately after the simulation.

Outcome
All students demonstrated empathy, acknowledged the mother's emotions, and communicated the concern for abuse. Additionally, all students explained the x-ray findings, need for hospital admission, and referral to investigative agency for further evaluation.

Conclusion
Simulations designed to provide advanced practice nursing students with experience interviewing a parent and responding in the case of suspected child abuse are an important method of preparing them for initial clinical encounters.
Mitochondrial Dysregulation in Sepsis
Authors: Graham Julie-Kathryn , Stacy Kathleen 
Published: June 2020

Background
Until 2016, the condition Sepsis was widely understood to be the systemic immune response syndrome in the presence or suspicion of an infectious source. Systemic immune response syndrome, an adaptive response, has been repeatedly demonstrated to lack specificity for sepsis. The current definition of sepsis describes a dysregulated host response to infection, yet the dysregulated nature of the response has yet to be defined. Successful recognition and management of sepsis are critically dependent on understanding and operationalizing the definition of sepsis.

Objective
The authors sought to review the current literature on sepsis and its relationship to oxygen downregulation within the mitochondria along the electron transport chain.

Methods
Articles retrieved from databases PubMed and CINAHL, pertaining to human cells, post 2001, in English, original experimental, quasi-experimental, or cohort design. Articles were selected and retrieved by the first author and synthesized by both authors.

Results
The 10 articles included in the review were all bench science cellular studies. They demonstrated consistent, statistically significant differences when investigating mitochondrial oxygen downregulation in sepsis versus control, offering strong, statistically significant support for the hypothesis of mitochondrial dysregulation in the septic host.

Conclusions
The evidence makes a compelling case for mitochondrial dysregulation to inform the current definition of sepsis as a dysregulated host response. As the evidence points to a linear, progressive time/exposure-dependent disruption in oxygen downregulation in sepsis at the cellular level, it lends credence to the recommendations for early intervention and its relationship with survivability. Time is not on the side of the individual with sepsis.
An Unusual Cervical Injury Caused by Accidental Electrical Burns
Authors: Mosbahi Amal , Majdoub Wael , Sriha Badreddine , Turki Elyes 
Published: June 2020

Abstract
High-voltage electrocution is mostly unintentional, and it is associated with significant morbidity and mortality due to severe tissue damages. The present report describes an atypical electrocution with multiple victims and a fatal outcome of a 48-year-old man due to unusual neck injuries caused by accidental electrical burns.
Fatal Intracerebral Hemorrhage During “Muay Thai” in a 21-Year-Old Man With Undiagnosed Acute Myeloid Leukemia
Authors: Caputo Fiorella , Barranco Rosario , Fraternali Orcioni Giulio , Frigiolini Francesca Maria Elena , Ventura Francesco 
Published: June 2020

Abstract
Acute myeloid leukemia (AML) is characterized by the rapid growth of abnormal white blood cells in the bone marrow that interferes with the production of normal blood cells. This disease is burdened by a high risk of bleeding complications involving central nervous system hemorrhages, purpura, gingival bleeding, and gastrointestinal bleeding. In this article, the authors report a case of a fatal intracerebral hemorrhage in a 21-year-old man who was affected by an undiagnosed AML. The subject practiced a combat sport (Muay Thai), and 2 days before his last training, he was involved in a fight where the aggressor punched him in the face; however, after the fight, he did not claim of any symptoms. The current case highlights the importance of the role of the forensic pathologist because only through a careful and complete circumstantial, autoptic, and histological analysis it is possible to date the origin of a cerebral hemorrhage and establish whether it is spontaneous or posttraumatic in subjects with undiagnosed preexisting diseases. Through an integrated study, it is also important to date the lesion and identify the traumatic event responsible of the bleeding. Finally, this case has a relevant clinical importance relatively to sports medicine, where it would be appropriate that athletes undergo blood test as a preventive measure. In fact, in presence of an acute hematological disease, such as AML, even mild traumatic injuries may be fatal.
Diagnostic Discordance in Pediatric Critical Care Transport
Authors: Noje Corina , Costabile Philomena M. , Henderson Eric , O'Donnell Erin , Bhatia Pooja , Singh Sarabdeep , Hattab Mohammad W. , Anders Jennifer F. , Klein Bruce L. 
Published: June 2020

Objectives
The aims of the study were to describe diagnostic discordance rates at our pediatric tertiary care center between the reason for transfer of critically ill/injured children (determined by the referring institution) and the inpatient admission diagnosis (determined by our accepting institution), to identify potential factors associated with discordance, and to determine its impact on patient outcomes.

Methods
We conducted a retrospective chart review of all critically ill/injured children transferred to the Johns Hopkins Children's Center between July 1, 2017, and June 30, 2018. All patients whose initial inpatient disposition was the pediatric intensive care unit were included.

Results
Six hundred forty-three children (median age, 51 months) from 57 institutions (median pediatric capability level: 3) met inclusion criteria: 46.8% were transported during nighttime, 86.5% by ground, and 21.2% accompanied by a physician. Nearly half (43.4%) had respiratory admission diagnoses. The rest included surgical/neurosurgical (14.2%), neurologic (11.2%), cardiovascular/shock (8.7%), endocrine (8.2%), infectious disease (6.8%), poisoning (3.1%), hematology-oncology (2.2%), gastrointestinal/metabolic (1.9%), and renal (0.3%). Forty-six (7.2%) had referral-to-admission diagnostic discordance: 25 of 46 had discordance across different diagnostic groups and 21 of 46 had clinically significant discordance within the same diagnostic group. The discordant group had higher need for respiratory support titration in transport (43.9% vs 27.9%, p = 0.02); more invasive procedures and vasopressor needs during the day of admission (26.1% vs 11.6%, P = 0.008; 19.6% vs 7%, P = 0.006); and longer intensive care unit (ICU) and hospital stays (5 vs 2 days; 11 vs 3 days, P < 0.001). When compared with respiratory admission diagnoses, patients with cardiovascular/shock and neurologic diagnoses were more likely to have discordant diagnoses (odds ratio [95% confidence interval], 13.24 [5.41–35.05]; 6.47 [2.48–17.75], P < 0.001).

Conclusions
Seven percent of our critically ill/injured pediatric cohort had clinically significant referral-to-admission diagnostic discordance. Patients with cardiovascular/shock and neurologic diagnoses were particularly at risk. Those with discordant diagnoses had more in-transit events; a higher need for ICU interventions postadmission; and significantly longer ICU stays and hospitalizations, deserving further investigation.
POCUS Case Review
Authors: Malik Rabia , Chen Lei , Riera Antonio 
Published: June 2020

Abstract
We report a case of a 16-year-old adolescent girl who presented to the pediatric emergency department for worsening abdominal pain and vomiting and had significant weight loss over the previous 4 months. Point-of-care ultrasound was used to assess for signs of superior mesenteric artery syndrome.
Acute Care Utilization and Health Care Expenditures in Medicaid‐Enrolled Children
Authors: Masonbrink Abbey R. , Richardson Troy , Goyal Monika K. , Hall Matt , Reed Jennifer L. , Alpern Elizabeth R. , Samuels-Kalow Margaret E. , Neuman Mark I. 
Published: June 2020

Objectives
Although recent health care reform efforts have focused on minimizing high cost health care utilization, the relationship between acute care use and health care expenditures among certain vulnerable populations such as Medicaid-insured children remains poorly understood. We sought to evaluate the association between acute care utilization and health care expenditures and to identify characteristics associated with high spending.

Methods
We performed a retrospective cohort study of Medicaid-enrolled children 1–21 years old from 1/1/2016 to 12/31/2016. Children were categorized by acute care use (including emergency department and urgent care visits) as 0, 1, 2, 3, and 4 or more visits. Our main outcomes were annualized spending, total per-member-per-year spending, and acute care-related per-member-per-year spending.

Results
There were 5.1 million Medicaid-enrolled children that comprised the study cohort, accounting for US $32.6 billion in total spending. Children with 4 or more acute care visits were more likely to be younger than 2 years or older than 14 years, female, and have a chronic condition. Children with 4 or more acute care visits consisted of only 4% of the cohort but accounted for 15% (US $4.7 billion) of the total spending. Increasing acute care visits were associated with increasing total annualized spending in adjusted analyses (P < 0.001). This association was disproportionately observed in older age groups and children without chronic medical conditions.

Conclusions
Medicaid spending for children increases with increasing acute care use; this trend was disproportionately observed in older age groups and children without chronic medical conditions. Improved understanding of factors contributing to frequent acute care utilization and disproportionate spending is needed to potentially reduce unnecessary health care costs in these pediatric populations.
The COVID-19 Pandemic: Crisis Management for Plastic Surgeons
Authors: Hollier Larry H. , Tanna Neil , Kasabian Armen K. , Abu-Ghname Amjed , Davis Matthew J. , Gibstein Alexander , Reece Edward M. 
Published: June 2020

Summary:
The worldwide outbreak of coronavirus disease 2019 (COVID-19) has forced health care systems across the United States to undertake broad restructuring to address the ongoing crisis. The framework of crisis management can assist plastic surgeons navigate the dynamic environment of the COVID-19 pandemic. This article outlines crisis management tools at a number of different levels, from hospital-wide to plastic surgeon–specific, and it offers a practical discussion of the coronavirus situation as it affects plastic surgeons. Although there are innumerable ways that this virus is currently changing plastic surgeons’ practices, it is crucial to remember that these changes are temporary, and they will be best met by being confronted head-on.
Mindfulness-Based Interventions for the Improvement of Well-Being in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis
Authors: Carletto Sara , Cavalera Cesare , Sadowski Isabel , Rovaris Marco , Borghi Martina , Khoury Bassam , Ostacoli Luca , Pagnini Francesco 
Published: June 2020

ABSTRACT

Objective
The study aims to meta-analytically review studies about the effects of mindfulness-based interventions (MBIs) on well-being of people with multiple sclerosis (MS).

Methods
Seven electronic databases were searched from June 2018 to September 2018. A systematic review and a meta-analysis were conducted.

Results
Twenty-one studies were included in qualitative synthesis, and 10 studies were included in meta-analysis. MBIs are effective with an overall moderate effect size (Hedges' g = 0.70) in improving well-being in people with MS, with lasting effects at the follow-up (g = 0.55). In particular, MBIs demonstrated to highly reduce stress (g = 1.07) and to improve depression and anxiety symptoms with a moderate to large effect at postintervention (g = 0.77 and g = 0.63, respectively).

Conclusions
MBIs represent a valid and effective mind-body intervention to improve the well-being of patients with MS. Further studies should investigate which components of MBIs could be more beneficial for patients with progressive MS.

PROSPERO registration
CRD42018099704.
Being Happy and Becoming Happier as Independent Predictors of Physical Health and Mortality
Authors: Willroth Emily C. , Ong Anthony D. , Graham Eileen K. , Mroczek Daniel K. 
Published: June 2020

ABSTRACT

Objective
The present study tested preregistered predictions regarding the prospective associations between level and change in subjective well-being (SWB) and physical health.

Methods
In two large longitudinal panel studies conducted in the United States (N = 3294) and Japan (N = 657), we used multilevel growth curve models to estimate level and change in components of SWB (i.e., life satisfaction, positive affect, and negative affect). Next, we used random intercepts and slopes to predict subsequent self-reported general health and number of chronic health conditions (in the United States and Japan) and mortality risk (in the United States).

Results
Greater life satisfaction, higher positive affect, and lower negative affect were associated with better health (0.22 < |β values| < 0.46) and longer survival. Above and beyond SWB level, longitudinal increases in life satisfaction and positive affect and longitudinal decreases in negative affect were associated with better health (0.06 < |β values| < 0.20). Moreover, all three SWB components independently predicted health, and life satisfaction and negative affect independently predicted survival. The preregistration and analysis scripts are available at osf.io/mz9gy.

Conclusions
The present findings suggest that being happy and becoming happier across time are independently associated with better physical health in the United States and Japan.