bluuebunny/crossref_metadata_2025_split huggingface dataset:
Macrophage activation syndrome in children with Kawasaki disease: an experience from a tertiary care hospital in northwest India
Authors: Pilania Rakesh Kumar , Jindal Ankur Kumar , Johnson Nameirakpam , Prithvi Ashwini , Vignesh Pandiarajan , Suri Deepti , Rawat Amit , Gupta Anju , Singh Surjit 
Published: October 2020

Abstract

Objectives
To carry out a review of clinical characteristics, laboratory profiles, management and outcomes of patients with Kawasaki disease (KD) and macrophage activation syndrome (MAS).

Methods
Medical records of patients treated for KD and MAS between January 1994 and December 2019 were reviewed. Patient demographics, clinical signs, laboratory values, coronary artery abnormalities, treatments and outcomes of patients with KD and MAS were recorded. We also performed a review published studies on the subject.

Results
Of the 950 cases with KD, 12 (1.3%; 10 boys, 2 girls) were diagnosed with MAS. The median age at diagnosis was 4 years (range 9 months–7.5 years). The median interval between onset of fever and diagnosis of KD was 11 days (range 6–30). Thrombocytopenia was seen in 11 patients. The median pro-brain natriuretic peptide value was 2101 pg/ml (range 164–75 911). Coronary artery abnormalities were seen in 5 (41.7%) patients; 2 had dilatation of the left main coronary artery (LMCA), 1 had dilatation of both the LMCA and right coronary artery (RCA), 1 had dilatation of the RCA and 1 had bright coronary arteries. All patients received IVIG as first-line therapy for KD. MAS was treated with i.v. methylprednisolone pulses followed by tapering doses of oral prednisolone. Additional therapy included i.v. infliximab (n = 4), second-dose IVIG (n = 1) and oral ciclosporin (n = 1).

Conclusion
MAS is an unusual and underrecognized complication of KD. In our cohort of 950 patients with KD, 1.3% had developed MAS. KD with MAS is associated with an increased propensity towards development of coronary artery abnormalities.
The Politics of Labels: Imperial Categorisations and the Marginalisation of Ethnomedicine in Nigeria during the Twentieth Century
Authors: Williams Ogechukwu E 
Published: October 2020

Abstract
The names imposed on traditional medical institutions in colonial Nigeria criminalised and designated ethnomedical practitioners as quacks, charlatans and ‘witch doctors’ whose practices lacked merit. These labels shifted throughout the colonial and post-colonial era based on imperial politics and biomedical interests. Drawing from medical reports, anthropological essays and archival documents, this article explores twentieth-century colonial and post-colonial labels assigned to ethnomedicine in Nigeria as a strategy for delegitimisation and reflects on the post-colonial implications of such labels. Various scholars have explored the role of medicine in creating classification systems that were essential to the operation of colonial power. The article extends this body of literature by exploring the impacts of specific labels and naming patterns on representations of ethnomedicine throughout the twentieth century. It examines the various ways, including Nigeria’s extensive Nollywood film industry, through which stereotypes from pre-1960s labels continued to be propagated well beyond the colonial era.
Trajectories of sleep problems in childhood: associations with mental health in adolescence
Authors: Shimizu Mina , Zeringue Megan M , Erath Stephen A , Hinnant J Benjamin , El-Sheikh Mona 
Published: October 2020

Abstract

Study Objectives
We examined initial levels (intercepts) of sleep–wake problems in childhood and changes in sleep–wake problems across late childhood (slopes) as predictors of externalizing behavior problems, depressive symptoms, and anxiety in adolescence. To ascertain the unique effects of childhood sleep problems on adolescent mental health, we controlled for both childhood mental health and adolescent sleep problems.

Methods
Participants were 199 youth (52% boys; 65% White/European American, 35% Black/African American). Sleep–wake problems (e.g. difficulty sleeping and waking up in the morning) were assessed during three time points in late childhood (ages 9, 10, and 11) with self-reports on the well-established School Sleep Habits Survey. At age 18, multiple domains of mental health (externalizing behavior problems, depressive symptoms, and anxiety) and sleep–wake problems were assessed.

Results
Latent growth curve modeling revealed that children with higher levels of sleep–wake problems at age 9 had consistently higher levels of such problems between ages 9 and 11. The initial level of sleep–wake problems at age 9 predicted externalizing behaviors, depressive symptoms, and anxiety at age 18, controlling for mental health in childhood and concurrent sleep–wake problems in adolescence. The slope of sleep–wake problems from ages 9 to 11 did not predict age 18 mental health.

Conclusions
Youth who had higher sleep–wake problems during late childhood had higher levels of mental health problems in adolescence even after controlling for childhood mental health and concurrent sleep–wake problems. Findings illustrate that childhood sleep problems may persist and predict adolescent mental health even when potentially confounding variables are rigorously controlled.
Cross-sectional and prospective associations between sleep regularity and metabolic health in the Hispanic Community Health Study/Study of Latinos
Authors: Fritz Josef , Phillips Andrew J K , Hunt Larissa C , Imam Akram , Reid Kathryn J , Perreira Krista M , Mossavar-Rahmani Yasmin , Daviglus Martha L , Sotres-Alvarez Daniela , Zee Phyllis C , Patel Sanjay R , Vetter Céline 
Published: October 2020

AbstractStudy ObjectivesSleep is an emergent, multi-dimensional risk factor for diabetes. Sleep duration, timing, quality, and insomnia have been associated with diabetes risk and glycemic biomarkers, but the role of sleep regularity in the development of metabolic disorders is less clear.MethodsWe analyzed data from 2107 adults, aged 19–64 years, from the Sueño ancillary study of the Hispanic Community Health Study/Study of Latinos, followed over a mean of 5.7 years. Multivariable-adjusted complex survey regression methods were used to model cross-sectional and prospective associations between the sleep regularity index (SRI) in quartiles (Q1-least regular, Q4-most regular) and diabetes (either laboratory-confirmed or self-reported antidiabetic medication use), baseline levels of insulin resistance (HOMA-IR), beta-cell function (HOMA-β), hemoglobin A1c (HbA1c), and their changes over time.ResultsCross-sectionally, lower SRI was associated with higher odds of diabetes (odds ratio [OR]Q1 vs. Q4 = 1.64, 95% CI: 0.98–2.74, ORQ2 vs. Q4 = 1.12, 95% CI: 0.70–1.81, ORQ3 vs. Q4 = 1.00, 95% CI: 0.62–1.62, ptrend = 0.023). The SRI effect was more pronounced in older (aged ≥ 45 years) adults (ORQ1 vs. Q4 = 1.88, 95% CI: 1.14–3.12, pinteraction = 0.060) compared to younger ones. No statistically significant associations were found between SRI and diabetes incidence, as well as baseline HOMA-IR, HOMA-β, and HbA1c values, or their changes over time among adults not taking antidiabetic medication.ConclusionsOur results suggest that sleep regularity represents another sleep dimension relevant for diabetes risk. Further research is needed to elucidate the relative contribution of sleep regularity to metabolic dysregulation and pathophysiology.
Trusts and the Chinese Civil Code: toward a new era of codification
Authors: Qu Jian 
Published: October 2020

Abstract
Starting from 28 May 2020, China, which has long been considered a civil law jurisdiction, finally has its own Civil Code. However, among 1260 articles of the Code, trust is mentioned only once. From a perspective of comparative law, the trust’s appearance in the civil code has always been informative for observing its transplantation process. Thus, by investigating the five rounds of civil law codification in China over decades, as well as the considerable controversy regarding trusts and codification, this article attempts to discuss the reasons, implications, and influences of the legislative result of trusts in the Code.
Intersubject Spatial Pattern Correlations During Movie Viewing Are Stimulus-Driven and Nonuniform Across the Cortex
Authors: Zhang Angela , Farivar Reza 
Published: October 2020

AbstractA fundamental step to predicting brain activity in healthy and diseased populations is characterizing the common spatio-temporal response to a shared experience. Multivoxel pattern analysis allows us to investigate information encoding through these patterns; however, we have yet to explore local, stimulus-driven, patterns of cortical activity during naturalistic stimulation. We sought to examine these patterns with minimum interpolation—excluding functional alignment—to characterize the most basic degree of shared response between subjects. We used an unbiased analytic approach, combined with rich, naturalistic, and nonsemantic stimulation to estimate shared spatial patterns in functional magnetic resonance imaging responses across a large group. We found that meso-scale spatial patterns were shared nonuniformly across the visual cortex and represent information distinct from the shared temporal response. Shared spatial patterns were stimulus-driven, modulated by pattern size, and more sensitive to the contrast of 3D versus 2D stimulus differences than the temporal signals. Although the grand functional structure of the brain is understood to be common, these results suggest that even at a meso-scale, we share common spatial structures with anatomical alignment alone. The strength of this similarity varies across the cortex, suggesting some spatial structures are innately organized, whereas others are shaped by factors such as learning and plasticity.
Stability of the Initial Diagnosis of Autism Spectrum Disorder by DSM-5 in Children: A Short-Term Follow-Up Study
Authors: Kadam Archana , Patni Bindu , Pandit Anand , Patole Sanjay 
Published: October 2020

Abstract

Background
Assessing the stability of the diagnosis of autism spectrum disorder (ASD) in children is important. Only few such studies have been reported from India. We aimed to assess the stability after 18–30 months, of an initial diagnosis of ASD based on DSM-5, in children ≤ 5 years of age using Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2).

Methods
A total of 125 children with ASD diagnosed by DSM-5 at ≤ 5 years of age were followed up at 18–30 months using ADOS-2, which is considered as the ‘gold-standard’ observational assessment for diagnosing ASD and hence suitable for confirming the stability of the diagnosis.

Results
Similar to previous studies from developed countries, the stability of ASD diagnosis was 80%. There was no significant correlation between gender, socioeconomic status and the stability of the final diagnosis. All the children continued to have some developmental difficulties mainly in the domain of language, attention or social communication.

Conclusion
Our results suggest that DSM-5 can be used for the initial diagnosis ASD to initiate early intervention for children with this condition in resource-limited set-ups. Adequately powered prospective studies with long-term follow-up are needed to confirm our findings.
Patient and Physician Preferences for Antibiotics in Acute Uncomplicated Diverticulitis: A Delphi Consensus Process to Generate Noninferiority Margins
Authors: Garfinkle Richard , Sabboobeh Sarah , Demian Marie , Barkun Alan , Boutros Marylise 
Published: October 2020

BACKGROUND:
Despite the existing evidence, the omission of antibiotics in the management of acute uncomplicated diverticulitis has not gained widespread acceptance.

OBJECTIVE:
This study aims to incorporate the input of both patients and physicians on the omission of antibiotics in uncomplicated diverticulitis to generate noninferiority margins for 3 outcomes.

DESIGN:
This was a mixed-methods study, including in-person interviews with patients and a Delphi process with physicians.

SETTINGS:
North American patients and physicians participated.

PATIENTS:
Consecutive patients undergoing colonoscopy, 40% of whom had a previous history of diverticulitis, were selected.

INTERVENTIONS:
Informational video (for patients) and evidence summaries (for physicians) regarding antibiotics in diverticulitis were reviewed.

MAIN OUTCOMES MEASURES:
Noninferiority margins were generated for time to reach full recovery, persistent diverticulitis, and progression to complicated diverticulitis in the context of a nonantibiotic strategy. Consensus was defined as an interquartile range <2.5.

RESULTS:
Fifty patients participated in this study. To avoid antibiotics, patients were willing to accept up to 5.0 (3.0–7.0) days longer to reach full recovery, up to an absolute increase of 4.0% (4.0–6.0) in the risk of developing persistent diverticulitis, and up to an absolute increase of 2.0% (0–3.8) in the risk of progressing to complicated diverticulitis. A total of 55 physicians participated in the Delphi (round 1 response rate = 94.8%; round 2 response rate = 100%). Consensus noninferiority margins were generated for persistent diverticulitis (4.0%, 4.0–5.0) and progression to complicated diverticulitis (3.0%, 2.0–3.0), but could not be generated for time to reach full recovery (5.0 days, 3.5–7.0).

LIMITATIONS:
Patients were recruited from a single institution, and Delphi participants were invited and not randomly selected.

CONCLUSION:
Noninferiority margins were generated for 3 important outcomes after the treatment of acute uncomplicated diverticulitis in the context of a nonantibiotic strategy.
Attitudes Toward Submental Fat Among Adults in the United States
Authors: Shridharani Sachin M. , Baumann Leslie , Dayan Steven H. , Humphrey Shannon , Breshears Laura , Sangha Sara 
Published: October 2020

BACKGROUND
Excess submental fat (SMF) can cause submental fullness resulting in negative perceptions of individuals. However, the impact of SMF on perceptions of social traits has not been well studied.

OBJECTIVE
To characterize the impact of SMF on external value judgments in adults in the United States.

METHODS
Respondents completed an online survey in which they reacted to statements about individuals with varying grades of SMF. Attributes were rated on a scale from 0 to 100 with higher scores for more positive attributes.

RESULTS
Similar proportions of respondents (N = 1996) indicated that women and men with double chins were less attractive than those without (91% and 90%, respectively). A double chin was more likely to be noticed on a woman than on a man (78% of respondents). With increasing SMF, individuals were perceived as significantly less likeable, intelligent, happy, active, and easygoing. Those with greater amounts of SMF were rated as significantly less attractive than those with less SMF. For all attributes, male respondents rated all individuals lower than female respondents did.

CONCLUSION
Results from this study provide further evidence of negative perceptions of individuals with SMF. Aesthetics of the submental area, especially SMF, likely impact the overall assessment of attractiveness and social attributes.
Hyperglycemia and arterial stiffness across two generations
Authors: Taimour Soumia , Gottsäter Anders , Jujic Amra , Nilsson Peter M. 
Published: October 2020

Objective:
Hyperglycemia and diabetes mellitus associate with arterial stiffness. This observational study aimed to investigate such links in two related generations from a population-based study.

Methods:
Data from 2640 participants in the ongoing Malmö Offspring Study, Sweden, was used. The participants were direct descendants, that is, parents (median age 52.5 years) and children (26.9 years). In linear regressions, arterial stiffness measured through carotid--femoral pulse wave velocity was associated with markers of glucose metabolism (fasting glucose, glycated hemoglobin, skin autoflourescence of Advanced Glycation End products), adjusted for age, sex, smoking, BMI, lipids, SBP and antihypertensive medication. Analysis was first performed in all participants and then separately in each generation. T-tests with diabetes mellitus as the grouping variable were performed for all participants and per generation.

Results:
In all participants, pulse wave velocity was significantly associated with glucose (β = 0.007, P = 0.018) and hemoglobin (β = 0.017, P < 0.001), but not with autoflourescence. Stratified by generation, arterial stiffness was associated with glucose (β = 0.013, P = 0.008) and glycated hemoglobin (β = 0.022, P < 0.001) only in parents. Mean pulse speed differed between participants with and without diabetes in the total group (mean difference 1.7 m/s, P < 0.001), as well as within each generation (parents: 1.3 m/s; P < 0.001, and children: 0.7 m/s; P = 0.040).

Conclusion:
Impaired glucose metabolism and arterial stiffness were significantly associated only in the parental generation, indicating the influence of hyperglycemia on vascular aging. However, carotid--femoral pulse wave velocity differed significantly between participants with or without diabetes mellitus in both generations, suggesting that diabetes might negatively affect arterial stiffness also at a younger age.
Improving Neonatal Follow-up: A Quality Improvement Study Analyzing In-hospital Interventions and Long-term Show Rates
Authors: Brachio Sandhya S. , Farkouh-Karoleski Christiana , Abreu Anketil , Zygmunt Annette , Purugganan Oscar , Garey Donna 
Published: October 2020

Introduction:
Neonatal follow-up (NFU) clinics play an essential role in the multidisciplinary care of preterm patients. Despite the inherent value of NFU clinics, many clinical programs report poor compliance with follow-up visits. Preterm infants followed with difficulty in the long-term have higher rates of disability and lower IQ scores, even after adjustment of significant perinatal and sociodemographic variables. This quality improvement study aimed to improve the show rate for preterm infants from 60% to 80% at the initial 6-month adjusted age visit by implementing a multilevel education bundle.

Methods:
Participants included neonatal intensive care unit (NICU) physicians, physician extenders, registered nurses, and parents of preterm patients admitted to the NICU who qualified for NFU. Our 75-bed NICU is the regional perinatal center within an urban free-standing children’s hospital. Our bundle included NICU provider education, discharge planning, and parent education. A tracking system was developed to identify qualifying patients to streamline workflow.

Results:
The monthly first visit show rate improved from 60% to 76% during the intervention period. Seventy-five percent of families who received parent education presented for their initial visit, compared to 51% of families who did not receive parent education. In anonymous surveys of families who presented for their initial visits, 95% indicated that bedside education played the most important role in appointment attendance. Interdisciplinary rounds are crucial for reaching all families before discharge.

Conclusion:
Implementing a multidimensional in-hospital education bundle and tracking system is feasible and can improve NFU clinic show rates, but may require dedicated personnel for sustainability.
Tranexamic Acid in Infantile Craniosynostosis Surgery: Friend or Foe?
Authors: Danforth Rachel M. , Cook Julia A. , Bennett William E. , Tholpady Sunil S. , Gerety Patrick A. 
Published: October 2020

Background:Recent studies support the prophylactic use of tranexamic acid during craniosynostosis surgery to reduce blood loss. The study aims to assess national trends and outcomes of tranexamic acid administration.Methods:The Pediatric Health Information System database was used to identify patients who underwent craniosynostosis surgery over a 9-year period (2010 to 2018). Search criteria included patients younger than 2 years with a primary diagnosis of craniosynostosis (International Classification of Diseases, Ninth Revision, 756.0;International Classification of Diseases, Tenth Revision, Q75.0) and CPT code for craniotomy (61550 to 61559). Tranexamic acid use, complications, length of stay, and transfusion requirements were recorded. Subgroup analysis was performed for fronto-orbital advancements and single-suture surgery.Results:A total of 1345 patients were identified. Mean patient age was 229 ± 145 days. Four hundred fifty-four patients (33.7 percent) received tranexamic acid. Tranexamic acid use increased from 13.1 percent in 2010 to 75.6 percent in 2018 (p= 0.005), and mean blood products per patient increased from 1.09 U to 1.6 U (p= 0.009). Surgical complication rate was higher in those receiving tranexamic acid (16.7 percent versus 11.1 percent;p= 0.004). Tranexamic acid administration was associated with increased transfusion requirements on univariate and multivariate analysis (1.76 U versus 1.18 U; OR, 2.03;p< 0.001). In the fronto-orbital advancement subgroup, those receiving tranexamic acid received more total blood products (2.2 U versus 1.8 U;p= 0.02); this difference was present but not significant within the single-suture group (0.69 U versus 0.50 U;p= 0.06).Conclusions:Tranexamic acid use in craniosynostosis surgery has increased dramatically since 2010. However, it was associated with higher transfusion and complication rates in this data set. Optimization of its use and blood loss mitigation in infant craniosynostosis deserve continued research.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.
Plastic Surgeons as Institutional Leaders
Authors: Davis Matthew J. , Abu-Ghname Amjed , Patrinely J. Randall , Başağaoğlu Berkay , Perdikis Galen J. , Reece Edward M. , Hollier Larry H. 
Published: October 2020

Background:
Physicians, especially plastic surgeons, are underrepresented in hospital leadership. As such, the steps an aspiring plastic surgeon should take toward assuming a high-level administrative role remain unclear. The authors aim to profile the chief executive officers and surgeons-in-chief at top-ranked U.S. hospitals with the goal of better characterizing the attributes of institutional leaders.

Methods:
Chief executive officers and surgeons-in-chief at top-ranking hospitals in the 2019 to 2020 U.S. News and World Report “Best Hospitals Honor Roll” were included in this study. For each leader, sex, title, degrees, years of experience, total number of publications, practice specialty (for physician leaders), and previous leadership roles in national societies were reviewed. Descriptive statistical analyses were performed.

Results:
A total of 99 leadership positions at 66 institutions were included. Of these, 67 were chief executive officers and 32 were surgeons-in-chief. Overall, 28 of 67 chief executive officers (42 percent) were physicians—23 nonsurgeons and five surgeons. Of all surgeon executives, only two were plastic surgeons, and both were surgeons-in-chief. The “average” physician–chief executive officer had 24 years of experience, no M.B.A., over 100 publications, zero to one fellowship, and was involved in national leadership. There was no difference in professional qualifications (defined as years of experience, business training, number of publications and fellowships, and leadership positions) between nonsurgeon- and surgeon–chief executive officers, or between plastic surgeons and other surgeons in leadership positions.

Conclusions:
Despite possessing adequate qualifications, plastic surgeons are underrepresented in American health care institutional leadership roles. Aspiring plastic surgeon leaders should lean on their peer credibility and experience delivering patient-centered care to succeed in leadership roles.