bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Bradycardia and the Use of Atropine in Pediatric Rapid Sequence Intubation in the Emergency Department
Authors: Kovacich Nikolas J. , Nelson Amelia C. , McCormick Taylor , Kaucher Kevin A. 
Published: April 2021

Objective
Bradycardia during rapid sequence intubation (RSI) is an uncommon but serious adverse effect encountered in pediatric intubations. Atropine has historically been used in the pediatric population as RSI premedication to prevent bradycardia, especially when using succinylcholine as an induction agent. The objective of this analysis was to identify the incidence of bradycardia with or without atropine use.

Methods
This single-center, retrospective, observational case series reviewed pediatric patients up to 18 years old requiring intubation from January 1, 2015, to December 31, 2018. Bradycardia was determined by analyzing heart rates associated with time during and up to 5 minutes after intubation.

Results
A total of 62 patients were included. Three (4.8%) patients experienced a bradycardic event during intubation. A total of 15 (24.2%) patients received atropine for pretreatment of RSI. Incidence of bradycardia was similar between those who received atropine and those who did not. An increasing trend in atropine use was shown throughout the assessment period, yet only 18 (29%) patients met criteria for atropine pretreatment based on the 2015 Pediatric Advanced Life Support guideline recommendations for RSI.

Conclusion
Bradycardia incidence was low in pediatric patients undergoing RSI in our emergency department. Use of atropine or succinylcholine did not affect the incidence of bradycardia during pediatric intubation over this study period. Our results show a low incidence of bradycardia and support the 2015 Pediatric Advanced Life Support Guideline recommendation of limiting the use of atropine premedication in pediatric intubations.
Comparison of Different Clinical Decision Support Tools in Aiding Dental and Medical Professionals in Managing Primary Dentition Traumatic Injuries
Authors: Huh Amy Jee Hye , Chen Jung-Wei , Bakland Leif , Goodacre Charles 
Published: April 2021

Background
Many patients are taken to the emergency room for dental trauma treatment, but studies reveal that medical professionals do not feel confident in diagnosing and treating children with traumatic dental injuries. The purpose of this study was to determine if a clinical decision support tool (CDST) would improve dental trauma knowledge of primary teeth in medical students and pediatric dentists. Another purpose was assessing effectiveness of print and mobile app CDSTs.

Methods
Medical students (n = 100) and pediatric dentists (n = 49) were given a pretest to assess baseline dental trauma knowledge. All subjects were randomly assigned to 1 of 3 groups for the posttest: no CDST, print CDST, and mobile app CDST. Test scores and total time spent on each test were recorded and analyzed.

Results
Compared with medical students, pediatric dentists scored significantly higher in both pretest (8.57 ± 0.96 vs 4.20 ± 1.58; P < 0.001) and posttest (8.37 ± 1.09 vs 4.96 ± 1.99; P < 0.001). There was no significant difference in time spent to complete the 2 tests between both groups. Medical students and pediatric dentists who utilized the mobile app CDST had scored highest (P = 0.028) but took the longest time (P < 0.001) on the posttest.

Conclusions
Both print and mobile app CDSTs improved diagnosing and managing traumatic dental injuries in primary dentition significantly compared with those without aid. Medical students with CDSTs showed significant improvement in managing primary dental trauma; therefore, it is recommended for better, more accurate diagnosis and treatment in patients.
Diagnosis and Management of Pediatric Venous Thromboembolism
Authors: Doshi Bhavya S. , Ellison Angela M. 
Published: April 2021

Abstract
The incidence of venous thromboembolism (VTE) is increasing in pediatric patients. Prompt recognition and evaluation of VTE in young patients could prevent significant morbidity or mortality. In contrast to VTE in adults, current treatment guidelines are largely based on expert opinion as limited randomized controlled trial data exist about the appropriate management in pediatric patients with traditional anticoagulants. However, recently approved direct-acting oral anticoagulants in adults are also being investigated in pediatric VTE and these data could inform future evidence-based treatment principles. Thus, healthcare providers must be well informed about the management of pediatric VTE and the data from these trials to date. This continuing medical education article will provide a summary of management of pediatric VTE with particular emphasis on emerging direct-acting oral anticoagulants.
Low-Resource Emergency Department Visits for Children With Complex Chronic Conditions
Authors: Pulcini Christian D. , Coller Ryan J. , Macy Michelle L. , Alpern Elizabeth , Harris Debbi , Rodean Jonathan , Hall Matt , Chung Paul J. , Berry Jay G. 
Published: April 2021

Objective
Reducing emergency department (ED) use in children with complex chronic conditions (CCC) is a national health system priority. Emergency department visits with minimal clinical intervention may be the most avoidable. We assessed characteristics associated with experiencing such a low-resource ED visit among children with a CCC.

Methods
A retrospective study of 271,806 ED visits between 2014 and 2017 among patients with a CCC in the Pediatric Health Information System database was performed. The main outcome was a low-resource ED visit, where no medications, laboratory, procedures, or diagnostic tests were administered and the patient was not admitted to the hospital. χ2 Tests and generalized linear models were used to assess bivariable and multivariable relationships of patients' demographic, clinical, and health service characteristics with the likelihood of a low- versus higher-resource ED visit.

Results
Sixteen percent (n = 44,111) of ED visits among children with CCCs were low-resource. In multivariable analysis, the highest odds of experiencing a low- versus higher-resource ED visit occurred in patients aged 0 year (vs 16+ years; odds ratio [OR], 3.9 [95% confidence interval {CI}, 3.7–4.1]), living <5 (vs 20+) miles from the ED (OR, 1.7 [95% CI, 1.7–1.8]), and who presented to the ED in the day and evening versus overnight (1.5 [95% CI, 1.4–1.5]).

Conclusions
Infant age, living close to the ED, and day/evening-time visits were associated with the greatest likelihood of experiencing a low-resource ED visit in children with CCCs. Further investigation is needed to assess key drivers for ED use in these children and identify opportunities for diversion of ED care to outpatient and community settings.
Racial and Language Disparities in Pediatric Emergency Department Triage
Authors: Metzger Peter , Allum Leyla , Sullivan Erin , Onchiri Frankline , Jones Maya 
Published: April 2021

Objective
The aim of this study was to assess the impact race and language have on emergency department (ED) triage scores while accounting for illness severity. We hypothesized that non-White and non–English-speaking patients were assigned lower-acuity triage scores compared with White and English-speaking patients, respectively.

Methods
We used a chart review–based retrospective cohort study design, examining patients aged 0 to 17 years at our pediatric ED from July 2015 through June 2016. Illness severity was measured using a truncated Modified Pediatric Early Warning Score calculated from patient vital signs. We used univariate and multivariate multinomial logistic regression to assess the association between race and language with Emergency Severity Index scores.

Results
Our final data set consisted of 10,815 visits from 8928 patients. Non-Hispanic (NH) White patients accounted for 34.6% of patients. In the adjusted analyses, non-White patients had significantly reduced odds of receiving a score of 2 (emergency) (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.33–0.49) or 3 (urgent) (OR, 0.5; 95% CI, 0.45–0.56) and significantly higher odds of receiving a score of 5 (minor) (OR, 1.34; 95% CI, 1.07–1.69) versus a score of 4 (nonurgent). We did not find a consistent disparity in Emergency Severity Index scores when comparing English- and non–English-speaking patients.

Conclusions
We confirm that non-White patients receive lower triage scores than White patients. A more robust tool is required to account for illness severity and will be critical to understanding whether the relationship we describe reflects bias within the triage system or differences in ED utilization by racial groups.
Update in Disaster Rehabilitation
Authors: Khan Fary , Amatya Bhasker 
Published: April 2021

Abstract
Disasters (both natural and man-made) are escalating worldwide, resulting in a significant increase in survivors with complex and long-term disabling injuries. Physical and rehabilitation medicine is integral in disaster management and should be included in all phases of the disaster management continuum, which comprise mitigation/prevention, preparation, response, and recovery phases. This Joel A. DeLisa Lecture was presented on February 11, 2021, at the Association of Academic Physiatrists Annual Scientific Meeting–“Physiatry 21.” The lecture highlights the synergistic position of the International Society of Physical and Rehabilitation Medicine and the Disaster Rehabilitation Committee, to provide crucial leadership and governance role in liaison and coordination with the World Health Organization (and other stakeholders), to provide rehabilitation input during future disasters.
Preliminary evidence for conserved transcriptional response to adversity in adults with temporomandibular disorder
Authors: King Christopher D. , Boggero Ian A. , Schulert Grant S. , Pickerill Hannah M. , Cole Steve 
Published: April 2021

Introduction:
Temporomandibular disorder (TMD) is one of the most common orofacial pain conditions. Alteration in immune functioning is one promising biological mechanism underlying pain in TMD. However, there is a gap in the understanding of molecular bases contributing to altered immune functioning in these patients.

Objectives:
In the current study, we investigated whether individuals with TMD would exhibit differential activity of 3 specific transcription factors involved in inflammatory (nuclear factor-kappa B, NF-kB), antiviral (interferon-regulatory factors, IRF), and sympathetic (cAMP response element-binding protein, CREB) processes using a promoter-based bioinformatics analysis, which is characterized as the “Conserved Transcriptional Response to Adversity.”

Methods:
Adults with TMD (n = 19) and without (n = 17) underwent a standardized clinical examination for TMD. A blood sample was collected for genome-wide transcriptional RNA profiling. Bioinformatic analyses tested for differential prevalence of proinflammatory and antiviral transcription factor activity in core promoter sequences from all genes showing >1.2-fold differential expression in TMD vs controls.

Results:
Promoter-based bioinformatic analyses of genome-wide transcriptome profiles confirmed upregulation of genes bearing response elements for proinflammatory transcription factor (NF-kB, P = 0.002) and downregulation of genes with response elements for IRF (P = 0.037) in patients with TMD relative to controls. Results also indicated upregulated activity of CREB in patients with TMD (P = 0.08), consistent with increased activity of the sympathetic nervous system.

Conclusion:
These results provide initial support that the regulation of immune pathways is altered in individuals with TMD. A shift of transcriptional resources to a proinflammatory state may be driven by psychosocial stress and contributes to symptoms associated with TMD.
Potential for increased prevalence of neuropathic pain after the COVID-19 pandemic
Authors: Attal Nadine , Martinez Valéria , Bouhassira Didier 
Published: April 2021

Abstract
Although coronavirus disease 2019 (COVID-19) most commonly manifests with acute respiratory symptoms, one very common symptom of COVID-19 is pain. As COVID-19 often causes peripheral or central neurological complications, it is anticipated that a number of the chronic pain complications of COVID-19 will be neuropathic. This review first examines the most common viral infections responsible for neurological complications including neuropathic pain. These encompass herpes zoster, HIV, poliovirus, enteroviruses, and several tropical viruses. Neurological complications of COVID-19 including in particular Guillain–Barré syndrome, myelitis, and stroke are reviewed with regards to their potential risk of chronic neuropathic pain. Prospective longitudinal cohorts of patients should be implemented to evaluate the exact risk of neuropathic pain after COVID-19.
Implications of the national Stop the Bleed campaign: The swinging pendulum of prehospital tourniquet application in civilian limb trauma
Authors: Mikdad Sarah , Mokhtari Ava K. , Luckhurst Casey M. , Breen Kerry A. , Liu Betty , Kaafarani Haytham M.A. , Velmahos George , Mendoza April E. , Bloemers Frank W. , Saillant Noelle 
Published: April 2021

BACKGROUND
Prehospital tourniquet (PHT) utilization has increased in response to mass casualty events. We aimed to describe the incidence, therapeutic effectiveness, and morbidity associated with tourniquet placement in all patients treated with PHT application.

METHODS
A retrospective observational cohort study was performed to evaluate all adults with a PHT who presented at two Level I trauma centers between January 2015 and December 2019. Medically trained abstractors determined if the PHT was clinically indicated (placed for limb amputation, vascular hard signs, injury requiring hemostasis procedure, or significant documented blood loss). Prehospital tourniquets were further designated as appropriately or inappropriately applied (based on PHT anatomic placement location, occurrence of a venous tourniquet, or ischemic time defined as >2 hours). Statistical analyses were performed to generate primary and secondary results.

RESULTS
A total of 147 patients met study inclusion criteria, of which 70% met the criteria for trauma registry inclusion. Total incidence of PHT utilization increased from 2015 to 2019, with increasing proportions of PHTs placed by nonemergency medical service personnel. Improvised PHTs were frequently used. Prehospital tourniquets were clinically indicated in 51% of patients. Overall, 39 (27%) patients had a PHT that was inappropriately placed, five of which resulted in significant morbidity.

CONCLUSION
In summary, prehospital tourniquet application has become widely adopted in the civilian setting, frequently performed by civilian and nonemergency medical service personnel. Of PHTs placed, nearly half had no clear indication for placement and over a quarter of PHTs were misapplied with notable associated morbidity. Results suggest that the topics of clinical indication and appropriate application of tourniquets may be important areas for continued focus in future tourniquet educational programs, as well as future quality assessment efforts.

LEVEL OF EVIDENCE
Epidemiological, level III; Therapeutic, level IV.
A De Novo Missense Variant of SCN2A: Implications and Limitations for Understanding Clinical Phenotype and Treatment Recommendations
Authors: Deutsch Stephen I. , Burket Jessica A. 
Published: April 2021

Abstract
Autism spectrum disorder can be associated with a variety of genetic findings. We report a heterozygous de novo missense variant of SCN2A, the gene coding a voltage-gated sodium ion channel enriched in the axon initial segment and nodes of Ranvier of “immature” neocortical pyramidal neurons. With further understanding of the neurodevelopmental and functional effects of this missense variant on neuronal excitability and neocortical circuitry, there may be targeted pharmacotherapeutic interventions, potentially with “disease-modifying effects.”
Re-emergence of COVID-19 in Beijing was triggered by frozen virus: evidence from molecular clock
Authors: Zhang Yunjun , Zhang Yong , Liang Mifang , Zhang Yi , Li Yang , Ma Xuejun , Zhou Xiaohua 
Published: April 2021

ABSTRACTThe COVID-19 outbreak in Xinfadi (XFD) Wholesale market in Beijing, China in June, 2020 caused 368 reported cases within 39 days. Genetic evidences indicated that imported SARS-CoV-2 (belong to the lineage B1.1.29) initiated this outbreak. However, the transmission route of the virus is still unknown. We obtained from public database three SARS-CoV-2 genomes isolated in XFD (XFD genomes) and adopted the leaf-dating method to calculate their expected collection dates using temporal calibrating information from other 241 genomes collected in mainland of China. All three XFD genomes were calculated to have earlier collection dates than the recorded (Bayes factor >1), and hence exhibited a lack of genetic divergence. We additionally combined the XFD genomes with other 225 genomes subsampled from those of the lineage B1.1.29, among which five sequences were also included for control analysis. Two of three XFD genomes were calculated to have earlier collection dates than the recorded (Bayes factor >1), while no control genomes provided such evidence. According to present understanding of SARS-CoV-2, a lack of genetic divergence is most likely due to being frozen. Considering the fact that the XFD outbreak started from a booth of frozen food, we judged that the XFD outbreak was caused by contaminated frozen food. Our results provided molecular evidence for the source of COVID-19 outbreak in Beijing XFD, which highlights new targets for SARS-CoV-2 surveillance for the public health.
Platelet Activation by Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) Patient Serum is Blocked by COX, P2Y12 and Kinase Inhibitors
Authors: Smith Christopher W. , Kardeby Caroline , Di Ying , Lowe Gillian C. , Lester William A. , Watson Steve P. , Nicolson Phillip L.R. 
Published: April 2021

AbstractBackgroundThe novel coronavirus SARS-CoV-2 has caused a global pandemic. Vaccines are an important part of the response. Although rare, unusual thrombotic events and thrombocytopenia in recipients 4–16 days after vaccination with the AstraZeneca AZD1222 have been reported. This syndrome of vaccine-induced immune thrombotic thrombocytopenia (VITT) clinically resembles heparin induced thrombocytopenia (HIT), which is caused by platelet activating antibodies against platelet factor 4 (PF4). Here, we investigate the effect of serum from patients with VITT on platelet activation, and assess the ability of clinically available therapeutics to prevent platelet activation.MethodsAggregation responses of healthy donor washed platelets were assessed in response to serum from patients with VITT pre- and post-intravenous immunoglobulin (IVIg) treatment and in the presence of anti-FcγRIIA blocking IV.3 F(ab), anti-platelet drugs and kinase inhibitors.FindingsFour patients (21 - 48 years old) presented with thrombosis (three patients: cerebral venous sinus thrombosis, one patient: ischemic stroke) and thrombocytopenia 10-14 days after AZD1222 vaccination. All patients tested positive for anti-PF4 antibody despite no prior heparin exposure. Serum from patients with VITT, but not healthy donor controls, induced platelet aggregation, which was abrogated following IVIg treatment. Aggregation to patient sera was blocked by IV.3 F(ab) which targets FcγRIIA, and inhibitors of Src, Syk and Btk kinases downstream of the receptor. Anti-platelet therapies indomethacin and ticagrelor also blocked aggregation.InterpretationIn conclusion, serum from patients with VITT activates platelets via the FcγRIIA, which can be blocked in vitro by anti-platelet therapies suggesting possible new therapeutic interventions for this rare syndrome.FundingThis work was supported by an Accelerator Grant (AA/18/2/34218) from the British Heart Foundation (BHF).Key pointsSerum from patients with VITT activates platelets via the FcγRIIA.Platelet activation by serum from patients with VITT can be blocked by COX, P2Y12, Src, Syk and Btk inhibition.
Detection of SARS-CoV-2 variants by Abbott molecular, antigen, and serological tests
Authors: Rodgers Mary A , Batra Rahul , Snell Luke B , Daghfal David , Roth Richard , Huang Shihai , Kovacs Stephen , Nebbia Gaia , Douthwaite Sam , Cloherty Gavin A 
Published: April 2021

AbstractBackgroundViral diversity presents an ongoing challenge for diagnostic tests, which need to accurately detect all circulating variants. The Abbott Global Surveillance program monitors severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants and their impact on diagnostic test performance.ObjectivesTo evaluate the capacity of Abbott molecular, antigen, and serologic assays to detect the SARS-CoV-2 B.1.1.7, B.1.351 and the P.1 variants.Study designVirus variant culture stock dilutions (B.1.1.7, BEI NR-54011; B.1.351, BEI NR-54008 and 54009; P.1, BEI NR-54982) and clinical samples from patients with confirmed B.1.1.7 variant infection were run on the Abbott ID NOW COVID-19, m2000 RealTime SARS-CoV-2, Alinity m SARS-CoV-2, and Alinity m Resp-4-Plex molecular assays; the BinaxNOW COVID-19 Ag Card and Panbio COVID-19 Ag Rapid Test Device; and the ARCHITECT/Alinity i SARS-CoV-2 IgG and AdviseDx IgM assays, Panbio COVID-19 IgG assay, and ARCHITECT/Alinity i AdviseDx SARS-CoV-2 IgG II assay.ResultsCultured virus stocks and B.1.1.7 clinical samples were detected with molecular, antigen, and serologic assays in the expected ranges, confirming in silico predictions. The ratio between genome equivalents (GE) and calculated median tissue culture infectious dose (TCID50) were 31-to 83-fold higher for B.1.1.7 cultures compared to B.1.351 and P.1 cultures, demonstrating that GE are more consistent units between cultures than TCID50.ConclusionsAbbott molecular and antigen assays effectively detect B.1.1.7, B.1.351, and P.1 variant infections and Abbott serologic assays detect B.1.1.7 antibodies in patient sera. Future studies with SARS-CoV-2 virus cultures should use quantitative viral load values to compare detection of variants.HighlightsAbbott SARS-CoV-2 molecular and antigen assays detect B.1.1.7, B.1.351, and P.1 variantsAbbott SARS-CoV-2 antibody assays detect B.1.1.7 antibodies in recovered patient seraQuantitation of viral load in genome equivalents allows comparison of assay performance