bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improvement of diagnostic accuracy of 18fluorine-fluorodeoxyglucose PET/computed tomography in detection of infective endocarditis using a 72-h low carbs protocol
Authors: Gazzilli Maria , Albano Domenico , Durmo Rexhep , Cerudelli Elisabetta , Mesquita Tinoco Claudio , Bertagna Francesco , Giubbini Raffaele 
Published: May 2020

Background
The major challenge in diagnosing infective endocarditis using 18fluorine-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) is the high physiological myocardial 18F-FDG uptake, which may interfere with the detection of pathological uptake. Our aim was to retrospectively analyse the impact of a low-carbohydrate, high-protein, high-fat (LCHPHF) diet starting 72 h before the examination with classic overnight fasting.

Methods
We included 92 patients (51 with LCHPHF diet 72 h before the examination and 41 with overnight fast only). Left ventricular (LV) myocardial 18F-FDG uptake was visually evaluated, to estimate the effect of LCHPHF on myocardial 18F-FDG uptake, we used a three-point visual scale: 0, negligible uptake and evaluable examination; 1, mild uptake and doubtful examination and 2, intense uptake and not evaluable examination. SUVmax and SUVmean were calculated putting a region of interest on LV myocardium at the level of the largest cardiac footprint and on the site of suspected lesion. Thus, a ratio between SUV of the suspect lesion and SUV of LV was calculated as SUV ratio.

Results
By visual assessment, in LCHPHF diet group 46 patients (96.1%) had score 0, 3 patients (5.9%) had score 1 and nobody had score 2. In control group, 23 patients (56.1%) had a score 2, 12 (29.3%) patients obtained a score 1 with a doubtful examination and 6 patients (14.6%) were classified with a score 0 with reportable examination.

Conclusion
We demonstrated that an LCHPHF diet can adequately suppress the physiological myocardial uptake leading to a significant improvement in the interpretability and diagnostic accuracy of 18F-FDG PET/CT in infective endocarditis.
Incidence and Sequelae of Liver Injury Among Children Treated for Solid Tumors
Authors: Cardenas Vanessa , Mankuzhy Nikhil , Mody Rajen , McCaffery Harlan , Fontana Robert J. , DiPaola Frank 
Published: May 2020

ABSTRACTObjectives:Pediatric oncology patients are at risk of adverse drug events. The incidence and etiologies of liver injury in this population are not well characterized. We utilized a large, single‐center pediatric oncology registry to investigate the incidence, causes, and outcomes of liver injury during treatment for solid tumor malignancies.Methods:We reviewed all young individuals (age <25 years) who received treatment for any solid tumor at the University of Michigan between January 2004 and July 2016. Subjects with liver injury meeting predetermined laboratory criteria were identified. Cases were independently reviewed by 2 expert hepatologists to assign a cause of liver injury. Clinical characteristics of drug‐induced liver injury (DILI) and non‐DILI cases were compared. Cases of liver injury occurring after bone marrow or liver transplant were excluded.Results:Of 1136 solid tumor patients, 160 (14%) experienced liver injury, and the overall frequency of DILI was 4%. DILI was the leading identified cause of liver injury (31%), followed by infection (17%), metastatic/malignant biliary disease (13%), and perioperative liver injury (13%). Most DILI cases (>90%) were mild acute hepatocellular injury episodes that did not result in modification to the chemotherapy plan, and all DILI eventually resolved. Severe presentations involving jaundice and/or prolonged hospital course were significantly more common among non‐DILI versus DILI cases (23% vs 2%, P < 0.001).Conclusions:DILI is the leading cause of liver injury events among pediatric solid tumor patients. In our registry, DILI was of mild severity and did not result in an alteration of the treatment plan in most patients. In contrast, non‐DILI‐related liver injury events, including infection, were more likely to have a more severe presentation and a complicated course with a greater mortality during follow‐up.
Emotional Wellbeing in Parents of Children on Home Parenteral Nutrition
Authors: Halsey Mary , Hodgson Kate , Russell Rachel , Campion Anna , Machado Catarina , Beattie Robert M. , Batra Akshay 
Published: May 2020

ABSTRACTObjectives:Caring for a child on home parenteral nutrition (HPN) is stressful, and its emotional impact not fully appreciated. This study explored the emotional wellbeing and coping styles of parents and children on HPN.Methods:Questionnaire data were collected for parents of children (0–18 years) on HPN. Children 8 years and older completed the revised children's anxiety and depression scale. Parents completed the Hospital Anxiety and Depression Scale, Paediatric Inventory for Parents (PIP) and brief COPE.Results:A total of 14 children were included, 20 parents (13 females) and 4 children completed the survey. Parents had mean PIP difficulty and frequency score of 117.9 and 124, respectively, higher compared to parents of children with other chronic illness. PIP scores were significantly higher where children were also enterally tube fed (P < 0.05). Thirty‐five per cent parents scored above clinical threshold on anxiety subscale of Hospital Anxiety and Depression Scale and 30% in borderline range. On depression subscale 15% scored above clinical threshold range and 15% in borderline range. Mean anxiety and depression scores in parents of children with short bowel syndrome (11.8, 7.8) were significantly higher than those with neuromuscular disease (5.8, 1.6) P < 0.05. Coping styles differed according to health condition and whether child was enterally fed.Conclusions:There is a significant emotional impact of caring for a child on HPN, assessment and treatment of anxiety, depression, and stress should be a routine part of care. Individual needs of the child and parent need to be taken into account in providing the most appropriate psychological support.
Role of Budesonide for the Treatment of Rejection in Pediatric Liver Transplantation
Authors: Chen Justin , Ferreira Johanna , Martinez Mercedes , Lobritto Steven , Goldner Dana , Vittorio Jennifer 
Published: May 2020

ABSTRACTIntroduction:Corticosteroids are an integral part of liver transplant (LT) immunosuppression regimens but are often accompanied by many adverse effects. Budesonide is an oral corticosteroid with extensive (80%–90%) hepatic first‐pass metabolism and minimal systemic absorption. The aim of this study was to examine the safety and efficacy of budesonide for management of acute cellular rejection (ACR) in pediatric LT recipients.Methods:A retrospective descriptive analysis was performed for all pediatric patients who underwent LT at our center and were prescribed oral budesonide for the treatment of ACR. Alanine aminotransferase (ALT) values and documented adverse effects were reviewed.Results:Twenty‐nine patients were prescribed budesonide for the treatment of ACR; 65.5% with biopsy‐proven acute rejection and 34.5% with presumed ACR. There was a significant decrease in ALT noted from the time of rejection when compared to values 1 month (P = 0.0011), 3 months (P = 0.0003), and 6 months (P = 0.0001) after treatment with budesonide. There was no difference noted between patient baseline ALT levels before rejection when compared to 1, 3, and 6 months posttreatment values suggesting resolution of rejection. Three patients required conversion from budesonide to systemic steroids. There were no discontinuations of budesonide secondary to adverse effects.Conclusion:Oral budesonide may be a promising alternative to systemic corticosteroids for the management of mild/moderate ACR and for empiric treatment of ACR in select pediatric LT recipients. Data from this study may provide the foundation for larger, prospective, multicenter trials to assess the effectiveness of budesonide in the treatment of ACR.
Sexually Transmitted Infection Prevalence Among Women at Risk for HIV Exposure Initiating Safer Conception Care in Rural, Southwestern Uganda
Authors: Chitneni Pooja , Bwana Mwebesa Bosco , Owembabazi Moran , O'Neil Kasey , Kalyebara Paul Kato , Muyindike Winnie , Musinguzi Nicholas , Bangsberg David R. , Marrazzo Jeanne M. , Haberer Jessica E. , Kaida Angela , Matthews Lynn T. 
Published: May 2020

Background
Knowledge of sexually transmitted infection (STI) prevalence and risk factors is important to the development of tenofovir-based preexposure prophylaxis (PrEP) and safer conception programming. We introduced STI screening among women at risk for HIV exposure who were participating in a safer conception study in southwestern Uganda.

Methods
We enrolled 131 HIV-uninfected women, planning for pregnancy with a partner living with HIV or of unknown HIV serostatus (2018–2019). Women were offered comprehensive safer conception counseling, including PrEP. Participants completed interviewer-administered questionnaires detailing sociodemographics and sexual history. We integrated laboratory screening for chlamydia, gonorrhea, trichomoniasis, and syphilis as a substudy to assess STI prevalence. Multivariable logistic regression was used to determine correlates.

Results
Ninety-four women completed STI screening (72% of enrolled). Median age was 30 (interquartile range, 26–34) years, and 94% chose PrEP as part of safer conception care. Overall, 24% had STIs: 13% chlamydia, 2% gonorrhea, 6% trichomoniasis, 6% syphilis, and 3% ≥2 STI. Sexually transmitted infection prevalence was associated with younger age (adjusted odds ratio [AOR], 0.87; 95% confidence interval [CI], 0.77–0.99), prior stillbirth (AOR, 5.04; 95% CI, 1.12–22.54), and not feeling vulnerable to HIV (AOR, 16.33; 95% CI, 1.12–237.94).

Conclusions
We describe a 24% curable STI prevalence among women at risk for HIV exposure who were planning for pregnancy. These data highlight the importance of integrating laboratory-based STI screening into safer conception programs to maximize the health of HIV-affected women, children, and families.
Construction and Validation of LEA Hindi Chart: A Multicenter Study
Authors: Datta Sourav , Varadharajan Srinivasa , Mazumdar Deepmala , Narayanan Anuradha , Monira Sirajum , Panda Soumya , Hyvärinen Lea , Satgunam PremNandhini 
Published: May 2020

SIGNIFICANCEThis study explains the construction and validation of a chart in Hindi language, one of the commonly spoken languages in the world. The new visual acuity chart is called LEA Hindi chart. The calligraphy construction method described here can help develop other such acuity charts.PURPOSEThe purpose of this study was to construct and validate a new logMAR Hindi visual acuity chart (LEA Hindi chart) using principles similar to that of LEA symbols acuity chart.METHODSA multicenter (three centers) study was conducted in two phases. The first phase consisted of identifying and constructing the Hindi optotypes using calligraphy techniques. The Hindi optotypes were calibrated against the Landolt C optotypes by measuring the threshold distance for visual acuity. In the second phase, the newly constructed LEA Hindi chart was validated against the Early Treatment Diabetic Retinopathy Study (ETDRS) and Landolt C visual acuity charts. Sixty participants were enrolled for the first phase (centers 1 and 2) and for the second phase of the study (centers 1 and 3). Additional 15 participants were enrolled (center 1) for testing repeatability.RESULTSFour Hindi optotypes were identified and used for the construction of the chart (first phase). In the second phase, the LEA Hindi chart was found to be comparable with both the Landolt C, (logMAR acuity difference, 0.03 ± 0.13;P> .18) and ETDRS (logMAR acuity difference, −0.02 ± 0.09;P> .25) charts. All the three charts were also found to be repeatable (95% limits of agreement within 0.24 logMAR).CONCLUSIONSThe newly constructed LEA Hindi visual acuity chart gave comparable levels of visual acuity as that measured in an ETDRS or Landolt C charts. The repeatability was also similar to the standard charts. The LEA Hindi visual acuity chart can be used for patients comfortable with Hindi language and also in studies requiring multiple measurements of visual acuity, to avoid familiarity to a given chart.
Longitudinal Changes in Optical Quality, Spatial Vision, and Depth Vision after Laser Refractive Surgery for Myopia
Authors: Sarkar Samrat , Bharadwaj Shrikant R. , Reddy Jagadesh C. , Vaddavalli Pravin K. 
Published: May 2020

SIGNIFICANCE
Laser refractive surgery procedures are efficacious at correcting myopia, but they result in long-term deterioration of optical quality that affects monocular and binocular visual performance. The study shows that the optical quality of the two eyes needs to be similar to optimize binocular visual performance after surgery.

PURPOSE
This study aimed to systematically analyze longitudinal changes in optical quality, high- and low-contrast logMAR acuity and random-dot stereoacuity before and after three refractive surgery procedures for correcting myopia.

METHODS
A total of 106 subjects (laser-assisted in situ keratomileusis, 40; photorefractive keratectomy, 26; small-incision lenticule extraction, 40) with myopia and astigmatism ≤1.5 D participated in this prospective cohort-based study. All aforementioned outcome variables were measured in both eyes pre-operatively and 1 week and 1, 3, and 6 months post-operatively.

RESULTS
Pre-operative myopic spherical equivalent of refraction (median [25th to 75th interquartile range], −6.4 D [−8.0 to −4.2 D] for laser-assisted in situ keratomileusis, −4.3 D [−5.0 to −3.5 D] for photorefractive keratectomy, −5.5 D [−6.5 to −4.3 D] for small-incision lenticule extraction) was corrected to within ±0.75 D of emmetropia in all cohorts up to 6 months post-operatively (P < .001). Higher-order wavefront aberrations, uncorrected high- and low-contrast logMAR acuity, and stereoacuity all worsened and remained so up to 6 months post-operatively, relative to pre-operative values (P < .001). Stereoacuity worsened with both interocular average and difference in the magnitude of higher-order aberrations, whereas logMAR acuities worsened only with interocular average of these aberrations (r
2 ≥ 0.40; P < .01 for all).

CONCLUSIONS
Although the refractive surgery procedures tested here correct myopia, they result in a sustained (up to 6 months) loss of optical quality and spatial and depth-related visual functions post-operatively. Both interocular average and difference in the eye's optical quality seem to impair binocular visual functions after refractive surgery for myopia.
Evaluation of Bivalirudin As an Alternative to Heparin for Systemic Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation*
Authors: Hamzah Mohammed , Jarden Angela M. , Ezetendu Chidiebere , Stewart Robert 
Published: May 2020

Objectives:
Heparin is the universal anticoagulant for patients receiving extracorporeal membrane oxygenation support. However, heparin has many disadvantages, especially in young children, who develop heparin resistance. Recently our center has used bivalirudin, a direct thrombin inhibitor, for systemic anticoagulation in pediatric extracorporeal life support. Bivalirudin binds directly to thrombin with no need for antithrombin III and it inhibits both circulating and clot-bound thrombin. In this study, we sought to evaluate our experience with bivalirudin in pediatric extracorporeal life support.

Design:
Retrospective chart review study of patients receiving extracorporeal membrane oxygenation support between October 2014 and May 2018.

Setting:
Tertiary, academic PICU.

Patients:
Sixteen patients receiving heparin and 16 patients receiving bivalirudin on extracorporeal life support were included in the study.

Interventions:
None.

Measurements and Main Results:
Patients in the bivalirudin group had a median age of 31 months versus 59 months in the heparin group (p = 0.41). Recovery and extracorporeal membrane oxygenation decannulation were similar in both groups (56% in the heparin group and 62% in the bivalirudin group; p = 0.62). Time to reach goal therapeutic anticoagulation level was shorter in the bivalirudin group (11 vs 29 hr; p = 0.01). Bleeding events were fewer in the bivalirudin group, and there was no difference in the rate of thrombotic events between the two groups. Comprehensive cost analysis that includes anticoagulant, laboratories, and antithrombin III cost, showed that heparin anticoagulation therapy total cost was significantly higher than bivalirudin (1,184 dollars per day in heparin group vs 494 dollars per day in bivalirudin group; p = 0.03). Bivalirudin dose required to maintain target anticoagulation will increase over time, and this is associated with an increase in creatinine clearance and an increase in fibrinogen serum levels.

Conclusions:
This study showed that the use of bivalirudin in pediatric extracorporeal membrane oxygenation support is feasible, safe, reliable, and cost-effective in comparison to heparin. Further prospective randomized clinical trials are necessary to confirm our observations.
Organizational Interventions to Support Second Victims in Acute Care Settings: A Scoping Study
Authors: Wade Laura , Fitzpatrick Eleanor , Williams Natalie , Parker Robin , Hurley Katrina F. 
Published: May 2020

Objectives
Health care providers that experience harm after adverse events have been termed “second victims.” Our objective was to characterize the range and context of interventions to support second victims in acute care settings.

Methods
We performed a scoping study using Arksey and O’Malley’s process. A library scientist searched PubMed, Cumulative Index of Nursing and Allied Health, EMBASE, and Cochrane Central Register of Controlled Trials in September 2017, and updated the search in November 2018. We sought gray literature (Canadian Electronic Library, Proquest and Scopus) and searched reference lists of included studies. Stakeholder organizations and authors of included studies were contacted. Two reviewers independently reviewed titles and abstracts and extracted data. A qualitative approach was used to categorize the context and characteristics of the 22 identified interventions.

Results
After screening 5634 titles and abstracts, 173 articles underwent full-text screening. Twenty-two interventions met the criteria and were categorized as providing peer support (n = 8), proactive education (n = 6), or both (n = 8). Programs came from Canada (n = 2), Spain (n = 2), and the United States (n = 18). A specific traumatic event triggered the development of 5 programs. Some programs used a standard definition of second victims, (n = 6), whereas other programs had a broader scope (n = 12). Confidentiality was explicitly assured in 9 peer support programs. Outcome measures were often not reported.

Conclusions
This is a new area of study with little qualitative data from which to determine whether these programs are effective. Many programs had a similar design, based on the structure proposed by the same small group of experts in this new field. Concerns about potential legal proceedings hinder documentation and study of program effectiveness.
Prediction of Perioperative Cardiovascular Events in Liver Transplantation
Authors: Koshy Anoop N. , Farouque Omar , Cailes Benjamin , Ko Jefferson , Han Hui-Chen , Weinberg Laurence , Testro Adam , Robertson Marcus , Teh Andrew W. , Lim Han S. , Gow Paul J. 
Published: May 2020

Background.
Hepatorenal syndrome (HRS) is a serious complication of liver cirrhosis with poor survival in the absence of liver transplantation (LT). HRS represents a state of profound circulatory and cardiac dysfunction. Whether it increases risk of perioperative major adverse cardiovascular events (MACE) following LT remains unclear.

Methods.
We performed a retrospective cohort study of 560 consecutive patients undergoing cardiac workup for LT of whom 319 proceeded to LT. All patients underwent standardized assessment including dobutamine stress echocardiography. HRS was defined according to International Club of Ascites criteria.

Results.
Primary outcome of 30-day MACE occurred in 74 (23.2%) patients. A significantly higher proportion of patients with HRS experienced MACE (31 [41.9%] versus 54 [22.0%]; P = 0.001). After adjusting for age, model for end-stage liver disease score, cardiovascular risk index, history of coronary artery disease, and a positive stress test, HRS remained an independent predictor for MACE (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.13-5.78). Other independent predictors included poor functional status (OR, 3.38; 95% CI, 1.41-8.13), pulmonary hypertension (OR, 3.26; 95% CI, 1.17-5.56), and beta-blocker use (OR, 2.56; 95% CI, 1.10-6.48). Occurrence of perioperative MACE was associated with a trend toward poor age-adjusted survival over 3.6-year follow-up (hazard ratio, 2.0; 95% CI, 0.98-4.10; P = 0.057).

Conclusions.
HRS, beta-blocker use, pulmonary hypertension, and poor functional status were all associated with over a 2-fold higher risk of MACE following LT. Whether inclusion of these variables in routine preoperative assessment can facilitate cardiac risk stratification warrants further study.
Critical levels of mask efficiency and of mask adoption that theoretically extinguish respiratory virus epidemics
Authors: Kot Alan D. 
Published: May 2020

AbstractUsing a respiratory virus epidemiological model we derive equations for the critical levels of mask efficiency (fraction blocked) and of mask adoption (fraction of population wearing masks) that lower the effective reproduction number to unity. The model extends a basic epidemiological model and assumes that a specified fraction of a population dons masks at a given initial number of infections. The model includes a contribution from the ocular (nasolacrimal duct) route, and does not include contributions from contact (fomite) routes. The model accommodates dose-response (probability of infection) functions that are linear or non-linear. Our motivation to study near-population-wide mask wearing arises from the concept that, between two mask wearers, the concentration of particles at inhalation should be the square of the mask penetration fraction. This combination, or team, of masks can provide a strong dose-lowering squaring effect, which enables the use of lower-efficiency, lower-cost, lower pressure-drop (easier breathing) masks.For an epidemic with basic reproduction number R0 = 2.5 and with a linear dose-response, the critical mask efficiency is calculated to be 0.5 for a mask adoption level of 0.8 of the population. Importantly, this efficiency is well below that of a N95 mask, and well above that of some fabric masks. Numerical solutions of the model at near-critical levels of mask efficiency and mask adoption demonstrate avoidance of epidemics. To be conservative we use mask efficiencies measured with the most-penetrating viral-particle sizes. The critical mask adoption level for surgical masks with an efficiency of 0.58 is computed to be 0.73. With surgical masks (or equally efficient substitutes) and 80% and 90% adoption levels, respiratory epidemics with R0 of about 3 and 4, respectively, would be theoretically extinguished.