bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Associated With Knowledge Retention 3 Months After a Sexual Assault Forensic Examiner Blended Learning Course
Authors: Patterson Debra , Resko Stella 
Published: July 2020

ABSTRACT

Introduction
A blended learning continuing education course may appeal to busy healthcare professionals because the primary content can be learned online while an in-person component can hone clinical skills. The current study assessed knowledge retention in a sample of healthcare professionals who participated in a nationwide sexual assault forensic examiner blended learning course (12-week online course and 2-day in-person patient simulation).

Methods
Participants' characteristics, motivation, and external barriers were collected through a precourse web-based survey. Participants' knowledge was assessed through pretests and posttests for 12 modules and a 3-month postcourse examination. Utilizing repeated measures analysis of variance, the study examined whether participants retained their knowledge at the 3-month follow-up point. Multiple linear regression was utilized to explore the factors associated with knowledge retention.

Results
The results found a knowledge score from 77.92% to 68.83% correct. The findings indicate that participants who were interested in the blended learning course because of the 2-day patient simulation were more likely to retain knowledge. Learners with more years of experience also had slightly higher knowledge retention. Conversely, participants who were interested in becoming a sexual assault forensic examiner because of a sexual assault experience had lower knowledge retention. Participation in a past online course also was associated with a reduction in knowledge retention.

Discussion
The findings indicate a modest knowledge loss 3 months after the blended learning course. Still, some participants experienced less knowledge retention than others. Postcourse activities such as a brief refresher course may be useful to help these participants maintain their knowledge gains.
Genetic Predictors of Long‐term Response to Antitumor Necrosis Factor Agents in Pediatric Inflammatory Bowel Disease
Authors: Salvador‐Martín Sara , Bossacoma Ferrán , Pujol‐Muncunill Gemma , Navas‐López Víctor Manuel , Gallego‐Fernández Carmen , Viada Javier , Muñoz‐Codoceo Rosana , Magallares Lorena , Martínez‐Ojinaga Eva , Moreno‐Álvarez Ana , Solar‐Boga Alfonso , Segarra Oscar , Clemente Susana , Rodriguez‐Martinez Alejandro , Alvarez‐Vayo Concepción , Loverdos Inés , Merino‐Bohórquez Vicente , Balboa‐Vega María J. , Blanca‐García José A. , Fobelo María J. , Millán‐Jiménez Antonio , García‐Romero Ruth , Sanchez Cesar , Tolín Mar , de Caldas Rafael Gonzalez , Eizaguirre Francisco J. , Sánchez‐Hernandez José G. , Torres‐Peral Ricardo , Aznal Elena , García‐González Xandra , Sanjurjo‐Sáez María , López‐Fernández Luis A. 
Published: July 2020

ABSTRACTObjectives:Inflammatory bowel disease (IBD) is more complex in children and they will have to live with the disease for much longer. For this reason, it is necessary to optimize treatment. The polymorphisms associated with the response to anti‐tumor necrosis factor (TNF) drugs in adults with IBD have not been analyzed in children. The aim of the study was to identify genetic variants associated with the long‐term response to anti‐TNF drugs in children with IBD.Methods:An observational, longitudinal, ambispective cohort's study was conducted. We recruited 209 anti‐TNF‐treated children diagnosed with IBD and genotyped 21 polymorphisms previously studied in adults with Crohn disease (CD) using real‐time PCR. The association between single‐nucleotide polymorphisms (SNPs) and time‐to‐failure was analyzed using the log‐rank test.Results:After multivariate analysis, 3 SNPs in IL10, IL17A and IL6 were significantly associated with response to anti‐TNF treatment among patients diagnosed with CD (rs1800872‐HR, 4.749 (95% confidence interval [CI] 1.156–19.517), P value < 0.05; rs2275913‐HR, 0.320 [95% CI 0.111–0.920], P value < 0.05; and rs10499563‐HR, 0.210 [95% CI 0.047–0.947], P value 0.05, respectively). None of these SNPs were associated with response to infliximab in adults diagnosed with CD. Among patients diagnosed with ulcerative colitis (UC), 1 SNP in LY96 was significantly associated with response to anti‐TNF treatment (rs‐11465996‐HR, 10.220 [95% CI 1.849–56.504] P value < 0.05).Conclusions:Genotyping of these DNA variants before starting treatment may help to identify children who are long‐term responders to anti‐TNF drugs, and thus tailor treatment of pediatric IBD.
Parent Perspectives on Exclusive Enteral Nutrition for the Treatment of Pediatric Crohn Disease
Authors: Mehta Pooja , Pan Zhaoxing , Furuta Glenn T. , Kim David Yonghyuk , de Zoeten Edwin F. 
Published: July 2020

ABSTRACTObjectives:Exclusive enteral nutrition (EEN) is infrequently used in the United States but is an effective treatment for pediatric Crohn disease (CD). Limited data exists regarding patient and parent perspectives on this treatment modality. The aim of this study was to determine parent and provider perspectives regarding EEN and understand parent‐cited barriers to its use.Methods:We surveyed the parents/guardians of children ages 1 through 17 with CD in our institution regarding EEN. Healthcare provider perspectives regarding reason for stopping EEN and those cited by survey respondents were compared using retrospective chart review.Results:One hundred fifteen (62.5%) out of 184 recipients responded to the survey. Ninety percentage of respondents had heard of EEN but of these, 26% had not discussed it with their gastroenterologist. Thirty‐eight patients (33%) were treated in the past and 15 (13%) were currently on EEN. Common barriers cited by current EEN users were cost/finances and difficult social situations. Of the children who stopped EEN, most did so as parents felt it was not working (n = 14, 37%). In these cases, their primary gastroenterologist cited treatment failure for 4 cases and nonadherence for 6.Conclusions:Despite the efficacy of EEN and interest in dietary treatments by patients with CD, there are many barriers surrounding effective communication and successful implementation of dietary therapies. Future research is needed regarding patient‐physician communication, cost mitigation, and coping with the social limitations of dietary therapies.
Gut Microenvironment and Bacterial Invasion in Paediatric Inflammatory Bowel Diseases
Authors: Zaidi Deenaz , Huynh Hien Q. , Carroll Matthew W. , Mandal Rupasri , Wishart David S. , Wine Eytan 
Published: July 2020

ABSTRACT

Objectives:
Host-microbial relationship is disrupted in inflammatory bowel diseases (IBD). We hypothesized that altered gut luminal microenvironment can impact microbial virulence in IBD, leading to disruption of homeostasis and disease. We investigated the relationship between gut microenvironment and microbial virulence.

Methods:
Intestinal aspirates were collected from 10 non-IBD controls, 9 Crohn disease, and 10 ulcerative colitis paediatric patients during endoscopy. In vitro invasion of bacteria isolated from the duodenum and terminal ileum (TI) was quantified using gentamicin protection assays. Intestinal epithelial cells were infected in vitro by known Escherichia coli strains with patient intestinal aspirates added. Nuclear magnetic resonance spectroscopy (NMR) analysis was conducted on intestinal aspirates to identify metabolites associated with invasion; these metabolites were then introduced to the infection model.

Results:
There was no difference in in vitro invasion of bacteria obtained from intestinal aspirates of non-IBD and IBD patients. Incubation of laboratory E coli strains with TI aspirates from IBD patients increased their invasion into epithelial cells in vitro. NMR analysis revealed intestinal metabolites that correlated with bacterial invasion; succinate present in the intestinal aspirates correlated positively, whereas acetate and formate related negatively with invasion. Addition of exogenous succinate increased invasion of E coli in vitro.

Conclusions:
Alterations in the gut microenvironment in IBD can affect bacterial invasion. Succinate is associated with increased bacterial invasion and can alter bacterial virulence in IBD. This highlights the interaction between specific metabolites and bacteria that could be instrumental in propagating or suppressing inflammation in paediatric IBD patients.
Factors Associated With 5- and 10-Year Survival After Intestinal Transplantation in Infants and Children
Authors: Kara Balla Abdalla , Elsabbagh Ahmed , Khan Khalid M. , Kroemer Alexander H.K. , Hawksworth Jason S. , Yazigi Nada A. , Fishbein Thomas M. , Matsumoto Cal S. , Kaufman Stuart S. 
Published: July 2020

ABSTRACT

Objectives:
Intestinal transplantation is an option for permanent intestinal failure with parenteral nutrition intolerance. We sought to determine long-term intestinal graft survival in pediatric patients at our center and to identify factors influencing survival.

Methods:
Retrospective chart review of 86 patients transplanted between 2003 and 2013, targeting potential explanatory variables related to demographics, perioperative factors, and postoperative complications.

Results:
Intestinal graft survival was 71% and 65% after 5 and 10 years, respectively. Five-year graft survival was attained in 79% of patients with a history of anatomic intestinal failure compared with 45% with functional intestinal failure (P = 0.0055). Compared with nonsurvival, 5-year graft survival was also associated with reduced incidences of graft-versus-host disease (2% vs 16%, P = 0.0237), post-transplant lymphoproliferative disorder (3% vs 24%, P = 0.0067), and de novo donor-specific antibodies (19% vs 57%, P = 0.0451) plus a lower donor-recipient weight ratio (median 0.727 vs 0.923, P = 0.0316). Factors not associated with 5-year intestinal graft survival included graft rejection of any severity and inclusion of a liver graft. Factors associated with graft survival at 10 years were similar to those at 5 years.

Conclusions:
In our experience, outcomes in pediatric intestinal transplantation have improved substantially for anatomic but not functional intestinal failure. Graft survival depends on avoidance of severe infectious and immunological complications including GVHD, whereas inclusion of a liver graft provides no obvious survival benefit. Reduced success with functional intestinal failure may reflect inherently increased susceptibility to complications in this group.
Reduced Intestinal Inflammation With Lumacaftor/Ivacaftor in Adolescents With Cystic Fibrosis
Authors: Tétard Candice , Mittaine Marie , Bui Stéphanie , Beaufils Fabien , Maumus Pascale , Fayon Michael , Burgel Pierre‐Regis , Lamireau Thierry , Delhaes Laurence , Mas Emmanuel , Enaud Raphaël 
Published: July 2020

ABSTRACTA chronic intestinal inflammation may occur in patients with cystic fibrosis (CF), while no therapeutic management is proposed. Although Lumacaftor/Ivacaftor is well‐known to modulate the defective cystic fibrosis transmembrane conductance regulator (CFTR) protein in lungs, no data are available on the impact of this treatment on CF intestinal disorders. We, therefore, investigated the evolution of intestinal inflammation after initiation of Lumacaftor/Ivacaftor in CF adolescents (median of follow‐up: 336 days [IQR: 278;435]). Median fecal calprotectin concentrations decreased significantly after Lumacaftor/Ivacaftor initiation (102 μg/g [IQR: 69–210]) compared with the baseline (713 μg/g (IQR:148–852), P = 0.001). To our knowledge, this study showed for the first time that CF‐related intestinal inflammation is improved by Lumacaftor/Ivacaftor treatment.
Cystic Fibrosis‐related Liver Disease
Authors: Baker Robert D. , Baker Susan S. 
Published: July 2020

ABSTRACTUp to 40% of individuals with cystic fibrosis have cystic fibrosis‐related liver disease (CFLD); however, only 5% to 10% will have clinically evident disease. With the introduction of powerful cystic fibrosis transmembrane conductance regulator (CFTR) enhancers, effective treatment for cystic fibrosis is available. The role of CFTR enhancers in liver disease is unknown at this time. The traditionally accepted theory of the pathogenesis of CFLD is being questioned. A different pathogenesis may lead to new ways to treat CFLD. The way that CFLD is diagnosed and monitored is evolving as new imaging technology become available.
A Case of Lysosomal Acid Lipase Deficiency Confirmed by Response to Sebelipase Alfa Therapy
Authors: Shen Joseph J. , Davis Jessica L. , Hong Xinying , Laningham Fred H. , Gelb Michael H. , Kim Grace E. 
Published: July 2020

ABSTRACTLysosomal acid lipase (LAL) deficiency, or cholesterol ester storage disease, is a disorder affecting the breakdown of cholesterol esters and triglycerides within lysosomes. Clinical findings include hepatomegaly, hepatic dysfunction, and dyslipidemia with a wide range of phenotypic variability and age of onset. The available clinical and molecular information of the patient presented herein was consistent with a diagnosis of LAL deficiency, but her LAL activity assay repeatedly showed normal or borderline low results. Her response to enzyme replacement therapy and demonstrable deficiency on a newer specific enzymatic assay ultimately confirmed her diagnosis of LAL deficiency.
Lipidomics in Nonalcoholic Fatty Liver Disease
Authors: Draijer Laura G. , Froon‐Torenstra Denise , van Weeghel Michel , Vaz Frédéric M. , Bohte Anneloes E. , Holleboom Adriaan G. , Benninga Marc A. , Koot Bart G.P. 
Published: July 2020

ABSTRACTObjectives:Disturbances in lipid metabolism play an important role in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). Using lipidomics, an analytical technique that is used to broadly survey lipid metabolism, we searched for biomarkers in plasma that are correlated with the presence of hepatic steatosis in children with obesity.Methods:Lipidomics was performed in plasma samples of 21 children with obesity in whom steatosis was detected using proton magnetic resonance spectroscopy (1H‐MRS) and were compared with the lipidome of 21 samples of nonsteatotic subjects with obesity.Results:Forty‐two samples were analyzed (57% boys; median age 15 years). A total of 18 lipid classes constituting 839 different lipid species were identified. A statistically significant increase in alkyldiacylglycerol (TG[O]) and phosphatidylethanolamine (PE) species and a significant decrease in alkyl/alkenyl‐phosphatidylethanolamine (PE[O]), alkyl/alkenyl‐lysophosphatidylethanolamine (LPE[O]) and alkyl/alkenyl‐phosphatidylcholine (PC[O]) was observed in children with hepatic steatosis compared with controls. Twelve individual lipid species of 3 lipid classes were significantly increased in steatotic subjects compared with controls.Conclusions:In this pilot study, we found statistically significant alterations in 5 major lipid classes and 12 individual lipid species in children with steatosis. These might be potential biomarkers for pediatric NAFLD. Lipidomic studies in larger cohorts of children are needed to determine the diagnostic value of these lipids and determine whether results can be generalized for different age groups and ethnic backgrounds.
Fall Prevention Practices and Implementation Strategies: Examining Consistency Across Hospital Units
Authors: Turner Kea , Staggs Vincent S. , Potter Catima , Cramer Emily , Shorr Ronald I. , Mion Lorraine C. 
Published: July 2020

Objective
Our study examines how consistently fall prevention practices and implementation strategies are used by U.S. hospitals.

Methods
We conducted a cross-sectional, descriptive study of 60 general adult hospital units.
We administered a survey measuring 5 domains of fall prevention practices: visibility and identification, bed modification, patient monitoring, patient safety, and education. We measured 4 domains of implementation strategies including quality management (e.g., providing data and support for quality improvement), planning (e.g., designating leadership), education (e.g., providing consultation and training), and restructuring (e.g., revising staff roles and modifying equipment).

Results
Of 60 units, 43% were medical units and 57% were medical-surgical units. The hospital units varied in fall prevention practices, with practices such as keeping a patient’s bed in a locked position (73% strongly agree) being used more consistently than other practices, such as scheduled toileting (15% strongly agree). Our study observed variation in fall prevention implementation strategies. For example, publicly posting fall rates (60% strongly agree) was more consistently used than having a multidisciplinary huddle after a fall event (12% strongly agree).

Conclusions
There is substantial variation in the implementation of fall prevention practices and implementation strategies across inpatient units. Our study found that resource-intensive practices (e.g., scheduled toileting) are less consistently used than less resource-intensive practices and that interdisciplinary approaches to fall prevention are limited. Future studies should examine how units tailor fall prevention practices based on patient risk factors and how units decide, based on their available resources, which implementation strategies should be used.
Influence of Human Immunodeficiency Virus Infection on the Management and Outcomes of Acute Myocardial Infarction With Cardiogenic Shock
Authors: Vallabhajosyula Saraschandra , Subramaniam Anna V. , Sundaragiri Pranathi R. , Cheungpasitporn Wisit , Temesgen Zelalem , O'Horo John C , Jaffe Allan S. , Barsness Gregory W. 
Published: July 2020

Background:There are limited data on the outcomes of acute myocardial infarction–cardiogenic shock (AMI-CS) in patients with HIV infection and AIDS.Setting:Twenty percent sample of all US hospitals.Methods:A retrospective cohort of AMI-CS during 2000–2017 from the National Inpatient Sample was evaluated for concomitant HIV and AIDS. Outcomes of interest included in-hospital mortality and use of cardiac procedures. A subgroup analysis was performed for those with and without AIDS within the HIV cohort.Results:A total 557,974 AMI-CS admissions were included, with HIV and AIDS in 1321 (0.2%) and 985 (0.2%), respectively. The HIV cohort was younger (54.1 vs. 69.0 years), more often men, of non-White race, uninsured, from a lower socioeconomic status, and with higher comorbidity (allP< 0.001). The HIV cohort had comparable multiorgan failure (37.8% vs. 39.0%) and cardiac arrest (28.7% vs. 27.4%) (P> 0.05). The cohorts with and without HIV had comparable rates of coronary angiography (70.2% vs. 69.0%;P= 0.37) but less frequent early coronary angiography (hospital day zero) (39.1% vs. 42.5%;P< 0.001). The cohort with HIV had higher unadjusted but comparable adjusted in-hospital mortality compared with those without [26.9% vs. 37.4%; adjusted odds ratio 1.04 (95% confidence interval: 0.90 to 1.21);P= 0.61]. In the HIV cohort, AIDS was associated with higher in-hospital mortality [28.8% vs. 21.1%; adjusted odds ratio 4.12 (95% confidence interval: 1.89 to 9.00);P< 0.001].Conclusions:The cohort with HIV had comparable rates of cardiac procedures and in-hospital mortality; however, those with AIDS had higher in-hospital mortality.
Brief Report: Retrospective Evaluation on the Efficacy of Lopinavir/Ritonavir and Chloroquine to Treat Nonsevere COVID-19 Patients
Authors: Gao Guiju , Wang Aibin , Wang Sa , Qian Fang , Chen Meiling , Yu Fengting , Zhang Ju , Wang Xudong , Ma Xiaoyang , Zhao Tianwei , Zhang Fujie , Chen Zhihai 
Published: July 2020

Background:
The effectiveness of lopinavir/ritonavir (LPV/r) and chloroquine treatment for COVID-19 has not been verified.

Methods:
We conducted a retrospective study to summarize the clinical practices of nonsevere patients with COVID-19 receiving the standard care, LPV/r or chloroquine in Beijing Ditan Hospital from January 20 to March 26, 2020. The main outcome measurements include the changes of cycle threshold values of open reading frame 1 ab (ORF1ab) and nucleocapsid (N) genes by reverse transcriptase–polymerase chain reaction assay from day 1 to 7 after admission for patients receiving standard care or after treatment being initiated for patients receiving either LPV/r or chloroquine. The proportion of developing severe illness, fever duration and the time from symptom onset to chest computer tomography improvement, and negative conversion of nucleic acid were compared.

Results:
Of the 129 patients included in the study, 59 received the standard care, 51 received LPV/r, and 19 received chloroquine. The demographics and baseline characteristics were comparable among the 3 groups. The median duration of fever, median time from symptom onset to chest computer tomography improvement, and negative conversion of the nucleic acid were similar among the 3 groups. The median increase in cycle threshold values of N and ORF1ab gene for patients receiving LPV/r or chloroquine or the standard care during the treatment course was 7.0 and 8.5, 8.0, and 7.6, 5.0, and 4.0, respectively. These figures were not found significantly different among the 3 groups.

Conclusions:
Antiviral therapy using LPV/r or chloroquine seemed not to improve the prognosis or shorten the clinical course of COVID-19.
Costs and Cost-Effectiveness of the Patient-Centered HIV Care Model: A Collaboration Between Community-Based Pharmacists and Primary Medical Providers
Authors: Shrestha Ram K. , Schommer Jon C. , Taitel Michael S. , Garza Oscar W. , Camp Nasima M. , Akinbosoye Osayi E. , Clay Patrick G. , Byrd Kathy K. ,   for the Patient-centered HIV Care Model Team
Published: July 2020

Background:
The patient-centered HIV care model (PCHCM) is an evidence-informed structural intervention that integrates community-based pharmacists with primary medical providers to improve rates of HIV viral suppression. This report assesses the costs and cost-effectiveness of the PCHCM.

Setting:
Patient-centered HIV care model.

Methods:
Three project sites, each composed of a medical clinic and 1 or 2 community-based HIV-specialized pharmacies, were included in the analyses. PCHCM required patient data sharing between medical providers and pharmacists and collaborative therapy-related decision making. Intervention effectiveness was measured as the incremental number of patients virally suppressed (HIV RNA <200 copies/mL at the last test in a 12-month measurement period). Microcosting direct measurement methods were used to estimate intervention costs. The cost per patient, cost per patient visit, and incremental cost per patient virally suppressed were calculated from the health care providers' perspective. Additionally, the number of HIV transmissions averted, lifetime HIV treatment cost saved, quality-adjusted life years (QALYs) saved, and cost per QALY saved were calculated from the societal perspective, using standard methods and reported values from the published literature.

Results:
Overall, the PCHCM annual intervention cost for the 3 project sites was $226,741. The average cost per patient, cost per patient visit, and incremental cost per patient virally suppressed were $813, $48, and $5,039, respectively. The intervention averted 2.75 HIV transmissions and saved 12.22 QALYs and nearly $1.28 million in lifetime HIV treatment costs. The intervention was cost saving overall and at each project site.

Conclusions:
The PCHCM can be delivered at a relatively low cost and is a cost-saving intervention to assist patients in achieving viral suppression and preventing HIV transmission.